SCMS BULLETIN - December 2021

Page 1

The

Bulletin Saginaw County Medical Society

December 2021 | Volume 79 | No 9

REGISTER NOW!

January Membership Meeting “Management of Sleep-Related Disorders from a Medical and Dental Perspective”

SCMS Calendar of Meetings for 2022 p. 5 LARA Electronic Licenses Starting 1/1/22 p. 9 How to Write a Resolution to the MSMS House of Delegates p. 16

www.SaginawCountyMS.com


Expert rehabilitation is

CLOSE AT HAND.

IAN GONZALES, MD

BABATUNDE BABALOLA, MD

KEVIN ORLOSKI, MD

MARGARET SNOW, MD

JENNIFER WEEKES, MD

M. SOHAIL JILANI, MD

A team of physiatrists with specialized training and experience in rehabilitative care have joined Dr. Sohail Jilani, medical director of the Mary Free Bed at Covenant HealthCare Physical Medicine and Rehabilitation Program. Our inpatient program now serves children and adults with complex conditions, such as brain injuries, multiple trauma and spinal cord injuries. Outpatient services include follow-up care for former inpatients as well as treatment for common diagnoses, including back pain and disorders of muscles, tendons and bones. For more information and referrals, please call 989.583.2720 (Outpatient Practice) or 989.583.2817 (Inpatient Rehabilitation).

MaryFreeBedatCovenant.com 700 Cooper, Suite 1100, Saginaw, MI 48602 GPS Address: 1100 Cooper, Saginaw, MI 48602


contents

The

Bulletin Saginaw County Medical Society

2021-2022 OFFICERS AND DIRECTORS President Anthony M. Zacharek MD President-Elect Tiffany K. Kim MD Past President Mildred J. Willy MD Secretary Caroline G.M. Scott MD Treasurer Miriam T. Schteingart MD Board of Directors Mark G. Greenwell MD Christopher J. Allen MD Furhut R. Janssen DO Harvey K. Yee MD Mary J. McKuen MD Kai Anderson MD Bulletin Editor Louis L. Constan MD Resident Representatives Jessica H. Faris MD Lydia T. Mansour DO Mohammed A. Saiyed MD Retiree Representative Caroline G.M. Scott MD Medical Student Representatives Ann Sobell, MD Candidate, Class of 2023 Mary Galuska, MA, MD Candidate, Class of 2024 MSMS Delegates Elvira M. Dawis MD Julia M. Walter MD Anthony M. Zacharek MD Christopher J. Allen MD Miriam T. Schteingart MD Kala K. Ramasamy MD Jennifer M. Romeu MD MSMS Alternate Delegates Caroline G.M. Scott MD Waheed Akbar MD Mohammad Yahya Khan MD Steven J. Vance MD Karensa L. Franklin MD Judy V. Blebea MD Elizabeth M. Marshall MD Nicholas E. Haddad MD Peer Review Ethics Committee Waheed Akbar MD, Chair Caroline G.M. Scott MD James R. Hines MD MSMS Region 7 Representative Mildred J. Willy MD MSMS President-Elect Thomas J. Veverka MD Executive Director Joan M. Cramer Administrative Assistant Keri Benkert

5, 32 REGISTER NOW!

10

5, 32 SCMS Calendar of Meetings

12-13 Preventing Suicide in

7

16-17 How to Write a Resolution

January Membership Meeting “Management of Sleep-Related Disorders From a Medical and Dental Perspective”

and Events for 2022

9

4 5 5 5 6 8 11 11

14 18 19

Renew Your SCMS/MSMS Membership for 2022 Today! LARA – Electronic Licenses Starting January 1, 2022 and Medical License Renewal What You Need to Know

President’s Letter Retirees Meet for Lunch Guest Writers Welcome! Caduceus Meeting for Recovering Health Care Professionals From the Editor Barb Smith SRRN Applications for Membership FREE Confidential Counseling For Frontline Healthcare Workers Ascension St. Mary’s Health Can’t Wait (SB 247) CMU College of Medicine CMU Health

E-Prescribing Exemptions for Compounded Prescription Formulations Update: Mandatory E-Prescribing Enforcement Delayed Until 2023 Michigan Men (PRiSMM) to the MSMS House of Delegates

25 31

Contact Your Elected Officials Today! 10 Facts About Physician Suicide and Mental Health

21 22 24

Peer Review Ethics Committee

25 26

Birthdays – January

Covenant HealthCare

MSMS – Legislative Update and MDHHS School Quarantine Guidance/Masking

AMA – Surprise Billing Litigation and Truth in Advertising Campaign

28

Health Professional Recovery Program

29 SafeHavenTM 30 End the Epidemic – MI CARES 30 Advertiser Index 32 Key Providers

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

EDITOR Louis L. Constan, MD EXECUTIVE DIRECTOR Joan M. Cramer DESIGNER Lori Krygier

PUBLISHER Saginaw County Medical Society 350 St. Andrews Rd., Ste. 242, Saginaw, MI 48638-5988 Telephone (989) 790-3590 | Fax (989) 790-3640 Cell (989) 284-8884 | jmcramer@sbcglobal.net Hours By Appointment | SaginawCountyMS.com

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 | December 2021 3


PRESIDENT'S LETTER

Change Management Anthony M. Zacharek, MD MHA

A

s 2021 draws to a close, now is a good time to look back on the year and reflect on what went right, and maybe what could have gone better. This self-reflection can apply to both your personal and your professional life. Are there examples of situations where you hoped a different outcome occurred? Was there a situation where you felt a lack of control or where you felt your voice was not heard? Was there a goal that you or your organization set and actually achieved? We can all learn from situations in our lives where a good outcome occurred or where nothing changed at all. At the heart of any outcome is the people involved and how well they stick to a goal. These ideas of setting a goal and reaching it come into play in the concept of change management. One way to think about change management is as an approach to managing change, whatever that change may be. In healthcare, change management

can apply to your office where you may want to change the way things are done, and it can apply to healthcare systems which may want to implement a new technology to improve patient care. Whatever the change may be, the field of change management can help guide you towards successfully reaching the change/goal that you are hoping for. A delightful book on the concept of change management is “Our Iceberg is Melting,” written by John Kotter in 2005. The book presents a group of penguins who are living on an iceberg that is melting, but only a few penguins know that. The challenge in the book is getting all the penguins that live on the iceberg to realize that it is melting and to leave the iceberg, before the iceberg actually melts. In the end, the book really teaches the reader about the important steps in change management, and how those steps can apply to your everyday life. According to John Kotter and his book, eight important steps

in change management are the following – create a sense of urgency, pull together the guiding team, develop the change vision and strategy, communicate for understanding and buy-in, empower others to act, produce short-term wins, don’t let up, and create a new culture. (Kotter, J. “Our Iceberg is Melting,” 2005) This eight step process for change management suggests that leadership, listening to all voices, and working towards a goal are important aspects in allowing a change to occur. In case you were wondering whatever happened to the penguins, they did finally all agree to leave the iceberg before it melted and found a safer iceberg to live on. Not only that, but the following year, they found a better iceberg to live on, and they moved again! Happy holidays to all members of our county medical society, and I hope you get whatever change you are hoping for this holiday season.

One way to think about change management is as an approach to managing change, whatever that change may be.

Read previous issues of The Bulletin at www.SaginawCountyMS.com. under the Bulletin tab 4

The Bulletin | December 2021


CALENDAR OF MEETINGS AND EVENTS FOR 2022* MAKE YOUR RESERVATION NOW! Tuesday, January 18, 2022 Horizons Conference Center, 6200 State Street, Saginaw Board Meeting – 5:30 p.m. Membership Meeting Welcoming our Dental Colleagues – Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Program: “Management of Sleep-Related Breathing Disorders from a Medical and Dental Perspective” Speakers: Christopher J. Allen, MD and Michael Thomas, DDS CLICK HERE TO MAKE AN ONLINE RESERVATION or scan the QR Code Tuesday, February 15, 2022 CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m. There is no Membership Meeting in February. Tuesday, March 15, 2022 CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m. There is no Membership Meeting in March.

RETIREES MEET FOR LUNCH! 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 questions, please contact Joan Cramer at (989) 284-8884 or Dr. Caroline Scott at (989) 295-2721.

Tuesday, April 19, 2022 Horizons Conference Center, 6200 State Street, Saginaw Board Meeting – 5:30 p.m. Membership Meeting – Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Program: “TED Talks – Overcoming Obstacles in Health Care” (inspirational talks that physicians can relate to) Speakers TBA Email meeting notices will be sent in early April. Online reservations are required. Saturday-Sunday, April 30-May 1, 2022 MSMS House of Delegates (location TBA) Tuesday, May 17, 2022 Horizons Conference Center, 6200 State Street, Saginaw Board Meeting – 5:30 p.m. ANNUAL MEMBERSHIP MEETING and ANNUAL SCMS FOUNDATION MEMBERSHIP MEETING – Social (cash bar) at 6:30 p.m., followed by dinner and meetings at 7 p.m. Email meeting notices will be sent in early May. Online reservations are required. Saturday, June 4, 2022 SCMS Foundation Golf Outing – Saginaw Country Club Tuesday, June 14, 2022 (second Tuesday) CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m. There is no Membership Meeting in June. *subject to change

Caduceus Meeting for Recovering Health Care Professionals Third Thursday of each month at 7 p.m. Zion Lutheran Church 454 7th Street, Freeland, Michigan (Behind Pat’s Grocery Store on Midland Road in Freeland)

GUEST WRITERS WELCOME!

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

If you would like to write an article of interest to your colleagues for publication in a future issue of The Bulletin, please contact Joan Cramer at jmcramer@sbcglobal.net for further information.

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

Articles are not designed for self-promotion, but rather as information for members.

