MI MEDICINE SEP/OCT 2021

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 120 / NO. 5

September / October 2021

QUALITY. INDEPENDENCE. OPPORTUNITY.

How Michigan's physician organizations are making a difference.

msms.org

Convenient to specialists specialistsatat Convenientaccess access to

MICHIGAN’S ROLLHOSPITAL HOSPITAL MICHIGAN’SONLY ONLY HONOR HONOR ROLL Convenient access to specialists at

MICHIGAN’S ONLY HONOR ROLL HOSPITAL

• Make appointments • Transfer patients • Consult with physicians • Make appointments • Make appointments • Get patient information • Transfer patients • Transfer patients

• Consult with physicians • Consult with physicians • Get patient information • Get patient information

M-LINE:

800-962-3555

2 4 hour s a da y, 7 da y s a we e k

M M -- LLIINNEE: : 8 80 0 0 -09-6926-23 -535 55 5 5 24 2 4 hhour o u r ssaad day, a y, 7 7 d adays y s a wae w e ke e k

p resident 's Dear Colleagues, As we all know, the effective practice of medicine involves far more than healing patients and saving lives. There also are major, hidden components: contracting, billing, training staff, and much more.

This is where our state’s physician organizations have stepped up. For decades, these experts have provided a growing array of valuable options to help support their members in the most fundamental aspects of their businesses. During the pandemic, these organizations went the extra mile to procure PPE, vaccines, and other essential items, and now they’re poised to lead the way in contracting, reporting, and countless other ways.

PINO D. COLONE, MD (GENESSEE COUNTY) MSMS PRESIDENT

Their work has done more than just keep independent practitioners…well, independent. They’ve also been a major force for good in reducing burnout, providing advocacy, and sharing best practices in Michigan and nationally.

“During the pandemic,

In this issue, we’ll show you the leading edge of a much larger physician

physician organizations

organization portfolio, highlighting some of their most important activities

went the extra mile to

and initiatives. Of course, this is only the beginning where these groups are concerned and, if you’re not already a member of one of our state’s most

procure PPE, vaccines, and

dynamic, collaborative health care alliances, you’ll definitely want to take

other essential items, and

another look.

now they’re poised to lead

After all, most of us would agree we didn’t go into medicine because we

the way in contracting,

have an unquenchable thirst for negotiating contracts and doing paperwork.

reporting, and countless

The support our state’s physician organizations are doing helps us stay focused on what matters most: the wellbeing of our patients.

other ways.”

Sincerely,

PINO D. COLONE, MD, MSMS PRESIDENT

SEPTEMBER / OCTOBER 2021 |

michigan MEDICINE® 3

FEATURES & CONTENTS July / August 2021

12 Quality. Independence. Opportunity.

How Michigan's physician organizations are making a difference.

For decades, health care organizations across Michigan have been quietly supporting the delivery of services to patients—leading to growth in physician satisfaction, quality improvements, and the creation of new opportunities for leadership and growth.

(Story begins on page 12.)

4 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

06

I-9 Compliance is Essential to Avoid Costly Fines

BY ROBERT S. ANDERSON, JD

20

Q & A with House Health Policy Committee Chair, Bronna Kahle MICHIGAN STATE MEDICAL SOCIETY

24 08

Preventing Influenza During the 2021-2022 Flu Season Amid the Ongoing COVID-19 Pandemic

Deferred, Delayed, Disrupted: Mitigating Risks From Care During COVID-19 RICHARD E. ANDERSON, MD, FACP

27 NEW & REINSTATED MEMBERS 28 EDUCATION

JODI SCHAFER, SPHR, SHRM-SCP

STAY CONNECTED!

Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Publication Design STACIA LOVE, REZUBERANT! INC. rezudesign.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

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

ALSO INSIDE

Constructive Criticism Isn’t ‘Constructive’ at All

Chief Executive Officer JULIE L. NOVAK

All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast.

MICHELLE DOEBLER, MPH

10

MICHIGAN MEDICINE® VOL. 120 / NO. 5

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 2021 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. ©2021 Michigan State Medical Society

michigan MEDICINE® 5

ASK OUR LAWYER

I-9 Compliance is Essential to Avoid Costly Fines

By Robert S. Anderson, J.D., MSMS Legal Counsel

Q:

What is “Form I-9” used for? Why am I as an employer responsible to complete it every time I hire an employee?

6 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

The Biden Administration recently announced plans to increase enforcement of workplace laws. This occurs as many companies are returning to the office and resuming hiring. Now is the time to ensure your medical practice is in compliance with the often used but seldom understood Form I-9.

T

he federal Immigration Reform and Control Act (the “Act”) requires employers to verify the identity and employment eligibility of all those individuals they hire. The Employment Eligibility Verification Form I-9 was designated as the means of documenting this employer verification. Employers are required by law to complete, retain and produce for inspection original Form I-9s for all their current employees.

Employers are also required to retain Form I-9s for all former employees for a period of at least 3 years from their date of hire or for 1 year after the employee is no longer employed, whichever is longer.

Employers are required by law to complete, retain and produce for inspection original Form I-9s for all their current employees, and for former employees for a period of at least 3 years from their date of hire or for 1 year after the employee is no longer employed, whichever is longer.

Form I-9 has three sections that must be completed and signed within a required time period: Section 1 – must be completed and signed/dated by the Employee no later than the first day of employment, but not before accepting a job offered.

Section 2 – must be completed and signed by the Employer or authorized representative within three business days of an employee’s first day of employment.

For verification purposes an employer must physically examine: • one original document from List A (the Lists are attached to the I-9 instructions); or • a combination of one original document from List B and one original document from List C.

Section 3 – should only be completed and signed by the Employer or authorized representative if there is a need to reverify documents and/or rehire an employee.

The Act provides for civil penalties for substantive/uncorrected technical paperwork violations range from $234 to $2,332 per violation, while fines for knowingly hiring or continuing to

employ unauthorized workers range from $583 to $4,667 per violation.

For substantive/uncorrected technical paperwork violations, the amount of the fine is determined by dividing the number of violations by the number of employees for which an I-9 should have been prepared to obtain a violation percentage. This percentage provides the auditor with a base fine amount depending on 1st time offense, 2nd time offense, or 3rd or more time offense. The standard fine amount is then applied to each I-9 with violations.

As a result, a company’s fines can add up quickly, especially if the majority of an employer’s I-9 forms have violations.

For example: if an employer is audited for the first time and the Auditor notes that there should have been 100 completed Form I-9s for employees, but 60 had some type of uncorrected/substantive violation. The employer could expect a fine of up to $2,332 per I-9 that the auditor determines has a violation ($2,332 x 60 = $139,920).

ROBERT S. ANDERSON, JD, MSMS LEGAL COUNSEL, IS A MEMBER OF KERR RUSSELL.

