SCMS BULLETIN - November 2018

The

Bulletin Saginaw County Medical Society

November 2018 | Volume 77 | No 3

15th Annual Jingle Mingle Benefits BSSR&RN Suicide Programs – Free Admission to Shop! p. 5 Federal Advocacy is Yet Another Benefit MSMS/SCMS Provides to its Members p. 26 www.SaginawCountyMS.com

WARNING SIGNS OF

STROKE

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.

Sudden trouble walking, dizziness, loss of balance or coordination.

Sudden, severe headache with no known cause.

Sudden trouble seeing in one or both eyes.

Sudden confusion, trouble speaking or understanding.

For more information go to www.covenanthealthcare.com

Every minute counts CALL 911

Do not wait for the symptoms to go away.

Š2018 Covenant HealthCare. All rights reserved. PK 5/18 10834

The

Bulletin Saginaw County Medical Society

SAGINAW COUNTY MEDICAL SOCIETY 2018-2019 OFFICERS AND DIRECTORS

President Julia M. Walter, MD President-Elect Zubeda S. Khan, MD Past President Virginia R. Dedicatoria, MD

contents 5

12

15th Annual Jingle Mingle Benefits Barb Smith SR&RN Suicide Programs No cost to stop in and shop!

10 10

Secretary Caroline G.M. Scott, MD

Call for Resolutions: Who Sets MSMS Policy? You Do!

Save the Dates – 2019 Membership Meetings

16-17 18

October Membership Meeting Maintenance of Certification Contact Rep. Vaupel NOW!

A Guide to 2019 Physician License Renewal Requirements

Treasurer Mohammad Yahya Khan, MD Board of Directors

4

President’s Letter

Anthony M. Zacharek, MD

6

From the Editor

Jorge M. Plasencia, MD

7

Mildred S. Willy, MD

22

Extortion Scam Targeting DEA Registrants

Kala K. Ramasamy, MD

7

Medical Missions Articles Needed

Bulletin Editor Louis L. Constan, MD

8

Covenant HealthCare

Retiree Representative Rustico B. Ortiz, MD

11

Tiffany K. Kim, MD Mark G. Greenwell, MD

Resident Representative Mary J. McKuen, MD MSMS Delegates

Key Provider of the Month – HealthSource Saginaw

13

Applications for Membership

Zubeda S. Khan, MD

14

Ascension St. Mary’s Hospital

Julia M. Walter, MD

19

Elvira M. Dawis, MD

Virginia R. Dedicatoria, MD

Barb Smith Suicide Resource & Response Network

20

Children’s Grief Center

Jorge M. Plasencia, MD

20

Attention Retired Members!

Christopher J. Allen, MD

21 AMA

Mildred J. Willy, MD Anthony M. Zacharek, MD

MSMS Alternate Delegates Caroline G.M. Scott, MD Waheed Akbar, MD Mohammad Yahya Khan, MD Danielle C. Duncan, MD Steven J. Vance, MD Amandeep S. Dhaliwal, MD Miriam T. Schteingart, MD Peer Review Ethics Committee Waheed Akbar, MD, Chair Caroline G.M. Scott, MD James R. Hines, MD MSMS District 8 Director Thomas J. Veverka, MD EXECUTIVE DIRECTOR Joan M. Cramer ADMINISTRATIVE ASSISTANT Keri Benkert

23 24

Caduceus Meeting for Recovering Health Care Professionals December Birthdays CMU College of Medicine | CMU Health

26 MSMS 28

Save the Date! 15th Annual Health Fair “The Doctor Is In!”

29

Second Victim Resources Available

30

Advertiser Index

31

SCMS Foundation – Make a Tax Deductible* Gift Today

32

2018-19 Key Providers

32

Calendar of Events

The Bulletin can be viewed online at www.SaginawCountyMS.com under the Bulletin tab.

ON THE COVER: (l-r) Drs. Chris Allen, Julia Walter, Tiffany Kim, Ryan Kim and Mary McKuen EDITOR Louis L. Constan, MD

PUBLISHER Saginaw County Medical Society

EXECUTIVE DIRECTOR Joan M. Cramer

350 St. Andrews Rd., Suite 242, Saginaw, Michigan 48638-5988. Hours: Tuesday, Wednesday, Thursday 8:30 AM - 3:30 PM. Web: SaginawCountyMS.com

DESIGNER Lori Krygier

Telephone: (989) 790-3590. Fax: (989) 790-3640 E-Mail: jmcramer@sbcglobal.net

All statements or comments in the Bulletin are those of the writers, and not necessarily the opinion of the Saginaw County Medical Society. Contributions are welcome. We publish committee reports, letters to the editor, Alliance reports, public health activities of the members, and some personal items (birthdays, weddings, graduations and like events).

The Editor determines which are accepted. Advertisements are accepted as space is available at our going rates. Members may advertise office information, professional services, skills, and procedures, also at our going rates. We do not accept advertisements from nonmembers, or non-Saginaw hospitals.

The Bulletin is mailed free of charge to SCMS members as part of their membership.

Complimentary copies are sent to various other parties. Others may subscribe at the rate of $50 per year.

The Bulletin | November 2018 3

PRESIDENT’S LETTER

Marijuana Use During Pregnancy

By Julia M. Walter, MD

B

y the time this column is published, it is possible the ballot measure to legalize marijuana will have passed.

That would make Michigan the 10th state in the union to legalize recreational marijuana. It continues to remain illegal under federal law.

Things to know about this legislation: • Must be 21 or older to possess, use and grow certain amounts; • Impose 10 percent excise tax at the retail level, and six percent sales tax; • Split revenues: 35% to education 35% to roads 15% to communities that allow marijuana businesses 15% to counties where marijuana businesses are located; • Local governments or electors will decide whether to limit or ban marijuana businesses; • Restrict purchases to 2.5 oz., but can keep up to 10 oz.; and • Cultivate up to 12 plants for personal use.

Benefits of legalized marijuana from a Washington state resident: • Increased state revenue; • Created jobs; • Cleared court system for more serious crime; • Made marijuana purchase safe;

• Decreased flow of money to drug gangs; and • Made purchase for minors more difficult.

As an obstetrician, I have many concerns the legalization of recreational marijuana will send a message that it is safe to use in pregnancy. That is not, however, what the literature suggests.

Studies indicate the self-reported prevalence of marijuana use in pregnancy is up to 28 percent, and higher to include those with no prenatal care. Many believe that marijuana is safer than tobacco, alcohol or other substances. Since medical marijuana is used for the nausea of chemotherapy in cancer treatment, many equate using marijuana for the nausea of pregnancy, hyperemesis gravidarum and beyond.

THC, an active ingredient in marijuana, is highly lipophilic and is distributed quickly to the brain and fat with a half-life of four to five days in heavy users. THC crosses the placenta.

Fetal plasma levels are 10 percent maternal levels after acute exposure and significantly higher after repeat exposure.

Studies have shown that in utero exposure may disrupt normal brain development and function. Children who have been exposed in utero had lower scores on tests of visual problem solving, visual motor coordination

and visual analysis. There is also an association with in utero exposure to decreased attention span and behavioral problems. There is also evidence of increased risks of birth weights less than 2500gm.

The evidence does not suggest an increased risk of premature delivery, fetal anatomic anomalies or increased risk of perinatal mortality.

There is insufficient data to evaluate the effects of marijuana use on infants during lactation and breastfeeding.

The use of marijuana in breastfeeding mothers is discouraged: Marijuana has known adverse impacts on adolescents: • Marijuana in now the number one reason kids enter treatment for substance abuse; • The human brain does not reach maturity until age 25 and it is in adolescence that the brain lays down the neurological platform for a person’s future life; • Addiction; • A lowered IQ compared with nonusers; and • Psychosis in some children/ adolescents.

Further research is needed on the long and short term effects of marijuana. For now, we need to educate what we do know about the effects of marijuana in pregnancy and on our youth.

THC crosses the placenta.

Fetal plasma levels are 10 percent maternal levels after acute exposure and significantly higher after repeat exposure.

4

The Bulletin | November 2018

The Saginaw County Medical Society Alliance Presents:

15th Annual “Jingle Mingle”

Purchase Some of the Area’s Most Unique Gifts

N STOP I O T T S NO CO HOP! AND S ble but la is avai h c n u L ations v r e s e r nt are e m y a ep and pr uired. req

Monday, December 3, 2018 Saginaw Country Club 4465 Gratiot Road, Saginaw 10:30 a.m. to 2:30 p.m.

Lunch | Unique Shopping | Christmas Piano Music | Specialty Drink | Mingling with Friends!

No charge to stop by and shop, but if you plan to stay for lunch, a reservation and payment must be received by November 26. Extra lunches will not be available the day of the event. n Please make a reservation for _____ people at $40 per person (Only RSVP’s will be included in the prize drawings!)

Names of those attending

n I/we would like to sponsor a table in the amount of $50* (name listed below) *Note: Table sponsorship does NOT include a ticket to the event

Name of table sponsor

Total Enclosed: $_________

All proceeds benefit

Please return this form with your check made payable to the SCMS Alliance no later than Monday, November 26, 2018, to: SCMS Alliance • 350 St. Andrews Road • Suite 242 Saginaw, MI 48638-5988 Questions? Contact Keri Benkert at (989) 790-3590 or keri.benkert@sbcglobal.net The Bulletin | November 2018 5

FROM THE EDITOR

We’re Only Human

By Louis L. Constan, MD

I

love my new car. It’s big and shiny.

It talks to me in a soothing voice.

It has lots of bells and whistles. It nudges me when I’m about to do something stupid like change lanes into another car. It has a fancy entertainment system and navigation system that I like to play with. I feel good when I get in my car. I feel safe when I drive around in my car. Lately though, I feel that some of this is an illusion. The fancy electronics may actually distract me from my main job while driving which is to keep my eyes on the road, thereby making me less safe.

