Issuu

The

Bulletin Saginaw County Medical Society

December 2019 | Volume 78 | No 4

January Membership Meeting p. 7

SAVE THE DATE!

Free 8-Hour MAT DATA Waiver Training Through ASAM | April 25, 2020 p. 12-13

16th Annual Jingle Mingle Benefits Pregnancy Care Center of Saginaw p. 16-17

Advertise in the 2020 Membership Directory! p. 20-21

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The

Bulletin Saginaw County Medical Society

2019-2020 OFFICERS AND DIRECTORS President Mildred J. Willy MD President-Elect Anthony M. Zacharek MD Past President Julia M. Walter MD Secretary Caroline G.M. Scott MD Treasurer Miriam T. Schteingart MD Board of Directors Jorge M. Plasencia MD Tiffany K. Kim MD Mark G. Greenwell MD Harvey K. Yee MD

contents 7

12-13

16-17

SAVE THE DATE! Free 8-Hour MAT DATA Waiver Training Through ASAM | April 25, 2020

20-21

Medical Mission: CMU Street Medicine

President’s Letter

ED Violence Prevention Bill Passes the House

16th Annual Jingle Mingle Benefits Pregnancy Care Center of Saginaw Advertise in the 2020 Membership Directory New Medicare Card: Claim Reject Codes After January 1

January Birthdays

Application for Membership

CMU College of Medicine | CMU Health

Elizabeth A. Paulus MD

From the Editor

Furhut R. Janssen DO

Barb Smith SR&RN

Retiree Representative Rustico B. Ortiz, MD

Attention Retired Members!

29 THRIVE

Resident Representatives

18-19

Bulletin Editor Louis L. Constan, MD

Mary J. McKuen, MD Anushka N. Magal MD MSMS Delegates Elvira M. Dawis MD Julia M. Walter MD Mildred J. Willy MD

Great Lakes Bay Region Mental Health Provider Community Event

Covenant HealthCare

In Memory – Paul T. Werner, MD

Ascension St. Mary’s

Anthony M. Zacharek MD

26 MSMS

Jorge M. Plasencia MD

Christopher J. Allen MD Miriam T. Schteingart MD MSMS Alternate Delegates Caroline G.M. Scott MD Waheed Akbar MD Mohammad Yahya Khan MD Virginia R. Dedicatoria MD Steven J. Vance MD Joseph P. Contino MD Kristine K. Spence DO Karensa L. Franklin MD

Dr. Scott Serves on MSMS Judicial Commission

Caduceus Meeting

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

11th Annual Conference: The Region’s Health and Health Care Systems

Key Providers

Calendar of Events

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

ON THE COVER: 16th Annual SCMS Alliance Jingle Mingle Benefits Pregnancy Care Center of Saginaw (l-r) Christine Warren, Anne deBari, Colleen Cheney, Keri Benkert and Janie Gugino EDITOR Louis L. Constan, MD

PUBLISHER Saginaw County Medical Society

EXECUTIVE DIRECTOR Joan M. Cramer

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

DESIGNER Lori Krygier

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

Scott E. Cheney MD Michael W. Warren MD Peer Review Ethics Committee Waheed Akbar, MD, Chair Caroline G.M. Scott, MD James R. Hines, MD MSMS Region 7 Director Thomas J. Veverka, MD Executive Director Joan M. Cramer Administrative Assistant Keri Benkert

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 2019 3

PRESIDENT’S LETTER

An Introduction to the Medicine of Lifestyle By Renee Nilan, MD, FACEP

n the 1930’s, the first commercially available antibacterial, Prontosil, a sulfonamide, was released. This revolutionized medicine by significantly reducing the morbidity and mortality associated with infectious disease which was the leading cause of death at that time, as well as, through most of human existence. Over the past 80 years, the “modernized” world has seen a significant shift toward chronic diseases, including cardiovascular disease, cancer and Type 2 diabetes, as the leading causes of death. This shift is closely correlated to the changes in the Western lifestyle with the rise in processed foods and adoption of an increasingly sedentary lifestyle. Our current practice of developing medication or performing surgery for nearly every illness isn’t working and is eating up most of our health care dollars. It is time for a new revolution. It is time for us to consider lifestyle as the first-line treatment for the prevention and treatment of chronic disease.

“Lifestyle Medicine is the use of evidence-based lifestyle therapeutic approaches, such as plant-predominant dietary lifestyle, regular physical activity, adequate sleep, stress management, avoiding use of risky substances and pursuing other nondrug modalities to treat, reverse and prevent chronic disease.” – American College of Lifestyle Medicine Each of the pillars of total health mentioned in the above statement are worthy of lengthy discussion, but for the purpose of this article, will be briefly discussed. The reasons to avoid risky substances such as tobacco is well known and will not be reviewed. Nutrition Diets high in processed foods, trans fats and processed animal products tend to promote and accelerate chronic inflammation which has been implicated as a causative factor in nearly all chronic diseases. We are gaining an increased understanding of the importance of a healthy gut barrier and gastrointestinal biome in the maintenance of our health. Although not the only

causative factor, a diet high in saturated fats and sugars and low in fiber promotes intestinal inflammation and increased intestinal permeability. This allows toxins and other luminal components to enter the bloodstream resulting in extraintestinal inflammation and promotion of cardiovascular disease, obesity and Type 2 diabetes among other chronic diseases. There is increasing evidence that chronic inflammation is a causative factor in many cancers as well. Although there continues to be controversy regarding the optimal diet, there is consensus to adhere to a diet rich in a variety of whole foods, which is largely (if not entirely) plant-based, and to avoid processed foods, including processed meats and conventionally raised red meat. Leafy greens, vegetables, fruits, legumes and whole grains should be our staple foods. Physical Activity There is little controversy about physical activity as the science is clear. Sedentary lifestyles are associated with continued on page 5

We cannot care for our body without caring for our mind, nor care for our mind without caring for our body.

The Bulletin | December 2019

continued from page 4

an increased risk of all-cause mortality. The benefits of physical activity are independent of adiposity, and even small increases in the level of physical activity shows benefit. The greatest increase in benefit occurs with a minimum of 150 minutes of moderate activity or 75 minutes of vigorous activity per week, at which point a 20-25 percent reduction in all-cause mortality is achieved. (For the ease of quick discussion, at moderate levels of activity one can still talk but will find it hard to sing; at vigorous levels of activity one will find it hard to both talk and sing.) Longer durations of activity per week continue to show incremental benefit except at very high levels of activity. A small increase in mortality is seen once physical activity per week exceeds 25 hours. Most of our patients will not fall into this category, however, monitoring of endurance athletes may be warranted. In addition, prolonged sitting is an independent risk factor for all-cause mortality. Recommendations are to break up prolonged sitting by adding two minutes of moderate to vigorous activity for every 20 minutes of sitting. Physical activity recommendations also include strength training twice weekly for adults and three times a week for children and adolescents, as well as, flexibility and balance activities. Sleep Healthy sleep is an important component of total health. Throughout sleep, restorative work is occurring; DNA is remodeled and repaired, leptin (a natural appetite suppressant) is secreted and fatty acids are metabolized. In late sleep, longer periods of REM are noted and are thought to be responsible for learning consolidation and fear extinguishing. Although the length of time needed for a healthy sleep cycle differs between individuals, it is known that functional performance is typically best with seven to eight hours per night. Less than seven hours of sleep is considered short sleep, and anything under six hours is considered very short sleep. Teenagers typically need more sleep averaging about nine to ten and up to 12 hours per night. Short duration and disrupted sleep correlate with: • Increased BMI • Obesity (up to double the risk) • Metabolic syndrome • Diabetes • Refractory and non-dipper hypertension (level is not lower in the am) • MI and coronary events • Increased mortality due to cardiovascular disease • Increased vasospastic disorders • Major depression

• • • •

Bipolar disorder Seasonal affective disorder PMS Increased risk of developing PTSD if impaired sleep during the two weeks preceding the event • Increased risk of developing long-term sequelae after traumatic brain injury • Cancer o Breast o Endometrial o Prostate o Colorectal o AML – acute myeloblastic leukemia Fortunately, there are several things we can do to improve our ability to sleep well. Some may be more intuitive such as establishing a regular schedule for sleep, eliminating caffeine, minimizing bedroom light and noise, and using stress reduction techniques before bedtime. Others may be less intuitive. These include increased day-time exposure to sunlight, increased bedtime peripheral cutaneous dilation with a warm shower or socks for cold feet, as well as, avoiding halogen and blue spectrum light (CFL 6500K) for the hour before bedtime, among many other techniques. Stress management There is a strong connection between our emotional and physical health; for better and for worse. We cannot care for our body without caring for our mind, nor care for our mind without caring for our body. Emotional stress is an important factor, both directly and indirectly, in many illnesses, and is more likely to impact negatively on our health when it is chronic and unrelenting. The key is how we react to stress rather than what is going on around us; we need to be able to turn it off sometimes. Strong coping mechanisms can help manage the effect stress has on our well-being. Techniques such as yoga, meditation and mindfulness work to focus and quiet the mind giving us a greater sense of peace. Simply taking a deep breath stretches the diaphragm and stimulates the parasympathetic nervous system countering the sympathetic stimulation caused by stress. When our stress is reduced, we can think more clearly and creatively. There is growing evidence that regular practice helps to control anxiety and promote emotional health, lengthen attention span and may reduce age-related memory loss. Learning to manage stress is relevant to all individuals regardless of emotional, psychiatric or physical health. Motivating Lifestyle Change Considering lifestyle modification as part of our treatment options is important. We can use it in our armamentarium along with antihypertensives, hypoglycemics and anxiolytics. continued on page 6

