SPRING 2021
Bringing COVID-19 Vaccine into the Community
Plus AAFP Liaison to the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
MAFP Advocacy Efforts Take on Renewed Urgency in 2021 Women in Family Medicine
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TABLE OF CONTENTS Chair Keerthy Krishnamani, MD, MBA President Mustafa “Mark” Hamed, MD, MBA, MPH, FAAFP President-elect Srikar Reddy, MD, FAAFP Vice President Glenn Dregansky, DO, FAAFP Speaker Beena Nagappala, MD, MPH Treasurer Rachel Klamo, DO AAFP Delegates Robert Jackson, MD, MMM, FAAFP Loretta Leja, MD AAFP Alternate Delegates Tina Tanner, MD, FAAFP Mary Marshall, MD, RN, FAAFP Members-at-Large Harshini Jayasuriya, MD, FAAFP Brandon Karmo, DO Amy Keenum, DO, PharmD, FAAFP Holli Neiman-Hart, MD, FAAFP Sadeer Peter, MD Pamela Rockwell, DO, FAAFP Kristi VanDerKolk, MD, FAAFP Bashar Yalldo, MD Resident Member Linda Stanek, MD Student Member Jaclyn Israel Ex Officio, Chief Executive Officer Karlene Ketola, MSA, CAE
12
Bringing COVID-19 Vaccine into the Community Cover Story
6
New Year, New Challenges, and New Optimism
The Wisdom We’ve Gained— and Where We Go from Here
10
16
President’s Message
MAFP Advocacy Efforts Take on Renewed Urgency in 2021
FMFM BOARD OF TRUSTEES President Mary Marshall, MD, RN, FAAFP Vice President Keerthy Krishnamani, MD, MBA Secretary/Treasurer Robert Jackson, MD, MMM, FAAFP Executive Vice President Karlene Ketola, MSA, CAE Trustees-at-Large Jennifer Aloff, MD, FAAFP Christal Clemens David Kazanowski, MD Amy McKenzie, MD, MBA
Elizabeth Pionk, DO, FAAFP Jeanette Wilson, MD Bradford Woelke, MD
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. ©2021 MAFP. All rights reserved.
Editor: Dana Lawrence
Michigan Academy of Family Physicians 2164 Commons Parkway, Okemos, MI 48864 517.347.0098 | mafp.com
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CEO Insight
Priorities for the New Legislative Session
Advocacy Update
Meet the Legislators
18
20
Family Medicine Business Network
Members in the News
Telemedicine and COVID-19 Women in Family Medicine
22
Students of Street Medicine Members in the News
24
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New Year, New Challenges, and New Optimism by Mark Hamed, MD, MBA, MPH, FAAFP As 2020 was ending, we felt a sense of excitement at surviving the old year and beginning a fresh new one. Between the COVID-19 vaccine launch and the U.S. presidential election, it certainly has felt as though we are turning important pages in our shared history. We elected new leadership in the White House, which appeared to bring with it a renewed sense of purpose, change, and 6
SPRING 2021 | MAFP.COM
optimism. It also brought new diversity, with a vice president who represents many firsts—she is the first woman, first Black American and first South Asian person to be elected to the office. In December, two mRNA-based COVID-19 vaccines received federal emergency use authorization. These vaccines had reported great efficacy rates at about 95% and were rolled out to Michigan’s hospitals
and healthcare systems toward the end of December. This brought us all increased hope that we would soon beat this virus and end the pandemic that has infected nearly 20 million Americans and killed more than 450,000. All signs were in place that 2021 was going to be off to a smooth start. But then a couple of challenging incidents caught us off guard:
PRESIDENT’S MESSAGE
We will turn the page on this difficult portion of our history, and we will continue to work hard for our members and patients. •
•
Misinformation about alleged voter fraud led to mistrust of our electoral process and the result of the U.S. presidential election. On Jan. 6, the U.S. Capitol was stormed and violently attacked by rioters in an attempt to interrupt a joint session of Congress and overturn the results of the 2020 presidential election. Five Americans lost their lives and extensive physical damage was done to one of our nation’s most sacred institutions and symbol of democracy. In early January, as the mRNA vaccines were being distributed, many of Michigan’s family practices were left out in the cold. Even though they were part of the highest priority group to receive the vaccine, family physicians who were not associated with a large healthcare system were having difficulty securing a vaccine for themselves and their practice staff.
In response to those disappointing events in early January, the Michigan Academy of Family Physicians (MAFP) went into action. First, MAFP drafted a letter to the Michigan Department of Health and Human Services (MDHHS), which was co-signed and supported by a few other Michigan medical societies, to express grave concerns about the vaccine inequities experienced by many family physicians. MAFP reminded MDHHS that family physicians are working to keep all patients healthy and out of the hospitals, which have had dwindling capacity during this pandemic. MAFP also reminded MDHHS that patients are more likely to agree to receiving a vaccine if they are advised to do so by their family physician as compared to a retail pharmacist. It also reminded them that distributing COVID-19 vaccines to family physician offices should be part of the long-term plan to help Michigan achieve its vaccination goals. Second, in response to the electoral shenanigans that led to the attack on the U.S. Capitol, MAFP reevaluated its political contribution guidelines. In a statement crafted by MAFP and the Michigan Family Medicine Political Action
Committee, it was made clear that we will no longer consider contributing to any candidate or elected official who has taken a stance against the U.S. Constitution by working to subvert the outcome of a legally conducted election. As we position ourselves for moving forward into the rest of 2021, MAFP is optimistic about the future. We will turn the page on this difficult portion of our history, and we will continue to work hard for our members and patients. We will continue to provide resources to help get members through this pandemic. You can look for more vaccine advocacy, educational resources, and tools to help physicians adapt to telemedicine or alternative ways to manage the patients who cannot be seen in person. We also will keep working to better understand the healthcare and racial inequities that exist and how to overcome them. We will maintain advocacy for the family medicine specialty and ensure that the family physician scope of practice is retained and strongly supported. Finally, we will continue to advocate for our patients’ access to quality, safe, and value-driven care by ensuring that any healthcare team model is led by a family physician. We have renewed energy and are resolute in our determination to ensure 2021 is a year of success. Let’s make it happen!