We engage in group discussions where members may want to speak up, ask questions or share thoughts with fellow members. The Bulletin | December 2021 5


FROM THE EDITOR

It’s Not Your Fault By Louis L. Constan, MD

I

n the blockbuster motion picture “Good Will Hunting,” Robin Williams plays a professor trying to help a self-destructive mathematical genius played by Matt Damon, who actually wrote the screenplay based on his own childhood experience of being physically abused. After many rebuffs from Damon, in a dramatic scene in which Robin Williams brings up the abuse, Matt Damon’s character asks, “Have you had experience with that?” Williams knows that abuse victims often blame themselves (and punish themselves) for their abuse and reassures Damon that Damon’s abuse was “not your fault.” Damon starts to soften, but very slowly. It’s not your fault. Yeah. It’s not your fault. Yes I know. It’s not your fault. Yes I know that. This goes on ten, yes ten times. Finally, Williams shouts: “IT’S NOT YOUR FAULT!” and Damon breaks down, sobbing uncontrollably. The therapist in Robin Williams knows from personal experience that abuse victims often blame themselves for the abuse they suffer…and engage in self-destructive behavior as a way of punishing themselves. Matt Damon’s character needed to fully believe that “it is not your fault” before he could forgive himself and begin to heal. A truly dramatic scene. We should be able to relate to Matt Damon’s character. We doctors suffer a form of mental abuse currently known as “moral injury.” Defined as, when we “perpetrate, bear witness to, or fail to prevent an act that transgresses our deeply held moral beliefs.” Moral injury

was first described in soldiers who witnessed war crimes. And has since been described in other professions; especially in doctors, and mostly when we are caring for a patient who suffers because we cannot give him the care he requires. You know why. Insurance rules, government rules, employer rules. Something as mundane as navigating those endless clicks for that elusive screen needed for orders in the EMR. So, the question is, do we feel responsible when we fail to provide services even though we are handicapped? Of course we do…for the simple reason that we have taken that oath and there is always the thought that, no matter what the obstacles, we could or should have tried harder. An impossible expectation. So we become tired, cynical, depressed; we consider changing careers…traditionally called Burnout. Yet there are excellent reasons for designating this problem “Moral injury” rather than “Burnout.” The first is that 20 years of calling it Burnout has gotten us nowhere. Burnout implies we’re working too hard or improperly…and it’s up to us to fix this problem. We must “take care of ourselves.” Go to a seminar, start antidepressants, take time off, dabble in psychobabble reframing of the problem. The diagnosis is just wrong. “Moral Injury” is a much better description of what happens to doctors when we work day in and day out in an environment in which we are not allowed to do what is

right for patients…and indeed, are forced at times to do what is decidedly notright for them. With that in mind, let us imagine an encounter between Therapist Williams and a physician who is having recognizable angst: Physician: I’ve been trying to prescribe for my patient a new med, but the insurance company insists I try another med for a month. I know that med won’t work. I feel bad my patient will suffer for another month at least. Williams: It’s not your fault. Physician: I tried getting an MRI for my patient. The Insurance company insists on a CT first. That will needlessly delay the likely diagnosis of cancer, which may progress in the meantime. What can I do? Williams: It’s not your fault! Physician: My patient needs to be admitted, but there are no beds available. Williams: IT’S NOT YOUR FAULT! We realize the problems with healthcare in America; decisions are made by non-doctors and for financial reasons rather than for what’s best for patients. The persons making those decisions do not have to deal with the suffering that their decisions cause. We do. The patients suffer, and we suffer with them. That’s the moral injury and that’s what we as doctors need to challenge. continued on page 7

Yet there are excellent reasons for designating this problem “Moral injury” rather than “Burnout.” The first is that 20 years of calling it Burnout has gotten us nowhere. 6

The Bulletin | December 2021


continued from page 6

Bottom line: It’s not our fault, but IT IS OUR FIGHT! So, here is what it means to be a doctor in the 21st Century: We do our very best for the patient one-on-one, knowing that this will never be enough, given that our hands are often tied. Then, we fight like devils in the public arena, collectively, through organizations such as the SCMS and MSMS to un-tie those hands so that we can truly do what we know is right for that patient. If you find it difficult to communicate with your doctor; if you find it hard to get personal attention from an 'impersonal healthcare industry'; if you don't understand all those insurance-company rules; if you don't know how to change your bad health habits; if you think you may be on unnecessary medications; if you are perplexed by those annoying healthproduct advertisements; and if you'd like to know which are your greatest health risks - you'll appreciate this Family Doctor's advice, gleaned from 44 years of practice. Each chapter is illustrated with reallife examples from his and other doctors' practices. Each chapter ends with 'bonus' essays written by the author and published in newspapers and magazines giving the doctor's viewpoint. This will give you a unique perspective and allow you to 'get into the mind' of a doctor. Sweet! Available on Kindle (different cover but same book) and paperback. Available on Amazon by clicking HERE 1

All statements or comments in The Bulletin are those of the writer, and not necessarily the opinion of the Saginaw County Medical Society (SCMS). The Bulletin is made available electronically for members as an informational service. Reliance on any such information is at the user's own judgment. The SCMS, its officers and employees, cannot guarantee the accuracy, reliability, completeness or timeliness of any information, and may not be held liable for any individual’s reliance on our web or print publications. For questions or the latest information, please contact Joan Cramer of the SCMS at (989) 284-8884 or jmcramer@sbcglobal.net.

PLEASE PAY YOUR 2022 MEMBERSHIP DUES Membership dues for the SCMS and MSMS are due and payable on December 31, 2021. HOW TO PAY • Online CLICK HERE • Fax to (517) 481-3976 • Mail to: MSMS Membership Department | PO Box 950 East Lansing, MI 48823 Tax Information SCMS/MSMS dues are not deductible as a charitable contribution but may be deductible as an ordinary and necessary business expense (check with your tax specialist). SCMS dues are 100 percent deductible as an ordinary business expense, and 87.4 percent of MSMS dues are deductible because a portion of dues is attributable to lobbying activities. The SCMS and MSMS are non-profit organizations focused on improving the lives of physicians so they may best care for the people they serve. Click HERE for Benefits of SCMS membership. The strength and effectiveness of SCMS/MSMS as your professional association is predicated on strong membership. For questions about membership or if you have not yet received your 2022 dues invoice, please contact Joan Cramer, SCMS Executive Director at jmcramer@sbcglobal. net.

WHY PAY DUES? • Because all physicians need to “fund their voice.” • National polls show physicians as one of the most respected professions. Sadly, they don’t use their clout often enough to preserve their profession and protect their patients. • There is strength in numbers. Together we are stronger.

The Bulletin | December 2021 7


Hope Starts Here

The Saturday before Thanksgiving is recognized as International Survivors of Suicide Loss Day. This day brings together loved ones who have experienced a loss to suicide and offer connection, understanding and hope through their shared experience. On Saturday, November 20, more than 150 people attended Hope Starts Here at the Bavarian Inn Lodge in Frankenmuth. Frank Campbell, Ph.D., LCSW, C.T., a nationally-known expert on suicide grief, served as this year’s keynote speaker. Dr. Campbell has served as the Executive Director Emeritus of the Baton Rouge Crisis Intervention Center, where he founded the National Suicidology Training Center (NSTC). During his more than 35 years of working with those bereaved by suicide, he introduced his Active Postvention Model (APM) in 1997. It is most commonly known as the LOSS Team (Local Outreach to Suicide Survivors). He is a past-president of the American Association of Suicidology and a recipient of both national and international awards for his contributions. The Saginaw County Medical Society was once again proud to serve as one of the sponsors.

Survivors of Suicide Support Group

Survivors of Suicide is now back in person! If you or someone you know has been impacted by suicide, call us at (989) 781-5260 ext. 2 to learn more about our support group.

Consider Adding Survivors of Suicide, Inc., As Your Charity of Choice on Amazon Smile!

Are you in a crisis? Call 800-273-8255 or text TALK to 741741. Anyone who needs help can call the National Suicide Prevention Lifeline 24 hours a day, seven days a week, at 1-800-273-8255 or 1-800-273-TALK. Press 1 for the Veterans Crisis Line. Anyone under age 21 can ask to talk to a peer at Teen Link, 1-866-833-6546. TTY users can use their preferred relay services or dial 711 then 1-800273-8255.

www.SaginawCountyMS.com 8

The Bulletin | December 2021


Osteopathic physicians are required to complete a minimum of 60 hours in Category 1. Click HERE for a brief description of each category and the number of allowable hours and acceptable documentation.

Electronic Licenses Starting January 1, 2022 In 2017, the Bureau of Professional Licensing (BPL) started a project to migrate over 700,000 licenses to a new licensing platform called MiPLUS. We are happy to report this project was completed in October of this year. We would like to take this opportunity to thank you for your patience and support during this multi-year transition. We are happy to have the benefits MiPLUS offers which include an online account and an electronic application. As soon as your license is issued or renewed, you will receive an electronic copy of your license via email. Electronic copies of licenses are also stored in your MiPLUS account and can be accessed at any time. Due to the functionality of MiPLUS, paper copies of licenses will no longer be automatically mailed upon issuance or renewal beginning January 1, 2022. Instead, licensees will be able to choose if they’d prefer to have a copy of their license mailed to them during the application or renewal process. Not only does this change benefit licensees because an electronic copy is immediately available, but this change will have a positive impact on our environment by saving up to 300,000 pieces of paper each year. To access your MiPLUS account, please visit www. michigan.gov/miplus. If you have any questions, please contact us at bplhelp@michigan.gov or 517-241-0199. Debra Gagliardi, Director Bureau of Professional Licensing Department of Licensing and Regulatory Affairs

Medical License Renewal – What you Need to Know As a reminder, physician license renewals are quickly approaching. One third of licensed osteopathic and allopathic physicians are required to renew their three-year license every year. Please see the information below to assist with the process and requirements. Check your license by visiting the Department of Licensing and Regulatory Affairs online>> Every 3 Years Medical doctors are required to complete 150 hours of continuing education of which a minimum 75 hours of the required 150 hours must be earned in courses or programs designated as Category 1 programs. The remaining 75 hours may comprise of Category 1 and 2 credits within the maximums allowed. Click HERE for a brief description of each category and the number of allowable hours and acceptable documentation.

Required CME Within the 150 hours of continuing medical education, a minimum of one hour of continuing education must be in the area of medical ethics and three hours must be in the area of pain and symptom management (with at least one of the three hours specifically on controlled substance prescribing). In addition, effective June 2022, a minimum of three hours every three-year relicensing cycle is required in Implicit Bias education. Renewals in January 2022 need no training; renewals in 2023 need one hour; renewals in 2024 need two hours; renewals in 2025 need three hours. Then after, every threeyear renewal cycle will need to report three hours. Hours earned after June 2021 can be used. One-Time Requirements Effective January 4, 2019, LARA announced a one-time Opioids and Controlled Substances Awareness Training Standards for Prescribers and Dispensers of Controlled Substances. This is separate from continuing education for an individual seeking a controlled substance license or who is licensed to prescribe or dispense controlled substances. Licensees that prescribe or dispense controlled substances who renewed in 2019 must complete training by January 31, 2022; renewals in 2020 by 2023; and renewals in 2021 by 2024. Also, separate from continuing medical education requirements, physicians must complete a one-time human trafficking requirement. For physicians whose license renewed in 2019, this training must be completed by January 31, 2022. Recognition of Hours Worked Responding During the COVID-19 Emergency Include your hours claimed on behalf of Executive Orders 2020-13, 2020-49 and 2020-82 which stated that LARA may recognize hours worked responding to the COVID-19 pandemic as hours toward continuing education courses or programs required for licensure. These orders were in effect from March 17-June 9, 2020. Physician members were directed to submit hours to the MSMS Education Department for processing. Renewal Grace Period There is a 60-day grace period in which you may renew your license without having to go through the relicensure process. If you renew during the 60-day grace period, there is an additional $20 late fee when you renew your license. However, if your license is not renewed within the 60-day grace period after your expiration date, your license will lapse. The expiration date will reflect the original expiration date - it will not include the grace period. For example: If your license expires January 31, you have until April 1 to pay your renewal fee. If you do not renew by April 1, the end of the 60-day grace period, your license is considered lapsed as of January 31. Please note that when your license lapses, you can no longer practice your profession, nor can you identify yourself as a licensed individual. continued on page 27 The Bulletin | December 2021 9


E-Prescribing Exemptions Regarding COMPOUNDED PRESCRIPTION FORMULATIONS Courtesy of Healthway Compounding Pharmacy

