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The

Bulletin Saginaw County Medical Society

October 2021 | Volume 79 | No 7

SCMS Calendar of Meetings for 2021-22... p. 5 AMA BREAKING NEWS Final Rule on No Suprises Act... p. 15 September Membership Meeting

Resources for Physician Compassion Fatigue... p. 16-19 www.SaginawCountyMS.com

HIGHEST award for

stroke care Covenant HealthCare has once again achieved recognition by the American Heart Association and American Stroke Association for following the latest research-based standards for stroke care with a Gold Plus Get With The Guidelines® Stroke Quality Achievement Award. The Covenant Stroke Program is committed to improving patient outcomes and providing healthier lives for our stroke patients from diagnosis to recovery – and beyond. To learn more, visit CovenantStroke.com 2021 Covenant HealthCare. All rights reserved. PK 9/21 14301

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

5, 32

10 11

REGISTER NOW! October Membership Meeting SCMS Calendar of Meetings and Events for 2021-22 Renew Your SCMS/MSMS Membership for 2022 *Free CME credit if renewed by 11/30/21 SCHD Fall COVID Quarantine Protocol LARA E-Prescribing Date Moved to January 1, 2022

AMA BREAKING NEWS Summary of Interim Final Rule on No Surprises Act (includes link to ACEP Summary)

16-19 25

September Membership Meeting & Resources for Physician Compassion Fatigue ECHO Series* Supporting Treatment Courts & Health Professionals

End the Epidemic – MI CARES

National Vaccine Injury Compensation Program

Kai Anderson MD Bulletin Editor Louis L. Constan MD

4 5 6

President’s Letter

Barb Smith SR&RN

MSMS Delegates

8 12

Elvira M. Dawis MD

Resident Representatives Jessica H. Faris MD Lydia T. Mansour DO Retiree Representative Caroline G.M. Scott 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

Guest Writers Welcome! From the Editor

CMU College of Medicine CMU Health

FREE Confidential Counseling For Frontline Healthcare Workers

Ascension St. Mary’s

Applications for Membership

23 23 24 26 28 29

New Member Birthdays – November Covenant HealthCare MSMS Legislative Update – Part 1 Health Can’t Wait Caduceus Meeting for Recovering Health Care Professionals

30 31

Advertiser Index MiHIA - Live Your Life on Purpose

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

Caroline G.M. Scott MD

COVER PHOTO: DRS. ANTHONY AND CLAUDIA ZACHAREK

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

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 | October 2021 3

PRESIDENT'S LETTER

Ethics in Health Care Anthony M. Zacharek, MD MHA

e all deal with ethical dilemmas in our daily lives, whether as a physician or as a parent or a spouse. According to Filerman et al, “ethics is discussion, questioning, reasoning, or debate about morality (the right thing to do), and the terms (ethics and morality) are often used interchangeably. … More often, morally or ethically problematic situations or events are murky and have no unequivocal yes or no answer” (Filerman et al, Managerial Ethics in Healthcare, 2014). In other words, ethical issues require communication and debate in order to reach a reasonable conclusion to the issue. Imagine a patient being admitted to your hospital who is receiving a lifesaving treatment that costs thousands of dollars, and after a lengthy hospital stay, the patient

cannot afford the treatment and has no health insurance. What should the hospital do in this situation, especially if the patient needs to be admitted periodically in order to receive lifesaving care? The hospital has to try to stay financially viable in order to continue to operate, but at the same time, has the obligation to serve its community. This is just one of many examples of how ethical dilemmas arise in healthcare. In order to provide some guidance on ethical decision-making, the ACHE (American College of Healthcare Executives) has provided a six step process for approaching an ethical issue in healthcare. The six step process is the following: • Step One - recognize the background (the circumstances leading to the ethics conflict) • Step Two - identify the specific ethical question that needs clarification

• Step Three - consider the related ethical principles or organizational values • Step Four - determine the options for response • Step Five - recommend a response • Step Six - anticipate the ethical conflict This six step process is a logical way to approach any ethical dilemma. Hospital ethics committees use this process to come up with responses to ethical issues, and as Step Six suggests, there will always be ethical conflicts no matter what response you take. My challenge to our Medical Society is to incorporate ethics in your day-to-day routine of patient care and in your interaction with your colleagues. I believe an ethical approach to any healthcare issue should involve open communication with those people involved, listening, respect and a good heart.

In other words, ethical issues require communication and debate in order to reach a reasonable conclusion to the issue.

Read previous issues of The Bulletin at www.SaginawCountyMS.com. The SCMS paused printing hard copies of The Bulletin during the COVID pandemic due to economic struggles. All issues were distributed electronically. To view the current and prior issues, visit www.SaginawCountyMS.com and click on the Bulletin tab. If you would like to receive hard copies of The Bulletin, please email jmcramer@sbcglobal.net. Read through this month’s issue for a chance to win a $50 Amazon gift card on November 1! 4

The Bulletin | October 2021

CALENDAR OF MEETINGS AND EVENTS FOR 2021-22* Tuesday, October 19, 2021 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: “Future of Physician Leadership: Regionally and Nationally” 1.5 AMA PRA Category 1 CreditsTM available Speaker: Marilyn Skrocki, SVSU Professor of Health Sciences, Health & Human Services, Academic and Student Affairs Online reservations are required. CLICK HERE TO MAKE A RESERVATION (due 10/15/21) or scan the QR Code DISCLOSURE: The planners and speakers have no relevant financial relationships with ineligible companies to disclose. 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. CMU 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 1.5 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Tuesday, November 16, 2021 CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m. Tuesday, January 18, 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 and Speaker TBD Email meeting notices will be sent in early January. Online reservations are required.

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 and Speaker TBD 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. *subject to change

HIRE ME.

Tuesday, February 15, 2022 CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m. Tuesday, March 15, 2022 CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m.

GUEST WRITERS WELCOME! 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. Articles are not designed for self-promotion, but rather as information for members.

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

The Bulletin | October 2021 5

FROM THE EDITOR

My Body, My Choice By Louis L. Constan, MD

was lulled into drowsiness by the almost pastoral setting; peaceful music playing, the darkened room, both Mrs. Jones and her husband strangely cheerful between contractions. Why wouldn’t they be happy? They were having the baby ‘their way’ which is to say ‘naturally,’ although in the labor room with a fetal monitor on and me standing by. Suddenly I was alerted by a sharp drop in the fetal heart rate. “Nurse! Table flat! Lights up! Forceps!” “Doc, what are you doing? I want a natural delivery. Put me back where I was, immediately!” I ignored her. There was simply no time to have the argument she so clearly wanted to have. The baby was delivered in short order and was fine. The Jones’ were fuming. Clearly, they were not used to being told “no” by a physician. In the ordinary course of care, patients expect to be involved in the decisionmaking process for their treatment plans; sometimes referred to as “their body, their choice.” The Jones’ found out to their displeasure though, such ‘rights’ to make decisions, to ‘choose,’ has never been and will never be, absolute. For sure, there was the difficulty of making a quick decision in an emergency; but there was also the problem of other persons in the room with competing interests. One of the persons was the child, who didn’t much care for the ‘natural’

experience but did have an interest in being born alive. The other person was myself. If a ‘bad baby’ resulted from this situation, I likely would have been sued, and that lawsuit would have negatively impacted my ability to practice medicine. I made a moral decision for the benefit of the child, and a self-serving decision …very quickly…and justified it just as quickly as ‘good medicine.’ But, who’s to say for sure. There are other, less dramatic situations in which patients put us in situations of moral, ethical or social ambiguity. We don’t always see these conundrums coming at us when patients: • Ask us to tell that little white lie on an insurance form so they can get coverage • Request a post-dated excuse for work absence • Ask for a letter supporting their disability claim that back pain is caused by their work and not their obesity • Ask for a Viagra script and demand you recognize their confidentiality by not telling their wife • Refuse to even try to stop smoking, drinking, overeating, underexercising • Decline the COVID vaccine but expect you to take care of them anyway

When they make the conscious choices to defraud their employer, defraud their insurance company, cheat on their spouse, eat and drink to excess and refuse a life-saving vaccine, they have made seriously questionable choices which, perhaps, could be treated no differently than how I treated the Jones’ choice for a ‘natural’ delivery. That is, refused. In fact, the ability to make choices about one’s healthcare is more of a privilege than a right, and is dependent on the patient getting serious about his responsibility to step up and start making responsible choices. And oh, the irresponsible choices I’ve seen! Will they ever stop? Not if we don’t ask they won’t. So what exactly should we ask of patients? This is fairly simple. First of all, that they start thinking more seriously about the choices they make. Weighty choices of life and health should be made with sober judgment. Accepting the advice of friends and neighbors is not enough. Aping the ‘talking heads’ is not enough. They need to start paying attention to reliable sources of information from university, government or major hospital websites. Second, consider the effects of their decision on others, describe those effects, continued on page 7

In fact, the ability to make choices about one’s healthcare is more of a privilege than a right, and is dependent on the patient getting serious about his responsibility to step up and start making responsible choices. 6