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Mark Hamed, MD, MBA, MPH, FAAFP, is the president of Michigan Academy of Family Physicians. He is also medical director of the Departments of Emergency Medicine and Hospital Medicine at McKenzie Health System in Sandusky, medical director at health departments in eight rural Michigan communities, a senior staff physician and faculty at Henry Ford Health System/ Wayne State University’s residency program, and associate clinical instructor at the Michigan State University College of Human Medicine and Central Michigan University College of Medicine.
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7
CEO INSIGHT
The Wisdom We’ve Gained— and Where We Go from Here by Karlene Ketola, MSA, CAE Former U.S. President Herbert Hoover once wrote, “Wisdom consists not so much in knowing what to do in the moment as knowing what to do next.”
At the state level, it is an unpredictable time. MAFP will continue to focus on its advocacy priorities. The priorities will align within five pillars:
As our world continues to experience the lingering public health effects of the pandemic, economic upheaval, and political unrest, Michigan’s family physicians have shown everyone “what to do next” in countless extraordinary ways. At the Michigan Academy of Family Physicians (MAFP), we have sought to leverage and advocate for the substantial wisdom you have gained in your daily work this year.
• •
With more than 4,200 members statewide, MAFP remains the state’s largest specialty physician association. We are committed to sharing your opportunities, ideas, plans, and challenges with policy leaders at the state and federal levels and with your colleagues in both peninsulas. In 2021, there is much to discuss. The pandemic has shown us both the strengths and vulnerabilities inherent in the work we do and impacted many of our routine practices. There almost certainly will be policy implications as lawmakers and agency officials work at our sides to ensure high-quality public health during the months and years ahead. 8
SPRING 2021 | MAFP.COM
• • •
Increasing access to care for all Investing in the primary care workforce Reforming the payment and delivery system Reducing physicians’ administrative burden Preserving public health and safety
Moreover, our legislative priorities will continue to focus on prior authorization reform with an anticipated reintroduction of our previous legislation. One of our key areas of focus will be in the regulatory space as rules for electronic prescribing and implicit bias continuing-medical-education requirements are created. Budget priorities will also build upon efforts from the previous year, with a focus on investments into primary care through the physician workforce. At its January meeting, the board passed MAFP’s 2021 budget, funding initiatives to enrich member value. Thank you to our volunteer leaders who serve on boards and committees and in leadership roles at the American Academy of Family Physicians’ National Conference of Constituency Leaders, National Conference of
Family Medicine Residents and Medical Students, and Congress of Delegates. If you are considering getting more involved in your Academy, MAFP is now accepting applications from physician, resident, and student members for a variety of leadership positions and event scholarships. I invite you to visit mafp.com/get-involved to explore the best fit for you. While the pace of change this year has felt relentless and, at times, exhausting, Academy members have grown in wisdom. Our job now is to collaborate and share the innovative strategies we’ve gained through our experiences, so we can continue to help make our world a better place. Let’s get started.
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.
MAFP Advocacy Efforts Take on Renewed Urgency in 2021 by Matt Black The December 2020 lame-duck Legislature kept the Michigan Academy of Family Physicians (MAFP) busier than anticipated and set the table for an eventful legislative session to come. Due to COVID-19 concerns, session days were structured differently than in previous years, with both chambers infrequently holding session at the same time. Extended unemployment benefits for those impacted by COVID-19 is an example of some of the great pieces of legislation that passed. There also were some MAFPopposed bills adopted, including House Bills 4910 and 4911, which aimed to create 10 SPRING 2021 | MAFP.COM
regulation regarding emotional support animals. Fortunately, these bills were vetoed by Gov. Gretchen Whitmer. Senate Bill 612 — a bill that reforms the prior authorization and step therapy/ fail first process by introducing new transparency, fairness and clinical validity requirements — passed the Senate in the final days of session. However, the legislation saw some last-minute changes that removed portions of the transparency and reporting requirements. These changes were a large concern to MAFP and the Health Can’t Wait Coalition. We will work to reintroduce this bill again in the new legislative term.
The 2021-22 Legislature is effectively the same as in 2019-2020, with Republicans maintaining a 58-52 majority in the House of Representatives. Each party flipped two seats, resulting in no net change. The Senate did not have an election, but two Republican senators won their elections for county positions and resigned their Senate seats. This leaves the Senate with a 20-16 Republican majority. Both seats are in strong Republican districts and will be in a special election with an August primary and November general election. These vacancies should not have an impact, as republicans maintain a fourvote majority.
ADVOCACY UPDATE
We continue to advocate for the needs of our members, the needs for their patients, and for the community.
The House Health Policy Committee will have new faces and chairpersons. The former chair and minority vice chair were unable to continue serving due to term limits. As with every year following an election, I will be meeting with the new legislators, especially those who serve on Health Policy Committee and Department of Health and Human Services Appropriations Subcommittee. This year will move forward with a virtual meeting structure, as in-person meetings are limited until the vaccination is widely distributed. As with most events in 2020 and the beginning of 2021, Family Medicine Advocacy Day was held virtually. The aim this year was to not only inform legislators of MAFP budget and advocacy priorities but also to show the key role family physicians play in their patients’ health. Advocacy Day participants are encouraged to continue communication with legislators, and I am here to help if you need assistance with organizing a meeting or sending a letter. MAFP will continue to focus on all advocacy priorities. The MAFP Advocacy Committee is finalizing these priorities for
the 2021-22 legislative session. Priorities will all align within the five pillars of: • • • • •
Increasing access to care for all Investing in the primary care workforce Reforming the payment and delivery system Reducing physicians’ administrative burden Preserving public health and safety
Addressing a pandemic and the role of family physicians during a pandemic is something that will now be added to our list of priorities. MAFP members and staff continue working with legislators, the governor’s office, and state departments to assist in every means possible. We continue to advocate for the needs of our members, the needs for their patients, and for the community. Moreover, our legislative priorities will continue to focus on prior authorization reform with an anticipated reintroduction of our previous legislation. One of our key areas of focus will be in the regulatory space as rules for electronic prescribing are created. Budget priorities also will build
upon efforts from previous years, with a focus on investments into primary care through the physician workforce. Student loan repayment programs continue to be a valuable tool to help recruit and retain family physicians. With the federal government under single-party control following the inauguration of President Joe Biden and Vice President Kamala Harris and Democrats winning both runoff elections in Georgia to give the Senate a 50/50 split, we will work closely with American Academy of Family Physicians to ensure its Michigan members’ voices are heard.