UPDATE! Mandatory E-Prescribing Enforcement Delayed Until 2023 FAQ's 12.6.21 State of Michigan | Act No. 134 Public Acts of 2020 Enrolled House Bill No. 4217 Approved by the Governor July 8, 2020 Sec. 17754a (Click HERE to read the entire Public Act) 5) The requirement to transmit a prescription electronically under subsection (1) does not apply under any of the following circumstances: a) If the prescription is issued by a prescriber who is a veterinarian licensed under this article. b) If the prescription is issued under a circumstance in which electronic transmission is not available due to a temporary technological or electrical failure. c) If the prescription is issued by a prescriber who has received a waiver from the department under subsection (7). d) If the prescription is issued by a prescriber who reasonably believes that electronically transmitting the prescription would make it impractical for the patient who is the subject of the prescription to obtain the prescription drug in a timely manner and that the delay would adversely affect the patient’s medical condition. A prescriber who does not electronically transmit a prescription under this subdivision shall document the specific reason for his or her belief that the delay would adversely affect the patient’s medical condition. e) If the prescription is orally prescribed under section 7333 (3) or (4). f ) If the prescription is issued by a prescriber to be dispensed outside of this state. g) If the prescription is issued by a prescriber who is located outside of this state to be dispensed by a pharmacy located inside of this state. h) If the prescription is issued and dispensed in the same health care facility and the individual for whom the prescription is issued uses the drug exclusively in the health care facility. As used in this subdivision, “health care facility” includes, but is not limited to, any of the following: i) A hospital. ii) A hospice. iii) A dialysis treatment clinic. iv) A freestanding surgical outpatient facility. v) A skilled nursing facility. vi A long-term care facility that provides rehabilitative, restorative, or ongoing skilled nursing care to an individual who is in need of assistance with activities of daily living. 10 The Bulletin | December 2021

i) If the prescription contains content that is not supported by the National Council for Prescription Drug Programs Prescriber/Pharmacist Interface SCRIPT Standard. j) If the prescription is for a drug for which the FDA requires the prescription to contain content that cannot be transmitted electronically. k) If the prescription is issued under circumstances in which the prescriber is not required to include on the prescription a name of a patient for whom the prescription is issued including, but not limited to, a prescription issued under section 5110. l) If the prescription is issued by a prescriber who is prescribing the drug under a research protocol. SUMMARY Compound (Custom) Formulations are a defined exemption from the 2022 e-script requirements because Compound (Custom) Formulations are not included as a part of the National Script Standard Interface referenced in Public Act 134 of 2020. Currently, a prescriber cannot send an electronic prescription for a Compound (Custom) Formulation in the same manner as a manufactured medication to Retail Pharmacy. This is because the Compound (Custom) Formulation does not match with the medications listed in the National Script Standard Interface being used to electronically transmit prescriptions. There are non-traditional ways to send a prescription electronically (e-script) for a Compound (Custom) Formulation to a Compounding Pharmacy. If any prescriber needs information or assistance with an e-script for a compound, they can call us at (989) 791-1961, option #2. Because Compound (Custom) Formulations are exempt from the 2022 e-script regulatory requirements, prescribers still have multiple prescribing options with Healthway Compounding Pharmacy: Phone (989) 791-1691 | Fax (989) 791-4603 Bring in a paper prescription Questions? Contact our Compounding Pharmacists, Mike Collins or Eddie Wright at (989) 791-1691, option #2 Contact: Larry Greene | Healthway Compounding Pharmacy 2544 McLeod Drive N. | Saginaw, MI 48604 Phone (989) 791-1691 | Fax (989) 791-4603 Healthwayrx.com


APPLICATIONS FOR MEMBERSHIP SECOND READING: Applications for membership for second reading and vote for approval at the January 18, 2022, Board Meeting: Michael J. Mishkin, DO (Ascension St. Mary’s Riverfront Cardiology/MCVI) Specialty: Cardiovascular Disease - Board Certified 2015 Medical School: Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, 2008 Internship: Largo Medical Center, Largo, FL, Traditional, 6/08-6/09 Residency: University of South Florida, Tampa, FL, Internal Medicine, 7/09-6/12 Fellowship: University of South Florida, Cardiovascular Medicine, 7/12-7/15 Sponsors: Doctors Sarosh Anwar and Vipin Khetarpal

Free Confidential Counseling for Frontline Healthcare Workers Free, confidential counseling services are available for healthcare professionals and their immediate family to provide help coping with the stress and anxiety due to the COVID-19 pandemic.

Anirudh V. Penumetcha, DO (Ascension St. Mary’s Riverfront Cardiology/MCVI) Specialty: Non-Invasive Cardiology - Board Certified 2021 Medical School: Michigan State University College of Osteopathic Medicine, 2015 Internship/Residency: Wayne State University, Detroit Medical Center, Internal Medicine 7/15-6/18 Fellowship: Wayne State University, Cardiovascular Disease, 7/18-6/21 Sponsors: Doctors Sarosh Anwar and Vipin Khetarpal

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.

A new service to support and assist frontline healthcare workers with behavioral health services is now available from the Saginaw County Community Mental Health Authority.

Professional counselors provide primary care screening, assessment and monitoring of key health indicators. These services are available to those that need extra help coping during this extremely stressful time. There is no shame in talking, in person or virtually, with someone.

Call the Saginaw Community Care HUB at

989.498.2266

for an immediate appointment

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

The Bulletin | December 2021 11


PREVENTING SUICIDE IN PREVENTINGMICHIGAN SUICIDE IN MEN MICHIGAN MEN (PRISMM) (PRiSMM) "Everyone has a role to play" Project Summary

OVERVIEW

Preventing Suicide in Michigan Men (PRiSMM) is a 5-year CDC

5-year CDC Grant

grant funded program aimed at reducing suicide in men ages 25

Phase-1 of plan

and older. To achieve this goal, MDHHS has implemented a

Focus on Adult Men,

comprehensive, multi-sector partnership and action plan that

ages 25 and older

targets the male population in the state. Suicide is the 10th leading cause of death in Michigan and men are more than 3 times as likely to die by suicide than women. Adult men accounted for 67% of suicide deaths in the state of Michigan during the years 2009 – 2018. These statistics are likely due to the stigma that exists around men seeking mental health

Men are 3X more likely to die by suicide than women

treatment. Men who embrace gender norms are reluctant to acknowledge emotional issues, and therefore are less likely to seek help for depression, anxiety, and other mental health disorders. Because of this, it is important to reduce stigma,

Suicide Rate in Michigan by Age Group, 2019

have access to the help and resources they need. The Preventing Suicide in Michigan Men project, led by MDHHS’s

40

Injury and Violence Prevention Section, in strong collaboration

30

with University of Michigan’s Injury Prevention Center, the

20

University of Maryland Baltimore’s Man Therapy Michigan team, Central Michigan University's Interdisciplinary Center for

10

Community Health & Wellness, Henry Ford Health System, and

12 The Bulletin | December 2021

+

9

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65

9

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9

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crude rate per 100,000

50

promote mental wellbeing, and ensure that men in Michigan

Michigan’s Departments of Veterans Affairs and Corrections, will work to reduce suicide in Michigan men by 10% over the course of the next 5 years.


STRATEGIC PARTNERSHIP GOALS STRATEGIC PARTNERSHIP GOALS PARTNERS STRATEGIC PARTNERSHIP GOALS In accordance accordance with with the the Centers Centers for Disease DiseasePARTNERSHIP GOALS STRATEGIC In for

Control Control and and Prevention’s Prevention’s Technical Technical Package Package for for In accordance with the Centers for Disease Suicide, PRiSMM PRiSMM has has incorporated incorporated Suicide, and Prevention’s Technical Package for InControl accordance with the for comprehensive suicide prevention into its In accordance with theCenters Centers forDisease Disease comprehensive suicide prevention into its Suicide, PRiSMM has incorporated Control Prevention’s Technical program goals. Controland and Prevention’s TechnicalPackage Packagefor for program goals. comprehensive suicide prevention into its Suicide, PRiSMM has incorporated Suicide, PRiSMM has incorporated program goals. comprehensive suicide The include: comprehensive suicideprevention preventioninto intoitsits The goals goals for for PRiSMM PRiSMM include: program goals. program goals. •• Create strong Create strong multi-sectoral multi-sectoral partnerships partnerships The goals for PRiSMM include: •• Use data to focus interventions Use data to focus interventions on on our our • Create strong multi-sectoral partnerships The goals for PRiSMM include: The vulnerable goals for PRiSMM include: vulnerable population population • Use data to focus interventions on our • • Create strong multi-sectoral partnerships Leverage existing programming statewide Create strong multi-sectoral partnerships Leverage existing programming statewide vulnerable population • • Use data focus on to reduce reduce suicides and suicide suicide behavior behavior Use datatoto focusinterventions interventions onour our to suicides and • vulnerable Leverage existing programming statewide population and gaps vulnerable population and identify identify gaps in in programming programming to reduce suicides and suicide behavior • •• Leverage existing programming statewide Communicate effectively Leverage existing programming statewide Communicate effectively and identify gaps in programming to reduce suicides and suicide behavior •• to Perform quality reducerigorous suicidesevaluation and suicidefor Perform rigorous evaluation forbehavior quality • and Communicate effectively identify gaps in programming improvement andinsustainability sustainability and identify gaps programming improvement and Perform rigorous evaluation for quality • •• Communicate effectively Communicate effectively improvement and sustainability • • Perform evaluation for Performrigorous rigorous evaluation forquality quality improvement improvementand andsustainability sustainability

PARTNERS •• Michigan Department Michigan Department of of PARTNERS Corrections PARTNERS Corrections

•• Michigan Department of • Henry Henry Ford Ford Health Health System System Corrections • • Michigan Department ofof Central Michigan Michigan University Michigan Department Central University • Corrections Henry Ford Health System Interdisciplinary Corrections Interdisciplinary Center Center for for • Central Michigan University • • Henry Ford Health System Community Health and Henry Ford Health System

Community Health and

Interdisciplinary Center for • • Central Michigan Wellness Central MichiganUniversity University Wellness

Community Health andfor Center •• Interdisciplinary University Interdisciplinary Center for University Maryland-Baltimore Maryland-Baltimore

Wellness Community Health Administrations Community Healthand and Administrations •• Wellness University Maryland-Baltimore University • Wellness University of of Michigan Michigan Injury Injury Administrations • • University Maryland-Baltimore PreventionMaryland-Baltimore Center/ FACTS FACTS University Prevention Center/ • Administrations University of Michigan Injury Consortium Administrations Consortium Prevention FACTS • • University Michigan Injury Michigan Veterans Affairs University ofCenter/ Michigan Injury Michigan of Veterans Affairs Consortium Prevention Center/ Agency Rev. Rev. Prevention Center/FACTS FACTS Agency • Consortium Michigan Veterans Affairs Consortium Agency Rev. • • Michigan Veterans Michigan VeteransAffairs Affairs Agency AgencyRev. Rev.