We’ve been discussing Choosing Wisely® , an international program supported by virtually all the specialty societies, basically pleading with their members to stop doing certain tests, procedures, and treatments because they are too costly, unnecessary or harmful. So far, so good. The problem is, that after six years, their 600 or so suggestions are not catching on like they should. The question for today is: “Why not?” There have been many research articles, editorials, and exposés devoted to the question of why doctors have such a difficult time changing their practice when presented with evidence that

their practice patterns need to change.

Let’s imagine a typical doctor trying to explain this to his counsellor. It would go something like this: The first Choosing Wisely® issue: Overuse of antibiotics Psychologist: No fewer than six specialty societies have warned against using antibiotics for ear infections, pinkeye, sinusitis, sore throats and bronchitis. They don’t work, and they cause harm. Yet, you still commonly ignore these recommendations. Why do you think that is? This session is confidential. You can be totally honest with me.

Doctor/patient: I can give you several reasons, doc: “I’ve always done it this way” and “Everybody else does it” come to mind. But to be really honest, I usually do it because I think that the patient expects it and if I don’t do it, I’ll have to explain why not, and that might be difficult and time-consuming and who knows if it will satisfy the patient. I want patients to like me, to listen to me and to respect me, and I’m not sure they will if I don’t give them what they expect. Is that wrong of me, doc?

Psychologist: You need to stop putting so much pressure on yourself.

You’re not going to satisfy everyone.

You first need to satisfy yourself by doing what you know is right. It’s OK to fear alienating patients; by the way, you’re only human.

The second Choosing Wisely® issue: Overuse of imaging in head injuries Psychologist: Three specialty societies have decried the overuse of CTs and MRIs in uncomplicated (no neurological signs or symptoms) concussions. They point out the enormous cost, and the very real risk of excessive radiation exposure. There is concern that some children are getting downright dangerous radiation doses after multiple ER visits over a year.

This is scary. Like the car illustration above, too much technology can be harmful. Yet, I see that you still order neuroimaging for minor head injuries on a regular basis. Why do you think that is? This session is confidential. You can be brutally honest with me.

Doctor/Patient: In my defense, a concussion, even a mild, uncomplicated one, is a frightening situation. The patient has lost consciousness, if even for a few seconds. People worry about stroke or brain damage. They panic. continued on page 7

There have been many research articles, editorials, and exposés devoted to the question of why doctors have such a difficult time changing their practice when presented with evidence that their practice patterns Louis L. Constan, MD

6

The Bulletin | November 2018

need to change.

Extortion Scam Targeting DEA Registrants

continued from page 6

They inevitably remember the billboard ad about the new MRI or CT scanner in town and they want it. My very thorough neurological history and exam, which according to the guidelines is enough to obviate the need for a scan, means nothing to the patient. To them, technology is everything.

We live in a technology-driven age. People always want the newest and the best. So our hospital spends the money to buy it…and of course, they are going to advertise it so that it will be used and they can recoup their expense. Then the advertising stimulates unrealistic demands. Call it the technological imperative, or the tyranny of technology. I’m caught in the middle. I can’t do what I really want to do; that is, follow the guidelines. So I just order the test. I feel bad, but I feel I have no choice.

Psychologist: I see your conundrum. But you can’t go on day after day ignoring the fundamental tenant of your profession: “First, do no harm.” You will make yourself sick, physically and psychologically. You must find a way of educating patients about the advice given by the leaders of your profession and written up in the Choosing Wisely® guidelines. Perhaps these guidelines ought to be taped to the CT scanner or even literally handed out to the patients to read for themselves. What do you think about that suggestion? By the way, it’s OK to be frustrated. It’s a difficult situation, and you’re only human.

Well, that was easy, wasn’t it, and only 598 Choosing Wisely® recommendations to go. Kidding. I’m only planning on covering two more next month, but those are big ones.

Prepare for some fireworks.

1

American Academy of Family Physicians, American Academy of Ophthalmology, American Academy of Pediatrics, Infectious Disease Society of America, American Society of Otolaryngology and American Academy of Allergy

2

American Academy of Pediatrics, American College of Emergency Physicians and American College of Radiology

The Drug Enforcement Administration (DEA) Diversion Control Division is aware that registrants are continuing to receive telephone calls and emails by criminals identifying themselves as DEA employees or other law enforcement personnel. The issue was first brought to our attention in the spring, and in April, we notified physicians of the scam which unfortunately continues. The criminals have masked their telephone number on caller ID by showing the DEA Registration Support 800 number. Please be aware that a DEA employee would not contact a registrant and demand money or threaten to suspend a registrant’s DEA registration.

If you are contacted by a person purporting to work for DEA and seeking money or threatening to suspend your DEA registration, submit the information through “Extortion Scam Online Reporting” posted on the DEA Diversion Control Division’s website, www.DEADiversion.usdoj.gov .

EXTORTION SCAM ONLINE REPORTING For more information contact: Detroit Division Office | 431 Howard Street | Detroit, MI 48226 Phone: (313) 234-4187 | (313) 234-4028 | (313) 234-4202 Fax: (313) 234-4017 | (313) 234-4057 Registration Service Center: 1-800-882-9539 Email: DETROIT.DIVERSION.REGISTRATION@USDOJ.GOV Email: DEA.Registration.Help@usdoj.gov

MEDICAL MISSIONS ARTICLES NEEDED

The SCMS will again feature the Medical Missions of our members (physicians, residents and medical students) in the December 2018 Bulletin. If you or someone you know of has participated in a medical mission (at home or abroad) within the last year or so, please contact Joan Cramer at jmcramer@sbcglobal.net. We are looking for articles of approximately 400-800 words in length (submitted in Word format) along with photos (submitted individually as JPEGs) to publish for each Medical Mission article.

The deadline for submission is Tuesday, November 20, 2018, to jmcramer@sbcglobal.net.

Depending on the number of articles received, we may need to publish some of the articles in future issues of the Bulletin.

The Bulletin | November 2018 7

Covenant Center for Autism Moves Into Renovated Space

The Covenant Center for Autism has moved into a newly renovated space and recently offered the public a chance to visit the Center at 2919 E. Wilder Road in Bay City. Visitors met the team and saw the new 3,900 square foot facility, which includes a combination of private treatment areas, as well as, space for group activities. This, along with state-of-the-art technologies and an enhanced playground, make for an ideal space for patients to receive the necessary care.

“The Center has been serving the community for five years, and yet many people don’t know the scope of services we offer, or they are afraid to ask to be referred,” says Angie Dinninger, Covenant HealthCare Physical Medicine & Rehabilitation Manager. “Not only do we offer a Diagnostic Center to provide the diagnosis of Autism where appropriate, we also offer a Treatment Center for children ages 18 months to seven years to have one-on-one Applied Behavior Analysis therapy for 20-40 hours per week. It supports early intervention before children head off to school, and is individualized based on each child’s needs.”

The Covenant Center for Autism previously occupied different space within the same building. The Wilder Road facility offers other healthcare services including Physical Medicine & Rehabilitation Services, laboratory services, walk-in X-Ray services, Occupational Health, MedExpress urgent care, and physician office space.

Covenant HealthCare is proud to be approved to offer validated diagnostic screening and assessments to children displaying signs of an Autism Spectrum Disorder (ASD).

As a hospital with a foundation of compassion, Covenant HealthCare offers a place for families to find the answers, treatment and support.

The Covenant Center for Autism program consists of: • Board Certified Behavior Analysts • Licensed Psychologist • Pediatrician • Physical Medicine and Rehabilitation Team • Speech and Language Pathologist ASD often times makes it difficult for a child to communicate and relate to others. Symptoms typically appear before a child is three years old. Parents should look for the following signs of ASD: • A delay in learning to talk or not talking at all • Limited or no eye contact with people • Little or no pretend play • Not responding to their name at six months • Repetitive behaviors, unusual attachments to objects, and getting upset with routine changes If you are interested in getting your child into the Covenant Center for Autism or interested in more information, please call us at 989.671.5738 or visit www.covenanthealthcare.com/ autism.

Covenant “Back on Track” Program Supports Bariatric Patients Long Term Bariatric surgery is not a quick fix, but requires a long-term, lifetime commitment to proper diet and health management.

Fortunately, the Covenant HealthCare Bariatrics Program guides patients throughout the entire journey.

Libby Palmer, Covenant HealthCare Bariatric Program Administrator, emphasizes that bariatric surgery is a long-term commitment. “Patients have to commit to the lifestyle changes and be willing to make exercise a part of their life.” Patients will see their doctor several times during the first year to monitor their progress, and annually thereafter for the rest of their lives.

Monthly support groups are available for patients at any stage in the bariatric process, and Palmer encourages patients to consult the program any time they have questions or concerns. She says that many patients are embarrassed to admit they’ve gained weight back, or hit a plateau, and won’t consult their doctor. Palmer stresses, “We want them to come back. We need to see them, we want to help.” In fact, the program has a special “Back on Track” class for bariatric patients who have hit a plateau or regained some weight. The class meets once a week for four weeks to support those patients and get them losing again.

Palmer emphasizes the importance of follow-up. “Patients that follow up, that keep coming back, those are the ones that do really well.” continued on page 9

8

The Bulletin | November 2018

continued from page 8

If you or your patients have questions about the Covenant Bariatric Program, go to Covenant Bariatric and Metabolic Center or contact Libby Palmer at 989.583.4683 or lpalmer@chs-mi.com.

Veterans, Thank You for Your Service.

Covenant HealthCare is honored to once again recognize those employees, volunteers and physicians who not only work to care for our patients, but also have served honorably in the military.

On Monday, November 12, physicians who are veterans were invited for a brief recognition ceremony at 8 a.m. by the flagpole at Entrance A of the 700 Cooper building.