The Bulletin | December 2019 5

continued from page 5

Unfortunately, our practice of offering facts, advice and solutions does not work well to change the unhealthy behaviors of chronically ill patients. In contrast, Motivational Interviewing (MI) has been shown to be effective in facilitating behavior change. In brief, this is done by helping an individual determine what is important to them, discover their ambivalence to change and set attainable goals. Motivational Interviewing is difficult to learn, and many of us may choose instead to refer patients to a health coach to assist with behavior change. The advantages of using a coach is that they are skilled in MI and can meet with patients for longer, more frequent visits, often one-hour sessions per week to start. This gives our patients the optimal chance for positive behavior change. Helpful websites for further information Lifestylemedicine.org Mindful.org Lifestylefacts.org Health.gov/paguidelines Exerciseismedicine.org

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The Bulletin | December 2019

ED Violence Prevention Bill Passes the House

SCMS MEMBERSHIP MEETINGS

Courtesy of the American College of Emergency Physicians (ACEP)

Register now for our Tuesday, January 21, 2020, Membership Meeting at Horizons Conference Center. The social with cash bar starts at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Joint with the Saginaw County Dental Society.

On Thursday, November 21, the bipartisan Workplace Violence Prevention for Health Care and Social Service Workers Act was passed by the House of Representatives. ACEP worked closely with Rep. Joe Courtney (D-CT) to develop the legislation, which compels OSHA to issue an interim final standard in one year, and a final standard within 42 months requiring employers within the health care and social services sectors to develop and implement a workplace violence prevention plan. The bill also requires employers to identify risks, specify solutions, and it would also provide protections from retaliation for reporting violent incidents. Importantly, it protects health care and social service workers in the public sector in the 24 states not covered by OSHA protections. ACEP worked to ensure the important provisions will be implemented appropriately, taking into consideration how EDs are staffed and clarifying language to ensure any new federal requirements do not create any unintentional burdens for entities that do not control the health care workplace. During consideration of the bill on the House floor, ACEP sent an alert to congressional staff asking them to oppose an amendment that would have eliminated the requirement for OSHA to issue a standard within a specific timeframe, further delaying a process that has already suffered significant delays. Rep. Courtney noted ACEP’s advocacy and expertise on the issue during debate on the floor. The amendment was defeated, and ultimately the legislation passed the House in a bipartisan 251-158 vote. Next steps? ACEP’s advocacy efforts now move to the Senate. This bill comes on the heels of the new joint public awareness campaign between ACEP and the Emergency Nurses Association, “No Silence on ED Violence,” which is another way ACEP is bringing this critical issue to the public’s attention. Put a personal face on a widespread problem by sharing your thoughts and personal stories related to ED violence on social media using #StopEDviolence.

Tuesday, January 21, 2020, Membership Meeting

Topic: "Oral Health and Overall Health: 2020 and Beyond" 1.25 AMA PRA Category 1 CreditsTM available. Speaker: Darnell Kaigler, Jr., DDS, PhD from the University of Michigan Dental School This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Central Michigan University College of Medicine and the Saginaw County Medical Society. Central Michigan University College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Central Michigan University College of Medicine designates this live activity for a maximum of 1.25 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Tuesday, April 21, 2020, Membership Meeting Save the date for our Tuesday, April 21, 2020, Membership Meeting at Horizons Conference Center. The social with cash bar starts at 6:30 p.m., followed by dinner, meeting and program at 7 p.m. Program: “Physician Compassion Fatigue/Burnout” Speaker: Molly E. Gabriel-Champine, PhD, LP, Director of Behavioral Science, Family Medicine Residency at McLaren Bay Email meeting notices will be sent in early April. Online reservations are required.

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The Bulletin | December 2019 7

FROM THE EDITOR

Honesty Depends on Privacy By Louis L. Constan, MD

ingggg. Hello? Yes, this is Dr. Jones at Small-town-Michigan hospital ER. Sorry to wake you at 3 a.m., but we have one of your patients here with tachycardia, sweating and pressured speech. Can you tell me anything about his medical history? Sure. He’s done this several times, his work-up is negative, but he keeps doing it whenever he gets upset about something. His wife recently filed for divorce. That may be the trigger. (Heard next loudly over the phone): NURSE, YOU CAN DISCONNECT HIM FROM THE MONITOR. CONSTAN SAID THE WIFE LEFT HIM, IT’S JUST AN ANXIETY ATTACK. (Oh no! Hope the patient didn’t hear that!) The next morning, I received a phone call from the patient to the effect that he did indeed hear that; and he was irate that the nursing staff and other ER patients had also heard what was his private business; and I was a terrible doctor; and he would never darken my door again. Whew! Quite the education on how sensitive patients can be over privacy issues. Today, of course, that ER doctor would not have had to make the call to find out this patient’s highly sensitive information. He merely would have to log into the EHR and read my last office note. And he wouldn’t need to rudely yell out the information for the nurses and other

staff in the ER to learn about his divorce. Anyone there with a computer terminal could find that information. And why stop there? In reality, anyone in any office that uses the same EHR could have access to his private information. Granted, they’re not supposed to do so unless they have a ‘legitimate medical reason’ whatever that is. But people do break the rules. Some more than others. When we go to the doctor’s office, we are asked many, many personal questions, questions we would refuse to answer coming from any other business. So, why do we do so here? Because we “trust” the doctor and by inference, the people who work for that doctor. But what about all the other doctors; who we don’t know and trust, and all their staffs; who we similarly don’t know and trust; who will, once that data gets entered, have access, each and every one of them; to our data? That’s all bad enough, but I haven’t even gotten to the subject of largescale, computer data breaches. Recently, PBS NewsHour reported that the U.S. Department of Health and Human Services Office for Civil Rights documented hundreds of electronic hacks of healthcare providers every year. Such breeches are the motherlode for hackers. They contain full names, addresses, phone numbers, email

addresses, social security numbers, names of family members…everything necessary for the perfect identity theft. Plus, an added bonus. Medical data that can be used for blackmail. Think sexually transmitted diseases, mental health episodes, use of illegal substances, alcohol and tobacco use. What would you pay to keep such data out of the public sphere? This is all very alarming of course, and I am sure EHR companies will say that they are working on the problem. Can we trust them? Maybe, but maybe not. There is much money to be made by stealing data. And it makes the headlines practically every day. So how long before patients figure out that what they tell you during your patient history, social history and review of systems is so, so not very confidential? When that happens, they will stop being forthright about their health history, and that beautiful, elaborate, expensive EHR will be useless. I believe that this is already happening. I’ve watched CMU medical students present case histories for three years now. They are required to be extraordinarily detailed in their questioning, to go through everything in ROS, PH, FH, SH. Including sexual history and drug use. In all those cases, continued on page 9

When we go to the doctor’s office, we are asked many, many personal questions, questions we would refuse to answer coming from any other business.

The Bulletin | December 2019

continued from page 8

in three years, they have reported not a single patient who admitted to using illegal drugs or ever having had a sexually transmitted disease. And why would they? Would you admit to committing a crime in front of a doctor who is sitting in front of a computer ready to record it for god-knows-who to use? Yet the box remains on the EHR, and it’s worthless. How many other sections of the EHR are fundamentally flawed in this way? With the normal reluctance of patients to share sensitive information added to their concerns over data security, it seems we are left with a bit of a mess. But, as doctors always do, we adjust: • We hone our interviewing skills, knowing that what is in the (computer) chart cannot be counted on. We look away from the screen and engage the patient. • We realize that patients are simply not going to tell us certain information which, if it were to get out for some reason, would subject them to embarrassment, prosecution or the possibility of not being able to get life insurance. We know that patients commonly lie about their

alcohol use, and we make allowances for this fact, maintaining skepticism, looking at lab values and physical findings for hints of alcohol overuse. The spread of computer insecurity is apt to cause such lying to increase. The skill of reading subtle clues that patients are lying will become ever more important. The good news, of course, is that computers do not yet have this skill, which means we, human beings, still make the best doctors.

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

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Shop Amazon and Support the Network! When shopping on Amazon, please go through AmazonSmile at smile.amazon.com/ch/38-3400293. For your charity, choose SURVIVORS OF SUICIDE INC and 0.5 percent of eligible purchases will be donated to Survivors of Suicide, Inc. (now known as Barb Smith Suicide Resource & Response Network).