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. SPRING 2021 | MAFP.COM
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Bringing COVID-19 Vaccine into the Community by Andrea Becker, BSN, RN BS Division of Immunization, Michigan Department of Health and Human Services Who would have thought at the beginning of 2020 we would be finding ourselves in a global pandemic just a few short months later? One year ago—on March 11, 2020— the World Health Organization declared the coronavirus a global pandemic. Since then, it has spread to nearly every country in the world. According to data reported by Johns Hopkins University, the disease has killed more than 2.1 million people globally as of Jan. 26 and infected more than 100 million, with Michigan accounting for more than 14,000 deaths and 552,000 infections.1 12 SPRING 2021 | MAFP.COM
COVID-19 has had a substantial economic and emotional impact on individuals, families, businesses, and communities. From the loss of loved ones, businesses, and jobs, to mental health concerns, fear, anxiety, and isolation; we have seen and continue to see heartache and grief on many levels. These effects have shed light on the broad disparities within our society and provided us with an opportunity to address those disparities moving forward.
many pandemics before, and we have persisted despite them.
Currently, COVID-19 is commonplace; however, looking back, there have been
Immunizations are one of public health’s greatest achievements and one of the most
“The significant impact of COVID-19 has led to unprecedented, worldwide collaboration among scientists, medical doctors, health and government officials, and the private sector,” said Dr. Joneigh Khaldun, an accomplished practicing emergency physician and the chief medical executive for the state of Michigan.
COVER STORY
lifesaving modernizations in the history of medicine. Immunizations are considered victims of their own success in that they save us from diseases, then cause us to forget the diseases from which they saved us. We must remember the scientists and pioneers who saved millions of lives each year, but who also laid the foundation of future vaccine development. This foundation is what has led us to be better prepared in our fight against COVID-19. After nine long months of navigating through the darkness of COVID-19 and anxiously awaiting vaccine approval, the U.S. Food and Drug Administration (FDA) approved the first COVID-19 vaccine for emergency use Dec. 11. The Pfizer-BioNTech COVID-19 vaccine was recommended for use by the Advisory Committee on Immunization Practices (ACIP) in persons 16 and older. This vaccine is a two-dose series administered 21 days apart. Data from clinical trials showed that a two-dose regimen of the vaccine conferred 95% protection against COVID-19 in persons 16 and older.2 One week later on Dec. 19, the FDA approved
the second COVID-19 vaccine (Moderna) for emergency use. The Moderna COVID-19 vaccine was recommended for use by ACIP in persons 18 and older. This vaccine is a two-dose series administered one month (specifically 28 days) apart. Data from clinical trials showed that a two-dose regimen of the vaccine conferred 94.1% protection against COVID-19 in persons 18 and older.3 As of Jan. 26, when this article was written, Pfizer-BioNTech and Moderna were the only COVID-19 vaccines authorized and recommended for emergency use in the United States. However, large-scale, phase 3 clinical trial, were in progress for three additional COVID-19 vaccines (the Janssen pharmaceutical company of Johnson & Johnson, AstraZeneca, and Novavax). For the most up-to-date provider guidance and education, visit the Michigan Department of Health and Human Services (MDHHS) website at www.michigan.gov/ COVIDvaccine. Both the Pfizer-BioNTech and Moderna COVID-19 vaccines are made using mRNA
technology. This is a new approach to vaccines but not unknown. The concept of using mRNA to produce useful proteins to fight disease has been around for decades. Scientists have clinically tested mRNA vaccines for a wide range of infectious diseases, including rabies, influenza, Zika, and cytomegalovirus.4 Until now, none have made it past small, early-phase clinical trials. Both SARS-CoV-2 vaccines have far surpassed previous attempts in vaccine development, which has scientists optimistic about the future use of this technology. One advantage to the use of mRNA vaccines over traditional vaccine methods is that they do not rely on growing the virus or the proteins in the lab, which enables them to be developed more efficiently. This improved process is held to the same rigorous safety and effectiveness standards as all other types of vaccines in the United States. All COVID-19 vaccines must meet these standards before the FDA will make them available for use either through approval or emergency use, according to the Centers for Disease Control and Prevention (CDC). SPRING 2021 | MAFP.COM
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These partnerships have been crucial to our efforts to combat this pandemic in Michigan. I hope that we build upon these partnerships and lessons learned as we prepare for future outbreaks and pandemics. A significant amount of medical resources and skills have been dedicated in trying to slow down the spread of COVID-19 worldwide. We are better prepared today than we have been in the past. Joneigh S. Khaldun, MD, MPH, FACEP, is the chief medical executive for the state of Michigan and chief deputy director for Health in the Michigan Department of Health and Human Services
“I am confident in the scientific process and the data that shows that the currently authorized vaccines are safe and effective. This is the way we are going to end this pandemic,” said Dr. Khaldun. After receiving emergency use approval, introducing both COVID-19 vaccines into society presented its own challenges, including ensuring proper storage and handling, setting up vaccination locations, and communicating this with the public. One of the biggest challenges faced was vaccine supply. Due to a limited initial supply of COVID-19 vaccine, the CDC, based on ACIP recommendations, provided guidance to federal, state, and local governments about who should be vaccinated first. Health care workers as well as staff and residents of long-term care facilities were the first to receive vaccine. MDHHS used ACIP goals and ethical principles to prioritize allocation of COVID-19 vaccines. On Dec. 14, COVID-19 vaccinations began in Michigan. This monumental day brought hope to many who have seen and endured such great hardship throughout this pandemic. 14 SPRING 2021 | MAFP.COM
“The moment I heard about the vaccine, it felt like a weight had been lifted from my shoulders, like I could take a deep breath again. I felt excitement course through my veins” said registered nurse Miranda Kurncz Garcia, who has had the “honor and privilege” to care for the sickest of patients in the COVID-19 intensive-care unit at Memorial Healthcare in Owosso. “I see how hard they fight the ups and downs of their battles—some won and others lost. I have seen the effects it has on families, my co-workers, and have felt the effects myself. The knowledge that my family and friends have the opportunity to be safe and healthy gives me the courage and strength to keep fighting to beat COVID-19.” No one could have predicted the events that have occurred over the last year, and it is a grave reminder of how quickly a virus or bacteria can spread throughout the world and the damage that it can cause. Despite the challenges we have faced, we have come a long way in a short period of time in our fight against COVID-19. Although we still have work to do, the arrival of COVID-19 vaccines has brought a breath of fresh air and an end in sight.