The Bulletin | October 2021

continued from page 6

understand them. Explain why their own benefit warrants potential harm to others. We understand that sick patients often neglect others’ needs while they are ill; it’s natural. However, with the increasing prevalence of chronic disease, there has been an increase in narcissistic behavior by sick patients, in which they neglect ALL the needs of those around them. This is not right and we as doctors should not stand by and accept such behavior. Finally, accept the reality that they may not get what they want, no matter how much they want it, no matter how much research they have done; no matter how supportive their family is in this. Choice is never, never absolute. At best a privilege. The important thing is good patient care and the physician has the final say in that. Reader, If you’ve enjoyed my columns over the years, you may enjoy my book,” Two Minds, Your Body” available at Amazon Books: https://www.amazon.com/Two-Minds-Your-Bodyknowledge-ebook/dp/B08R5W4PSH

www.SaginawCountyMS.com

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 Free CME for Your SCMS/MSMS Membership Renewal by November 30 As a thank you for your loyalty as a member of the SCMS/ MSMS and for paying early all physicians who pay their 2022 dues in full by November 30 will receive a $100 coupon towards a CME course at an MSMS educational session. Installment payments available. 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. The free CME course is just a small token of appreciation for your continued support of organized medicine. 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 | October 2021 7

Hope Starts Here – Saturday, November 20, 2021 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. We are pleased to announce Frank Campbell, Ph.D., LCSW, C.T., a nationally-known expert on suicide grief, 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 pastpresident of the American Association of Suicidology and a recipient of both national and international awards for his contributions. SPONSORS NEEDED! Hope Starts Here is made possible in part from our annual Walk for Hope...Depression and Suicide Awareness event and Hope Starts Here sponsors. Please consider a sponsorship to help offset expenses of the event. Thank you!

www.SaginawCountyMS.com

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 1-800-273-8255.

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The Bulletin | October 2021

I would like to sponsor HOPE STARTS HERE, a day for family and friends who have experienced a loss to suicide. Help us create a circle of support for those who are hurting in our community. _____ $4,000 _____ $2,000 _____ $1,000 _____ $ 750 _____ $ 500 _____ $ 250 _____ $ 100

Keynote Speaker Sponsor - Dr. Frank Campbell (limit 1) Includes acknowledgement and signage at event as well as recognition on social media and event website Lunch Sponsor (limit 2) Includes signage at event as well as recognition on social media and event website Art Therapy Sponsor (Limit 2) Includes signage at event as well as recognition on social media and event website Welcome Food Sponsor (limit 2) Includes signage at event as well as recognition on social media Closing Ceremony Sponsor (limit 1) Includes signage at event as well as recognition on social media and event website Hope Tote Sponsor (limit 4) Includes signage at event as well as recognition on totes passed out to participants Hope Sponsor Includes signage at event

____ I would like to help promote the program at my agency, business, church, organization, etc. Please send me _____ # of brochures. ____ I would like to host a resource table ($15.00 charge for tables; this includes lunch). # of persons attending __________ Exact spelling of name/organization for promotional brochure or event signage: _________________________________________________

_____________________________

Contact Person Name_____________________________________________________________________ Agency_________________________________________________________________________________ Address________________________________________________________________________________ Phone__________________________________ Email__________________________________________ Make your tax-deductible checks payable to: Barb Smith Suicide Resource & Response Network and send completed form to: Barb Smith Suicide Resource & Response Network P.O. Box 6712 Saginaw, MI 48608-6712 For more jamie@srrn.netoror 989-781-5260 For moreinformation, information,contact contactJamie Jamie at jamie@srrn.net 989-781-5260 ext.ext. 3 3 YouYou can also online at: at:p2p.onecause.com/hope-starts-here-2021 p2p.onecause.com/ hope-starts-here-2021. can alsosign signup upand and pay pay online

The Bulletin | October 2021 9

COVID-19 Protocol

QUARANTINE Protocol Fall 2021

Quarantine is staying home and away from others AFTER EXPOSURE to COVID-19. It prevents someone from further spreading the virus in the event they develop it over the next 2-14 days, which is the incubation period for COVID-19.

EXPOSURE WITHIN OR OUTSIDE THE HOME

ADDITIONAL QUARANTINE OPTION

Vaccinated – do not need to quarantine, but should get

Serial antigen testing for all school/work days within the

tested 3-5 days after exposure and monitor for symptoms.

Unvaccinated – quarantine for at least 10 days. This means

10-day quarantine period (or 7-day with negative PCR test) for those who are symptom-free.

staying home and away from others:

The testing protocols for this strategy are:

• For 10 days while continuing to wear a mask indoors and monitor symptoms for 14 days or

• For 7 days with a negative PCR test taken 5 days after exposure while continuing to wear a mask indoors, and monitor symptoms for 14 days

• People identified as close contacts are to be tested DAILY first thing in the morning at school or work.

• Students may ride the bus to school for this testing with continued mask wear.

• All close contacts that test negative can

continue to attend work, school or extracurricular activities while wearing masks.

• Any close contacts that test positive must HOW DO YOU CALCULATE WHEN SOMEONE IS DONE WITH QUARANTINE? Determine when they last came into close contact with COVID+ person when they were contagious (anywhere from 48 hours before their symptoms developed or their test came back positive through their isolation period). Quarantine since that last contact. If the contact is with someone in your household who hasn’t isolated from you, your quarantine will be the 10 days of their isolation and the following 10 days without testing, or 7 days with a negative PCR test. Stay home through the 7th or 10th day to make sure you don’t develop COVID-19 at any time during its incubation period and spread it to others.

be isolated immediately and sent home for PCR confirmatory testing. PCR confirmatory testing is available at the Health Department Monday-Friday from 8:30 – 11:30 am.

WHAT IS CONSIDERED A CLOSE CONTACT? For most of us – within 6 feet for at least 15 cumulative minutes with or without masks.

In the school setting only – within 6 feet for at least 15 cumulative minutes without mask wearing or within 3 feet for at least 15 cumulative minutes with mask wearing. In order for the 3 feet rule to qualify BOTH the positive person and the close contact MUST be masked.

1600 N. Michigan Avenue • Saginaw, MI 48602 • (989) 758-3828 • www.saginawpublichealth.org 10 The Bulletin | October 2021

9.1.21

E-Prescribing Date Moved to January 1, 2022 September 22, 2021 The Bureau of Professional Licensing (BPL) within the Department of Licensing and Regulatory Affairs (LARA) is providing you with this notification regarding important implementation updates for Public Acts 134, 135 and 136 of 2020 which require electronic prescribing (e-prescribing) of prescriptions. As you may be aware, the law will soon require prescribers to electronically transmit controlled and non-controlled substance prescriptions. Pursuant to authority provided in MCL 333.17754a(10), BPL’s enforcement of the electronic prescribing standard will coincide with the Centers for Medicare & Medicaid Services' (CMS) enforcement schedule for Part D prescription drug programs. As a result, BPL will initiate enforcement of Michigan’s new electronic prescribing standard on the same date that CMS begins its electronic prescribing enforcement schedule – January 1, 2022. To help meet this effective date for implementation, the administrative rules for the general rules for pharmacy and the

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.

controlled substance rules are currently open and moving through the rule making process. Both rule sets should be through the public hearing and public comment period by the end of September. It is expected the rules will then go to the Joint Committee on Administrative Rules (JCAR) in October. BPL is hopeful that the rules will be promulgated by the end of October or first of November. As the rules continue to move through the administrative process, the Bureau is preparing the waiver process for certain prescribing circumstances and forms so that the information may be issued and shared once rules are promulgated. At such time, BPL will post online the information and also share the final version and details. Should you have any questions, please contact bplhelp@ michigan.gov. For more information on E-Prescribing, see page 10 of the September 2021 issue of The Bulletin.

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The Bulletin | October 2021 11

CMU Medical Education Partners Receives Approval for New Pediatric Residency Program Kate Worster

First Class Slated to Begin in 2022 Central Michigan University Medical Education Partners received approval on October 5, 2021, from the Accreditation Council for Graduate Medical Education to establish a new pediatric residency program. CMU will accept the first class of resident physicians in July 2022. The pediatric residency program will educate graduating medical students who aspire to become pediatricians and allow for greater access to ambulatory specialty care, thanks to the CMU College of Medicine's affiliation with University Pediatricians in Detroit. As the primary inpatient clinical site, Covenant HealthCare provides specialized services focused on the pediatric population providing an exceptional and diverse learning environment for the new residents. Covenant offers a regional pediatric intensive care and pediatric unit, an American College of Surgeons verified level II pediatric trauma center and a wide breadth of extensive clinical programs for children. "The building out of pediatric graduate medical education creates a pipeline of providers, which is currently needed to fill a shortfall of more than 24 pediatricians," said Samuel J. Shaheen MD, Executive Director of CMU Medical Education Partners. "In addition, the educational and clinical requirements of the program will increase the breadth of clinical care delivered." CMU will accept the first class of pediatric resident physicians in July 2022. Roland L. Chu MD, Director of the Pediatric Residency Program, and Katherine Battisti MD, Assistant Director, designed the new residency program to provide a new model for training future pediatricians. After working with College of Medicine faculty members to shape priorities for the new program, Drs. Chu and Battisti now are collaborating with physician leaders to prepare for the first class of residents. "The excitement and support of this new residency program by community physicians, Covenant HealthCare and CMU Partners has been amazing," Chu said. "Designing a training program to attract quality applicants requires tremendous support from the hospital system and the CMU faculty. I think having a residency program will only augment and build more pediatric services for this community. I am excited to have our first batch of residents next year." "Covenant HealthCare, in collaboration with CMU Partners, has been providing excellent care to pediatric patients in the Great Lakes Bay Region for a long time. The pediatricians and specialists are experienced educators of current residents

and medical students in the region," Battisti said. "We are incredibly excited to be building on this legacy with the addition of our new program and look forward to contributing to the improvement of pediatric health in our region." For more information, visit the Pediatric Residency Program website or call 989-746-7673.