On behalf of Covenant HealthCare, thank you for your service.

diabetes Self Management Program

In the United States,

30.3 million

people are living with diabetes – 84 million are living with prediabetes.

Focusing our practice on the needs of our community, we provide the following services for both individuals and businesses: n Monthly Accounting n Tax Planning n Financial and Business Consulting Service n Payroll Service n Tax Preparation Service n Retirement Planning Contact us for a complimentary visit at 989-791-1040.

Three convenient locations to serve you in: Saginaw | Vassar | Frankenmuth

“Attention to detail since 1980.”

We are the region’s most experienced diabetes management team. Our program is certified by the American Association of Diabetes Educators (AADE) through the Michigan Department Health and Human Service (MDHHS). We are certified to provide education for patients of all ages and diabetes diagnoses, including pregnant women.

Put your trust in the region’s most experienced diabetes management team . . . your PatientCentered Medical Home partner.

We also have a Diabetes Prevention Program to help prevent or delay Type 2 diabetes.

To refer a patient or for more information call 989.583.5193

©2018 Covenant HealthCare. All rights reserved.PK 1/18 10448

The Bulletin | November 2018 9

SAVE THE DATES! Tuesday, January 15, 2019 | Membership Meeting Mark your calendar now for our Tuesday, January 15, 2019, Membership Meeting joint with the Saginaw County Dental Society and Genesee County Medical Society at Horizons Conference Center. The social with cash bar starts at 6:30 p.m., followed by dinner, meeting and program at 7 p.m.

Speaker: Henry Reyna, was a law enforcement officer in Saginaw County for 32 years until his retirement in 2015. Additionally, he was also an instructor at the police academy for over 20 years, teaching recruits and in-service officers in the areas of defensive tactics, edge weapon defense, hand guns and the use of rifles.

Henry owns a security consulting business - Secure Solution, Inc. - and has been providing his services to businesses, medical and dental offices. He is a certified Crime Prevention Specialist, and has participated in multiple advanced crime prevention training programs around the country.

Online reservations are now being accepted at https://www. surveymonkey.com/r/SurvivingActsofViolence11519

Tuesday, April 16, 2019 | Membership Meeting Mark your calendar now for our Tuesday, April 16, 2019, Membership Meeting at Horizons Conference Center. The social with cash bar starts at 6:30 p.m., followed by dinner, meeting and program at 7 p.m.

Topic: “TED Talks* - The Human Challenge of Healthcare” Speakers: To be determined *So what is a TED Talk? A TED Talk is about ideas. It is about real people making connections with other real people. These talks are concise, every word counts, lasting from 5-18 minutes.

Generally these talks are delivered without notes, from memory, conveying passion and possibilities.

A speaker need not be an educated professional. They can be illiterate. Their experience is what matters. The audience plays a role in that they need to encourage if they feel the speaker is nervous. As a speaker, be real and kind. This is an opportunity to promote great ideas by working together to open each other’s eyes.

The theme of the evening will be The Human Challenge of Healthcare. So bring excitement, energy and focus on your idea and its application to the lives of others.

To join the list of guest TED Talkers to be considered for the meeting, please contact Joan Cramer at jmcramer@sbcglobal. net with a brief synopsis of your proposed TED Talk. All ideas will be submitted to the SCMS Board for review and consideration to present at the April Membership Meeting.

Tuesday, May 21, 2019 | Membership Meeting Mark your calendar now for our Tuesday, May 19, 2019, Annual Membership Meeting at Horizons Conference Center. The social with cash bar starts at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Featured will be an update on CMU College of Medicine.

READY TO RENEW?

A Guide to 2019 Physician License Renewal Requirements

150 HOURS Physicians must complete 150 hours of Continuing Medical Education Credits during a three year period prior to requesting renewal. Of these 150 hours, a minimum of 75 must come from Category 1 Credits.

Category 1 Credits include live in person programs, as well as, web-based programs

3 HOURS

Pain and Symptom Management

Of the 150 hours, a minimum of three hours must be in the area of Pain and Symptom Management.

Examples Include: • Michigan Pain and Controlled Substance Laws • Opioid Management • Pain Definitions • Specific Pain Conditions • Ensuring Quality Pain Care • Public Health Burden of Pain • Michigan Programs and Resources Relevant to Pain

1 HOUR Medical Ethics

Of the 150 hours, a minimum of one hour must be in the area of Medical Ethics.

Human Trafficking Victim Identification Training A one-time training that is separate from contiuing education. Licensees renewing for 2019 must complete training by renewal in 2022. Beginning in 2021, a completion of the training is a requirement for initial licensure.

Need all three requirements?

MSMS: A Day of Board of Medicine Renewal Requirements When: Wednesday, December 5, 2018, from 9 a.m. to 2:45 p.m. For information and to register, please click HERE To reference the complete LARA renewal brochure, please click HERE

Behavioral Medicine | Medical Rehabilitation | Long-Term Care

NTH! gs.

O M E H eetin bership m DER OF T

OVI upport for SCMS mem he Bulletin.

KEY PerR s T s” provide featured in

“Key Provid nth, a Key Provider is Each mo

We are like no other hospital in the area. Our focus is recovery. We specialize in getting you back on your feet from surgery, debilitating illness or injury, chemical dependency or mental issues. Whether your rehabilitation journey is short or long, we’re at your side every step of the way.

3340 Hospital Road • Saginaw Township • www.healthsourcesaginaw.org The Bulletin | November 2018 11

Call for Resolutions: Who Sets MSMS Policy? You Do! The Michigan State Medical Society (MSMS) House of Delegates (HOD), comprised of 319 elected delegates, is the official legislative and policy-making body of MSMS and its component societies, including the Saginaw County Medical Society (SCMS).

Resolutions debated during the annual MSMS HOD are the vehicles by which MSMS policies, priorities and directives are determined. Deadline for resolutions is March 1 at 5 p.m.

Resolutions must be submitted via the online submission form. If you have any questions, contact Stacey Hettiger at (517) 336-5766.

The best way to get your idea or recommendation adopted as MSMS policy or directive is at the grassroots level. As a member in good standing of MSMS/SCMS, you have the right to bring your ideas to the annual HOD for consideration by MSMS’ "legislators." To do so, present your suggestion and rationale at the SCMS meeting. If the SCMS agrees, the SCMS will work with you to draft a resolution to be presented at the next HOD meeting. The resolution should specify the desired MSMS policy or directive for MSMS action. If the SCMS does not agree with your idea, you may ask another delegate to submit a resolution on your behalf as an individual delegate.

It is also prudent to check MSMS’ current Policy Manual and, if relevant, the AMA Policy Finder to determine if policy on the issue already exists.

ADVANCED DIAGNOSTIC IMAGING is proud to be part

of mid-Michigan’s well-established medical community. Our highlyexperienced, sub-specialized radiologists are the region’s trusted leaders for professional diagnostic and interventional services.

THE RIGHT TESTS…THE RIGHT READS…RIGHT AWAY!

• Digital Diagnostic X-Ray • ACR Accredited Ultrasound Service General / Vascular / Musculoskeletal • Specialty Vein Services VenaCure Laser® Treatment / Phlebectomy / Sclerotherapy • 24-Hour Report Turn-Around • Same Day Call Reports for Urgent Studies LOCATION:

3400 North Center Road, Suite 400 • Saginaw, MI 48603 LOCAL TEL: (989) 799-5600 HOURS: Monday–Thursday, 8 am to 5pm

12 The Bulletin | November 2018

APPLICATIONS FOR MEMBERSHIP Please contact Joan Cramer at jmcramer@sbcglobal.net or 790-3590 if you have any questions or would like more information on the applicants.

FIRST READING Below is an Application for Membership that may be recommended for acceptance at the Tuesday, January 15, 2019, Board Meeting.

Mark J. Hass, MD (Advanced Diagnostic Imaging, PC) Specialty: Radiology - Diagnostic (Board Certified 2006), Breast Imaging Medical School: Spartan Health Sciences University, St. Lucia, West Indies, 1999 Internship/Residency: Oakwood Hospital & Medical Center, Dearborn, MI, Diagnostic Radiology, 2000-05 Fellowship: University of Virginia Health System, Charlottesville, VA, Breast Imaging, 7/16-6/17 Prior Practice: (1) Grand Traverse Radiologists, PC, Traverse City, MI, 7/05-5/06; (2) Drs. Harris, Birkhill, Wang, Songe & Associates, Dearborn, MI, 7/06-03/09; (3) Radiology Muskegon, PC, Muskegon, MI, 03/09-06/16; and (4) Marshfield Clinic, Minocqua, WI, 8/17-9/18 Sponsors: Doctors Mark R. Ludka and Harvey K. Yee SECOND READING Below are Applications for Membership that may be recommended for acceptance at the Tuesday, November 20, 2018, Board Meeting.

