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The

Bulletin Saginaw County Medical Society

Year End 2020 | Volume 79 | No 2

Please Pay Your 2021 Dues! p. 5

MiHIA: Bringing an End to Adverse Childhood Experiences p. 10

COVID Information & Resources p. 16-17, 22 www.SaginawCountyMS.com

Cover Photo: Jan Masica


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The

Bulletin Saginaw County Medical Society

2020-2021 OFFICERS AND DIRECTORS President Mildred J. Willy MD President-Elect Anthony M. Zacharek MD Past President Julia M. Walter MD Secretary Caroline G.M. Scott MD

contents 5

10

14

Treasurer Miriam T. Schteingart MD Board of Directors

16-17

PLEASE PAY YOUR 2021 MEMBERSHIP DUES

22

Bringing an End to Adverse Childhood Experiences January 13-14, 2021 (Virtual) Register Now!

COVID-19 Vaccine Information CDC, CMS and MDHHS

COVID-19 Vaccination Program for Providers FAQ

31

Benefits of SCMS Membership

Key Provider of the Month – CQ Simple Importance of Data Security In Healthcare

Jorge M. Plasencia MD

20

4

President’s Letter

5

SCMS Meetings and Events

6

From the Editor

8

Barb Smith SR&RN

Anushka N. Magal MD

11

MSMS Delegates

Caduceus Meeting for Recovering Health Care Professionals

28

MSMS Reimbursement Advocate Alert

Elvira M. Dawis MD

12

CMU College of Medicine CMU Health

29

Birthdays – January and February

13

30

Advertiser Index

CMU OCME – End of Year Survey

18

30

Covenant HealthCare

Fulfill Your Board of Medicine Requirements on Your Time

20

Ascension St. Mary’s

32

SCMS Meetings and Events

Tiffany K. Kim MD Mark G. Greenwell MD Harvey K. Yee MD Elizabeth A. Paulus MD Furhut R. Janssen DO Bulletin Editor Louis L. Constan, MD Resident Representative

Julia M. Walter MD Mildred J. Willy MD Anthony M. Zacharek MD Jorge M. Plasencia MD Christopher J. Allen MD Miriam T. Schteingart MD MSMS Alternate Delegates

Health Professional Recovery Program

23

In Memory

26

MSMS End-of-Year Legislative Report

Caroline G.M. Scott MD Waheed Akbar MD

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

Mohammad Yahya Khan MD Virginia R. Dedicatoria MD

COVER PHOTO COURTESY OF JAN MASICA

Steven J. Vance MD Joseph P. Contino MD Kristine K. Spence DO Karensa L. Franklin MD Scott E. Cheney MD Michael W. Warren MD Peer Review Ethics Committee Waheed Akbar, MD, Chair Caroline G.M. Scott, MD James R. Hines, MD MSMS Region 7 Director Thomas J. Veverka, MD Executive Director Joan M. Cramer Administrative Assistant Keri Benkert

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 | Year End 2020 3


PRESIDENT’S LETTER

COVID-19 Therapeutics and Vaccines Mildred J. Willy, MD Guest Writer: Jeffrey Davis, Director of Regulatory Affairs, American College of Emergency Physicians (ACEP)

HHS Issues Regulations and Guidance on COVID-19 Therapeutics and Vaccines

A

lthough COVID-19 cases, hospitalizations and deaths are climbing at an alarming rate, we did receive some positive news recently that will help us in our ongoing effort to combat the virus. On Monday, November 9, Pfizer announced that its vaccine has proven to be more than 90 percent effective in preventing the disease among trial volunteers who had no evidence of prior coronavirus infection (I should note these are initial results and more data, especially on the safety of the vaccine, are forthcoming and still need to be analyzed). Further, Food and Drug Administration (FDA) issued an emergency use authorization for the investigational monoclonal antibody therapy, bamlanivimab, for the treatment of mild-to-moderate COVID-19 in adult and pediatric patients.

While these announcements are a great first step, the road ahead to ensuring the safe and effective distribution and administration of COVID-19 vaccines and therapeutics is long. It will be essential going forward that physicians understand not only the clinical effectiveness and appropriate use of these vaccines and therapeutics, but also the rules and payment mechanisms associated with them. In other words, we must have solid regulations in place that will mitigate confusion and ensure smooth distribution and administration processes. The Department of Health and Human Services (HHS) has already issued some useful regulations and guidance around vaccines and therapeutics. With respect to vaccines, the Centers for Medicare & Medicaid Services (CMS) within HHS announced a series of actions at the end of October to ensure that many Americans have access to the COVID-19 vaccine at no cost when it becomes available. CMS released a regulation that allows for Medicare coverage of any vaccine that the FDA authorizes without beneficiary

cost sharing. The reg also implements CARES Act requirements providing private health plan coverage of a COVID-19 vaccine without cost sharing from in- and out-of-network providers during the public health emergency. CMS has also issued toolkits for state Medicaid agencies, health care practitioners and health insurance plans that provide important information on the vaccine related to coverage and reimbursement. The agency also released new Medicare provider payment rates for COVID-19 vaccine administration, including setting the rate at $28.39 for administration of single-dose vaccines. Moving on to therapeutics, after the FDA issued the new emergency use authorization for bamlanivimab, HHS announced plans to distribute an initial 300,000 doses of the therapy to states and territorial health departments. HHS states that it has the ability to purchase up to another 650,000 doses by the middle of next year. CMS, in turn, announced that continued on page 5

The road ahead to ensuring the safe and effective distribution and administration of COVID-19 vaccines and therapeutics is long.

4

The Bulletin | Year End 2020


continued from page 4

Medicare will cover the therapy at no cost to beneficiaries. The agency also released some initial billing and coding instructions for health care providers. The Medicare payment rate for the administration of bamlanivimab will be $309.60. I understand that regulations are only one piece of the puzzle to ensuring that you have the information and resources you need to protect yourself and properly treat your patients. There are significant operational, supply chain, and storage and handling issues that go way beyond regs. These challenges are being addressed in part by the Centers for Disease Control and Prevention (CDC), the National Institutes of Health, the Biomedical Advanced Research and Development Authority, the Department of Defense and other federal agencies through Operation Warp Speed. However, I am sure that when vaccines are approved and additional therapeutics become available, you will have numerous questions that existing regulations and Operation Warp Speed have not yet addressed. ACEP has biweekly discussions with the CDC and is in constant communication with the FDA and other HHS officials as issues arise. We are committed to ensuring that your questions and concerns are addressed in a timely manner.

SCMS MEETINGS AND EVENTS Due to COVID-19, the SCMS has cancelled meetings and events through the end of the year. The Board continues to evaluate the state of the pandemic and the safety of meeting in person. We are looking into presenting virtual programs in the near future. The April 2020 Membership Meeting program, “Physician Compassion Fatigue” to be presented by Molly E. GabrielChampine, PhD, LP, Director of Behavioral Science, Family Medicine Residency at McLaren Bay, will be rescheduled in 2021 once it is safe to start meeting in person. We will not host our annual Health Fair in 2021. We do not feel it is in the best interests of the public who attend (many of whom have multiple medical conditions), our vendors, members and staff to bring together a large group of people. Board meetings for the immediate future will be held virtually.

PLEASE PAY YOUR 2021 MEMBERSHIP DUES As you are aware, 2020 has been an exceptionally difficult year for all of us. As a result of cancellation of revenue-producing projects and events, the SCMS has experienced a substantial financial setback. MSMS has sent out 2021 dues invoices for SCMS/MSMS membership with a due date of December 31, 2020. If you have not already done so, would you kindly pay your 2021 dues at this time? Dues income is currently our only source of revenue, and we appreciate whatever you can do to facilitate payment and allow us to continue to serve our members in the manner in which they have become accustomed. 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, and 88 percent of MSMS dues are deductible (12 percent are attributable to lobbying activities and not deductible as a business expense). 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. Benefits of SCMS Membership can be found in this issue of The Bulletin on page 31. HOW TO PAY YOUR DUES • Dues can be paid by credit card through the MSMS website by clicking HERE. o Questions about signing in to the MSMS website? Call MSMS at (517) 336-5716 or email Joan Cramer at jmcramer@sbcglobal.net. • Fax dues notice and credit card information to MSMS at (517) 481-3976. • Mail check payable to MSMS to: o MSMS Membership Account Specialists, 120 W. Saginaw Street, East Lansing, MI 48223 The strength and effectiveness of SCMS/MSMS as your professional association is predicated on strong membership. For questions about membership or if you have not yet received your 2021 dues invoice, please contact Joan Cramer, SCMS Executive Director at jmcramer@sbcglobal.net.