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story on their journey of grief. Jamie Martinez and her uncle, John Martinez, of ArtClubHub. com created a beautiful butterfly painting during the event. Guest speaker, Gwen Kapcia, LBSW, CT, brought a special message of hope and humor. Gwen is the Director of Program Development at Starlight Ministries, a licensed Social Worker and certified in Thanatology. She has been involved in grief work her entire career, spanning over 30 years. A majority of that time was spent as Director of Grief Support at a large funeral home in the Lansing area where she led a suicide survivor group. In addition, her experience includes facilitating support groups, teaching educational series on grief and providing individual support. She has directed six summer camps for bereaved children. She speaks frequently to community groups, churches and professional organizations, and has extensive experience in helping families who are hurting.

Sponsors: Health Level: • W.L. Case & Company Funeral Homes • HealthSource Saginaw • Saginaw County Medical Society Friends Level: • Children's Grief Center • Joy Buchanan • Something Beautiful • Tri-County Mental Health Additional Sponsors: • Bronner's Christmas Wonderland • Art Club Hub

Hope Starts Here! The Saturday before Thanksgiving is recognized as a National Day to support loved ones bereaved by a loss to suicide. For over 20 years, the Barb Smith Suicide Resource & Response Network has hosted Hope Starts Here, an annual event to recognize this day. On Saturday, November 23, Hope Starts Here was held at the Bavarian Inn Lodge in Frankenmuth. This year’s Hope Starts Here welcomed 150 participants who were survivors of suicide loss, in addition to 15 local vendors who offered their services to those impacted by suicide. A panel of persons with lived experience shared a bit of their 10 The Bulletin | December 2019

10 Tips for Surviving the Holidays After Losing a Loved One 1. Acknowledge that the holidays will feel different and be difficult. This season can be an emotional minefield, and most of the time just the anticipation over how tough something is going to be is worse than the actual event itself. 2. Remember their memory. There’s a misconception that bringing up a deceased loved one’s memory will inflame the pain, but for the grieving, saying the name of the person you lost and sharing memories in conversation, help with the coping. 3. Seek support. With everything and everyone filled with so much gosh-darn holiday cheer around this time of year, sometimes it’s helpful to talk with others who understand the struggle. Reminding loved ones when you’re having a rough time may be enough, but it also never hurts to reach out for more support. 4. Explore the holidays in a new way. Grief is a license to evaluate what parts of the holidays you enjoy and what parts you don’t. Don’t be apprehensive to create entirely new traditions or alter familiar ones to make them fit better with this new phase in your life. 5. Pass on holiday events if you are in holiday overload. Skip the holiday altogether. Yes, you can cancel the holiday. Grief can be a beautiful permission slip to learn how to say no to everyone and everything else around you so you can say yes to yourself and self-care. 6. Seek gratitude. If you find yourself in the holiday funks this year, practice daily gratitude throughout the season. Intentionally choose it. Write it down, photograph it, send out holiday gratitude cards to friends and loved ones … whatever that looks like for you, gratitude matters so look for the little things.

7. Avoid social media. There are a lot of triggers you can’t control around the holidays like being subjected to Christmas music in line at Trader Joes. Constantly seeing holiday inspired posts as you scroll through Instagram and Facebook can leave you comparing how you choose to participate in holiday festivities against the “magical” gatherings depicted in your feed. It’s okay to limit the time you spend on social media if you find the holiday posts provoking pains of longing. Logging out for a while can help assert some level of control over your holiday cheer and remember, that life goes on for other people and it’s okay that they’re happy to celebrate this year just as its equally okay if you’re not. 8. Allow yourself to feel. The holidays can trigger a wide range of emotions. One of the harshest parts of surviving the jubilee of the season for the grieving is the belief they have to be joyful and merry during them. The grieving often feel bad for not feeling good around the holidays, or guilty if they do manage to enjoy themselves because they think they should still be in mourning. It’s a bit of a vicious cycle. Allow yourself to feel those emotions whatever they are without judgment. 9. Create your own honorary family. If you find yourself alone this season, select your kindest and most supportive friends to celebrate with. Host a Christmas cookie exchange, send out invites for a tree trimming party, or attend an ugly sweater celebration. 10. Pay it forward. Even in the midst of grief, you still have something to offer the world. Performing a few acts of kindness can be good for the grieving spirit. Doing something kind for others, such as volunteering at a soup kitchen, delivering presents to the disadvantaged, or working with children, may lift your spirits and help everyone feel better about the holidays.

ATTENTION RETIRED MEMBERS! Retired physicians meet for lunch every Wednesday at 12 noon at IHOP, 2255 Tittabawassee Road in Saginaw. Those attending are responsible for their own lunch, and the informal gathering lasts about an hour. Join your retired colleagues whenever you like! If you have any questions, please contact Joan Cramer at the SCMS office at 790-3590 or by email at jmcramer@sbcglobal.net. The Bulletin | December 2019 11

SAVE THE DATE! CMU Seeks Clinical Educators and Partnerships in MAT to Treat Opioid Use Disorders

Opioids (including prescription opioids, heroin, and fentanyl) killed more than 47,000 people in 2017, and 40% of all opioid overdose deaths involved a prescription opioid. The opioid epidemic is hitting close to home – Michigan has experienced a 21% cumulative increase in drug overdose deaths since 2013. Central Michigan University (CMU), has a goal to combat the opioid epidemic by training medical and PA students with 8-hours of mandatory classroom learning using the American Society of Addiction Medicine’s (ASAM)-accredited curriculum with medication-assisted treatment (MAT) Drug Addiction Treatment Act (DATA) waiver training requirements. Additionally, CMU is seeking partnerships with clinical educators at certified opioid treatment facilities or primary care offices that offer MAT to host our students for clinical experience. CMU is offering community educators free 8-hour MAT DATA waiver training through ASAM on: Saturday, April 25th, 2020 9:00 am – 5:30 pm CMU College of Medicine 1280 E. Campus Drive, Room 2403 Mt. Pleasant, MI 48859 Registration Link: https://elearning.asam.org/p/mtpleasant425 Participants will receive a $25 gift card for participating and completing a brief questionnaire along with 8 Category 1 CME hours. Livestreaming will also be available at the CMU College of Medicine building in Saginaw located at 1632 Stone St., Saginaw, MI. For additional information, please contact the project coordinator, Alyson Hill at Alyson.hill@cmich.edu or at 989-746-7506 for any questions or if you are interested in hosting student(s) to learn about MAT in your practice setting.

CMU’s clinical sites and MAT (M) partnership sites as of 10/2019

12 The Bulletin | December 2019

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

Physicians, Nurse Practitioners, Physician Assistants, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists who wish to obtain a waiver to prescribe buprenorphine in an office-based setting for opioid use disorder. Clinicians and healthcare team members such as RNs, MA/LPNs, social workers, pharmacists, counselors, clinic administrators/office managers, and others working with providers who prescribe buprenorphine in an office-based setting to treat opioid use disorder.

Course Format: 8 hours live This training satisfies eight hours of education requirements for providers to qualify for a DEA DATA2000 waiver. Upon completion of this course, physicians qualify for the waiver to prescribe buprenorphine in an office-based setting. NPs and PAs can qualify after completing an additional 16 hours provided by ASAM, the American Association of Nurse Practitioners, and the American Academy of PAs.

Are you an NP or PA? ASAM also provides the additional 16 hours required for NPs and PAs to qualify for a waiver free of charge.

ASAM is an approved provider by CSAT/SAMHSA of DATA 2000 training. ACCME ACCREDITATION STATEMENT: The American Society of Addiction Medicine (ASAM) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. AMA CREDIT DESIGNATION STATEMENT: The American Society of Addiction Medicine designates this live activity for a maximum of 8 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The Bulletin | December 2019 13

MEDICAL MISSION CMU Street Medicine Elise Edwards-Cavalieri MD Candidate Class of 2020 CMU College of Medicine This October, during my endocrinology rotation, I met a woman whose story will stay with me throughout the course of my future medical career. She was the same age as me, but our fates were completely different. She had been diagnosed with Type 1 diabetes, and required multiple shots of insulin and a strict regimen to manage her sugar levels. As a result of poorly controlled diabetes, she had a mouth abscess, causing the right side of her face to double in size. When I asked how her condition had gotten this severe, she told me, "I have no home. I've been living in a bus shelter." It was a story that I had heard many times before through my work with CMU Street Medicine - the shelters were full, her family would not let her stay with her, and most places would not accept her given her history of medication noncompliance. But how could a homeless person store their insulin in a fridge? As she told me her story, tired yet determined, I could not help but think our current health system continued to fail her...and our actions here on forward will determine her health outcomes. – Yasmeen Mann, MS4 In January 2017, Saginaw County had an estimated homeless population of over 1,700 adults and children. For perspective, Michigan’s entire homeless population in January 2018 was estimated to be 8,351. A few shocking “quick facts” from our literature review: • Displaced individuals are two times more likely to have a disability. • Diabetes, heart disease and HIV/AIDs affect homeless populations at a rate of three to six times more than the general population. • The average life expectancy in the homeless population in the U.S. is estimated to be between 42-52 years, compared to the general population’s life expectancy of 78 years. • Death rates for the pediatric homeless population are more than ten times greater than that of the general population. • In the homeless population, it is nearly ten times more likely to have a current, prior or impending diagnosis of a mental disorder such as substance dependence, psychotic illnesses or major depression. These statistics are a sobering reminder of the health disparities facing the homeless population today. We know there are essentially three ways that homelessness contributes to these disparities: • Major mental illnesses can cause homelessness – schizophrenia due to the lack of appropriate treatment and social isolation, alcohol and opioid substance abuse, and cognitive impairment predispose individuals to housing instability. 14 The Bulletin | December 2019