“These vaccines will enable us to reopen our communities, our businesses, our schools, and restore a sense of normalcy to our lives,” Dr. Khaldun said. “We all have a role to play in ending this pandemic, and getting a vaccine as soon as one is available to you is important.” 1.
Michigan Department of Health and Human Services. Coronavirus. Retrieved fromwww.michigan.gov/ coronavirus. Accessed 26 Jan. 2021 2. Polack, Fernando P., et al. “Safety and Efficacy of the BNT162b2 MRNA Covid-19 Vaccine.” New England Journal of Medicine, vol. 383, no. 27, 2020, pp. 2603–2615., doi:10.1056/nejmoa2034577. 3. Baden, Lindsey R., et al. “Efficacy and Safety of the MRNA1273 SARS-CoV-2 Vaccine.” New England Journal of Medicine, 2020, doi:10.1056/ nejmoa2035389. 4. Kwon, Diana. “The Promise of MRNA Vaccines.” The Scientist Magazine®, www.the-scientist. com/news-opinion/the-promise-ofmrna-vaccines-68202.
COVER STORY
What We Can Do to Lower COVID-19 Vaccine Hesitancy As of Jan. 25, the COVID-19 pandemic has resulted in 24.8 million cases and 416,010 deaths in the U.S. alone.1 Herd immunity is required to end the pandemic. Experts estimate herd immunity will require 70-85% of the population to receive a COVID-19 vaccination to avoid thousands more deaths and additional strain on our healthcare systems. The Pew Research Center reports a significant number of Americans express COVID-19 vaccine hesitancy. Out of those surveyed, 60% profess intent to vaccinate, while 39% say they definitely or probably would not get a coronavirus vaccine— though about half of that group says it’s possible they would decide to get vaccinated once people start getting a vaccine and more information becomes available. Still, 21% of U.S. adults do not intend to get vaccinated and are “pretty certain” more information will not change their mind. Trust in the vaccine development process to produce a safe and effective vaccine was a significant factor that shaped vaccination intent. The survey indicated Black Americans are less inclined to get vaccinated than other racial and ethnic groups. English-speaking Asian Americans are most likely to say they would definitely or probably get vaccinated. Three-quarters of adults ages 65 and older say they would definitely or probably get vaccinated, compared with 55% of those under age 30.2 A Kaiser Family Foundation survey found worries about possible side effects, safety, and efficacy were cited as primary reasons for vaccine hesitancy.
WHAT WE CAN DO TO LOWER COVID-19 VACCINE HESITANCY • MAKE A STRONG RECOMMENDATION TO VACCINATE. Physician recommendations
to vaccinate result in higher vaccination uptake. The only contraindications to vaccination are severe allergic reaction (e.g., anaphylaxis) or immediate reaction of any severity after a previous dose of an mRNA COVID-19 vaccine or allergies to any of its components.3 Centers for Disease Control and Prevention (CDC) guidance for vaccination can be accessed at www.cdc. gov/vaccines/covid-19/info-by-product/ clinical-considerations.html.
• EDUCATE AND INFORM PATIENTS ABOUT EFFICACY OF COVID-19 VACCINES.
Reassure patients that mRNA vaccines have been studied for decades. Inform patients that mRNA vaccines teach our cells how to make a harmless “spike” protein found on the surface of the SARS-CoV-2 virus through introduction of genetic material that is then destroyed once copies of the protein are made. This process triggers an immune response to produce immunity: It cannot alter or affect a vaccine recipients’ DNA, it cannot result in a COVID-19 infection, and it cannot transmit COVID-19 to others.4
• EDUCATE PATIENTS ABOUT SAFETY OF COVID-19 VACCINES PRODUCED SO RAPIDLY. Aided by government
funding, researchers used existing clinical trials to begin COVID-19 vaccine trials, and vaccine production was started while clinical trials were still underway. Explain that mRNA vaccines are faster to produce than traditional vaccines, and CDC and Food and Drug Administration prioritized the review, authorization, and recommendations of COVID-19 vaccines with safety as a top priority. In addition to traditional robust safety monitoring systems in place,
the CDC created a new system called V-safe, which uses active surveillance through text messaging and webbased monitoring to provide telephone follow up to anyone who reports medically significant adverse events.
• EDUCATE PATIENTS ABOUT VACCINE SIDE EFFECTS. Common side effects
are normal and mild; are usually resolved in or two days; and include pain and swelling at the vaccination site, fever, chills, fatigue, and headache. 1.
covid.cdc.gov/coviddata-tracker/#cases_ casesper100klast7days 2. www.pewresearch.org/ science/2020/12/03/ intent-to-get-a-covid-19vaccine-rises-to-60-asconfidence-in-research-anddevelopment-process-increases/ 3. www.cdc.gov/vaccines/ covid-19/info-by-product/ clinical-considerations.html 4. www.cdc.gov/ coronavirus/2019-ncov/ vaccines/different-vaccines/ mrna.html
Pamela G. Rockwell, DO, FAAFP, is an associate professor with the Department of Family Medicine at the University of Michigan. Dr. Rockwell serves as the Michigan Academy of Family Physicians liaison to the Michigan Department of Health and Human Services and the American Academy of Family Physicians liaison to the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. SPRING 2021 | MAFP.COM
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Priorities for the New Legislative Session At the start of the 2021-2022 legislative session, House Speaker Jason Wentworth appointed Rep. Bronna Kahle and Rep. Angela Witwer to lead the House Health Policy Committee as Chair and Minority Vice Chair, respectively. The committee, which is critical to family physicians, is responsible for deliberating on issues related to public health, health professionals, mental health, wellness and overall access to health care. Having a strong connection to healthcare, both want to increase patient access to care and see telemedicine expansion as one of the tools to achieve this goal.
Representative Bronna Kahle In addition to the COVID-19 work, Chair Kahle would like to reduce the cost of prescription medicine and expand telehealth services to improve access to both physical and behavioral health services. In rural parts of Michigan and the 57th District, even those with insurance can struggle with access to care. “I believe telemedicine can deliver better health care services to those who may not be able to get to a physician’s office or hospital easily. The expanded use of telemedicine could be one answer to help combat access to care issues,” she said.
