Michigan Family Physician Magazine Summer 2020 by M3 Group Publications

Telemedicine Expanding Access to Care Advocacy Through the Lens of COVID-19 Virtual Professional Development, CME & Networking Events Chronic Kidney Disease

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TABLE OF CONTENTS MAFP BOARD OF DIRECTORS Chair Mary Marshall, MD, RN, FAAFP President Keerthy Krishnamani, MD, MBA President-elect Mustafa ‘Mark’ Hamed, MD, MBA, MPH, FAAFP Vice President Srikar Reddy, MD, FAAFP Speaker Glenn Dregansky, DO, FAAFP

Telemedicine: Expanding Access to Care Cover Story

Treasurer Beena Nagappala, MD, MPH AAFP Delegates David Walsworth, MD, FAAFP Robert Jackson, MD, MMM, FAAFP AAFP Alternate Delegates Tina Tanner, MD, FAAFP Loretta Leja, MD Members-at-Large Harshini Jayasuriya, MD, FAAFP

Brandon Karmo, DO Amy Keenum, DO, PharmD, FAAFP

Rachel Klamo, DO Sadeer Peter, MD Pamela Rockwell, DO, FAAFP Kristi VanDerKolk, MD Bashar Yalldo, MD

Resident Member Julie Ngoc Thai, MD

Student Member Shelby Owens Ex Officio, Chief Executive Officer Karlene Ketola, MSA, CAE

FMFM BOARD OF TRUSTEES President Robert Jackson, MD, MMM, FAAFP Vice President Mary Marshall, MD, RN, FAAFP Secretary / Treasurer David Walsworth, MD, FAAFP

It’s a New World

President’s Message

Advocacy Through the Lens of COVID-19

Michigan Family Physician is published quarterly by Michigan Academy of Family Physicians and provided to MAFP members. Statements of fact and opinion are the responsibility of the authors and do not imply an opinion on the part of the Board of Directors or members of MAFP. Materials may not be reproduced without written permission. For subscription information, reprints, and back issues, email info@mafp.com. ©2020 MAFP. All rights reserved.

Editor: Dana Lawrence

Michigan Academy of Family Physicians

SUMMER 2020 | MAFP.COM 4 2164 Commons Parkway, Okemos, MI 48864

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COVID-19 and the Family Medicine Community

CEO Insight

Removing Barriers to Chronic Kidney Disease Diagnosis

Advocacy Update

Clinical Corner

Stories From the Frontline

Members in the News

Executive Vice President Karlene Ketola, MSA, CAE Trustees-at-Large Jennifer Aloff, MD, FAAFP Amy McKenzie, MD, MBA Lynn Gray, MD, MPH, FAAFP Elizabeth Pionk, DO Adam Jablonowski, MPA Jeanette Wilson, MD David Kazanowski, MD

Meet the Legislators

Professional Development, CME & Networking Events

COVID-19 Resources and Support for Michigan FPs

Academy News

Students & Residents

NEW FROM CDC

HIV Nexus offers a comprehensive collection of key federal resources on COVID-19 and HIV. More than half of HIV clinicians are primary care providers. To support health care providers managing patients with HIV during the COVID-19 pandemic, the Centers for Disease Control and Prevention has compiled these resources to: • Address concerns related to COVID-19 and HIV. • Provide guidance to health care providers managing people with HIV. • Highlight how people with HIV can protect their health.

To access COVID-19 and HIV resources for your practice and patients, visit:

www.cdc.gov/HIVNexus

SUMMER 2020 | MAFP.COM

PRESIDENT’S MESSAGE

It’s a New World

by Keerthy Krishnamani, MD, MBA Thank you for working through the COVID-19 public health emergency. On behalf of MAFP, I commend you for your commitment to your patients, which may have put your own physical and fiscal health at risk. Concerns about patients, the care team, the CARES Act, revenue, and reimbursement are undoubtedly on the mind of every family physician.

Delivering Patient-Centered Care

Many of you are now practicing virtual family medicine via video and telephone— some for the first time, having switched over to this model of care quickly and unexpectedly. Others are already veterans of this technology and able to share best practices and lessons learned with colleagues (page 12). Virtual care has the potential to change the future of healthcare delivery. There is no doubt that the post-COVID-19 era is going to be quite different than the healthcare environment we were previously accustomed to. The American Academy of Family Physicians’ advocacy on our behalf was key to the Centers for Medicare & Medicaid Services’ temporary rule changes that allow for Medicare parity between evaluation and management visits delivered via telemedicine—including telephone-only— and in-person. While this helps with our bottom line, the benefits are not just revenue related; the option of telephone visits allows us to deliver the most effective and efficient care based on patients’ needs.

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Although video visits are preferable when providing virtual care, for many of our patients—especially those without smartphones and internet connection—the option of (previously uncompensated) telephone visits removes significant barriers to care. As more vendors come forward that offer HIPAA compliant platforms, adopting newer technologies will continue to become easier. Family medicine is better positioned to be a leader in not only adopting technology, but also utilizing it appropriately so that our patients are not left behind.

Flattening the Curve

Gov. Gretchen Whitmer’s stay-at-home order was necessary to help slow the spread of the virus. As Michigan is starting to reopen different parts of our economy, we must all stay vigilant to avoid a second surge. A third surge could be catastrophic, especially for those with chronic diseases. We are already seeing a concerning decrease in vaccination rates in both our adult and pediatric populations. Our outreach to vulnerable patients is more important than ever. MAFP continues to monitor this new world, share up-to-date information, provide educational resources, facilitate connections in newer ways, and work with our partners across the state to protect the practice of family medicine.