Nicholas E. Haddad, MD (CMU Health – Internal Medicine) Specialty: Internal Medicine (Board Certified 2000) and Infectious Diseases (Board Certified 2002) Medical School: American University of Beirut, Beirut, Lebanon, 1996 Internship/Residency: Indiana University School of Medicine, Indianapolis, IN, Internal Medicine, 6/97-6/00 Fellowship: Washington University School of Medicine, St. Louis, MO, Infectious Diseases, 7/00-6/02 Other Practice: Aleda E. Lutz VA Medical Center, Saginaw, MI, 12/02 to present Sponsors: Doctors Sudha Nallani and Sajeeda Nusrat

Wynee S. Lou, DO (CMU Health – Primary Care) Specialty: Internal Medicine (Board Certified 2016) and Sports Medicine (Board Certified 2017) Medical School: West Virginia School of Osteopathic Medicine, Lewisburg, WV, 2013 Internship/Residency: Texas Tech University Health Sciences Center, Lubbock, TX, Internal Medicine, 2013-16 Fellowship: Texas Tech University Health Sciences Center, Sports Medicine, 2016-17 Prior Practice: EP Premier Medical Group, Attending Physician, Lubbock, TX, 8/17 to 7/18 Sponsors: Doctors Juliette M. Perzhinsky and S. Sethu K. Reddy Venkat Maganti, MD (Ascension St. Mary’s Heritage Family Physicians) Specialty: Family Medicine (Board Certified 2016) Medical School: St. Matthew’s University School of Medicine, Grand Cayman, Cayman Islands, 2012 Internship/Residency: Doctors’ Hospital of Michigan, Pontiac, Family Medicine, 7/13-6/16 Sponsors: Doctors Bapineedu Maganti and Raghu Sarvepalli Michael W. Warren, MD (Advanced Diagnostic Imaging, PC) Specialty: Radiology – Diagnostic (Board Certified 2018) and Radiology – Vascular and Interventional Medical School: Wayne State University School of Medicine, 2012 Internship: Detroit Medical Center/Wayne State University, General Surgery, 2012-13 Residency: St. John Providence Hospital and Medical Centers, MSU, Southfield, MI, Diagnostic Radiology, 2013-17 Fellowship: William Beaumont Hospital, Royal Oak, MI, Vascular and Interventional Radiology 2017-18 Military: Michigan Army National Guard, 2003-15 Sponsors: Doctors Scott E. Cheney and Kristin M. Nelsen

WELCOME BACK TO SAGINAW! Reactivated Member Vivek Variar, MD CMU Health - Internal Medicine 1000 Houghton, Saginaw, MI 48602 Office (989) 746-7500 Internal Medicine, Endocrinology, Diabetes & Metabolism The Bulletin | November 2018 13

St. Mary’s Officially Adopts Ascension Name Ascension Michigan’s statewide brand integration project concluded with the renaming of all St. Mary’s of Michigan and St. Joseph Health System hospitals with the Ascension name.

This rebranding creates a clear and consistent identity with the Ascension brand across the state.

The new naming structure leads with the Ascension brand name followed by the local legacy name.

Old St. Joseph Health System St. Mary’s of Michigan Medical Center St. Mary’s of Michigan Standish Hospital

New Ascension St. Joseph Hospital Ascension St. Mary’s Hospital Ascension Standish Hospital

In addition to the hospital names, all St. Mary’s and St. Joseph sites of care will be rebranded with the Ascension name. In the coming months, exterior and interior signage, and branded materials at hospitals and facilities will be updated with the Ascension name and logo.

“Having a unified national brand is a visible reminder for our patients and our communities of our founder’s visionary promise, lived out in present time by providing healthcare that works, healthcare that is safe, and healthcare that leaves no one behind,” said Dr. Stephanie Duggan, regional president, Ascension St. Mary’s, Ascension Standish and Ascension St. Joseph.

In September of 2016, Ascension Michigan announced the unification of the Ascension brand across Michigan.

Welcome New Neurosurgeon Ascension St. Mary’s welcomes neurosurgeon, Eric Bialaski DO, to their Neurosurgery team. He joins neurosurgeons E. Malcolm Field MD, Joseph Adel MD and Naman Salibi MD. Dr. Bialaski is fellowship trained in complex and reconstructive spine surgery and deformity surgery.

He earned his medical degree from West Virginia School of Osteopathic Medicine, and completed neurosurgery residencies at Garden City Hospital and Beaumont Hospital, both in Michigan. He recently completed his Fellowship at Northwestern University in complex and reconstructive spine surgery and deformity surgery.

Areas of expertise include: • Complex and reconstructive spinal surgery • Spinal deformities (such as scoliosis, kyphoscoliosis and spondylolisthesis) • Oncology spinal surgery • Minimally invasive spinal surgery • Microdiscectomy • Kyphoplasty Dr. Bialaski is accepting new patients. For more information or to refer a patient, call (855) 298-9888.

Ascension Medical Group Adds Business Development Director Alan Storm is the new Director of Business Development for the Ascension Medical Group (AMG), Mid-Michigan.

Alan has been in the healthcare industry for nearly 25 years, focusing on the development and implementation of an organization’s business strategies. This includes building provider relationships, as well as, establishing partnerships with the business community. Alan has promoted multiple outpatient service lines, with an emphasis on physician retention, recruitment and acquisition. In his role with AMG, Alan will be concentrating efforts on our strategic priorities related to physician recruitment, acquisition and retention while also supporting growth initiatives around key service lines. Alan is a graduate of Northwood University in Midland with both his undergraduate and MBA degrees. His primary office is based in Saginaw, and he can be reached at 989-9074149 or Alan.Storm@ascension.org.

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The Bulletin | November 2018

Remodeling or Building New - Start with Us!

Visit our blog for the latest medical office construction tips

Welcome New Physicians

Employed Medical Staff Expands Ascension St. Mary's continues to expand our care team and welcomes several new physicians to our employed medical staff.

• Neurosurgery Eric Bialaski, DO, specializes in complex and reconstructive spine surgery and spinal oncology surgery. He joins neurosurgeons E. Malcolm Field, MD, Joseph Adel, MD & Naman Salibi, MD. (855) 298-9888

Welcome

Eric Bialaski, DO Neurosurgery

• Primary Care Rachael Kasperowicz, MD, joins St. Mary's of Michigan Bay City Family Physicians (formerly Women's Health Center). (989) 671-9153

• Orthopedics Kevin Lawson, MD, brings years of experience in orthopedics with a special interest in laser spine surgery.

(989) 799-1350 • Podiatry Laura Reitz, DPM, specializes in foot and ankle surgery, wound care, hammertoes, tendon injuries and complex forefoot & rearfoot reconstruction. (989) 790-6719

• Hematology/Oncology Roma Srivastava, MD, joins medical oncologists Ernie Balcueva, MD and Asma Taj, MD to complement our comprehensive cancer care program. She will focus on the care of patients with disorders of the blood, bone marrow, and lymphatic systems. (989) 497-3226

Rachael Kasperowicz, MD

Primary Care

Kevin Lawson, MD Orthopedics

Laura Reitz, DPM Podiatrist/Foot and Ankle Surgery

Roma Srivastava, MD Hematology/Oncology

All are accepting new patients.

The Bulletin | November 2018 15

The regular Membership Meeting of the Saginaw County Medical Society was held on Tuesday, October 16, 2018, at HealthSource Saginaw. Julia M. Walter MD, SCMS President, called the meeting to order at 7:30 p.m.

See page 10 and save the dates for future membership meetings.

Dr. Walter gave special thanks to Lisa Lapham, President & CEO of HealthSource Saginaw, along with all of her support staff, for hosting the meeting. She welcomed members, medical students, spouses/significant others and guests, candidates and representatives for the November election, and Josh Richmond of MSMS. Dr. Walter thanked Key Providers in attendance for their ongoing support of SCMS programs: HealthSource Saginaw and Larry Greene of Healthway Compounding Pharmacy.

Dr. Walter announced a new member approved at the Board Meeting prior to the Membership Meeting: • Peter C. Morden MD - Advanced Diagnostic Imaging, PC She also welcomed the following new members to their first meeting: • Sonia S. Dhaliwal MD – CMU Psychiatry Resident • David B. Hansen DO – CMU Emergency Medicine Resident • Ryan J. Kim MD – Mid Michigan Vascular Surgery • Albert G. Linden MD – CMU Internal Medicine Resident • Wynee S. Lou DO – CMU Health Internal and Sports Medicine (member in process) Dr. Walter then conducted the following business of the SCMS: • The Minutes of the September 18, 2018, Membership Meeting were attached to the Agenda. MOTION: Approve the September 18, 2018, Membership Meeting Minutes as printed. MOTION APPROVED. • Members were asked to submit articles on medical missions they have participated in for publication in the December Bulletin.

• Members were reminded of the following upcoming events:

October Mem Right: (l-r) Drs. Sonia Dhaliwal, Dave Hansen, Wynne Lou and Al Linden Dr. Juliette Perzhinsky speaks about opposition to Proposal 1 Recreational Use of Marijuana

1) “Meet the Physicians of CMU Health and CMU College of Medicine” on Thursday, October 18 at the Saginaw Country Club from 5-7 p.m.

2) The 27th Annual Robert M. Heavenrich MD Lecture will be held on Thursday, October 25, at 6 p.m. at Horizons Conference Center.

3) “Psychiatry for the Non-Psychiatrist” will be held on Saturday, October 27 from 8 a.m.-1:30 p.m. at CMU College of Medicine Education Building in Saginaw.

4) Volunteers are needed to prepare and serve lunch at the East Side Soup Kitchen on Wednesday, November 7, 2018.

5) The SCMS is hosting another safeTALK Suicide Alertness Training on Saturday, November 10 from 8 a.m.-12 p.m. CME credit is available.

6) The 15th Annual SCMS Alliance Jingle Mingle will be held on Monday, December 3, 2018, from 10:30 a.m.2:30 p.m. at the Saginaw Country Club. Proceeds benefit the Barb Smith Suicide Resource & Response Network.

Program A Candidates’ Forum for the November election was held and moderated by Dr. Walter. Josh Richmond of MSMS explained the Maintenance of Certification (MOC) issue to be discussed. Candidates for the offices of Governor, Senate, U.S. House-District 4, State Senate-District 32, State Rep-94th District and State Rep-95th District were invited to attend.

The following candidates participated: 1) Senator Ken Horn (R) – Incumbent, State Senate District 32

2) Phillip Phelps (D) – Candidate, State Senate District 32 3) Rep. Vanessa Guerra (D) – Incumbent, State Rep 95th District 4) Rodney Wakeman (R) – Candidate, State Rep 94th District 5) Sarah Brooks representing Congressman John Moolenaar (R) – Incumbent, 4th Congressional District Prior to the start of the Forum, Juliette M. Perzhinsky MD, spoke about SCMS and MSMS opposition of Proposal 1 – Legalization of Recreational Marijuana.

