MI MEDICINE

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 119 / NO. 3

May / June 2020

COVID

19

SPECIAL EDITION: PHYSICIANS ON THE FRONTLINE

msms.org

FEATURES & CONTENTS May / June 2020

05

COVID-19: How MSMS is Supporting Physicians on the Frontline JULIE NOVAK, MSMS CEO

08

Immunity Protections Applicable When Treating Covid-19 Patients DANIEL J. SCHULTE, JD

10

Navigating COVID-19 with your Humanity, Sanity and Team Still Intact JODI SCHAFER, SPHR, SHRM-SCP

12

Help protect your traveling patients!

ANDREA BECKER, BSN, RN, MDHHS DIVISION OF IMMUNIZATIONS

24

15

Telemedicine for Medical Practices During Covid-19 THE DOCTORS COMPANY

DEPARTMENTS 26 Welcome New Members 28 MSMS Educational Courses

FEATURE

Michigan's COVID-19 Crisis: How We Got Here

BY NICK DELEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY

The year 2020 hasn’t gone the way anyone in the world would have hoped. But we’re learning more every day about how we got here and – thanks to Michigan physicians – how we’ll move forward safely. See the story on page 15.

STAY CONNECTED!

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The Michigan State Medical Society is working day and night to support physicians and patients during the COVID-19 MICHIGAN MEDICINE® VOL. 119 / NO. 3

pandemic. Michigan physicians are making meaningful

Chief Executive Officer JULIE L. NOVAK

strides toward addressing the growing challenges of the novel

Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org

coronavirus (COVID-19), and the Society is committed to supporting those efforts.

Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Publication Design STACIA LOVE, REZÜBERANT! INC. rezuberant.com Printing FORESIGHT GROUP staceyt@foresightgroup.net Publication Office Michigan Medicine® 120 West Saginaw Street East Lansing, MI 48823 517-337-1351 www.msms.org All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast.

Postmaster: Address Changes Michigan Medicine® Trisha Keast 120 West Saginaw Street East Lansing, MI 48823

Michigan Medicine®, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan.

The MSMS Committee on Publications is the editorial board of Michigan Medicine® and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors.

Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine® reserves the right to accept or reject advertising copy.

Products and services advertised in Michigan Medicine® are neither endorsed nor warranteed

by MSMS, with the exception of a few.

Michigan Medicine® (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2020 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110.

Single copies, $10. Printed in USA. ©2020 Michigan State Medical Society

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CEO'S PERSPECTIVE

COVID-19: How MSMS is Supporting Physicians on the Frontline

By Julie L. Novak, MSMS Chief Executive Officer

MSMS prepared resources for members well in advance of Governor Whitmer’s March 23 “Stay Home, Stay Safe” Executive Order, which directed all Michigan businesses and operations to temporarily suspend in-person operations that are not necessary to sustain or protect life.

T

he order also directed Michiganders to stay in their homes unless they’re a part of that critical infrastructure workforce, engaged in an outdoor activity, or performing tasks necessary to the health and safety of themselves or their family.

In early March, MSMS swiftly developed an online resource for its members: http:// MSMS.org/COVID19. This micro-site is updated regularly and includes MSMS original content and key updates from a broad variety of key sources including the Michigan Department of Health and Human Services (MDHHS), Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), American Medical Association (AMA), Occupational Safety and Health Administration (OSHA), and many more.

Physicians may access a variety of tools and resources such as financial relief package information, human resources information, posters and handouts, HIPAA and billing guidance, and latest best practices.

JULIE L. NOVAK MSMS CHIEF EXECUTIVE OFFICER

“In early March, MSMS swiftly developed an online resource for its members: http://MSMS.org/COVID19.

This micro-site is updated regularly and includes MSMS original content and key updates from a broad variety of key sources...”

CONTINUED ON PAGE 6

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COVID-19: HOW MSMS IS SUPPORTING PHYSICIANS ON THE FRONTLINE – CONTINUED FROM PAGE 5

MSMS also engages daily throughout the crisis in federal and state government advocacy to support the frontline efforts of Michigan physicians. That advocacy includes a broad variety of tactics, including: The production of a joint letter with the American Medical Association to ensure help for physicians in sustaining practices and delivering safe, quality patient care was included in federal “stimulus” legislation.

MSMS called on state and federal Administrations to use every lever to address protective equipment (PPE) needs and lack of COVID-19 tests, reinforcing to Governor Whitmer and President Trump that a lack of PPE for health care workers is “unacceptable.”

We’ve advocated with the Michigan Health Information Network (MIHIN) in support of a state funding proposal to provide a free telehealth platform for physicians.

MSMS worked with the physician community and the Administration to provide input on Governor Gretchen Whitmer’s numerous Executive Orders, including: • Executive Order 2020-17: MSMS helped provide a definition of elective surgeries.

• Executive Order 2020-25: MSMS provided guidance on the safest way to issue emergency refills, including ensuring an effort is made by the pharmacist to contact the prescriber.

• Executive Order 2020-30: MSMS supported granting provider immunity and made suggestions that any scope of practice expansion be done in consultation with the medical leadership team.

MSMS is engaged in ongoing communications with the Administration and state legislators regarding challenges facing physicians on the frontline, as well as economic impact on those who are doing their part to minimize patient exposure to the virus by postponing elective visits and procedures.

We’re advocating daily for state and federal dollars to be earmarked for direct financial support to physicians and their practices.

Your Michigan State Medical Society is also working directly with the Governor’s office and other administration officials to provide clear, evidence-based guidance as they craft policy to protect the state’s residents.

Ongoing communications with the Michigan Department of Licensing and Regulatory Affairs (ARA) regarding communication on chloroquine and hydroxychloroquine prescribing that recognizes evolving U.S. Food and Drug Administration (FDA) guidance and the importance of leaving room for clinical judgment played a critical role in improving the administration’s understanding and approach to this potentially life-saving medicine.

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MSMS is also working to remove obstacles to diagnosis and treatment.

This work has helped mobilize a dramatic increase in Michigan’s telemedicine capacity through advocacy and collection of telehealth resources (including MSMS’s Legal Alert, Telemedicine Resource Guide, Coding Alert, catalog of available vendors and How to Bill webinar)—all now available on http://MSMS.org/COVID19.

Additional critical efforts to make physicians’ practice simpler include: Submission of several grants seeking funding to assist physicians with the cost of implementing telehealth through a vendor platform.

