Page 1

The

Bulletin Saginaw County Medical Society

October 2017 Volume 76, No 2

Medical Mission Articles Needed! p. 7

ZEROSuicide p. 9-10

September Membership Meeting p. 16-18

www.SaginawCountyMS.com


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The

Bulletin Saginaw County Medical Society

SAGINAW COUNTY MEDICAL SOCIETY 2017-2018 OFFICERS AND DIRECTORS

contents 7

5

Save the Date 2018 Membership Meetings

President Julia M. Walter, MD President-Elect Zubeda S. Khan, MD Past President Virginia R. Dedicatoria, MD Secretary Sanjay J. Talati, MD Treasurer Thomas J. Veverka, MD Board of Directors B.L. Nahata, MD Mildred J. Willy, MD Gopi K. Nallani, MD Anthony M. Zacharek, MD Maliha N. Shaikh, MD Jorge M. Plasencia, MD Bulletin Editor Louis L. Constan, MD Retiree Representative Larry S. Kelly, MD Resident Representative Abhishek A. Bhandiwad, MD MSMS Delegates Elvira M. Dawis, MD B.L. Nahata, MD Zubeda S. Khan, MD Sanjay J. Talati, MD Julia M. Walter, MD Virginia R. Dedicatoria, MD Mohammad Yahya Khan, MD

9-10

Medical Mission Articles Needed!

8

ZEROSuicide - Identify

16-18 September Membership Meeting

14th Annual Jingle Mingle

4

President’s Letter

6

From the Editor

11

12

23 24

Key Provider of the Month Caretel Inns of Tri-Cities

MiHIA: Pharmacists & Barriers to Patient Care

13

MIPS Update

14

Hospital Hospitality House Seeking Volunteers

31

15 MSMS

19

Applications for Membership

20

St. Mary’s of Michigan|Ascension

22

CMU College of Medicine|CMU Health

Mildred J. Willy, MD

26 28 28 29 30

31 32

Retired Members Human Trafficking Awareness Training a Huge Success! Covenant HealthCare November Birthdays HAP Issues MSP Angel Program So You’re an Employed Physician: What You Ought to Know MSMS Physician Employment Contract Review Service Advertiser Index Calendar of Events

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

MSMS Alternate Delegates Caroline G.M. Scott, MD Waheed Akbar, MD Gopi K. Nallani, MD Anthony M. Zacharek, MD Steven J. Vance, MD J. Patricia Dhar, MD Danielle C. Duncan, MD Jorge M. Plasencia, MD Christopher J. Allen, MD Jacquelyn M. Charbel, DO Peer Review Ethics Committee Waheed Akbar, MD 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

ON THE COVER: Hedy Wald with CMU Medical Students Jisselly Sanchez Salcedo, Nicole Rebusi, Elizabeth Godfrey, Brent Oldham and Brad Demijohn 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 | October 2017 3


PRESIDENT’S LETTER

My Role as a Physician By Julia M. Walter, MD

A

s a mother, grandmother, wife, daughter and sister, my role as a physician has a poignant dynamic related to each of these hats that I wear. I have spent my life in love with science, and committed my career to caring for people. This is not always easy when the passion is diluted to the business of doing more with less, until it seems we will eventually be expected to do everything with nothing. I am still here, standing ready in my scrubs and crocs. We recently had an excellent dinner conference on the Resilient Physician, presented by Dr. Hedy Wald. She put forth the idea that we need to take care of our physical, emotional and

spiritual health. We do contribute to the business of caring for patients, through caring for ourselves and being active to our community, so that as a profession we are not just relevantbut significant. It seems as though these are tumultuous times for our country and world. Yet between politics, natural disasters and capitalism, the tone of human compassion is not lost. Demonstrated by some incredible philanthropy and even more incredible people, our culture has a unique way of finding unity and spirit in the midst of horrible chaos. As I look for the guilty pleasures that rejuvenate my passions and heal my soul, I look toward our community to participate and support each other.

My colleagues have shown me that I cannot do this alone, nor do I want to. So as a commitment to you and myself, I encourage you to step forward and outside your comfort zone, to listen and interact with people who are different. I challenge you to see how we are the same. We can find opportunities to do the waiting on, instead of being waited on. Give anonymously without accepting credit. Defend an idea that we are against and even criticize an idea that we believe in. Or, maybe we can simply sit down and have a conversation over a cup of coffee or tea. We need purpose in our efforts as much as our patients and staff need the results of our efforts. I love what we do.

It seems as though these are tumultuous times for our country and world. Yet between politics, natural disasters and capitalism, the tone of human compassion is not lost. Demonstrated by some Julia M. Walter, MD

incredible philanthropy and even more incredible people, our culture has a unique way of finding unity and spirit in the midst of horrible chaos.

4

The Bulletin | October 2017


Mark Your Calendar Now for our 2018 Membership Meetings Tuesday, January 16, 2018 Mark your calendar now for our Tuesday, January 16, 2018, Membership Meeting joint with the Saginaw County Dental Society at Horizons Conference Center. Jim P. Getzinger MD, a board certified Emergency Medicine physician from Beaumont, will present on “Head and Neck Trauma and Evaluating Back and Hip Pain in the Emergency Setting” (tentative title). Dr. Getzinger received his medical degree from Wayne State University School of Medicine, and completed his Emergency Medicine Residency at Beaumont Hospital.

Date:

Tuesday, January 16, 2018

Time:

6:30 p.m. Social (cash bar), 7 p.m. dinner, brief meeting and program

Place:

Horizons Conference Center 6200 State Street, Saginaw

Cost:

No cost for SCMS Members, CMU Medical Students and Saginaw County Dental Society Members (cash bar) Non-member physicians $100 each All others $60 each

Those who make a reservation and do not attend will be charged a $25 cancellation fee.

Online reservation instructions will be mailed and emailed in late December, but please mark your calendar now to attend.

There are no Membership Meetings in February or March Tuesday, April 17, 2018 Mark your calendar now for our Tuesday, April 17, 2018, Membership Meeting at Horizons Conference Center. The social with cash bar starts at 6:30 p.m., followed by dinner, brief meeting, program and panel discussion at 7 p.m. The tentative program is “Second Victims.” Who is a Second Victim? Second Victims are “healthcare providers who are involved in an unanticipated adverse patient event, medical error and/or a patient related injury and become victimized in the sense that the provider is traumatized by the event.” The Second Victim phenomenon can occur to any healthcare provider, in any organization.

Tuesday, May 15, 2018 Mark your calendar now for our Tuesday, May 15, 2018, Annual Membership Meeting. The social with cash bar starts at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Dean George E. Kikano, MD will give an update on the CMU College of Medicine and medical student and resident training in Saginaw.

The Bulletin | October 2017 5


FROM THE EDITOR

Boys and Girls By Louis L. Constan, MD

W

hat do you think about this?

Doctor: Push, Push, Push Patient: Ah…Ah…Ah... Doctor: (later) There you are, you’ve had a fine baby Patient: Is it a boy or a girl? Doctor: Impossible to tell. You’ll have to wait till it’s about three years old and ask Perhaps that’s a bit much, but you’ll have to admit that a lot of strange things have been happening these days. Boys become girls. Girls become boys. Colleagues of ours make a living doing “gender reassignment surgery.” Others do psychoanalysis on patients whose lives are mixed up and who become suicidal after being forced into a sexual role for which they are severely conflicted. Young children, often shy and self-conscious, are told to use bathrooms, forced into intimate, awkward situations with children with whom they do not ordinarily associate. And, of course,

those other young children sense their discomfort and bully them, as young children are prone to do. All this should not be entirely a surprise to us physicians. We know that gender is fluid to an extent. After all, we all studied those genetic anomalies, the XXX’s, the XXY’s, and so forth, and we know that gender is a complex interaction between endocrine and genetic components that can vary immensely depending on the stage of fetal development. Furthermore, we have all seen the “female patient” that is phenotypically more like a male patient, and the “male patient” that is phenotypically more like a female patient. It is not so hard for us to imagine that inside their skulls, these patients might have a brain that does not match their bodies. So, the interaction that determines real gender may be even more complex and include a mixture of genetic, endocrine, as well as, social factors. Given all this, doesn’t it seem rather silly all the brouhaha that’s going on around the country about whether women are as good as men in the computer industry, or in the

executive suite, or in the military; or if men are as good as women in jobs that require empathy and caregiving, or which partner should have parental leave to take care of the children? I understand the arguments many give against equality of the sexes. There are physical differences. But women have been saying for years that those differences have been exaggerated in the interests of keeping both sexes in clearly defined roles. Men should be powerful and in charge. They should wear uniformlike suits with a minimum of frills. Women are dependent and attractive to the man; they should wear makeup, frilly, colorful clothes, emphasizing their female form. This is the world many folks have grown up in and are reluctant to give up. Hence the handwringing. The fact is, and, if anyone really knows it, we physicians know it, people are more alike than they are different and we cannot judge their worth or their competence from their appearance. Man or woman… it doesn’t matter. You have a man or woman Family Doctor…it doesn’t matter. You have a man or woman

continued on page 7

The fact is, and, if anyone really knows it, we physicians know it, people are more alike than they are different and we cannot judge their worth or their competence from their appearance. Louis L. Constan, MD