Each candidate then had two minutes at the podium, followed by a Q&A during which the following issues, among others, were discussed: • MOC • Marijuana Ballot Initiative • Opioid Epidemic • Auto No-Fault • Lack of Residency Positions The next meeting will be held on Tuesday, January 15, 2019, at Horizons Conference Center. The speaker will be Henry Reyna, and the program is “Surviving Acts of Violence.”

The meeting was adjourned at 9 p.m.

Respectfully submitted, Joan M. Cramer Executive Director

mbership Meeting

Above: (l-r) Sen. Ken Horn, Rodney Wakeman, Rep. Vanessa Guerra, Sarah Brooks and Phil Phelps Left: (l-r) Drs. Lou Constan, Joe Talbot and Khalid Malik

Maintenance of Certification (MOC) Round Table members and Rep. Canfield informed Sen. Horn and Rep. Guerra on the specifics of the bills, why they support the bills, and asked for their support.

The SCMS is appreciative of the time Sen. Horn, Rep. Guerra and Rep. Canfield took out of their schedule to meet with them.

What Can You Do?

(l-r) Sen. Ken Horn, State Rep. Vanessa Guerra and State Rep. Ed Canfield

On Monday, October 1, members met at CMU College of Medicine Education Building with 32nd District State Senator, Ken Horn; 95th District State Representative, Vanessa Guerra; and 84th District State Representative, Edward Canfield DO to discuss House Bills 4134 and 4135, bills to rein in maintenance of certification red tape, to ensure Michigan patients have a right to the highest quality health care, and that physicians have the right to deliver it. Dr. Canfield introduced the bills, but is not seeking re-election and the bills are stalled in the Health Policy Committee.

Dr. Tom Veverka, District 8 Director, facilitated the Round Table, and was assisted by Josh Richmond of MSMS. SCMS

• Contact State Rep Hank Vaupel (District 47-R), Chair of the Michigan House of Representatives Health Policy Committee, and demand he bring the bills up for a vote this fall at (517)-373-8835 or HankVaupel@house.mi.gov.

• TAKE ACTION on MSMS’ website and contact your lawmakers directly. Simply enter your address to find your legislator. You will be directed to a prewritten letter you can edit or send as is once you enter your name and contact information. Learn more at Right2Care.org.

• Complete the MOC survey • Send any additional feedback to MSMS Director of State and Federal Government Relations, Christin Nohner, at cnohner@msms.org or 517-336-5737.

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Recipient of Battle of the Valleys Contest Barb Smith Suicide Resource & Response Network will be able to expand its community outreach thanks to a friendly university competition.

Photo courtesy of SVSU; content courtesy of WNEM TV-5.

The annual fundraising competition, Battle of the Valleys, netted the organization over $36,000 and gave another victory to Saginaw Valley State University (SVSU). Each year, SVSU and Grand Valley State University (GVSU) go head-to-head to see which college can raise the most money. The university that comes out on top not only claims bragging rights, but also ownership of a three-foot-tall traveling trophy named “Victoria.”

The trophy has spent 13 of the last 16 years with SVSU, but since the competition started in 2003, the universities have raised a combined total of $652,385 for charitable causes. “The greatest moment came when I walked onto the SVSU football field with many of the SVSU students and fans that were supporting us,” said Barb Smith, founder of the local suicide prevention and education initiative.

The competition began on Sunday, October 21, and the winner was announced during halftime at the Saturday, October 27 football game between SVSU and GVSU. “It brought tears to my eyes to have the opportunity to experience their energy as they anticipated hearing the amount announced, as they had been working hard all week to win this competition for us.”

Students from GVSU raised $14,915, which will support students in need of food support.

Internationally Acclaimed Suicidologist Trains 375 on Suicide Awareness and Assessment Dean George E. Kikano MD, of CMU College of Medicine and Barb Smith, of the Barb Smith Suicide Resource & Response Network hosted internationally acclaimed Suicidologist, Shawn C. Shea MD from October 15-17 in Saginaw.

On Monday, October 15, Dr. Shea presented two sessions – one for Primary Care providers and the second for Behavioral Health providers. On Tuesday, October 16, he spent the day with 28 CMU College of Medicine M3 students and Dr. Steve Vance, Associate Dean of Clinical Education. The students learned “The Delicate Art of Uncovering Suicidal Ideation and Intent: The Chronological Assessment of Suicide Events (CASE Approach).” Dr. Shea also presented the program to medical students from MidMichigan Medical Center on October 17. Thank you to the health care providers and participants who were willing to learn how they can make a difference in someone’s life by asking the right questions in a safe and effective way.

Do you want to raise awareness, volunteer or participate in an upcoming event?

Contact Barb Smith at sosbarb@gmail.com or 989-781-5260 and schedule a training or educational event or get more information.

The Bulletin | November 2018 19

The Children’s Grief Center (CGC) Great Lakes Bay Region held their 3rd Annual Saginaw Hearts of Hope Luncheon on Tuesday, October 23 at Horizons Conference Center presented

by Veronica and Ken Horn. The Horn’s two-year-old beloved granddaughter, Zelda (Zellie) Horn, unexpectedly passed away on September 24, 2017. Zellie’s brother and the Horn’s grandson, Liam, continues to receive services from the CGC to help him cope with the loss of his little sister.

CGC provides a safe and healing environment for children, teens and their families as they grieve the death of a parent, sibling, close family member or friend. CGC creates an atmosphere that fosters healing through peer support and trained volunteers. The participants use art, dance, theatre, storytelling and writing to express their feelings and share their experiences with each other. As they travel this journey together, they know they are not alone and feel supported.

Grief is an individual and unique process and each person is encouraged to allow themselves to grieve in the manner they choose.

For more information or to volunteer or support the Center, contact us at (989) 495-9335.

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(l-r) Don Steele, Barb Smith and Rachel Studebaker - The Barb Smith Suicide Resource & Response Network is a proud supporter of CGC

ATTENTION RETIRED MEMBERS!

Retired physicians meet for lunch every Wednesday at 12 noon at IHOP, 2255 Tittabawassee Road in Saginaw.

Those attending are responsible for their own lunch, and the informal gathering lasts about an hour.

Join your retired colleagues whenever you like!

If you have any questions, please contact Joan Cramer at the SCMS office at 790-3590 or by email at jmcramer@sbcglobal.net.

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Medical Laws and Ethics: What to do When Conflicts Occur

CMS Proposes Requiring Drug Prices be Listed in TV Commercials

Tanya Albert Henry, Contributing Writer - AMA Wire®

The Trump administration released a proposed rule on October 15 that would require pharmaceutical manufacturers to disclose the list prices of their products in direct-toconsumer television commercials. The proposal would mandate that brand manufacturers clearly state in all television advertisements the wholesale acquisition cost (WAC) of either a 30-day regimen or "typical" treatment regimen of any drug where that price is over $35.

The proposal would not require disclosure in print, radio or social media ads. The move, which follows calls from the AMA to include this information in direct-to-consumer advertising efforts, is expected to be challenged by the pharmaceutical industry.

In addition, the Centers for Medicare & Medicaid Services (CMS) is seeking comment on other approaches that could be utilized by the agency to increase transparency, including creation of a new drug-pricing counseling payment code for use by physicians and use of artificial intelligence methods to help beneficiaries select the lowest cost Part D drug plans. The proposal is open for public comment until December 17.

There are times when practicing physicians may encounter a situation where what a law requires conflicts with what the AMA Code of Medical Ethics says about how physicians must conduct themselves. The Code’s preamble warns physicians that the “relationship between ethics and law is complex.”

But the preamble adds that even though “ethical values and legal principles are usually closely related,” the “ethical responsibilities usually exceed legal duties.”

“Conduct that is legally permissible may be ethically unacceptable,” the Code says. “Conversely, the fact that a physician who has been charged with allegedly illegal conduct has been acquitted or exonerated in criminal or civil proceedings does not necessarily mean that the physician acted ethically.”

The Code’s preamble tells physicians that “in some cases, the law mandates conduct that is ethically unacceptable. When physicians believe a law violates ethical values or is unjust, they should work to change in law,” the Code says. “In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal duties.”

The Code’s preface further says that the AMA Council on Ethical and Judicial Affairs: Recognizes that circumstances at times impinge on physicians’ ability or opportunity to follow the guidance of the Code strictly as written. Recognizing when such circumstances exist and determining how best to adhere to the goals and spirit, if not the absolute letter, of guidance requires physicians to use skills of ethical discernment and reflection. Physicians are expected to have compelling reasons to deviate from guidance when, in their best judgment, they determine it is ethically appropriate or even necessary to do so.

The Council also recognizes that guidance is not always equally applicable to every individual physician, depending on the nature of the physician’s practice. Nonetheless, physicians are expected to be aware of guidance that may not be routinely relevant to their practice, to be sensitive to occasions when such guidance might be pertinent, and to respond in keeping with guidance when such situations occur.

In this respect too, then, the Code relies on the reasonable exercise of judgement.

Physicians Oppose Medicare E/M Payment Collapse Proposal Andis Robeznieks, Senior Staff Writer - AMA Wire® Physicians and other health professionals welcome and strongly support the Centers for Medicare & Medicaid Services’ (CMS) “Patients Over Paperwork” initiative, and say three of its components need to be enacted immediately to reduce “note bloat” redundancy. But they oppose a proposal to collapse payment rates for physician office visit services over concern about unintended consequences.

Those were the key messages included in a letter to CMS Administrator, Seema Verma, from the AMA and about 170 other organizations representing physicians, health professionals and health care stakeholders commenting on the proposed 2019 Medicare physician fee schedule and Quality Payment Program (QPP) rule.