October 2021 CME Announcements & Calendar CME CALENDAR: For a complete list of our CME accredited courses for October 2021 click HERE. CME ONLINE - eLearning Activities: CMU CME ONLINE Our accredited recorded eLearning courses offer those which are required for physician licensing in Michigan: Pain and Symptom Management, Medical Ethics, and Human Trafficking. Our catalog also includes courses in Emergency Medicine, Family Medicine, Internal Medicine, Ob-Gyn, Psychiatry, Surgery and Podiatric Medicine. These courses are free of charge to all CMU faculty, residents, students and our affiliated partners - Covenant, Ascension St. Mary’s, and the VA, as well as, to those who teach our medical students throughout Michigan and Ohio. Courses are also included from the Michigan Public Health Institute with links to their large eLearning library. To be published the first week of October: • Snakes and Ladders of Medical Publishing (Research), David Weindorf, PhD and Neli Ragina, PhD - This presentation describes how publishing one’s scholarly activity has become an important skill for both trainees and faculty. It focuses on how to successfully navigate through a complex process of determining authorship, choosing the most appropriate journal and discovering the economics of publishing. It is essential knowledge and practical “know how” for practicing physicians, faculty, residents and medical students. • The Master Adaptive Learner: Introduction to a Conceptual Model, Judy Blebea, MD, MTh - This presentation introduces the master adaptive learner conceptual model. • The Master Adaptive Learner: Practical Tips for Application in the Classroom and Clinical Learning Environment, John Lowry, PhD - This presentation reviews how to apply the Master Adaptive Learner model in both the classroom and clinical learning environments. CLAIM CME CREDIT and CERTIFICATE PROCESS – click HERE PODCASTS (All podcasts are accredited for AMA PRA Category 1 CreditTM and Social Work) Shifting Mindsets for Better Health - Professional Education (PE) podcast series: continued on page 13

12 The Bulletin | October 2021

continued from page 12

Children’s Health During COVID These podcasts provide urgently needed tools, strategies and resource connections for professionals working with children and for parents, families and caregivers. In this series, healthcare professionals from across multiple disciplines share their insights into the far-reaching effects the COVID-19 pandemic is having on children, caretakers and medical care providers, as well as, discuss strategies and resources that caregivers can use to help children build coping skills and develop resilience. There are six podcast episodes (of a total of 10) published to date in this series: • Episode 1: Physical Health of Children with COVID-19 • Episode 2: Mental Health of Children with COVID-19 • Episode 3: Protecting Children – Resources for Kids • Episode 4: Building Resilience in Caregivers • Episode 5: Physical Health Inequalities & Racism • Episode 6: Mental Health Inequalities & Racism Responding to ACEs: Resources for Resilience A six-part podcast series featuring thought-provoking insights regarding the science behind adverse childhood experiences (ACEs), trauma and resilience. • Episode 1: Defining Adverse Childhood Experiences (ACEs) and Their Detrimental Effect on the Health of Children and Adults • Episode 2: The Physiological Effects of Trauma and Toxic Stress on the Brain • Episode 3: Assessing for ACEs

Massage

• Episode 4: Parent Child Interaction Therapy: An EvidenceBased Intervention • Episode 5: Trauma-Focused Cognitive Behavioral Therapy: An Evidence-Based Intervention • Episode 6: Adults Dealing with ACEs CREDIT FOR TEACHING - CMU College of Medicine appreciates ALL that you do in teaching our residents and medical 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 Best Locally Owned Business & Overall Care

Chiropractor

7075 Gratiot Rd., Suite 2, Saginaw • (989) 781-7700

Sports Injuries | Neck Pain | Headaches | Mid-Back Pain | Low Back Pain Hip Pain | Knee & Ankle Pain | Shoulder, Elbow & Wrist Pain | Muscle Soreness Chiropractic, Massage Therapy and the latest in hi-tech therapy—the MR4 Super Pulsed Cold Laser. The only FDA cleared device to combine neuroadaptive electrical stimulation and cold laser in a single emitter. This allows us to quickly locate and automatically deliver appropriate energy dose to the affected area for quicker pain relief and faster healing.

Dr. Michael Dense

Certified Chiropractic Sports Medicine Specialist

Dr. Jason Barrigar

Certified Chiropractic “Rock Tape” Provider

Dr. Andrew Hohman Chiropractor

Dr. Matthew Waro Chiropractor

The Bulletin | October 2021 13

National Vaccine Injury Compensation Program • Understand the patient's concerns and request information. Contact MPIE to report and discuss the potential claim. • Discuss with the patient the various federal programs for assisting with future medical expenses and/or compensation. • Continue communication with the patient and follow their progress.

Courtesy of MPIE Risk Management

Federal Protection and Injury Compensation Program for Vaccine Injuries More Important Now Than Ever! Situation Healthcare providers should understand the National Vaccine Injury Compensation Program's (VICP) role and benefits. This program can offer healthcare providers protections against potential vaccine injury liability. Improperly following the program's process though may jeopardize those protections and have professional liability implications. Background VICP was created by a federal law that limits the liability of an "administrator or manufacturer" for complications or injuries following the administration of certain "covered" vaccinations. Individuals who believe a covered vaccine has resulted in injury may "file a claim against the Secretary of the Department of Health and Human Services (HHS) in the U.S. Court of Federal Claims seeking compensation from the Vaccine Trust Fund. Eligible claimants can recover compensation for vaccine injuryrelated medical and rehabilitative expenses, pain and suffering, and lost earnings. Claimants may also recover reasonable attorney's fees and costs."[i] VICP covers the most common vaccines administered (e.g., measles, seasonal flu and whooping cough (DTaP or Tdap)). However, the COVID-19 vaccines are not currently included. A separate program may cover a COVID-19 vaccine complication/injury under the Countermeasures Injury Compensation Fund. Congress can (and likely will) add the COVID-19 vaccines as covered vaccines as they receive full approval from the FDA. (As of this writing, Pfizer is FDA approved, and Moderna has applied to obtain it). These protections are especially likely as booster vaccinations become recommended for continued immunity against the COVID-19 variants. Assessment Healthcare providers who give vaccines should be aware and knowledgeable of VICP. Ensure appropriate steps are followed to make certain the provider accesses the protections, and the patient properly claims benefits and compensation under VICP. Recommendation If alerted to a patient injury or complication, providers must follow proper procedures to protect the patient's claim and prevent potential professional liability allegations. • Discuss the complication or injury with the patient (refrain from making any admissions of liability, pointing fingers, and/or making any assertions or offers of compensation). 14 The Bulletin | October 2021

MPIE risk management is available to answer your questions and provide additional information. For assistance, please contact MPIE Risk Management at risk@mpie.org. Disclaimer: This information is provided as a risk management resource and should not be construed as legal, compliance, technical or clinical advice. This information may refer to specific local regulatory or legal issues that may not be relevant to your organization. Consult your professional advisors or legal counsel for guidance on issues specific to your organization. Medical or clinical information presented is offered for educational and informational purposes only and does not replace independent professional judgment. The information is intended to provide guidance to the clinician in the management of patient care and is not intended to establish a standard of care. The clinician shall defer to applicable prevailing medical authority. [i]

https://www.justice.gov/civil/vicp

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.

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. 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

BREAKING NEWS SUMMARY OF INTERIM FINAL RULE ON NO SURPRISES ACT On September 30, 2021, the Biden administration issued a second interim final rule (IFR) to implement the No Surprises Act (NSA) that takes effect in January. Among other provisions, the IFR implements the Independent Dispute Resolution (IDR) process that can be used to settle out-of-network payment disputes between payers and physicians and other health care providers in surprise billing situations. The IFR significantly undermines the fairness and independence of the IDR process by requiring IDR entities to make their decisions based on the “qualifying payment amount (QPA)” unless the provider can prove otherwise. Although the QPA is meant to represent the median innetwork rate, the method used to calculate it as outlined in the first IFR, will often result in lower amounts. As a result of these two rules combined, physicians will face an uphill battle to receiving fair payment for their out-ofnetwork services in situations where patients have not had an opportunity to consent, such as emergency care. But perhaps even more concerning is the impact these rules will have on the ability of physicians to enter into meaningful

contract negotiations with health plans who have little incentive now to offer fair contracted rates. CLICK HERE to read the AMA’s initial summary of the rule. We will be submitting comments to the Departments in the coming weeks expressing our serious concerns, and we are exploring all of our options to prevent or minimize the impact of this IFR on physicians and patients. American College of Emergency Physicians (ACEP) Summary of No Surprises Act Interim Final Rule Part 2 CLICK HERE TO VIEW