Continue to elevate your voice and defend your profession by paying your 2021 dues now! The Bulletin | Year End 2020 5


FROM THE EDITOR

A Scientist,and Proud! By Louis L. Constan, MD

I

f you’re inclined to be skeptical of your patients’ respect for your scientific approach to their illness and treatment, given all the antiscience rhetoric out there these days, you’re in good company. After all, the most prestigious doctor/scientists in the land are routinely called out by some of the most scientifically ignorant people you can imagine. Why should you be any different? Why should your patients take your word for it that your diagnosis is correct? Why should they refrain from consulting Dr. Google, alternativemedicine practitioners, for-profit websites, south-of-the border clinics? Does it even matter to your patients that you mastered Organic Chemistry, Statistics, Anatomy? And that was just medical school. As a doctor, does it matter to them the Herculean effort you put towards keeping up with the latest in medical research, or agonizing over an extensive differential diagnosis? Since you are a scientist first and foremost, you are obligated to think through a patient’s medical issues scientifically before reaching a conclusion and settling on a treatment regimen. But that occurs behind the scenes, in your mind, and patients never see it. The hands-on part they do see seems simple…and if you try to explain it… they zone out; the bottom line being that the scientist in you, all the complicated,

difficult stuff you do, is underrecognized and undervalued by patients. With that in mind, you can imagine my delight when I read about a study supported by the prestigious Kavli Foundation1 about American attitudes towards science. Turns out that all the hoopla in the media about negative bias towards science by the American public is completely wrong! In fact, Americans as a whole strongly believe in science…and this holds true across people of different ethnic groups, different races, even different political views. Yes, Republicans as much as Democrats. In fact, the strong consensus from the survey is that the country needs more science, not less; the country needs to spend more on basic research; American children need to choose science careers; and the Federal government needs to make it possible. Is this a change in thinking because of some of the high-profile challenges the country faces? Maybe so, especially since respondents seemed focused on: • • • • •

Economic growth Climate change Safe drinking water Ensuring the food supply Ending Covid-19 and other diseases

It is likely that, in the course of the country’s response to the above problems, science will become more

and more prominent in the public’s consciousness. And that is as it should be. You and I know that; we’ve always known that. When one of the issues above gets discussed, the immediate response should always be: “listen to the scientists.” Everyone else just has an opinion. The scientist’s conclusion is based on research-derived facts, and stands a much better chance of leading to a successful resolution of the problem. Did you notice the last problem above (COVID) was a MEDICAL problem, so the public needs YOU, a doctor/scientist to help solve it? Perhaps, my friends, now is the time to remind our patients that WE, in fact, are scientists, just like Drs. Fauci, Redfield, Birx and Frieden. All of us routinely apply the scientific method to our patients’ care; first positing a hypothesis, then testing that hypothesis with…well, tests… then deciding on a course of treatment to correct the problem - which is exactly what the public wants scientists to do with the problems on the list above. Then maybe, just maybe, our patients will appreciate that scientific medicine, evidence-based medicine, is something to be respected and valued. You! The Doctor. You! The Scientist. It is time to stand up and be proud of that! 1

1,894 adults surveyed by Research!America

Science will become more and more prominent in the public’s consciousness.

6

The Bulletin | Year End 2020


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Governor’s Suicide Prevention Commission Barb Smith was appointed to the Governor's Suicide Prevention Commission back in the Spring. The Commission has been working diligently with experts from across the state and country to write a Michigan Suicide Prevention Plan. The subgroups include policy, data, special populations and workplace. Barb has had the honor of working with some of the finest advocates, and they should have a draft plan submitted to the Governor by March 2021. They are making changes to the way we care for those who struggle with their mental health, persons with suicidal thoughts and those people who have been impacted by suicide. CDC Grant Partnership We are honored to be partnering with Central Michigan University College of Medicine to create a replicable model for training and implementing mental health and suicide prevention services, acting as the consultant in the Great Lakes Bay Region. Michigan is one of nine states to receive a suicide prevention grant from the Center for Disease Control (CDC). The CDC identifies suicide as a public health crisis, and this grant aims to reduce the number of deaths and suicide attempts among men age 25 and older by at least 10 percent over the next five years. This is part of a total statewide $4.25 million grant for suicide death prevention. Barb Smith Receives WAVE Award From Saginaw County The Saginaw County Board of Commissioners recently presented Barb with the WAVE Award. WAVE stands for Work, Achievement, Valiant, Effort to highlight excellence at work and in our community. “She’s the most phenomenal person you don’t want to meet, only because that means the most horrific thing has happened in your life. It means you are now part of a club that you never wanted to be a member of…a survivor

of suicide. The instant you meet her, that’s when you grab on to her hand and she will guide you back to the light. It is because Barb has personally felt this raw pain from her own devastating losses that she understands the range of emotions that survivors of suicide will face.” Upcoming ASIST Trainings ASIST (Applied Suicide Intervention Skills Training) is a twoday interactive workshop in suicide first aid. In this training, you will learn how to help prevent suicide by recognizing signs, providing skilled intervention, and developing a safety plan to keep individuals safe from suicide. Continuing Education Credits Available Social Work 13.5 CE’s | SCECH 11 CE’s If you have questions about an upcoming training or would like to set up one for your group, please contact us at (989) 7815260 or info@srrn.net. Radiant Church, Bay City MI January 29-30, 2021 | 8 a.m. - 4:30 p.m. Registration: p2p.onecause.com/bcasist P2P Program Kicks Off at Midland County Schools Our Network has partnered with The ROCK Center for Youth Development and The Midland Schools Mental Health Gaps Committee to bring P2P (Peer 2 Peer) to eight schools throughout Midland County. The University of Michigan designed the thorough and comprehensive program to educate students about depression and depressive illnesses, and support them in finding creative ways to convey this knowledge to their peers in order to reduce stigma, raise awareness, encourage help-seeking, and ultimately, help to promote the early detection of depression, bipolar disorder and related illnesses. This year's program kicked off with an all-day event. Over 50 7th - 12th graders were trained in either suicide awareness or safeTALK in the morning, and then attended a virtual group discussion to start planning what the group will be doing in their schools over the next seven months. Thank You! Thank you to the Youth Advisory Endowment Fund of the Bay Area Community Foundation for your commitment to continued on page 9

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The Bulletin | Year End 2020


continued from page 8

our growing organization and your willingness to financially support suicide prevention and increase help-seeking behavior throughout Bay County schools. We are so excited to have kind donors like your organization. Your financial support of $10,400 will make it possible for us to offer three safeTALK training programs and one Applied Suicide Intervention Skills Training (ASIST) at no cost for participants. This will allow 90 teachers, staff or administrators to receive training to become someone who can connect a person with thoughts of suicide to an intervention resource. It will also provide 30 counselors, administrators or community support persons to receive training to be able to intervene when someone has thoughts of suicide. Together, our goal is to educate 120 new individuals in suicide prevention and further the efforts to implement an evidence-based, layered model of suicide prevention training to Bay County students and staff. Without your financial contribution, we would not be able to bring the most effective model of suicide prevention training to Bay County students and staff. This model creates a safety net around individuals with thoughts of suicide through layers of training all around the community. On behalf of the Board of Directors of the Barb Smith Suicide Resource and Response Network, our staff and Barb, please extend our humble gratitude for the tremendous generosity of the Youth Advisory Endowment Fund! We will continue to do our work in honor of all those lost to suicide, as well as, coordinate and deliver trainings to educate people on how to prevent future suicides. Make a Year-End Donation! Please consider making a year-end donation to the Barb Smith Suicide Resource & Response Network, a 501(c)(3) nonprofit, EIN Number: 38-3400293. Your tax-deductible donation can be made online or by mail: Donate Online: https://p2p.onecause.com/srrn/donate Mail check payable to BSSR&RN and mail to: PO Box 6712 | Saginaw, MI 48608-6712 Our Mission Prevent suicide through education and resources, and to support those impacted by suicide. Our Vision Eliminate suicide and reduce its impact. Guiding Principles • Suicide prevention is mental health promotion. • Mental health is just as important as physical health.

• A healthy community addresses the needs of the whole person - body, mind and spirit. • Preventing suicide requires fostering and nurturing strong community partnerships. • Training must be provided with an unwavering commitment to quality and excellence in delivery, while being tailored to the needs of unique audiences. • Providing support to individuals to navigate complex community systems improves access to critical services and care. • Providing support for those impacted by suicide is critical.