• Certain conditions result from homelessness – substance abuse, tuberculosis, viral hepatitis, HIV/AIDs, chronic pain, injury, skin abscesses, frostbite and hypothermia. • Specific complications arise due to homelessness – lack of medicine/syringe storage complicates management of diabetes, hypertension and asthma, in addition to a poor diet due to high salt, sugar and starches in shelter meals; poor hygiene leads to poor wound healing, and high stress/dangerous living conditions can exacerbate or manifest as psychiatric issues. Central Michigan University College of Medicine (CMED) Street Medicine Student Interest Group started serving the Saginaw homeless community at the City Rescue Mission in January 2019 to address these healthcare deficits. Run by medical students and staffed by physician volunteers, Bernard Noveloso MD and Wynee Lou MD, we hold monthly “mobile clinics” to decrease barriers to healthcare in the local homeless population. Issues we tackle directly include lack of insurance, lack of adequate healthcare utilization due to distrust of medical professionals, poor education regarding follow-up necessity, limited phone access and lack of transportation. At each session, we take a full history, perform physical exams complete with vital signs and blood glucose levels, provide patient education, and treat immediate issues by prescribing medication bridges, calling EMS or giving simple conservative managements. Omar Jones, a Certified Community Health

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Worker from Great Lakes Bay Health performs on-site Medicaid applications and approvals, and schedules appointments with providers directly. Students also actively follow-up after the initial encounter to see if further assistance, such as phone access, is needed to schedule appointments or set up transportation. We have already seen the immediate benefit of our interventions: • In the young mother with a tooth abscess who could not access a dentist; • The older man who ran out of blood pressure medicine and was unaware of his hypertensive emergency; • The mother of three with abnormal uterine bleeding who did not understand the importance of seeing a gynecologist; and • The young man with a blood glucose level of 600 who was not aware he was diabetic, just to name a few from more than 90 other patients. Moving forward, we aim to implement on-site vaccination and STI screening, and to begin regular visits to homeless encampment sites to reach individuals not currently staying at shelters. Funding to date has been provided through grants and fundraisers, and without community financial partners, we may be unable to stabilize the longevity of our group and this important work in Saginaw County. As we look forward to graduation in May, we hope to have created a sustainable practice to be continued by CMED’s future medical students.

Note: Author has reference citations available upon request at edwar2el@cmich.edu. The Bulletin | December 2019 15

16th Annual Jingle Mingle Benefits Pregnancy Care Center of Saginaw The SCMS Alliance would especially like to thank Keri Benkert of the SCMS who worked tirelessly to organize and staff this successful event.

The SCMS Alliance’s 16th Annual Jingle Mingle held on Saturday, November 23, at the Saginaw Country Club was a success again in 2019 with all funds raised benefitting Pregnancy Care Center of Saginaw (PCC) . Many thanks to the vendors, table sponsors, participants and the Saginaw Country Club. The Alliance would also like to thank Norma Roenicke who once again this year entertained guests with Christmas piano music. Vendor gifts, along with pixie Poinsettias, were given away in prize drawings to those attending. The SCMS Alliance would especially like to thank Keri Benkert of the SCMS who worked tirelessly to organize and staff this successful event. Pam Krueger of PCC gave an informative presentation of their services which are provided entirely by volunteers. No matter what age, nationality, race or religion, PCC is there to help. They understand an unplanned pregnancy can be an overwhelming experience. Women may feel hurt, afraid, alone, confused or angry. The good news is they don't have to deal with this all by themselves. The caring volunteers at PCC have assisted hundreds of women facing unplanned pregnancies. Their volunteer mentors listen to questions and concerns, provide a free, confidential pregnancy test, and then provide information needed to make informed decisions. They can help women find real solutions that work for them. In addition to pregnancy tests, PCC provides confidential Bible-based mentoring; referrals for prenatal care, food, insurance, jobs, housing, etc.; information on a variety of topics; and free maternity and baby items. In addition, PCC has the following objectives: • To offer positive, God-pleasing guidance to help women make and maintain prolife decisions and attitudes; and • To share the gospel of Jesus Christ with their clients and their family and friends.

Highlights from the th 16 Annual Jingle Mingle

PCC uses your donations of baby items and money to serve - in your stead - the members of the Saginaw community who are in need. The baby items you donate are distributed free of charge to those in need. Your financial contributions provide the facilities that clients enter when they need PCC’s services. Donations of baby items and money to PCC, a 501(c)3 non-profit, are tax deductible. Monetary gifts are appreciated and needed to continue sharing the good news of Jesus with those PCC serves. Please make checks payable to Christian Life Resources Saginaw Valley and mail to Pregnancy Care Center, 916 Gratiot Ave., Saginaw, MI 48602. Online donations can be made by clicking HERE. In addition to financial support, PCC always needs: • Diapers - sizes 5 & 6 • Wipes • Pajamas in sizes preemie-4T • Winter outfits - socks, boots, mittens, winter coats and snowsuits in sizes newborn-4T • Formula • Bible story books for children • Laundry detergent • $10 Admiral or Speedway gas cards • $10 grocery store gift cards (Kroger, Aldi, Meijer, etc.) • Baby wash and shampoo • Bottles (bagless) • Strollers, car seats (newer than five years), high chairs and baby safety gates

Table Sponsors

Dr. Ronald C. Barry Dr. Scott & Colleen Cheney Dr. George & Janie Gugino Dr. Andrew & Tina LaFleur Peak Performance PC Services Ben & Keri Benkert Saginaw County Medical Society Dr. Michael & Christine Warren

Vendors

A Country Girl’s Candle ~ Alexandria Roaten Arbonne ~ Cathy Jesko Busy B’s Crafts ~ Beth Stanson Cabi ~ Cathy Jesko Color Street ~ Christa Himmelein Custom Carmel Corn & Candy ~ Denise Siler-McComb Discovery Toys ~ Shirley Bitters Gift of Hope Boutique ~ Marci Thurlow Hound Heaven Dog Treats ~ Jessica Gruenberg Last Minute Mom Designs & Crafty Grandma ~ Tracy Wenzell Luxe Fringe ~ Jackie Gascho Marna Ross with Pampered Chef ~ Marna Ross Michigan Corian Cutting Boards ~ Don Anderson Outsider Art Jewelry ~ Cherie Davila Paparazzi Jewelry ~ Analaura Nieto Puppy Paw Creations ~ Shirley Mercer Purple Frog ~ Trish Boersma R & R Sny Enterprises/Tupperware ~ Ruth Sny Usborne Books & More ~ Brandy French

Below (l-r): Top Row: Tupperware, Busy B's Crafts, Custom Carmel Corn, Discovery Toys, Hound Heaven Dog Treats, Michigan Corian Cutting Boards Bottom Row: Pampered Chef, Pregnancy Care Center's Pam Krueger, Lonna Hummel and Deborah Bula, Puppy Paw, Usborne Books

The Bulletin | January 2019 17

Background With unanimous support from the 40+ Board of Directors for the Great Lakes Bay Regional Alliance, the Great Lakes Bay Region Mental Health Partnership began in 2018 when it was agreed there was a mental health crisis in our region. A key driver and funder of this initiative is the Family and Friends of Chad William Dunn who, as a result of mental illness, died by suicide on July 29, 2013. The initiativesâ€™ key supporters also include Central Michigan University College of Medicine, The Dow Chemical Company Foundation, University of Michigan Depression Center and the Great Lakes Bay Regional Alliance.

Mission Collaborate with stakeholders to proactively tackle the mental health crisis to help people obtain the best possible care in the Great Lakes Bay Region.

Vision

Ensure that everyone in the Great Lakes Bay Region knows where to turn for help when struggling with a mental health issue, seeks help without fear of stigma, and receives prompt access to excellent care.

Problem Pipeline

Connect

Questions: info@greatlakesbaymentalhealth.com Resources: greatlakesbaymentalhealth.com

About the Great Lakes Bay Region Mental Health Partnership The Great Lakes Bay Region Mental Health Partnership is a collaborative initiative to address the mental health crisis in the Great Lakes Bay Region. The Partnership is working with community stakeholders and resources to ensure that everyone knows where to turn for help when struggling with a mental health issue, seeks help without fear of stigma and receives prompt access to excellent care. Key supporters of the Partnership include the Family and Friends of Chad William Dunn, Central Michigan University College of Medicine, University of Michigan Depression Center, The Dow Chemical Company Foundation and the Great Lakes Bay Regional Alliance.

The Bulletin | December 2019

Mental Health Provider Community Event When

Thursday, January 16, 2020, from 5-7 p.m. EST

Where

Castle Museum of Saginaw 500 Federal Avenue Saginaw, MI 48607

Please join us for our second Mental Health Provider Community Event by registering below. This event is designed to engage mental health providers in the Great Lakes Bay Region to build a community that supports one another while also retaining and attracting providers. The evening will include appetizers and enjoyable activities. This is only the beginning, but as this community evolves, there may be lunch and learn opportunities, newsletters promoting self-care tips, education and training opportunities, along with ways to celebrate provider successes in the region and the eventual creation of an annual mental health summit. We ask that you share this invitation with other mental health providers in the Great Lakes Bay Region by sharing the event page with them. We have limited capacity available, so please register as soon as possible (limit four providers per organization).