SEPTEMBER / OCTOBER 2021 |

michigan MEDICINE® 7

MDHHS UPDATE

Preventing Influenza During the 2021-2022 Flu Season Amid the Ongoing COVID-19 Pandemic

By Michelle Doebler, MPH, Influenza Epidemiologist, MDHHS – Division of Immunization

Influenza infections annually typically cause millions of illnesses and thousands of hospitalizations and deaths throughout the United States. The 2020-2021 flu season was unique compared to many previous seasons. Influenza activity remained low or below baseline thresholds for many surveillance programs throughout the entire flu season.1

8 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

D

uring this time, jurisdictions also had many measures in place including mask mandates, social distancing recommendations, and stayat-home orders to mitigate the spread of the COVID-19 pandemic. Community mitigation measures could have contributed to the reduced transmission of influenza activity between seasons and during the 2020-2021 influenza season.2 Flu activity in Michigan reflected patterns of activity seen on a national level.

A Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) stated that influenza activity during the period between October 2020 and May 2021 was lower than any previous influenza season since 1997, which was the first season that publicly available flu data were available.3 Among over 1 million specimens tested at clinical laboratories, only 0.2% of specimens were positive for an influenza virus compared to 2.35% positivity during 2019.4 As COVID-19 mitigation measures are relaxed and schools and workplaces continue to resume in-person activities, public health professionals indicate the importance of fall influenza vaccination campaigns in addition to the use of everyday preventative actions.

The most effective way to prevent flu is with an annual flu vaccination. The Advisory Committee on Immunization Practices recommends that all persons aged 6 months and older, without contraindications, receive a flu vaccination every year. However, flu vaccination coverage across the country is below the Healthy People 2030 goal of 70 percent. Preliminary estimates for the 2020-2021 flu season indicate that national coverage for children

decreased compared to the 20192020 season.5 Flu vaccination coverage among children aged 6 months through 17 years was estimated to be 58.2% as of the week ending April 17, 2021, for the 2020-2021 season, compared to 63.8% for the 2019-2020 flu season.

The most effective way to prevent flu is with an annual flu vaccination.

The Advisory Committee on Immunization Practices recommends that all persons aged 6 months and older, without contraindications, receive a flu vaccination every year.

Preliminary available vaccination coverage estimates among adults aged 18 years and older for the 2020-2021 flu season indicated that coverage has increased to 55%, compared to 48.4% for the 2019-2020 flu season. In Michigan, utilizing data from the Michigan Care Improvement Registry (MCIR), flu vaccination coverage for everyone aged 6 months and older was 34.3% for the 2020-2021 flu season.6 Influenza is not the “stomach flu” and not just a “bad cold” but rather is a highly contagious respiratory illness that can lead to extreme illness and even death. Young children can be especially susceptible to severe complications from the flu. Children aged 6 months through 8 years may require two doses of influenza vaccine to be fully protected for a season. Children that do not receive their second dose may still be at risk from developing illness from influenza infection. Providers are encouraged to communicate

the importance of the second dose of influenza vaccine to parents. We can do better in Michigan to protect our most vulnerable children.

Annually, CDC and the Michigan Department of Health and Human Services develops a plethora of resources to educate patients and increase influenza vaccine coverage rates. Many of these resources provide sample messaging to address the misconceptions preventing people from choosing to get an influenza vaccine. Educational materials are available at www.cdc.gov/ flu and www.michigan.gov/flu.

While every flu season is unpredictable, the importance of flu vaccination during the 2021-2022 flu season cannot be overstated. National Influenza Vaccination Week, held annually during the first full week of December, reminds individuals that it is not too late to get an influenza vaccine. Providers are encouraged to assess their patients throughout the fall and winter months for flu vaccination status and continue to offer flu vaccine for the entire season!

REFERENCES 1 Centers for Disease Control and Prevention (CDC). (2021).

Weekly U.S. Influenza Surveillance Report. Retrieved from https://www.cdc.gov/flu/weekly/index.htm 2 Olsen et al. (2020). Decreased Influenza Activity During the COVID-19 Pandemic – United States, Australia, Chile, and South Africa, 2020 3 Olsen SJ, Winn AK, Budd AP, et al. Changes in Influenza and Other Respiratory Virus Activity During the COVID-19 Pandemic — United States, 2020–2021. MMWR Morb Mortal Wkly Rep 2021;70:1013–1019. DOI: http://dx.doi. org/10.15585/mmwr.mm7029a1 4 CDC. (2020). Flu Vaccination Coverage, United States, 201920 Influenza Season. Retrieved from FluVaxView https:// www.cdc.gov/flu/fluvaxview/coverage-1920estimates.htm 5 CDC. (2021). Weekly National Flu Vaccination Dashboard.

Retrieved from https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-dashboard.html 6 Michigan Care Improvement Registry. (2021). Seasonal Influenza Vaccination Dashboard. Retrieved from https:// www.michigan.gov/flu/0,6720,7-321-101697---,00.html 7 CDC. (2021). The Flu Season. Retrieved from https://www. cdc.gov/flu/about/season/flu-season.htm

SEPTEMBER / OCTOBER 2021 |

michigan MEDICINE® 9

ASK HUMAN RESOURCES

Constructive Criticism Isn’t ‘Constructive’ at All

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

Q:

When I interview a potential candidate,

I ask them how well they take criticism. I have never had anyone say that they do not take it well.

Yet in reality, I find that when I criticize a staff member, they often get upset and some actually cry.

They make the changes I suggest, but they often seem resentful.

This frustrates me, as I am trying to operate a business. It is my practice and I expect my staff to do as I ask. I don’t need to be dealing with a bunch of people who simply cannot take direction. Is there a way to make sure that I am hiring thicker-skinned employees?

10 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

A

s the old adage goes, “It’s not what you say, it’s how you say it,” and I have a feeling that you need to consider the manner in which you deliver the feedback.

Listen, no one likes to be criticized.

And most people want to do the job the right way. So, if an employee is not doing the job as you want them to do it, then you need to let them know. The resentment may be tied to your delivery of the critique rather than the critique itself. For example:

Did you raise your voice when you gave them the criticism?

If you did, the employee will hear and remember the volume of your voice and not the words you used.

Did you ask the employee why they were doing something a certain way and allow them to respond before telling them to do it differently?

in a similar situation working with you and the hurt feelings escalate.

Did you point out their mistake in front of a coworker, patient or vendor?

If so, they will remember their embarrassment and resent you for causing it.

Did you tell them the way you would like the task done and why?

If not, you missed an opportunity to teach, which would have secured the knowledge in a positive manner and opened the door for more dialogue and learning.

I could go on and on. The phrase ‘constructive criticism’ is a misnomer and is rarely effective in the develop-

And, if so, did you actually listen to their response? If you did not, on both counts, they may harbor a grudge and will have a need to “let it out”, usually to co-workers. And of course, the

ment of a person’s skill set. I would

co-workers will tell of their experiences

Approach the conversation from a

begin by discontinuing the use of this phrase. In its place, begin to use these opportunities as teachable moments and remember, ‘telling isn’t teaching’.

coaching perspective versus a directing standpoint. When you see something you need to address, note it, and look for an opportunity to meet with the employee privately as soon as possible. If you are angry, wait until you calm down and think about how you are going to frame this conversation.