Are you in a crisis? Call 800-273-8255 or text TALK to 741741.

www.SaginawCountyMS.com

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 | Year End 2020 9


Bringing an End to Adverse Childhood Experiences

Event Purpose As we begin to understand the ways in which ACEs have wide-ranging health and social consequences for both individuals and communities, we can work together to prevent or mitigate them. We — providers, social workers, parents, mentors, coaches, teachers and friends — have the power to help children build resilience and break cycles of generational trauma. We need a massive culture shift that focuses on “What happened to you?” versus “What’s wrong with you?” In partnership with Michigan ACE Initiative, MiHIA invites YOU to become a Michigan ACE Community Champion (MACC). As a Community Champion, you will have the knowledge and tools needed to spread the message of ACEs from board rooms to living rooms!

The goals of the MACC Training include opportunities to: • Model and practice the skills to articulate clearly: ACE research findings and implications, how ACEs impact brain development and function, the capacity of community core protective systems, and how the development of community capacity can help reduce ACEs in children. • Understand the impact ACEs have on our own lives. • Gain awareness and learn techniques for responding to emotional responses of audiences with respect and empathy in a non-judgmental way. • Develop approaches for creating safety necessary for trauma-sensitive learning environments. • Ongoing peer and self-reflection on the boundaries of our own expertise and knowledge.

AGENDA Presenters will include: Rich VanTol, Great Start Collaborative BAISD; Jason Sroufe, Wellspring Lutheran Services; Gretchen Wagner, HSCC Bay County; and Alison Arnold, CMU Interdisciplinary Center for Community Health & Wellness.

REGISTER NOW! 10 The Bulletin | Year End 2020


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

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

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

Caduceus meetings are available to health care industry professionals, and have adopted many of the principles of 12-Step programs. Caduceus meetings are “closed” meetings for recovering health care professionals including, but not limited to, nurses, doctors, dentists and pharmacists. We engage in group discussions where members may want to speak up, ask questions or share thoughts with fellow members.

The Bulletin | Year End 2020 11


CMU Seeks Clinical Educators and Partnerships in MAT to Treat Opioid Use Disorders Opioids (including prescription opioids, heroin and fentanyl) killed 46,802 people in 2018, and nearly 70 percent of all opioid overdose deaths involved a prescription opioid. The opioid epidemic is hitting close to home – Michigan has experienced a 16 percent increase in synthetic opioid related deaths in 2018. The COVID-19 pandemic has led to increased opioid use and overdoses, which emphasizes the need for clinicians to become MAT prescribers. CMU College of Medicine and the CMU PA Program have worked to implement a MAT training program into the curriculum for medical and PA students. Phase 1 of the curriculum is to combat the opioid epidemic by training medical and PA students with 8-hours of mandatory classroom learning (and additional 16-hours online for PA students) using the American Society of Addiction Medicine’s (ASAM)-accredited curriculum with medicationassisted treatment (MAT) Drug Addiction Treatment Act (DATA) waiver training requirements. Phase 2 of the curriculum is providing these students with an opportunity in a clinical setting working with patients receiving MAT for opioid use disorder at certified Opioid Treatment Facilities or at primary care offices offering MAT for opioid use disorder in the form of office-based outpatient treatment. We are seeking partnerships with clinical educators at certified opioid treatment facilities or primary care offices that offer MAT to host our students for this clinical experience. If you are interested in hosting students please contact, Alyson McClintock at hill1am@cmich.edu or at (989) 746-7506. Thank you. Juliette Perzhinsky, MD, MSc and Alyson McClintock, Project Coordinator SAVE THE DATE: Free 8-hour MAT DATA Waiver Training Through ASAM – Saturday, April 17, 2021, from 8:30 a.m. to 4:30 p.m.

College of Medicine Announces First Endowed Chair Congratulations to Kathleen L. Meert, MD, the newly named Schotanus Family Chair of Pediatrics at the CMU College of Medicine. Dr. Meert is president of University Pediatricians and pediatric specialist-in-chief at Detroit Medical Center Children’s Hospital 12 The Bulletin | Year End 2020

of Michigan. "A clinician and avid researcher, Dr. Meert is nationally recognized for conducting multicenter clinical trials," said George E. Kikano, MD, CMU Vice President for Health Affairs and Dean of the CMU College of Medicine. Read more.

ICYMI: Stories from CMU News and Social Media College of Medicine faculty and staff have been prominently featured in CMU news and on our social media channels for their research and expertise in public health. Here are some of the stories you may have missed. Don't take COVID-19 with you Advice for travel to prevent the spread of COVID-19 during the holiday break. "We must be vigilant to prevent taking this virus home to our families and spreading it further into other communities," said Dean George E. Kikano, MD. "Also, we all must continue to wear masks, socially distance and wash our hands." Learning on medicine’s front lines Equipped with a passion for research, Asim Kichloo, MD, CMU Health Academic Hospitalist, is paving the way for understanding COVID-19 and how to manage the disease in the Great Lakes Bay Region. Dr. Kichloo treats patients and trains medical residents at Ascension St. Mary's Hospital, and is one of the first to describe cases of the illness in combination with other conditions such as kidney disease, Epstein-Barr virus, lupus pneumonitis, heart arrhythmia and more. CDC grants will equip CMU to fight suicide, childhood trauma The CMU College of Medicine and the CMU Interdisciplinary Center for Community Health and Wellness (ICCHW) are key partners to the state of Michigan in receiving $5 million-plus in CDC grants for statewide public health initiatives. The CDC granted the awards for suicide death prevention in men and to address adverse childhood experiences. Alison Arnold is director of CMU's ICCHW, which will administer the grant funds for CMU. "We expect numerous community mental health partners to become involved in these efforts," Arnold said. "CMU is honored to coordinate and support our community in addressing a broad range of risk factors including isolation, stress, substance abuse, and relationship and financial issues." continued on page 13


CMU OCME END OF YEAR SURVEY

continued from page 12

State enlists CMU faculty in COVID-19 early warning efforts Michael J. Conway, associate professor for microbiology at CMU’s College of Medicine along with two additional CMU faculty are part of a statewide pilot project to search for signs of the COVID-19 virus in wastewater samples. “The hope is that we can get a really good footprint of what the virus is doing,” said Conway.

It’s almost the end the year (and what a year!) when we invite your feedback to take a short two minute survey to assist us in better meeting your continuing medical education needs in 2021. Please click this LINK to the Survey. In November 2019, no one could have predicted what occurred in 2020. All of our courses had to “go virtual” in a few days in March. Please let us know how we performed and whether we met your CME needs during this turbulent and unpredictable year. Your suggestions are welcome and invited. We have two special CME presentations in January: • Thursday, January 7, 12-1 p.m. - “Overview of Neuropsychiatric Impairments & Management of Agitation in Dementia,” Asif Khan, MD, FAPA • Friday, January 29, 12-1:15 p.m. – “The Increase of Opioid Abuse and Overdose during the COVID-19 Pandemic,” Judge Patrick Shannon and William Morrone, DO Please check out our eLearning courses and podcasts at CMU CME ONLINE.

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

Wishing you safe and Happy Holidays. Joan C. Ford, CHCP, Administrator Melissa J. Morse, CME Program Specialist

The Bulletin | Year End 2020 13


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Importance of Data Security in Healthcare The Problem Now-a-days as computers have become an essential part of our daily lives, it is increasingly important that data security is also placed front and center on our list of priorities. In the healthcare industry, where thoughts are often focused on saving someone’s life and rightly so, securing access to interfaces and computer systems that store private data like medical records is also an essential factor to consider. Data security is a corresponding action between controlling access to information while allowing free and easy access to those who need that information. Given the sensitive nature of healthcare data, it is vital for providers to have a robust and reliable information security service in place. The strategies should not only react and protect healthcare data, but also predict and prevent any assaults launched by cyber criminals. In recent years, cyber criminals are more interested in electronic medical records (EMRs) as the black-market rate for this kind of information is much higher than credit card numbers or bank account passwords. This trend might be surprising, but the reasons are quite obvious. Altogether, the data in the EMRs contains patient name, date of birth, address, phone number, place of work and position, ID, card numbers, and medical insurance. Stealing of such information can lead to a complete identity theft, rather than just a one-time bank hack. Despite all the vulnerabilities healthcare data security encounters in the age of technology, there are ways to mitigate these risks. Similar to any other type of organization, medical facilities need data protection from dangers like targeted attacks and hacking, virus infiltration, employee actions committed due to illiteracy or with a purpose to steal medical records.