Investing in You

Your Academy is also focused on keeping members safe. Due to Metro Detroit being one of the hardest hit areas in the country in terms of COVID-19 cases and deaths, MAFP had to make the difficult decision to cancel this year’s summer Michigan Family Medicine Conference & Expo. Instead, we are holding a virtual Annual Meeting of the membership on Saturday, Aug. 8 (page 21) to install new officers and take care of official business. I invite all members to attend! Family physicians are strong, and with our training, compassion, and personal relationships, we will work together to revive our practices so that we continue to be here for our patients. Family medicine will emerge stronger and more respected. In closing, I ask each one of you to take care of yourself and your family while you are busy working hard for all of your patients. Quoting from a recent FPM article (aafp.org/fpm/2020/0300/p17. html), “Caring for me is caring for you.” Keerthy Krishnamani, MD, MBA is the 2019-2020 president of Michigan Academy of Family Physicians. He oversees four Henry Ford Health System (HFHS) ambulatory medical centers, is associate medical director for revenue cycles at HFHS, and is an associate clinical professor at Wayne State University School of Medicine.

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CEO INSIGHT

COVID-19 and the Family Medicine Community

Life Lessons on Crisis, Connection, and Innovation by Karlene Ketola, MSA, CAE The past three months have taught us valuable lessons about community. As COVID-19 required many Michiganders to “stay home to stay safe,” we have come to recognize just how much we enjoy interacting with our community of family, friends, and co-workers. Likewise, we, at MAFP and Family Medicine Foundation of Michigan (FMFM), are more appreciative than ever of the family medicine community. Thank you, members, for your frontline and behind-the-scenes work during this public health crisis. The care you provide is valued, as is your continued membership and engagement in the Academy!

have volunteered to provide babysitting and home concierge services and assist with drive-thru COVID-19 testing and phone triage. Residents pivoted to the growing abundance of educational webinars as sources for continued learning and some moved to the front of the frontline, putting their own health at risk to care for some of the sickest of the sick—often without adequate personal protective equipment. And family physicians transitioned their services to the telemedicine sphere, offering virtual medical visits even before codes were updated and payment parity was in place, to ensure patients had access to care.

Adapting to Change

Meeting Members’ Needs

You and your Academy have had to make difficult decisions and change plans again and again due to COVID-19. Medical students were forced to abruptly conclude their academic year virtually. Graduating seniors had to forego in-person Match Day and commencement ceremonies and celebrations. For many residents, the elimination of rotations translated to fewer patient contact hours. Family physicians experienced a dramatic decrease in the volume of appointments when, to protect health and safety and slow the spread of COVID-19, nonessential in-person care was restricted via executive order.

At MAFP and FMFM, we, too, are leveraging new technologies to assist family physicians and their practices in delivering high-quality, cost-effective healthcare across the state. We have enhanced our connections with members by hosting “hot topic” webinars to provide the latest must-know information in this new world; establishing online memberonly discussion portals; updating, in real time, a COVID-19 information and resources webpage; more frequently distributing our e-newsletter, Family Medicine Update; and reserving urgent communications for MAFP’s new text messaging service (to sign up, text FMCONNECT to 52886).

Throughout the crisis, the family medicine community has demonstrated the adaptability that is characteristic of individuals drawn to the specialty. Students

Your Academy has also continued to educate lawmakers and payers on what family physicians need to care for patients efficiently and effectively while also being fairly paid

SUMMER 2020 | MAFP.COM

for their services, and to build connections with the media to amplify these messages. Recognizing that members’ attention during this pandemic must remain focused on patients, MAFP and FMFM leadership postponed Board and committee meetings and canceled in-person events, including the 2020 Michigan Family Medicine Conference & Expo. We are excited to announce that the 2021 conference will be held Aug. 5-8 at the Detroit Marriott Troy (save the date!), and that this year’s MAFP Annual Meeting will be held virtually on Saturday, Aug. 8, 12-2 pm ET (page 21). Whether you’re a life member, practicing physician, resident, or student, I hope you consider MAFP as your professional resource. Your Academy’s mission is to support YOU through leadership, collaboration, and innovation to achieve the best patient outcomes. As always, I encourage you to reach out and share your point of view. We are stronger together and are learning lessons each day related to this public health crisis, member connection, and innovation. Karlene Ketola, MSA, CAE is Michigan Academy of Family Physicians’ chief executive officer and Family Medicine Foundation of Michigan’s executive vice president. She joined the MAFP/ FMFM team in spring 2019 after serving as executive director of the Lansing-based Michigan Oral Health Coalition for 10 years.

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Family medicine advocates with State Rep. Isaac Robinson during Michigan Family Medicine Advocacy Day on Feb. 25. Rep. Robinson passed away from COVID-19 in March.

Advocacy Through the Lens of COVID-19 by Matt Black

When we ushered in the new year, never did we imagine today’s “new normal” of living, working, and—for family physicians— practicing medicine. COVID-19 has, indeed, altered every sector of the American way of life, advocacy included. While MAFP’s advocacy work has forged ahead, the “how” and “what” have significantly changed.

The “How” of Virtual Advocacy

Gone for the time being are meetings with legislators at their offices in the Senate, House, and Capitol buildings in downtown Lansing. Also gone for the time being are face-to-face committee hearings of testimonials in support of/opposition to legislation. Like so many others, advocates and legislators have adapted to meet socialdistancing standards, relying on phone calls, video chats, and emails as the new norms for government relations. Our 2020 Family Medicine Advocacy Day on Feb. 25 was, unbeknownst to us at the time, more impactful than those of years past. It marked one of the final large gatherings of Michigan advocates of the spring, where constituent family physicians’, residents’, and medical students’ passion for the 10 SUMMER 2020 | MAFP.COM

health of patients and the practice of family medicine left lasting impressions. Since then, MAFP members have participated in virtual legislative town halls and coffee hours to discuss the sciencebased facts of COVID-19 and to answer questions and address concerns of their fellow constituents. This has helped raise the visibility of family physicians as expert resources and key players in responding to a public health crisis such as this.