“The proposals included in the 2019 Medicare physician payment rule demonstrate that you listened to our members’ concerns about the significant administrative burdens due to the documentation requirements associated with evaluation continued on page 22

The Bulletin | November 2018 21

continued from page 21

and management (E/M) services,” the letter states. “We are grateful for your efforts to simplify these requirements and reduce their associated red tape.”

CMS calculated the proposed changes would reduce the time needed for documentation tasks by 1.6 minutes per visit.

If a physician sees eight Medicare patients a day, 240 days a year, that would equal 51.2 hours of total time saved annually.

Doctors seek cure for note bloat Excessive E/M documentation requirements take time away from patient care and make it difficult to locate pertinent medical information in a patient’s record. The proposed fee schedule rule, which runs almost 1,500 pages, includes several documentation-policy changes that should help alleviate this problem. Specifically, the AMA and other organizations called for immediate adoption of these proposals: • Changing required documentation of patient’s history to focus only on the interval since the previous visit.

• Eliminating requirement for physicians to re-document information that has already been documented in the patient’s record by practice staff or by the patient.

• Removing need to justify providing a home visit instead of an office visit.

How Can You Help?

Do you want to raise awareness, volunteer or participate in an upcoming event?

Contact Barb Smith at sosbarb@gmail.com or 989-781-5260 and schedule a training or educational event or get more information.

Barb Smith Suicide Resource & Response Network is supported solely by donations and grants.

To make a donation, please make your check payable to Barb Smith SR&RN and mail to: Barb Smith Suicide Resource & Response Network PO Box 6712, Saginaw, MI 48608-6712 The organization is a 501(c)(3) nonprofit, and your donation is tax deductible (EIN 38-3400293).

22

The Bulletin | November 2018

Rate changes may cause patient harm However, the CMS proposal to “collapse” payment rates for eight E/M office visit services into two has the potential to create unintended negative consequences for patients.

“We oppose the implementation of this proposal because it could hurt physicians and other health care professionals in specialties that treat the sickest patients, as well as, those who provide comprehensive primary care, ultimately jeopardizing patients’ access to care,” the letter states.

The AMA and the other organizations joining the letter also oppose a proposed policy that would cut payments for multiple services delivered in the same day. The organizations note their willingness to work with CMS to resolve issues connected with calculating the appropriate coding, payment and documentation requirements for different levels of E/M services. They also declare their support for the workgroup the AMA created of coding experts who would “arrive at concrete solutions” in time for CMS to implement in the 2020 Medicare physician fee schedule.

The AMA has outlined a 10-page initial summary of the proposed rule several weeks prior to issuing these comments.

The final rule is expected to be released in the fall.

Caduceus Meeting for Recovering Health Care Professionals Tuesday Nights at 7 p.m.

Zion Lutheran Church 454 7th Street, Freeland, Michigan (Behind Pat’s Grocery Store on Midland Road in Freeland)

Caduceus meetings are available to health care industry professionals, and have adopted many of the principles of 12-Step programs.

Caduceus meetings are “closed” meetings for recovering health care professionals including, but not limited to, nurses, doctors, dentists and pharmacists.

We engage in group discussions where members may want to speak up, ask questions or share thoughts with fellow members.

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MEDICAL MISSIONS ARTICLES NEEDED

The SCMS will again feature the Medical Missions of our members (physicians, residents and medical students) in the December 2018 Bulletin. If you or someone you know of has participated in a medical mission (at home or abroad) within the last year or so, please contact Joan Cramer at jmcramer@sbcglobal.net. We are looking for articles of approximately 400-800 words in length (submitted in Word format) along with photos (submitted individually as JPEGs) to publish for each Medical Mission article.

The deadline for submission is Tuesday, November 20, 2018, to jmcramer@sbcglobal.net.

Depending on the number of articles received, we may need to publish some of the articles in future issues of the Bulletin.

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The Bulletin | November 2018 23

College of

Medicine CMU Awarded Grant to Support Training for the Care of Patients with Opioid Addiction The Substance Abuse and Mental Health Services Administration (SAMHSA) recently awarded CMU College of Medicine and CMU College of Health Professions a Provider’s Clinical Support System – Universities grant of $433,500.

The curricular implementation project will be developed

by Juliette Perzhinsky MD MSc FACP and her team on an Interprofessional Training Initiative to Expand Access to Medication-Assisted Treatment for Patients with Opioid Use Disorders in Rural Mid-Michigan.

This three-year project will integrate both on-site clinical experiences and in-classroom training on medication-assisted treatment (MAT) in the care of patients with opioid addiction.

CMU is grateful to the American Society of Addiction Medicine who will provide the curriculum to all collaborating institutions for helping to build access and workforce capacity in MAT for mid-Michigan communities.

Key collaborators on this project include John Lopes, DHSc PA-C at CMU College of Health Professions, Wendy Biggs MD, CMU College of Medicine Comprehensive Community Clerkship Director, and John Hopper MD, a triple boardcertified addiction medicine physician at Integrated Health Associates (IHA) of Ann Arbor. Affiliated clinical collaborators include John Evans DO, an addiction specialist at Victory Clinical Services in Saginaw, and Kate Regan MD, addiction psychiatrist at MidMichigan Health in Midland.

Keeping Physician Burnout at Bay College of Medicine, residency program, students team up to save lives “None of us saw this coming.”

Those haunting words end a note from a University of Kentucky Emergency Medicine Residency Program Director to colleagues that a resident had taken his own life. The note lamented that although the risk of suicide among physicians and trainees is higher than in the general public, it is not always made known and addressed.

“We must speak its names,” he wrote.

Speaking the names - burnout and suicide - is what the faculty, staff and students at CMU College of Medicine and its Saginaw residency program are doing strategically through mandatory awareness campaigns, stress reduction education and counseling.

Awareness is job one.

Leading the awareness charge is Furhut Janssen DO, Director of the Psychiatry Residency Program and College of 24

The Bulletin | November 2018

Medicine assistant professor. She holds seminars for residents training at CMU, and speaks on the topic to physicians locally and nationwide. “You can’t have intervention until you have awareness, and that awareness has to be in the people who are experiencing it,” she said.

Physician suicide is a national problem which she demonstrates with a slide show of statistics. One of the most startling is that more than one physician a day commits suicide; and among medical students, suicide is the second most common cause of death.

Dr. Janssen decided to become involved because as a practicing psychiatrist, many physicians would tell her they were struggling with burnout and depression. She offered to help, but even after reassurance of privacy and offers of appointments with therapists or psychiatrists, they would not schedule an office visit. She knew why. “There’s a stigma with doctors seeking help,” she said. “They are afraid of losing their jobs.”

Her involvement and passion of raising awareness for prevention of physician suicide has grown. She now gives medical school lectures and public seminars, always hopeful that troubled doctors and others will recognize the seriousness of their feelings and get help.

College of Medicine Collaboration Burnout is the most prevalent issue facing current physicians, statistics show. A 2018 Forbes article, citing a survey of doctors, said that 17 percent of doctors said they always felt burned out, and 34 percent said they often felt that way.

Modern technology has worsened the problem and taken away the art of practicing, Janssen said. The advent of electronic health records and productivity metrics have taken away much of the joy from the patient-doctor encounter, multiple reports have shown.

Efforts to keep stress in check begin at orientation to CMU’s College of Medicine. “Student stress is a reality in medical school, and for many students, it starts even before they get to campus,” said Tina Thompson, Senior Associate Dean of Academic Affairs. Navigating a new curriculum, loss of established support networks and fear of failure can lead to anxiety, self-doubt and the imposter syndrome, she said.

CMU’s Office of Student Affairs has developed a wellness program that teaches students how to manage stress. Among the topics discussed are sleep habits, exercise options, relaxation techniques, physical and mental health, music therapy and supportive relations. Required courses also include coping techniques, and faculty and staff are trained to continued on page 25

continued from page 24

notice and report issues before they can snowball, she said.

Burnout awareness and avoidance techniques are part of required well-being training for all residents, led by Mary Jo Wagner MD, Chief Academic Officer at CMU Medical Education Partners and Bethany Figg, GME Accreditation Manager. “We can deal with burnout if they get there, but our goal is to never let them get to that point,” Figg said.

The training is through a number of workshops on stress management. Saginaw-based Covenant HealthCare and Ascension St. Mary’s Hospital partners with the residency program, help with much of the training. Stress outlets include massage therapy, exercise and stretching, an interfaith wellness panel, and a resident wellness committee that plans activities outside work, including sports, parties, music and art contests.

“We put a lot of heart into what we do,” Figg said.

Students lead the way Maryssa Lyons, a third-year medical student from Freeland, spearheaded this spring’s student-led burnout and suicide prevention program. It was started the previous year by medical student Brittany Fields, and Lyons got involved because of her own struggles with mental health as a high school student, she said.

Their effort included a poster campaign, a workshop, a TED Talk, speeches and a fun night. She said the effort has received great support from faculty and students, including funding from the College of Medicine. Other medical schools around the state have shared information and are now beginning similar programs. Last spring, Wayne State and Michigan State held their programs concurrently with CMU’s.

Lyons’ goal is a statewide program to create a culture where the topic is dealt with openly. “I want to build a medical community that has colleagues who are mindful of their colleagues’ needs and help each other grow.” Plus, she said, “Talking about mental health and tackling these hard topics will only help me in my future career as a psychiatrist.”

College of Medicine students also were involved this spring in a successful effort by the Saginaw County Medical Society to persuade the American Medical Association to adopt a new policy to increase awareness and physician training on recognizing potential suicide risks among patients.

College of Medicine Dean George Kikano has instituted mandatory suicide awareness training at the College, and it is expected that more than 400 medical students will take part in the safeTALK training this year. Members of future incoming classes also will be trained.