You are now wearing a teacher’s hat and your goal is to change the manner in which the employee is performing and/ or behaving. This requires awareness and accountability on the part of the employee – it’s a process and they need to be an active participant in their own development.

Here are some tips to guide you: Always focus on the task or the behavior, not the person.

Explain the ‘why’ as well as the ‘how’.

Keep your voice at a respectful level.

Prepare for the meeting by developing questions that will allow the employee to become aware of the same issues/ concerns that you notice – so they are more willing to work on correcting it.

Do not argue.

Encourage feedback.

Listen to the employee’s responses and encourage them to ask questions for a deeper understanding.

The goal is to develop employees and get their buy-in. You do this by coming alongside them as a partner in their learning, not as their parent looking to correct and scold. In this current state of hiring difficulty, practices need to do everything they can to attract and retain staff. If you have a reputation (whether deserved or not) of being too demanding, let me assure you, word will get around and you will have difficulty hiring and keeping high quality staff.

SEPTEMBER / OCTOBER 2021 |

michigan MEDICINE® 11

FEATURE

QUALITY. INDEPENDENCE. OPPORTUNITY.

How Michigan's physician organizations are making a difference.

12 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

SEPTEMBER / OCTOBER 2021 |

michigan MEDICINE® 13

For decades, dozens of health care organizations across Michigan have been quietly supporting the delivery of services to patients.

Their comprehensive, forward-thinking efforts are leading to growth in physician satisfaction, quality improvements, and the creation of new opportunities for leadership and growth.

Physician Organizations Today

T

oday, Michigan’s 40 physician organizations are dynamic forces for change in a field that’s evolving more rapidly by the year.

“When we got started, we were really focused on the administrative and billing needs of physicians,” says Mark Komorowski, MD, who serves as president of the Great Lakes Physicians Organization in Midland and MSMS Board Chair. “Our focus was on contracting with insurance plans and providing support on the business side, so we could help keep independent physicians focused on their patients without having to worry about the volume of paperwork and intensity that happens behind the scenes.”

Doctor Komorowski says physician organizations have met and exceeded all expectations when it comes to this initial purpose. So, too, does the research.

According to a 2019 study by Deloitte, “Health care systems get the most value when their physicians and other clinicians are practicing at the ‘top of their license,’ focusing their time,

14 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

attention and effort on providing patient care rather than completing administrative tasks.” The study goes on to recommend the establishment of physician organizations as its top strategy for helping health care systems create their own future.

It’s an area where Michigan already is leading the way.

“Quite honestly, over the years physician organizations have played an instrumental role in keeping practitioners independent,” Doctor Komorowski says. “The practice of medicine gets more complicated every year and having a high-quality physician organization to support those of us who choose to work outside of a hospital system really is more important than ever.”

Then, beginning in 2005, physician organizations began working on a whole new playing field. Thanks to a major initiative facilitated by MSMS, Blue Cross Blue Shield of Michigan and physician organizations began collaborating to build a groundbreaking new approach to quality improvement.

Value Partnerships—formerly known as the Physician Group Incentive Program (PGIP)—offers a reward pool that incentivizes high-quality, efficient patient care. Physicians receive reimbursement based on their performance relative to certain key metrics. Payments are made through physician organizations, which leverage the effective use of data, offer practice improvement strategies, and support research, training and collaboration among their members.

““The practice of medicine gets more complicated every year and having a high-quality physician organization to support those of us who choose to work outside of a hospital system really is more important than ever.”

MARK KOMOROWSKI, MD, GREAT LAKES PHYSICIANS ORGANIZATION

“For physician organizations today, quality is the gateway,” Doctor Komorowski says. “But it is truly only the beginning of all that’s available, and of all that’s possible.”

During the past decade, the role of the physician organization has been transformed from one that primarily contracts and troubleshoots to one that fosters Patient-Centered Medical Homes, supports the frail and elderly through an integrated High-Intensity Care Management Program, and provides other targeted supports for chronic conditions.

In fact, some physician organizations are now branching out to include other care providers beyond MDs and DOs. Some now include behavioral health providers, chiropractors, and other caregivers, with an emphasis on providing a full range of comprehensive care services to the patients they serve.

“Today, our membership includes optometrists, psychologists, podiatrists, nurse practitioners, physician assistants and behavioral health providers like licensed master’s social workers, and licensed professional counselors,” says Shay Raleigh, who serves as executive director of the Great Lakes Physicians Organization.

Research suggests this type of integrated delivery system is effective in bolstering cohesion, scale, and affiliation— all of which serve as proxies for other, less tangible characteristics of high performance.

Across the U.S., the number of physicians moving into large physician organizations has increased in ways

researchers call “remarkable”. According to a June 2020 study by Zhang et al, “The average organization more than doubled (147–324) between 2008 and 2014, and the share of physicians associated with big organizations grew from 43 to 56 percent.”

This same study finds that a 16 percent reduction in overall patient spending is associated with practitioners who transition into larger physician organizations.

“Here in Michigan, Blue Cross and its partner physician organizations together have really transformed the quality, cost and value of health care,” says Jun Garcia, MD, who serves as medical director for Lake Huron Physician Hospital Organization. “It's something that I don't think is touted enough. It's just not. I think Michigan is in the top tier to control costs because together, we’ve figured out how to at least show the doctor or motivate the doctor to change certain behaviors that cost a lot of money.”

When it comes to using data to leverage practice improvements, physician organizations are keeping their members focused on the big picture.

“Today, we look at data differently,” says Ruth Clark, executive director of Integrated Health Partners in the southern lower peninsula. “We help our physicians go beyond merely getting a report and saying, ‘Oh, this person was in the hospital.’ Now, our members are going have the data to assess the information more broadly.

They can ask themselves, ‘Is this a diagnosis I'm seeing frequently go to the hospital across the organization?

“The average organization more than doubled (147–324) between 2008 and 2014, and the share of physicians associated with big organizations grew from 43 to 56 percent.”

And if so, what are some of the things that had we done something differently we could have avoided that to begin with? What can we do differently so that we can keep people healthier?’”

This additional layer of self-assessment can lead to practice improvements that extend across the entire physician organization. Many are extending their leadership to include wellness activities that go out into communities in an effort to effect long-term health and wellbeing across entire populations.

“We’re now doing quite a bit of community outreach, even fundraising,” says Doctor Garcia. “Pre-COVID, we had started doing patient seminars to help bring people in for support with their critical health issues. We rented space and brought in volunteer physicians to keep the public educated and well cared for."

Before the onset of COVID-19, these clinics were becoming more commonplace as physician organizations led the way in preventative patient care and education.

And then, with the onset of pandemic, everything changed.