The “What” of MAFP’s Advocacy Priorities

The MAFP advocacy team’s work since March has focused heavily on securing payment parity between virtual and in-person office visits and analyzing the governor’s executive orders for how they impact members and their patients. While some temporary changes are long overdue, and ones which we are advocating remain post-COVID-19—namely, those that allow physicians to deliver and get paid for virtual care—others, such as relaxation of scope of practice regulations, have raised concerns and our voice.

MAFP continues to educate appropriations leadership on the importance of investing in initiatives aimed at shoring up Michigan’s shortage of primary care physicians. We have also been adjusting the Academy’s funding priorities. With a July 1 deadline looming for the House and Senate to send Fiscal Year 2020-2021 budget proposals to Gov. Gretchen Whitmer, MAFP continues to educate appropriations leadership on the importance of investing in initiatives aimed at shoring up Michigan’s shortage of primary care physicians. Recognizing that the COVID-19 pandemic has caused a tremendous financial burden for the State of Michigan, MAFP’s state budget priorities, guided by the Advocacy Committee, are now limited to:

ADVOCACY UPDATE • Maintaining funding for the State Loan Repayment Program, which offers student loan forgiveness for chosen applicants who work for at least two years in a federally designated health professional shortage area

To learn more about your Academy’s advocacy priorities, visit mafp.com/advocacy/ advocacy-priorities.

• Maintaining funding for the MIDOCS, designed to expand primary care residency positions and retain physicians in underserved areas • Maintaining primary care physicians’ Medicaid reimbursement rate Focusing our budget requests on just these three requests is fiscally responsible given that many initiatives face cuts or complete elimination in the coming months. A $2.5 billion shortfall was identified for the current Fiscal Year 2019-2020 state budget, which will require a negative supplemental to reduce expenditures, compounded by a $3 billion deficit next year. This unprecedented time has brought forward unique hurdles, but through our family medicine community’s diligent work based on MAFP’s three-pronged advocacy approach—grassroots advocacy, Family Medicine Political Action Committee investments made possible through member contributions (mafp. com/advocacy/family-medicinepac), and professional lobbying—we are confident that family medicine will continue to advance and have a seat at the legislative and state budget tables in Michigan. I encourage all members to continue communicating with your local legislators, highlighting the important work you do every day to keep Michigan healthy and underscoring the importance of programs designed to grow the primary care physician workforce in our state.

OUR BUSINESS IS UNDERSTANDING YOURS

ALEX LEBEDINSKI HEALTHCARE & BUSINESS LAWYER

Matt Black serves as Michigan Academy of Family Physicians’ director of government relations. He is responsible for directing the organization’s state public policy agenda, analyzing legislation and regulatory changes for potential impact on patients and the practice of medicine in Michigan, and bridging the gap between members and elected officials.

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COVER STORY

Telemedicine Expanding Access to Care What was once an optional mode of healthcare delivery is now considered a necessity due to COVID-19. Over the past few months, telemedicineâ&#x20AC;&#x201D;the practice of medicine using technology to deliver care at a distanceâ&#x20AC;&#x201D;has reached significant physician and consumer adoption. As of April 2020, nearly half (48%) of all physicians in the U.S. reported treating patients through telemedicine, up from 18% in 2018.1 An early adopter of telemedicine, Srikar Reddy, MD, FAAFP, has offered video visits, texting, and store-and-forward (asynchronous) care for more than four

years at Ascension South Lyon Family Medicine, where he serves as medical director. From his experience, Dr. Reddy asserts that family medicine is the most equipped medical specialty to handle the surge of consumer-based healthcare, and that adaptability to changing times and technology should never be a barrier to practicing full-scope family medicine. Michigan Family Physician had the chance to talk with Dr. Reddy about best practices and some of his lessons learned for providing efficient, quality patientcentered virtual care.

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MFP: What are some of the biggest strengths of telemedicine? Dr. Reddy: Outreach and access to

care for patients everywhere are, by far, the biggest strengths. No platform for evaluation and assessment of patients is perfect, but with the advancement of digital technology, individuals and families in rural and urban settings anywhere can have access to a boardcertified physician in a matter of minutes.

MFP: What shortfalls do you see with telemedicine and how can they be overcome? Dr. Reddy: Linking a video-based

(webcam) face-to-face interaction with native electronic health records (EHRs) can be a burden as it involves dual scheduling and learning different platforms. This can be overcome with more widespread integration of webcams and HIPAAcompliant virtual platforms in native EHRs. Another shortfall is the lack of access to equiment that can help establish a provider’s differential diagnosis. Otoscopes and virtual stethoscopes are a few medical instruments still in the works for being accessible and used on a broad scale in telemedicine. However, you can overcome this barrier by taking a good history and using other physical exam skills. If you feel that further evaluation is needed for an assessment and plan, let the patient know he/she should be seen in person. My experience has been that patients still value and appreciate the virtual visit as engaging in an initial evaluation with their family physician.

MFP: How has telemedicine impacted your practice? Dr. Reddy: I have been able to incorporate

the service to supplement my revenue stream by allowing me to fill more patient slots. I recommend that physicians and their staff decide as a team what scheduling patterns work best for them and when to reserve time slots for virtual visits. It is a service that should be offered at some level because most insurers are actively encouraging patients to use it as part of their new benefit plans.

MFP: What HIPAA considerations must FPs take into account when providing telehealth care? Dr. Reddy: While federal guidelines have loosened due to the COVID-19 pandemic, 14 SUMMER 2020 | MAFP.COM

Best Practices • You and patients should test your computers to ensure adequate internet bandwidth prior to appointments. • Wear a white lab coat and/or professional attire, as patients want to know you are taking virtual visits just as seriously as you do in-person visits. • To provide for a HIPAA-compliant workspace, conduct vitual visits in a private room with the door closed and background noise to an absolute minimum. • Sit in front of a simple, neutral background to minimize distractions for the patient. • Position yourself 2-3 feet away from the camera and make a habit of looking directly into the camera. • Ensure proper lighting. • Use headphones or a headset to prevent unwanted feedback. • Begin each visit by confirming callback numbers for the patent and you in case your connection is disconnected. • Prior to visits, encourage patients to write down their questions and to have a thermometer, blood pressure cuff, and weight scale that you will guide them in using. It is especially important to have pediatric weights, as childhood prescriptions are weight-based.