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 continued on page 13 2544 McLeod Dr. N. | Saginaw, MI 48604 | 989.791.1691 | www.healthwayrx.com The Bulletin | October 2021 15

September Membership Meeting Minutes

he Saginaw County Medical Society Membership Meeting was held on Tuesday, September 21, 2021, at Horizons Conference Center. The meeting was the 21st Annual Joint Meeting with the Saginaw Valley Osteopathic Society (SVOS). Mildred J. Willy MD, Immediate Past President, called the meeting to order at 7:02 p.m. Dr. Willy welcomed SVOS members and the evening’s speaker, Molly Gabriel-Champine PhD, LP. The in-person meeting was the first since January of 2020 due to the COVID pandemic. Anthony M. Zacharek MD took over as President at the virtual annual meeting on June 14, 2021, but was not officially installed before the membership. Dr. Willy called Dr. Zacharek to the podium and placed the presidential medallion around his neck and stated, “It is my honor to introduce the 117th President of the Saginaw County Medical Society, Dr. Tony Zacharek.” Dr. Zacharek then thanked Dr. Willy and the entire SCMS Board for extending their terms of office for an additional year due to the pandemic. He presented a plaque to Dr. Willy in recognition of her service as President from 2019-2021. Dr. Zacharek took over the meeting and welcomed Taylor Gaudard MD, a board certified family medicine physician with CMU Health. Dr. Gaudard earned her medical degree from CMU College of Medicine in 2018, and completed her residency at Mercy Health St. Mary’s in Grand Rapids in 2021. In addition to seeing patients, Dr. Gaudard serves as a faculty member for CMU Medical Education Partners Family Medicine Residency Program. Dr. Zacharek welcomed SVOS president, Jonathan Horbal DO, to the podium. Dr. Horbal conducted business for the SVOS.

Drs. Tony Zacharek and Millie Willy

The Bulletin | October 2021

Dr. Zacharek then conducted business of the SCMS: • Approval of the June 14, 2021, Membership Meeting Minutes which were attached to the Agenda. MOTION: Approve the June 14, 2021, Membership Meeting Minutes as presented. MOTION APPROVED. • Calendar of Meetings and Events for 2021 – 22 Dr. Zacharek asked those attending to mark their calendars for future meetings. • Congratulated Thomas J. Veverka MD on his election as MSMS President Elect at the House of Delegates in May 2021. Dr. Veverka will be installed as MSMS President on April 30, 2022. • Congratulated Mildred J. Willy MD on her election as Region 7 Representative serving on the MSMS Board of Directors representing Arenac, Bay, Gladwin, Gratiot, Isabella-Clare, Midland and Saginaw Counties. • Noted current legislation and asked those attending to contact their representatives through the SCMS at www.SaginawCountyMS.com under the Advocacy tab, or MSMS at www.MSMS.org under the Advocacy tab: o Senate Bill 247 – Prior Authorization (Health Can’t Wait) o House Bill 4486 and Senate Bill 314 – Auto accident victims’ right to recover o House Bill 4355 – Maintain quality of care and protect Michigan patients o Senate Bill 191 – Protect patients – mental health o Senate Bills 184 and 185 – Ensure safe drinking water in Michigan schools

Dr. Furhut Janssen

continued on page 17

Drs. Karensa Franklin, Jenny Romeu and Taylor Gaudard

continued from page 16

Dr. Zacharek welcomed Dr. Willy to the podium. Dr.Willy and Molly Gabriel-Champine, PhD, Director of Behavioral Science Education, Director of Scholarly Activity McLaren Bay Region, Family Medicine Residency in Bay City, Michigan, presented a CME-accredited program on “Physician Compassion Fatigue.” Dr. Willy started the program by sharing a personal story describing the difficulty of learning about her mother’s diagnosis with pancreatic cancer, assisting her through her treatments ultimately ending with hospice care, all while also assisting her disabled father with his medical conditions. She discussed the difficulty of doing this for a sustained amount of time, while living 300 miles away, and while continuing to work full time as an emergency physician. She spoke of her struggle with compassion fatigue when returning to work while trying to establish some sort of normalcy in her life after her mom’s passing. Molly joined Dr. Willy and talked about the human emotions we experience and specifically, how physicians may attempt to limit or diminish these in times of crisis and loss, assuring the audience these are normal and to be expected given the situations in life that we encounter. In addition, it is important for us to experience these emotions to heal, and to be able to continue to provide compassion to our patients and others as this also allows for healing. Molly talked about how during the pandemic, many of those working in healthcare also experienced compassion fatigue and how she interacted with physicians and staff while working in the hospital. “Many providers may be reluctant to admit they are having difficulties due to fear of repercussion from their peers, employer or others in leadership roles.” Molly found that when she made herself available on a regular basis and stayed connected with those she worked with, people started opening up and asking for resources. During the presentation, she offered suggestions for health care providers

Dr. Millie Willy and Molly Gabriel-Champine

Dr. Tiffany Kim and Palmer, Drs. Kris Spence, Chris Allen, Mary McKuen and Vickie Mello

to receive confidential assistance dealing with issues they may be experiencing in addition to online self-help resources. She encouraged physicians to take notice of any changes in those they work with, and to have an honest and confidential conversation if they feel someone is struggling. Molly said, “There is a stigma for medical professionals to seek professional counseling, and there shouldn’t be.” She also shared a list of counseling resources for health care workers (see p. 18-19) in Bay County, if needed, in addition to a QR code to access McLaren’s Stay Well Program for ideas to implement at their own facilities and practices. Her contact information is provided here Molly.Gabriel1@mclaren.org for those seeking help or with additional questions. Dr. Zacharek thanked Dr. Willy for sharing her very personal story, and Molly for talking about the emotions Dr. Willy experienced, how they were normal and to be expected, and how to find help. Dr. Zacharek reminded members to sign in at the registration table and complete the online survey within 30 days to receive CME credit for the program. The next Membership Meeting will be held on Tuesday, October 19, 2021, at Horizons Conference Center. Marilyn Skrocki JD, MBA, MISM, FACHE, Professor Health Sciences Graduate Coordinator - Health Administration and Leadership, College of Health & Human Services at SVSU will present a program on “Future of Physician Leadership: Regionally and Nationally.” There being no further business, the meeting was adjourned at 8:28 p.m. Respectfully submitted, Joan M. Cramer Executive Director

Drs. Miriam Schteingart, Sundhar and Kala Ramasamy and Tom Veverka

The Bulletin | October 2021 17

BAY RESOURCES BAYCOUNTY COUNTY COUNSELING COUNSELING RESOURCES Courtesy of Molly E. Gabriel-Champine, PhD, LP

Courtesy of Molly E. Gabriel-Champine, PhD, LP Molly.Gabriel1@mclaren.org Molly.Gabriel1@mclaren.org BAY ARENAC BEHAVIORAL HEALTH201 Mulholland, Bay City, MI 48708-7693989-895-2300 ARENAC CENTER1000 W. Cedar Street, Standish, MI 48658-9421 989-846-4573 Serves adults, children and families with mental illness, developmental disabilities and serious emotional disturbances. Priority for service includes persons with Medicaid and low income without insurance. Services include clinical assessment, individual, family and group therapy, home based services, case management/support coordination, psychiatric services, 24-hour emergency services, respite, geriatric outreach, residential services, day programming, vocational services and Hispanic outreach. To request services, call: 1-800-448-5498 (Monday-Friday 8 a.m.-5 p.m.) For 24-hour emergency services, call 989-895-2300 or 1-800-327-4693 Great Lakes Bay Health (Therapy & Psychiatry) MPA (Therapy, Psychiatry & DBT) 690 S. Trumbull Street, Bay City, MI 48708-7692 1217 S. Euclid Avenue, Bay City, MI 48706-3311 989-922-5700 989-667-9661 List Psychological (Therapy & Psychiatry) Journey Counseling Center (Therapy) 126 Washington Ave., Bay City, MI 48708-5846 4771 2 Mile Road, Bay City, MI 48706-2775 989-684-7977 989-778-2323 Planning for Living (Therapy) Corner Stone Counseling Services (Therapy) 2355 Delta Road, Bay City, MI 48706-9340 111 E. Midland Road, Auburn, MI 48611-9780 989-684-6832 989-283-9047 Delta Psychological (Therapy & Psychiatry) Saginaw Psychological (Psychiatry & Therapy) 114 N. Tuscola Road, Bay City, MI 48708-6995 615 S. Euclid Avenue, Bay City, MI 48706-3271 989-895-0788 989-439-1513 Bay Psychological (Therapy & Psychiatry) Hema Talasila, MD (Psychiatry) 1420 Center Avenue, Bay City, MI 48708-6110 200 S. Wenona Street, Bay City, MI 48706-8833 989-686-1990 998-893-3212 Reflections Counseling (Therapy & DBT) JLK Counseling (Therapy) 200 S. Wenona, Ste 280, Bay City, MI 48706-8845 301 W. Midland Rd, Ste. 8, Auburn, MI 48611-9360 989-272-2010 989-391-4212 Recovery Pathways (Therapy & Psychiatry) Sandra Murray, MA, LPC, CAADC (Therapy) 863 N. Pine Road, Ste A, Essexville, MI 48732-2159 721 Washington Avenue, Suite 411 (Phoenix Bldg.) 989-928-3566 Bay City, MI 48708-5726 Primary for outpatient substance abuse 989-295-2733 $10-$25 per session