6

The Bulletin | October 2017


continued from page 6

COMPLIANCE MADE SIMPLE Hospitalist…it doesn’t matter. You have a man or woman Cardiac Surgeon…it doesn’t matter. You have a man or woman Neurosurgeon…it doesn’t matter. You just have a Family Doctor, or a Hospitalist, or a Cardiac Surgeon, or a Neurosurgeon. Bottom line: Male/Female it doesn’t matter. The whole transgender angst we’re experiencing in America today is because we as a society have not come to grips with the fact that all individuals are equal, and all individuals have a certain amount of femaleness and a certain amount of maleness within them, and that such things as secondary sexual characteristics can be changed with surgery and hormones. Girls can be boys and boys can be girls. There is a sense in which girls are actually already boys and boys are actually already girls. And transgender individuals, now that they have received some recognition, are much more common than previously thought. Indeed it is likely, in an organization as large as the Saginaw County Medical Society, that we have one or more transgender members. Does it matter to us? Does it matter to you?

Assisted CEs & BAs in Passing Audits Protects the Organization Ensures Privacy & Security Compliance Cost Effective Easy to Implement

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The Canadian government has actually just issued its first genderless ID card to a baby born to a parent who preferred not to designate the child as either male or female 1

MEDICAL MISSIONS ARTICLES NEEDED The SCMS will again feature the Medical Missions of our members in the December 2017 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 as JPEGs) to publish for each Medical Mission article. The deadline for submissions is Monday, November 20, 2017, to jmcramer@sbcglobal.net. The December Bulletin will feature physicians who participate in any of the following: Volunteer Medical Work Overseas Missionary Service Environmental and Conservation Programs Public Health Programs Depending on the number of articles received, we may need to publish some of the articles in future issues of the Bulletin.

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.” The Bulletin | October 2017 7


The Saginaw County Medical Society Alliance Presents:

14th Annual “Jingle Mingle” Monday, December 4, 2017 at the Saginaw Country Club 4465 Gratiot Road, Saginaw 10:30 a.m. to 2:30 p.m.

A BRINGD!!! FRIEN person

0 per ps 4 $ s i hi Cost onsors 50 p S e l Tab le for $ b a l i a v e are a includ ot (does n ket) a tic

Purchase Some of the Area’s Most Unique Gifts

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 22. 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 CASA (Court Appointed Special Advocates) 8

The Bulletin | October 2017

Please return this form with your check made payable to the SCMS Alliance no later than Wednesday, November 22, 2017, 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


IDENTIFY

Identify every person at risk for suicide. Screen and assess every new and existing patient for suicidal thoughts and behaviors in an ongoing and systematic way using standardized tools.1 Overview: Finding Those At Risk An estimated 9.3 million adults (3.9 percent of the total U.S. population) reported having suicidal thoughts in the past year. Approximately 2.7 million people (1.1 percent) reported making a plan about how they would attempt suicide.2 An estimated 4.6 percent of the overall U.S. population reported a lifetime suicide attempt.3 We know that these individuals at risk for suicidal behaviors are seen in health care settings for a wide variety of concerns. Of people who die by suicide, 77 percent of individuals had contact with their primary care provider in the year before death.4 45 percent of individuals had contact with their primary care provider in the month before death.

A meta-analysis concluded that screening lowers suicide rates in adults.5 As the Joint Commission notes in its 2016 alert,1 failure to assess suicide risk was the most common root cause of suicides qualifying as sentinel events. Screening for suicide risk should be included in health and mental health care visits. The known risk factors that should trigger screening for suicide include mental health or substance use diagnoses, psychosocial trauma or conflict, recent loss (e.g., of a job or the death of a family member), family history of suicide, and personal history of suicide attempts.1

Recommendation: Systematic Screening & Assessment Evidence-based screening and assessment tools should be incorporated into clinical practice as the use of such tools coupled with clinical judgment has been found to be more accurate than clinician judgment alone.1 Screening can improve identification and treatment of mental health and suicide risk.1,6,7 Comprehensive screening occurs in multiple settings: primary care, urgent care, specialty clinics, mental health, crisis care, and other settings where individuals at risk are seen. These screenings should occur with every patient, including existing patients, especially when risk factors or life events determine screening is appropriate. Whenever a patient screens positive for suicide risk, a full risk assessment, including risk formulation, should be completed for the patient. It is important to develop policies and procedures for screening and assessing patients and to train staff on evidence-based screening, assessment, and documentation tools, policies, and procedures. Simon, et al. examined the relationship between elevated responses to question 9 of the Patient Health Questionnaire-9 (PHQ-9) screening questionnaire and suicide deaths.6 They found a tenfold increase in suicide within the following year for patients reporting frequent thoughts of self-harm, suggesting that routine screening does detect suicidal individuals who should then be engaged for ongoing treatment and care.6 Use of an assessment such as the Columbia-Suicide Severity Rating Scale (C-SSRS) can help reduce the burden on the provider, encourage and streamline follow-up, and improve documentation of risk. The tool can be useful in increasing the quality of information gathered from the patient, encouraging self-disclosure, while also improving care delivery, treatment planning, and outcomes.7 Systematic use of the C-SSRS has been shown to decrease

LEAD

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IDENTIFY

burden and false positives while improving detection.8 The C-SSRS has been used in the U. S. Marine Corps and

the U. S. Army with other suicide prevention strategies and has been associated with a decrease in suicidal ideation and behaviors.9 Further, the research shows that prediction leads to prevention: “It [the C-SSRS] was able to show, for the first time, that behaviors beyond previous suicide attempts–such as self-injury or making preparations for an attempt–may be used as predictors of subsequent suicide attempts. … It also was able to determine clinically meaningful points at which a person may be at risk for an impending attempt, something that other scales have been unable to consistently determine.” — NIMH Science Update, Nov. 28, 2011 In the Zero Suicide model, the Zero Suicide elements are interrelated. It is key to conduct a risk assessment using risk formulation, develop a collaborative safety plan, and use evidence-based treatments in the least restrictive setting.

Conclusion: Take Steps Toward Efficient & Effective Identification Systematic screening, identification, and assessment of suicide risk among people receiving care dramatically increases the efficiency and effectiveness of interventions. Developing policies and procedures around identification of risk that leverage evidence-based tools is a crucial step toward safer suicide care. Citations The Joint Commission. (2016). Sentinel Event Alert, Issue 56: Detecting and treating suicide ideation in all settings. Retrieved from http://www. jointcommission.org/assets/1/18/SEA_56_Suicide.pdf

1

National Center for Injury Prevention and Control. (2015). Suicide: Facts at a Glance. Retrieved from https://www.cdc.gov/violenceprevention/ pdf/suicide-datasheet-a.pdf

2

3 Kessler, R.C., Borges, G., & Walters, E.E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56, 617–626.

Abed-Faghri, N., Boisvert, C.M., & Faghri, S. (2010). Understanding the expanding role of primary care physicians (PCPs) to primary psychiatric care physicians (PPCPs): Enhancing the assessment and treatment of psychiatric conditions. Mental Health in Family Medicine, 7(1), 17-25.

4

Mann, J.J., Apter, A., Bertolote, J., Beautrais, et al. (2005). Suicide prevention strategies: a systematic review. JAMA, 294(16), 2064-2074. Retrieved from http://www.daveneefoundation.org/wp-content/uploads/Suicide-Prevention-Strategies.pdf

5

Simon, G.E., Rutter, C.M., Peterson, D., Oliver, M., Whiteside, U., Operskalski, B., & Ludman, E.J. (2013). Does response on the PHQ-9 Depression Questionnaire predict subsequent suicide attempt or suicide death? Psychiatric services, 64(12), 1195-1202. Retrieved from https:// www.ncbi.nlm.nih.gov/pubmed/24036589

6

Mundt, J.C., Greist, J.H., Jefferson, J.W., Federico, M., Mann, J.J., & Posner, K. (2013). Prediction of suicidal behavior in clinical research by lifetime suicidal ideation and behavior ascertained by the electronic Columbia-Suicide Severity Rating Scale. The Journal of Clinical Psychiatry, 74(9), 887-893. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24107762

7

Viguera, A. C., Milano, N., Laurel, R., Thompson, N. R., Griffith, S. D., Baldessarini, R. J., & Katzan, I. L. (2015). Comparison of electronic screening for suicidal risk with the Patient Health Questionnaire Item 9 and the Columbia Suicide Severity Rating Scale in an outpatient psychiatric clinic. Psychosomatics, 56(5), 460-469. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26278339

8

Posner, K. (2016). Evidence-based assessment to improve assessment of suicide risk, ideation, and behavior. Journal of the American Academy of Child & Adolescent Psychiatry, 55(10), S95. Retrieved from http://www.jaacap.com/article/S0890-8567(16)30400-2/fulltext

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Posner, K. (2016, Dec. 1). Personal communication with the Zero Suicide Institute.