The development of a comprehensive payer comparison detailing billing policy for telehealth, coverage for COVID-19 testing and treatment and any other useful information such as incentives and administrative relief —available on http://MSMS.org/COVID19.

Issuing Reimbursement Advocate Alerts multiple times per week to keep practices up-to-date on the latest payer policy changes.

COVID-19 Resource Center for Physicians and Patients Visit www.MSMS.org/COVID19 to access a variety of useful tools and resources such as:

MSMS original content and key updates

Financial relief package information

Human resources information

Posters and handouts

HIPAA and billing guidance

The latest best practices

Querying Michigan’s health plans regarding telehealth payments and advocating for telehealth equity.

Developing a comprehensive “Coding Alert” on reimbursement policies for COVID-19 testing, treatment and telemedicine which is being updated continuously.

Ongoing payer advocacy to reduce administrative burdens for physicians and their patients.

Sharing information on the financial assistance and related resources, including grants and loans, continues to be a priority for MSMS.

Your team in Lansing is working remotely to support physicians during these unprecedented times. Now, more than ever, MSMS and our county medical society partners appreciate the incredible work and dedication of physicians. For the latest news and updates important to your practice, physicians are encouraged to visit the continuously updated MSMS COVID-19 microsite – www.MSMS.org/COVID19.

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ASK OUR LAWYER

Immunity Protections Applicable When Treating Covid-19 Patients

By Daniel J. Schulte, JD, MSMS Legal Counsel

Q:

Physicians have been prescribing drugs and providing other treatments to COVID-19 patients that are for the most part untested. They certainly have not been subjected to governmental review and approval processes.

Nor have they been examined by any peer review body. Instead, these treatments are selected based mainly on anecdotal evidence of success without the experience required to fully understand side effects and the long-term effects of their use.

Can you explain the immunity protections recently made available? Will they protect physicians prescribing these treatments?

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There have long been several different types of immunities provided to health care providers under Michigan and federal law. Some are applicable to physicians and others who volunteer. Others are applicable in times of a declared state of emergency or disaster.

T

he recent additions to these im-

state official or agency or county or local

is not being compensated or reimbursed

munities that are directly relevant

coordinator or executive body” are con-

in any way other than reimbursement

to your question are contained in

sidered authorized disaster relief workers

for mileage and being provided personal

Governor

Executive

and have immunity from claims arising

protection equipment to be used while

Order 2020-30 and Section 3215 of the

from those services except when the act

volunteering. The CARES Act immuni-

federal Coronavirus Aid, Relief, and Eco-

or omission is willful or constitutes gross

ty expressly contemplates immunity be-

nomic Security Act (“CARES Act”).

negligence. The concern was that for phy-

ing provided by state law. Its preemption

sicians to have the immunity for treating

provision states that it preempts inconsis-

COVID-19 patients would first have to

tent state law unless the state law provides

requested by a state official, agency or co-

greater protection from liability. Executive

ordinator to do so.

Order 2020-30 certainly provides great-

Whitmer’s

Section 7 of Executive Order 2020-30 states: “Consistent with MCL 30.411(4), any licensed health care professional or designated health care facility that provides medical services in support of this state’s

er protection from liability to physicians

MSMS received a prompt response

response to the COVID-19 pandemic is

from the Governor’s office. It clarified

not liable for an injury sustained by a per-

both that:

son by reason of those services, regardless of how or under what circumstances or by what cause those injuries are sustained, unless it is established that such injury or death was caused by the gross negligence,

(1.) the Governor’s issuance of Executive Order 2020-30 satisfies the “express or implied request”

treating COVID-19 patients, so it is not preempted by Section 3215 of the CARES Act.

DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL

requirement of MCL 30.411(4); and

as defined in MCL 30.411(9), of such

(2.) immunity applies wherever

health care professional or designated

the patient is treated (e.g. a

health care facility.”

government operated field

MSMS questioned what was meant by

hospital, a private hospital, a

“Consistent with MCL 30.411(4)” and

physician practice office, etc.).

sought clarification from the Governor’s office. That statute is a part of Michigan’s Emergency Management Act. It provides

The immunity provided by Section 3215

that physicians who render services during

of the CARES Act is the same, but it only

a state of disaster declared by the Governor

applies when a physician is acting in a vol-

and “at the express or implied request of a

unteer capacity. This means the physician

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ASK HUMAN RESOURCES

Navigating COVID-19 with your Humanity, Sanity and Team Still Intact

By Jodi Schafer, SPHR, SHRM-SCP, Human Resources Management Services, LLC

A

mid all of the chaos,

#1: Stay Connected

#2: Grant Grace

confusion and anxiety

Regardless of which end of the ‘busy’ spectrum your practice is on right now, carving out time to touch base with your team is paramount. The self-preservation instinct has kicked into overdrive for many people and their orientation has been shifted to look for the danger. In the absence of information, people will fill in the gaps of understanding with their own conclusions.

Rarely does this bode well. You team needs to know that you care about them, that you are in this with them and that you are working on plans to secure the viability of the business so that you can all return to some sense of normalcy in the future.

Connection can happen through face-toface conversations, through daily or weekly update emails, phone calls, text messages, videos or zoom meetings. The frequency is almost as important as the content. Be intentional with these touchpoints – especially when you are physically separated.

We all need to be reminded that there are brighter days ahead.

COVID-19 has turned our world upside down. Nothing is as it was and to pretend otherwise is not only naïve, but detrimental. Teams are having to find new ways to perform job functions. Practices have implemented physical changes to their workspace to limit contact and the spread of this virus. Some workers are attempting to do their jobs from home, often with spouses and kids occupying the same space at the same time. It’s not normal. There will be disruptions. There will be competing priorities. There will be frustration and non-productive time and technology challenges. Take a breath, let the little things go and allow others to do the same.

Granting grace is granting permission for life to be messy sometimes and for each of us to be human. Provide flexibility where you can and tell your team to take a break when you can see that they need one. Give yourself that same permission. This is a marathon, not a sprint.

that has resulted from the COVID-19 pandemic,

leadership has never been more important. To survive (and dare I say ‘thrive’), leaders must adopt a mindset that allows you to put one foot in front of the other, especially when it’s hard.