Srikar Reddy, MD, FAAFP

Resources for Learning More American Telemedicine Association americantelemed.org American Medical Association Telehealth Implementation Playbook ama-assn.org/system/files/2020-04/ ama-telehealth-playbook.pdf Upper Midwest Telehealth Resource Center umtrc.org

• For any form of virtual care, follow the same documentation requirements as for in-person care.

MAFP On-demand Webinars mafp.com/cme-events/covid-19-webinars

• Become familiar with reimbursement rules, regulations, and payer policies in Michigan; many were relaxed or temporarily suspended during the COVID-19 emergency—make sure you are aware of what is up to date today.

American Academy of Family Physicians aafp.org/patient-care emergency/2019coronavirus.html

• Be receptive to and patient while learning and adapting to new developments in technology. these will be updated as we settle into the “new normal.” I recommend always verifying the patient’s date of birth and location. Remember that state guidelines differ from federal guidelines, so the

patient must be in a state where you are licensed to practice. I always explain to new patients that there are limitations with virtual visits because a complete physical exam cannot be conducted. I then

COVER STORY ask their permission to proceed with a consultation and document this first part of my history of present illness or progress note.

MFP: Who is the ideal telemedicine patient? Dr. Reddy: An ideal telemedicine

We are the only specialty that can treat all patients, virtually, regardless of age. This is extremely valuable in virtual urgent care and direct-to-consumer platforms.

patient is one who has a basic understanding of the internet and feels comfortable using a computer webcam or a smartphone video. It is also a patient who doesnâ&#x20AC;&#x2122;t have multiple chronic diseases or comorbidities that would require a thorough physical exam to formulate a differential diagnosis. Patients who need to be seen for acute sick visits, medication checks, or behavioral health issues are great candidates for telemedicine visits. As long as the patient is getting a complete in-person physical exam once a year, and the visit does not require an immunization, injection, or other procedure, most patients could benefit from the convenience of a virtual visit. Moving forward, I believe in-person visits in primary care settings will be mostly annual physical exams, musculoskeletal injury evaluations, scheduled procedures, and immunization or injection visits.

MFP: How has the explosion of telemedicine impacted family medicine? Dr. Reddy: For the first time,

family medicine is at the forefront of healthcare (by providing) the most sought-after service by patients and insurers alike. We are the only specialty that can treat all patients, virtually, regardless of age. This is extremely valuable in virtual urgent care and directto-consumer platforms. It is also valuable as it can enhance your practice and add extra income, as there are many independent vendors/companies that need to staff their service. You are no longer dependent on your physical office location.

1. www.merritthawkins.com/ news-and-insights/media-room/ press/-Physician-Practice-PatternsChanging-as-a-Result-of-COVID-19/ SUMMER 2020 | MAFP.COM

Advocacy Through the Lens of COVID-19 by Matt Black

Removing Barriers to Chronic Kidney Disease Diagnosis by Kal Ismail, MD; Ann Andrews, MPH; and Elizabeth Montgomery In order to improve chronic kidney disease screening and management, the National Kidney Foundation of Michigan is collaborating with the Michigan Department of Health and Human Services to engage primary care physicians, other healthcare professionals, and laboratories.

50% of those having advanced CKD.2 A population health model that includes routine screening for CKD and its progression has been demonstrated to reduce incident end-stage kidney disease in a high-risk population by 50%.3

Thirty-seven million American adults are estimated to be living with chronic kidney disease (CKD)1, and more than 80% of them are unaware of the condition. CKD puts patients at increased risk for cardiovascular events and progression to kidney failure and death.1 Currently, in primary care populations, almost 90% of adults with type-2 diabetes and CKD remain undiagnosed, with as many as

Chronic kidney disease is diagnosed by two widely available and inexpensive tests: estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR). eGFR and uACR are independent and complementary predictors of important clinical outcomes, including CKD progression, end-stage renal disease, acute kidney injury, cardiovascular mortality, and all-cause mortality.4 Both

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Diagnosing CKD

tests are necessary, as albuminuria is often detected before the eGFR drops below 60 mL/min/1.73 m2 , thus allowing earlier CKD diagnosis and intervention. However, there is significant underutilization of uACR testing in people at risk for CKD. In fact, less than 10% of individuals with hypertension and less than 40% with diabetes are assessed for albuminuria.4,5

The Kidney Profile

Early detection of CKD offers an opportunity to prevent complications before symptoms occur and to slow the loss of kidney function over time. When CKD is diagnosed early, primary care physicians are more likely to avoid harmful medications, such as non-steroidal

CLINICAL CORNER

anti-inflammatory drugs, prescribe ACE inhibitors and angiotensin receptor blockers when indicated, and refer to a nephrologist when appropriate.