Visit www.zerosuicide.sprc.org/toolkit for additional tools, resources, & more. LEAD

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©2017 by the Education Development Center, Inc. All Rights Reserved.

10 The Bulletin | October 2017


Rest, Relaxation & Rehabilitation

Caretel® Inns of Tri-Cities You’ll Want to Rehab Here! Recovering from a fall, stroke or any major life event is work, but you can face it with confidence at Caretel. Our physical, speech and occupational therapists are the best in the area. Hard work deserves it’s just reward, and we know a thing or two about pampering. Every Caretel mixes the amenities of an inn with 24/7 assistance from caregivers. Rest, Relax, Rehab, Repeat until you are back to your best health. TH! E MON H T tings. F m O ership ee VIDER O MS memb C R S . P r n fo ti Y e rt ll o E u K The B e supp

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Let’s Focus on:

Let’s Focus on:

Pharmacists & Pharmacists & Barriers to Patient Care Barriers to Patient Care

The Michigan Health Improvement Alliance, Inc. (MiHIA) is conducting focus groups to Michigan Health Improvement Inc. (MiHIA) is conducting focus groups to gainThe a better understanding of the roleAlliance, community pharmacist can play in increasing patient gain a better understanding of the role community pharmacist play in increasing engagement associated with medication self-management andcan adherence for adultspatient in the engagement associated with medication self-management and adherence for adults in the central Michigan area. central Michigan area.

The purpose of this focus group is to provide an opportunity for physicians and pharmacists to come together in a planned yet purpose casualThe setting to: of this focus group is to provide an opportunity for physicians and pharmacists to come together in a planned yet casual setting to:

Develop recommendations for systems design that will increase positive patient outcomes.

Discuss current activities within care practiceagreements agreements drug therapy patient • Discuss current activities within careteams teamsthat thatleverage leverage collaborative collaborative practice forfor drug therapy and and patient care service models. care service models.

Explore the opportunities to to expand practiceagreements agreementsoror other systems change efforts that may • Explore the opportunities expandthe theuse useofofcollaborative collaborative practice other systems change efforts that may optimize patient carecare services, drug therapy, andadherence, adherence, and patient outcomes. optimize patient services, drug therapy,medication medication monitoring monitoring and and patient outcomes.

• Collect information to educate/informthe theState StateofofMichigan Michigan on patient engagement in in Collect information to educate/inform onapproaches approachestotoincreasing increasing patient engagement treatment for hypertension. treatment for hypertension.

Develop recommendations for systems design that will increase positive patient outcomes.

Should Attend: Pharmacists, physicians,physician physician assistants, assistants, nurse and other healthcare providers WhoWho Should Attend: Pharmacists, physicians, nursepractitioners, practitioners, and other healthcare providers Focus Group Sessions Available:

Focus Group Sessions Available: November 10 | 8:30a-10a

November 10 | 8:30a-10a CMU College of Medicine - Saginaw Education Bldg CMUConference College ofRoom Medicine 2015 - Saginaw Education Bldg Conference Room 2015 1632 Stone Street, Saginaw, MI 48602 1632Register Stone Street, here Saginaw, MI 48602 Register here

November 10 | 3:30p-5p CMU College of Medicine November 10 | 3:30p-5p Conference Room C CMU College of Medicine 2520 S. University Conference Room C Park Drive, Bldg. D, Mount Pleasant, MI 48859 Register here

2520 S. University Park Drive, Bldg. D, Mount Pleasant, MI 48859 Register here

November 17 | 8:30a-10a November 17 | 8:30a-10a Dow Health Services Dow Health Services Conference Room CR Conference Room CRMI 48640 715 E Main St, Midland, 715 E here Main St, Midland, MI 48640 Register

Register here

November 17 | 3:30p-5p Gratiot Family17 Practice November | 3:30p-5p Community Room Gratiot Family Practice 1910 Pine Ave, Room Alma, MI 48801 Community Register here

1910 Pine Ave, Alma, MI 48801 Register here

For more information visit mihia.org or contact Beth Pomranky, MiHIA Operations Manager, at b.pomranky@mihia.org

For more information visit mihia.org or contact Beth Pomranky, MiHIA Operations Manager, at b.pomranky@mihia.org 12 The Bulletin | October 2017


Merit-based Incentive Payment System (MIPS) Update Stacey P. Hettiger, Director • Medical and Regulatory Policy

MIPS Overview If you decide to participate in the Merit-based Incentive Payment System (MIPS), you will earn a performance-based payment adjustment to your Medicare payment. How Does MIPS Work? You earn a payment adjustment based on evidence-based and practicespecific quality data. You show you provided high quality, efficient care supported by technology by sending in information on quality, cost, advancing care information and improvement activities. MACRA: It’s Not Too Late to Avoid a Penalty in 2019 Medicare’s shift to value-based payment has been occurring incrementally over the past several years. Initiatives incorporating a “carrot and stick” approach to quality reporting such as the electronic prescribing, physician quality reporting system (PQRS), meaningful use (MU), and the value-based payment modifier (VBPM) are all precursors to Medicare’s latest and most transparent effort to shift from volume to outcomes. When Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in April 2015, most of the attention was on the repeal of the sustainable growth rate (SGR). However, MACRA provided the opportunity to further goals set by the U.S. Department of Health and Human Services (HHS) to link traditional, or fee-for-service, Medicare payments to value-based outcomes. Per HHS, by 2018, the goal is to have 50 percent of Medicare payments tied to some type of alternative payment model such as Accountable Care Organizations (ACOs) or bundled payment, and 90 percent of all traditional Medicare payments tied to quality or value. This new Medicare payment structure is known as the Quality Payment Program (QPP). The QPP establishes two new payment pathways for physicians. The first pathway is a modified fee-for-service model that combines and streamlines existing Medicare quality reporting programs (PQRS, MU and VBPM). This pathway is referred to as the Merit-Based Incentive Program (MIPS). MIPS replaces the multiple payment adjustment methodologies under the previously mentioned legacy programs with one payment adjustment structure that will measure physicians and other eligible clinicians based on performance in four categories: • • • •

Quality Cost Advancing Care Information Improvement Activities

The second pathway provides a fixed five percent annual bonus payment to physicians participating in identified valuebased alternative payment models (APMs) that focus on reduced costs and high-value services. This is referred to as the Advanced APM pathway. Payment adjustments pursuant to the QPP are scheduled to begin on January 1, 2019. However, as with other Medicare quality programs, there is a two-year look back for the data on which those payments will be computed. So, the actions taken by physicians in 2017 (performance year) will determine their Medicare payments in 2019 (payment adjustment year). For the 2017 performance year, physicians and other eligible professionals have several options for participation to avoid a negative payment adjustment in 2019. CMS refers to the options as “Pick Your Pace.” These options range from minimal reporting to full-year reporting, to participation in and Advanced APM. Reporting will occur during the first quarter of 2018. Physicians and other eligible clinicians choosing not to participate in either the MIPs or Advanced APM pathways in 2017 and who are not exempt will receive a four percent penalty in 2019. Most physicians participating with Medicare will follow the MIPS pathway. If you have any question about whether you need to participate to avoid a negative payment adjustment, check your participation status at https://qpp.cms.gov/. If you are just familiarizing yourself with the QPP or haven’t yet taken the steps necessary to submit at least 90 consecutive days of data, don’t despair, there is still time to act to avoid a negative payment adjustment in 2019. By choosing one of the options below, you can report the bare minimum data required and earn enough points to put you at or over the benchmark threshold: 1.