Challenges can be viewed as stressful and overwhelming or challenges can be viewed as opportunities. Your mindset will determine how you feel about the situation that surrounds you and will heavily influence your success in our current reality. Now is the time to refocus. Here are four key strategies for navigating COVID-19 with your humanity, your sanity and your team still intact.

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#3: Orient Towards the Positive

#4: Be Transparent

While this is an unprecedented time for all of us, it is not without hope and light.

We need to be reminded of the good to keep our energy up and our outlook positive. You could start each shift meeting with everyone sharing something they are grateful for. You could highlight the number of COVID patients successfully treated and discharged. You could ask your team to participate in a volunteer effort. If you have staff working remotely or not at all right now, you could include them in a virtual recipe exchange, a virtual happy hour or a fun contest of some sort. Take time to fill your tank and gain perspective.

You’ll need to draw on these pick-me-up moments during the hard times ahead.

The only constant in this world is change and boy has that been the case lately! Don’t let fear of making the wrong choice stop you from making any choice. Push forward with the information you have and let your team know the WHY behind your decisions. Provide opportunities for questions and suggestions and be willing to reconsider your options if/when additional guidance and support becomes available.

Prepare your teams for operating with a degree of unknown and provide them with regular updates to keep their focus on what you DO know vs. what you DON’T. Remember, communication is key, but it has to be honest, transparent, authentic communication if you want to keep everyone moving forward.

While we can’t accurately predict what the days ahead will bring, we do have the ability to control our responses and to identify lifelines that will guide us through these uncharted waters. To use a sports cliché, ‘It’s game time’! Your employees are watching how you perform under this pressure.

Your patients are watching how quickly you adapt to change and how deftly you respond to their fears and their needs.

Your colleagues are watching. Your community is watching. The whole world is watching. Crisis reveals character and for those of you who have been putting in the work to fine tune your leadership and communication skills over the years, it’s about to pay off.

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MDHHS UPDATE

Help protect your traveling patients!

By Andrea Becker BSN, RN, MDHHS Division of Immunization

The recent COVID-19 outbreak is a grave reminder on the importance of immunizations and how quickly diseases can spread across the world.

People travel, both domestically and internationally, for work, to explore, and to visit loved ones around the globe. Unfortunately, traveling comes with the risk of spreading and/or contracting disease.

Preventative health measures, such as vaccines, are not always at the top of individuals’ pre-travel checklist. Often these measures are not addressed or are pushed aside leaving individuals vulnerable to contracting disease.

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he Centers for Disease Control and Prevention (CDC) recommends including travel questions in routine assessments and identifying opportunities for patient vaccination, medication, testing, and education.

In addition to routine vaccinations and booster doses, travelers, depending on their destination and risk factors, may need specific travel vaccines or medications. These may include but are not limited to: Hepatitis A1 Hepatitis B MMR1 Typhoid Rabies Yellow Fever Japanese Encephalitis Cholera Meningococcal Influenza Malaria

If providers do not carry routine and/or travel vaccines, it is important for them to know where to refer patients. CDC has resources to assist providers in locating local health departments, specific vaccines, travel clinics, and yellow fever clinics. Please see wwwnc.cdc.gov/travel/ page/find-clinic for additional information. There are many valuable travel resources for both providers and patients such as travel notices, destination and risk-specific recommendations, fact sheets, and specific traveler advice on CDC’s Traveler’s Health Website at www. cdc.gov/travel. Providers should become familiar with the resources that are offered on this website.

In honor of May being observed as Hepatitis Awareness Month, it is important that providers also educate their patients on how to best protect themselves, especially when traveling. The most common types

of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C. Each virus produces similar symptoms, but all affect the liver differently, have different routes of transmission, and impact different populations.

Currently, there is no vaccine for hepatitis C, however, there is a vaccine for both hepatitis A and hepatitis B. In short, preexposure prophylaxis against hepatitis A infection through the administration of hepatitis A vaccine and/or immunoglobulin (IG) is recommended for unvaccinated persons traveling to or working in countries that have high or intermediate hepatitis A virus endemicity. Infants age 6-11 months should receive 1 dose prior to departure; however, this dose does not count towards the routine 2-dose series. The 2-dose hepatitis A vaccination series should be initiated at age 12 months according to the routine, age-appropriate vaccination schedule.

Unvaccinated healthy persons 12 months to 40 years should receive a single dose of hepatitis A vaccine as soon as travel is considered and should complete the 2-dose series according to the routine schedule.

For additional recommendations regarding infants <6 months, persons >40 years, immunocompromised persons, persons with chronic liver disease, and those for whom vaccine is contraindicated, please see “Recommendations for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel.”2 Hepatitis B vaccine is also recommended for individuals who are traveling to countries with high or intermediate hepatitis B disease. Short-term travelers to countries in which hepatitis B virus infection is of high or intermediate endemicity typically are at risk for infection only through exposure to blood in medical or disaster-relief activities, receipt of medical care that involves parenteral exposures, sexual activity, or drug use. In order to prevent

hepatitis B virus transmission outside of the perinatal setting, it is recommended to vaccinate children and adolescents not previously vaccinated and adults at risk for hepatitis b infection (e.g., those with a sexual or percutaneous exposure and international travelers to certain countries). Strategies to eliminate hepatitis B have been implemented successfully in the United States, but challenges remain.

According to CDC, vaccine coverage (≥ 3 doses) is lower among adults (31.6%) who traveled outside the United States to countries other than Europe, Japan, Australia, New Zealand or Canada since 19953, leaving them vulnerable to hepatitis B infection.

In summary, not only are routinely recommended vaccinations imperative in keeping patients and the community safe, but vaccinations based on specific risk factors (i.e., travel) are also important.

By providing a pre-travel risk assessment and consultation, patients will be better prepared and protected prior to their planned travel. Overall, the most effective way to stay healthy and minimize the spread of infectious disease is to follow preventative measures by staying up to date on all recommended vaccines.

REFERENCES 1 Hepatits A and MMR vaccine have specific international travel recommendations for 6-11 months of age. Review the “Child and Adolescent Immunization Schedule”: https://www.cdc.gov/vaccines/ schedules/downloads/child/0-18yrs-child-combined-schedule.pdf 2 “Recommendations for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel” MMWR November 2, 2018/67(43): https://www.cdc.gov/ mmwr/volumes/67/wr/mm6743a5.htm?s_cid=mm6743a5_e 3 “Prevention of Hepatitis B Virus Infection in the United States” MMWR January 12, 2018/67(1): https://www.cdc.gov/mmwr/volumes/67/rr/ rr6701a1.htm?s_cid=rr6701a1_e

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michigan MEDICINE® 13

Turning the tide Determining whether or not an error occurred is best left to an expert clinician, not an insurance executive. That’s why every incident reported to MagMutual is reviewed by a physician — and appropriate medicine is always expertly defended.