COMMUNICATION GOALS

KEY STAKEHOLDERS public health health and and KEY • STAKEHOLDERS public behavioral/mental behavioral/mental KEY KEYSTAKEHOLDERS STAKEHOLDERS

• ••• • • ••• ••• ••• ••• •• • ••• • ••• ••• ••• ••• •• • ••• •

The goals COMMUNICATION The communication communicationGOALS goals of of the the PRiSMM PRiSMM project project are: are: To keep keep the the public public and stakeholders stakeholders informed informed of of the the COMMUNICATION GOALS •• To and COMMUNICATION GOALS

health health organizations public and health organizations employment/labor behavioral/mental employment/labor public publichealth healthand and higher education health organizations higher education behavioral/mental behavioral/mental health care employment/labor health care health healthorganizations organizations legal higher education legal employment/labor employment/labor law enforcement/ health care law enforcement/ higher education higher education corrections legal corrections health healthcare care agricultural law enforcement/ agricultural legal legal organizations corrections organizations law lawenforcement/ enforcement/ private sector agricultural private sector corrections corrections legislative liaisons organizations legislative agricultural agriculturalliaisons media private sector media organizations organizations academics legislative liaisons academics private privatesector sector persons with with lived lived media persons legislative legislativeliaisons liaisons experience academics experience media media survivors of suicide persons with lived survivors academics academicsof suicide loss experience loss persons personswith withlived lived local suicide coalitions survivors of suicide local suicide coalitions experience experience faith communities loss faith communities survivors ofofsuicide survivors suicide local suicide coalitions loss loss

The communication goals offor the project to build support thePRiSMM program.project are:

project to build support for the program.

•• communication To the adult public andofin stakeholders informed the The goals project are: The goals ofthe thePRiSMM PRiSMM project are: To keep increase men Michigan utilization ofof Man • communication To increase adult men in Michigan utilization of Man

to build support for the program. Toproject keep public and informed Therapy. To keepthe the public andstakeholders stakeholders informedofofthe the Therapy. To increase adult men in Michigan utilization of Man project totobuild support for program. To access to suicide care project build support forthe the program. To improve improve access to quality quality suicide care whether whether they they ToTherapy. increase adult men in Michigan utilization of Man are in or settings, and systems To men in Michigan utilization of Man areincrease in urban urbanadult or rural rural settings, and utilize utilize systems To improve access to quality suicide care whether they Therapy. delivering Therapy. delivering quality quality care. care. in urban or rural settings, and utilize systems • • Toare improve access totoquality care whether they Disseminate information onsuicide reducing access to lethal lethal To improve access quality suicide care whether they Disseminate information on reducing access to delivering quality care. are ininurban means. are urbanororrural ruralsettings, settings,and andutilize utilizesystems systems means. • Disseminate information on reducing access lethal to quality care. Improve community community reporting on suicide suicide (as to it relates relates delivering quality care. •• delivering Improve reporting on (as it to means. • • Disseminate information safe Disseminate informationon onreducing reducingaccess accesstotolethal lethal safe messaging). messaging). •• means. Improve community reporting on suicide (as it relates to To create create data data reports, reports, social social media media tools, tools, and and marketing marketing means. • To safe messaging). • • Improve community reporting on suicide materials that the of the Improve community reporting onwork suicide (asitproject. itrelates relatestoto materials that help help advance advance the work of (as the project. • safe To data reports, social media tools, and marketing messaging). safecreate messaging). that help advance the work of the project. •Contact social tools, and marketing Contact Information • Tomaterials Tocreate createdata datareports, reports, socialmedia media tools, and marketing Information Kristen Smith materials Kristen Smith that materials thathelp helpadvance advancethe thework workofofthe theproject. project. •• •• • •• •

PRiSMM Program Contact PRiSMMInformation Program Coordinator Coordinator smithk134@michigan.gov Kristen Smith smithk134@michigan.gov Contact ContactInformation Information www.michigan.gov/suicideprevention PRiSMM Program Coordinator www.michigan.gov/suicideprevention Kristen Smith Kristen Smith smithk134@michigan.gov PRiSMM PRiSMMProgram ProgramCoordinator Coordinator www.michigan.gov/suicideprevention smithk134@michigan.gov smithk134@michigan.gov

The Bulletin | December 2021 13


Expansion at Ascension St. Mary’s Emergency Care Center Complete Just over two years ago, a groundbreaking was held at Ascension St. Mary’s Hospital to expand its emergency department. With construction and renovation now complete, the facility has been transformed into a modern-day emergency care and Level II trauma center. The $17.6 million expansion included the construction of a 12,600-square foot building that was added to the front of the hospital. Enhancements and renovations to existing space now provide 24 treatment rooms and two state-of-the-art trauma rooms. The new building also improves access for ambulances and the public. “We have dreamt of this for years, and now, seeing the new Emergency Care Center come to fruition is so rewarding,” said Stephanie J. Duggan, MD, Regional President & CEO, Ascension Michigan Northern Ministries. “When Ascension announced its commitment to our northern hospitals in May 2018, and provided an initial $50 million investment, this dream started to become reality. The expanded medical facility will provide an increase in capacity, enhance the flow of patient care and improve access.” Focus on patient care guided the building design and site development including access for ambulances and the public. Significant excavation work occurred to elevate the grade to build a covered ambulance entry that can accommodate multiple vehicles. The new facility also provides an airport style drop-off/pick up and continuous drop-off canopy for inclement weather. “Ascension's recent announcement of an additional $125 million investment for Ascension Michigan’s Northern Health Ministries is evidence of their continued commitment to the communities we are privileged to serve. It is a validation of what we have been working towards,” said Dr. Duggan. “It’s all about patients, they are at the center of everything we do. It’s also a testament to our front line caregivers and medical providers who continue to fulfill our Mission of caring for all. We will continue to be here for generations to come.” 14 The Bulletin | December 2021

Emergency Medicine Physician Honored with 2021 Spirit of St. Vincent Award Cornette Ball continues virtual format for 2021 Ascension St. Mary’s Foundation proudly announces Steven T. McLean, MD, as the 2021 honoree of the prestigious Spirit of St. Vincent Award. Dr. McLean is recognized for 24 years of service as an emergency medicine physician, medical director, leader and mentor to physicians, nurses and clinicians. He is an asset and role-model for personalized, compassionate care. “Dr. McLean is such a deserving person to receive the Spirit of St. Vincent Award,” said Dr. Duggan. “As an ER physician, I worked alongside Dr. McLean for many years and witnessed the dedication and compassion he has for people at a time when they are sick, injured and most vulnerable. He focuses on what is best for the patient and achieving the best outcome. I am so proud to call him a colleague, friend and member of the Ascension St. Mary’s family.” Dr. McLean has been an instrumental leader in the design and development of the Ascension St. Mary’s Hospital Emergency Care Center expansion. His input regarding patient care, patient experience enhancements and improvements in the flow and efficiency of care has been invaluable. In addition, his leadership in ensuring quality patient care was not interrupted during construction of the expansion, especially as we continue to navigate the COVID-19 pandemic, which has been key as we meet and exceed the emergency care needs of our community. The virtual format of the Cornette “Corantine'' continues this year as we remain diligent in following COVID-19 safety protocols. From January 10-14, individuals can enjoy the “Corantine-Style” program which will begin with a special video honoring Dr. McLean as the 2021 Spirit of St. Vincent honoree. During the week, people can participate in the online auction and 50/50 raffle. This year, donations and sponsorships will support the MRI program at Ascension St. Mary’s Hospital. To learn more, visit Ascension St. Mary’s Foundation website.


Welcome New Providers Ascension Medical Group is pleased to welcome the following new providers to our employed medical staff.

Selina Akbar, MD

Toby Blosser, AT

Internal Medicine AMG Primary Care Towne Centre

Athletic Trainer AMG Orthopedics & Sports Medicine

Carlyn Hinish, DPM

Jasleen Kaur, MD

Podiatry AMG Orthopedics & Sports Medicine

Rheumatology AMG Rheumatology

Anirudh Penumetcha, DO Amanda Petzold, PA Cardiology AMG Riverfront Cardiology

Joginder Singh, MD Family Medicine AMG Family Physicians - Gratiot

Electrophysiology AMG Riverfront Cardiology

Pragna Dholakia, NP Cardiology AMG Riverfront Cardiology

Christopher Kukla, PA Sports Medicine AMG Orthopedic & Sports Medicine

Sefako Phala, MD Family Medicine AMG Bay City Family Physicians

Leigh Gilpin, DO Urology Placed with TriCity Urology

Melissa Fritch, NP

Medical Oncology AMG Medical Oncology & Hematology

Alexey Levashkevich, MD Marisa Mohammed, PA UroGynegology AMG Obstetrics & Gynecology - Genesys

Patchawan 'PorPor' Phunwutikorn, PsyD Psychology AMG Bariatrics

Sports Medicine/Ortho AMG Orthopedic & Sports Medicine

Angela Ritter, PA

Neurosurgery AMG Neurosurgery

Tiffany Wirtz, NP Orthopedics AMG Orthopedics

Taylor Sinda, PA

December 2021


How to Write a Resolution to the MSMS House of Delegates Saginaw County Medical Society | Michigan State Medical Society https://www.msms.org/About-MSMS/House-of-Delegates

How to Write a Resolution to the MSMS House of Delegates Introduction Watch our webinar: MSMS HOD Resolution Writing 101 >> (Note: If the webinar doesn’t load, click CANCEL on the first screen and it should then load)

T

he House of Delegates (HOD) is the official policymaking body of the Michigan State Medical Society (MSMS). Resolutions and Board Action Reports are the vehicles used to debate and determine the policies, priorities and direction of MSMS during the ensuing 12 months and beyond. Therefore, a well-crafted resolution is essential in order to present the most effective case for those issues that are of importance and concern to you.