Report one quality measure for one Medicare Part B patient via CMS’ claims form before the end of 2017. Use the search tool available at https://qpp.cms.gov/ mips/quality-measures to select a quality measure that is applicable to your practice and that allows “claims” as a data submission method. The American Medical Association has a step-by-step guide available at www.ama-assn.org/qpp-reporting that walks you through the selection and claims submission process. Please note that you may want to report on more than one patient to give yourself a “cushion.” 2. Report at least one improvement activity via attestation. You will need to be engaged in the activity in 2017; however, you probably won’t be able to attest until the end of 2017 or beginning of 2018. Some examples of improvement activities include 24/7 access, accepting and seeing Medicaid patients in a timely manner, utilizing the Michigan Automated Prescription system (MAPS), designation as a Patient-Centered Medical Home, using shared decision-making aids such as Choosing Wisely® resources, and closing referral loops. Visit https://qpp. cms.gov/mips/improvement-activities for a complete list of the 90+ eligible activities. continued on page 14 The Bulletin | October 2017 13


continued from page 13 3. If you are using 2014 or 2015 Certified Electronic Health Record Technology for electronic prescribing, patient access to information (i.e., a patient portal) and health information exchange, and you have completed your security risk analysis, you can report these required base measures to get credit under the Advancing Care Information category. More details can be found at https://qpp.cms.gov/mips/improvement-activities. Should you have further questions regarding the QPP, contact Stacey P. Hettiger, MSMS Director of Medical and Regulatory Policy, at shettiger@msms.org or (517) 336-5766.

QPP Resources • • •

CMS MACRA QPP Web Site – https://qpp.cms.gov/ MSMS – http://msms.org/MACRA AMA – http://www.ama-assn.org/ama/pub/advocacy/ topics/medicare-physician-payment-reform.page • MGMA – https://www.mgma.com • Lake Superior Quality Innovation Network (QIN) – https://www.lsqin.org • QPP Resource Center – https://www.qppresourcecenter.com

Hospital Hospitality House of Saginaw is a 501(c)(3) nonprofit organization that serves as a home away from home to out-of-town patients and families receiving medical care in the Saginaw area. We are currently seeking Hospitality Volunteers to run our front desk by checking guests in/out, answering phones, greeting guests, taking referrals, as well as, assisting with cleaning rooms upon checkout. We are looking for volunteers between the hours of 8 a.m. and 4 p.m., Monday through Friday. Any time you can give is appreciated. If you, or someone you know, would like to make a difference in the lives of patients and families in crisis, please call (989) 583-0155 and ask for Diana or Courtney.

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It’s Renewal Time: MSMS dues are 88 percent tax deductible and SCMS dues are 100 percent tax deductible Contributions or gifts to the Michigan State Medical Society and Saginaw County Medical Society are not tax deductible as charitable contributions for federal income tax purposes. However, a portion of your dues may be tax deductible as ordinary and necessary business expenses. MSMS estimates that 12 percent of your 2018 dues will be nondeductible as this portion is allocable to lobbying as defined by law. SCMS dues are 100 percent tax deductible. If you pay your 2018 MSMS and SCMS dues prior to December 31, 2017, you may deduct up to 88 percent and 100 percent, respectively, as a business expense. READ MORE

Put Patients, Motorists First: Oppose Duggan/Theis Auto Insurance Reform Competing automobile insurance reform plans are dominating headlines again in Lansing. The legislation making the biggest headlines is the highly controversial House Bill 5013, sponsored by state Representative Lana Theis (R-Brighton) and championed by Detroit Mayor, Mike Duggan and House Speaker, Tom Leonard. The Duggan/Leonard plan would dramatically decrease coverage for many Michigan drivers, create a draconian fee schedule that would limit accident survivors access to care, and send taxpayer costs skyrocketing by an estimated $150 million each year by shifting accident survivors off private insurance and onto Medicaid.

MSMS strongly opposes the Duggan/Leonard plan, House Bill 5013. Under the Duggan/Leonard plan, motorists would be encouraged to choose limited personal injury coverage - a $250,000 policy - with claims they may see a small reduction in their premiums for a short amount of time. The bill language shows the majority of the $250,000 coverage is for “an emergency medical condition and related emergency care only.” That coverage will get a driver through an emergency, but once the real recovery starts, the lifetime care cap is only $25,000. This is nowhere near enough to cover the lengthy rehabilitation therapy, and possibly years of care needed after a catastrophic accident. What’s worse is that the $25,000 cap would also include wage loss, replacement services and survivor’s loss benefits. HB 5103 also caps family-provided attendant care, and it dramatically cuts funding for health care services, instituting a fee schedule on health care providers treating auto accident victims tied to the Medicare reimbursement rate. The nonpartisan House Fiscal Agency released an analysis this month showing the plan would cost taxpayers $150 million a year in higher Medicaid costs, by just the tenth year of the reform. HB 5103, the Duggan/Leonard plan, is bad for motorists, bad for health care access, and bad for taxpayers across Michigan. MSMS supports an alternative proposal which has also generated headlines. The “Fair and Affordable” No-Fault

reform plan is a bi-partisan, 16 bill package, featuring 14 different Republican and Democrat bill sponsors, including Republican representative, Ben Frederick and Democrat representative, Donna Lasinski. The “Fair and Affordable” plan stops non-driving related factors from unfairly impacting auto insurance rates, institutes transparency requirements for the Michigan Catastrophic Claims Association, aggressively tackles fraud and claims handling abuse, and adopts a much more reasonable fee schedule to rein in medical costs related to auto injuries, all without hundreds of millions of dollars in additional costs to Michigan taxpayers. Lawmakers should oppose House Bill 5103, the Duggan/ Leonard plan, and support the bi-partisan “Fair and Affordable” reform package. Click HERE to contact your lawmaker through the MSMS website.

MSMS Offers Ongoing Legal Support Through Amicus Briefs MSMS supports issues critical to the medical profession through submission of amicus curiae (“friend of the court”) briefs, including six such briefs during the past 18 months. The criterial for MSMS amicus briefs: (1) the issue must be one that affects Michigan physicians generally; and (2) the court must be capable of establishing precedent (i.e. generally, the Court of Appeals or Supreme Court). READ MORE

Thank you SCMS for the opportunity to work with you!

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The Bulletin | October 2017 15


Next Membership Meeting - Tuesday, January 16, 2018, joint with the Saginaw County Dental Society at Horizons Conference Center. Jim P. Getzinger MD, a board certified Emergency Medicine physician from Beaumont, presents. Reservations Required! See page 5 for more information.

Top from left: Dr. Steve Vance moderates the Q&A Dr. Meena Ramani and Hedy Wald Bottom from left: CMU Medical Students Brent Oldham, Elizabeth Godfrey, Brad and Sara Demijohn Dr. Lou Constan relates his story 16 The Bulletin | October 2017

September 2017 Meeting Minutes The regular meeting of the Saginaw County Medical Society was held on Tuesday, September 19, 2017, at Horizons Conference Center. The meeting was also the 18th annual joint meeting with the Saginaw County Osteopathic Society. Julia M. Walter MD, SCMS President, called the meeting to order at 7:08 p.m. Dr. Walter gave special thanks to Dean George E. Kikano MD of the CMU College of Medicine, and the CMU Office of Continuing Medical Education for sponsoring our speaker, Hedy S. Wald PhD, and providing CME credit. She then welcomed Robert L. Borenitsch DO, Saginaw County Osteopathic Society President, members and spouses; our speaker, Dr. Hedy Wald; Dr. Jean Bailey, Director, Educator Development Programs, CMU College of Medicine; CMU students and guests, and SCMS members and guests. Dr. Walter thanked Key Providers in attendance for their ongoing support of SCMS programs: Bieri Hearing Specialists, Caretel Inns of Tri-Cities and HealthSource Saginaw.


New members approved at the Board Meeting prior to the Membership Meeting were announced: • Marina J. Ananich MD (Advanced Diagnostic Imaging), Radiology and Neuroradiology; • Vedang J. Bhavsar MD (Michigan CardioVascular Institute), Cardiology; • John Blebea MD (CMU Health-Surgery), Surgery – Vascular and General; • Syed R. Hassan MD (Covenant Cancer Care Center), Internal Medicine and Oncology; • Rajeev Savanth Sudhaker MD (Michigan CardioVascular Institute), Cardiology; and • Gregory Sutton MD (Covenant Cancer Care Center), Gynecologic Oncology. Member-in-process, Sethu K. Reddy MD (CMU College of Medicine, Chair of Medical Disciplines), Internal Medicine, Endocrinology and Metabolism, was in attendance and introduced to the membership. Dr. Walter welcomed Dr. Borenitsch to the podium to conduct business of the Saginaw County Osteopathic Society. Dr. Walter then conducted the following business of the SCMS: • The Minutes of the May 16, 2017, Membership Meeting were attached to the Agenda and published in the June/ July issue of The Bulletin. MOTION: Approve the May 16, 2017, Membership Meeting Minutes as printed. MOTION APPROVED.