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VACCINE COVID-19 Vaccination Recommendations (last updated 12/1/20) When a COVID-19 vaccine is authorized by the FDA and recommended by the Advisory Committee on Immunization Practices (ACIP), vaccination in the initial phase of the COVID-19 vaccination program (Phase 1a) should be offered to both: • Healthcare personnel • Residents of long-term care facilities Healthcare personnel are defined as paid and unpaid people serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials. Long-term care facility residents are defined as adults who reside in facilities that provide a variety of services, including medical and personal care, to persons who are unable to live independently.

Vaccine Storage and Handling Toolkit Requirements for the CDC COVID-19 Vaccination Program The Vaccine Storage and Handling Toolkit has been updated with a COVID-19 Vaccine Addendum with information on Storage and Handling best practices for COVID-19 vaccines. All vaccination providers participating in the COVID-19 Vaccination Program must store and handle COVID-19 vaccines under proper conditions to maintain the cold chain as outlined in the toolkit and addendum. Click HERE to download the Toolkit 16

The Bulletin | Year End 2020

The addendum will be updated with specific storage and handling information for each COVID-19 product. Please sign up for email alerts on the CDC website to be notified when updates are made or check the website often. (Sign up is in the left column of the CDC website page) The 2020 Vaccine Storage and Handling Toolkit is a comprehensive guide that reflects best practices for vaccine storage and handling from Advisory Committee on Immunization Practices (ACIP) recommendations, product information from vaccine manufacturers and scientific studies. The toolkit has been updated for 2020 to clarify language including: • Beyond use date (BUD) • Routine maintenance for vaccine storage units • New definition added to the glossary

CDC COVID-19 Vaccine Reporting Specifications (CVRS) Instructions V2 Vaccine Administration Documentation COVID-19 vaccination providers must document vaccine administration in their medical record systems within 24 hours of administration, and use their best efforts to report administration data to the relevant system for the jurisdiction (i.e., IIS) as soon as practicable and no later than 72 hours after administration. This specification defines the COVID-19 vaccination reporting requirements to the CDC’s Immunization Data Clearinghouse (DCH). Whenever possible, existing and new connections between provider organizations and immunization information systems (IISs) should be leveraged to report vaccinations directly to IISs. This specification addresses how IISs will report these data to CDC’s DCH, as well as, how provider organizations that are unable to report to IISs can still report to CDC’s DCH to ensure a comprehensive accounting of administered doses of COVID-19 vaccine. Currently, this specification supports the submission of deidentified case-level data. It includes reference to identified data elements, but these elements may be populated with “Redacted” or an appropriate coded value.


In the future, this specification will be expanded to include two additional models for reporting. All models of reporting will use the same file format, but will vary in what identifying information is provided. The specification allows for submission of different types of events: (1) vaccination events and (2) vaccine refusals. Each has unique requirements and is defined in the “Deidentified Extract Format.” Only vaccination events are required to be reported at this time. The CDC understands that not all IISs collect data about comorbidities or serology. When these data are not collected by the IIS, the values for these variables must be reported as “unknown.” It is also understood that an IIS may not have information about refusals. These data are only required to be reported if and when available. “What Every Clinician Should Know about COVID-19

Vaccine Safety” This webinar was presented and recorded on December 14, 2020. The slide set is available under "Call Materials" on the COCA Call webpage. Continuing Education (CE) was not offered for this webinar. OVERVIEW Monitoring vaccine safety is a vital part of the nation’s response to the COVID-19 pandemic. As COVID-19 vaccines become available, the public’s knowledge and confidence in their safety, both initially and during extended use, is an important part of a successful national vaccination effort. CDC remains committed to ensuring that public health officials, healthcare providers and the public have accurate and timely information on the safety of COVID-19 vaccines. During the COCA call, clinicians learned how to educate their patients on what to expect after a COVID-19 vaccination. In addition, they learned how they can play an important role in monitoring the safety of COVID-19 vaccines, including encouraging patients to enroll in v-safe and to use v-safe to report how they’re feeling. Clinicians also learned how to report adverse events (possible side effects) to the Vaccine Adverse Event Reporting System (VAERS). Presenters were Tom Shimabukuro, MD, MPH, MBA, Vaccine Safety Team

Lead, COVID-19 Response, CDC and David T. Kuhar, MD, Healthcare Infection Control Team, COVID-19 Response, CDC.

COVID-19 Vaccines and Monoclonal Antibodies Medicare Part B Payment for COVID-19 Vaccines and Certain Monoclonal Antibodies during the Public Health Emergency CMS has released a set of toolkits for providers, states and insurers to help the health care system prepare and assist in swiftly administering these products once they become available. These resources are designed to increase the number of providers that can administer the products and ensure adequate reimbursement for administration in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover these products at no charge to beneficiaries. This webpage provides the payment allowances and other related information for these products. For more information, review the COVID-19 provider toolkit. Reimbursement Update COVID-19 vaccination providers must administer COVID-19 vaccine regardless of the vaccine recipient’s ability to pay COVID-19 vaccine administration fees or health plan coverage status. According to recent guidance from CMS, COVID-19 vaccination providers may seek appropriate reimbursement from a program or plan that covers COVID-19 vaccine administration fees for the vaccine recipient. COVID-19 vaccination providers may not seek any reimbursement, including through balance billing, from the vaccine recipient.

COVID-19 Vaccine FAQ’s COVID-19 Vaccine Information for Providers COVID-19 Vaccination Prioritization Guidance The Bulletin | Year End 2020 17


Caring for the Community During A Pandemic Thank You As we continue moving through this pandemic, Covenant HealthCare would like to thank all the local healthcare providers for the collaboration. Caring for the community in times like this is a true reminder of the importance of the oath we each took. As the largest regional healthcare system, we take seriously the responsibility of caring for critically ill patients from across 20 counties. On behalf of the Covenant staff, administration, nursing leadership, support services, clinical teams, and most importantly, our patients, thank you for helping us and continuing our mission of extraordinary care for every generation. In addition, while we are unable to gather together for the annual physician office holiday reception, a donation will be made in your honor to the local food pantries. This gift will aid in what has been an exceptionally difficult year for members of our community. From all of us at Covenant HealthCare, we wish you safe and happy holidays, followed by a joyous and healthy new year. Stay safe, mighty, and well!

Covenant HealthCare has also achieved an A grade five consecutive times, the highest safety rating given by the Leapfrog Group.

Covenant Medical Group Welcomes New Providers Hospital Medicine Paritharsh Ghantasala, MD; Sonya Gupta, DO; and Mulham Shikh-Hamdon, MD 1447 North Harrison, Saginaw, MI 48602 | Phone 989.583.4220

Primary Care Abayomi Abimbola, MD 1910 Pine Avenue, Alma, MI 48801 | 989.463.3101 Essa Alsharif, DO 800 Main Street, Birch Run, MI 48415 | 989.624.7001 Jamal Fadhel, MD 3875 Bay Rd. Suite 4S, Saginaw, MI 48603 | 989.583.5150 Joseph Natole, MD 4701 Towne Centre Road, Suite 103, Saginaw, MI 48604 989.793.4747

Covenant HealthCare Again Named Top Teaching Hospital

Melissa Victor, MD 3875 Bay Road, Suite 2N, Saginaw, MI 48603 | 989.583.5300

The only Michigan hospital to earn the Fall 2020 Leapfrog Top Teaching Hospital Award. For the second time in a row, Covenant has been named a Top Teaching Hospital by the Leapfrog Group, and for the fifth time in a row an “A” rated hospital. “It speaks to our dedication to the Covenant Culture of Safety that we could earn this distinction while facing the most threatening health crisis in centuries,” notes Dr. Michael Sullivan, Covenant Vice President for Performance Improvement and Chief Medical Officer. The highest performing hospitals on the Leapfrog Hospital Survey are recognized annually with the prestigious Leapfrog Top Hospital award. Top Hospitals have better systems in place to prevent medication errors, higher quality on maternity care and lower infection rates, among other laudable qualities. Hospitals that are eligible to receive a Leapfrog Hospital Safety Grade must have received an A in the most recent round of scoring to be eligible. The award is not given to a set number of hospitals, but rather, to all teaching, general, rural and children's hospitals that meet the high standards defined in each year's Top Hospital Methodology.