Driving Directions

Register Here If you have any questions about the event or how to register, email providers@greatlakesbaymentalhealth.com. Thank you for your continued interest in the Great Lakes Bay Region Mental Health Partnership. We look forward to seeing you at the Castle Museum on Thursday, January 16th from 5-7 p.m.

Great Lakes Bay Region Mental Health Partnership Castle Museum Website

The Bulletin | December 2019 19

2020 Saginaw County Medical Society Physician Directory

Attention all Physicians, Group Practices and Medical Partners The 2020 Physician Directory is produced by the Saginaw County Medical Society

To reserve a page for your company or physician, please call Joan Cramer at 989.790.3590 or email jmcramer@sbcglobal.net Space and Copy Deadline is Friday, January 31, 2020 Previous year’s “Premium Position” advertisers have first right to those positions until Friday, January 10, 2020, at 5 p.m. To submit fully finished ads, please provide press quality pdf files with all fonts embedded. All ads submitted should be 300 dpi at 100% for best printing. All files should be CMYK color. If you need your ad designed, please provide ad copy in Word or Text format and art and logos as jpeg or eps files.

Promote your company, office and/or group practice with an advertisement in the 2020 Saginaw County Medical Society Physician Directory. Join the many other medical suppliers and vendors and take advantage of this unique opportunity to promote your practice, group or medical company in this widely used, easy reference resource. There will be two separate versions of this conveniently sized Directory distributed in 2020. The Private Physician version will be distributed to members’ offices, and the Public Directory will be marketed and delivered directly into the hands of the public at the Annual Health Fair, events and expos throughout the year. A limited number of additional copies will be available at the Saginaw County Medical Society office and available electronically for download at www.SaginawCountyMS.com under the Pictorial Membership Directory tab. Ad Position Back Page Inside Front/Pg. 2 Page 3 Inside Back Page 4, 5 or 7 Center Spread Full Page Half Page Quarter Page

Full Color $1,800 $1,700 $1,700 $1,700 $1,700 $2,900 $1,600 $905 $490

Actual Size 6.25” wide x 9.62” high 6.25” wide x 9.62” high 6.25” wide x 9.62” high 6.25” wide x 9.62” high 6.25” wide x 9.62” high 2 center pgs - 13” wide x 9.62” high 6.25” wide x 9.62” high 6.25” wide x 4.75” high or 3” wide x 9.625” high 6.25” wide x 2.37” high or 3” wide x 4.75” high

Price includes both Physician and Public versions. All ad design services are at no additional cost.

20 The Bulletin | December 2019

2020 Saginaw County Medical Society Physician Directory ADVERTISING AGREEMENT Name of Advertiser ________________________________________________________________________ Address ______________________________ City ___________ State _____ Zip ______________________ Contact Name ___________________________________ Phone (_____) ____________________________ Email ___________________________________________

Date Completed/Signed ___/___/_________

Signature of Authorized Representative ______________________________________________________ Please Check Ad Desired *Premium Positions n Outside Back Cover n Inside Front Cover n Inside Back Cover n Pages 3, 4, 5 and 7 n Page Desired ____ n Center Spread Randomly Placed n Full Page n Half Page n Quarter Page

Full Color

Actual Size

$1,800 $1,700 $1,700 $1,700

6.25” wide x 9.62” high 6.25” wide x 9.62” high 6.25” wide x 9.62” high 6.25” wide x 9.62” high

$2,900

2 center pages – 13” wide x 9.62” high

$1,600 $ 905 $ 490

6.25” wide x 9.62” high 6.25” wide x 4.75” high OR 3” wide x 9.625” high 6.25” wide x 2.37” high OR 3” wide x 4.75” high

*Current “Premium” advertisers have right of first refusal of current space until Friday, January 10, 2020, at 5 p.m.

The above agrees to place and pay for the advertisement(s) listed above in the 2020 edition of the Saginaw County Medical Society Physician Directory (includes both Private and Public versions). The total price for the advertisement(s) is listed next to the ad dimensions. Publication date is scheduled for March 2020. All billing statements will be sent to advertisers immediately following receipt of this Advertising Agreement, and the total is due and payable by February 1, 2020, or 20 days after receipt of the invoice, whichever is later. Please return this Advertising Agreement to Joan Cramer at jmcramer@sbcglobal.net, or mail to: Saginaw County Medical Society | 350 St. Andrews Road, Suite 242 Saginaw, MI 48638-5988 | Office (989) 790-3590 | Fax (989) 790-3640 | Mobile (989) 284-8884 The Public Directory will be distributed at the 2020 Health Fair on Saturday, March 14, 2020, and throughout the year at events and physician offices/medical facilities. The Private Directory will be distributed in mid-April to physicians. Advertisers will receive both Directories which will also be available for download at www.SaginawCountyMS.com on the home page and under the Pictorial Membership Directory tab. Published by the Saginaw County Medical Society

The Bulletin | December 2019

whole and promote the highest levels of employee and physician engagement. This team is the epitome of what we have defined as necessary for not only meeting, but exceeding, our mission of Extraordinary Care for Every Generation.”

Covenant Emergency Care Center Named “Team of the Year” Press Ganey’s “Team of the Year” Award was given to Covenant HealthCare Emergency Care Center (ECC) for its unique and purposeful “One Team Approach.” This approach embodies patient-centered care by physicians and nurses routinely entering a patient’s room together, resulting in enhanced communication and expectations for care, caregiver alignment and patient engagement. The award was also given for the team effort given by each individual, including all essential services. Caregivers’ coordinated efforts to care for patients and their perception of teamwork are the largest differentiating factors in how patients experience hospital care. The Press Ganey “Team of the Year” Award honors a team that demonstrates outstanding care coordination and teamwork in pursuit of delivering safe, high-quality, compassionate care. Covenant ECC Medical Director, Dr. Matt Deibel, and Director, Jill Toporski, BSN, RN, encourage teamwork throughout the department. With 47 emergency medicine physicians, six advanced practice providers, and more than 250 ECC staff members, Toporski credits the family-dynamic the team shares for their successes. Dr. Deibel states, “We strive to provide an environment where everyone feels respected for their contributions to patient care.” “The ECC sees almost 100,000 patients annually and consistently performs in the top decile, 95th and even 99th percentile for patient experience across the nation in their peer group,” said Executive Vice President/Chief Nursing Officer, Beth Charlton. “In addition, they continually surpass quality targets and clinical outcome measures, as well as, promote the fiscal success of the organization. They celebrate individual and team triumphs and shoulder challenges as a collective 22

The Bulletin | December 2019

Covenant Receives Third Consecutive ‘A’ for Patient Safety Covenant HealthCare was once again awarded an “A” Hospital Safety Grade from The Leapfrog Group. This is the third consecutive “A” Covenant has received recognizing efforts in protecting patients from harm and meeting the highest safety standards in the United States. Covenant is the only medical center in Saginaw, Bay and Midland Counties to receive the Leapfrog A safety grade. About The Leapfrog Group: Founded in 2000, The Leapfrog Group is a national nonprofit organization committed to improving healthcare quality and safety for consumers and purchasers. The Safety Grade assigns an A, B, C, D or F grade to hospitals across the country based on their performance in preventing medical errors, injuries, accidents, infections and other harms to patients in their care. Meet Our Physician Recruiters As you know, it takes a pipeline of physicians to continue providing high-quality health care to fulfill the communities’ needs. If you know someone looking for an opportunity to move to Michigan or be part of the great work being done in the Great Lakes Bay Region, please connect them with a member of the Covenant Physician Recruitment team. Cecilia Jerome, MBA Physician Recruiter Phone 989.583.7510 Email Cecilia.Jerome@chs-mi.com Hannah Molitor, RN, BSN, MBA Physician Recruiter Phone 989.583.7595 Email Hannah.Molitor@chs-mi.com Jon Meyers, BA Physician Recruiter Phone 989.583.7505 Email Jonathon.Meyers@chs-mi.com Season’s Greetings and Happy New Year From all of us at Covenant HealthCare, we wish you safe and happy holidays, followed by a joyous and healthy new year!