A combination of eGFR and ACR testing is a strong predictor of CKD and cardiovascular mortality. 6

To facilitate testing of Michiganders at risk for CKD—including individuals with diabetes, hypertension, and/or family members with CKD, or those over age 60—the National Kidney Foundation of Michigan is partnering with Michigan laboratories to launch the Kidney Profile. The Kidney Profile combines the eGFR and uACR tests into one easily identifiable ordering unit, which may be ordered in combination with the basic or comprehensive metabolic panel with no duplication in testing. For the first time, people with laboratory evidence of CKD can have their abnormal eGFR and uACR results clearly identified as being related to potential kidney impairment, increasing their awareness of underlying CKD. The Kidney Profile will standardize screening for CKD, improve the consistency of test results between laboratories, and increase early recognition of the disease. 1. Centers for Disease Control and Prevention, Chronic Kidney Disease in the United States, 2019. 2019, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention: Atlanta, GA. 2. Szczech, LA, et al., Primary Care Detection of Chronic Kidney Disease in Adults with Type-2 Diabetes: The ADD-CKD Study (Awareness, Detection and Drug Therapy in Type 2 Diabetes and Chronic Kidney Disease). PLOS ONE, 2014. 9(11): p. e110535. 3. Bullock, A, et al., Vital Signs: Decrease in Incidence of Diabetes-Related End-Stage Renal Disease among American Indians/Alaska Natives—United States, 1996–2013, in Morbidity and Mortality Weekly Report. 2017: Atlanta. p. 26-32. 4. Inker, LA, et al., KDOQI U.S. commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. American Journal of Kidney Diseases: the official journal of the National Kidney Foundation, 2014. 63(5): p. 713-35. 5. United States Renal Data System, 2016 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. 2016, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Bethesda, MD. 6. Matasushita, K, et al., Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes; a collaborative metaanalysis of individual participant data. The Lancet Diabetes & Endocrinology 2015Jul; 3(7):514-525.

CKD Resources The Kidney Profile and CKD Patient Education Materials kidney.org/CKDintercept/laboratoryengagement

Integrating CKD Care Processes Into Existing Practice Workflows for Diabetes and Hypertension kidney.org/contents/chronic-kidney-disease-change-package

Kal Ismail, MD is chair of the National Kidney Foundation of Michigan Scientific Advisory Board; program director of the Nephrology Fellowship at St. John Macomb/Oakland Hospital; clinical assistant professor of medicine at Michigan State University College of Osteopathic Medicine; medical director at Fresenius Medical Services Warren and Madison Heights; and Apheresis Hypertension Nephrology Associates in Warren, MI.

Ann Andrews, MPH is senior program manager at National Kidney Foundation of Michigan. Since 1955, the National Kidney Foundation of Michigan has led the fight against kidney disease, enhancing the lives of many Michigan residents through its patient services, prevention programs, education programs, children’s programs, and research. For more information about the early identification and management of CKD or the Kidney Profile, contact Ann at aandrews@nkfm.org.

Elizabeth Montgomery is senior program director of the NKF Primary Care Initiative at National Kidney Foundation. The Primary Care initiative was launched in 2014 to provide primary care clinicians with the essential skills and tools to recognize, diagnose, and treat early stage kidney disease. This includes helping clinicians to better support patients in managing conditions that contribute to kidney disease, such as diabetes, high blood pressure, and heart disease.

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Stories From the Frontline Wayne State University/Ascension family medicine residents.

by Dana Lawrence physician. It has helped me make a difference in people’s lives, both in the clinic and in the community.”

In late March, just weeks into the COVID-19 response in Michigan, MAFP President Keerthy Krishnamani, MD, MBA sent an e-message of hope and appreciation to members. “During this crisis, your work, your expertise, your training, and your care are making the difference between life and death for your patients. Michigan’s family physicians—each of you—are truly serving on the frontlines of the pandemic … Michiganders are waking up and appreciating in new ways the work you do each day. They’re watching you on the news, they’re listening to your advice, and they’re counting on your expertise. Our state couldn’t be in better hands.” From seasoned family physicians to residents in training to medical students at the beginning of their journey to choosing their specialty, the family medicine community enlisted in the battle against COVID-19. “Family medicine is facing this pandemic like no other specialty, on multiple fronts…all ages and ranges (young, old, male, female, elderly, pregnant) and in all arenas (offices, homes, nursing homes, hospitals, homeless shelters),” said Michael Bishop, MD, FAAFP, Mercy Health Grand Rapids Family Medicine Residency program director. Now that our state’s economy is re-opening and the medical community has been given the go-head to resume “nonessential” care, stories from the frontline continue to emerge—stories of service and sacrifice that exemplify the commitment of family physicians to their patients, their colleagues, and their communities. Below is just a snapshot of stories. You may read more at mafp.com/covid19-storiesfrom-the-frontline and share your own by emailing info@mafp.com.

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Of his residency mentor, MAFP Presidentelect Mark Hamed, MD, MBA, MPH, FAAFP, said, “Dr. Patsalis was a great family physician, teacher, and human being. He will be sorely missed.”

Tribute to the ‘American Doctor’

Remembering Angelo Patsalis, MD, FAAFP

Longtime Academy member and past president of Michigan Academy of Family Physicians (2008-2009) and Family Medicine Foundation of Michigan (20152016), Angelo Patsalis, MD, FAAFP (Livonia), passed away in early April due to complications from COVID-19. Dr. Patsalis was a steadfast champion of his beloved specialty, dedicating his career as a family physician to providing primary care for all. He is remembered as a tireless family medicine mentor and educator; volunteer leader at the local, state, and national level; and a catalyst for change in Metro Detroit, where he was born, raised, lived, worked, spent time with family and friends; and served as president of the Southeastern Michigan Academy of Family Physicians. His giving nature is exemplified by the words he shared upon beginning his term as president of Family Medicine Foundation of Michigan, where he continued to serve as a trustee until the time of his death. “When you believe in something deeply and know it is important, you always find time, you’re never too busy and never too tired. I am proud and blessed to be a family

Jeffrey Laman, MD, a thirdyear resident at Western Michigan University Homer Stryker M.D. School of Medicine, wrote original lyrics to the tune of country artist Toby Keith’s ‘American Soldier’ to honor his fellow physicians, nurses, and other healthcare workers on the COVID-19 frontline. “I hope they feel a sense of pride in knowing that they’ve taken a stand and done a lot and sacrificed a lot for the betterment and the lives of their patients,” Dr. Laman said. “I also hope that the song reminds them that they are not alone, that we are in this together, and that we each have people working alongside us in this fight.” To listen to Dr. Laman’s ‘American Doctor,’ visit youtu.be/u5ZF7R_A-30.