It’s a better, more policyholder-focused way to process claims, and it’s only at MagMutual.

magmutual.com/innovation | 800-282-4882

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COVID

19

SPECIAL EDITION: PHYSICIANS ON THE FRONTLINE

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It was New Year’s Eve. Across the United States, Americans were planning their resolutions, heading to parties, and tuning in to watch the ball drop in New York City. They embraced the coming new year the way we always tend to – with excitement and optimism, focused on the kinds of opportunities we tend to believe only a fresh start can bring.

A world away, in China’s Hubei province, communist party officials spent December 31st confirming publicly for the first time dozens of cases of pneumonia from an unknown or unexplained cause.

C-19 TIMELINE

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DECEMBER 31, 2019 –

JANUARY 31, 2020 –

CHINESE AUTHORITIES IN THE WUHAN

PRESIDENT TRUMP BANS TRAVEL FROM

PROVINCE CONFIRM DOZENS OF

CHINA TO THE UNITED STATES IN AN

LOCAL CASES OF AN UNKNOWN OR

EFFORT TO LIMIT THE SPREAD OF THE

UNIDENTIFIED PNEUMONIA.

NOW-IDENTIFIED COVID-19 VIRUS.

2020 HASN’T GONE THE WAY ANYONE IN THE WORLD WOULD HAVE

16 she temporary closed schools across the

HOPED, LEAST OF ALL IN MICHIGAN. INSTEAD OF FOCUSING ON

state – an order she’d later make perma-

RESOLUTIONS, THE RITES OF SPRING, PREPARING FOR GRADUATIONS OR OPENING DAY, RESIDENTS ACROSS MICHIGAN HAVE LEARNED A

effectively shuttering the economy. Residents working “non-essential” jobs were required to “stay home” and “stay safe.”

TERRIFYING “NEW NORMAL.”

T

nent, and on March 23rd signed an order

The governor and policymakers say the increasingly tough measures were designed

he first few months of the

On January 31st, President Donald Trump

new year have been filled

announced a travel ban, cutting off air

with illness, panic, govern-

travel from China. By March 12th, he’d

ment-imposed restrictions,

extended the ban to Europe. The virus was

indefinite suspensions of

already being transmitted across the Unit-

Constitutional freedoms, overrun Michi-

ed States, particularly in big cities like De-

Despite these best efforts, hospitals quickly

gan hospital systems, and shortages of ven-

troit. Two days before the President’s move

began running out of personal protective

tilators, medicines, and personal protective

to restrict flights from across the Atlantic,

equipment, ventilators, and bed space. The

equipment.

the Michigan Department of Health and

Michigan National Guard was deployed to

Human Services had identified the first 2

construct field hospitals, the TCF Cen-

confirmed cases of COVID-19 in Mich-

ter (formerly Cobo Hall) in Detroit was

igan.

turned into a 900 bed infirmary, and hos-

Globally, hundreds of thousands of men, women and children have tested positive for the novel coronavirus, COVID-19.

to “flatten the curve,” and give physicians and health care workers a chance to fight the virus without being overrun by seriously ill patients.

pital groups cleared the board of elective

Experts and epidemiologists predict

That same day, March 10, Governor

the number of individuals who’ve actu-

Gretchen Whitmer declared a state of

ally contracted the virus may be up to

emergency and, leaning on some of the

The United States leads the world in the

7 times the number who have shown

state’s best medical minds, began taking

symptoms, gotten tested, and received

emergency actions to protect residents

number of confirmed cases, and at the outbreak’s worst, our national death rate

medical confirmation.

from the coming pandemic. On March

CONTINUED ON PAGE 6

MARCH 10, 2020 –

MARCH 13, 2020 –

MARCH 14, 2020 –

MICHIGAN DEPARTMENT OF HEALTH

GOVERNOR WHITMER ANNOUNCES

MICHIGAN COVID-19 CASES

AND HUMAN SERVICES CONFIRMS THE

THE MARCH 16 CLOSING OF ALL

SURPASS 30.

FIRST 2 CASES OF COVID-19 INFECTION

MICHIGAN SCHOOLS AND BANS

IN MICHIGAN.

GATHERINGS OF 250 OR MORE.

and less urgent procedures.

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michigan MEDICINE® 17

HOW WE GOT HERE – CONTINUED FROM PAGE 17

As of publication, Michigan appears to

was doubling faster than anywhere else on

have “flattened the curve” of new in-

the planet. Few states were harder hit than

fections, and global, national and state

Michigan, with Detroit and the counties

modeling indicates we may have already

surrounding it rivaled only by New York

reached the virus’s seasonal peak. There’s

and California for the sheer volume of

still, though, much physicians and re-

death and serious illness.

searchers are working to learn, including

While a global pandemic is bound to produce bad news to dominate the headlines, it’s also been a year of remarkable personal sacrifice and innovation by Michigan physicians, health care providers, and everyday Michiganders mobilized and motivated to support them.

Physicians guided policymakers at every turn. They bravely treated patients even when it became impossible to use or obtain adequate personal protective equipment. Many suffered grave consequences, becoming ill themselves.

the catalysts and conditions that may launch a second wave of infections, and the pandemic’s risk of worsening later this year with the start of the traditional cold and flu season.

WE’RE NOT OUT OF THE WOODS YET.

The Michigan State Medical Society is on the ground working night and day to support Michigan’s heroic physicians. We’ve created and compiled key resources to help physicians address their patients health, their personal safety, and to keep the lights on and the practice running during dif-

Everyday Michiganders did their part, too,

ficult times. We’ve also partnered with

distancing to limit the spread of the dis-

legal and industry leaders to address key

ease, donating supplies, buying meals for

concerns and provide additional tools and

health care teams, and even sewing masks

information to assist you when you need

to help protect them on the job.

it most.

We’re learning more every day about how Michigan got here and – thanks to Michigan physicians – how we’ll move forward safely.