Specialty Care

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Jeffrey Balazsy, MD Covenant Orthopaedics - Adult and Pediatric Orthopedic Traumatology and Reconstruction Pelvis/Acetabulum Surgery 900 Cooper, Suite 3100, Saginaw, MI 48602 | 989.583.7450 Jason Kuhn, DO Covenant Surgery - Bariatric Surgeon 5415 Cardinal Square, Saginaw, MI 48604 | 989.790.4855 Qasim Omran, MD Covenant Pulmonary and Critical Care 800 Cooper Ave., Suite 4, Saginaw, MI 48602 | 989.583.7380 Mark Raphael, DO Covenant Medical Group Digestive Care 900 Cooper, Suite 4300, Saginaw, MI 48602 | 989.583.7460

Covenant Physician Leads Effort to Reinstate Michigan Chapter of the Society of Critical Care Medicine, Seeking Members Rania Esteitie, MD of Covenant HealthCare recently collaborated with healthcare professionals from Beaumont and Wayne State University to reinstate the Michigan chapter of the continued on page 19


continued from page 18

Society of Critical Care Medicine (SCCM). SCCM is the largest non-profit medical organization dedicated to promoting the practice of critical care. Now more than ever, Dr. Esteitie recognized a need to promote awareness, offer continuing education and share research amongst medical professionals in the field of critical care. “This as an incredible opportunity and resource for the medical community throughout the state, and it is especially timely given the uncertainty before us with COVID-19 and the flu season at hand,” she said. “With this resource of critical care professionals and critical care practitioners, we aim to foster a collaboration among caregivers at the regional level for the enhancement of patient care.” Eligible members of the chapter include physicians and physicians-in-training, physician assistants, nurse practitioners, nurses, respiratory therapists, pharmacists, dietitians and industry representatives. This would include specialties that

diabetes SELF MANAGEMENT PROGRAM

have an interest in critical care medicine such as pulmonary critical care, cardiology, trauma surgery, neurosurgery, anesthesiology and emergency medicine. Chapters provide a vehicle for members to host conferences or webinars, to exchange information, network with local critical care practitioners, and discuss the impact of national issues on their communities. Dr. Esteitie adds that the organization will also aid in connecting smaller, rural hospitals and institutions with additional resources during this time of pandemic. For more details on the SCCM membership, contact Dr. Rania Esteitie at Rania.Esteitie@chs-mi.com or resteitie@gmail. com. More at www.sccm.org.

In the United States, 30.3 MILLION people are living with diabetes – 84 million are living with prediabetes. Covenant HealthCare is the region’s most experienced diabetes management team. Our program is certified by the Association of Diabetes Care & Education Specialists (ADCES) through the Michigan Department Health and Human Service (MDHHS). We are certified to provide education for patients of all ages and diabetes diagnoses, including pregnant women. Put your trust in the region’s most experienced diabetes management team – your Patient-Centered Medical Home partner. We also have a Diabetes Prevention Program to help prevent or delay Type 2 diabetes.

To refer a patient or for more information call:

989.583.5193.

©2020 Covenant HealthCare. All rights reserved. PK 2/20 13001

The Bulletin | Year End 2020 19


Dr. Medley Larkin Honored With Spirit of St. Vincent Award The Ascension St. Mary’s Foundation proudly announces Medley A. Larkin, MD, MPH, as the 2020 honoree of the prestigious Spirit of St. Vincent award. Dr. Larkin is an asset and rolemodel for patient care in the field of gastroenterology for the Great Lakes region. While the annual Cornette Ball has been postponed, a new virtual “Corantine-Style” program will take place in early 2021. Individuals will be able to participate and show support by staying home and being safe while 100 percent of donations and sponsorships will support the purchase of breast cancer diagnosis and patient treatment enhancements at Ascension St. Mary’s. Dr. Larkin is dual board-certified in Internal Medicine and Gastroenterology, and is a fellow in the American College of Osteopathic Internists. After earning a Bachelor of Science degree from Central Michigan University, she obtained a Master’s in Public Health at the University of Michigan followed by her Doctor of Osteopathy from Michigan State University (MSU). She started private practice in Reese, Michigan in 1985 as an internist before returning to training in a fellowship in Gastroenterology. She established her practice in Saginaw Health care professionals are not immune to substance abuse or mental health disorders. Many otherwise highly qualified professionals may develop these problems due to stress, long hours, a genetic predisposition, or a tendency to

self-medicate. To assist health care professionals impaired by these disorders, consider the care monitoring services of the Health Professional Recovery Program (HPRP). The Michigan HPRP was established by legislation in 1993 to assist impaired professionals before their actions harm a patient or damage their careers through disciplinary action. Any licensed or registered health care professional in the State of Michigan is eligible to participate in the program. To maintain participant confidentiality, the HPRP is operated by a private-sector contractor under the authority of the Health Professional Recovery Committee (HPRC), a committee comprised of a representative from each of the health professional licensing boards. The Michigan Department of Community Health, Bureau of Health Professions provides administrative services to the HPRC. 20 The Bulletin | Year End 2020

in 1995, and quickly became a well-regarded provider of gastroenterology care in the community. Dr. Larkin has served in diverse medical roles throughout her career. In addition to work caring for the migrant population in rural Michigan, she was medical director for the Saginaw County jail and medical director for an eating disorders program through Saginaw General Hospital. She served as an educator, starting as Director of Medical Education for Saginaw Osteopathic Hospital and then as a clinical assistant professor at MSU College of Osteopathic Medicine. In addition, Dr. Larkin was an instructor and director of advanced cardiac life support for the American Heart Association. She proudly promotes the osteopathic profession as past president of the Saginaw County Osteopathic Society, and continues to support this organization. Today, she serves the Saginaw medical community as Chairperson of the Towne Centre Surgery Center, and holds a position on the board of the Saginaw Valley Endoscopy Center. She also provides medical care for veterans at the Aleda E. Lutz VA Medical Center. Dr. Larkin’s medical accomplishments were recognized as a recipient of the Tri-Cities “Best of the Best” doctors in Gastroenterology. Ascension St. Mary’s Foundation will celebrate Dr. Larkin’s incredible honor in true Cornette Ball style when we can gather together again in person. More details will be forthcoming.

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

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


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.

© Ascension 2020. All rights reserved.

The Bulletin | Year End 2020

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CDC COVID-19 Vaccination Program Frequently Asked Questions for Provider Organizations How does an Organization participate in the CDC COVID-19 Vaccination Program? You can access the registration tool at www.MICovidVaccineProviders.org or by visiting the Resources tab at https://www.michigan.gov/Coronavirus.

What if the Provider is not in the Michigan Care Improvement Registry (MCIR)? Not every health care provider uses MCIR, but in order to administer the COVID-19 Vaccine, providers must register with MCIR. To begin registration in MCIR, Providers need to complete a MCIR Usage Agreement. The completed form then needs to be faxed to 517-763-0370. Once your site is registered, MCIR Training can be arranged from the MCIR Regional Office Staff. Already a MCIR registered site but do not remember your MCIR ID? Log into the MCIR application (via MILogin) and use this job aid link to assist with finding your MCIR ID.

Who should complete the CDC COVID-19 Vaccination Program Provider Agreement? The Organization information may be completed by the Vaccination Coordinator or other administrative professional. The Agreement (Section A) must be signed by the Chief Executive Officer (CEO) or Chief Fiduciary Officer AND the Chief Medical Officer.

Who should complete the CDC COVID-19 Vaccination Site – Provider Registration? The CDC COVID-19 Vaccination Site-Provider Registration may be completed by the Organization’s Vaccine Coordinator, Location Practice Manager or other appropriate delegate. The Pharmacy Director or Medical Director must sign the Provider Registration.

Do we have to complete a CDC COVID-19 Vaccination Site – Provider Registration tool for each location expected to administer COVID-19 vaccinations? Yes, each vaccination site must complete and submit a Vaccination Site Provider Registration tool/survey to be eligible to administer vaccine. Each site must have a unique MCIR ID.

Do I need to complete a new Vaccination Site – Provider Registration tool if a provider leaves, changes location or we hire a new provider? No, once you have submitted the Provider Registration tool, there is no need to update it or resubmit unless requested by MDHHS.

If a Provider serves multiple sites, will they need to be listed for each Vaccination Site? No, once a Provider is listed for one Vaccination Site they do not need to be listed on additional sites.

How can we review or access our Vaccination Site – Provider Registration tool/survey after it is submitted? When you submit the tool/survey, you’ll receive a confirmation email that your application has been received. The confirmation email will include a link to access the information submitted.