SUBSTANCEABUSE ABUSE TREATMENT SUBSTANCE TREATMENT

OUTPATIENT SUBSTANCE SUBSTANCE ABUSE OUTPATIENT ABUSE TREATMENT TREATMENT

List Psychological 126 Washington Avenue Bay City, MI 48708-5846 989-684-7977 Recovery Pathways 863 N. Pine Road, Ste A Essexville, MI 48732-2159 989-928-3566 DOT Caring Center 3190 Hallmark Court, Suite 1 Saginaw, MI 48603-2107 989-790-3366 18

The Bulletin | October 2021

Bay Psychological 1420 Center Avenue Bay City, MI 48708-6110 989-686-1990 Kairos Healthcare Center 3400 S. Washington Avenue Saginaw, MI 48601-4958 989-755-1072 Family & Children Services 1714 Eastman Avenue Midland, MI 48640-4216 989-631-5390

Sacred Heart Rehabilitation 1106 Washington Avenue Bay City, MI 48708-5708 989-894-2991 PPPS Health Care 1600 N. Michigan Ave. Suite 503 Saginaw, MI 48602-5306 989-755-8225 Sterling Health Center 725 E. State Street Sterling, MI 48659-9548 989-654-3501

SUBSTANCEABUSE ABUSE TREATMENT SUBSTANCE TREATMENT

RESIDENTIAL SUBSTANCE ABUSE TREATMENT

Ten 16 1213 E. Isabella Road Midland, MI 48640-8344 P 989-835-3466 F 989-835-7242 Holy Cross (Women) 3400 S. Washington Road Saginaw, MI 48601-4958 P 989-755-1072 F 989-755-1401 Our Hope (Women) 324 Lyon NE Grand Rapids, MI 49548 P 616-451-2039 F 616-451-3590 Sunrise Centre 630 Walnut Street Alpena, MI 49707-1832 P 877-205-5217 F 989-356-3559

RESIDENTIAL SUBSTANCE ABUSE TREATMENT Medicaid Only

DOT Caring Center 6840 Midland Road Freeland, MI 48623-8708 P 989-790-3366 F 989-790-5027 Sacred Heart 400 Stoddard Road Memphis, MI 48041 P 810-392-2167 F 810-392-3530 Pine Rest 300 68th Street Grand Rapids, MI 49548 P 616-281-0061 F 616-281-4258 Great Lakes Recovery 241 Wright Street Marquette, MI 49855 P 906-228-7611 F 906-228-8156

Holy Cross (Men) 1321 S. Fayette Saginaw, MI 48602-1447 P 989-792-8000 F 989-792-8445 Odyssey House 529 M.L. King Blvd. Flint, MI 48502-2002 P 810-238-5888 F 810-238-4866 Phoenix Hall (Women) 445 E. State Street Traverse City, MI 49686 P 800-622-4810 F 231-929-0416 House of Common (Men) 706 Curtis Street Mason, MI 48854-2539 P 517-244-0393 F 517-244-9155

Odyssey House (Women) 128 N. Warren Street Saginaw, MI 48607-1548 P 989-754-4673 F 989-754-5154 Corcoran House 8212 N. Jennings Road Mt. Morris, MI 48458 P 810-687-5100 F 810-687-0520 Dakoske Hall (Men) 116 E. Eighth Street Traverse City, MI 49684 P 800-622-4810 F 231-929-0416 Harbor Hall (Men) 704 Emmet Street Petoskey, MI 49770-2910 P 231-347-5511 F 231-347-5422

Medicare Only Medicare & Commercial Ridgeview Hospital Turning Point Hospital Brighton Hospital Harbor Oaks Hospital 17872 Lincoln Highway 3015 S. Veterans Pkwy. 12851 Grand River 35031 23 Mile Road New Baltimore, MI 48047 Middle Point, OH 45863 Moultrie, GA 31788 Brighton, MI 48116 P 586-725-5777 P 419-968-2950 P 229-985-4815 P 810-227-1211 F 586-725-8518 F 855-356-4046 F 229-891-4068 F 810-227-2029 Medicaid & Commercial Private Insurance Only ASR Insurance & Commercial White Sands Fort Myers White Sands Tampa Maple Grove Center Meridian Health 1820 Colonial Blvd. 6773 W. Maple Road 2011 N. Wheeler Street 1255 N. Oakland Blvd. W. Bloomfield, MI 48322 Fort Myers, FL 33907 Plant City, FL 33563 Waterford, MI 48327 P 248-661-6100 P 877-876-5429 P 877-876-5429 P 248-599-8999 F 248-691-4933 F 239-689-5783 F 813-756-6570 F 248-406-0107 BCBS Private Pay 1st Step Residential Michael’s House (Men) Dawn Farms-Ypsilanti Dawn Farms-Sepra 3685 N. Federal Hwy. 2095 N. Indian Canyon 6633 Stony Creek Road 501 W. Huron Pompano Bch, FL 33064 Palm Springs, CA 92262 Ypsilanti, MI 48197 Ann Arbor, MI 48108 P 866-971-5531 P 866-494-7787 P 734-485-8725 P 734-669-8265

McLaren’s Stay Well Program

Questions? Molly.Gabriel1@mclaren.org Questions? Molly.Gabriel1@mclaren.org

The Bulletin | October 2021 19

Ascension Invests Additional $125 Million in Northern Michigan Hospitals, Ensuring Care to Communities for Years to Come On September 17, Ascension announced it will be investing $125 million in operational capital into their northern Michigan health ministries - Ascension St. Mary’s Hospital in Saginaw, Ascension Standish Hospital in Standish and Ascension St. Joseph Hospital in Tawas City. This latest investment from Ascension is evidence of the organization’s ongoing commitment to the growth and success of its three northern Michigan hospitals that was initiated in May 2018. At that time, $50 million was dedicated to facility renovations and upgrades, advanced imaging technology, various patient care enhancements and an $18 million emergency care center expansion at Ascension St. Mary’s Hospital in downtown Saginaw which is expected to be complete in November. Combined, this equates to more than $175 million of investment into Ascension’s northern Michigan hospitals. This latest capital dollar commitment will support multiple strategic growth initiatives identified through the development of master facility plans including: • The renovation and expansion of intensive care units and rooms, and private patient rooms throughout Ascension St. Mary’s Hospital • Upgrades to cardiac catheterization and electrophysiology labs at Ascension St. Mary’s Hospital • Development of a new emergency department waiting area at Ascension Standish Hospital • Construction of a medical office building at Ascension Standish Hospital for primary and specialty care physician offices, laboratory and rehabilitation services • Relocation and expansion of obstetrics and the birthing center at Ascension St. Joseph Hospital • Two new linear accelerators for the radiation oncology services at Ascension St. Mary’s Seton Cancer Institute in Marlette and West Branch “This exciting news is possible thanks to the dedication and commitment of our associates, physicians and hospital leaders who work hard each and every day to provide compassionate, personalized care,” said Joe Hurshe, FACHE, Chief Operating Officer, Ascension Michigan. “We are thrilled these enhancements will be coming to fruition and our care teams can continue to be proud of the incredible work and service they provide to the communities we are privileged to serve.” Details and timelines for the projects will be established and shared in the coming weeks. 20 The Bulletin | October 2021

“I am so overjoyed by this announcement and Ascension’s acknowledgment of the great work performed at our healthcare sites,” expressed Stephanie Duggan, MD, Regional President and CEO, Ascension Michigan Northern Ministries. “Ascension's ongoing investment and commitment to the northern Michigan ministries is a validation of what we have been working towards. This is all about our patients, they are at the center of everything we do. It’s a testament to our front line caregivers and medical providers who continue to fulfill our Mission of caring for all. We will be here for generations to come.” Ascension St. Mary’s Welcomes Four New Providers Ascension St. Mary’s proudly introduces the newest members to the medical staff. These providers are now caring for individuals at their office locations and Ascension St. Mary’s Hospital in support of our Mission to improve the health of our community. Sefako Phala, MD, a family medicine physician, joins his wife, Brittany Phala, MD, at Ascension Medical Group (AMG) Bay City Family Physicians, located at 4040 North Euclid Avenue, just south of Wilder Road. Dr. Phala received his bachelor's degree from the University of Western Ontario and his medical degree from the University of Medicine and Health Sciences in St. Kitts and Nevis, an accredited Caribbean medical school . He completed his family medicine residency at Wheeling Hospital in West Virginia. Dr. Phala is accepting new patients and can be reached at 989-671-9153. Jasleen Kaur, MD, is a fellowship trained rheumatologist. She is seeing patients at AMG Primary Healthcare, 1015 S. Washington Avenue, 2nd floor, in Saginaw. Besides in person appointments, Dr. Kaur also offers virtual visits. Appointments can be made by contacting Dr. Kaur at 989-753-5300. Dr. Kaur received her medical degree from Bharati Vidyapeeth Medical College in India and completed an internal medicine residency at Detroit Medical Center. She also completed a fellowship in rheumatology at Wayne State University, Henry Ford Health Services. Dr. Kaur believes in providing compassionate care to each person with treatment plans that are evidence based and personalized to each individual. continued on page 22

Saginaw’s only Comprehensive Stroke Center Advanced stroke care close to home Ascension St. Mary’s is certified as a Comprehensive Stroke Center which means we provide the highest level of care available anywhere in the greater Saginaw area. Should you or your loved one need it, you’ll have access to advanced training, technology and capabilities all located within Ascension St. Mary’s Hospital. Our stroke specialists work quickly to understand your situation and deliver the care you need, including follow-up care, when you need it.