• Members were asked to mark their calendar for the Tuesday, October 17, 2017, Membership Meeting hosted at HealthSource Saginaw. Barb Smith of Survivors of Suicide will present a program on “ZeroSuicide.” • Volunteers are needed to serve at the East Side Soup Kitchen on Wednesday, November 8. • The Dr. Raana Akbar Memorial Lecture Series will present “The Sultan and the Saint,” at the Temple Theatre on Thursday, September 28. Proceeds benefit the East Side Soup Kitchen. • CMU College of Medicine is offering a free CME Human Trafficking Training on Saturday, September 30, through a grant from The Dow Chemical Company Donor Advised Fund. Online registration is still open. • Janie Gugino, past SCMS Alliance President and current MSMS Alliance President, is being honored by the Underground Railroad at their Empowerment Dinner & Celebration on Wednesday, October 25, 2017, in Frankenmuth. Tickets and sponsorship opportunities are available. Program Dr. Walter introduced Hedy S. Wald PhD, a Clinical Professor of Family Medicine at the Warren Alpert Medical School of Brown University. Dr. Wald directs continued on page 18

Above left to right: Dr. Dave and Michele Krebs and Dr. Dave and Lisa Wiersema Hedy Wald (center) with CMU Medical Students Nicole Rebusi and Jisselly Sanchez Salcedo Drs. Millie Willy, Sethu Reddy and Steve Vance Hedy Wald with Dr. Elvira Dawis

The Bulletin | October 2017 17


continued from page 17

the reflective writing curriculum in the Family Medicine Clerkship, and has been honored with Dean’s Excellence in Teaching Awards. She is Director of Resident Resilience & Wellbeing, Residency Programs in Child Neurology & Neurodevelopmental Disabilities, Boston Children’s Hospital - Harvard Medical School. She served as a Fulbright Scholar in medical education for the Ben Gurion University of Health Sciences Faculty of Medicine in Israel, and is a Gold Humanism Foundation Harvard-Macy Scholar. She presents internationally on interactive reflective writing-enhanced reflection to support professional identity formation in health care professions education. Dr. Wald’s program tonight is “The Becoming: Crafting a Story of You for Resilience and Vitality.” Dr. Wald’s presentation was followed by an informational Q&A. The SCMS would like to thank Steven J. Vance MD for moderating the Q&A session. Those attending were reminded to compete the online CME evaluation form within 30 days to obtain credit.

Members waiting in line to register for CME

The next meeting will be held on Tuesday, October 17, 2017, at HealthSource Saginaw. The speaker is Barb Smith of Survivors of Suicide, and she will present a program on “ZEROSuicide.” The meeting was adjourned at 8:45 p.m. Respectfully submitted, Joan M. Cramer Executive Director

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The Bulletin | October 2017

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APPLICATIONS FOR MEMBERSHIP

Kaitlyn E. Matz Bishop, DO

(Covenant HealthCare Emergency Department) Primary: Emergency Medicine Medical School: Michigan State University College of Osteopathic Medicine, 2013 Sponsors: Doctors Matthew D. Deibel and Aaron K. Smith

Below are Applications for Membership that may be recommended for acceptance at the Tuesday, November 21, 2017, Board Meeting. Please contact Joan Cramer at jmcramer@sbcglobal.net or 790-3590 if you have any questions or would like more information on the applicants.

S. Sethu K. Reddy, MD

Joseph P. Contino, MD

(Covenant Cancer Care Physician Group) Primary: Surgery-General, Board Certified Secondary: Surgery-Breast Medical School: Loyola Stritch Medical School, Chicago, IL, 1988 Sponsors: Doctors Ronald A. Bays and Sussan M. Bays

(Endocrinology, Diabetes & Metabolism) Chair, Discipline of Medicine | CMU College of Medicine Primary: Internal Medicine, Board Certified 1984 Secondary: Endocrinology, Diabetes & Metabolism, Board Certified 1985 Medical School: Memorial University of Newfoundland, 1980 Sponsors: Doctors Ramakrishnayya Gadam and Steven J. Vance

Asif H. Khan, MD

Benjamin R. Schoener, MD

(CMU Health-Psychiatry) Primary: Psychiatry, Board Certified 2016 Secondary: Psychiatry-Geriatric Medical School: Khyber Medical College, Peshawar, Pakistan, 2004 Sponsors: Doctors Furhut R. Janssen and Sunil D. Parashar

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23rd Annual Cornette Ball to Honor Valley Anesthesia Physicians St. Mary’s of Michigan Foundation is pleased to announce, for the first time in history, a physician group will receive the prestigious Spirit of St. Vincent Award. Valley Anesthesia, comprised of five outstanding physicians, will be honored during the 23rd Annual Cornette Ball on Saturday, November 18 at 5:30 p.m. at Horizons Conference Center. Serving the Great Lakes Bay region for more than 17 years, Valley Anesthesia has devoted their careers to living the values and mission of St. Mary’s. The physician group includes: Bapineedu Maganti MD, Anirudha Bhandiwad MD, Sunil Pandit MD, Zakir Qureshi MD and Ramesh Raju MD. Their combined years of service to St. Mary’s of Michigan is more than 116 years.

Working quietly behind the scenes, the physicians have provided care for thousands of patients. No matter the time of year or day of the week, Valley Anesthesia has covered all surgical cases during the group’s tenure at St. Mary’s of Michigan Medical Center and St. Mary’s of Michigan Towne Centre. It is with great pride this humble team has never had to call in a replacement anesthesiologist. The St. Mary’s of Michigan Foundation Cornette Ball is one of the grandest black-tie galas in the region. The evening includes a cocktail hour, a magnificent five-course gourmet meal and live music by Detroit’s Intrigue. The Spirit of St. Vincent Award is presented annually to at least one highly respected physician or group who has rendered long and noteworthy service to the Great Lakes Bay community and beyond. Proceeds from the event will stay local by supporting the purchase of a new state-of-the-art cardiac catheterization lab. New technology provides faster and more precise cardiovascular exams, potentially decreasing time spent in the operating room or saving a patient from surgery altogether. For sponsorship information or to purchase tickets, call the Foundation at 989-907-8300 or visit www.stmarysofmichigan.org/foundation. 20 The Bulletin | October 2017

St. Mary’s Chesaning Physicians Give Back This summer, St. Mary’s of Michigan in Chesaning held its annual sports physical events for middle and high school students. Two events were held and, just as in past years, all event proceeds were donated back to Chesaning athletic programs. Presenting this year’s contribution of $2,000 to the Chesaning High School athletic program are, l-r: Susan Jaskiewicz NP; Robert Sager, Chesaning High School; Doug Forsyth MD; and Mike Persons, PA. In addition, St. Mary’s Chesaning donated $300 back to the youth football program.

St. Mary’s Re-Verified as Level II Trauma Center The Trauma Center at St. Mary’s of Michigan has been reverified as a Level II Trauma Center by the Verification Review Committee (VRC), an ad hoc committee of the Committee on Trauma (COT) of the American College of Surgeons (ACS). This achievement recognizes the Trauma Center’s dedication to providing optimal care for injured patients. St. Mary’s of Michigan has been designated a Level II Trauma Center since 2008. Samer Kais MD, Trauma Medical Director, leads the St. Mary’s trauma program and can be reached for consults through the Emergency Department at (989) 907-8200. As a Level II Trauma Center, St. Mary’s provides 24-hour immediate coverage by highly trained trauma surgeons and physicians specializing in emergency medicine, anesthesiology, neurosurgery, orthopedic surgery, radiology and critical care, and trauma-trained nurses. In addition, a Level II Trauma Center is committed to trauma prevention, continuing education of the trauma team members and to continued improvement in trauma care through a comprehensive quality assessment/performance improvement program. The re-verification process occurs every three years to ensure optimal care is given to trauma patients. The process includes an extensive review of the hospital’s physical plant, equipment, personnel qualifications, and performance improvement process during a two-day site visit.


St. Joseph

Lung C a ncer Scr eening Progr a m

Take charge of your lung health A lung screening could save your life!

Is it covered by insurance?

If you’re a long-time smoker age 55 to 80, you’re at a higher risk for developing lung cancer. National studies have shown a low-dose CT (computed tomography) lung screening can diagnose early stage lung cancer, when it can be more effectively treated. An early diagnosis could save your life.

• Medicare covers an annual low-dose CT lung cancer screening for beneficiaries who meet the criteria.

Why is a lung cancer screening important? • Can detect cancer long before symptoms are present • Identifies the cancer’s stage to help your doctor decide the best course of treatment. • Early diagnosis can reduce the risk of death by up to 20%

• Most private insurances now cover all or a majority of the screening cost. A self-pay option is also available.