Taking control as the Chair of, and returning to serving on, the House Health Policy Committee, Representative Kahle (R-Adrian) is embarking on her third and final term in the House of Representatives. She will also be serving on the Insurance and Judiciary Committees. During her first term, she served on Health Policy and was awarded the 2017 Good Public Health Policy Award. Last term she served on the House Ways and Means Committee which reviewed most all policy legislation and helped craft the final bills before sending to the House floor for a vote. Due to term limits she will not be able to seek reelection in the House. Addressing the many issues stemming from COVID-19 will remain important to Chair Kahle. This will include work on both the physical and economic aspects to ensure the well-being for Michigan. 16 SPRING 2021 | MAFP.COM
A 2015 report by Citizens Research Council of Michigan found four rural counties fell well below the recommended rations of primary care physicians to population and another seven fell below in every other field examined. Another report she mentioned found an expected shortage of 4,400 physicians in Michigan, include family physicians. These numbers are a major concern for the representative. She is focused on access to care from many different angles. Prior to being elected to the House of Representatives, Chair Kahle served as Director of the Adrian Senior Center. She owned a small business that provided home care for seniors and vulnerable members of the community. Now in her third term she has gained more experience through the previous four years in the legislature. After always hearing about how divided politics is and how all items are a partisan battle, chairwoman Kahle was pleasantly surprised to learn how most legislation passes with strong bi-partisan support. “It should be heartening for everyone to see
both parties collaborate effectively to put the people of Michigan first,” she said. “I came into office with the goal of working with my colleagues on both sides of the aisle and I hope my new role as Chair of the House Health Policy Committee contributes to achieving that goal.” “As the state’s largest specialty physician association, I hope to hear from you on a regular basis about issues that would affect your members and their patients,” she encourages MAFP members. She also wants to make sure she can listen and learn while using MAFP as a resource. “I am honored to have been appointed the Chair of the House Health Policy Committee. This committee has such broad potential to help others in a positive, meaningful way. I hope to lead efforts to improve access to better care for all Michigan residents. Over the past year our state battled COVID-19 and its impact on every facet of our lives. As we are finally seeing hope on the horizon, we must work together to make way for a healthier Michigan,” she said. When not serving the 57th District in Lansing, Chairwoman Kahle lives with her husband of 30 years, Patrick, where they enjoy time outdoors and at her local church. They have two children Ben and Rebekah and a daughter-in-law- Savanna. The representative continues to be a healthy living and service champion for the community where she volunteers for Lenawee Walk to End Alzheimer’s, Associated Charities, and Habitat for Humanity. She is extremely active and ran in the 2014, 2015, and 2016 Boston Marathons.
MEET THE LEGISLATORS
Representative Angela Witwer she said. Additionally, when speaking with constituents, the subject of mental healthcare is often of concern. One of the issues topping the representative’s concerns is, the safety of healthcare workers. Unlike assaulting first responders, assaulting emergency room staff in not an automatic felony in Michigan. While assault and battery is a 93-day misdemeanor, assaulting a police officer is a two-year felony minimum, even without causing harm. Trying to create automatic protections for healthcare workers is something Representative Witwer continues to work on in the legislature.
Representative Witwer (D-Delta Township) is beginning her second term in the House of Representatives representing the 71st District, which encompasses part of the western edge of Lansing into the rural communities to the West. She will be serving as the Minority Vice-chair of the Health Policy Committee for 20212022. Representative Witwer also served as a member on the committee during the 2019-2020 legislative term. Serving as the ranking democrat on the committee, Representative Witwer has a few priorities she would like to focus on including telemedicine, prescription drug costs, access to mental healthcare, and workplace violence in the healthcare setting. She understands how important telemedicine is during the COVID pandemic, but she also recognizes the value in how telemedicine helps patients in rural settings get the care they need. On prescription drug costs, she worked last term on a bill package. This year she would narrow that work on transparency and consumer protection, “so that people don’t have to choose between groceries and their prescription medication,”
“I’ve spent a lifetime in healthcare, beginning when I was a candy striper at St. Lawrence Hospital in Lansing,” Representative Witwer said in discussing her healthcare background. Following this, the representative received a bachelor’s degree in business administration and nursing school and went on to work in both the clinical and administrative settings for 22 years within Sparrow Health System. She currently owns a marketing and public relations company that focuses on healthcare, education, and highly regulated businesses, which she started, and continues to run, prior to serving the 71st District. Before joining the legislature, she was an elected school board member. The political divide, and how that divide makes it difficult to pass good legislation was surprising to Representative Witwer. Often great policy can be sidetracked due to politics. She would like to see workplace violence protection continue to move forward. “It seems to be something we could find common ground on, but the bill is very difficult to move through the legislative process,” she stated. As we often hear, the best way for MAFP members to be a better resource for
Representative Witwer is through direct contact with her or her office. Legislators see bills on nearly every topic you can think of, and there is no way possible for them to be experts in every field, or even to know every aspect of the field they are experts in. Therefore, they rely on constituents and professionals across all aspects to assist them and share their thoughts or concerns. If you live or work in the 71st House District you can always contact her office or attend a virtual coffee hour that she frequently hosts through Facebook Live. “I have sat through a lot of healthcare CEO’s presentations,” she said, “and I have never seen so many quotes as I did in those presentations.” Through all of this, there was a quote from Thomas Frist, MD, “take care of the patient and everything else will follow.” This quote has stuck with the representative, and she thinks of it when addressing healthcare policy. “If we look at policy through the lens of a patient, we should not go wrong,” Representative Witwer stated. She feels protecting and helping the healthcare team combined with doing what is best for the patient is the best approach for healthcare policy. Representative Witwer has been a Delta Township resident for nearly 50 years where she lives with her husband and their dog Lucy. They have two adult children who are both married and have blessed them with four granddaughters. She was born and raised on the family farm in Buckley, near Traverse City. Following the passing of her father at 18, Representative Witwer wanted to live out her parents’ legacy of giving to the community that has given so much to them. This is shown through the efforts she puts in for community members in need of adequate healthcare and quality public education. She is a passionate advocate for her district. SPRING 2021 | MAFP.COM
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Telemedicine and COVID-19 by Alex Ealy, JD The COVID-19 pandemic changed the practice of medicine in multiple ways. Among some of the more visible changes is the requirement to integrate physical distancing measures into routine medical encounters. This challenge has paved the way for an exponential increase physicians using telemedicine. A recent report estimated that 46% of patients currently use telemedicine and $250 billion was spent on virtual healthcare by year-end 2020.