To talk to a doctor about your risk for stroke - call 844-960-1435..

If you are experiencing a life-threatening emergency, go directly to the ER or dial 911.

The Bulletin | October 2021

continued from page 20

Anirudh Penumetcha, DO, recently joined Ascension Medical Group Cardiology/ MCVI as a non-invasive cardiologist. Dr. Penumetcha received his medical degree from Michigan State University College of Osteopathic Medicine. He completed an internal medicine residency, as well as, a fellowship in cardiovascular disease at Wayne State University, Detroit Medical Center. AMG Cardiology is located at 1015 S. Washington Avenue in Saginaw. He will also see patients at specialty clinics at Ascension Standish Hospital in Standish and Ascension St. Joseph Hospital in Tawas City. To refer or schedule a patient, Dr. Penumetcha can be reached at 989-7543000. Christopher Kukla, PA joins the orthopedic and sports medicine team at AMG Orthopedics and Sports Medicine. As a physician assistant, he will provide high quality, personalized care from their practice located in the Medical Arts III building at 4677 Towne Centre, Second Floor in Saginaw Township. He attended Grand Valley State University and graduated as a physician assistant with special interest in sports and orthopedic medicine. In addition. he holds a master’s degree from Northwood University and completed his undergraduate studies in biomedical engineering at Michigan Technological University. New patients are being accepted by calling 989-790-6719. Ascension St. Mary’s Celebrates Breast Cancer Survivors with the Saginaw Spirit Ascension St. Mary’s and the Saginaw Spirit partner again for the 14th Annual Pink Out hockey game at the Dow Event Center on Sunday, October 17 at 5:30 p.m. to increase awareness of breast cancer and raise funds for the hospital’s breast care fund. Before the Saginaw Spirit play the Erie Otters, a special pre-game tribute will honor local breast cancer survivors. Fundraiser tickets cost $15, with $5 from each ticket sale going toward the Ascension St. Mary’s Breast Care Fund. Tickets are available online at www.saginawspirit.net/groupsales with the group ID: pinkout2021 and password: Ascension, or at the Saginaw Spirit office. (Tickets purchased at the Dow Event Center do not apply to the Pink Out Fundraiser.) Pink Out game specials include free pink light up bracelets that will be given to the first 2,500 attendees, and an exclusive player Pink Out jersey auction following the game. 22

The Bulletin | October 2021

Ascension St. Mary’s Breast Care Fund provides mammograms and follow-up ultrasounds for qualified uninsured and underinsured patients. To date, more than $65,000 has been raised from the Pink Out event to benefit area patients. Ascension St. Mary’s Offers No Cost Screenings for Lung Cancer November is lung cancer awareness month and Ascension St. Mary’s Hospital is offering a no-cost, low dose CT screenings of the lungs. The event will be Saturday, November 6 from 9 a.m.–3 p.m. at Ascension St. Mary’s Towne Centre, 4599 Towne Centre Road, Saginaw. A low dose CT scan of the chest is one the simplest screening exams a person can have. It’s quick and easy, completely painless and results in a minimal amount of radiation exposure. Detailed images allow providers to see any abnormalities within the lungs before individuals may even notice symptoms, often catching cancer in the early stages when it is treatable. Individuals eligible for the CT lung screenings must meet the following criteria: • Be between the ages of 55 - 77 years old • Currently a smoker or have quit within the past 15 years • Have, at minimum, a 30+ pack year smoking history (i.e. 1 pack a day for 30 years, 2 packs per day for 15 years, etc.) For questions, or to register, call 989-493-9610. Walk-ins will be accepted.

Creating a

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

APPLICATIONS FOR MEMBERSHIP

BIRTHDAYS

SECOND READING AND APPROVAL:

November

Applications for membership that may be recommended for acceptance at the October 19, 2021, Board Meeting: Taylor S. (Boehler) Gaudard, MD (CMU Health – Family Medicine) Specialty: Family Medicine - Board Certified 2021 Medical School: CMU College of Medicine, 2018 Training: Internship/Residency: Mercy Health St. Mary’s, Grand Rapids, MI, Family Medicine, 2018-21 Sponsors: Doctors Matthew D. Deibel and Steven J. Vance Alan I. Rebenstock, MD (Advanced Diagnostic Imaging) Specialty: Radiology – Diagnostic and Pediatric (completed Board Exam 6/21) Medical School: New York Medical College, Valhalla, NY, 1997 Training: Internship/Residency: SUNY at Buffalo, NY, General Surgery, 7/97-4/99 and 6/00-2/01 Leave of Absence-Family Medical Needs 4/99-6/00 and 3/01-06/01 Fellowship: University of Pennsylvania, Philadelphia, PA, Nuclear Medicine, 7/01-6/03 and 10/03-2/04 Residency: Wayne State University/Detroit Medical Center, Detroit, MI, Diagnostic Radiology, 7/06-6/10 Fellowship: UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, Pediatric Radiology, 8/18-1/20, continued as research fellow through 6/20 Sponsors: Doctors Scott E. Cheney and Harvey K. Yee Lodewijk J. vanHolsbeeck, MD (Advanced Diagnostic Imaging) Specialty: Radiology – Diagnostic (Board Certified 2015) and Pediatric Medical School: Wayne State University School of Medicine, 2009 Training: Internship/Transitional: Henry Ford Hospital, Detroit, 2009-10 Residency: Thomas Jefferson University Hospital, Philadelphia, PA, Radiology, 2010-14 Fellowship: University of Michigan, Musculoskeletal Radiology, 2014-15 and Pediatric Radiology, 2015-16 Sponsors: Doctors Gopi K. Nallani and Harvey K. Yee

NEW MEMBER Matthew S. McRae MD Covenant HC-Emergency Dept. 900 Cooper Saginaw, MI 48602-5182 Office (989)-583-6521 Fax (989)-583-4134 www.covenanthealthcare.com Emergency Medicine

Deven McCullers Student Asad I. Mehboob DO Kirstan K. Meldrum MD Caleb Morris DO Andrew M. Namespetra MD Cristina M. Nituica MD Bernard D. Noveloso MD Loretta R. O'Donnell MD Christopher J. Osterbauer DO Jorge M. Plasencia MD Christopher L. Price MD Sinong Qian MD J. Eugene Rank MD Fermin Rankin MD Rita S. Ratani MD Deborah L. Russell MD Anastasiya Shchatsko MD Thomas Taugher DO Julie Taylor MD Spencer J. Thornock MD Patricia V. Valia MD Vishwas P. Vaniawala MD Chandler G. Veenhuis DO Michael W. Warren MD Mildred J. Willy MD Pervez Yusaf MD

Steven Ater DO Michael T. Bergeon MD John Blebea MD Julie Bunyard DO Michael A. Butman MD Jessica N. Buttinger Student Michael A. Cannova DO Jeffery W. Carney MD Anthony deBari MD Amandeep S. Dhaliwal MD Matthew C. French DO Christopher M. Gill DPM Mark G. Greenwell MD Zeina Habib MD Ronald C. Hazen MD Danielle L. Hebert MD Eileen M. Hoban Student Furhut R. Janssen DO Beverly A. Jarema DO Adebambo M. Kadri MD Phadej Keopunna MD George E. Kikano MD Nikolai Kinachtchouk MD John M. Kosanovich MD Daniel J. Lin MD Neil W. Love MD Mona Mahmoud MD

Focusing our practice on the needs of our community, we provide the following services for both individuals and businesses: n Monthly Accounting n Tax Planning n Financial and Business Consulting Service n Payroll Service n Tax Preparation Service n Retirement Planning Contact us for a complimentary visit at 989-791-1040. Three convenient locations to serve you in: Saginaw | Vassar | Frankenmuth

“Attention to detail since 1980.”

The Bulletin | October 2021 23

Once Again, Covenant Achieves Top American Heart Association Honor for Quality Stroke Care Covenant HealthCare has received the American Heart Association’s Gold Plus Get With The Guidelines® Stroke Quality Achievement Award for commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines. Covenant HealthCare provided stroke care for more than 1,000 patients last year. The Covenant Stroke Program is equipped with an expert team, state-of-the-art technologies and advanced treatment options. “Receiving this award year after year is a testament of our Covenant Stroke Program team’s extraordinary commitment to improving patient outcomes and providing healthier lives for our stroke patients from diagnosis to recovery - and beyond,” says Tracy Sullivan RN, SCRN, Covenant HealthCare Stroke Program Administrator. Stroke is the No. 5 cause of death and a leading cause of adult disability in the U.S. On average, someone in the U.S. suffers a stroke every 40 seconds, and nearly 795,000 people suffer a new or recurrent stroke each year. Each year, program participants apply for the Get With The Guidelines® Stroke Quality Achievement Award by demonstrating how their organization has committed to providing quality care for stroke patients. In addition to following treatment guidelines, participants also provide education to patients to help them manage their health and rehabilitation once at home. About the Covenant HealthCare1 Stroke Program The Covenant HealthCare Stroke Program is designed to provide extraordinary care in the prevention, diagnosis and treatment of strokes. Because when it comes to the brain, we make the most of every minute and provide the immediate care needed to improve overall quality of life. We’ll do what it takes to improve odds for recovery from a stroke; to save patient’s brain and ability to walk, talk, see, reach and feel working in partnership with our trusted rehabilitation team with Mary Free Bed at Covenant. Learn more about our awardwinning stroke care at www.covenanthealthcare.com/ch/ covenantstrokeprogram.