What are the benefits of going to St. Mary’s of Michigan and St. Joseph Health System? • Education about the benefits and risks of a lung cancer screening to help you make an informed decision.

• Noninvasive, painless and only takes a few minutes.

• Low-dose computed tomography with expert radiological interpretation.

Who should get a lung screening?

• Interdisciplinary lung nodule review by physicians for every positive screening result.

High-risk category 1: • Age 55-80 years (77 with Medicare)

• A thorough follow-up report and recommendation is sent to your primary care physician.

• Asymptomatic (no signs or symptoms of lung cancer)

• Immediate access to experts in the treatment of lung cancer.

• Smoked at least 30 pack years (1 pack a day for 30 years OR 2 packs a day for 15 years, etc.)

• Patient Navigator to coordinate care, answer questions and provide support.

• Currently smoking or have quit smoking within the last 15 years

Where do I go for my screening?

High-risk category 2a:

St. Mary’s of Michigan & St. Joseph Health System offer two convenient locations:

Age 50 or older with a 20+ pack year history AND one additional risk factor (family history of lung cancer, emphysema, pulmonary fibrosis or exposure to certain carcinogenic substances).

• Located inside St. Mary’s of Michigan Towne Centre 4599 Towne Centre Road, Saginaw • Located inside St. Joseph Health System 200 Hemlock, Tawas City

Call now to learn about your options and to schedule your The Bulletin | October 2017 lung cancer screening. 1-866-246-4673

21


Office of Continuing Medical Education

DIABETES DAY for Health Professionals REGISTER NOW by contacting Carolyn.Yordy@cmich.edu or (989) 774-1258 Saturday, November 11, 2017, from 7:30 a.m. to 12:15 p.m. CMU College of Medicine in Mt. Pleasant Target Audience: Primary Care Physicians and Health Professionals Engaged in Diabetes Care The inaugural CMU College of Medicine and McLaren Central Michigan Health Diabetes Day for Health Professionals will include industry exhibitors and topics ranging from bionic pancreas and metformin failure to retinopathy and female reproductive health. CMU College of Medicine Partners with Grand Valley State University Collaborative program grants early admission assurance to GVSU pre-med students Through a new cooperative agreement, Grand Valley State University pre-medical students will have an opportunity of early assurance of admission to the Central Michigan University College of Medicine through the Early Assurance Program (EAP). “We are very excited about this new partnership,” said CMU College of Medicine Dean Dr. George E. Kikano. “It will provide an enhanced opportunity for GVSU’s pre-medical students who demonstrate a desire to practice medicine in Michigan, and it expands upon our existing interprofessional education relationship with GVSU.” The agreement - signed by CMU President George E. Ross and GVSU President Thomas Haas on October 19 in a formal ceremony that took place on CMU’s campus will enhance opportunities for GVSU pre-med students to

L-R Dr. Jean Nagelkerk, Dr. Maria Cimitile, Dr. Thomas Haas, Dr. George Ross, Dr. Michael Gealt and Dr. George Kikano

22

The Bulletin | October 2017

GVSU President Thomas Haas (left) and CMU President George E. Ross talk with CMU College of Medicine student, Shelby Falkenhagen, who received her bachelor’s degree from GVSU.

navigate more easily through the highly competitive CMU College of Medicine admissions process by: • Waiving supplemental application fees. • Processing endorsed students on an earlier admissions timeline. • Facilitating engagement opportunities between GVSU pre-med students and existing CMU College of Medicine students. • Reserving up to five positions for endorsed GVSU students to be admitted. This is the same agreement the College of Medicine has in place with CMU, Albion College and Saginaw Valley State University, providing pre-med students at these institutions the same opportunity to compete for admission. “This partnership increases the footprint of the College of Medicine, with GVSU’s multiple locations throughout the state, and is just one more way we will be achieving our mission to produce physicians with a passion for serving the people of Michigan who need them most,” Kikano said. “We identify our admitted students based largely on their expressed desire to focus on rural and underserved populations, which is core to our mission.” Students will be required to meet the College of Medicine’s academic standards to participate in the EAP, which is designed as a three-year pilot. Jean Nagelkerk, Vice Provost for Health at GVSU, said this agreement serves as an example of public higher education institutions collaborating to meet the needs of the state of Michigan and its residents. Added benefits of the program, Nagelkerk said, are that admitted students do not have to submit multiple applications to medical schools and are notified of their acceptance before their senior year at GVSU. “This affords students an opportunity to concentrate on broadening their continued on page 23


continued from page 22 knowledge base and skill set while engaging in high-impact learning experiences during their senior year,” she said. Resilience in Health Professions Education and Practice A fantastic series of presentations were brought to the CMU College of Medicine’s medical students, faculty and staff on September 20 by Hedy S. Wald, PhD, a Clinical Professor of Family Medicine at The Warren Alpert Medical School of Brown University and Director of Resident Resilience and Wellbeing for Residency Programs in Child Neurology and Neurodevelopmental Disabilities at Boston Children’s Hospital/Harvard Medical School. Dr. Wald presents keynotes, plenaries, and experiential workshops promoting resilience, well-being, and vitality in health professions education and practice. This dynamic medical educator also presented to the Saginaw County Medical Society at their evening Membership Meeting (see p. 16-17). Opioid Conference a Success Opioid use is a huge topic of concern right now, and Central Michigan University appreciated the flurry of media attention received for Michigan’s Opioid Epidemic: A Regional Forum held in October at the CMU College of Medicine, including on WNEM TV5 News. The forum examined how the opioid epidemic is impacting the Great Lakes Bay Region and Michigan. This forum was a collaboration of the CMU College of Medicine, Central Michigan University College of Health Professions and the College of Education and Human Services. Mary Keane Stellar Educator Award Winner Sue Baase, RN, of CMU Health’s Family Medicine Department, was presented with the Mary Keane Stellar Educator Award. This award was created in memory of Mary Keane, NP, to annually honor a CMU Health employee who represents the qualities Mary personified each day of her life and in her dedication to excellence in education. Sue has worked for the CMU

Health Department of Family Medicine for 14 years, and is exceptionally devoted to patient care and resident education. “Sue is a well-respected member of the Family Medicine team,” said Dr. Delicia Pruitt, Family Medicine Program Director. “She was voted most helpful by the most recent class of graduating residents, and is always willing to answer questions from residents and faculty.” Dr. Mary Jo Wagner, DIO and Chief Academic Officer, said of Sue: “In graduate medical education, we recognize that the training of residents requires much more than just teaching from faculty physicians. Sue represents the critical contribution that nurses, medical assistants and other personnel can bring to rounding out the education of our future physicians.” Podiatry Residency Now Offered at CMU In addition to the five residency programs offered by CMU Medical Education Partners, podiatry is now the sixth program. CMU was granted approval on July 27, 2017, by the ACGME to commence a Podiatric Medicine and Surgery Residency with Reconstructive Rearfoot/Ankle Program, which began on August 1, 2017. This addition will greatly enhance the continuum of medical education we are able to provide, thereby improving patient care delivered by resident and fellow physicians. Learn more about the program by clicking here. Save The Date for 2018! The CMU College of Medicine and CMU Medical Education Partners Research Symposium is scheduled for Wednesday, April 11, 2018. More details to come from the symposium organizers, Dr. Neli Ragina, Dr. Edward McKee and Dr. Mary Jo Wagner. Until then, direct any questions you may have to Dr. Ragina at ragin1n@cmich.edu. More details to come…

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. The Bulletin | October 2017 23


Human Trafficking Awareness Training a Huge Success! Thank You CMU College of Medicine Office of Continuing Medical Education

On Saturday morning, September 30, CMU College of Medicine Office of Continuing Medical Education offered a CME accredited Human Trafficking Awareness Training at Horizons Conference Center in Saginaw. The training was funded by a grant from The Dow Chemical Company Foundation Donor Advised Fund. Many SCMS members and healthcare professionals attended the training which is now required by the State of Michigan/LARA for license renewal. Dr. Sam Shaheen opened the event, and introduced Attorney General, Bill

Schuette. Assistant Attorney General, Kelly Carter, Chair of the Michigan Human Trafficking Commission, MSP Trooper William Smith, and LaClaire Bouknight, MD, FACP, certified in Addiction Medicine, Capital Area Anti-Trafficking Task Force and Founder of EagleVision Ministries also presented. The final speaker was Joyce Dixson-Haskett LMSW ASCW SAP, a Human Trafficking Survivor who went to prison for saving her own life by killing the person who sold her as property. She finished her Bachelor’s Degree while incarcerated, and is now a front-runner in the advocacy for children of incarcerated parents. Joyce holds a Master’s Degree in Social Work from the University of Michigan; but more importantly, she was an incarcerated mother for 17 years. She knows firsthand how the incarceration of a parent adversely affects the children. Joyce began fighting for the rights of women and their children while she was behind bars, and continues to work diligently on behalf of this “elite” population. She is also among those in the fight against Human Trafficking and continues to advocate for freedom and the restoration of dignity and value to those affected by a broken system. Those in attendance gave her a standing ovation for her bravery in returning to Saginaw where it all started, and sharing her story so others could be saved. Dr. Millie Willy, Chair of the CME Committee, closed the training by thanking those who spoke and attended. The Saginaw County Medical Society would like to thank CMU College of Medicine Office of Continuing Medical Education for presenting the training.