MARCH 16, 2020 –

MARCH 17, 2020 –

MICHIGAN COVID-19 CASES SURPASS

MICHIGAN COVID-19 CASES

50. GOVERNOR WHITMER CLOSES

SURPASS 100. MICHIGAN CONFIRMS

ALL BARS, RESTAURANTS, GYMS AND

ITS FIRST COVID-19 RELATED DEATH.

PUBLIC PLACES.

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KEY RESOURCES

T

hroughout the evolving COVID-19 public health crisis, Michigan physicians have served on the frontlines to meet the needs of their patients.

Behind the scenes, the Michigan State Medical

Society is working diligently to meet the needs of Michigan

The Business of Medicine: Keeping Your Practice Humming Billing and Coding Policy Updates: COVID-19 Practices across Michigan are scrambling to keep up with

physicians.

changes to the way health plans and payers handle claims. Our

We’ve proudly created and compiled a robust armory of re-

lists and details for health systems and payers across the state

sources to help you manage your patient load, your busi-

to help your practice keep track of the billing and coding policy

ness, your personal health, and the future of your practice.

changes caused by the crisis.

A full assembly of those resources is available online at

Financial Relief for Businesses

https://bit.ly/39GQ3iU. Among the helpful tools you’ll find

Practices are as different as the patients they treat, and the

there are:

various orders and guidance from Lansing and Washington,

dedicated COVID-19 resource page for physicians also includes

D.C. are having different effects on different physicians. Online

Telehealth Resources

you can find the latest information and resources to help phy-

Free Course – Telemedicine and Other Technology

and the federal government.

Codes in a COVID-19 Environment

The Latest from the AMA

Telemedicine Vendor List MSMS has made available free of charge a new online course for physicians titled “Telemedicine and Other Technology Codes in a COVID-19 Environment. The course will help physicians and their staffs make the most of their remote practice,

sicians and their practices access financial relief from the state

The American Medical Association is working as hard as we are, and we’ve assembled the most important updates relevant to Michigan physicians, from Tips for Keeping Your Practice in Business During the COVID-19 Pandemic to their Senior Physician COVID-19 Resource Guide.

and ensure they and their teams are properly reimbursed for

Accessing the Supplies You Need

the life-saving work they do each day.

The primary concern of many physicians right now is accessing

MSMS Legal Alert – Telemedicine in Michigan:

need to protect their patients and themselves. We’ve compiled

What Physicians Need to Know

the latest resources to empower your practice, including:

Physicians are embracing new technologies to interact with pa-

• Pure Michigan Business Connect Offering Virtual, Statewide

tients and to deliver the care they need. Mastering these tech-

Matchmaking Platform for Suppliers, Buyers Providing Criti-

nologies means understanding the legal framework around

cal Response to COVID-19

them. We’ve assembled a helpful guide covering the basics.

Telemedicine Can Help Social Distancing Effort Our resource center also features information and explains

the personal protective equipment and medical supplies they

• Opportunities to donate surplus PPE; and • Resources to Contact Your Regional Healthcare Coalition to access whatever other help you need.

Our goal is to support you well while you support your patients.

how telemedicine can assist in limiting the spread of viruses

As long as you’re on the job, MSMS will be working in the back-

and other infections, this season and in the future.

ground to empower you.

MARCH 22, 2020 –

MARCH 23, 2020 –

MICHIGAN COVID-19 CASES

GOVERNOR WHITMER ISSUES A “STAY HOME STAY SAFE”

SURPASS 1,000.

ORDER SHUTTERING ALL “NON-ESSENTIAL” BUSINESSES IN MICHIGAN.

MAY / JUNE 2020 |

michigan MEDICINE® 19

PHYSICIAN WELLNESS in the Time of Coronavirus

P

hysicians on the frontlines of Michigan’s COVID-19 public health crisis find themselves at incredible risk. Every week, physicians learn of another friend, colleague or former medical school classmate who has contracted the novel coronavirus while treating patients.

When physicians have looked after their own wellness, they’re better equipped to spread calm and competence, to dial down the sense of chaos patients are feeling, and to perform best when the stakes are highest.

Thousands of Michigan health care providers have contracted the virus in the last three months, and some have even lost their lives. Beyond the headlines, an unseen physician health and wellness crisis is raging as well, creating an impact that could be felt long after the state turns the corner on the infection epidemic.

“One skill that is essential for all providers of care all the time, and even more so in times of crisis is that of emotional self-regulation,” she said. “We are surrounded by human suffering and have pledged to relieve it. It’s inevitable that our own emotions will be affected. We may experience anger, sadness, exhaustion and more.”

Claudia Finkelstein, MDCM, is the Director of Wellness, Resilience and Vulnerable Populations at Michigan State University’s College of Human Medicine. A general internist with more than 30 years of clinical care and teaching experience, she is laser focused today on the wellbeing of medical professionals.

“The first step is to recognize when we are out of balance (am I snappy, irritable, shut down?). The next is to make the adjustments that are possible in the situation you are in. For example, stop and do some deep breathing for a minute. Consider when you last ate or drank something and adjust as needed. Being prepared is best, so

Doctor Finkelstein suggests a number of approaches physicians should keep in mind as they approach their own wellness.

For physicians, looking after their own health and wellness has never been more important than in times of crisis.

“The mood, kindness, and alertness of each physician affects so many lives under normal circumstances,” said Doctor Finkelstein.

“We have the power to make so many people suffer less or more with each word and act. This is even more vital when so much is unknown and so many people are ailing.”

MARCH 28, 2020 – MICHIGAN’S DEATH TOLL SURPASSES 100, WITH 4,650 CONFIRMED CASES. PRESIDENT DONALD TRUMP APPROVES A DISASTER DECLARATION MAKING FEDERAL FUNDS AVAILABLE FOR MICHIGAN COMMUNITIES.

michiganMEDICINE® 20 20 michigan MEDICINE®

| MAY / JUNE 2020

Ask the Lawyer Michigan’s health care landscape changes daily during the ongoing public health crisis. The legal framework in which physicians are practicing medicine and managing their practices is more fluid than ever, too.

We asked Daniel J. Schulte, and attorney with Kerr Russell Attorneys and Counselors for a little free legal advice.

Question: The Families First Coronavirus Response Act (“FFCRA”)

getting enough sleep and exercise, bringing snacks and drinks and knowing a few relaxation techniques are a great idea.”

She also reminds providers to cut themselves some slack.