The Bulletin | October 2021

About Get With The Guidelines® Get With The Guidelines® is the American Heart Association/American Stroke Association’s hospital-based quality improvement program that provides hospitals with tools and resources to increase adherence to the latest research-based guidelines. Developed with the goal of saving lives and hastening recovery, Get With The Guidelines® has touched the lives of more than 9 million patients since 2001. For more information, visit heart.org/quality.

COVID-19 Drive-thru Testing Center Re-opens at Fashion Square Mall Location Due to increased testing demand, Covenant re-opened the drive-thru COVID-19 Testing Center on Friday, October 1, 2021. All patients who need testing for one of the below reasons should use this location only: • Currently experiencing COVID-19 symptoms • Have had a recent, known COVID-19 exposure • Proof of testing needed for upcoming travel Patients who do not have COVID-19 symptoms and need a COVID-19 test prior to a procedure or surgery (preauthorization) should visit any of the other laboratory locations. The drive-thru Covenant COVID-19 Testing Center is located at 4900 Fashion Square Mall, Saginaw, MI 48604. The building is on the corner of Bay and Tittabawassee in the northwest corner of the mall parking lot. As a safety precaution, people are asked to remain in their vehicles throughout the process. Results are expected within one to two days. Testing demand may impact the turnaround time of results. The Covenant COVID-19 Testing Center is operational Monday through Friday from 9 a.m.-5 p.m. and Saturday from 9 a.m.-12 p.m. The center is closed on Sunday. All COVID-19 testing performed at Covenant requires a physician order. If you believe you need a test, please call your physician for an order for testing or call our Covenant Care Connect hotline at 989.583.3135 to be screened for an order.

Free Mammograms Available Year-Round by Appointment Free breast screening mammograms are available by appointment for those who qualify by calling the Covenant Breast Health Nurse Navigators at 989.583.5154 or 989.583.5263. Patients must meet the below criteria: - Age 40 or over - Uninsured - Have not had a mammogram in the past 12 months - Eligibility based on household income Advance sign-up is required.

ECHO Series* Supporting Treatment Courts and Health Professionals REGISTER FOR UPCOMPING PROGRAMS IN THIS SERIES • Friday, November 12, 3-4 p.m. - Addiction & Co-Occurring Mental Health Disorders • Friday, December 10, 3-4 p.m. - MOUD and Integrating Treatment Courts, Jails and Health Professionals • Friday, January 21, 3-4 p.m. - Ethical Issues Related to Opioid Use Disorder Statement of Accreditation: The Michigan State Medical Society (MSMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. AMA Credit Designation Statement: The MSMS designates this live activity for a maximum of .75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. *This ECHO Series is made possible through a grant from the Michigan Health Endowment Fund. The Michigan Health Endowment Fund works to improve the health and wellness of Michigan residents and reduce the cost of healthcare, with a special focus on children and seniors. You can find more information about the Health Fund at mihealthfund.org.

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

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 | October 2021 25

Current Legislative Projects – Part 1 • Scope of Practice To proactively address “scope creep,” MSMS created Michigan for Advancing Collaborative Care Teams (MiACCT). This coalition of partner organizations will focus on the value of physician-led health care teams and the importance of medical school education in delivering quality, cost-effective care. Activities such as direct legislative and executive lobbying, coordinated lobby days, and a monthly e-newsletter for legislators and their staff will be key components of the initiative. Public-facing resources and communications, including earned media, will be deployed to generate legislative and public support for physician-led health care teams as well. Talking Points • Evolving health care delivery and reimbursement models require more integration and teamwork to deliver high quality, effective, and efficient person-centered care. • Team-based care fosters integration and coordination unlike independent practice which furthers care delivery silos. • Collaborative approach utilizes the unique skill set and training of each team member. • As the team members with the highest level of training, education and preparation, physicians guide the interplay of the team. • The public overwhelmingly wants a physician to have the primary responsibility for the diagnosis and management of their health care. • Advanced practice professionals (APPs) are increasingly engaged in what has traditionally been considered the practice of medicine and the practice of osteopathic medicine and surgery. • The public does not differentiate between health care delivery and the “practice of medicine” which perpetuates a misunderstanding of the scope of training of APPs. o More recently, some non-physician providers have attempted to change their professional titles which misleads patients about who is providing their care. • Team-based care is essential to protecting and maintaining public health and safety. Current Status While the bill which would have originally allowed certified registered nurse anesthetists to practice independently is now behind us, new scope-related legislation is expected to be introduced this fall which would allow for full independent practice for nurse practitioners. MSMS will share additional information as it becomes available when the bill is introduced.

• Prior Authorization Reform – Senate Bill 247 The prior authorization process diverts valuable resources away from direct patient care, can delay the start or continuation of necessary treatment and can negatively impact patient health outcomes. Over the course of the last two years, MSMS has worked closely with the legislature, regulators, and stakeholders on ways to streamline, standardize and make the prior authorization process more transparent, clinically appropriate and evidence based. To support this effort, MSMS also created the Health Can’t Wait coalition, which is a coalition of over fifty patient advocacy and health care organizations dedicated to reforming the prior authorization process. Talking Points Senate Bill 247 would reform the prior authorization process to do the following: • Requires an insurer to make available, by January 1, 2023, a standardized electronic prior authorization request transaction process. • Requires prior authorization requirements to be based on peer-reviewed clinical review criteria. • Require an insurer to post on its website if it implemented a new prior authorization requirement or restriction or amended an existing requirement or restriction, with respect to any benefit under a health benefit plan. • Requires an insurer or its designee utilization review organization to notify, on issuing a medical benefit denial, the health professional and insured or enrollee of certain information, including the right to appeal the adverse determination, and require an appeal of the denial to be reviewed by a health professional. • Prohibits an insurer or its designee utilization review organization from affirming the denial of an appeal unless the appeal was reviewed by a licensed physician. • For urgent requests, the prior authorization is considered granted if the insurer fails to act within 72 hours of the original submission. For non-urgent requests, the prior authorization is considered granted if the insurer fails to act within seven business days of the original submission. • Requires an insurer to adopt a program that promotes the modification of prior authorization requirements of certain prescription drugs, medical care, or related benefits, based on the performance of the health care providers with respect to adherence to nationally recognized evidencebased medical guidelines and other quality criteria (i.e., gold carding). Current Status Senate Bill 247 unanimously passed the Senate in late-April and is now under consideration by the House Health Policy continued on page 27

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Committee. As a top strategic priority of MSMS and the Health Can’t Wait coalition, we will be focusing efforts on the passage of this important piece of legislation when the House returns in September. • Telehealth Reimbursement and Coverage Parity for Telehealth Services To ensure continuity of care and minimize the spread of COVID-19, physicians quickly adopted telehealth during the pandemic. Payers also temporarily removed some of the regulatory and administrative barriers that were limiting telehealth use and payment of telehealth services, including payment at in-person rates during the public health crisis; however, payments are now reverting to pre-pandemic rates. MSMS believes the time is right to make these equitable policies permanent given that telehealth is, and will continue to be, an effective method of health care delivery. Talking Points • Telehealth has proven to be an important care delivery method for improving access in underserved communities, particularly rural areas, areas with physician shortages, and areas with limited access to primary care services. • The decision to see a provider in-person or via telehealth should be a case-by-case decision made between a patient and their provider. Payers should not be enabled to promote one care modality over another. • The standard of care does not change if a patient and provider opt to use telehealth (ex: the physician is still performing evaluations, determining course of treatment, coordinating follow-up care, etc.). • Telehealth should be utilized when medically appropriate and patients should still have access to their physician inperson. • Equitable payment and coverage policies will ensure greater access to care and will also ensure telehealth remains a sustainable option for providers to offer. MSMS also recently created a telehealth advisory group of physicians. The purpose of the group is to gather information about telehealth best practices, plan for future needs, understand potential issues and develop solutions. The list below highlights a few of the topics we discussed at our first meeting that you might find useful: • The way telehealth has helped the physicians stay in touch with their elderly patients. For this patient demographic, both telephone and video telehealth has worked. Some patients do have younger family members help them with the technology. • It is also a way to interact with patients in rural areas, those who are homebound and for those who are still concerned about COVID exposure.