Resolutions are presented to the MSMS HOD by voting delegates on behalf of their county delegation, specialty society, ethnic medical society, MSMS membership section, or as individual delegates. In order to be considered as regular business of the HOD, resolutions must be submitted to MSMS by 5 p.m. on either March 1 or the next business day if March 1 falls on a Saturday or Sunday. Once received, resolutions are reviewed by MSMS staff for comparison to existing MSMS and AMA policy, legal considerations, and 16

The Bulletin | December 2021

appropriate editing. They are then assigned numbers and referred to one of the six House reference committees or placed on the "Reaffirmation Calendar." All resolutions for which the “Resolved” state either MSMS or AMA existing policy will be placed on a "Reaffirmation Calendar" and voted upon at Sunday's session. A delegate can ask the Committee on Rules and Order of Business to extract a resolution from the Reaffirmation Calendar for referral to a reference committee. The Committee on Rules and Order of Business meets on Saturday morning prior to the opening of the House. Please note, pursuant to adopted HOD Resolution 65-14, any resolutions "submitted to the MSMS HOD that require action by the AMA may only be submitted by MSMS members that are also members of the AMA." The reference committees are responsible for listening to testimony on the rationale and merits of the submitted resolutions, discussing the issues raised for and against resolutions, and making recommendations to the HOD on the fate of the resolutions. Process All resolutions are to be submitted online at http://www. msms.org/hod. To complete the online resolution form, simply fill out the required fields and hit the "submit" button. Persons completing the form will need to include the following information: • Name, email, telephone number, affiliated organization, and county of the original author • Resolution title • The name of the person introducing the resolution and for whom the resolution is being introduced • Resolution text • Fiscal information (if applicable) • Footnotes/Endnotes (if applicable) Deadline 5 p.m. on March 1 (or the next business day if March 1 falls on a Saturday or Sunday) Late Resolutions Resolutions received after the deadline will be considered late resolutions and will be referred to the Committee on Rules continued on page 17


continued from page 16

and Order of Business which meets on Saturday morning. The Committee reviews any late resolutions on the following criteria: • Could the resolution have been submitted before the deadline? • Did new developments after the deadline justify the acceptance of the resolution? • Were there any extenuating circumstances? • Are there any other resolutions that cover the same logic? If the Committee on Rules and Order of Business agrees to accept a late resolution, the resolution will be immediately referred to one of the six reference committees for testimony and consideration later that morning. The final recommendation as to the resolution’s fate will be submitted to the House as part of the respective committee's report on Sunday. If the Committee on Rules and Order of Business does not accept a late resolution, a delegate may ask to have the resolution extracted from the Report of the Committee on Rules and Order of Business on Sunday morning and present his or her arguments before the Committee of the Whole. If the House concurs with the Committee on Rules and Order of Business's recommendation to not accept the late resolution, there is no further recourse and the resolution will not be considered. Structure of a Resolution Title: • Select a title that is brief and accurately reflects the action for which the resolution calls. Body: • Begin with the inclusion of one or more "whereas" statements. • "Whereas" statements explain why the resolution is needed, provide documentation in support of the resolution (i.e., data, statistics, references), and contribute to the general understanding of the subject matter. • "Whereas" statements lead into one or more "resolved" sections. • "Resolved" sections define the "ask" or intent of the resolution (e.g., the author’s desired action). • Because the HOD only adopts the "resolved" sections, each "resolved" section must be able to stand independent of the "whereas" statements.

o Example of an improperly written "resolved" statement, as the reader cannot readily identify the targeted issue(s), specific action requested, or to whom responsibility for acting upon the issue(s) is directed: RESOLVED: That physicians need to know about the process and extent of diversion in the community and need to act as described above. o Example of a properly written "resolved" statement in which the issue and "ask" are clearly stated: RESOLVED: That MSMS actively educate physicians about the process and extent of prescribed opiate medication diversion in the community and urge the health care providers prescribing daily opiates in chronic pain patients to monitor those patients at a minimum with yearly quantitative urine drug screens. Tips Paying particular attention to the following will enhance your chances of drafting a successful resolution: • Ensure the accuracy of information presented in the resolution. • Determine whether the topic of the resolution is existing MSMS and/or AMA policy prior to submission. o MSMS policy can be searched and accessed at https://www.msms.org/msmspolicies • MSMS policy manual addenda can be accessed at https://www.msms.org/About-MSMS/ MSMS-Policy-Manual o AMA policy can be searched and accessed at https://policysearch.ama-assn.org/policyfinder/ search/policy%20manual/relevant/1/ • If the Resolved statement is already existing policy, the resolution will be placed on the "Reaffirmation Calendar." • If the Resolved statement is consistent with existing policy, specifically state the amendment you want to that policy. • If the Resolved statement is not consistent with existing policy, indicate that you want to replace the existing policy. • Ensure that the desired intent or "ask" is clear. • Consider whether the requested action is feasible continued on page 18

The Bulletin | December 2021 17


continued from page 17

(i.e., is it relevant to medicine and to what MSMS can reasonably affect). • Determine whether there are cost implications to the proposed policy, program, or action and if so, select an estimated cost range. • Contact Joan Cramer at the Saginaw County Medical Society jmcramer@sbcglobal.net with your resolution idea. The proposed resolution will be placed on the agenda for the next SCMS board meeting, where it will be reviewed for relevance, content and support. Contacts MSMS staff is available to answer additional questions you may have. Please direct questions to Stacey Hettiger at 517336-5766 or shettiger@msms.org. Thank you for your interest in helping to establish the business of the MSMS HOD. Please remember, only online resolutions will be accepted and they must be received by 5 p.m. on March 1 (or the next business day if March 1 falls on a Saturday or Sunday). To review resolutions submitted to the 2020 HOD, click HERE. To review resolutions submitted to the 2021 HOD, click HERE. Following are resolutions submitted by the SCMS and CMU medical students the last few years: 59-19 Opioid Education in Medical Schools 75-19 Promote Prostate Cancer Screening for Minority Populations in Michigan 02-18 Suicide Awareness Training AMA Press Release re Suicide Awareness Training 6/18 https://www.ama-assn.org/press-center/press-releases/ increasing-awareness-suicide-risks-save-lives 2016 Assessing HealthCare Needs to Care for the General Population. Health Can’t Wait is a coalition of patients, physicians and health care providers dedicated to putting Michigan patients first and ending delays in patients’ access to health care. This past spring, the Senate unanimously passed SB 247 - prior authorization reform that reduces the red tape patients and providers are forced to navigate. The bill has now moved on to the House of Representatives for consideration. To be as proactive and productive as possible in the lead-up to the 2022 legislative session, we are asking for your help in reaching out to these lawmakers on SB 247.

Making direct contact with Representatives on this issue will go a long way towards helping us duplicate the success we experienced with this legislation in the Senate. We have also produced two new action alerts - one for patients and one for providers - that make it easier for an individual to quickly contact their Representative and communicate the importance of the reforms outlined in SB 247.

PLEASE CONTACT YOUR STATE REPRESENTATIVE NOW AND URGE THEM TO VOTE YES ON SB 247 IN 2022. 18

The Bulletin | December 2021


2021 Faculty Awards and Recognition The third annual CMU College of Medicine Faculty Awards and Recognition Ceremony was held on October 21, 2021. During this virtual ceremony, faculty were recognized for their exemplary commitment to teaching within their respective disciplines and for excellence in research. During the ceremony, the newly appointed members of the Central Michigan University Academy of Medical Educators were also announced. Congratulations to all the faculty recognized during the ceremony! Dr. Debasish and Chinu Mridha Spirit of Teaching Award This award honors faculty members who combine outstanding accomplishments and effective teaching; recognize contributions of faculty members who strive to maintain and enhance the reputation of the college as an outstanding medical school; and to reward faculty who inspire, stimulate, challenge and motivate their students. This year the recipient is Omar Marar, MD, Assistant Professor of Surgery. Dr. Marar has the highest student evaluations in surgical discipline. His students have many great things to say about him. Excellence in Teaching in Pediatric Sciences Mary D. Moore, MD, Associate Professor of Pediatrics is a passionate teacher, and she is known for her ability to give spontaneous talks about any topic in pediatrics. Her teaching is focused on pathophysiology in pediatrics. She is a great example of a lifelong learner and educator.

CMU and Saginaw County Health Department Affiliate to Create Academic Health Department Agreement improves community health outcomes, enhances medical student and resident education, and advances public health research In mid-November, CMU College of Medicine and the Saginaw County Health Department (SCHD) announced formation of an affiliation to address community health in a collaborative, coordinated approach through a new, five-year agreement that will expand public health offerings for CMU, the SCHD and the Saginaw community. With CMU as an academic affiliate, the SCHD will be able to improve access to patient care, collaborate on research and seek external funding opportunities for joint programs and projects with CMU. Their combined efforts will address emerging health problems and chronic conditions in the region, including obesity, behavioral health, pediatric and maternal health, and COVID-19.

"As an 'academic health department,' we gain greater capacity to investigate and find answers to some of Saginaw's most pressing issues that impact public health," said Christina Harrington, Health Officer, SCHD. She points to examples such as higher-than-average hospitalization rates for asthma, one of the state's highest infant mortality rates, and cancer clusters across the county's geography. "On a day-to-day basis, it's also a win-win. SCHD clients will benefit from access to CMU medical experts, while students gain an added clinical learning environment through the SCHD." The formalized relationship is a continuation of collaborative efforts that strengthened during the COVID-19 pandemic. Both organizations are driven by a desire to conduct research and translate findings into practical applications for public health providers to utilize in public health and clinical care practices. "This agreement bridges the gap between traditional medical care and public health and expands on our educational offerings in Saginaw," said George E. Kikano, MD, CMU Vice President for Health Affairs and Dean of the CMU College of Medicine. "Formalizing our working relationship with the SCHD firmly supports our mission of educating medical students to provide care to traditionally underserved communities, both rural and urban." The SCHD leads the way in preventing disease, prolonging life and promoting health in every corner of its service area, which is an 800-square-mile mix of urban, suburban and rural neighborhoods. In addition to the COVID-19 pandemic response, SCHD staff continue to deliver immunizations; vision and hearing screenings; Women, Infants and Children services; communicable and sexually transmitted disease tracking and testing; environmental health services; restaurant inspections; soil/water/spore/lead testing; family planning services; Children's Special Health Care Services; and the Nurse Family Partnership.

CMU College of Medicine Exchange Student from Austria The College of Medicine is hosting its first exchange student since entering into an educational exchange agreement with the Medical University of Graz, Austria in the fall of 2020. Christoph Strohhofer, an M5 medical student, is the first to come to Michigan through the program. Strohhofer is currently completing clinical rotations on our Saginaw campus. He has completed a four-week rotation in emergency medicine and is currently on an internal medicine rotation. Strohhofer says he enjoys the clinical interactions, the variety of cases and “…the precise schedule of the rotation in which students are assigned continued on page 20

The Bulletin | December 2021 19


continued from page 19

to a specific doctor every shift, making it easier to integrate into the team.” Strohhofer does miss being able to walk wherever he needs to go, which is something he has taken for granted in Graz! College of Medicine students, faculty and staff have been welcoming, providing rides, and including him in activities. If you see Strohhofer in the hospital, stop and say hello!

2020-21 Annual Report of the College of Medicine Available Online This year’s report highlights leaders in education, research and patient care; provides a look at how the College of Medicine is meeting the challenges posed by a global pandemic and systemic racism; and showcases the many ways the college continues to fulfill our mission.