Regulatory Framework
It is essential for providers to be familar with their state’s regulations regarding telemedicine licensing, credentialing, and Medicaid reimbursement. For example, most states require physicians practicing telemedicine be licensed in the state where the patient resides. However, the Interstate Medical Licensure Compact provides a mechanism to expedite telehealth licensure for physicians who wish to practice telemedicine in multiple states. Currently, 29 states participate in the compact as well as the District of Columbia 18 SPRING 2021 | MAFP.COM
and the territory of Guam. The Federation of State Medical Boards published an overview on licensure and reimbursement regarding telemedicine policies. The American Medical Association (AMA) also has a state-specific chart regarding the expansion of telemedicine in response to COVID-19.
Telemedicine Changes Due to COVID-19
Many existing federal and state telehealth rules have been modified and relaxed in light of the national health emergency caused by COVID-19. Several federal efforts are in place to encourage telehealth adoption. Medicare now reimburses healthcare providers for telemedicine at the same rate it does for in-person visits. This reimbursement relaxation is not restricted to services that only treat COVID-19. Patients are no longer required to have a preexisting relationship with the physician before the first telehealth visit. For Medicare
purposes, physicians are allowed to use telemedicine across state lines. These changes, however, do not erase requirements related to state licensure and credentialing. Currently, physicians may use smartphones for telemedicine visits. Also, the Michigan Department of Health and Human Services Office for Civil Rights (OCR) is using its discretionary authority to allow physicians to use popular online communication platforms if they are not “public facing.” Permitted platforms include those like FaceTime and Skype. Facebook Live, Twitch, or TikTok are not allowed. Most governors addressed the COVID-19 pandemic with executive orders declaring states of emergency. The orders consistently imposed physical distancing limitations on interpersonal contact. Along with state legislative and agency efforts, these orders implemented changes to encourage physicians to adopt
FAMILY MEDICINE BUSINESS NETWORK
telemedicine as an additional effort to limit physical contact. Although many telehealth rules are currently relaxed, they have not necessarily been simplified. While increasing telemedicine access for patients, physicians must remain mindful that nearly all the recent state and federal measures are temporary. If further legislative and agency action is not taken at both the state and federal levels, most telehealth regulations will revert to their pre-COVID-19 status.
Telehealth Risk Considerations
For all its potential benefits, implementing telemedicine in your practice may present a number of professional liability risks. Informed consent and patient education: Informed consent remains a nondelegable duty of the physician in a telemedicine encounter, just as it does for the inperson visit. However, a telemedicine visit presents additional areas for discussion. Chief areas to examine include the technical limitations of telemedicine as well as how the lack of a physical exam may limit the provider’s ability to diagnose and treat certain conditions. Patient education should be a focal point during any telemedicine encounter. Documentation: As with in-person visits, each and every telemedicine visit must be properly documented in a complete and accurate medical record. When reviewing the record of a telemedicine encounter, it should be readily apparent what type of visit occurred as well as the physician’s impressions and plan of care. Consultations, follow-up appointments, and referrals should also be clearly documented. Licensing/Credentialing: Familiarize yourself with the applicable state telehealth licensing and credentialing regulations. While the Centers for Medicare and Medicaid Services has temporarily relaxed a number of restrictions on practicing telemedicine across state lines, licensing and credentialing primarily remains regulated at the state level. Patient selection and age-related challenges: The provider must screen each
patient for suitability for telemedicine encounters. For example, older adult patients may not be suitable for virtual encounters since some may not have access to a computer, smartphone, or high-speed internet. Older adult patients might also have difficulty hearing, seeing, or being heard during a telemedicine visit. Providers must also be aware of statespecific telehealth rules related to treating minor patients. Coverage: Be sure to consider coverage implications if you are adding telemedicine as a component of your practice. Technology: Technology used to facilitate telemedicine visits must be safe, secure, and regularly backed up. Providers should know that the continuity of care can be disrupted by technology issues, and they should have a plan to address any disruption. If applicable, providers should document how technology has affected the diagnosis. Security and privacy of protected health information: Physicians must meet or exceed all state and federal security and privacy requirements regarding protected health information. This includes requirements of the Health Insurance Portability and Accountability Act of 1996 Privacy Rule and Security Rule. The AMA and the American Hospital Association issued joint guidance regarding cybersecurity for physicians practicing telemedicine. Other considerations: Develop and regularly review policies and procedures if you plan to implement telemedicine for long-term use.
Alex Ealy, JD, is a risk resource adviser for ProAssurance, advising physicians and other healthcare providers on professional medical liability issues. In private practice, Ealy litigated civil cases and focused on workers’ compensation claims. He earned a bachelor’s degree from the University of Alabama and his law degree from Cumberland School of Law at Samford University. He is an active member of his community and is the current president of the Workers’ Compensation Section, Birmingham Bar Association. He is also a member of the Alabama Bar Association, the American Society for Healthcare Risk Management, and the Alabama Society for Healthcare Risk Management.
1.
2. 3.
4.
5. 6. 7. 8. 9.
Conclusion
Telehealth popularity is growing to encompass a significant percentage of U.S. healthcare encounters. As a result, the federal and state regulatory environment will continue to evolve. At this time, it’s uncertain whether the rules temporarily relaxed in response the COVID-19 crisis will become permanent. To mitigate risk, physicians implementing telemedicine in their practices must remain up to date on federal and state rules.
10. 11. 12.
13.