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The Bulletin | November 2018 25

Federal Advocacy is yet Another Tangible Benefit MSMS/SCMS Provides to its Members Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019 On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019. The calendar year (CY) 2019 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment and innovation.

Physicians are challenged with excessive regulatory requirements in their practices. It is a high priority of MSMS/ SCMS to help reduce or develop efficiencies on these requirements. We are pleased to see the Administration is beginning to address that regulatory paperwork burdens on physicians, who will now be able to spend more time with their patients building a meaningful patient-physician relationship.

Specifically, MSMS/SCMS is grateful that the CMS: • Changed the required documentation of the patient’s history to focus only on the interval history since the previous visit.

• Eliminated the requirement for physicians to re-document information that has already been documented in the patient’s record by practice staff or by the patient; and • Removed the need to justify providing a home visit instead of an office visit.

• Declined to move forward on a proposal to reduce payment for office visits when performed on the same day as another service.

MSMS/SCMS are also grateful the Administration is not moving forward in 2019 with the payment collapse of E/M codes. In September, MSMS, along with 169 other organizations, signed onto a joint letter in regards to the Administration’s proposals. In a separate letter , MSMS further stressed its opposition to the proposed E/M changes and support for the recommendations in the health care stakeholder’s joint letter including the suggestion to allow the AMA’s workgroup to further analyze the issue and develop actionable recommendations for submission to CMS for

consideration. Additionally, MSMS noted its opposition to proposals to reduce payments for multiple services delivered in the same day, and mandatory use of 2015 Edition of Certified Electronic Health Record Technology under the MeritBased Incentive Payment System (MIPS).

Physician Tax - Michigan Medical Community Celebrates an Important Anniversary Nine years ago, the Michigan legislature voted down - by a narrow margin - the Quality Assurance Assessment Program (better known as the physician tax). It was an enormous victory for patients, physicians and the medical community as a whole here in Michigan.

Many came together to play a part in that victory, but there’s no question that MDPAC served a critical role in the winning effort. MDPAC enabled Michigan physicians to effectively deliver their message to supporters and swing voters alike. Working together, MDPAC ensured enough promedicine ‘no’ votes were in place to defeat this ill-conceived legislation when it came up for a vote on the Senate floor.

Were it not for MDPAC’s work, the medical landscape here in Michigan would likely look very different today. The passage of the physician tax would have had significant and widespread negative consequences, directly impacting you, your colleagues, and most importantly, the wellbeing of the patients you serve.

Threats to Michigan patients are exactly why MDPAC exists. Often, the rules and processes imposed on the medical profession are drafted outside of the exam room by insurance companies, regulators, lobbyists, politicians and others who lack experience and understanding of what it means to deliver quality patient care.

It’s this reality that creates the need for organized medicine and the efforts of MDPAC. As physicians, we have a responsibility to our patients and ourselves to work to elect leaders who understand and share the interests and needs of the medical community.

Opinion: Michigan Residents Receiving Inaccurate Information on No-Fault Effective communication is one of the most important skills in a physicians’ toolkit. In fact, communication forms the very foundation of the physician-patient Julie Novak, MSMS CEO relationship.

continued on page 27

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The Bulletin | November 2018

continued from page 26

My organization – the Michigan State Medical Society – represents more than 15,000 physicians throughout our state. We’re concerned that Michigan residents are being fed inaccurate information around no-fault insurance, the model system that saves taxpayers money while ensuring that accident victims get the care they need.

In short, no-fault insurance means that if you get injured in an accident, you will receive the care you need, for as long as you need it. Despite the name, it doesn’t have anything to with establishing who is “at fault” for an accident. A catastrophic collision can happen to anybody, and medical costs can easily rise into the millions - especially for the youngest accident victims, who sometimes need care for the rest of their lives.

Thanks to no-fault, we’re able to help these individuals lead the most meaningful, productive lives possible.

No-fault saves taxpayer’s money, as well. In states with a tort system, like Ohio and Indiana, families injured in an accident who are deemed to be at-fault will have nowhere to turn for payment of their medical bills. Meanwhile, attorney fees add up and needed rehabilitative therapies may not be available to them during the long legal process.

As a result, these families are forced into medical bankruptcy and onto Medicaid. When Colorado changed from a no-fault to a tort state, its Medicaid costs increased by 205 percent.

Eliminating no-fault would essentially be a secret tax hike on all Michigan residents, shifting costs to taxpayers instead of reducing them.

Sadly, there is a movement to entirely eliminate no-fault in Michigan – a move that would destroy thousands of lives while doing nothing to guarantee lower premiums. Detroit Mayor Mike Duggan has filed a lawsuit that would declare nofault unconstitutional, on the basis that rates are not “fair and equitable.” We can all agree that premiums are too high - but eliminating no-fault won’t solve the issue.

We need to hold the insurance companies accountable for their unfair practice of using non-driving rating factors, like gender, credit score and ZIP code, to set rates. We need to bring more transparency to the way rates are set. We need to create a fraud authority that stops fraudulent claims by claimants, providers and insurance companies who knowingly deny legitimate claims. And we need to lower health care costs by setting a fee schedule.

All of these fixes have been proposed in a bipartisan, comprehensive no-fault reform package called the Fair and Affordable plan that will provide a lasting fix to our automobile insurance system. We need fair and affordable auto insurance reform now.

Courtesy of the Detroit News Published 10:38 p.m. ET Oct. 18, 2018

Auto No-Fault New poll reveals majority of Michigan residents support protecting auto no-fault benefits, cracking down on insurance companies’ discriminatory practices. Survey also finds support for bipartisan Fair and Affordable no-fault reform package, which remains largely neglected in the Michigan Legislature.

Two-thirds of Michigan residents support a package of bills in the Michigan Legislature that seeks to lower auto insurance premiums while protecting the lifetime medical and lost-wage benefits provided by the state’s auto no-fault insurance system, according to a new statewide poll conducted by ROI Insight.

The poll showed strong support for the benefits provided by the no-fault system. Sixty-five percent of likely voters (56 percent strongly) reject any plan to eliminate or limit medical benefits for auto accident victims. Meanwhile, 56 percent believe rates should not be slashed at the expense of accident victims.

In addition, 77 percent of respondents said they do not believe insurance companies when they say they want to save them money, and 65 percent of respondents said rates are high because the State of Michigan does a poor job regulating rates to protect consumers.

“Voters strongly want to protect the lifetime medical benefits and limited lost wage benefits that no-fault provides,” said Paul King, president of ROI Insight. “When voters discuss the protections provided by the no-fault system, the polling data show their perceptions are significantly positive. In fact, nearly three-quarters of voters say no-fault’s protections of lifetime medical benefits to accident victims are good things, with a plurality saying ‘very good.’”

The statewide survey of 800 likely voters, which was conducted by live callers between September 15 and 20, included a 30-percent mix of cell phone users. The margin of error was +/-3.46. The survey was commissioned by CPAN (Coalition Protecting Auto No-Fault), a coalition of consumer groups and care providers working in a bipartisan way to reduce premiums while protecting Michigan drivers and families.

The bipartisan Fair and Affordable package of bills, which has sat in the Michigan Legislature for over a year without receiving a hearing, includes bills which would end the insurance industry’s discriminatory practices of using nondriving rating factors like gender and ZIP code when setting rates; require more transparency in how rates are set; crack down on fraud by insurance companies, consumers and continued on page 28

The Bulletin | November 2018 27

continued from page 27

medical providers; and lower health care costs by establishing a fee schedule for medical providers.

This survey shows that the Fair and Affordable package is supported by 66 percent of likely Michigan voters.

BCBSM Grants MOC Exceptions Blue Cross Blue Shield of Michigan (BCBSM) will begin granting board certification exceptions for family practice, internal medicine and pediatric practitioners that are designated as Patient-Centered Medical Home providers.

Effective January 1, 2019, the board certification status of family medicine, internal medicine and pediatric practitioners will be reviewed annually. If their board certification status has lapsed and they are a designated patient centered medical home physician, BCBSM will grant an exception and allow the practitioner to remain in their Blue Cross and Blue Care Network (BCN) managed care networks. This exception does not apply to new practitioner enrollments. Blue Cross and BCN will continue to require all providers to have board certification upon initial enrollment for affiliation.

“MSMS has put in an incredible amount of work to address MOC requirements, from introducing legislation and educating lawmakers to working with physician specialty societies to advocating with the payers. We commend BCBSM for taking this important first step,” said Julie Novak, MSMS CEO. “The work on MOC remains. Physicians are required by Michigan law to complete 150 hours of continuing medical education credits as a condition of re-licensure every three years. Today’s physicians want to focus on delivering high quality care, not the redundant MOC requirements by the specialty boards.”

Family medicine, internal medicine and pediatric practitioners who are found to be non-board certified and are not designated as PCMH physicians will be required to complete maintenance of certification requirements within a two-year time frame. Failure to meet these requirements will result in termination from our managed care networks.

• 36% are system glitches, such as software updates, which inadvertently expose confidential information.

• 24% are malicious and criminal attacks.

A data breach can be devastating to a practice. The practice must offer credit monitoring to patients, analyze how the data breach occurred and develop steps to avoid another breach. This can be costly and time consuming. The estimated remediation cost is $73 per record, which becomes expensive without an appropriate insurance policy. For example, if a software update inadvertently exposes confidential information for 4,000 records, the remediation costs would be $292,000.

MSMS Physicians Insurance Agency sells a comprehensive data breach policy that helps cover these costs. This policy offers: • Various liability limits and retention values • Full limit for breach notification costs • Full limit for computer forensics • A duty to defend policy • Coverage for breach contract claims • Coverage that incorporates wording from HIPAA HITECH to help ensure coverage triggers properly • Coverage for regulatory actions, including state attorney general investigations • Coverage for civil penalties and compensatory awards If you would like to learn more about a data breach policy, or know anyone who would qualify, please contact Gin Gibson at 517-336-5730 or at vgibson@msms.org.