Continuing Medical Education CME CALENDAR: For a complete list of our CME accredited courses, click HERE. CME ONLINE - eLearning Activities: CMU CME ONLINE CLAIM CME CREDIT and CERTIFICATE PROCESS – click HERE

students! To ensure that you adequately obtain your Category 2 Credit for Teaching, all forms (2017 to 2021) and instructions are available on our website at med.cmich.edu/cmecert under Category 2 Credit Forms. CME COMMENTS AND SUGGESTIONS - Your comments and suggestions about CME are always invited (and are very important to us). They may be submitted at any time on our website at med.cmich.edu/cme under Team - Comments Suggestions. Please contact us for any questions about continuing medical education, applying for or claiming CME credit and lifelong learning for medical professionals. Joan Ford, CHCP, Administrator Melissa Morse, CME Program Specialist Email: CMEDCME@cmich.edu | P: 989-746-7602 or 746-7555 Fax: 989-746-7579

ACCME motto: Learn well Albert Einstein: Intellectual growth should commence at birth and cease only at death

CREDIT FOR TEACHING - CMU College of Medicine appreciates ALL that you do in teaching our residents and medical

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Partner with a Graphic Designer to Promote and Grow your Business! Providing a singular source for marketing and design, I am here to deliver creative services for print and digital. Proud to be the Designer for the Saginaw County Medical Society Lori Krygier | Graphic Designer 989.239.1056 | lkrygier@charter.net lorikrygier.com

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989-272-8123 IT Specialist to the SCMS and many physician practices Hours: MON-FRI 9 AM to 5 PM


PEER REVIEW ETHICS COMMITTEE The Saginaw County Medical Society has a Peer Review Ethics Committee (“Committee”) which is comprised of Waheed Akbar, MD – Chair, Caroline G.M. Scott, MD and James R. Hines, MD. Members of the Committee are elected by the membership. The following is the definition of the Committee pursuant to Chapter IX Conduct and Discipline of Members of the SCMS Bylaws:

Focusing our practice on the needs of our community, we provide the following services for both individuals and businesses:

Section 5. PEER REVIEW ETHICS COMMITTEE. This Society shall have a standing committee designated the Peer Review Ethics Committee, charged with duties and powers concerning the maintenance of standards of conduct and discipline of members including the duties and powers specifically set forth in this chapter. Whenever any matter of alleged misconduct is referred to the Peer Review Ethics Committee, such Committee shall have the right to conduct investigations and hearings thereon, both informal and formal, and to make findings of fact and recommendations for discipline.

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.

If you need to refer a matter to the Committee, please contact Drs. Akbar, Scott or Hines, or Joan Cramer at the Saginaw County Medical Society office. All matters are confidential and are not to be disclosed to the Board or membership.

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The Bulletin | December 2021

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Ribbon Cut for $41 Million Rehabilitation Hospital Serving Great Lakes Bay Region

rehabilitation treatment for residents of the Great Lakes Bay region. Here’s why:

In a virtual ceremony, leaders from Mary Free Bed Rehabilitation at Covenant HealthCare dedicated a new hospital in Saginaw. The three-story building, located on the main Covenant campus, is specially designed for rehabilitation. It houses 60 private inpatient rooms, outpatient therapy spaces, offices for six board-certified rehabilitation physicians, as well as, treatment and fabrication space for patients who require braces and prosthetic limbs. “This beautiful and sophisticated new space is the product of the solid relationship between Mary Free Bed and Covenant HealthCare,” said Beth Charlton, President and CEO of Covenant HealthCare. “Together we’ve dreamed of elevating rehabilitative medicine in the Great Lakes Bay Region, and determination has pushed us through everything from supply chain shortages to global pandemics.” In March 2018, a joint venture between the two health care providers became operational. The pairing has been positive, and the number of people needing rehabilitation has been growing, fueling the decision to move forward with the new hospital. Kent Riddle, President and CEO of Mary Free Bed, came to know rehabilitation when his wife suffered a traumatic brain injury in a car crash. “I can personally attest that miracles can happen when hopeful and motivated patients connect with rehabilitation experts who love their profession and the patients they serve,” he said. Riddle predicted the future of Mary Free Bed at Covenant will include new programs, additional technology and helping more patients regain hope and freedom. Decorated Vietnam veteran, Bob Podleski, also spoke about the critical importance of vigorous rehabilitation. The two-time Purple Heart recipient, who’s constantly battled the adverse effects of Agent Orange, contracted COVID-19 in July. After a lengthy hospitalization, he arrived at Mary Free Bed at Covenant unable to sit up by himself. He’s home now, standing and determined to walk again.

INPATIENT REHABILITATION • Housed on Floors Two and Three • 60 adult private rooms with natural light • Designated areas for patients with critical conditions and brain injuries • Four therapy gyms with specialized equipment to treat specific diagnoses • Dining rooms on Floors Two and Three with space to gather with family • Laundry rooms for family use

Mary Free Bed Rehabilitation at Covenant HealthCare Facts Thanks to all the contractors, donors, vendors, employees and volunteers who worked so hard to make this vision a reality, the new Mary Free Bed at Covenant Hospital elevates

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The Bulletin | December 2021

OUTPATIENT REHABILITATION • Located on Floor One near convenient parking • Cheerful lobby with registration area, low-stimulation waiting room, kid-friendly space and “Market Place” for grab-and-go food items • Private treatment rooms • Therapy gyms with specialized equipment • Pediatric gait and low stimulation gyms Orthotics & Prosthetics + Bionics • Private treatment rooms • Fabrication lab • Gathering spaces for support groups and exercise classes TECHNOLOGY • Ceiling-mounted Zero-G system with harness to secure patients while working on walking and balance • Tollos in-ceiling lifts to safely lift, move and reposition patients • Lokomat robotic-assisted walking technology • Bioness therapy system to improve visual, cognitive, motor and balance skills • Apartments to practice home activities OUTDOOR SPACES • Social spaces for patients and families to relax and refresh • Rooftop patio • Northern Therapy Garden • Southern Tranquility Garden LOCATION • Main campus of Covenant HealthCare • 700 Cooper Ave., Building 1100, Saginaw • GPS Location: 1100 Cooper Ave., Saginaw For more information and facts on the new Mary Free Bed at Covenant, visit www.MaryFreeBedatCovenant.com.

Covenant Earns 7th Consecutive “A” Leapfrog Hospital Safety Grade Covenant received its seventh consecutive “A” grade in the fall 2021 Leapfrog Hospital Safety Grade, a national continued on page 23


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distinction recognizing the Covenant team’s achievements protecting patients from errors, injuries, accidents and infections. It is the only hospital rating program based exclusively on hospitals’ prevention of medical errors and other harms to patients in their care. “During these challenging times, we are again, extremely humbled and inspired to be recognized with the Leapfrog Hospital ‘A’ Safety Grade,” says Michael W. Sullivan, MD, Vice President of Quality Improvement/Chief Medical Officer. “Now more than ever, during the pandemic, this honor recognizes the dedication and commitment of each and every one of our caregivers to patient safety and Zero Harm.” “An ‘A’ safety grade is an elite designation that your community should be proud of,” said Leah Binder, President and CEO of The Leapfrog Group. “The past year has been extraordinarily difficult for hospitals, but Covenant HealthCare shows us it is possible to keep a laser focus on patients and their safety, no matter what it takes.” Developed under the guidance of a national Expert Panel, the Leapfrog Hospital Safety Grade uses up to 27 measures of publicly available hospital safety data to assign grades to more than 2,700 U.S. acute-care hospitals twice per year.

Covenant Medical Group Welcomes New Providers Dr. Almaas Patel Joins Covenant Hospital Medicine Covenant HealthCare welcomes Almaas Patel, MD, as a member of the Covenant Medical Group. Dr. Patel joins the Covenant Hospitalist team. Her office is located at 1447 North Harrison, Saginaw, MI 48602 and the team can be reached at 989.583.4220. Dr. Christopher Price Joins Covenant Medical Group-Family Medicine Covenant HealthCare welcomes Christopher L. Price, MD, as a member of the Covenant Medical Group. Dr. Price joins the Covenant Primary Care team. The office is located at 8767 Gratiot Road, Saginaw, MI 48609 and can be reached at 989.583.0630. Dr. Triptpal Sanghera Joins Covenant Medical Group-Family Medicine Covenant HealthCare welcomes Triptpal S. Sanghera, MD, as a member of the Covenant Medical Group. Dr. Sanghera joins the Covenant Primary Care team. The office is located at 2919 E. Wilder Road, Suite 150, Bay City, MI 48706 and can be reached at 989.671.5775.

WE LEAD IN HEALING CHRONIC WOUNDS What is Hyperbaric Oxygen Therapy? Hyperbaric Oxygen Therapy (HBOT) is the administration of 100% oxygen in a pressurized environment. Diffusing oxygen throughout the body promotes angiogenesis, allowing a chronic wound to get the nutrient and oxygen rich blood it needs to heal. Specialized wound care, including HBOT, is often necessary for optimal treatment of chronic wounds. HBOT is an effective adjunctive therapy used in conjunction with advanced wound care. Along with proper attention to nutrition and other underlying medical problems, we achieve greater healing results. HBOT is a proven treatment for: • Chronic Refractory Osteomyelitis • Lower Extremity Diabetic Ulcers • Radiation Cystitis/Proctitis or Radiation Necrosis

David Gustavison, DO Medical Director

Covenant Wound Healing Center “There are approximately 6.5 million patients in the U.S. suffering from chronic wounds (e.g. diabetic foot ulcers and pressure ulcers) and approximately 140,000 patients are hospitalized every year with new wounds. Currently, over 23 million people have been diagnosed with diabetes.”* Covenant Wound Healing & Hyperbaric Medicine Center has a team of experts trained to evaluate your patient’s wound and develop a treatment plan. Using the most advanced technology and research, our wound care team can work with you and your patients to heal wounds quickly.

Anthony de Bari, MD, CWSP

Scott Byron, DPM, FAAPSM

Mark Bullock, DPM

Khalid Malik, MD

*https://WWW.NCBI.NLM.NIH.GOV, article PMC6161627 • © 2021 Covenant HealthCare. All rights reserved. PK 5/21 13958

ONLY ACCREDITION IN MICHIGAN; SECOND IN THE U.S. COVENANT WOUND HEALING & HYPERBARIC MEDICINE CENTER 900 Cooper, Saginaw, Michigan 989.583.4401 • covenanthealthcare.com

The Bulletin | December 2021 23


LEGISLATIVE UPDATE Mandatory E-Prescribing Enforcement Delayed Until 2023 Michigan prescribers have until at least January 1, 2023, before they will be required to electronically transmit all prescriptions for controlled and non-controlled substances. This delay is due to the Centers for Medicare & Medicaid’s (CMS) decision to postpone enforcement of Medicare’s e-prescribing mandate. Earlier this fall, the Michigan Department of Licensing and Regulatory Affairs (LARA) sent a formal statement to prescribers and stakeholders confirming that the Bureau of Professional Licensing’s (BPL) enforcement of the electronic prescribing standard will coincide with the CMS enforcement schedule for Part D prescription drug programs. The 2022 Medicare Physician Fee Schedule Final Rule extended the date of compliance actions to no earlier than January 1, 2023. Michigan’s statute allows for a waiver to be issued if a prescriber cannot meet the electronic prescribing requirements. Rules promulgated by LARA address the process for obtaining a waiver and related eligibility criteria. They are expected to be finalized by the end of 2021. Once the rules are in place, BPL will have a process for applying for a waiver. The form and instructions for applying for the waiver will be posted on their website, www.michigan.gov/bpl. MSMS actively participated in the public comment process, submitting several suggested changes that were incorporated by LARA.

Lead Poisoning Identification and Treatment as a Condition of License Renewal – House Bill 5414 As noted in the previous update, legislation was introduced (House Bill 5414) in the House that would mandate all licensed medical professionals to take Continuing Medical Education (CME) courses on lead poisoning identification and treatment as a condition of license renewal. The House Health Policy Committee held a hearing on House Bill 5414 on December 9, 2021, where Dr. Robert Flora, MSMS Board member and Chief Academic Officer and Vice President of Academic Affairs at McLaren Health Care, testified in opposition to the bill. Dr. Flora explained to the Committee how the numerous mandates and requirements from all aspects of the health care system are overtaxing physicians, and how physicians are already taking the necessary steps to ensure they have the proper knowledge and competency. The committee responded positively to Dr. Flora’s testimony, and a future hearing on the bill has not been scheduled.