SEPTEMBER / OCTOBER 2021 |

michigan MEDICINE® 15

Weathering the Pandemic

“A

t first, just like a lot of other businesses and professions, our physicians didn’t know what to do,” says Karen Swanson, MD, chief medical officer at The Physician Alliance. “Our physician organization was at the forefront of trying to find just basic supplies for our physician practices—the masks, the shields, the gowns. We were fortunate enough to purchase a significant number of supplies to distribute to our practices.”

Doctor Swanson notes her physician organization also played a key role in many unseen aspects of physician operations during the pandemic.

“We showed people how to do telehealth overnight,” she says. “A lot of primary care started operating virtually until they had adequate supplies and were able to organize their team members to come into the practice.

And at that point, our CEO was able to

get an accelerated distribution of some incentive payments to our physicians.

After all, when you shut down you can’t make payroll.”

Finally, Michigan physician organizations were instrumental in helping distribute the vaccine to independent practitioners.

“For the physicians affiliated with or employed by health systems, it wasn't an issue, but we had a lot of private physicians that wanted themselves and their teams in their practices vaccinated,” Doctor Swanson says. “We were able to help coordinate with our hospital partners to offer that to our practices.

That level of local coordination was essential, and physician organizations were fortunate to be right at the center of many key relationships.

“We’d already developed relationships with health departments and other local officials from our community

“We’d already developed relationships with health departments and other local officials . . . so we were on the phone from day one, talking about local needs and solving the problems that impacted all of us.

KAREN SWANSON, MD CMO, THE PHYSICIAN ALLIANCE

meetings and engagement efforts,” Clark says. “So we were on the phone from day one, talking about local needs and solving the problems that impacted all of us. Before you knew it, we were working with the community on getting PPE for our members and sharing information about where telehealth was happening, what changes we’ve seen in patient volumes, and more. Those relationships really helped us get through the pandemic much more effectively.”

But there were other supports as well.

“During the pandemic, the government loosened or waived a lot of the red tape for patients and physicians, and so did insurance payers,” Doctor Swanson says. “In some ways it made it easier for the physicians to actually care for their patients because they didn't have that burden. Our leadership team has begun to work with these organizations to see how much this relief can be extended in the future.”

16 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

Preventing Physician Burnout

B

y providing extensive behindthe-scenes support, physician organizations also help prevent burnout among their members.

With some national studies indicating nearly 80 percent of all physicians experience feelings of burnout, efforts in this area are urgently needed.

Let’s pause on this point. It’s known that a major contributing factor to burnout is the amount of time it takes to assimilate new medical information.

Currently, it’s estimated that the doubling time of medical knowledge is roughly 73 days, compared to 50 years in 1950. With that staggering amount of new information to bring on board,

it’s no wonder Michigan physicians often find themselves mentally and physically exhausted.

Add to that the fact that for every hour spent with a patient, nearly double that time is spent on documentation.

Michigan’s physician organizations can leverage both issues by supporting documentation, offering training and other professional development tools in fast and friendly ways, and—perhaps most of all—creating communities of caregivers that can deliver much-needed collegiality and peer support. These strategies allow physicians to practice at the top of their license and be affirmed through research, shared

“With the data we share, everyone is ranked against each other, and they know where they stand . . . There's no animosity there.

It's, let's do this as a group and who can push each other higher and what can we learn from each other?”

SHAY RALEIGH, EXECUTIVE DIRECTOR, GREAT LAKES PHYSICIANS ORGANIZATION

It’s known that a major contributing factor to burnout is the amount of time it takes to assimilate new medical information. Currently, it’s estimated that the doubling time of medical knowledge is roughly 73 days, compared to 50 years in 1950.

data, and relationships with other likeminded practitioners.

“With the data we share, everyone is ranked against each other, and they know where they stand and they bring their own internal drive to perform better,” Raleigh says. “There's no animosity there. It's, let's do this as a group and who can push each other higher and what can we learn from each other?

So, there's that freedom, that independence in terms of life, work balance.”

Your resource for physician and provider well being — made for physicians, by physicians.

MSMS.org/Resources/Welcome-to-SafeHaven

SEPTEMBER / OCTOBER 2021 |

michigan MEDICINE® 17

Looking Into the Future As the leaders and members of Michigan’s physician organizations forecast what’s next for themselves and their members, they predict a continuing emphasis on managing risk and adding value to patients and physicians alike.

“Our physician organization has a strong role to play when it comes to increasing the transparency of key information,” Doctor Swanson says.

“Many physicians don’t know about the pricing differences between, say, a Beaumont versus Providence versus Henry Ford. There are huge pricing variations between those facilities.”

Doctor Swanson also suggests greater transparency is necessary with respect to the data physicians should see about themselves.

“For instance, they may be a huge outlier on ordering MRIs for low back pain. It's a costly test,” Doctor Swanson says. “You don't know you're an outlier until you have some data, so one of our strategies right now is to really educate physicians on their own costs and provide action plans and follow up on what to do about that.”

Once this information is in hand, physician organizations take care to work with their members on effective solutions.

“Let’s continue the MRI example,” Doctor Swanson says. “When we share the utilization data, we might get pushback from a physician who says, ‘Well, the patient's coming in with back pain and they want the test.’ We, in turn with some of our higher quality metrics or where we see a higher cost, help create important alternatives for physicians and then educate

18 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

them on how they might be used. We’ll also introduce patient education materials about how low back pain can be treated in other ways.”

In Midland, Raleigh is of the same mind when it comes to his own physician organization.

“Looking ahead, the elements for success include having IT and analytic infrastructure, continued physician and patient engagement, and having clinical FTEs that can also be that clinical coach or clinical messenger for what's new and what's coming around the corner,” Raleigh says. “The future also holds a lot of consumerism for patients.

You can go on your smartphone now and schedule an endoscopy and you might get an alert on your phone that says you can save $800 if you go to this freestanding center instead of to the hospital for your endoscopy. Not every payer is there yet, but we're working on that patient education aspect.”

Some physician organizations also are leaning into opportunities to have more control and accountability when it comes to the cost of patient care.

“We should be letting our physicians hold the checkbook when it comes to being accountable for cost of care,” Raleigh says. “We have proven our

merit time and time again when it comes to resource stewardship, utilization management, and quality of care metrics, yet there's still persists a myriad of vendors and other factors out there that are doing prior authorization and setting up other barriers that are really just red tape for the physicians.

If you truly want to go to risk, we need to be in the driver's seat. We can't be dependent on other drivers towards cost of care if we're truly going to be responsible.”

Michigan physician organizations also point to better state program alignment and the ability to enter group contracts as other strong levers for change.

“We could achieve so much more if state health programs could be better aligned so that we could focus on a fixed set of the most important benchmarks,” Clark says. “Currently, we find that this initiative is looking at six metrics and that other one is looking at 12 metrics that are completely different, we find ourselves searching for alignment and not finding it.”

Clark went on to suggest that clarity around program outcomes is only the beginning.

“It would actually be very helpful if physician organizations could actually

“It would be helpful if physician organizations could contract on behalf of ALL their member practices, rather than each individual one.

It would help us better view and aggregate the contractual provisions and outcomes data and share them more efficiently.”