IN MEMORY Paul T. Werner, MD

Paul T. Werner, MD passed away peacefully on the morning of Friday, November 22, 2019, at his home at the age of 72. Paul was born January 14, 1947, in Alpena, Michigan to the late Theodore and Eileen (Koehler) Werner. He married Jane Cotton on December 23, 1967, in Kalkaska, Michigan. Paul attended the University of Michigan earning his undergraduate degree, and attended medical school at Michigan State University, earning a doctorate degree in medicine. He worked as the Director of Education of the Upper Peninsula Medical Education Program in Escanaba for Michigan State University, and was Vice President of Medical Affairs for St. Mary’s of Michigan Hospital, retiring in 2003. While living in Escanaba, Paul was instrumental in implementing the first hospice program in Michigan. After retirement, he was trained as a lay minister and was a Synodically Authorized Minister serving many Lutheran congregations. He was a faithful and active member of Our Saviour Lutheran Church for many years, and was a dedicated volunteer at the Saginaw Metro Ministries Food Pantry. He was an avid reader and always had a passion to learn new things and strived to better his education. But what he

really loved most was being a Papa to his only grandchild and spending time with his family. Surviving are his wife, Jane; children, Nathan Werner and Amanda (Craig Johnson) Werner; a grandson, Silas; his brother, David; and extended family. Funeral services were held on November 27, 2019, at Our Saviour Lutheran Church in Saginaw. In keeping with Paul’s wishes, cremation has taken place. Those planning an expression of sympathy may wish to consider memorials to Our Saviour Lutheran Church, The Food Bank of Eastern Michigan P-981 or to the organization of your choice. Please share your thoughts and memories with the family at the church or through www.deislerfuneralhome. com.

Find Us and Like Us on Facebook! Visit Us at www.SaginawCountyMS.com

PROVIDING NEW

COVENANT REGIONAL WOUND HEALING & HypERbARIC MEDICINE CENTER

900 Cooper, Fourth Floor Saginaw, Michigan 48602 989.583.4401 Tel Hours: Monday – Friday 8 am – 5 pm

www.covenanthealthcare.com

Extraordinary care for every generation. The Bulletin | December 2019 23

International Peace Prize Being Awarded to Dr. Gary Dunbar

Ascension Medical Group Opens Primary Care Office in Downtown Saginaw

Ascension St. Mary’s is excited to announce that Dr. Gary L. Dunbar, Executive Director of the Field Neurosciences Institute in Saginaw, is one of 18 recipients of the prestigious Gusi Peace Prize International Award. The Gusi Peace Prize International is Asia's foremost awarding body and among the leading in the world today. This recognition is bestowed by the Gusi Peace Prize Foundation to recognize individuals and organizations who contribute to global peace and progress through a wide variety of fields. Dr. Dunbar was selected for the award because of his global contributions in both the educational and research domains of neuroscience. Similarly, his outstanding contributions in research, especially for developing new strategies for treating damage to the nervous system, including transplantation of genetically altered adult stem cells as a potential therapy for injury to the brain and spinal cord, as well as, neurological deficits in Huntington's, Parkinson's and Alzheimer's diseases, has earned international recognition and a prominent leadership role in the American Society for Neural Therapy and Repair. Congratulations, Dr. Dunbar!

To better serve patients, Ascension Medical Group Primary Healthcare family practice has opened a new downtown Saginaw office. Adam Kandulski, MD, and the Primary Healthcare team are now located at 1015 S. Washington Avenue, in the Ascension St. Mary’s Riverfont building (across the street from Ascension St. Mary’s Hospital). A blessing and ribbon cutting was held on Monday, November 11 to celebrate the opening of the new location. The new and larger 2nd floor office offers more comfort and convenience with additional exam rooms, a comfortable waiting area and more available parking. Being in the Ascension St. Mary’s Riverfront building also provides proximity to other specialty offices including cardiology, pulmonology and critical care, bariatric services, cardiac rehabilitation and pulmonary rehabilitation. New patients are being accepted. Appointments can be made by calling the office at (989) 753-5300 or scheduled online at GetAscensionMichiganCare.com. The office is open Monday – Friday beginning at 8 a.m.

25th Annual Ascension St. Mary’s Foundation Cornette Ball Was a Huge Success! Hundreds of physicians, community leaders and associates attended the 25th Annual Ascension St. Mary’s Foundation Cornette Ball and honored Dr. Rao Gudipati as the recipient of The Spirit of St. Vincent Award. He was bestowed with the award from Dr. Stephanie Duggan, Regional President, Ascension Northern Michigan Ministries, in recognition of his long and noteworthy service to the Great Lakes Bay community and beyond. Family, friends and colleagues of Dr. Gudipati were in attendance at the celebration. The Ascension St. Mary’s Foundation Cornette Ball has raised more than $2.9 million during the past 25 years to support equipment upgrades and hospital programs and services. This year’s event raised more than $215,000 which will support the purchase of advanced imaging equipment and community health and wellness programs. To see more photos, check out our Facebook page theater and be sure to like and share.

The Bulletin | December 2019

Annual Light Up a Life Campaign Ascension St. Mary’s Foundation will host its Light up a Life campaign during the month of December. This annual holiday campaign is an opportunity to remember those who were such an important part of our life during the holidays ... and throughout the year. For a gift of $20, a white light will be illuminated in honor or memory of a loved one. For a gift of $35, a commemorative ornament will be mailed to an address of the purchaser's choice. Donations of $125 will sponsor a tree in front of the hospital which be illuminated in honor or memory of a loved one. A sign will be placed in front of the tree and notification of your gift will be sent to the address of your choice. A Remembrance Reception was held on December 10 in the Ascension St. Mary’s Hospital Health Education Center. Proceeds will support community health and wellness programs. For more information, call the Foundation at (989) 907-8300.

Ascension Online Care Anywhere, anytime

Ascension Online Care is here for you and your family 24/7. From anywhere, at any time, talk with a doctor using your smartphone, tablet or laptop. Get the care you need and start feeling better for only $49 per visit. No insurance required. Get started at ascension.org/onlinecare or download the mobile app.

See us for a wide variety of symptoms and conditions, including: • Sinus or upper respiratory infections • Eye infections • Allergic reactions/ allergies • Cold/flu • Fever • Urinary tract infections

If you are experiencing a major emergency, go to the ER as soon as possible or call 911. © Ascension 2019. All rights reserved. The “Android” name, the Android logo, the “Google Play” brand, and other Google trademarks, are property of Google LLC. All rights reserved. Apple, the Apple logo, iPhone, and iPad are trademarks of Apple Inc. All rights reserved.

The Bulletin | December 2019 25

Nominations Being Accepted for MSMS Board Designated Director Positions – DEADLINE 12/31/19

to participate actively in making decisions on behalf of the organization, and to exercise best judgment while doing so. At the MSMS 2019 House of Delegates (HOD) meeting, the • Duty of Loyalty - Each board member must put the interests House approved a bylaw change that revised the composition of the organization before personal and professional of the Board of Directors. With these changes, there will be up interests when acting on behalf of the organization in a to six (6) Designated Directors elected by the HOD representing decision-making capacity. The organization’s needs come those constituencies that are deemed to be the most relevant to first. the current health care marketplace. The Designated Directors • Duty of Obedience - Board members bear the legal will be identified by the Nominating Committee of the HOD with responsibility of ensuring that the organization complies input from the Board of Directors and the HOD. with the applicable federal, state and local laws and adheres Now that the Nominating Committee has been elected, the to its mission. Committee is responsible for identifying physicians who meet the For the full job description, click HERE. To complete the criteria and qualify for a specific category. The HOD approved the nomination form, please click HERE. A current curriculum following six (6) Designated Director categories: vitae (CV) is also required for consideration. • Physician Organization Leader • Independent Small Practice Physician #FixPriorAuth because #HealthCantWait: • Physician Leader from Health System Support SB 612 • Physician Serving in Government/Public Health Role The Health Can’t Wait Act of 2019 was introduced as Senate • Physician Serving as DIO/Representing GME Training Bill 612 in October by Senator Curt VanderWall (R-Ludington). • At-large Physician An Action Alert is now live and ready for you to write your The MSMS Board of Directors’ responsibilities center around Senator at http://healthcantwait.org/take-action. three duties: continued on page 27 • Duty of Care - Each board member has a legal responsibility

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

Key Provider to the SCMS

Healthway Compounding Pharmacy 2544 McLeod Dr. N. | Saginaw, MI 48604 | 989.791.1691 | www.healthwayrx.com 26

The Bulletin | December 2019

continued from page 26

Surprise Out-of-Network Billing Legislation - Urge the Michigan Ways and Means Committee Members to Put the Needs of Patients First Lawmakers in Michigan, in Congress and around the country are debating the appropriate recourse to address unanticipated out-of-network bills. Patients are receiving these high bills because the care they believed was covered, actually was not. This is a problem, but it is also a complex issue tied up in provider-payer negotiations and market dynamics. MSMS continues to deploy grassroots action alerts, and engage in discussions with legislative staff and lawmakers, including leadership in an effort to - at the very least - slow the process down. A letter to the quadrant leaders, signed by all of the presidents of the various medical societies, asking for the legislature to consider slowing the process to first and foremost consider the scope was also circulated recently. Separately, MSMS is working with Senator Bizon's office to draft alternative language for possible inclusion in the bills. Click HERE to Write the Committee Members NOW

Dr. Caroline Scott Serves on MSMS Judicial Commission Caroline G.M. Scott, MD was recently elected to serve another term on the MSMS Judicial Commission. When MSMS receives a complaint from a patient or physician who may have a grievance with a MSMS member, the MSMS Judicial Commission oversees county medical society peer review committees that handle cases occurring within their geographical jurisdiction. If MSMS receives a complaint for a member who practices in a county without an active county medical society, the Judicial Commission would conduct the peer review process. The Judicial Commission is also responsible for hearing appeals from members whose membership has been revoked. Congratulations, Dr. Scott!