Senate Passes Legislation to Avoid Medicare Cuts in Year-End Sprint Last month, we also shared information about the Centers for Medicare and Medicaid Services (CMS) reducing payments 24

The Bulletin | December 2021

for certain health care providers. Without lawmaker action, these cuts would have led to fewer primary care providers, limited access to specialists, a disruption in care, and additional barriers to life-saving treatment. We are happy to inform you that on December 9, 2021, the Senate passed legislation which largely averts Medicare physician cuts that were previously scheduled to go into effect on January 1, 2022. Specifically, the legislation: • Mitigates 3% of the -3.75% impact of the previously delayed 2021 budget neutrality adjustment to the Medicare physician fee schedule conversion factor through CY 2022; • Nullifies the imposition of the 4% statutory pay-as-yougo sequester resulting from the American Rescue Plan Act through CY 2022; • Delays the reinstatement of the existing 2% Medicare sequester through March 2022, and phases in a 1% sequester through June 2022; and • Delays cuts to physician office laboratories and the next round of data reporting. The passage of this legislation will prevent Medicare from imposing 9% of the 9.75% planned payment reductions to physician practices.

MDHHS RELEASES UPDATED SCHOOL QUARANTINE GUIDANCE, RECOMMENDS UNIVERSAL MASKING

On December 3, 2021, MDHHS issued streamlined quarantine recommendations for schools designed to help prevent transmission of COVID-19 among the school-aged population while reducing disruptions to inperson learning. In addition to vaccination, which is approved for ages five and up, layered prevention measures, including masking, should be put in place for consistent in-person learning to keep kids, staff and families safe. MDHHS recommends local health departments and schools work together to quickly isolate COVID-19 cases among students and staff, identify close contacts of those cases, and adopt quarantine policies that reduce the risk of transmission in schools while allowing in-person learning. When evidence-based prevention measures are utilized, such as vaccination, masking and testing, students exposed to COVID-19 cases may not have to quarantine at home and can stay in the classroom. MDHHS continues to recommend universal masking in all K-12 school settings. Quarantine and isolation are determined by the local health department and are used as important tools to prevent the spread of disease. • You isolate when you are infected with COVID-19 and have tested positive, even if you do not have symptoms. continued on page 25


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Isolation is used to separate people who are infected with COVID-19 from those who are not infected. • You quarantine when you might have been exposed to COVID-19. This is because you might become infected with COVID-19 and could spread COVID-19 to others. • Any individual that displays COVID-19 symptoms, regardless of vaccination status, should not attend school and should be tested for COVID-19.

COVID-19 School Quarantine Guidelines for Asymptomatic Students • Fully vaccinated contacts without symptoms do not need to quarantine. • Contacts that are not fully vaccinated and do not have symptoms: • If masking was maintained, contacts can participate in school activities if wearing a mask for 14 days after exposure and using a "Test to Stay" strategy • If masking was not maintained, if additional testing and mitigation strategies are used, contacts may participate in school activities at the discretion of the local health department.

MI Safer Schools Testing Program MDHHS is providing schools antigen testing supplies free of charge through the MI Safe Schools Testing program. Schools and individual school districts can request antigen test kits through the MI Safer Schools: School Antigen COVID Test Ordering form. MDHHS will be leveraging our partnership with Intermediate School Districts to help distribute COVID-19 antigen tests based on the orders placed in the School Antigen COVID Test Ordering Form.

Questions about test supply orders can be sent to your Intermediate School District and any other school testing related questions can be sent directly to MDHHS at MDHHSCOVIDtestingsupport@michigan.gov.

CONTACT YOUR ELECTED OFFICIALS TODAY! Click on the following topics and access a prewritten, editable letter to send to your lawmakers in under a minute each! • Health Can’t Wait, SB247, writing to the House of Representatives in support • Auto No-Fault, asking lawmakers to support HB 4486 and SB 314 • Opposition to HB 4355 which allows out-of-state physicians to treat patients without a Michigan license via telemedicine • Expanding the mental health professional definition to include physician assistants, certified nurse practitioners and clinical nurses - oppose SB 191 • Ensure Safe Drinking Water in Michigan Schools support SBs 184-185 • Support Behavioral Health Integration by adding language to SBs 597-598 which would ensure the utilization of the team-based collaborative care model

BIRTHDAYS January Jamal U. Akbar MD Ghaith Al-Qudah MD Sarosh Anwar MD Edward Austin MD Ernie P. Balcueva MD Steve Balian MD John K. Bartnik MD Ronald A. Bays MD Abbas Bekhrad MD Robert L. Borenitsch DO Tony Bourdkane MD Gary A. Brooks MD Paul B. Bry MD Lowell A. Butman MD Marcello L. Caso MD Doris D. Cataquiz MD Bryon C. Chamberlain MD

Moonyoung S. Chung MD Louis L. Constan MD Elvira M. Dawis MD Lara DeStefano MD Angie Lynn F. Domingo MD Steven D. Hale MD Gabriel S. Hamawi DPM Leatha B. Hayes DO Gregory C. Hazen MD Carlyn M. Hinish DPM Alicia Hoban MD Ali E. Ibrahim MD Mohammad Jafferany MD Shakeel M. Jamal MD Michelle G. Jin Student Ashley Jones MD Roger N. Kahn MD

Sreevastav T. Kalangi MD Nadim Kanaan MD Charles A. Keane Student Mohammad Yahya Khan MD Young H. Kim MD Haley Kopkau Student Ayushi A. Kumar Student Menelito D. Lilagan DO Marko Lubardic Student Mark R. Ludka MD Ben R. Mayne MD Matthew F. McDowell DO Vickie B. Mello DO Babu L. Nahata MD Sunil P. Pandit MD Abigail J. Pittard MD Emily Ridge Student

Alan I. Rebenstock MD S. Sethu K. Reddy MD Douglas J. Saylor MD Susan K. Schmiege MD Michael L. Schultz MD Maliha N. Shaikh MD F. Ann Sobell Student Molly Stanford Student Craig J. Thomas MD Angelika J. Urbaniak Student Matthew N. Vartanian MD Venkatramana R. Vattipally MD Daniel J. Wechter MD Arno W. Weiss, Jr. MD Kiara A. Whitsell MD

The Bulletin | December 2021 25


Surprise Billing Litigation On December 9, 2021, the American Medical Association (AMA) and American Hospital Association (AHA) filed a complaint and motion to stay against the federal government over the misguided implementation of the federal surprise billing law. The lawsuit challenges a narrow but critical provision of a rule issued on September 30, 2021, by the U.S. Department of Health and Human Services (HHS) and other agencies. The provision being challenged ignores requirements specified in the No Surprises Act and would result in reduced access to care for patients. The rule and this flawed provision are set to take effect January 1, 2022. The AHA and AMA strongly support protecting patients from unanticipated medical bills and were instrumental in passing the landmark No Surprises Act to protect patients from billing disputes between providers and commercial health insurers. The legal challenge became necessary because the federal regulators’ interpretation upends the careful compromise Congress deliberately chose for resolving billing disputes. According to the lawsuit, the new rule places a heavy thumb on the scale of an independent dispute resolution process, unfairly benefiting commercial health insurance companies. The skewed process will ultimately reduce access to care by discouraging meaningful contracting negotiations, reducing provider networks, and encouraging unsustainable compensation for teaching hospitals, physician practices, and other providers that significantly benefit patients and communities. Congress created an independent dispute resolution process that is required when providers and insurers are unable to reach agreement on payment for out-of-network services from providers who are not under contract with the insurer. However, federal regulators have directed arbiters under independent dispute resolution to presume that the median in-network rate is the appropriate out-of-network rate and limiting when and how other factors come into play. The suit argues that the regulations are a clear deviation from the law as written and all but ensure that hospitals, physicians, and other providers will routinely be undercompensated by commercial insurers and patients will have fewer choices for access to in-network services.

Importantly, today’s challenge does not prevent the law’s core patient protections from moving forward and will not increase out-of-pocket costs to patients. It seeks only to force the Administration to bring the regulations in line with the law before the dispute negotiations begin. Last month, a bipartisan group of 152 lawmakers urged the Administration to fix the independent dispute resolution provisions, noting the rule’s approach “is contrary to statute and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and jeopardize patient access to care – the exact opposite of the goal of the law.” The AHA, AMA and their co-plaintiffs filed their lawsuit against the departments of HHS, Labor, and Treasury, along with the Office of Personnel Management in the U.S. District Court for the District of Columbia.

AMA Truth in Advertising Campaign

The AMA Truth in Advertising Campaign is designed to ensure health care providers clearly and honestly state their level of training, education and licensing. Patients deserve to have this information when in face-to-face encounters, as well as, when they read health care providers’ advertising, marketing and other communications materials. Patients are confused about the qualifications of different health care professionals. Many non-physicians earn advanced degrees, and many of those degree programs now confer the title “doctor.” As a result, patients often mistakenly believe they are meeting with physicians (medical doctors or doctors of osteopathic medicine) when they are not. To ensure patients know which “doctor” is providing their care, truth in advertising legislation: • Requires all health care professionals to clearly and accurately identify themselves in all writings, advertisements and other communications. • Requires all health care professionals to wear, during patient encounters, a name tag that clearly identifies the type of license they hold. • Prohibits advertisements or websites advertising health care services from including deceptive or misleading information. Andis Robeznieks, Senior News Writer

MEMBER APPRECIATION!

Enter to win a $50 Amazon Gift Card as a thank you for reading The Bulletin! To enter, send an email to Joan Cramer at jmcramer@sbcglobal.net with “I WANT TO WIN - DECEMBER 2021” in the subject line. The winner will be randomly drawn on January 15. 26

The Bulletin | December 2021


continued from page 9

If you have not completed your CME requirements by your license renewal date, you are allowed to use this grace period to complete those credits. Do not submit your renewal prior to completing your CME but do not exceed the 60-day period.

Creating a

safety network

Renewing Your License Physicians will be sent a renewal notification to both your mailing and email address on record approximately 90 days prior to the expiration date of your license. You will not be able to renew before that time. Remember to notify LARA of any address change by submitting a MiPLUS modification. LARA states that it is the providers responsibility as a licensed health professional to renew your license on time. Failure to receive the renewal postcard, email notification, or to notify LARA of an address change does not exempt physicians from renewing their license on time. To renew your license, go online to your MiPLUS account at www.michigan.gov/MiPLUS. Renewal payments can be taken by using a debit or credit card containing a Visa, MasterCard, American Express or Discover logo.

for our

community Our goal is to save lives through prevention, intervention, and aftercare.

Our Network trains individuals in evidence-based suicide prevention with the hope of destigmatizing suicide, increasing help-seeking behaviors, and caring for those impacted by suicide.