“Self-compassion is another vital approach,” said Doctor Finkelstein. “Generally, people choosing this field are altruistic, perfectionistic and extremely hard working. These are all great traits until they crowd out self-compassion. We need to acknowledge our shared humanity – humans sometimes make mistakes, sometimes aren’t perfect and almost never in full control of the outcome. A commitment to perfect practice while acknowledging human imperfection is a balance to work towards.”

She says physicians may find a helpful reminder by thinking about their early days in practice.

“All of us who have chosen these careers are lucky in that we don’t need to dig deep to find the purpose in our work,” she said.

“Remembering the essays we wrote as personal statements when applying to school or residency programs may help us to make sense of our roles.”

is now effective. I understand this obligates me to provide paid sick leave and expanded family and medical leave. I am told there is an exception for a “healthcare provider.” Will this exception apply to everyone working at my practice or only licensed personnel?

Answer: According to the March 30, 2020 version of the US Department of Labor’s FAQs on the FFCRA, a health care provider is “anyone employed at any doctor’s office, hospital, healthcare center, clinic, post-secondary educational institution offering healthcare instruction, medical school, local health department or agency, nursing facility, retirement facility, nursing home, home healthcare provider, any facility that performs laboratory or medical testing, pharmacy, or any similar institution, employer, or entity.”

Therefore, it appears that all employees of medical practices are exempt from these requirements to provide paid sick leave and expanded family and medical leave.

Please note that the department of labor FAQs further provide “to minimize the spread of the virus associated with covid-19, the department encourages employees to be judicious when using this definition to exempt healthcare providers from the provisions of the FFCRA.”

APRIL 2, 2020 –

APRIL 9, 2020 –

APRIL 12, 2020 –

GOVERNOR WHITMER CLOSES K-12

GOVERNOR WHITMER EXTENDS “STAY HOME

THE NUMBER OF NEW

SCHOOLS FOR THE REMAINDER OF

STAY SAFE” ORDER; SHUTTERS “NON-ESSENTIAL”

COVID-19 CASES PER DAY

THE SCHOOL YEAR.

BUSINESSES; EXPANDS TO INCLUDE CAPACITY

BEGINS TO SLOW.

GUIDELINES AND ADDITIONAL BUSINESSE MAY / JUNE 2020 |

michigan MEDICINE® 21

MDHHS ANNOUNCES:

Peer-run Warmline to Aid Persons with Mental Health Needs During COVID-19 Pandemic

O

n April 13, the Michigan Department of Health and Human Services (MDHHS) launched a statewide warmline for Michiganders living with persistent mental health conditions. The warmline will connect

individuals with certified peer support specialists who have lived experiences of behavioral health issues, trauma or personal crises, and are trained to support and empower the callers.

The warmline will operate seven days a week from 10 a.m. to 2 a.m. at 888-PEER-753 (888-733-7753). Individuals in crisis, including those considering suicide, are urged to contact the Disaster Distress Helpline 24/7 at 800-985-5990 or the National Suicide Prevention Lifeline 24/7 at 800-273-8255.

120 West Saginaw Street, East Lansing, MI 48823 P: 517 / 337.1351 » E: msms@msms.org www.msms.org

michiganMEDICINE® 22 22 michigan MEDICINE®

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23 michigan MEDICINE®

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Telemedicine for Medical Practices During Covid-19

By David O. Hester, FASHRM, CPHRM, Director, Department of Patient Safety and Risk Management, The Doctors Company; Devin O’Brien, Esq., Deputy General Counsel, Vice President, Legal Department, The Doctors Company

To support the medical profession during this unprecedented time, the following are answers to some frequently asked questions regarding telemedicine.

24 michigan MEDICINE®

| MAY / JUNE 2020

Does my professional liability policy cover telemedicine?

What about documentation?

Documentation is critical. Telemedicine

The Doctors Company’s medical professional liability policy covers telemedicine as it does not draw a distinction between traditional care and telemedicine. Physicians should check with their professional liability insurer about coverage.

doesn’t change the fact that physicians

Are there malpractice risks specific to telemedicine?

the risks of COVID-19 exposure for this

Under normal circumstances, telemedicine is fairly low risk from a medical malpractice liability standpoint. The Doctors Company’s data shows that we had 38 closed claims involving telemedicine from 2007 to 2018, out of 27,559 claims. That said, under normal circumstances, a clinician encountering a potentially high-acuity condition via telemedicine who does not refer the patient for an office visit or to the Emergency Department could face a potential liability risk if an adverse event were to occur. That liability is essentially the same liability the provider would face after failing to make a needed referral following a face-to-face visit.

cord to mitigate liability risks.

should use their best clinical judgment and document their medical reasoning in patients’ medical records. If a patient’s complaint would generally warrant an in-person visit, the physician should weigh the risks of any emergent condition against patient, make the call, and document the reasons for this decision in the patient’s re-

Does informed consent need to be modified for virtual visits?

No. Inadequate informed consent communication between a healthcare provider and the patient/family is a top factor contributing to claims, according to closed claims studies by The Doctors Company.

The same standard of care applies to telehealth as to face-to-face visits, so physicians should make certain an informed consent discussion occurs when using technology or the phone to treat a patient.

An informed consent form signed by the

Contributed by The Doctors Company

thedoctors.com

patient, along with the documented informed consent discussion, is ideal—the provider of the telehealth platform may be able to advise you how to incorporate your informed consent document. Barring this, healthcare providers should document the results of the informed consent conversation with the patient in the medical record. In addition, the provider should verify and authenticate the patient’s identity. A telehealth informed consent form can be downloaded here.

What about licensure and crossing state lines?

During the COVID-19 pandemic, states have relaxed licensing requirements to encourage medical professionals to cross state lines to assist in the emergency. The Federation of State Medical Boards is maintaining a database of licensing requirements and waivers. In states that haven’t waived license requirements, physicians should comply. Additionally, many states have licensing requirements specific to the use of telehealth that they are waiving during the COVID-19 emergency.

What about privacy concerns when using telemedicine?

To assist medical practices in accelerating implementation of telehealth services, the Health and Human Services (HHS) Office for Civil Rights (OCR) has made a change affecting HIPAA enforcement: Effective immediately, according to a reference guide created by the Center for Connected Health Policy, the HHS OCR will “exer-

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Reprinted with permission. ©2019 The Doctors Company (www.thedoctors.com).

cise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.”