Residents Rise to the Challenge

“We are being exposed to a new way of practicing medicine. The way I look at it is that we are at war,” Nikhil Hemady, MD, FAAFP, chief medical officer at Honor Community Health, a federally qualified health center and program director at Pontiac General Hospital Family Medicine Residency, said early on in Michigan’s pandemic response. “Our residents and faculty have taken the lead in caring for an unprecedented number of COVID-19 patients on every front: COVID-19 units, ICU, urgent care, family medicine center, and virtually. I am very proud

MEMBERS IN THE NEWS

of my faculty and residents who have become ‘convengers’ in this war against the virus.” These sentiments were echoed by Pierre Morris, MD, clinical assistant professor and residency program director for the Wayne State University/Ascension Family Medicine and Transitional Year residency programs. “Our residents joined COVID-19 teams headed by our family medicine faculty physicians and also joined our hospital ICU COVID teams headed by our pulmonologists, providing direct care to the most critically ill patients. It is a daunting task that is persistently physically and emotionally draining, but our residents and faculty continued to confront this challenge daily,” Dr. Morris said. Recognizing a warm meal might provide a few moments of comfort to residents on the frontline, MAFP and Family Medicine Foundation of Michigan offered the state’s 38 residency programs a gift card for purchasing a meal for their residents from a local restaurant.

Students Collaborate in New Ways

When in-person instruction and clinical rotations were cancelled in March, students at Michigan’s medical schools eagerly volunteered to help on the frontline and behind the scenes. Some, like 2020 Central Michigan University College of Medicine graduate Sara Robinson, helped with COVID-19 testing. Sara and a group of her classmates volunteered at a drive-through COVID-19 testing center of Great Lakes Bay Health Center, a federally qualified health center in Saginaw, assisting clinicians in administering, labeling, and bagging COVID-19 tests.

I Am Grateful Upon finishing her daily progress notes after completing a COVID-19 inpatient service, Rachel Klamo, DO, MS, chief of medicine at Ascension Providence Rochester Hospital and MAFP board member, reflected on what this experience has meant to her as a family physician. I am grateful to be a Family Physician. I am grateful that I was trained to take care of Inpatient Medicine patients. I am grateful that I am empathetic. I am grateful that I know the principles of Critical Care. I am grateful that I can treat the whole patient. I am grateful that I can help my colleagues in the ED if needed. I am grateful that I understand not to be afraid. I am grateful that I trained to provide maternity care and care for neonates if needed. I am grateful for those working on our team - nurses, techs, social workers, case managers, and residents. I am grateful to serve. I am grateful to be a part of the Family Medicine presence in the community. I am grateful to be alive. I am grateful to be a Family Physician.

For Eli Benchell Eisman, PhD, a rising fourth-year student at Michigan State University College of Osteopathic Medicine, finding “ways to participate meaningfully in care in other ways while not in the hospital,” was important. He volunteered to assist the Detroit Health Department with information and COVID-19 management. Diana Alaouie co-lead an effort at Wayne State University School of Medicine to secure childcare, groceries, and other home management support for physicians and other healthcare professionals in southeast Michigan. Through a Google form circulated through hospitals in Detroit, student volunteers were matched to help meet physicians’ needs.

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COVID-19 Resources & Support for Michigan FPs Throughout the spring and continuing into the summer and beyond, MAFP is responding to members’ needs for COVID-19 information and resources to maintain the ability to care for patients.

Information Sharing & Education • We continue to host live and ondemand webinars on topics identified by members as those for which guidance is needed, such as telemedicine and coding and billing— mafp.com/cme-events/covid-19webinars. • Our COVID-19 webpage remains active and updated in real time at mafp.com/news/coronaviruswhat-michigan-family-physiciansneed-to-know. • Our e-newsletter, Family Medicine Update, delivers timely need-to-know information to members’ inboxes on 20 SUMMER 2020 | MAFP.COM

Fridays and other days as needed— subscribe at mafp.com/familymedicine-update-subscriptionform. • MAFP’s new text message service overcomes barriers presented by email firewalls to deliver urgent breaking news, advocacy calls to action, and event information to members’ phones—sign up by texting FMCONNECT to 52886.

Advocacy & Practice Management • MAFP’s advocacy work focuses on ensuring health policy and legislation protects the practice of family medicine and preserves the patient-physician relationship—check out MAFP’s new advocacy webpage at mafp.com/ advocacy/advocacy-action-center. • We continue to be a leader in working

with public and private payers on family medicine payment and reimbursement issues, incorporating new and expanded models of care and reducing administrative burden.

Community • MAFP continues to showcase frontline stories of service and sacrifice at mafp.com/covid19-storiesfrom-the-frontline, and to connect members with the media to increase awareness of science-based facts and the value of family medicine. Do you have a story to share or would you like to be a media key contact for an area of expertise? Email info@mafp.com. • We launched a COVID-19 online discussion portal open to all members and a WhatsApp group chat for family medicine residents to facilitate member discussions and collaboration.

ACADEMY NEWS

Changes to Academy CME & Member Dues Requirements AAFP implemented the following continuing medical education reporting and member dues payment flexibilities to make maintaining your valuable Academy membership easier during the COVID-19 pandemic.

July 14, 2020

Members who have not yet paid their 2020 dues have until July 14 to do so to stay connected to the Academy. Paying dues online is quick and easy—visit aafp.org/quickpay. Or, call AAFP’s Member Resource Center at 800.274.2237.

Dec. 31, 2020

Members whose CME reelection cycle ended on Dec. 31, 2019, now have until Dec. 31, 2020, to report the CME they earned prior to Dec. 31, 2019, to remain eligible for membership.

Dec. 31, 2021

For members whose CME reelection cycle ends on Dec. 31, 2020, the deadline to earn and report CME has been extended to Dec. 31, 2021. Members who prefer to not have their reelection cycle extended should contact the Member Resource Center at 800.274.2237 or aafp@aafp.org.