MSMS Online CME Courses Online CME courses including the required content areas are available here>>

To request trainings or resources, contact info@srrn.net I www.srrn.net I 989.781.5260

Details on the required and one-time CME are available here>> For more information or for questions, please contact Brenda Marenich or Rebecca Blake.

Commercial medications not meeting the needs of your patients? We produce customized medications specially suited to meet the patient’s needs; thus, allowing limitless prescribing opportunities. • Liquid solutions • Discontinued medications • Topical medications • Human Identical Hormone Replacement for men and women • Sugar free/dye free medications • Non narcotic pain medications

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Health care professionals are not immune to substance abuse or mental health disorders. Many otherwise highly qualified professionals may develop these problems due to stress, long hours, a genetic predisposition, or a tendency to self-medicate. To assist health care professionals impaired by these disorders, consider the care monitoring services of the Health Professional Recovery Program (HPRP). The Michigan HPRP was established by legislation in 1993 to assist impaired professionals before their actions harm a patient or damage their careers through disciplinary action. Any licensed or registered health care professional in the State of Michigan is eligible to participate in the program. To maintain participant confidentiality, the HPRP is operated by a private-sector contractor under the authority of the Health Professional Recovery Committee (HPRC), a committee comprised of a representative from each of the health professional licensing boards. The

Michigan Department of Community Health, Bureau of Health Professions provides administrative services to the HPRC. Participation in the HPRP is confidential. If a licensee/ registrant is referred to the program, has a qualifying diagnosis and complies with the HPRP requirements, his/her name will not be disclosed to state regulatory authorities or the public. Provided there is no readmission, records of HPRP participants are destroyed five years after successful completion. Referrals to the HPRP may come in the form of a selfreferral from a licensee/registrant or from colleagues, partners, employers, patients, family members or the State. Any of the 20 health professional licensing boards may also refer licensees/registrants to the HPRP for monitoring as a condition to regain or retain their license to practice. The names of individuals reporting a licensee/registrant suspected of impairment are also kept confidential. For more information on the HPRP, call 1-800-453-3784 or visit www.HPRP.org. Informational presentations on the HPRP are available to employers and health professional groups at no charge. Call the toll-free number to arrange a presentation at your facility.

TO MAKE A REFERRAL OR SELF REPORT, CALL 1-800-453-3784

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The Bulletin | December 2021


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The Bulletin | December 2021 29


END THE EPIDEMIC MI CARES How Raising Her Hand is Strengthening Our Country’s Addiction Medicine Workforce ‘You can’t train medical students in addiction if you don’t have trained faculty’ Board-certified Addiction Medicine Physician Cara Poland, MD, MEd, FACP, DFASAM wanted the State of Michigan to train a future generation of physicians to treat substance use disorders, but first, she realized that Michigan’s medical schools needed core faculty. Like nearly every state in the United States, Michigan is seeing staggering increases in overdose due to illicitly manufactured fentanyl, fentanyl analogs, methamphetamine and cocaine. Prescription opioid-related overdose and alcohol use disorder also remain top issues in Michigan. “In 2018, during a statewide meeting of the seven medical schools, I asked how many schools had core faculty to teach addiction. Only one did,” Dr. Poland said. “Now, almost all do. It sounds obvious, but you can’t train medical students in addiction if you don’t have trained faculty.” Dr. Poland, Assistant Professor of Women’s Health at Michigan State University, said that the 2018 meeting was eye-opening for everyone. The state had been working through multiple efforts to increase access to evidence-based treatment for substance use disorders (SUDs), but it hadn’t considered the role of medical schools and residency programs. “We had a blind spot, but we all had that ah-ha moment when we realized we could do better for our communities if we just built it into the curricula.” Given the relative lack of examples across the board, the Michigan physicians and deans realized that it was up to them to act. Through utilization of State Opioid Response funds, a collaboration was born: MI CARES. Led by Dr. Poland, the program not only trains physician-level addiction specialists in Michigan but across the country. Nearly 400 physicians in 43 states are currently on the pathway to becoming board-certified in addiction medicine. Michigan State University’s MD and DO colleges also began implementing curricular changes to offer more training in treating persons with substance use disorders to their medical students. Student response has been overwhelmingly positive. Of the inaugural 36 first-year elective students taught by Dr. Poland and Jamie Alan, RPh, PharmD, PhD, all 36 stated that they would recommend the elective to a colleague.

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The Bulletin | December 2021

“We didn’t figure it out overnight, but we’re on a great path. I also realize that not all of our students and residents will choose addiction medicine as their career,” said Dr. Poland. “But all of them - whether they become surgeons, Ob-gyns, family physicians, general internists or any other specialty will be able to better serve their patients.” Dr. Poland emphasized that the training being done in Michigan builds on a foundation of medical evidence, nonstigmatizing practice, and the recognition that a patient with a SUD is like any other patient with a chronic disease. Followup surveys given to students are also helping Dr. Poland and other faculty evaluate the coursework and the students’ perceptions of patients with a SUD, the role of treatment, and addiction medicine overall. Among the students’ responses: • Amazing intersession! Completely changed my mindset and understanding of patients with SUDs. The PCSS training we completed should be mandatory for all ECE students. Extremely valuable. • Dr. Alan and Dr. Poland are both extremely passionate about the topic, and it came through and made the class interesting and enjoyable. • This was fantastic!! I absolutely loved this intersession, and Dr. Poland & Dr. Alan are amazing! They made the zoom time together not only informative and engaging but truly fun. • This was probably my favorite intersession and I can’t say enough positive things about it. Just keep it up! I appreciate the work that everyone put in to make this intersession possible. • This was the best intersession I have taken. The combination of patient care, board cases and training were great. Also, I wish Dr. Poland and Dr. Alan could teach all of my classes! “I’m grateful for my co-faculty and the students who challenge themselves and are open to learning a field of medicine that is incredibly rewarding,” said Dr. Poland. “And as faculty, I need to learn how to continue to be better for my students. What we’re building at the medical school will resonate throughout the state, so we must always strive to improve.” To learn more about MI CARES, please visit micaresed.org. Dr. Poland’s brother Max died of a substance use disorder, and she dedicates her life’s work to him.

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10 FACTS ABOUT PHYSICIAN SUICIDE AND MENTAL HEALTH 1. Suicide generally is caused by the convergence of multiple risk factors — the most common being untreated or inadequately managed mental health conditions. 2. An estimated 300 physicians die by suicide in the U.S. per year.1 3. Physicians who took their lives were less likely to be receiving mental health treatment compared with nonphysicians who took their lives even though depression was found to be a significant risk factor at approximately the same rate in both groups.2 4. The suicide rate among male physicians is 1.41 times higher than the general male population. And among female physicians, the relative risk is even more pronounced — 2.27 times greater than the general female population.3 5. Suicide is the second-leading cause of death in the 24–34 age range (Accidents are the first).4 6. Twenty-eight percent of residents experience a major depressive episode during training versus 7–8 percent of similarly aged individuals in the U.S. general population.5 7. Among physicians, risk for suicide increases when mental health conditions go unaddressed, and self-medication occurs as a way to address anxiety, insomnia or other distressing symptoms. Although self-medicating, mainly with prescription medications, may reduce some symptoms, the underlying health problem is not effectively treated. This can lead to a tragic outcome. 8. In one study, 23 percent of interns had suicidal thoughts. However, among those interns who completed four sessions of web-based cognitive behavior therapy, suicidal ideation decreased by nearly 50 percent.6 9. Drivers of burnout include workload, work inefficiency, lack of autonomy and meaning in work, and work-home conflict. 10. Unaddressed mental health conditions, in the long run, are more likely to have a negative impact on a physician’s professional reputation and practice than reaching out for help early.

SOURCES 1. Center, C., Davis, M., Detre, T., Ford, D. E., Hansbrough, W., Hendin, H., Laszlo, J., Litts, D.A., Mann, J., Mansky, P.A., Michels, R., Miles, S.H., Proujansky, R., Reynolds, C.F. 3rd, Silverman, M. M. (2003). Confronting Depression and Suicide in Physicians. JAMA, 289(23), 3161. doi:10.1001/jama.289.23.3161 2. Gold, K. J., Sen, A., & Schwenk, T. L. (2013). Details on suicide among US physicians: Data from the National Violent Death Reporting System. General Hospital Psychiatry, 35(1), 45-49. doi:10.1016/j. genhosppsych.2012.08.005 3. Schernhammer, E. S., & Colditz, G. A. (2004). Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis). American Journal of Psychiatry AJP, 161(12), 2295-2302. doi:10.1176/appi.ajp.161.12.2295 4. CDC National Center for Injury Prevention and Control. (2015). 10 Leading Causes of Death by Age Group, United States - 2014 Retrieved from http://www.cdc.gov/injury/images/lc-charts/ leading_causes_of_death_age_group_2014_1050w760h.gif 5. Mata, D. A., Ramos, M. A., Bansal, N., Khan, R., Guille, C., Angelantonio, E. D., & Sen, S. (2015). Prevalence of Depression and Depressive Symptoms among Resident Physicians. JAMA, 314(22), 2373. doi:10.1001/jama.2015.15845 6. Guille, C., Zhao, Z., Krystal, J., Nichols, B., Brady, K., & Sen, S. (2015). Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns. JAMA Psychiatry, 72(12), 1192. doi:10.1001/jamapsychiatry.2015.1880

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CALENDAR OF MEETINGS AND EVENTS FOR 2022* Tuesday, January 18, 2022 Horizons Conference Center, 6200 State Street, Saginaw Board Meeting – 5:30 p.m. Membership Meeting Welcoming our Dental Colleagues – Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Program: “Management of Sleep-Related Breathing Disorders from a Medical and Dental Perspective” Speakers: Christopher J. Allen, MD and Michael Thomas, DDS CLICK HERE TO MAKE AN ONLINE RESERVATION or scan the QR Code Tuesday, February 15, 2022 CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m. There is no Membership Meeting in February. Tuesday, March 15, 2022 CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m. There is no Membership Meeting in March.

Tuesday, April 19, 2022 Horizons Conference Center, 6200 State Street, Saginaw Board Meeting – 5:30 p.m. Membership Meeting – Social (cash bar) at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Program: “TED Talks – Overcoming Obstacles in Health Care” (inspirational talks that physicians can relate to) Speakers TBA Email meeting notices will be sent in early April. Online reservations are required. Saturday-Sunday, April 30-May 1, 2022 MSMS House of Delegates (location TBA) Tuesday, May 17, 2022 Horizons Conference Center, 6200 State Street, Saginaw Board Meeting – 5:30 p.m. ANNUAL MEMBERSHIP MEETING and ANNUAL SCMS FOUNDATION MEMBERSHIP MEETING – Social (cash bar) at 6:30 p.m., followed by dinner and meetings at 7 p.m. Email meeting notices will be sent in early May. Online reservations are required. Saturday, June 4, 2022 SCMS Foundation Golf Outing – Saginaw Country Club

All statements or comments in The Bulletin are those of the writer, and not necessarily the opinion of the Saginaw County Medical Society.

Tuesday, June 14, 2022 (second Tuesday) CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m. *subject to change There is no Membership Meeting in June.

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