Professional organizations that support telemedicine assist with licensure in multiple states. More information can be found at Interstate Medical Licensure Compact.

This information was updated March 25, 2020.

MAY / JUNE 2020 |

michigan MEDICINE® 25

Welcome New Members www.msms.org/Membership

Alpena/Alcona/Presque Isle

Kalamazoo

Ottawa

Leah Conboy, DO

Ryan Bradstreet, MD

John Easa, MD

Claudio Duarte, MD

Mark Uggeri, MD

Kelly Jo Parling-Lynch, DO

Kent

Saginaw

Thomas Gribbin, MD

Elizabeth Daniel, MD

Frances Wong, MD

Chelsea Houthoofd, MD

David Schindler, MD Marla Signs, DO

Bay

Derek Schaller, MD, FACEP

John Buday, MD Robert Chadwick, DO Candice Colby-Scott, MD

Livingston Derek Thigpin, DO

Joshua Adams, MD

Christina Kozlovski, MD Ryan Lilly, MD Andrew Whiteside, DO

Mason County Michelle Cranick-Kuster, DO

Holli Neiman-Hart, MD

John Fox, MD, MPH

Oakland

Genesee

Li Alice, MD

Mamoon Elbedawi, MD

Wayne County Juan Estigarribia, MD

Midland

Calhoun

St. Clair

Zoe Deol, MD

Jamal Farhan, MD, FACS

Sayeeda Fatima, MD

Orlando Filos, MD

Marianne Huben, DO

Robert Flora, MD, MBA, MPH

Peter Littrup, MD

Ashley Richardson, DO

Larry Manders, MD

Radhika Gogoi, MD Andrew Isaacson, MD Asim Kagzi, MD Ayaz Khawaja, MD Carlos Murga Zamalloa, MD Madiha Salim, MD Hillel Sternlicht, MD

Alyssa Miceli, DO

Grand Traverse/Benzie/Leelanau John Stanifer, MD

Jyotiranjan Pradhan, MD Prakash Sanghvi, MD Charles Shanley, MD Natasha Smolcic McCaffrey, MD

Ingham

Christie Young Vahabzadeh, MD

Joshua June, DO

26 michigan MEDICINE®

| MAY / JUNE 2020

STAY CONNECTED!

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SOLID ADVICE.

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At The Health Law Partners, our unparalleled knowledge of the business of health care is coupled with timely, practical solutions designed to maximize value.

The HLP attorneys represent clients in substantially all areas of health law, with particular emphasis on: • Licensure & Staff Privilege Matters • Health Care Litigation • Health Care Investigations • Civil & Criminal False Claims Defense • Stark, Anti-Kickback, Fraud & Abuse, and Other Regulatory Analyses • Physician Group Practice Ancillary Services Integration and Contractual Joint Ventures • Appeals of RAC, Medicare, Medicaid and Other Third Party Payor Claim Denials and Overpayment Demands • Health Care Contractual, Corporate, and Transactional Matters • Compliance & HIPAA

TheHLP.com [284.996.8510] MAY / JUNE 2020 |

michigan MEDICINE® 27

Educational Offerings MSMS On-Demand Webinars Pain and Opioid Management

FREE! COVID-19 Webinars

Prescribing Legislation

*Support for this webinar/educational program is provided by Blue Cross and Blue Shield of Michigan as part of the BCBSM Value Partnerships program. Although Blue Cross Blue Shield of Michigan and the Michigan State Medical Society work collaboratively, the opinions, beliefs and viewpoints expressed by this webinar/educational program do not necessarily reflect the opinions, beliefs and viewpoints of BCBSM or any of its employees.

The CDC Guidelines

CARES Act Impact Telemedicine and Other Technology Codes

in a COVID-19 Environment

What Physicians Need to Know as Employers

During the COVID-19 Pandemic

Tapering Off Opioids

The Current Epidemic and Standards of Care The Role of the Laboratory in Toxicology and Drug Testing Treatment of Opioid Dependence Update on the Opioid Crisis 2019 (Fulfills the 1-time training on opioids and other controlled substances awareness)

Coding and Billing Webinars: Access to Medicare Changes to E&M Codes for 2019 and other Coding Updates Billing 101

Webinars that meet Board of Medicine Requirements: Human Trafficking Medical Ethics – Conscientious Objection among Physicians Medical Ethics – Decision Making Capability Medical Ethics – Just Caring: Physicians and Non-Adherent Patients Pain and Symptom Management Series Balancing Pain Treatment and Legal Responsibilities MAPS Update and Opportunities Michigan Automated Prescription System Update Opioid Town Hall

Claim Appeals Credentialing Medical Necessity Tips on Documentation to Prove it Reading Remittance Advice Tips and Tricks on Working Rejections

Webinars at No Cost to Members: Billing 101 Balancing Pain Treatment and Legal Responsibilities Claim Appeals Credentialing Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities

Visit msms.org/OnDemand for complete listing of On-Demand Webinars.

28 michigan MEDICINE®

| MAY / JUNE 2020

Visit msms.org/OnDemand for complete listing of On-Demand Webinars.

Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.

SAVE THE DATE for 2020!

HEDIS Best Practices In Search of Joy in Practice: Innovations in Patient Centered Care Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media MAPS Update and Opportunities Medical Necessity Tips on Documentation to Prove it Michigan Automated Prescription System Update Opioid Town Hall Prescribing Legislation Reading Remittance Advice Section 1557: Anti-Discrimination Obligations

A Day of Board of Medicine Renewal Requirements Date: Tuesday, October 20 Location: The Westin, Southfield Intended for: Physicians and all other health care professionals.

Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

Annual Scientific Meeting Date: Wednesday - Saturday, October 21 - 24 Location: The Westin, Southfield Intended for: Physicians and all other health care professionals.

Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

24th Annual Conference on Bioethics Date: Saturday, November 14 Location: DoubleTree by Hilton, Ann Arbor Intended for: Physicians and all other health care professionals.

Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

Sexual Misconduct – Prevention and Reporting Tips and Tricks on Working Rejections Update on Chronic Fatigue Syndrome Part 1:

Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.

Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS Update on Chronic Fatigue Syndrome Part 2: Uniting Compassion, Attention and Innovation to treat ME/CFS

Other Webinars: NEW – Michigan Medical Marihuana Law

MAY / JUNE 2020 |

michigan MEDICINE® 29

ADVOCACY ADVOCACY ADVOCACY ADVOCACY

Five Reasons to to Five Reasons

Five Reasons BACK theto the PAC

BACK PAC BACK the PAC Activate your Activate your Activate your political voice! political voice! political voice!