• It is a way for the physicians to see their patients who are traveling and in different states (a lot of snowbirds). However, there needs to be further clarity on how to practice across state lines. • It is important that we do not go back to using telehealth as a replacement for urgent care. We need to ensure that patients will continue to see their physicians and not use the stand-alone or payer-sponsored telehealth applications (Amwell, MD Live, etc.). Current Status MSMS has drafted a model bill requiring insurers to cover and reimburse telehealth services the same as if the service were provided in-person and the bill is expected to be introduced in the House by Representative Richard Steenland (D-Warren) as soon as early October. Out-of-State Telehealth Expansion - House Bill 4355 House Bill 4355 would allow out-of-state doctors to treat Michigan patients via telemedicine without a Michigan license or oversight requirements under the following conditions: • The health professional directly or indirectly obtains consent, as required under the code for a person licensed as a health professional in Michigan providing care through telehealth. • The health professional provides only those health services he or she would be allowed to provide if he or she were authorized to engage in that health profession in Michigan. • Before providing the health service to the patient, the health professional provides the patient with the hyperlink or address for his or her authorization to practice the health profession in the other state on the website of the licensing department, board or other authority of that other state. MSMS and the Michigan Health and Hospital Association have taken a public position of opposition and have offered amendments to the bill that would ensure the following: • The individual is currently licensed to practice a health profession in another state which is recognized by LARA for purposes of licensure. • The individual is not the recipient of a previous disciplinary action by any other state or jurisdiction including, but not limited to, the revocation or suspension of a license to practice a health profession. • The individual is not the subject of a pending investigation by a state health professional board or another state or federal agency. • The individual has passed the relevant medical examination for the services that are expected to be rendered. continued on page 28

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• The individual completed an application for an out-of-state telehealth license for the practice of a health profession across state lines and submitted the requisite fees as outlined by LARA. • An individual who has been issued an out-of-state telehealth license to practice a health profession across state lines shall not open an office in this state, meet in this state with patients, or receive calls in this state from patients unless the individual is licensed to practice a health profession. In addition to MSMS and MHA’s opposition, LARA is also strongly opposed to the bill. Talking Points • While physicians see tremendous value in expanding access to health care through telemedicine, allowing outof-state providers to deliver these services without licensure or oversight requirements raises significant concerns about patient safety and the potential effects on Michigan’s health care marketplace. • With the growing use of commercial telemedicine services, provider-patient encounters are now occurring outside of normal care settings. While convenient, this can lead to fragmented care when there is not an established relationship between the physician and the patient. o An established provider-patient relationship should be required so that physicians can use telemedicine to provide quality care for a patient’s existing condition and ensure necessary follow-up care is delivered. • Telemedicine providers should be licensed to practice medicine in Michigan to ensure Michigan patients are protected from fraud, liability and privacy issues. Current Status House Bill 4355 narrowly passed the House on March 24, 2021, and is now under consideration by the Senate Health Policy & Human Services Committee. A hearing has not been scheduled at this time. • COVID-19 – House Bill 4471 House Bill 4471 would create the Informed Consent in the Workplace Act, which would “prohibit discrimination against

an employee or volunteer who declines or has not received certain vaccinations, including for COVID-19. An employer also could not require the employee or volunteer to wear a mask in the workplace or disclose to the public that the employee or volunteer has declined or not received a vaccination.” The bill also would prohibit employers from requiring vaccinations against the flu, tetanus, diphtheria or pertussis, and employees could sue and collect damages against an employer who violates this proposed law. Specifically, under HB 4471, an employer could not do any of the following: • Discharge, fail or refuse to hire or recruit, or otherwise discriminate against a qualified individual with regard to employment, compensation, or a term, condition, or privilege of employment (or threaten to do so) because the individual declines or has not received a specified vaccination. • Require a qualified individual who declines or has not received a specified vaccination to do either of the following: o Wear a surgical face mask as a consequence of declining or not receiving a specified vaccination. o Display on the qualified individual’s person a mark that distinguishes him or her from others who received or did not decline a specified vaccination. o Disclose to the public that the qualified individual has declined or not received a specified vaccination. • Retaliate or discriminate against a person because the person has done or is about to do any of the following: o File a complaint under this act. o Testify, assist, or participate in an investigation, proceeding or action concerning a violation of this act. o Oppose a violation of this act. Talking Points • The vaccines named in House Bill 4471 are proven to be safe and effective at preventing infection and reducing the severity of illness. continued on page 29

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 this critical fall 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 THIS FALL. 28

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• Masks have long been used in the delivery of health care services in hospitals and other health care settings, especially in the operating room. o House Bill 4471 would instead allow unmasked and unvaccinated individuals to regularly come in close contact with patients, many of whom are critically ill. • This legislation would ignore hundreds of years of infection control research and severely hinder the ability of employers to protect the health and wellness of their employees and their customers. • There have been no efforts at the state-level in Michigan to implement government-backed COVID-19 vaccine mandates. Further, the Governor has already stated that she does not have plans to implement any such policy. Current Status The House Workforce, Trades and Talent Committee recently held a hearing on House Bill 4471 in which MSMS submitted a card of opposition to the bill. Also opposing the bill were the following organizations: • Michigan Chapter of the American Academy of Pediatrics • Detroit Regional Chamber of Commerce • Michigan Chamber of Commerce • Michigan Association of School Boards • Michigan Health and Hospital Association • Michigan Bankers Association To be continued in the November 2021 Bulletin

Caduceus Meeting for Recovering Health Care Professionals Third Thursday of each month at 7 p.m. Zion Lutheran Church 454 7th Street, Freeland, Michigan

25th Annual Conference on Bioethics* Saturday, November 13 (Hybrid/Virtual and In-person) Sheraton Ann Arbor 8:45 a.m. – 4:15 p.m. Approved for 6 AMA PRA Category 1 Credit(s)™ Doctor Mark Navin will present on Governing Vaccination by Harming the Innocent? Protecting the Interests and Rights of Unvaccinated Children, at the MSMS Foundation’s 25th Annual Conference on Bioethics. Mark Navin, PhD, HEC-C, is a Professor and Chair of Philosophy at Oakland University, Lecturer in the Department of Foundational Medical Studies at Oakland University William Beaumont School of Medicine and Clinical Ethicist at Beaumont. Doctor Navin’s research is primarily in clinical ethics and ethics in public health and includes empirical work in both areas. His monograph, Values and Vaccine Refusal: Hard Questions in Ethics, Epistemology and Health Care, was published by Routledge in 2016. His current projects include a book about vaccine mandates with Katie Attwell (America’s Vaccine Wars: California and the Politics of Mandates, under contract with Oxford University Press). He also co-chairs Beaumont Hospital’s Ethical Allocation Committee for COVID-19 vaccines and serves on Oakland University’s Student Success Committee and the Vaccine Exemption Committee. Other presentations include: • How did we get here? A Brief History of Racism and Bias in Medicine • Racism and its Impact on Health • Global Health with a Women’s Health Lens • The Hazard of Diluted Bioethics in the Ongoing Flint Water Crisis: A Residents View

(Behind Pat’s Grocery Store on Midland Road in Freeland)

FOR MORE INFORMATION AND TO REGISTER, CLICK HERE.

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

Statement of Accreditation: The Michigan State Medical Society (MSMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Caduceus meetings are “closed” meetings for recovering health care professionals including, but not limited to, nurses, doctors, dentists and pharmacists. We engage in group discussions where members may want to speak up, ask questions or share thoughts with fellow members.

*AMA Credit Designation Statement: The MSMS designates this live activity for a maximum of 6 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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 October 2021” in the subject line. The winner will be randomly drawn on November 1. The Bulletin | October 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.

ADVERTISER INDEX Advanced Diagnostic Imaging, P.C . Ascension St. Mary’s Hospital Barb Smith Suicide Resource & Response Network Covenant Wound Healing Center 30

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“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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We invite you to this year's Live Your Life On Purpose, a free event focused on health, well-being, community and connection. This year's theme is social isolation and the need for connection, which has never been more important. Due to concerns for inperson attendance, we are now moving this event to virtual only. If you previously registered for in-person attendance, we will send you Zoom information shortly.

We are facing the biggest public health risk of our time and it may not be what you think. As devastating and impactful as COVID-19 has been, social isolation increases your risk of serious illness and dying the most. Close relationships and the number of people you interact with each day have been shown to be the two biggest predicators of not just how long, but how well you live.

Event: Live Your Life On Purpose: Social Isolation and the Need for Connection Date: Monday, October 25 | Time: 5-7 p.m. EST | Location: Virtual (Registration below) Please come prepared to learn about the factors that determine not only good health but a life rich with meaning. CLICK HERE TO REGISTER

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2019-2021 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.

CALENDAR OF MEETINGS AND EVENTS FOR 2021-22* Tuesday, October 19, 2021 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: “Future of Physician Leadership: Regionally and Nationally” 1.5 AMA PRA Category 1 CreditsTM available Speaker: Marilyn Skrocki, SVSU Professor of Health Sciences, Health & Human Services, Academic and Student Affairs (See p. 5) Online reservations are required. CLICK HERE TO MAKE A RESERVATION (due 10/15/21) or scan the QR Code Tuesday, November 16, 2021 CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m. Tuesday, January 18, 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 and Speaker TBD Email meeting notices will be sent in early January. Online reservations are required. Tuesday, February 15, 2022 CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m.

Tuesday, March 15, 2022 CMU College of Medicine, 1632 Stone Street, Saginaw Board Meeting – 5:30 p.m. 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 and Speaker TBD 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. *subject to change