Elective Credit

Kristi VanDerKolk, MD discussing a proposed resolution at the 2019 MAFP Annual Meeting.

Virtual 2020 MAFP Annual Meeting Aug. 8, 12-2 pm ET

While the Michigan Family Medicine Conference & Expo is on a one-year hiatus, the MAFP Annual Meeting will take place virtually this year.

Academy members’ time spent on COVID-19 professional enrichment activities—informal self-directed learning activities, such as attending/ viewing MAFP’s free COVID-19 live or on-demand webinars and reading journals—may be reported to AAFP as Elective Credit via the professional enrichment category, commensurate with participation. Reporting selfdirected professional enrichment activities to AAFP must be done by each individual member.

Per MAFP bylaws, an annual meeting must be held for the membership to make necessary governance and business decisions. The meeting will include:

Contact MAFP Meeting Planner Denna Bunting at dbunting@mafp.com with questions.

• Election of officers

What’s your membership worth? Academy membership is valued at

more than $4,000!

• AAFP Degree of Fellow convocation • Remarks from MAFP’s CEO and outgoing and incoming presidents • Installation of the Board of Directors • Presentation of the 2020 ‘Academy’ Awards • Presentation, discussion, and voting on resolutions. To register for the MAFP Annual Meeting and access meeting materials and the log-in/call-in information, visit mafp.com/events/MAFPAnnual-Meeting-Registration. SUMMER 2020 | MAFP.COM

Working Toward Quality, Affordable Healthcare for All by Matt Black With backgrounds in healthcare and wellness, Michigan Rep. LaTanya Garrett and Sen. Michael MacDonald are committed to improving access to quality, affordable healthcare. They are also focused on mitigating the impacts of COVID-19 on their constituents and communities, and on collaborating with family physicians to ensure policy is focused on helping all Michiganders get and stay healthy.

Rep. LaTanya Garrett

Geography, formal education, and life experiences frame one’s viewpoints, as Rep. LaTanya Garrett (D-Detroit) can attest. Living in Detroit, obtaining several healthcare degrees and certifications, and having a daughter with a medical condition have provided the representative with a firsthand perspective of what is working well in the U.S. healthcare system and what needs improvement. These factors have also prepared her for finding legislative solutions to what she sees as the biggest healthcare issue of all— lack of access to care. Rep. Garrett views access as predominantly centered on equality and cost.

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Scientific advancements and quality improvement initiatives continue to increase quality of care, yet there is concern that not all Michiganders are experiencing this increased quality care of care, she explained. Rep. Garrett is especially concerned that racial bias in the healthcare system is leaving parts of her district behind, she said, as the overwhelming number of COVID-19 cases and fatalities are affecting minorities. “These issues are not new for the residents of my district, but work can be done to help resolve them, and we must ensure that improving quality of care does not bring additional unaffordable costs along with it,” she said. “Prescription costs and other healthcare costs that are continuing the upward trend will put care out of reach for many residents.” Physicians have a significant role in finding solutions to problems such as these, said Rep. Garrett. “Physicians can be important resources by collaborating with their legislative offices on policy that is effective in their practices and policy that is unsuccessful in their practices,” she said. “Both successful policy and ones viewed negatively should be shared with legislators. We need to hear both sides as we work through different policy

It is my wish that all patients, no matter what, are treated with the same amount of respect. initiatives. Also, engaging with lawmakers regarding community health initiatives and wellness programs can reduce healthcare disparities that are present in certain regions throughout the state.” Now in her third and final term in the Michigan House of Representatives, and also a member of the House Health Policy Committee, Rep. Garrett remains committed to working with legislative colleagues on both sides of the aisle to prioritize healthcare for underserved populations. “It is my wish that all patients, no matter what, are treated with the same amount of respect,” she said. Rep. Garrett lives in Detroit with her loving, supportive husband and three children— two teenagers and one toddler. With a strong attachment to her community, she can be found helping with initiatives aimed at improving quality of life for her neighbors and exploring different treasures the city and district hold.

MEET THE LEGISLATORS

Sen. Michael MacDonald “I am a huge believer in the theory that an ounce of prevention is worth a pound of cure. Therefore, I am greatly interested in policies and programs that help Michigan residents get healthy and stay healthy,” said Sen. Michael MacDonald (R-Macomb Township) of his healthcare priorities. This first-term state senator is equally interested in the intersection of behavioral health and physical health. “I believe that these are two sides of the same coin and that more can be done to identify ways to improve both,” he said. A member of the Senate Health Policy and Human Services Committee and the Appropriations Subcommittee on Community Health and Human Services, Sen. MacDonald helps shape policy and allocate funding for programs that impact both prevention and care integration. Ensuring affordable healthcare for all “is the responsibility of legislators, residents, healthcare professionals, and other stakeholders working together to tackle the problem,” he said. Thus, he is also focused on reducing healthcare costs—a task that has been made more difficult by the COVID-19 crisis. His district alone has seen thousands of healthcare workers furloughed due to the suspension of non-urgent procedures during the crisis, creating financial implications for not only the individuals and their families, but also hospitals, other healthcare facilities, and the U.S. healthcare system as a whole. This is one of the biggest issues facing healthcare today, he said.

Working on solutions to help get the healthcare system back up and running and ensuring a smooth return to “care as normal” for patients and healthcare professionals are among his most immediate goals. The Senate recently passed legislation he introduced to protect healthcare professionals during a declared emergency.

Quality healthcare is a vital part of any community and must be valued and cultivated. Prior to his election to the Michigan Senate, Sen. MacDonald worked as an exercise scientist and personal trainer. With a particular interest in obesity, he devoted his doctoral studies to trying to identify ways to mitigate the impact of obesity on public health. Today, he is committed to ensuring Michiganders have the resources they need to get and stay healthy. “Quality healthcare is a vital part of any community and must be valued and cultivated,” he said. “I believe that my previous life experience has prepared me to understand the challenges we are facing as a state and to promote new solutions to those challenges.” That, he said, requires cooperation and teamwork.