JANUARY BIRTHDAYS Jamal U. Akbar MD Naveed Akhtar MD Ghaith Al-Qudah MD Sarosh Anwar MD Edward Austin MD Ernie P. Balcueva MD John K. Bartnik MD Ronald A. Bays MD Abbas Bekhrad MD Kaitlyn E. Matz Bishop DO Robert L. Borenitsch DO Gary A. Brooks MD Paul B. Bry MD Happy Special Birthday! Lowell A. Butman MD Doris D. Cataquiz MD

Bryon C. Chamberlain MD Louis L. Constan MD Elvira M. Dawis MD Happy Special Birthday! Lara DeStefano MD Michael S. Dixon (Student) Avi B. Dobrusin (Student) Angie Lynn F. Domingo MD Robert M. (Matt) Dumas MD Mark E. English (Student) Preeti Gudimella MD Leatha B. Hayes DO Gregory C. Hazen MD Mali Him MD Carlyn M. Hinish DPM Ali E. Ibrahim MD

Mohammad Jafferany MD Shakeel M. Jamal MD Michelle G. Jin (Student) Roger N. Kahn MD Charles A. Keane (Student) Mohammad Yahya Khan MD Young H. Kim MD Ghanesh D. Kini MD Haley Kopkau (Student) Menelito D. Lilagan DO Marko Lubardic (Student) Mark R. Ludka MD Ben R. Mayne MD Kristina M. Munoz (Student) Lindsay E. Murphy (Student) Babu L. Nahata MD

Sunil P. Pandit MD Elizabeth A. Paulus MD Abigail J. Pittard MD S. Sethu K. Reddy MD Douglas J. Saylor MD Susan K. Schmiege MD Michael L. Schultz MD Maliha N. Shaikh MD Molly Stanford (Student) Craig J. Thomas MD Angelika G. Urbaniak (Student) Venkatramana R. Vattipally MD Daniel J. Wechter MD Arno W. Weiss, Jr. MD Kiara A. Whitsell MD

APPLICATION FOR MEMBERSHIP SECOND READING: Application for membership that may be recommended for acceptance at the Tuesday, January 21, 2020, Board Meeting: Jeffrey D. Osborne, MD (Covenant Orthopaedics - Gratiot) Specialty: Surgery â€“ Orthopaedic, Sports Medicine Medical School: Wayne State University School of Medicine, 2013 Internship/Residency: William Beaumont Hospital, Orthopaedic Surgery Residency, Oakland University, Royal Oak, MI 2013-18 Fellowship: Detroit Medical Center, Sports Medicine 2018-19 Sponsors: Doctors James J. Jesko and Michael J. Wolohan The Bulletin | December 2019 27

College of

Medicine CME Fall 2019 Survey – Deadline 12/31/19 Season’s Greetings! Twice each year, we ask your opinion about your CME learning experience in a brief five question survey that takes less than three minutes. We greatly value your opinion. Would you kindly complete this survey before December 31, 2019? Click here for the survey. You can always express your concerns, requests, observations, comments and suggestions at any time at CME Comments and Suggestions. Wishing you and yours a healthy and happy Holiday Season. Office of Continuing Medical Education

Would You Like to Mentor a Medical Student? The SCMS Board encourages members to volunteer as mentors for medical students. The goal is to make a personal connection with the students during their stay in Saginaw, mentor and encourage them to stay in Saginaw for residency and to practice. Please consider mentoring a student or two, tell them about Saginaw and the SCMS, answer their questions, bring them to a future SCMS meeting, and guide them as needed. If you are interested in mentoring a student, please contact Michele Reynolds, MA, Assistant Director of Student Affairs at CMU College of Medicine at michele.reynolds@ cmich.edu.

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

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)

Caduceus meetings are available to health care industry professionals, and have adopted many of the principles of 12-Step programs. Caduceus meetings are “closed” meetings for recovering health care professionals including, but not limited to, nurses, doctors, dentists and pharmacists.

The Bulletin | December 2019

Frances Greathouse, M2 Class of 2021 From November 14-16, students from Central Michigan University College of Medicine attended the AMA Interim Conference in San Diego, California. Attending the meeting were Samuel Borer, Sanjay Das, Frances Greathouse, Haley Maser and Lindsay Murphy. The SCMS Foundation funded hotel accommodations for the CMU students. The students attended the medical student section meetings where resolutions, created by the students, were discussed. It was a very rewarding experience that helped us see the importance of (l-r) Lindsay Murphy, physicians and medical students Frances Greathouse, Haley Maser, Samuel Borer and coming together to fight for Sanjay Das physician and patient rights. The resolutions that were passed will make a substantial difference in human medicine, and it was a great opportunity to witness this taking place. In addition to policy making, we networked with many other medical students from the U.S. The relationships we formed will continue to grow throughout our medical career. Many of these medical students opened our eyes to the endless possibilities on how to further our involvement in the AMA. We were all encouraged to become more involved in AMA, MSMS and SCMS.

Caduceus Meeting for Recovering Health Care Professionals

n Monthly Accounting n Tax Planning n Financial and Business Consulting Service n Payroll Service n Tax Preparation Service n Retirement Planning

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

SCMS Foundation Supports CMU Medical Students Attending AMA Interim Conference

“Attention to detail since 1980.”

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

Good News on Opiates! By Louis L. Constan, MD I got some good news from my insurance company the other day. My co-pay for physical therapy visits just decreased from $40 to $10. Wow! And why would they do that? I’d like to think the insurance company is finally getting serious about discouraging doctors from reflexively ordering opiates for chronic pain just because the preferred treatment, physical therapy, was just too expensive. The other good news: An AMA article details a study from U of M in which the school convinced BCBSM to allow surgeons to use a -22 modifier on their surgical bills if they counselled their patients on managing their post-operative pain. The bumpup on the reimbursement? Thirty-five percent. Yes 35 percent! At U of M, this led to a dramatic increase in surgeons advising patients on how to manage pain without opiates, and a dramatic decrease in the use of opiates for post-operative pain. And the even better news: The -22 modifier is available to ALL Michigan surgeons. Think of the above developments as the carrots. Now think of the sticks: All the state and federal regulations making it onerous to prescribe opiates, as well as, the increasing fears our patients have of getting addicted whenever we try to prescribe these drugs. Is there really an excuse not to make the switch from opiates to alternative methods of pain relief? So let’s review those alternative methods. Acute pain first: The first thing is to remember that, in order to treat acute pain, you must actually see the patient “acutely.” If your office does not keep open slots for call-ins and the soonest you ever see patients is “a week from Thursday,” then, by default, you see only chronic pain patients and you should probably change your scheduling plan for the benefit of your acute pain patients. As far as pharmacology is concerned, Tylenol works well, of course, in adequate doses. One thousand mg q eight hours. Patients need to be reminded they should build up a “steady state” level of the drug in their bloodstream by taking it regularly for four to five half-lives to get the full benefit. Then NSAIDs, either over-the-counter or prescription, which can be less irritating on the stomach. (Ditto with the ‘taking it regularly lecture.’) Hint, many patients feel more cared for when their doctor goes to the trouble of writing a prescription. We mustn’t forget this. Of course, if opiates are deemed

necessary, and the U of M study allowed this, small amounts were preferred, two- or three-days’ worth of pills. Others remind us that codeine is less addictive than hydrocodone or oxycodone. Alternative meds for acute pain include muscle relaxers and benzodiazepines, depending on the physician’s judgment as to the type of patient having the pain. Of course, not all patients will need pharmacology to treat acute pain. “If it only hurts when you move it, then don’t move it,” is advice patients sometimes need to heed. Then, ice, compression, elevation…it’s what football players get after the game. Finally, of course, is early referral to a physical therapist if there is no improvement after a few days. Now for chronic pain: The most important thing with chronic pain is to avoid actions that enable your patient to become addicted to opiates. Repeat, the most important thing with chronic pain is to avoid actions that enable your patient to become addicted to opiates. (If that happens, of course, consider how your patient has access to appropriate treatment including MAT (Medication Assisted Treatment), from those who can provide that treatment including addiction specialists.) And the best way you avoid letting your patient get addicted, if you absolutely must prescribe opiates, is to only give him small doses for limited times and refuse to renew them. • Ever and always, consider non-opiates first: Tylenol, NSAIDs. They work equally well for chronic as for acute pain, as long as they are used aggressively. • Other alternatives if pharmacology doesn’t work: Physical therapy referral. Chronic pain often leads to deconditioned muscles. PTs can help correct this, and stronger muscles can protect sore joints, ligaments and tendons. • Occupational therapy referral. Often the patient’s real issue is not so much the pain itself as it is the inability to perform certain activities at home or work. OTs can help a lot. • A Physical Medicine and Rehabilitation Physician referral. These colleagues can provide a global prospective into pain, work, home life…and creative solutions. • A psychologist. Chronic pain patients are often depressed and in need of counselling. Even if they are not, psychologists can teach techniques such as Mindfulness and Guided Imagery, which have been well proven to reduce pain. • Pain specialist referral. Nerve and spinal blocks are options for some patients. As you might expect, THRIVE, is working at making more resources available to our community for comprehensive rehabilitation of chronic pain patients. More later.