Endnotes
www.mckinsey.com/industries/ healthcare-systems-and-services/ our-insights/telehealth-a-quartertrillion-dollar-post-covid-19reality# accessed September 23, 2020. www.imlcc.org/ accessed September 28, 2020. www.fsmb.org/siteassets/ advocacy/key-issues/ telemedicine_policies_by_state. pdf accessed September 28, 2020. www.ama-assn.org/system/ files/2020-04/telemedicinestate-orders-directives-chart.pdf accessed September 28, 2020. www.hhs.gov/coronavirus/ telehealth/index.html accessed September 23, 2020. Ibid. Ibid. Ibid. www.hhs.gov/hipaa/forprofessionals/special-topics/ emergency-preparedness/ notification-enforcementdiscretion-telehealth/index.html accessed September 23, 2020. Ibid. Ibid. www.hipaajournal.com/aha-andama-release-joint-cybersecurityguidance-for-telecommutingphysicians/ accessed September 28, 2020. healthsectorcouncil.org/wpcontent/uploads/2018/08/ AHIMA-Telemedicine-Toolkit.pdf accessed September 28, 2020. SPRING 2021 | MAFP.COM
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Women in Family Medicine According to Kaiser Family Foundation, women make up a little more than one-third of the active medical professional workforce in the United States.1 That percentage is undoubtedly on the rise, given that in 2019, for the first time, more than half of medical students were women.2 This Women’s History Month, we celebrate all female family physicians and highlight several who exemplify the mission of the Academy. 1. 2.
www.kff.org/other/state-indicator/physicians-by-gender/?dataView=1&currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7 www.detroitnews.com/story/opinion/2020/12/22/opinion-how-celebrate-holidays-and-prevent-covid-19-spread/3991559001/
Leanne Swiderski With a love of science and a desire to make a difference in people’s lives, Leanne Swiderski, MD, (Garden City) was drawn to medicine during high school. “As I look back on it, even though I didn’t know about medical specialties at that time, family medicine was always my vision of the type of physician that I wanted to ultimately become,” she said. It was during her medical school rotations at the Wayne State University School of Medicine that she quickly came to appreciate the unique qualities of the family medicine specialty. Most notably, family medicine’s opportunity for building relationships with patients of diverse backgrounds while enabling her to treat a wide range of medical conditions are what bring Dr. Swiderski the most joy in her decision to become a family physician. 20 SPRING 2021 | MAFP.COM
“I am grateful that the relationships patients have with their family doctors can be a constant in an ever-changing system,” she said, noting the hardships of 2020 due to the COVID-19 pandemic.
“Watching patients and co-workers directly impacted by COVID-19 has been emotionally challenging,” she said. This hasn’t deterred Dr. Swiderski’s passion for her chosen profession, however.
Learning to adapt her practice to include more telemedicine this past year, while also dealing with frequently fluctuating medical information and general uncertainty, has impacted her professional and personal lives, she acknowledged.
“I would not trade the relationships that I have with my patients and the privilege of caring for them for anything,” she said.
As the mother of a 5-year-old and 7-monthold, that makes balancing work and family life ever more important. This, she said, has helped her develop an even deeper appreciation for the blessings in life. “I will not lie and say that I have completely figured out the answer to worklife balance, but I do my best to try to be fully present in each situation,” she said. In regard to COVID-19, Dr. Swiderski said that some days she wonders what has not changed, noting this has been the hardest year that most have experienced.
Since completing residency at Beaumont Health-Wayne Family Medicine Residency in 2015, Dr. Swiderski said she has learned to trust her instincts. This is the top tip she gives medical students as they choose their specialty. “At the end of the day, you will feel much more fulfilled and have so much more to offer your patients if you truly enjoy what you do,” she said. Dr. Swiderski also gives physicians in training this piece of advice: “If you enjoy everything you encounter during your medical training, then it is worthwhile to seriously consider family medicine as your specialty.”
MEMBERS IN THE NEWS
1,836 female Michigan members
1,065 female Michigan active members Fatin Sahhar
“The reward of being a physician is unmatched, and I cannot imagine making a different decision,” said Fatin Sahhar, MD, FAAFP.
background, where women’s jobs are often seen as dispensable, many in her community discouraged her from pursuing a degree in the United States. This was a stigma she had to overcome when she moved here, which was made easier by her supportive family.
Dr. Sahhar’s path to becoming a family physician was unconventional. A native of Iraq, she was most interested in treating children and being part of their growth, so she chose to pursue a medical degree in pediatrics, which she earned in 1984. Then, after moving to the United States, she completed a transitional medicine residency to become a family physician.
Today, Dr. Sahhar serves as associate program director at Detroit Medic Center-Sinai Grace Family Medicine, where she is committed to teaching medical students, students pursuing a master’s degree in public health, and residents.
“I realized the rewards of becoming a primary doctor for adults and the elderly, too,” she said. “Family medicine combined my passion for treating each patient holistically at each stage of their lives while also being able to care for their family and loved ones.” The journey to becoming a family medicine physician wasn’t easy, she acknowledged. Having come from a Middle Eastern
“I am most proud of my residents and students—including my medical and master’s in public health students—as well as my son and daughter, who are both medical residents,” she said. “My students and residents have achieved wonderful things and keep my career exciting, full of meaning, and constantly changing.” To her female medical students, Dr. Sahhar advises them to follow the specialty that keeps them curious and wanting to continuously learn.