“There are times when we (legislators) do not agree on the best way to tackle problems, but I have been able to work cooperatively with individuals on both sides of the aisle, the House, the Senate, and the executive branch,” he said. Identifying family physicians and MAFP as valuable resources for elected officials as they are working on legislation or preparing answers to constituent questions, the senator encourages MAFP members to continue communicating with their legislative offices. Sen. MacDonald is a lifelong resident of Macomb County, where he currently lives with his wife, Laura, and their dog Gizmo. Together they like to work out; eat “mostly healthy” meals prepared by Laura, a chef; and enjoy walks around the district. The MacDonalds welcomed their first child, Evelyn Michelle, in May.

Text MIFMCONNECT to 52886 to subscribe to MAFP’s text messaging service. Be among the first to receive: • Advocacy action alerts • Urgent news impacting family medicine • information about CME, professional development and networking events Message rates apply. Text STOP to stop receiving text messages. Text HELP to get help.

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Annual Student and Resident Conferences Going Virtual by Dana Lawrence

With the COVID-19 pandemic putting a halt to large gatherings, this year’s annual conferences hosted for students and residents by American Academy of Family Physicians, Michigan Academy of Family Physicians, and Family Medicine Foundation of Michigan have transitioned to virtual events.

popular event for medical students to connect with family physicians and residency programs in Michigan.

Jacyln Israel

Christal Clemens

National Conference: July 30-Aug. 1

By going virtual, AAFP is able to continue the tradition of offering valuable education and networking opportunities at the National Conference of Family Medicine Residents & Medical Students despite the COVID-19 pandemic. The conference dates of July 30-Aug. 1 remain the same, but the times have been adjusted to accommodate varying time zones. Highlights include: • 11 hours of live education through workshops and main stage sessions • On-demand access to all sessions— 30 hours of education—for 30 days after the conference • Virtual Expo Hall, including the ability to schedule one-on-one appointments with residency programs, recruiters, and other exhibitors • Networking opportunities, including the option of chatting (including via video) with fellow students and residents • Reduced registration fee—pay just $130 when you register by July 2 at aafp.org/events/ national-conference.html While student and resident congress sessions will not be held this year, elections for national student and resident leadership positions within AAFP and

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Linda Stanek, MD

Himanshi Chopra, MD

partnering family medicine organizations will take place during the virtual conference. Representing Michigan are: • Student Delegate: Jaclyn Israel (Michigan State University College of Osteopathic Medicine) • Student Alternate Delegate: Christal Clemens (Central Michigan University College of Medicine) • Resident Delegate: Linda Stanek, MD (Beaumont Health Grosse Pointe Family Medicine Residency) • Resident Alternate Delegate: Himanshi Chopra, MD (McLaren Oakland Family Medicine Residency) Student and resident members interested in running for a national position can learn more at aafp.org/membership/involve/lead/ students-residents/resident.html.

Michigan Future of Family Medicine Conference: Oct. 24 This annual FMFM conference, now in its seventh year, has become a

Flagship features of the event include panel sessions with family physicians to learn about the variety of practice settings that a career in family medicine offers, and with residency program directors and residents to get tips for preparing for the Match, program interviews, and what it’s really like to be a resident. Details about the conference’s online sessions and registration will be posted at mafp.com/events and shared via MAFP’s e-newsletter, Family Medicine Update.

Although this conference’s format looks different than in years past, we are pleased we can continue Family Medicine Foundation of Michigan’s tradition of providing this important opportunity for medical students to explore the breadth and depth of the specialty. - Christine Medaugh, MD, chair of FMFM’s Student & Resident Education Committee

STUDENTS & RESIDENTS

Two Student Members Selected for Family Medicine Leadership Institute Adjoa Kusi-Appiah (Michigan State University College of Human Medicine) and Ashleigh Peoples (Wayne State University School of Medicine) were selected by AAFP Foundation to participate in the 2020 Family Medicine Leads Emerging Leader Institute.

Adjoa Kusi-Appiah

Ashleigh Peoples

This year-long program, now in its sixth year, focuses on developing family medicine leaders to bolster

the primary care workforce pipeline. Scholars participate in in-depth workshops and complete a leadership project guided by a family physician mentor. Applications for the 2021 Family Medicine Leads Emerging Leader Institute will open in mid-December. Members interested in serving as mentors can learn more at aafpfoundation.org.

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STUDENTS & RESIDENTS

Advocacy and Health Policy Curriculum Toolkit Advocacy is a necessary skill for advancing the specialty of family medicine, but the tools and resources to advocate for and effect change in healthcare at the policy level are not always readily accessible, especially in resource-limited communities. Now available is a new toolkit designed to guide residency programs in developing an advocacy and health policy curriculum. “Empowering family medicine resident trainees—some of whom may go on to become faculty—to advocate on behalf of the patients they serve in both a clinical and social context is important to not only protect our patients, but also the practice of medicine and the patient-physician

relationship,” said Julie Thai, MD, MPH, co-author of the curriculum, which has been introduced as a four-week elective at McLaren Flint Family Medicine Residency. Various components of the curriculum will be incorporated into the residency program’s required Health System Sciences rotation in order to help residents develop crucial leadership and advocacy skills early on in their training, while meeting milestones for ACGME core competencies, shared co-author and program director Prabhat Pokhrel, MD, MS, PhD. The curriculum is accessible at mafp.com/advocacycurriculum-toolkit.

Prabhat Pokhrel, MD, MS, PhD; Hussein Saghir, DO; and Julie Thai, MD, MPH

Best wishes, 2020 medical school and residency program graduates, as you begin the next chapter of your family medicine career! Your family medicine family is celebrating with you! 26 SUMMER 2020 | MAFP.COM