Is there really an excuse not to make the switch from opiates to alternative methods of pain relief? The Bulletin | December 2019 29

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New Medicare Card: Claim Reject Codes After January 1 Get Paid. Use Medicare Beneficiary Identifiers (MBIs) Now. If you do not use MBIs on claims (with a few exceptions) after January 1, you will get: • Electronic claims reject codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity’s contract/member number), and an Entity Code of IL (subscriber). • Paper claims notices: Claim Adjustment Reason Code (CARC) 16 “Claim/service lacks information or has submission/billing error(s)” and Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier.” We encourage people with Medicare to carry their cards with them since we removed the Social Security Number-based number; if your patients do not bring their Medicare cards with them: • Give them the Get Your New Medicare Card flyer in English (PDF) or Spanish (PDF) . • Use your Medicare Administrative Contractor’s look-up tool. Sign up (PDF) for the Portal to use the tool. • Check the remittance advice. Until December 2019, we return the MBI on the remittance advice for every claim with a valid and active Health Insurance Claim Number (HICN). See the MLN Matters Article (PDF) to learn how to get and use MBIs.

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Call for Resolutions: Who Sets MSMS Policy? You Do! The Michigan State Medical Society (MSMS) House of 11th Annual Conference: The Region’s Health and Health Care Systems Delegates (HOD), comprised of 319 elected delegates, is the official legislative and policy-making body of MSMS and its component societies, including the Saginaw County Medical Society (SCMS). Resolutions debated during the annual MSMS HOD are the vehicles by which MSMS policies, priorities and directives are determined. Deadline for resolutions is March 1 at 5 p.m. Resolutions must be submitted via the online submission form. If you have any questions, contact Stacey Hettiger at (517) 336-5766. The best way to get your idea or recommendation adopted as MSMS policy or directive is at the grassroots level. As a member in good standing of MSMS/SCMS, you have the right to bring your ideas to the annual HOD for consideration by MSMS’ "legislators." To do so, present your suggestion and rationale at the SCMS meeting. If the SCMS agrees, the SCMS will work with you to draft a resolution to be presented at the next HOD meeting. The resolution should specify the desired The health of our community’s population continues to be of paramount importance. MSMS policy or directive for MSMS action. If the SCMS does Across the nation, moving upstream is recognized as vital to health outcomes. Living conditions and not agree with your idea, you may ask another delegate root cause factors, generally referred to astosocial determinants of health are taking center stage. submit aThe resolution on2020 your behalf as an individual January conference speakersdelegate. are exceptional pioneers who are providing unprecedented leadership and innovation in upstream health efforts, routinely breaking the mold of past approaches. It is also prudent to check MSMS’ current Policy Manual Their broad information andtosubstantial routinely transform thinking and drive action and, if relevant, the AMA Policy Finder determine ifexperience policy while maintaining quality and positive care experiences. on the issue already exists.

Communities Achieving Excellence & Moving Upstream

FRIDAY, JANUARY 24,s Health 2020and| Health 8:15Care A.M. TO 1:00 P.M. 11th Annual Conference: The Region’ Systems

SAGINAW VALLEY STATE UNIVERSITY Ott Auditorium | Regional Education Center | 7400 Bay Rd, University Center, MI 48710

* Simulcast at Central Michigan University & Kirtland Health Sciences Center, Grayling

SPEAKERS:

Rishi Manchanda, M.D., MPH; President and CEO, Health Begins BREAKTHROUGH THINKING FOR UPSTREAM IMPACT - The early work of upstream thought leaders in health care focused on improving the transactional dimensions of care. Yet, at its best, upstream work is transformational. A more recent focus strives to transform both the relationships and the social structures that influence health, not only the transactions of care. As this movement matures, institutions, multi-sector collaboratives and entire communities face similar challenges. How do we take a bundle of interventions purporting to address a variety of social needs and shape them into a cohesive investment strategy that can achieve long-term health, social and financial impact? First, use an investment mindset. Second, tackle structural determinants, not just social needs.

Communities Achieving Excellence & Moving Upstream

Brian C. Castrucci, MA, DrPH; President and CEO, de Beaumont Foundation PUBLIC HEALTH PROGRESS THROUGH PARTNERSHIPS: BUILDING SUSTAINABLE COLLABORATIONS Public health has traditionally operated in a silo, but achieving long-term wellbeing for our communities increasingly requires cross-sector collaboration. Policies from “Tobacco 21” to safe rental housing have passed with business buy-in, empowering Americans to live healthier lives. Although cross-sector partnerships have inherent challenges, effective collaboration allows communities can go beyond focusing solely on individual social needs and instead tackle the social SAGINAW VALLEY STATE UNIVERSITY The health of our community’s population continues to be of paramount importance. determinants of health. Case studies of successful, sustainable partnerships can help pave the way for effective future Ott Auditorium | Regional EducationisCenter | 7400asBay Rd, Center, MI 48710 Across the nation, moving upstream recognized vital toUniversity health outcomes. Living conditions and collaborations.

FRIDAY, JANUARY 24, 2020 | 8:15 A.M. TO 1:00 P.M.

cause at factors, to&asKirtland social determinants healthGrayling are taking center stage. *root Simulcast Centralgenerally Michiganreferred University Health SciencesofCenter,

The January 2020 conference speakers are exceptional pioneers who are providing unprecedented REGISTER TODAY! REGISTER TODAY! leadership and innovation in upstream health efforts, routinely breaking the mold of past approaches. Their broad information and substantial experience routinely transform thinking and drive action while maintaining quality and positive care experiences. For more informtion

For more information contact contactadmin@mihia.org admin@mihia.org

FRIDAY, JANUARY 24, 2020 | 8:15 A.M. TO 1:00 P.M.

SAGINAW VALLEY STATE UNIVERSITY The Bulletin | December 2019 31 Ott Auditorium | Regional Education Center | 7400 Bay Rd, University Center, MI 48710 * Simulcast at Central Michigan University & Kirtland Health Sciences Center, Grayling

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2019-2020 KEY PROVIDERS

These Area Businesses Support Saginaw County Medical Society Membership Meetings. When you have a need for a service, please consider our Key Providers. Please mark your calendar for the following meetings and events for the first six months of 2020. You will receive an email meeting notice and reminder each month for SCMS events. Non-SCMS events are listed as a courtesy and you must contact the sponsor directly to register. SCMS Membership Meetings are held on the third Tuesday of January, April, May, September and October. The SCMS Board meets on the third Tuesday of every month (except July, August and December) at 5:30 p.m. There is no Board or Membership Meeting in December. Happy Holidays! Thursday, January 16, 2020 Castle Museum of Saginaw - GLBR Mental Health Provider Community Event. See page 19 to register. Tuesday, January 21, 2020 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Membership Meeting joint with the Saginaw County Dental Society with Social (cash bar) at 6:30 p.m. followed by dinner and program at 7 p.m. Speaker: Darnell Kaigler, Jr., DDS, PhD from the University of Michigan Dental School. Program: "Oral Health and Overall Health: 2020 and Beyond." CME CREDIT AVAILABLE. See page 7 to register. Friday, January 24, 2020 SVSU Ott Auditorium - 11th Annual Conference: The Region's Health and Health Care Systems. See page 31 to register. Tuesday, February 18, 2020 CMU College of Medicine, 1632 Stone Street – SCMS Board meets at 5:30 p.m. Saturday, March 14, 2020 Horizons Conference Center - 16th Annual Health Fair “The Doctor Is In!” from 9 a.m.-12 p.m. Tuesday, March 17, 2020 CMU College of Medicine, 1632 Stone Street – SCMS Board meets at 5:30 p.m.

Tuesday, April 21, 2020 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Membership Meeting with Social (cash bar) at 6:30 p.m. followed by dinner and program at 7 p.m. Speaker: Molly E. Gabriel-Champine, PhD, LP, Director of Behavioral Science, Family Medicine Residency at McLaren Bay. Program: “Physician Compassion Fatigue/Burnout.” Saturday, April 25, 2020 CMU College of Medicine, Mt. Pleasant, with livestreaming at the Saginaw Campus, 9 a.m. – 5:30 p.m. Free eight-hour MAT DATA waiver training through ASAM. See pages 12-13 for more information and to register. Saturday-Sunday, April 25-26, 2020 The Henry in Dearborn – 155th Annual MSMS House of Delegates. Tuesday, May 19, 2020 Horizons Conference Center - SCMS Board meets at 5:30 p.m. Membership Meeting with Social (cash bar) at 6:30 p.m. followed by dinner and SCMS and SCMS Foundation Annual Meetings at 7 p.m. Program: “Update on CMU College of Medicine.” Saturday, June 6, 2020 Saginaw Country Club – 11th Annual SCMS Foundation Golf Outing. Four-person scramble. 12 p.m. Registration and Lunch, with 1 p.m. Shotgun Start. Tuesday, June 16, 2020 CMU College of Medicine, 1632 Stone Street – SCMS Board meets at 5:30 p.m.