Does completing the CDC COVID-19 Vaccination Program Agreement ensure we will be approved to administer COVID-19 vaccine? No, applications will be reviewed by MDHHS and approved locations will be notified. Not all approved Providers will be able to receive COVID-19 vaccine immediately or in quantities ordered as specified in the State of Michigan COVID-19 Vaccination Plan.

If you have additional Provider-related questions about the Michigan CDC COVID-19 Vaccination Program, please email: MDHHS-COVIDVaccineProviders@michigan.gov

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IN MEMORY Please keep the families of those who passed in your prayers. Minoo Khurshed Rao, MD, 02/16/1938 11/23/2020 of Linwood passed away following complications due to Alzheimer's. Dr. Rao was born in Multan, India. Covenant HealthCare named Dr. Rao the 2004 Distinguished Physician of the Year, after being nominated by many of his colleagues. Dr. Rao earned his medical degree from MGM College in India in 1961. He began practicing medicine at Saginaw hospitals in 1972, following his surgical residency and fellowships in thoracic surgery and cardiac catheterization at Henry Ford Hospital in Detroit. He also completed a fellowship in pediatric cardiovascular surgery in 1973 in Toronto, ON. Beyond surgery, Dr. Rao's passion was training residents in his field. He was very proud to have won the Outstanding Volunteer Educator award four times from residents at Synergy Medical Education Alliance of Saginaw. Dr. Rao was a member of the medical staff at both the former St. Luke's and Saginaw General Hospitals. Additionally, he was chief of staff at Saginaw General Hospital in 1994 and 1995.

He served as chief of the Surgery and Thoracic/Vascular Section and was a member of the St. Mary's Hospital medical staff. Dr. Rao held leadership positions with both the Saginaw County Medical Society and the Saginaw Surgical Society. He retired in 2004, and became a member of the Covenant HealthCare Emeritus Medical staff. Minoo is survived by his wife of 24 years, Kandy; his daughter Tara (Troy) of Pittsburgh and their son Spencer; his son Steven (Laura) of Buffalo, and their children Noah, Griffin, Maya and Sydney; his sister Farida (Sterling Heights); his cousin Dr. Jehangir Rao (Bloomfield Hills); best buddy Dr. Surendra Kaul (Midland) and many loving cousins, nephews, nieces and friends. The family extends heartfelt gratitude to all of the staff at Bayfield Assisted Living & Memory Care of Bay City and Residential Hospice for their devoted care of Minoo. Those planning an expression of sympathy are asked to consider the East Side Soup Kitchen of Saginaw, P.O. Box 330, Saginaw, MI 48606. For online tributes and to pay respects, please visit www.cremationsocietymidmi.com. continued on page 24

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The Bulletin | Year End 2020 23


continued from page 23

Donald J. Cady MD, husband, father, grandfather and great-grandfather passed away on Tuesday, December 1, 2020. Born in Saginaw on April 12, 1924, the son of the late Frederick J. and May (Sanders) Cady. One of five siblings, Don graduated from Saginaw High School in 1941, attended the University of Michigan for eight years earning his undergraduate and his medical degree, graduating in 1947. After serving his internship and residencies, Don practiced in Florida for one year. He served his country in the United States Army for two years before returning to Saginaw and opening his private practice in internal medicine in the mid 50’s. He continued his practice for the next 50 years, retiring in 2003. He married Janice Nachtweih on September 28, 1985, at Second Presbyterian Church in Saginaw. She survives him. They made their home at Linwood Beach, overlooking the Saginaw Bay. Don had a long association with St. Mary’s Hospital, serving in many capacities in its history to Saginaw. Don had a passion for reading books of all genre. He loved race-sailing and participated in over 30 Bayview Mackinaw races, sailing from Port Huron to Mackinaw Island. He was an avid sports fan, especially the University of Michigan football and baseball teams. He is survived by his wife, Jan; six sons, Donald Jr., Robert, Daniel, Timothy, Andrew, and Patrick; foster son Charles (Hong Soon) Lee; twelve grandchildren; three great-grandchildren; sister, Geraldine (Charles) O’Laughlin of Chicago; brother, Dean (Lois) Cady of Milwaukee and many nieces and nephews. He also leaves behind many friends inside and outside the medical field. Don was preceded in death by his brother, Frederick (Beverly) Cady II; brother, David Cady; and his first wife and mother of his children, Mary Ellen (Blunt) Cady. Don was loved and respected by his family and his community; he returned the love and respect to them twofold. Funeral services took place on Saturday, December 5, 2020 with committal service following at Roselawn Memorial Gardens. Those planning an expression of sympathy may wish to consider memorials to a charity of their choice.

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Lisa Lapham, CEO of HealthSource Saginaw - The world lost a treasured wife, mother, daughter, sister and friend, Lisa (Heric) Lapham, on November 3, 2020. Lisa stood up to breast cancer with great courage, and never let it stop her from living and loving life. Lisa died at M.D. Anderson while recuperating from brain surgery. Lisa was born in Marquette on June 10, 1971. She was happily raised by her proud, loving parents, Vincent & Nancy (Ghiardi) Heric, who instilled strong Catholic values. Lisa graduated from Gwinn High School in the U.P. of Michigan in 1989, and with honors from Central Michigan University in 1992. She married Ronald Lapham on August 21, 1993. Lisa took great pride in her family and always enjoyed encouraging her children in school and sports. She also loved boating, skiing, hiking and cheering on the Packers. She made everyone feel welcome and loved shaking drinks to share, and occasionally wowed friends with her flash cooking. Lisa was so much more than CEO to her colleagues at HealthSource Saginaw; she was their friend. She was extremely dedicated to her work, working longer hours than most. Regardless of her high position and standards, she insisted that she be treated the same as all other employees. Lisa is survived by her fun-loving husband Ron; children, Jacob, Allison and Joshua; mother Nancy (Robert) Van Stee; siblings, Rick Heric and Lynn (Steve) Rodgers; best friend, Jen Chichester; as well as, many aunts, uncles, nieces, nephews and cousins. She was preceded in death by her father, Vincent Heric; maternal grandparents, Martin and Vera Ghiardi; and paternal grandparents, Vedo and Margaret Heric. Funeral services were held on Thursday, November 12 at St. Brigid Catholic Church in Midland, followed by burial at City of Midland Cemetery. Those planning an expression of sympathy are asked to consider donating in Lisa’s honor to your local women’s shelter, mental health clinic or breast cancer research. Nijole Vince Rice, loving mother and grandmother passed away Wednesday, November 4, 2020, at the Toni and Trish House in Auburn, Michigan at the age of 86. The daughter of the late Vince and Vaclava Sarka, Nijole was born May 25, 1934, in Lithuania, immigrated to America in 1950 and settled in Detroit. She was married to Dr. William T. Rice. He predeceased her on November 17, 1996. Nijole was a nurse in Detroit where she met her husband and moved to Saginaw where they spent the continued on page 25


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rest of their lives. She volunteered in the community for years. Painting was her passion and she loved walking, sunshine and beaches. Nijole was colorful, bold, strong and generous. She had a strong faith, and was a member of Faith Lutheran Church. Nijole fought to the end to be independent and stay at home in the city she loved so much. Surviving to cherish her memory are one daughter, Inga and Bryon Stephens; one son, Eric and Kimi Rice; five grandchildren, Rachel, Andrea and Katie Stephens, Carew and Luke Rice; one niece, Diana Cernis and her husband, Roger Wohlman; and one nephew, Victor Cernis. Nijole was preceded in death by her sister, Izolda Cernis. Honoring Mrs. Rice’s wishes cremation has taken place and a memorial service will take place at Oakwood Cemetery in the summer of 2021. Those planning an expression of sympathy may wish to consider memorials to the Vasculitis Foundation www.vasculitisfoundation.org or the Toni and Trish House, www.toniandtrishhouse.org. Ilse E. Letson, age 77, passed away on Friday, November 27, 2020. She was surrounded by her loving family who helped her peacefully transition into heaven with God's loving grace. Ilse was born on January 18,1943, in Dortmund, Germany to Marianne and Rudolph Friederich. She spent her childhood and teenage years in Hamburg, Germany. She had a keen interest in marketing and publishing, leading her to an internship with the renowned Axel Springer Publishing Company, and she continued working there until her departure to the United States. Her determined, adventurous, independent spirit prompted her to set off on her own, at the age of 20, moving to the U.S. where she integrated with the Cox family in the Main Line of Philadelphia as an Au Pair. She lovingly looked after their four children for several years. A year later, she attended Bryn Mawr College both as a student and Lab Technician in the Psychology Department but left to raise her own family. However, in a constant quest for the value of her higher education, at the age 57, she returned to school and she graduated from Northwood University with highest honors in 2000. In 1965, Ilse married James A. Letson, Jr. MD. She is survived by their children, James A. Letson III (wife Tammy), Lisa Conlee, Kristin Snyder (husband James) and Andrew Letson, as well as, her beloved grandchildren, Elise Letson and Wolfgang Snyder. A brother (Rudolf Friederich) and grandsons, Hunter