RUTH CLARK, EXECUTIVE DIRECTOR, INTEGRATED HEALTH PARTNERS

MSMS Board of Directors Disclosures contract on behalf of all their member practices, rather than each individual one,” she says. “It would help us better view and aggregate the contractual provisions and outcomes data and share them more efficiently, and I think Michigan could have better, more aligned outcomes that way.”

“If we aren't moving toward universal health care, then the physician organization is really essential because there are so many changes happening all at the same time.”

KAREN SWANSON, MD CMO, THE PHYSICIAN ALLIANCE

Swanson echoes this sentiment, emphasizing the central role a physician organization now plays in the health care marketplace.

“If we aren't moving toward universal health care, then the physician organization is really essential because there are so many changes happening all at the same time,” she says. “It becomes more and more complex with all the individual payers looking at different measures, and the data reporting is becoming more and more complicated.

“Our physician organization, like so many others, places tremendous value on patient-centered care. I'm always really proud of how we put that forward, because it helps ensure our physicians are continually focused on what matters most.”

House of Delegates Resolution 25-13 states that “MSMS annually provide Michigan physicians with a list of all officers, officials, candidates and staff who receive money as salary or non-patient care compensation from Blue Cross Blue Shield of Michigan (BCBSM) or any other insurer, medical product company or its affiliates annually in Michigan Medicine®.” Following are the disclosures of the MSMS Board of Directors, officers and staff.

Belen Amat, MD – None Paul D. Bozyk, MD – None T. Jann Caison-Sorey, MD, MSA, MBA – Blue Cross Blue Shield of Michigan, recently retired: 6/30/2021 Pino D. Colone, MD – None Donald P. Condit, MD, MBA – None Jayne E. Courts, MD – None Talat Danish, MD, MPH, FAAP – Robert M. Doane, MD – None Robert F. Flora, MD, MBA - None Thomas M. George, MD – None Paul S. Harkaway, MD – Priority Health: Consulting Work Bryan W. Huffman, MD – None Larry R. Junck, MD – None

Statement of Ownership, Management, and Circulation

Mark C. Komorowski, MD – None Nita M. Kulkarni, MD – None P. Dileep Kumar, MD – None

13. Publication Title

14. Issue Date for Circulation Data Below

Michigan Medicine

July/August 2021

15. Extent and Nature of Circulation

Average No. Copies No. Copies of Single Each Issue During Issue Published Preceding 12 Months Nearest to Filing Date

8411

a. Total Number of Copies (Net press run)

1. Publication Title

Statement of Ownership, Management, and Circulation (All Periodicals Publications Except Requester Publications) 2. Publication Number

Michigan Medicine

0

Bi-monthly

Six (6)

4. Issue Frequency

0

2

_

6

3. Filing Date

2

2

9

3

5. Number of Issues Published Annually

7. Complete Mailing Address of Known Office of Publication (Not printer) (Street, city, county, state, and ZIP+4 ®)

120 West Saginaw Street, East Lansing, MI 48823

8/02/2021

6. Annual Subscription Price

$110.00 Contact Person

Kevin McFatridge

Telephone (Include area code)

8. Complete Mailing Address of Headquarters or General Business Office of Publisher (Not printer)

517-336-5745

120 West Saginaw Street, East Lansing, MI 48823

9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor (Do not leave blank) Publisher (Name and complete mailing address)

Kevin M. McFatridge, 120 West Saginaw Street, East Lansing, MI 48823 Editor (Name and complete mailing address)

b. Paid Circulation (By Mail and Outside the Mail)

(1)

Mailed Outside-County Paid Subscriptions Stated on PS Form 3541 (Include paid distribution above nominal rate, advertiser’s proof copies, and exchange copies)

(2)

Mailed In-County Paid Subscriptions Stated on PS Form 3541 (Include paid distribution above nominal rate, advertiser’s proof copies, and exchange copies)

(3)

Paid Distribution Outside the Mails Including Sales Through Dealers and Carriers, Street Vendors, Counter Sales, and Other Paid Distribution Outside USPS®

(4)

Paid Distribution by Other Classes of Mail Through the USPS (e.g., First-Class Mail®)

(4)

Michigan State Medical Society

Melanie S. Manary, MD – None

457

Mark E. Meyer, MD – None

0

0

0

0

7414

0

S. Bobby Mukkamala, MD – None

0

0

0

Dennis M. Ramus, MD – Board of Directors, Blue Cross Blue Shield of Michigan

0 0

8042

7414

Michael J. Redinger, MD – None

8411

7538

Daniel M. Ryan, MD – Hospital stipend; medical director stipend

Average No. Copies Each Issue During Preceding 12 Months

No. Copies of Single Issue Published Nearest to Filing Date

369

g. Copies not Distributed (See Instructions to Publishers #4 (page #3))

124

100% and Circulation 100% Statement of Ownership, Management, * If you are claiming electronic copies, go to(All line 16Periodicals on page 3. If you are Publications not claiming electronic copies, skip to line 17 on page 3. Publications) Except Requester i. Percent Paid (15c divided by 15f times 100)

16. Electronic Copy Circulation

120 West Saginaw Street, East Lansing, MI 48823

b. Total Paid Print Copies (Line 15c) + Paid Electronic Copies (Line 16a) c. Total Print Distribution (Line 15f) + Paid Electronic Copies (Line 16a)

Full Name

Complete Mailing Address

Brian R. Stork, MD – None

d. Percent Paid (Both Print & Electronic Copies) (16b divided by 16c Í 100)

I certify that 50% of all my distributed copies (electronic and print) are paid above a nominal price.

Bradley J. Uren, MD - None

17. Publication of Statement of Ownership PS Form 3526, July 2014 (Page 2 of 4) If the publication is a general publication, publication of this statement is required. Will be printed

Publication not required.

Sept/Oct 2020 in the ________________________ issue of this publication.

18. Signature and Title of Editor, Publisher, Business Manager, or Owner

12. Tax Status (For completion by nonprofit organizations authorized to mail at nonprofit rates) (Check one) The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes: Has Not Changed During Preceding 12 Months Has Changed During Preceding 12 Months (Publisher must submit explanation of change with this statement) PS Form 3526, July 2014 [Page 1 of 4 (see instructions page 4)] PSN: 7530-01-000-9931

PRIVACY NOTICE: See our privacy policy on www.usps.com.