Save the Date!

Data Breach Insurance MSMS is constantly evaluating new products and services that help physicians address emerging issues in their practices.

A data breach is a sudden event which occurs when personally identifiable information is compromised, and they occur every day. Even though hacking incidents receive the most attention, it isn’t the most common. Three out of four incidents result from human error.

• 40% of the data breach cases are from people making mistakes, such as losing laptops and flash drives.

28

The Bulletin | November 2018

15th Annual Health Fair “The Doctor Is In” Saturday, March 16, 2019 9 a.m. to 12 p.m. (note new end time) Horizons Conference Center Click HERE for Vendor Registration form.

APRIL 2018 BULLETIN APRIL 2018 BULLETIN Put right after Second Victim info info Put right after Second Victim

Second Victim Resources Available RESOURCE

Second Victim INDICATIONS Resources Available FOR RESOURCE

RESOURCE

•

Chaplain Office on-­‐call chaplain Use Vocera and ask for

Chaplain Office Use Vocera and ask for on-­‐call chaplain

•

Employee Assistance Program (EAP) Office: 989.790.7500

• Wellness C enter o f C hild nd Family Services Employee Assistance Parogram (EAP) Office: of Saginaw 989.790.7500 www.childandfamilysaginaw.org

Wellness Center of Child and Family Services of Saginaw • Covenant Employee Health www.childandfamilysaginaw.org (After hours, contact the Shift Administrator.)

Covenant Employee Health (After hours, c ontact the Shift Administrator.)

Personal Counselor

Patient SCafety Personal ounselor Alan Spencer 989.583.6176 BJ Helton 989.583.4257

Patient Safety

Alan Spencer 989.583.6176 Risk Management BJ Helton 989.583.4257

Tyler Danek: 989.583.4142 Kristen Tomke: 989.583.7264

Risk Management Tyler Danek: 989.583.4142 Kristen Tomke: 989.583.7264

• • • •

• •

Following a stressful a person’s sense of INDICATIONS FOR eRvent, ESOURCE

and ab selief system often into •spirituality Following tressful event, a cpomes erson’s sense of focus. Chaplains can provide the following spirituality and belief system often comes into services: focus. Chaplains can provide the following o Spiritual assessments services: o Spiritual guidance and grief counseling o Spiritual assessments o Crisis intervention o Spiritual uidance support and grief counseling o Assistance in agcquiring services o Crisis from one’s intervention own tradition or faith o Assistance in atcquiring support o Help with exploring he new m eaning services ne’s poroviding wn tradition r ftaith after from the eo vent, hope foor he future. o Help with exploring the new meaning For assistance with the working through problems, after event, providing hope for the concerns, and other issues that may relate to the future. or atssistance hat may bw e tith riggered by tthe event.

•event For working hrough problems, Available t o a ssist w ith n on-­‐work-­‐related concerns, and other issues that may relate to the problems as fm amily, mtarital, occupational, event souch r that ay be riggered by the event. financial, legal, substance abuse, emotional and • Available to assist with non-­‐work-­‐related phase of life concerns. problems such as family, marital, occupational, If you are experiencing physical or emotional financial, legal, substance abuse, emotional and symptoms that may require medical attention, life oconcerns. you phase should orf each ut to Covenant Employee •Health If ytou a re e xperiencing physical r emotional o discuss your options.

Also, polease fill symptoms t hat m ay r equire m edical a ttention, out a “Work Related Injury” form in RL Solutions. you should reach coounselor, ut to Covenant If you have a personal you can Edmployee iscuss o dtiscuss your options. lso, please fill this Health event wtith hem for support and g Auidance. a “Work Related Injury” form in Rquality L Solutions.

For qout uestions regarding patient safety and •of care.

If you have a personal counselor, you can discuss For qthis uestions adverse event and guidance. event regarding with them for support and nrext steps. patient safety and quality •investigations For questions egarding Identification of care. of system issues/problems that relate to patient safety concerns.

• For questions regarding adverse event investigations and next steps.

For questions about liability issues/concerns.

•For qIdentification of system issues/problems that uestions regarding disclosure process and relate to patient safety concerns. documentation strategies.

• •

For questions about liability issues/concerns.

The Bulletin | November 2018 29 For questions regarding disclosure process and

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SCMS FOUNDATION SCMS FOUNDATION Make a Tax Deductible* Make a Tax Deductible* Gift Today!

Foundation Giftmembers Today!

The Foundation Board would like to thank the following who made donations this past year: • • • •

Dr. Ron and Cindy Jenson in memory of Dr. Walter Averill Dr. The Che Foundation Song Park in memory of like Dr. to Donato abrera Board would thankCthe following members who made donations this past year: Dr. S usan S chmiege i n m emory o f D r.

D onato C abrera • Dr. Ron and Cindy Jenson in memory of Dr. Walter Averill • Dr. Susan Schmiege in memory of Dr. Donato Cabrera Dr. Dan nd Alyce • Dr. CheaSong Park W in echter memory of Dr. Donato Cabrera • Dr. Dan and Alyce Wechter

WHAT IS THE PURPOSE OF THE FOUNDATION? • Provides low interest loans to medical students with ties to the Saginaw area, with a maximum of $20,000 over four years.

• All interest is forgiven if the student returns to Saginaw upon completion of a residency to practice.

• If the loan recipient returns to Saginaw to practice upon completion of their residency and they are a dues paying member of the SCMS/MSMS, 25 percent of the principal balance will be forgiven at the end of each year they are practicing in Saginaw County, with a maximum of $5,000 per year forgiven.

• Assists the SCMS Alliance (spouses of members) in awarding scholarships to Saginaw County nursing students.

• Awards scholarships to high school juniors and seniors interested in becoming a physician and practicing in Saginaw County.

• Provides scholarships, grants and awards to medical students and residents for research projects.

The annual Golf Outing raises approximately $20,000 per year for these programs, but the Foundation also relies on donations to continue and increase funding programs in order to assist as many students as possible.

! If you would like to honor a colleague who is living or deceased, please make a contribution to the SCMS Foundation ! Please remember the SCMS Foundation in your Will

*The SCMS Foundation is a 501(C)(3) nonprofit. Gifts have charitable tax benefits so please consult with your tax advisor for specifics. A tax receipt will be provided.

PLEASE COMPLETE AND RETURN THE FOLLOWING WITH YOUR CHECK (We are unable to accept credit card payments) ! -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐!

Enclosed is my contribution made payable to the SCMS Foundation (please designate amount):

" $1,000 " $500 " $250 " $100 " $50 " Other __________ Donor’s Name ______________________________________________________________ Mailing Address ___________________________________________ City, State, Zip _____________________________________ Daytime Phone (_____) ________________ Email __________________________________________________________________ How would you like to receive your receipt? # Email # Postal Mail

$ $ $ $ If you wish to make your gift as a memorial or tribute, please provide the following: My gift is: " in honor of " in memory of Occasion/Person to be honored: _______________________________________ Please send notice of my gift (without specifying amount) to: Name _____________________________________________________________________ Mailing Address ___________________________________________ City, State, Zip _____________________________________ Checks should be made payable to the SCMS Foundation and sent to the SCMS office at 350 St. Andrews Road, Suite 242, Saginaw, Michigan 48638-­‐5988. Thank you!

The Bulletin | November 2018 31

PRSRT STD U.S. POSTAGE PAID Saginaw, MI 48605 PERMIT #228

350 ST. ANDREWS ROAD | SUITE 242 SAGINAW, MI 48638-5988

ADDRESS SERVICE REQUESTED

2018-2019 KEY PROVIDERS

These Area Businesses Support Saginaw County Medical Society Membership Meetings.

When you have a need for a service, please consider our Key Providers.

Please mark your calendar for the following meetings and events in 2018-19. You will receive an email meeting notice and reminder each month for SCMS events. Non-SCMS events are listed as a courtesy and you must contact the sponsor directly to register.

Monday, December 3, 2018 Saginaw Country Club – “15th Annual SCMS Alliance Jingle Mingle.”

Proceeds benefit Barb Smith Suicide Resource & Response Network.

See page 5 for information.

There is no Board Meeting in December.

Tuesday, January 15, 2019 Horizons Conference Center - SCMS Board meets at 5:30 p.m.

Membership Meeting joint with the Saginaw County Dental Society with Social (cash bar) at 6:30 p.m. followed by dinner and program at 7 p.m. Program: “Surviving Acts of Violence.” See page 10 for more information.

Tuesday, February 19, 2019 CMU College of Medicine, 1632 Stone Street – SCMS Board meets at 5:30 p.m.

Saturday, March 16, 2019 Horizons Conference Center - 15th Annual Health Fair “The Doctor Is In!” from 9 a.m.-12 p.m.

Tuesday, March 19, 2019 CMU College of Medicine, 1632 Stone Street – SCMS Board meets at 5:30 p.m.

Tuesday, April 16, 2019 Horizons Conference Center - SCMS Board meets at 5:30 p.m.

Membership Meeting with Social (cash bar) at 6:30 p.m. followed by dinner and program at 7 p.m. Program: “TED Talks.” See page 10 for more information.

Tuesday, May 21, 2019 Horizons Conference Center - SCMS Board meets at 5:30 p.m.

Membership Meeting with Social (cash bar) at 6:30 p.m. followed by dinner and Annual Meeting at 7 p.m. Program: “Update on CMU College of Medicine.”

Saturday, June 8, 2019 Saginaw Country Club – 10th Annual SCMS Foundation Golf Outing

Joan Cramer/SCMS | Office 790-3590 | Fax 790-3640 | Cell 284-8884 | jmcramer@sbcglobal.net