and Connor Letson, preceded her in death and greeted her in heaven. According to Ilse's wishes, cremation has taken place. Her ashes will be buried under a special Dogwood Tree this Spring. She wanted to let her beloved family and friends know that she always appreciated their love, generosity and support in her many endeavors. Friends who would like to share time with the family and other close friends are invited for a "Celebration of Life" the weekend of Mother's Day 2021 when hopefully we can gather safely to honor her loving legacy (place TBD). Those planning an expression of sympathy are asked to consider a donation in her name to "Doctors Without Borders" (888-392-0392) or to the City Rescue Mission in memory of Ilse Letson, checks made payable to City Rescue Mission, PO BOX 548, Saginaw MI 48606 or donate online www.rescuesaginaw. org. "Would have traded all tomorrows for one more today"-Ilse Phil. 4:4.7

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

The Bulletin | Year End 2020 25


2020 END-OF-THE-YEAR LEGISLATIVE REPORT As with everything else in 2020, the COVID-19 pandemic brought about many challenges and changes to the legislative process. While much of the legislature’s focus was shifted to the state’s pandemic response, several other health care related items remained at the forefront of legislative and regulatory action throughout the year. Below is a briefing prepared by MSMS staff of several issues of consequence to physicians and patients that MSMS has been tracking throughout the year. If you have any questions or comments regarding information included in this report, please contact MSMS Department of State and Federal Government Relations at (517) 336-5737.

Surprise Out-of-Network Billing Debate around Surprise Out-of-Network (OON) medical bills by the Michigan Legislature began during the mid-to-latter part of 2019 and continued through 2020. Few would argue these circumstances don’t occur; however, varied opinions with respect to how pervasive this problem is in Michigan exist. On October 22, 2020, HB’s 4459, 4460, 4990 and 4991 were signed into law, prohibiting OON physicians and other health care providers from balance billing patients in certain situations, such as the receipt of emergency care or care received without an option to choose an in-network provider. Instead, nonparticipating providers will be paid pursuant to a specified fee schedule. Additionally, in cases of elective or planned procedures, OON providers are required to provide advance notice to patients of the estimated cost of the health care service(s). The thrust of MSMS’s concerns were related to the mandatory fee schedule imposed on OON physicians, which was originally set at 125 percent of Medicare, the lack of an independent dispute resolution (IDR) process, creation of an unequal playing field significantly favoring insurers, impact on health care access and challenging administrative requirements. While the version of the bills that were signed into law remain problematic, MSMS was able to secure important changes throughout the process to improve the legislation including the following: • Fairer fee schedule to include the median contracted rate for the region and specialty or 150 percent of Medicare, whichever is greater; • Inclusion of an arbitration process when there are cases with complicating factors; 26

The Bulletin | Year End 2020

• Elimination of barriers to disputing payment such as proving the insurer did not have an adequate network, thereby allowing providers access to this process; and • Removing patients from the middle of disputes by ensuring payments are sent directly from the insurance company to the physician. MSMS Position/Action: Opposed. In lieu of the current price-fixing approach, MSMS continues to strongly advocate for a comprehensive approach to surprise OON billing that holds insurance companies accountable for the products they sell to patients, and allows insurance companies and providers to negotiate in good faith with an IDR process as backstop. MSMS will continue pursuing these common-sense changes in 2021.

Prior Authorization, Step Therapy: Health Can’t Wait Over the course of the last couple years, MSMS created a campaign to reform prior authorization and step therapy in Michigan. In that time, MSMS also assembled a coalition that has grown to 50 organizations, collectively known as the Health Can’t Wait (HCW) coalition. The group includes partners from physician specialty organizations, other provider associations and patient groups. The HCW campaign officially kicked off in March of 2019, and since then, MSMS has worked closely with coalition partners to lay the groundwork for a legislative remedy to address issues arising from insurance company prior authorization and step therapy practices. Senate Bill 612, introduced by Senator Curt VanderWall (R-Ludington) on October 29, 2019, was the culmination of that initial groundwork. The bill covers all benefits, including services and pharmaceuticals, and is built on the core principles of transparency and fairness; clinical validity, timeliness and administrative efficiencies; continuity of care; and alternatives and exemptions. On December 16, the Senate passed a revised, and deeply flawed version of SB 612 on to the House. At the last minute, several provisions were added that completely undermine the bill. With the addition of this new language, the bill no longer adequately addresses the initial goals of the legislation - timeliness of treatment; increased transparency and accountability; and shared decision-making between patients and their physicians. Specifically, the new version: • Allows insurance companies to reset the "clock" on decision deadlines (one business day for urgent requests continued on page 27


continued from page 26

and five business days for non-urgent requests) EVERY TIME they ask for further information; • Removes language requiring prior authorization criteria at point of care; • Provides a major loophole for third-party vendors who are financially incentivized when prior authorizations are denied to develop the clinical review criteria; • Removes the requirement for physician consultation or review when non-physician health professionals deny a prior authorization request; • Removes the requirement for specialty-specific physician review of appeals; • Excludes physician input when medication prior authorizations are established or changed (only pharmacist input is required); • Expands the scope of practice of pharmacists by requiring them to authorize prior authorizations denials for medications instead of physicians; and • Removes all language requiring insurers to publicly post data on prior authorization approvals and denials (this is key to providing increased transparency and accountability).

VOTED IN FAVOR OF SB612 AS AMENDED: Senate Democrats: Alexander, Ananich, Bayer, Bullock, Chang, Hertel, McCann, McMorrow, Moss and Polehanki State Republicans: Barrett, Bumstead, Daley, Horn, Johnson, LaSata, Lauwers, Lucido, MacDonald, MacGregor, McBroom, Outman, Runestad, Schmidt, Shirkey, Stamas, Theis, VanderWall (BILL SPONSOR), Victory and Zorn

VOTED AGAINST SB612 AS AMENDED: Senate Democrats: Brinks, Geiss, Hollier, Irwin, Santana and Wojno State Republicans: Bizon and Nesbitt All of these changes undermine timely patient care and ultimately patient safety. On December 21, the House formally adjourned for the session, effectively ending the possibility of this flawed version of SB 612 becoming law. Looking ahead to 2021 and the beginning of a new legislative sessions, HCW will continue its fight to address this important issue. Prior authorization is still an abused and overused practice that insurance companies use to deny patients the care and treatment they need.

Medical Liability Immunity The COVID-19 pandemic created unprecedented health care challenges that not only put physicians’ physical wellbeing at risk, but their financial well-being too. Physicians and other health care providers were left to treat patients without adequate supplies of Personal Protective Equipment (PPE), ventilators and clinically tested drugs. The stay-athome order and cancellation of elective procedures resulted in care delays. Additionally, governmental and regulatory guidance changed rapidly throughout the pandemic, forcing providers and facilities to constantly implement new procedures and protocols. After Governor Whitmer's declaration of a state of emergency, she signed Executive Order 2020-30 on March 29, 2020, which included immunity language for health care professionals providing medical or other services to COVID-19 patients, or otherwise in support of the state’s response to the COVID-19 pandemic. An extension of the order was signed under EO 2020-61 on April 26, 2020; however, it was later rescinded on July 13, 2020. There have also been legislative efforts to address medical liability immunity. Senate Bill 899, introduced by Senator Mike MacDonald (R-Macomb) on April 29, 2020, proposed to extend liability protections during the period from March 10, 2020, to January 1, 2021, to any death or injury arising out of or resulting from any act or omission by a health care provider or health care facility while engaging in one or more of the following activities, which would constitute health care services rendered in support of the state’s response to the COVID-19 pandemic: • Rendering COVID-19-related health care services to a person with presumed, suspected or confirmed COVID-19. • Arranging, scheduling, rescheduling, canceling or postponing the rendering of health care services, including a decision to use telehealth or other remote services instead of an in-person encounter, in reliance on or in compliance with any administrative or governmental agency, division, or department policy, rule, or directive or any executive order or law regarding health care services provided by a health care provider or health care facility. continued on page 28