Kevin M. McFatridge

Digitally signed by Kevin M. McFatridge DN: cn=Kevin M. McFatridge, o=Michigan State Medical Society, ou=Marketing, Communications and Public Relations, email=kmcfatridge@msms.org, c=US Date: 2015.09.11 09:09:44 -04'00'

Herbert C. Smitherman, Jr., MD, MPH – None F. Remington Sprague, MD –Board of Directors, Blue Cross Blue Shield of Michigan

a. Paid Electronic Copies

11. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or More of Total Amount of Bonds, Mortgages, or None Other Securities. If none, check box

Tabitha E. Moses – None

0 0

Free or Nominal Rate Distribution Outside the Mail (Carriers or other means)

e. Total Free or Nominal Rate Distribution (Sum of 15d (1), (2), (3) and (4))

Christopher J. Milback, MD, MBA – None

0

0

Free or Nominal Rate Copies Mailed at Other Classes Through the USPS (e.g., First-Class Mail)

h. Total (Sum of 15f and g)

10. Owner (Do not leave blank. If the publication is owned by a corporation, give the name and address of the corporation immediately followed by the names and addresses of all stockholders owning or holding 1 percent or more of the total amount of stock. If not owned by a corporation, give the names and addresses of the individual owners. If owned by a partnership or other unincorporated firm, give its name and address as well as those of each individual owner. If the publication is published by a nonprofit organization, give its name and address.)

Full Name Complete Mailing Address

6957

488

Free or Nominal Rate In-County Copies Included on PS Form 3541

f. Total Distribution (Sum of 15c and 15e)

Kevin M. McFatridge, 120 West Saginaw Street, East Lansing, MI 48823

7554

Free or Nominal Rate Outside-County Copies included on PS Form 3541

Managing Editor (Name and complete mailing address)

Gunjan B. Malhotra, MD – None

7538

8042

c. Total Paid Distribution [Sum of 15b (1), (2), (3), and (4)] d. Free or (1) Nominal Rate Distribution (2) (By Mail and Outside (3) the Mail)

Eric L. Larson, MD – None

Date

8/4/2021

I certify that all information furnished on this form is true and complete. I understand that anyone who furnishes false or misleading information on this form or who omits material or information requested on the form may be subject to criminal sanctions (including fines and imprisonment) and/or civil sanctions (including civil penalties).

Thomas J. Veverka, MD – None David T. Walsworth, MD – Blue Care Network, Medical Leadership Institute John A. Waters, MD – None Mildred J. Willy, MD – None Phillip G. Wise, MD – None

19

ADVOCACY CORNER

Q & A with House Health Policy Committee Chair Bronna Kahle

By Michigan State Medical Society

State Rep. Bronna Kahle was first elected in November 2016 to the Michigan House to represent the 57th District, which includes most of Lenawee County. She holds a Bachelor’s Degree in Business Administration and an MBA from Baker College. Kahle owned a small business, which provided home care for seniors and vulnerable members of the community.

Recently, she served as Director of the Adrian Senior Center.

In addition to her professional work, Rep. Kahle ‘s community involvement includes the Lenawee Walk to End Alzheimer’s Committee, Adrian Symphony Orchestra, Adrian Chamber of Commerce, Habitat for Humanity’s Neighborhood Revitalization Initiative, and more.

Following are a few of the questions we asked State Rep. Kahle, along with her answers:

20 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

What originally inspired you to run for office?

What’s a typical session day like for you?

The decision to run for office was born out of my desire to see the people in my community and state grow and thrive. As a community, we care deeply about our families and neighbors. Listening to concerns, lifting up the vulnerable and working to support a healthy economy where small businesses, job providers, and workers are free to grow and succeed are priorities for me. I know we can advance solutions that provide opportunities for a brighter future for everyone.

Session days are typically very busy.

Aside from the full Michigan House meeting for session on those days, there are typically back-to-back meetings with stakeholders and interest groups on various issues, as well as meetings with constituents who may have traveled up from the district. In addition, there are committee hearings and caucus meetings to attend. I also make time to meet with my staff so we can discuss issues of concern in my district.

You’re halfway through your third term. What’s something you wish you had known as a freshman?

When I was first elected in 2016, people told me the months and years serving in office would go very quickly and they were right! As a freshman, I wish I had realized just how very quickly it would pass. Thankfully, I was blessed to receive good advice from many excellent mentors early on, which I took to heart and tried to apply quickly. While there was variation in the advice I was given, one theme remained consistent: build relationships. Build relationships with your colleagues on BOTH sides of the aisle; build relationships with stakeholders and association members; build relationships with advocacy groups, professionals and leaders; build relationships with the people in your district; and build relationships with staff. In my opinion, one of the biggest challenges as a legislator is prioritizing time and finding enough hours in each day to develop and invest in these professional relationships. Not only do thriving relationships make one’s work life richer, they are also an integral part of growth, learning, and—in the case of public policy— developing and advancing solutions to make life better for the people of Michigan.

Bronna Kahle (R) Represents Michigan House District 57 which includes Adrian, MI and most of Lenawee County

Adrian, MI

What is something that has surprised you as a legislator/ committee chair?

What kind of background preparation goes into each Committee Hearing?

I was pleasantly surprised to find out early on in my first term how most legislation is passed in a bi-partisan manner. It has been amazing to see both parties collaborate effectively to put the people of Michigan first. I came into office with the goal of working with my colleagues on both sides of the aisle and I feel confident that I will be able to continue doing that.

I believe in advancing solutions and solving problems that genuinely help people and I hope my role as Chair of the House Health Policy Committee is helping to advance that goal.

Each Health Policy Committee hearing requires quite a bit of preparation.

Before a bill is even placed on the agenda, I want to make sure it’s good public policy. I work with my staff and policy staff to determine if there is anything the committee can do to make the bill better. I work with the stakeholders and community members that would be directly affected if the legislation were to pass. Typically, I am approached proactively by groups that both support and oppose a bill, or I’ll reach out to them to get feedback. This helps tremendously in my preparation.

“While there was variation in the advice I was given, one theme remained consistent: build relationships.

Not only do thriving relationships make one’s work life richer, they are also an integral part of growth, learning, and— in the case of public policy—developing and advancing solutions to make life better for the people of Michigan.”

SEPTEMBER / OCTOBER 2021 |

michigan MEDICINE® 21

“Access to health care—even for those with insurance— remains a problem in rural Michigan. Those residing in a rural area may not have access to health care services in close proximity.

This is where I believe the use of telemedicine could be one answer. ”

How do you work with the many interest groups and stakeholders to make sure you’re crafting the best policies for Michigan?

When you work with so many different interest groups and stakeholders on a regular basis, open communication is key. I want to hear from everyone on the issues we’re working on because that truly is the only way to make sure we’re doing what’s best for Michigan citizens.

What areas do you think we need to work on to protect Michigan patients?

Our priorities regarding health care should include expanding telehealth services, improving access to mental health services and lowering the cost of prescription drugs. We need to address workforce shortages in the health care industry, access to care in rural communities and access to affordable quality care.

In addition, we need to fix our broken behavioral health system in Michigan and work to reduce prescription and health care costs for Michiganders.

We’ve passed legislation like surprise billing and telehealth expansion, but there is still more to be done. We are working to bring greater transparency to the health care system.

22 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

What do you see as the biggest issues facing health care in Michigan today?

Aside from the COVID-19 pandemic, access to health care is a major concern for so many people in our state. A 2015 study by the Citizens Research Council of Michigan found four rural counties in Michigan – Cass, Keweenaw, Lake and Oscoda – consistently fell below recommended ratios of primary care physicians to population. Seven other rural counties fell below suggested ratios in every field it examined except family practice.