The Michigan Doctors’ Political Action Committee (MDPAC) is The Michigan Doctors’ Committee (MDPAC) is the bipartisan political armPolitical of Political theAction Michigan State Medical(MDPAC) The Michigan Doctors’ Action Committee is the bipartisan political arm of the Michigan State Medical Society, the builtbipartisan by our physicians, residents, medical students, political arm of the Michigan State Medical Society, built by our physicians, residents, medical students, their families, andbuilt those invested in the future of health care.

Society, ourinvested physicians, medical their families, andby those in theresidents, future of health care. students, We work through the political process to create positive their families, invested thecreate futurepositive of health care.

We work throughand thethose political processin to contributions to the medical profession by supporting contributions to the medical profession by to supporting We work through the political process create positive pro-medicine candidates, withwith lawmakers, pro-medicine candidates, lawmakers,byand and contributions to engaging the engaging medical profession supporting working towards lasting legislative solutions. working towards lasting legislative solutions. pro-medicine candidates, engaging with lawmakers, and working towards lasting legislative solutions. we do can’tit do it alone.

Physician engagementis isessential essentialtoto But weBut can’t alone.

Physician engagement the success of a pro-medicine legislature.

Current and potential the success of a pro-medicine legislature. Current and potential But we can’t do it alone.

Physician engagement is essential to lawmakers to hear professionalsin inthethefield field lawmakers need need to hear fromfrom professionals ofof the success of a pro-medicine legislature.

Current and potential medicine, and they are willing to listen. Through MDPAC, you medicine, and they are willing to listen. Through MDPAC, you will activate your on thefrom things most important to field of lawmakers needvoice to hear professionals in the will activate your voice on the things most important to Michigan physicians. medicine, and they are willing to listen. Through MDPAC, you Michigan physicians. will activate your voice on the things most important to Michigan physicians.

Let your voice be heard at MDPAC.org

Let your voice be heard at MDPAC.org Let your voice be heard at MDPAC.org 30 michigan MEDICINE® 30 Michigan MEDICINE®

| MAY / JUNE 2020 | MAY / JUNE 2020

MDPAC builds and maintains MDPAC builds and maintains relationships with lawmakers. relationships with lawmakers. builds and maintains As MDPAC the face of Michigan’s physicians, we relationships Aswith thelawmakers. face of make sure to stay connected withMichigan’s our state’s physicians, we make sure and to stayare connected current policymakers always with our state’s As looking the faceforoffuture Michigan’s physicians, weduring current policymakers and are always friends of medicine make sure to stay connected with our state’s looking for are futurealways friends of medicine during election cycles.

Cultivating positive current policymakers and interactions a oflong way during to ensuring election cycles.

Cultivating positive looking for futuregoes friends medicine lawmakers willinteractions listen to our concerns. a long way to ensuring election cycles.

Cultivating positive . goes interactions goes lawmakers a long way will to ensuring listen to our . concerns. lawmakers will listen to our . concerns.

MDPAC has over three decades of successfulMDPAC lobbying efforts. has over three decades of MDPAC has over three decades of successful lobbying efforts. successful lobbyingand efforts.

MDPAC has protected strengthened tort reform, stopped the tax, MDPAC has protected and strengthened tort MDPAC has protected and physician’s strengthened torthelped push back the expansion of a non-physireform, stopped the physician’s tax, helped reform, stopped the physician’s tax, helped cian’s ofpush practice, soexpansion much more.of a non-physipush backscope the expansion of and a the non-physiback Wescope will ofnever stop fighting for the right cian’s practice, and so much more. cian’s scope oftheir practice, and so much more. for stop ourWephysicians, practices, Wepolicies will never fighting for thestop right will never fighting for the right and their patients. policies for our physicians, their practices, policies for our physicians, their practices, and their patients. and their patients.

MDPAC has power, prestige, MDPAC has power, prestige, and respect. and respect.

MDPAC has power, prestige, Wake sleeping andand helprespect.

MDPAC Wake youryour sleeping giantgiant and help MDPAC make rapid, positive changes for physicians make rapid, positive changes for physicians Wake your sleeping giant and help MDPAC patients.

It could ease administrative andand patients.

It could ease administrative rapid, changes for physicians pressures the current prior authorizapressures withwith themake current prior positive authorizaand patients. could process, you money and on administrative tiontion process, savesave you money and Ittime ontimeease youryourMaintenance of Certification, pressures theand current Maintenance of with Certification, andprior authorizaadvance public health issues. tion process, advance public health issues.save you money and time on your Maintenance of Certification, and advance public issues.

MDPAC’s opponents raise health MDPAC’s opponents raise enormous sums of money. enormous sums of money.

Trial lawyers, insurance groups, pharmaMDPAC’s opponents raise Trial lawyers, groups, pharmaceutical companies,insurance and enormous other interests sums of money. ceutical companies, interests have poured millions and into other harmful have poured millions into legislative pushesTrial over the years.

Toharmful lawyers, insurance groups, pharmacompete with these Goliaths, we need to andToother interests legislative pushes over the years. ceutical companies, risecompete up higherwith than ever We need to thesebefore.

Goliaths, we need to into harmful poured millions be rise strong, andhave physician proud. We up loud, higher than ever before. legislative pushes need over tothe years. To be strong, loud,compete and physician proud.Goliaths, we need to with these rise up higher than ever before. We need to The current political landscape is uncertain. be strong, loud, and physician proud.

The current political landscape We want to makeis uncertain. sure physicians and patients are protected now and forever. By We want current to make physicians andlandscape Thesure current political monitoring legislation, keeping lawmakers and addressing the By patients informed, are protected now and forever. is uncertain. problems we face while administering monitoring current legislation,care,keeping We make MDPAC will always workwant to ensure that the surethephysicians and lawmakers informed, andtoaddressing future of medicine is inwhile good are hands. patients protected now problems we face administering care,and forever. By

monitoring currentthatlegislation, keeping MDPAC will always work to ensure the lawmakers future of medicine is in goodinformed, hands. and addressing the problems we face while administering care, MDPAC will always work to ensure that the future of medicine is in good hands.

­

( ) ­ | @

MAY / JUNE 2020 |

michigan MEDICINE® 31

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