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continued from page 27

• Acts, omissions or decisions resulting from a shortage of necessary resources, including blood products, medical equipment, pharmaceuticals or staffing. Status: Passed Legislature. Vetoed by Governor Whitmer on August 10, 2020, stating the “bill goes much further in ways that are directly counter to the interests of those receiving care.” MSMS Position/Action: MSMS supported Senate Bill 899 after successfully securing liability protections for issues arising from delays in care. The bill was ultimately House Bill 6159, introduced on September 2, 2020 by Rep. Roger Hauck (R-District 99). The bill codified EO 2020-30 by creating the "Pandemic Health Care Immunity Act" to provide protection from liability for health care providers and health care facilities rendering health care services related to the COVID-19 pandemic, subject to exceptions. Under the bill, a health care provider or health care facility that provided

health care services in support of the State's response to the COVID-19 pandemic would not be liable for an injury, including death, sustained by an individual by reason of those services, regardless of how, under what circumstances, or by what cause those injuries were sustained, unless it was established that the provision of the services constituted willful misconduct, gross negligence, intentional and willful criminal misconduct, or intentional infliction of harm by the health care provider or health care facility. Liability protections would be provided retroactively for the period of March 29, 2020 to July 13, 2020. Status: Governor Whitmer signed House Bill 6159 into law on October 22, 2020. MSMS Position/Action: MSMS believes it is imperative that clinicians are provided the appropriate civil and criminal liability protections as they provide medical care to a growing number of Michiganders during the COVID-19 pandemic.

MSMS REIMBURSEMENT ADVOCATE ALERT

• Therapy Assistants Furnishing Maintenance Therapy • Medical Record Documentation • PFS Payment for Services of Teaching Physicians and Resident “Moonlighting” Services • Medicare Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs (OTPs) • Section 2002 of the Support Act • Section 2003 of the Support Act • Medicare Shared Savings Program

MSMS provides periodic updates to members and their offices on new and relevant payer policies. Please find some recent highlights below. For a comprehensive accounting of a health plans announcements, please consult the payer’s official communications.

Final Policy, Payment and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021 The final rule is packed with information regarding the Medicare Physician Fee Schedule for Calendar year 2021. Some key areas affecting physicians: • CY 2021 PFS Rate-setting and Conversion Factor • Medicare Telehealth and Other Services Involving Communications Technology • Remote Physiologic Monitoring Services • Immunization Services • Direct Supervision by Interactive Telecommunications Technology • Payment for Office/Outpatient Evaluation and Management (E/M) and Analogous Visits • Policies Regarding Professional Scope of Practice and Related Issues • Supervision of Diagnostic tests by Certain Nonphysician Practitioners (NPPs) • Pharmacists Providing Services Incident to Physicians’ Services 28

The Bulletin | Year End 2020

For more information please click here.

CPT Code 99072 The AMA recently announced a new CPT code to account for medical services sparked by the public health response to COVID-19 pandemic. CPT Code 99072 – Additional supplies, materials and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease. MSMS has been advocating with all Michigan and national payers, to reimburse this code. Many payers indicated they are waiting for CMS to act before making policy on this code. The AMA is also advocating with national payers and the CMS for reimbursement of CPT code 99072. Please contact Stacie Saylor or 517-336-5722 for questions or concerns.


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Fulfill Your Board of Medicine Requirements on Your Time MSMS offers numerous on-demand webinars that fulfill the Michigan Department of Licensing and Regulatory Affairs requirements for continuing medical education, including: • A series of 12 covering Pain and Symptom Management • Three on Medical Ethics • Human Trafficking Download and watch at your convenience 24/7. For a complete list and to register click HERE

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

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BENEFITS OF SCMS/MSMS

MEMBERSHIP T he Saginaw County Medical Society (SCMS) is the professional association of physicians in Saginaw County, and a component of the Michigan State Medical Society (MSMS). In order to be a member of one, you must be a member of both. I have been asked many times by both members and nonmembers “Why should I belong to the SCMS and MSMS?” “What do you do for me?” Some have responded they “don’t use their membership because they don’t attend SCMS meetings.” SCMS and MSMS membership is so much more than membership meetings. We are not only support for you, but for your office staff as well. I’m hoping the information below will help members who are on the fence about paying their dues decide to remain members, and also convince nonmembers why they should belong. We represent physicians in all specialties and in all types of practices – solo, group, employed, etc. Active membership is open to MDs and DOs. • Active physician dues are $795 per year ($495/MSMS and $300/SCMS). One hundred percent of SCMS dues and 87 percent of MSMS dues are tax deductible as a business expense. • The SCMS offers a discount for first year physicians, and MSMS offers discounts for first, second and third year physicians, as well as, physician spouses when both are members. • Resident and medical student memberships are also available.

What We Offer SCMS Members and Their Staff: • Five Membership Meetings per year where our members have an opportunity to network and enjoy the camaraderie of fellow physicians who love the practice of medicine and want to see progress made in the Saginaw medical community. In addition, our meetings include interesting speakers and an opportunity to earn FREE CME credit. A few recent and future program topics include: - Surviving Acts of Violence - Physician Resiliency - Ethics - Suicide Awareness Training - Human Trafficking - Second Victim - Implicit Bias - What to do if a complaint - Opioids has been filed against you • Representation of physicians in all specialties and in all types of practices–solo, group, employed, etc. • Communication and camaraderie with physicians of other specialties in a neutral setting. • Liaison with MSMS for assistance on practice issues, billing and coding, health information technology, legal alerts, legislative issues, insurance and much more. • An independent voice for physicians on issues they face at the hospitals. • The Bulletin with articles and information pertinent to SCMS members and their staff.

118 Years of Caring for Saginaw County Residents Joan M. Cramer, SCMS Executive Director

• Pictorial Membership Directory is published annually and used by members and their staff on a regular basis. Our Private Directory provides information on your practice to other member physicians outside your specialty. In addition, a Public Directory that includes office address and phone (but not fax numbers or email) is printed and distributed to 1,000+ households in Saginaw County. The response from the public on this listing of SCMS physicians has been extremely positive. • Website which is full of useful information and resources www.SaginawCountyMS.com. • Referrals to patients seeking a physician. • Contact with local, state and federal legislators regarding issues of importance in Saginaw County. The SCMS maintains contact with local legislators to provide issue education and help them understand the impact of healthcare legislation. • A unified voice on medical issues to our legislators, our area hospitals, insurance companies, etc. • Political activism in support of medicine-friendly candidates. • Loans and scholarships to local medical students, residents and nursing students. • Community service to actively and tangibly give back to the community where you live and work through SCMS sponsored projects, such as our annual Health Fair for the Saginaw community attended by 1,100+ offering free health screenings and information, plus the opportunity for residents to speak with our member physicians directly to answer questions and promote your practice. • An active Peer Review Mediation Committee to provide a forum for patient complaints to be heard. Peer Review reduces the number of malpractice lawsuits. • An active Peer Review Ethics Committee for physician to physician issues. • Confidential assistance for members with substance abuse or personal issues affecting their practice of medicine. • And more!

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. If you or your office staff need assistance on an issue of any kind, please feel free to contact me at jmcramer@sbcglobal. net, (989) 790-3590 (office) or (989) 284-8884 (cell) and I will work with you to come up with a resolution for your problem through a variety of resources available to you as a SCMS/ MSMS member.

SERVING ALL SPECIALTIES AND SOLO, GROUP AND HOSPITAL EMPLOYED PHYSICIANS SINCE 1902 Visit www.SaginawCountyMS.com for a Membership Application under the “Membership” tab


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SCMS MEETINGS AND EVENTS Due to COVID-19, the SCMS has cancelled meetings and events through the end of the year. The Board continues to evaluate the state of the pandemic and the safety of meeting in person. We are looking into presenting virtual programs in the near future. The April 2020 Membership Meeting program, “Physician Compassion Fatigue� to be presented by Molly E. GabrielChampine, PhD, LP, Director of Behavioral Science, Family Medicine Residency at McLaren Bay, will be rescheduled in 2021 once it is safe to start meeting in person. We will not host our annual Health Fair in 2021. We do not feel it is in the best interests of the public who attend (many of whom have multiple medical conditions), our vendors, members and staff to bring together a large group of people. Board meetings for the immediate future will be held virtually.

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

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

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SCMS BULLETIN - Year End 2020