Access to health care – even for those with insurance - remains a problem in rural Michigan. This is where I believe the use of telemedicine could be one answer. We know that there are several benefits associated with the use of telemedicine. Those benefits include convenience, cost-efficiency, and ability to reduce emergency room waiting times.

Further, those residing in a rural area may not have access to health care services in close proximity. I believe telemedicine can deliver better health care services to those who may not be able to get to a physician’s office or hospital easily.

The Center for Health Workforce Studies of the Association of American Medical Colleges projects a shortage in Michigan of 4,400 doctors - including both primary care doctors and

specialists - by 2020. That is something we should be focused on – attracting and retaining quality physicians to care for our citizens.

What do you expect to look at in the remainder of the year?

The House Health Policy Committee will continue working hard on several important issues in the second half of 2021. Ensuring there is adequate behavioral and mental healthcare available for everyone to meet the growing need across our state is a top priority, including improving availability of quality early interventions and access to mild-to-moderate care, inpatient care, and effective substance abuse treatment. There is a behavioral health House bill package that the committee will continue to review. A bipartisan Certificate of Need (CON) transparency package was introduced in June and we plan to hold hearings on the bills in the fall.

Greater transparency in our CON program will help ensure Michiganders have high-quality, accessible, affordable health care in the future. Both the Senate and the House have introduced legislation to address prior authorization in Michigan and the committee will likely begin to hold hearings on that important issue.

“The House Health Policy Committee has had a busy start to the 2021-2022 term with many robust hearings and the passage of significant legislation and I expect that to continue for the remainder of the year.”

“Our priorities regarding health care should include expanding telehealth services, improving access to mental health services and lowering the cost of prescription drugs. We need to address workforce shortages in the health care industry... and access to affordable quality care.”

What do you see as the role of physicians in helping to shape health care policy?

Physicians are integral to Michigan’s health care system and keeping Michiganders healthy. As a policymaker, hearing their voices, listening to their concerns, and learning from their experience is of utmost importance. Physicians play a key role in

helping legislators better understand their perspective regarding critical issues such as barriers to care, burdensome/duplicative regulations, and creating an environment that will attract more physicians to underserved areas across Michigan.

The voice of professionals within the health care system is vital in helping to shape good health care policy in

How can physicians more effectively communicate with you and your fellow lawmakers?

I encourage physicians to continue reaching out to their local state representatives and senators. Sharing their concerns about legislation moving through the process or even providing ideas and suggestions for legislative solutions is always welcome. It is also helpful to hear personal experiences and how legislation would impact a physician’s ability to treat their patients. The best and most impactful legislation comes from experts in their profession.

our state.

Driven by results.

As counsel to the MSMS community for over 70 years, we know how to help physicians.

DETROIT

|

T R OY

kerr-russell.com

SEPTEMBER / OCTOBER 2021 |

michigan MEDICINE® 23

Deferred, Delayed, Disrupted: Mitigating Risks From Care During COVID-19 Richard E. Anderson, MD, FACP, Chairman and Chief Executive Officer, The Doctors Company and TDC Group

24 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

Contributed by The Doctors Company

thedoctors.com

The pandemic thoroughly disrupted healthcare delivery across the spectrum of healthcare.

B

y mid-2020, more than 40 percent of U.S. adults had delayed medical care or avoided it entirely, including care for urgent and emergent complaints. Nearly a third of American children missed or delayed care in 2020. While many of these missed appointments will not have specific adverse outcomes, modeling predicts more than 10,000 excess deaths over the next decade from breast and colorectal cancers alone directly attributable to care delayed or missed during the pandemic. Estimates of the actual vs. expected total mortality rate in 2020 suggest hundreds of thousands of excess deaths beyond the documented toll of COVID-19 alone.

>40% of U.S. adults delayed medical care or avoided it entirely, including care for urgent and emergent complaints, by mid-2020.

Risks of Litigation We know most claims are based on poor outcomes, rather than poor care.

Remaining to be answered is the question whether there be a surge in claims for delayed or missed diagnoses related to the pandemic?

by a healthcare provider. Clinicians should identify and attempt to contact such patients. Examples include patients who communicated with the practice about things like breast lumps, rectal bleeding, or chest pain, who would be acutely aware of time passing while not seeing their physician.

We ask these questions just as many of the medical liability protections passed by the majority of states during the pandemic are expiring. New York has already allowed its protections to lapse. Further, it is possible that many plaintiffs’ attorneys are waiting to file patients’ claims in hopes that medicine’s well-earned halo—the positive light shining on the medical profession because of heroic actions during the pandemic—will fade.

Now, clinicians have the opportunity to identify patients whose conditions merit priority contact. Explicitly recommending that those without medical contraindications get vaccinated not only helps slow the spread of COVID19, but may also stop a patient from claiming that they remained unvaccinated for lack of counsel from their physician. Invite patients who have questions about vaccines to communicate their concerns.

Mitigating Risks From Deferred, Delayed, and Disrupted Care

Since risks exist even if patients did not present for care, documenting the practice’s efforts to reach patients who have delayed care will reduce the likelihood of a malpractice claim.

Situations most likely to lead to litigation are those in which patients themselves are acutely aware of delays. In such cases, liability risks exist even if care was available, but the patient felt too worried about COVID-19 to be seen

It’s not yet clear whether there will be a surge in claims related to COVID-19, but clinicians will be well served by remaining mindful of the new liability risks created by deferred, delayed, or disrupted care.