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(Above) Drs. Larry Whiting and Tony deBari (Middle - Top) Dr. Sam Shaheen opens the training (Middle - Bottom) LaClaire Bouknight, MD, FACP (Right - Top) Attorney General Bill Schuette and Dr. Millie Willy (Right - Botom) Dr. Millie Willy, HT survivor Joyce Dixson-Haskett and Joan Ford

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IT Specialist to the SCMS and many physician practices Hours: MON-FRI 9 AM to 5 PM The Bulletin | October 2017 25


Covenant Diabetes Center Seminar Covenant Diabetes Center is hosting their second annual seminar on Advancements in Diabetes Management on Friday, November 10 at St. Stephens School in Saginaw. The seminar is geared for the health professional working with diabetic patients, including physicians, nurses and dieticians. If you have any questions, contact Covenant Diabetes Center at 989.583.5193. Honoring Those Who Have Served A group of dedicated Covenant employees felt that all veterans – living or deceased – should receive the respect and recognition they deserve in return for their service to our country. The Covenant Veteran Recognition Program kicked-off Tuesday, May 30, 2017. The goal of the program is to identify veteran patients so they can be acknowledged and greeted appropriately throughout their hospital stay. If the patient

agrees to be identified, an American flag sticker will be placed on their whiteboard to indicate this patient is a veteran. Nursing staff and the care team will be encouraged to thank them for their service and elicit conversations regarding their branch, years and locations of service. Should a veteran pass away within our facility, permission will be sought from the family to honor their loved one with a “Final Salute” ceremony. If granted, “Code Honor” is paged overhead to alert staff, visitors and volunteers that the ceremony is occurring and on which unit. The patient is then draped with a flag and a blessing is performed at the bedside. As the deceased passes from the room to the elevator, personnel wishing to participate quietly line the hallway, placing their hand over their heart or if a veteran, they may salute. There is total silence as the patient and flag passes. The family is then presented with the folded flag and a certificate commemorating their loved one’s service to our country. Tony Lyle is a member of the Veteran Recognition team, a diverse group of hospital staff who’ve worked on this special

continued on page 27

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The Bulletin | October 2017

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continued from page 26 act of deference for nearly a year. “I’m proud to be part of an organization that strives to recognize and honor the veterans and their sacrifices and those of their family as well,” said Lyle, a Patient Safety Administrator and Navy veteran. To those veterans reading this, please accept Covenant’s appreciation for your service to our country.

Covenant Celebrates 10 Years Since EMR Go-Live Covenant HealthCare was the first hospital in the region to convert the entire organization over to an electronic medical record (EMR) system ten years ago. In 2007, Covenant invested more than $25 million into this project to improve patient safety and satisfaction, staff and physician efficiency, and improved quality of care. Today, patients continue benefitting from this investment. Here’s what took place: July 2007: Physician offices go-live August 2007: Hospital-wide training began for approximately 5,000 employees, physicians, students and volunteers Fall 2007: September 29 kicked-off hospital go-live, which included scheduling, billing, registration, pharmacy, clinical documentation and release of information. For roughly a year, 50 medical professionals from across disciplines committed to designing, building and integrating

EMR at Covenant using the Epic system. Today, IT continues to train thousands of doctors, advanced care practitioners, nurses, clinicians and staff, while keeping nearly 200,000 patients safe. The connectedness helps in the exchange of lifesaving information between providers and medical facilities. In addition, MyChart now allows Covenant patients to access their own medical records on smart phones, tablets and computers. Currently, 37,036 people use the MyChart application. “Covenant is a leader in identifying and implementing innovation that supports Extraordinary Care for Every Generation,” said IT Director, Frank Fear. “To be one of the first health systems in the state to implement Epic 10 years ago is just one example of our dedication to implementing patient centric innovation.” Covenant would like to thank many of you for the role you played in this 10-year journey.

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NOVEMBER BIRTHDAYS Saleh K. Alotaibi MD 11/10 Michael T. Bergeon MD 11/22 Vedang J. Bhavsar MD 11/30 John Blebea MD 11/12 Michael A. Butman MD 11/3 Jeffery W. Carney MD 11/26 Anthony deBari MD 11/19 Amandeep S. Dhaliwal MD 11/18 Mark G. Greenwell MD 11/23 Zeina Habib MD 11/24 Trina Hara MD 11/3 Ronald C. Hazen MD 11/7 Christopher R. Heberer DO 11/12 Furhut R. Janssen DO 11/20 Beverly A. Jarema DO 11/19 Adebambo M. Kadri MD 11/10 Phadej Keopunna MD 11/18 George E. Kikano MD 11/6 Nikolai Kinachtchouk MD 11/2 John M. Kosanovich MD 11/11 Neil W. Love MD 11/4 Happy Special Birthday to Dr. Love! Asad I. Mehboob DO Kirstan K. Meldrum MD Mary E. Mullins MD

11/28 11/7 11/13

Bernard D. Noveloso MD Loretta R. O'Donnell MD Niharika Perni MD Jorge M. Plasencia MD Tracie I. Potis MD J. Eugene Rank MD Rita S. Ratani MD Pallavi Rath MD Deborah L. Russell MD Julie Taylor MD Patricia V. Valia MD Chandler G. Veenhuis DO Mildred J. Willy MD Pervez Yusaf MD

HAP Issues I have been hearing providers are having issues with HAP authorizations, among other things. If you have not already done so, will you please contact me at jmcramer@sbcglobal.net and let me know if you have patients with HAP and are having issues, and if so, what kind? Please feel free to forward this request to your colleagues. HAP hosted a focus group in Genesee County this summer, and is looking to have one in Saginaw this fall. Information received will remain confidential. Thank you. Joan Cramer, SCMS Executive Director

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How the Angel Program started: For decades, police officers have been on the front lines of the war on drugs. In an attempt to disrupt an ever-increasing supply chain, police officers often find themselves arresting drug addicts as much, if not more so, than drug dealers and traffickers. In the meantime, heroin and opioid addiction has become a severe public health concern in the United States, destroying and often ending lives. In 2015, the Gloucester, Massachusetts Police Department developed a revolutionary new way to fight the war on drugs by doing something about the demand; not just the supply. Under this plan, drug addicts who seek help are placed in a recovery program rather than face arrest and jail time.

Questions about the MSP Angel Program? CONTACT: Michigan State Police Grants and Community Services Division Phone: 517-284-3208 MSP-Angel@michigan.gov www.michigan.gov/cjgrants

The Police Assisted Addiction and Recovery Initiative (PAARI) is a nonprofit organization whose mission is to support police departments with implementing similar programs that foster a dialogue around the unique opportunity for law enforcement to take direct action against the disease of drug addiction in their communities.

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MSP Angel Program - Volunteers Needed! The MSP Angel Program allows an individual struggling with drug addiction to walk into a MSP post during regular business hours and ask for assistance. If accepted into the MSP Angel Program, the individual will be guided through a professional substance abuse assessment and intake process to ensure proper treatment placement. An “Angel” volunteer, who is a member of the local community, will be present to support the individual during the process, and to provide transportation to the identified treatment facility. QUALIFICATIONS: Reliable, non-judgmental and compassionate individuals. Flexibility is a must in this position. Ability to stay calm under pressure or in difficult situations is a necessity. Willingness to assist in additional tasks, as needed, is essential. All Angels must sign applicable MSP Angel Program paperwork, including confidentiality and liability release waiver forms.

REQUIREMENTS: • At least 21 years of age • Valid driver’s license • Registered, insured vehicle in operating condition • Provide transportation to treatment center for participant • Pay for required meals and lodging up front then request reimbursement which may take up to 60 days • Submit to Criminal History Background Check • At least two years in recovery • Attendance at all mandatory training • Reliable contact information (phone and email) • Ability to provide schedule of availability • Fill out and sign required Angel paperwork PRIMARY RESPONSIBILITIES: • Must be within one hour drive of the MSP Post • Listen and engage with participants • Provide resources and encouragement • Assist participant with program paperwork

If you, or someone you know of, is interested in learning more about the “Angel Program,” please contact: Michigan State Police | Grants and Community Services Division Phone (517) 284-3208 | MSP-Angel@michigan.gov www.michigan.gov/cjgrants The Bulletin | October 2017 29


So You’re an Employed Physician: What You Ought to Know Despite the fact that employment now rivals ownership as a leading practice arrangement among doctors, physician contracts are being terminated - or not renewed - with more frequency than ever before. Much of that is physicians choosing to leave. One-fourth of physicians quit within the first three years working in a practice, according to data provided by the health carerecruiting firm Cejka Search. An education session at the 2017 AMA Annual Meeting in Chicago, led by lawyer Richard Levenstein, detailed this trend and how physicians can protect their interests in contract negotiations. “The more you do on the front end, the better off you are on the tail end. That’s why negotiating a contract is so important from the beginning,” said Levenstein, a partner at Kramer, Sopko & Levenstein who has been representing physicians in Florida for two decades. Per Levenstein’s presentation, contracts are generally terminated in two ways. • The first is termination without cause. This method is generally the least complicated form of termination. It can be utilized by either the physician-employee or the employer. It could be that an employer cannot afford to keep a physician or that a physician is opting to go into private practice. • The second is termination for cause. This type of termination typically means an employee or employer did not uphold their portion of the contract. It could involve a promise made by the employer in the verbiage of the contract - such as an assurance of partnership after a specified time frame - that is not upheld. In the case of the employee, something as simple as missing a few shifts, could trigger a termination for cause, were it stipulated in the contract.

What To Do When a Contract is Terminated The termination of a contract does not always signify the end of a physician’s responsibilities and obligations. Doctors have both professional and financial obligations they may have to meet. These may include completing health records and billing statements. Financially, a physician may have to repay vacation days or other vested benefits. If physicians don’t understand the compensation formula, they could be in for a rude awakening upon termination of the contract. “If there’s a draw against productivity or any other formula other than straight salary, the physician may find himself or herself in a position that the employer takes a position that they are owed money because of a lack of productivity,” Levenstein said. There’s also the matter of future employment. “If you’re terminated for cause, most employers ask why you left your prior employment,” Levenstein said. “Most of the time, 30

The Bulletin | October 2017

when a physician is terminated for cause, either there is a dispute between the physician and the practice or the practice isn’t satisfied with the physician’s performance. “If the prior employer is contacted, depending on the type of reference they give, it sometimes can be problematic,” he added. “A separation or termination agreement can be important because it will contain a non-disparagement clause.”

Understanding Restrictive Covenants Restrictive covenants - in some instances referred to as non-compete clauses - are commonplace in physician contracts, even if they may not be fully enforceable. Often these will impact when and where a physician can practice, but they can be much more wide-reaching than those basic restrictions. When you are in the process of dealing with a restrictive covenant, you should speak with a lawyer who knows the law on non-compete clauses and how it typically plays out for physicians in a particular jurisdiction. Levenstein said the following factors may affect the enforceability of restrictive covenants: • Are there legitimate business interests at stake? • Is the scope (time, geography) reasonable given market conditions? • Is there unreasonable restraint on physician’s trade, creating undue hardship? • Is there a public interest at stake? • Who and what triggered the contract termination? • Is there a buy-out option? One of the biggest mistakes physicians make, according to Levenstein, is failing to tie the non-compete covenant to the contract’s termination provisions. “If the employer terminates without cause, then the covenant not to compete should not apply,” he said. “And if the employee terminates for cause, the covenant should not apply.” How to Resolve a Contract Dispute If a physician cannot reach an agreement with her employer upon the termination of a contract, some of the other options for resolution include: • Courtroom litigation: The legal process offers extensive rights and the option to appeal, but it is costly and time consuming. • Binding arbitration: A less expensive alternative to courtroom litigation, but the arbitrators decision is final, meaning there’s no wiggle room for the losing party and no right to appeal. • Mediation: The cheapest option for dispute resolution, but it is not typically binding for all parties. The AMA provides many resources to help physicians understand employment contracts, including a variety of model contracts e-books (free to AMA members). The Association also offers its members detailed guidance on the different practice arrangements available to physicians. The newest resource (login required), “A guide to joining or aligning with a physician-led integrated health system,” helps physicians determine whether this kind of setting is the right practice option for them. The guide covers types of physician-led integrated health systems; tips for assessing the performance of a system; checklists to help determine whether an integrated system is the right fit; and alignment options for independent or small practices. Brendan Murphy, Staff Writer, AMA Wire®


Physician Employment Contract Review PHYSICIAN ALERT: Carefully Review Contracts BEFORE Signing on the Dotted Line Michigan State Medical Society teams with Kerr Russell to offer contract review service MSMS issued a physician alert for Michigan physicians preparing to sign a contract with a hospital, health care system, or other employer, urging physicians to more carefully review their contracts before putting their name on the dotted line. “Few things will make as big a difference in your professional life as the contract you sign,” said David M. Krhovsky, MD, Past-President of MSMS. “Physician compensation agreements and quality measurement expectations are increasingly complex, and they deserve a second look before you ink your name on the dotted line.” MSMS is proud to offer MSMS members a dynamic contract review service through our partners at Kerr Russell. “Time after time, Michigan physicians have signed a contract only to learn later exactly what they agreed to,” said Daniel J. Schulte, JD, MSMS Legal Counsel and Managing Partner with Kerr Russell. “Signing a contract without a thorough review can affect everything from a physicians’ hours, responsibilities and compensation, to the terms and conditions for future partnerships.” Kerr Russell and the MSMS recently highlighted four key areas physicians should examine closely during contract negotiations: 1. Physicians should be aware of “non-compete” language and understand that such language is always enforceable.

Physicians signing a contract with a non-compete clause who later leave their position and take another in violation of the clause can face litigation and/or have difficulty convincing a future employer to hire him or her. 2. Physicians should ensure that any non-compete language includes an exception that applies when an employer terminates a contract without cause early in the term. 3. Contracts should include a provision requiring the employer to pay during the notice period after a contract is terminated, even if or when the employer prevents the physician from working. 4. Physicians should have a say in the wording of the notice that goes to patients, medical staff, or other third parties when a physician’s employment ends or is terminated. Through MSMS’s partnership with Kerr Russell, reviews are provided at a reasonable, fixed fee for MSMS members, and include review and advice regarding your contract and a telephone conference with the legal team to discuss their findings. “Physicians owe it to their patients and to themselves - to get their contracts right,” said Doctor Krhovsky. Physicians interested in scheduling a contract review are encouraged to visit https://msms.org/ContractReviews

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Please mark your calendar for the following meetings and events for 2017-2018. 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. Saturday, November 18, 2017 Bavarian Inn Lodge in Frankenmuth – “Survivors of Suicide – Hope Starts Here.” Click HERE for details.

Saturday, March 17, 2018 14th Annual Health Fair “The Doctor Is In,” at Horizons Conference Center, 9 a.m. to 1 p.m.

Tuesday, November 21, 2017 SCMS Board meets at 5:30 p.m. at CMU College of Medicine, 1632 Stone Street, Saginaw in Room 1016. There is no membership meeting in November.

Tuesday, March 20, 2018 SCMS Board meets at 5:30 p.m. at CMU College of Medicine, 1632 Stone Street, Saginaw in Room 1016. There is no membership meeting in March.

Monday, December 4, 2017 Saginaw Country Club - SCMS Alliance’s “14th Annual Jingle Mingle” at the Saginaw Country Club. See page 8 for details.

Tuesday, April 17, 2018 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. Tentative Program: “Second Victim.” See page 5 for more details.

There is no Board or Membership Meeting in December. Merry Christmas and Happy New Year to you and yours! Tuesday, January 16, 2018 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Membership Meeting (Joint with the Saginaw County Dental Society and Saginaw Valley District Dental Society) with Social at 6:30 p.m. followed by dinner and program at 7 p.m. Tentative Program: Head and Neck Trauma and Evaluating Back and Hip Pain in the Emergency Setting.” Speaker: Jim P. Getzinger MD, Emergency Medicine at Beaumont. See page 5 for more details.

Tuesday, May 15, 2018 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Annual Membership Meeting with Social (cash bar) at 6:30 p.m. followed by dinner at 7 p.m. Program: “Update on the CMU College of Medicine,” by Dean George E. Kikano, MD. See page 5 for more details.

Tuesday, February 20, 2018 SCMS Board meets at 5:30 p.m. at CMU College of Medicine, 1632 Stone Street, Saginaw in Room 1016. There is no membership meeting in February.

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

SCMS BULLETIN - October 2017