SEPTEMBER / OCTOBER 2021 |

michigan MEDICINE® 25

NEW & REINSTATED MEMBERS BARRY COUNTY

SHIAWASSEE COUNTY

Nicole Horning, MD

Robert Carlson, MD

Salwa Mohamedahmed, MD

Hema Iyer, MD Pallavi Jasti, MD

GENESEE COUNTY

WASHTENAW COUNTY

Naveen Kachroo, MD

Abhijeet Ghatol, MD

Juan Luis Marquez, MD, MPH

Jamal Khattak, MD

Eric Greenberg, MD

Mary Kneiser, MD

Peter Sabbagh, MD

WAYNE COUNTY

Joseph Varghese, MD, FCCP

Damali Adu, MD

Robert Levine, MD, MHSA

John Youssef, MD

Mohammad Alhyari, MD

Michael Maceroni, DO

Lourdes Andaya, MD

KENT COUNTY

Rosamma Mathew, MD

Shobana Athimulam, MD

Katherine McGough, DO

Claudell Cox, MD

Bianca Barbat, MD

David Melville, MD

Ryan Barish, MD

Jacqueline Metz, DO

Andrew Baron, MD

Naomi Cook, MD

Glenn Minster, MD

Ravinder Boorgula, MD

Richard Hennig, DO

Daniel Olenchak, DO

Michael Callan, DO

Shabnam Pakneshan, MD

Claudia Cao, MD

Sujal Panchal, MD

Lance Chaldecott, MD

Andi Peshkepija, MD

Jennifer Cirino, MD

Henri Pierre-Jacques, MD

Michael Connor, MD

Natasha Prince, MD

Paul Corcoran, MD

Shazia Qamar, MD

Jennifer Cox, DO

Meaghan Roche, MD

Dennis Cunningham, MD, MHA

Naeem Sattar, MD

Mustapha Daouadi, MD

Theresa Schwartz, MD

Nishedh Davé, DO

Rebecca Simon, DO

Alexandra DePorre, MD

Ryann Sohaney, DO

OAKLAND COUNTY

Faryal Durrani, MD

Zakiya Stallings, DO

Paul Croissant, MD

Amy Eapen, MD

Stephen Steffes, DO

Timothy Dickson, MD

Mousab Eteer, MD

Johar Syed, MD

David Ellenberg, MD

Robert Federman, MD

Maria Thies, DO

Avery Mendelson

Kelita Fox, MD

Alanna Van Hooser, MD

Asha Shajahan, MD

Belinda Gavino, MD

Andrew Vargas, MD

William Thompson, DDS, MD

Kamel Ghaben, MD

Tobias Walbert, MD

Shoshana Gordon, DO

SAGINAW COUNTY

Kenneth Warner, MD

Sarah Habbal, MD

Jessica Was, MD

Jacquelyn Charbel, DO, FACOS, FACS

Keiko Hendrick (Ostlund), MD

Jian Xu, MD

Liaqat Zaman, MD

Rachel Hooper, MD

LIVINGSTON COUNTY

MACOMB COUNTY Allison Engel, MD Paavan Railan, MD

MONROE COUNTY Ashwin Shah, MD

MUSKEGON COUNTY Kristen Woods, MD

Jayme Laurencelle, MD

Thank you for your ongoing support of organized medicine in Michigan.

JULY / AUGUST 2021 | michigan MEDICINE® 27

MSMS ON-DEMAND WEBINARS The MSMS Foundation has a library of on-demand webinars available, many of which are free, making it easy for physicians to participate at their convenience to meet their educational needs.

Webinars that Meet Board of Medicine Requirements:

A Day of Board of Medicine Renewal Requirements Human Trafficking Medical Ethics – Conscientious Objection among Physicians Medical Ethics – Confidentiality: An Ethical Review Medical Ethics – Decision Making Capability Medical Ethics – Eliminating Disparities in Health Care What Can You Do? Medical Ethics – Just Caring: Physicians and Non-Adherent Patients Medical Ethics – Racial Disparities in Maternal Morbidity and Mortality: A Persisting Crisis Medical Ethics – Reclaiming the Borders of Medicine: Futility, Non-Beneficial Treatment, and Physician Autonomy Pain and Symptom Management Series

28 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

Balancing Pain Treatment and Legal Responsibilities MAPS Update and Opportunities Michigan Automated Prescription System (MAPS) Update Naloxone Prescribing Pain and Symptom Management 2020 Prescribing Legislation Tapering Off Opioids The CDC Guidelines 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

COVID-19 Webinars:

OTHER WEBINARS:

2020 Fall Symposium on COVID-19 Day One

24th Annual Conference on Bioethics

2020 Fall Symposium on COVID-19 Day Two

Coding Update for 2021

24th Annual Conference on Bioethics

Evaluation Management Updates for 2021

AMA Advocacy and Physician Resources

Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities

Best Practices for Implementation of Telemedicine CARES Act Impact

HEDIS Best Practices In Search of Joy in Practice: Innovations in Patient Centered Care

CARES Act Impact: Q&A with CPAs CARES Act Impact: Q&A with CPAs Part 2 Leading Through Crises: Financial Guidance and Strategies Medical Practices and Employment/ HR FAQs New Employment Policies for Practices

Integrating Pharmacists into Practice: The Missing Link for Comprehensive Medication Therapy Management Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage

Race Inequalities and COVID-19: Contagion, Severity, and Social Systems

Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media

Safe and Innovative Office Procedures for Seeing Patients

Medical Marijuana Law

Telemedicine and Other Technology Codes in a COVID-19 Environment

Medical Necessity Tips on Documentation to Prove it

Testing, Tracing and Tracking

Non-Pharmacologic Management of Musculoskeletal Pain Syndromes

New Waivers and Billing Changes for Telemedicine

The Changing Health Care Landscape: Preventing Diabetes During and Beyond the Pandemic What Physicians Need to Know as Employers During the COVID-19 Pandemic

Section 1557: Anti-Discrimination Obligations Sexual Misconduct – Prevention and Reporting

Grand Rounds Webinar Series:

Update on Chronic Fatigue Syndrome Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS

A Review of COVID-19 Variants Coronavirus Relief – Overview and Updates

Update on Chronic Fatigue Syndrome Part 2: Uniting Compassion, Attention and Innovation to treat ME/CFS

To register or to view full course details, visit: MSMS.org/OnDemandWebinars

Once registered, you will receive an email within 15 minutes with links to watch the on-demand webinar and to complete the survey evaluation.

Contact: Beth Elliott at 517/336-5789 or belliott@msms.org SEPTEMBER / OCTOBER 2021 |

michigan MEDICINE® 29

2021 CONFERENCE SCHEDULE

2021 Live Virtual Conference Schedule Grand Rounds Dates: September 8, October 13, November 10, and December 8, 2021 Time: 12:00 – 12:45 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

Monday Night Medicine Dates: September 7, October 4, and November 1, 2021 Time: 6:30 – 8:00 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

2021 Live In-Person Conference Schedule

A Day of Board of Medicine Renewal Requirements

A Day of Board of Medicine Renewal Requirements

Date: September 14, 2021

Date: November 12, 2021

Time: 8:00 am – 1:15 pm

Time: 9:00 am – 1:15 pm

Location: Virtual Conference

Location: Sheraton, Ann Arbor

Intended for: Physicians and all other health care professionals

Intended for: Physicians and all other health care professionals

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

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

Annual Scientific Meeting

24th Annual Conference on Bioethics

Virtual Conference Dates: September 15-16 and November 17-18, 2021

Date: November 13, 2021

In-Person Conference Dates: October 20-21,

Time: 8:45 am – 3:00 pm

In-Person Location: The Westin Southfield Detroit

Location: Sheraton, Ann Arbor

Intended for: Physicians and all other health care professionals

Intended for: Physicians and all other health care professionals

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

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

For more information or to register, visit MSMS.org/EO or contact Beth Elliott: email belliott@msms.org or call 517/336-5789

30 michigan MEDICINE®

| SEPTEMBER / OCTOBER 2021

­

( ) ­ | @

Working continuously to balance the

SCALES OF JUSTICE. We’re taking the mal out of malpractice insurance.

As a relentless champion for the practice of good medicine, we continually track, review, and influence federal and state bills on your behalf. All for one reason: when you can tip the scales in favor of the practice of good medicine, you get malpractice insurance without the mal. Find out more at thedoctors.com

Endorsed by