476 female
Michigan student members
215 female
Michigan resident members
“The more we question and dig deeper into our fields, the more we find ourselves drawn and rooted to that field,” she said. SPRING 2021 | MAFP.COM
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Photo Credit: TJ Morton
Students of Street Medicine: A Transdisciplinary and International Movement by Jaclyn Israel, fourth-year student, and Ellie Small, third-year student in the Michigan State University College of Osteopathic Medicine The simple act of going to the doctor can be an insurmountable task when a patient is experiencing homelessness. How does one find a primary care provider or schedule an appointment without access to a phone? How does one get to their appointment without transportation? How can costs or copays be covered without insurance or a reliable source of income? How does one pick up certain medications without identification? How does one replace an identification without an 22 SPRING 2021 | MAFP.COM
address? These are all barriers the patients we care for on the street face repeatedly when trying to access the care they need. Through street medicine, students advocate alongside our unsheltered patients to navigate these obstacles, develop creative solutions, and ultimately aid our brothers and sisters experiencing homelessness in accessing the care they deserve. Students are a passionate and powerful force, and when combined
with the insurgence of street medicine over the last several decades—going to the people to provide care—the result is empathy ingrained into the culture of an entire generation of future physicians. While our work occurs on the individual level, street medicine extends beyond any single institution, school, or student body: It is a movement. On the street, our patients’ primary concerns are not staying up to date on
MEMBERS IN THE NEWS
Photo Credit: TJ Morton
Photo Credit: TJ Morton
Photo Credit: TJ Morton
The street is not a classroom for students to practice their clinical skills, but it is instead a landscape to grow in the art of compassion, humility, empathy, cultural competency, patience, kindness, and love. annual checkups and appointments; they are concerned with how to survive. Our role as students in street medicine often begins by solving someone’s most tangible problems. From blankets and tents to nail clippers, socks and toothbrushes, we have the opportunity to meet needs despite a landscape ridden with obstacles. By offering empathy, kindness, and an open mind, we are able to build strong, trusting relationships with the individuals we serve. It is through this earned trust and accountability we are able to fill the healthcare gaps our unsheltered friends experience. As students, we have a great deal to learn from the resourcefulness, adaptability, and resilience of the patients we serve on the streets. We translate these lessons directly to the operations of our street medicine team, Detroit Street Care, which
is based out of the Detroit satellite campus of the Michigan State University College of Osteopathic Medicine. Detroit Street Care depends heavily on the dedication of volunteers from across the statewide MSU College of Osteopathic Medicine community to fulfill the needs of our patients. For many years, the nonprofit Street Medicine Detroit at the Wayne State University School of Medicine has been our steadfast partner. We collaborate and share resources to care for our mutual patient population in Detroit. Other neighboring medical schools — Oakland University and the University of Michigan — have also started street medicine programs, and as these programs have developed, so has our collaboration. There are student street medicine teams starting up around the world, with a central organization, the Street Medicine
Institute Student Coalition, to support them. The coalition created a platform to exchange ideas, share experiences, and learn from experts in the field, and it serves as an avenue for transdisciplinary and international collaboration. All of this mobilization is a result of students’ compassion: We see injustice, and we are invested in being part of the solution. The street is not a classroom for students to practice their clinical skills, but it is instead a landscape to grow in the art of compassion, humility, empathy, cultural competency, patience, kindness, and love. While not every student who volunteers with street medicine in school will go on to be a full-time street medicine provider, they will undoubtedly take the lessons of street medicine and a heightened sense of social responsibility with them into their future career. SPRING 2021 2020 | MAFP.COM
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EVENTS
Earn CMEs from the Comfort of Your Home or Office Webinars are hosted by Family Medicine Foundation of Michigan Exploring Plant-Based Medicine Webinar Wednesday, April 14 | 7-8 pm
Beyond Clinical & Curriculum: A Webinar Series on Family Medicine Practice Settings Tuesday-Thursday, April 20-22
Clinical Ethics: A Pragmatic Approach (On-Demand Webinar) Available until May 1
Let’s Talk About Bias Webinar Tuesday, May 4 | 7-8 pm
The Diagnosis and Preventative Treatment of Migraine Headache in Family Medicine (On-Demand Webinar) Available until Aug. 7
Identifying & Caring for Victims of Human Trafficking (On-Demand Webinar) Available until Aug. 7
Common Cyberthreats to Medical Organizations (On-Demand Webinar) Available until Aug. 7
Breakin’ Good? or Breakin’ Bad? What Family Physicians Need to Know (On-Demand Webinar) Available until Aug. 7
Opioids: How We got Here, What It Means for the Clinician and How to Prescribe by the Rules (On-Demand Webinar)
BEYOND CLINICAL & CURRICULUM: A WEBINAR SERIES ON FAMILY MEDICINE PRACTICE SETTINGS FOR RESIDENTS AND MEDICAL STUDENTS Family Medicine Foundation of Michigan is excited to offer a series of webinars where attendees will gain insight into the multitude of practice options a family medicine career has to offer. By attending this event, participants will gain access to three separate, live virtual panel sessions, via Zoom, with experienced family physicians from different practice settings. This event will take place from Tuesday, April 20 – Thursday, April 22. Visit www.mafp.com/events to register.
Agenda
Subject to change
Session One Tuesday, April 20 | 7-8:30 pm • Private Practice • Employed Practice • Hospitalist/Inpatient Care
Session Two Wednesday, April 21 | 7-9 pm
Pain and Symptom Management Virtual KSA
• • • •
Care of Women Virtual KSA
Session Three Thursday, April 22 | 7-8:30 pm
Coming in August
Saturday, Sept. 25 | 8 am to noon Saturday, Dec. 4 | 8 am to noon
Visit www.mafp.com/events to register and for more information on upcoming events. 24 SPRING 2021 | MAFP.COM
Geriatric Medicine OB/GYN Sports Medicine Substance Abuse/Addiction Medicine
• Academic Setting • FQHC • Telemedicine
E S I T R E V AD
HERE! Contact:
M E GA N F L EM I NG 5 1 7 - 2 0 3 - 3 3 33
STAY CURRENT AND CONNECTED TO YOUR ACADEMY Renew 2021 Membership at mafp.com/membership It’s time to renew your Academy membership for 2021. Renewal ensures you stay connected not only to Michigan Academy of Family Physicians—which provides you with close-to-home opportunities to earn continuing medical education, local networking events, access to Michigan-specific member-only benefit programs, and up-to-date news and information impacting the practice of family medicine in our state—but also to American Academy of Family Physicians’ expansive suite of benefits, services, and supports. As an Academy member, you are among more than 134,000 family medicine physicians, residents, and medical students across the country, including 4,200-plus right here in Michigan.
You can now earn your advanced degree through Michigan Academy of Family Physicians’ partnership with Davenport University. Davenport University campuses and online. Don’t
• Up to $4,500 for members and members’ employees toward tuition for most undergraduate and graduate degree programs**
miss this opportunity to complete your degree!
• Renewable Scholarship applies towards 6 classes or 22 credit hours per year
Visit us at davenport.edu/mafp.
• 20% tuition discount for spouses and dependents up to age 29
Full degree programs* are being offered at all
• 20% discount for Professional Development courses offered at DU campuses
davenport.edu/mafp| 800-686-1600
**Occupational Therapy (MSOT) is excluded. **Tuition discounts apply to new students who have not attended Davenport University in the past 24 months.
Behavioral Health Services Available in Michigan Via Telehealth Services During COVID-19 Teletherapy and Telepsychiatry
Our 300+ licensed, outpatient clinicians are providing care for all ages. Additional services include intensive outpatient therapy and some groups. 866.852.4001 | pinerest.org/telehealth
Virtual Walk-In Psychiatry for Adults
The Psychiatric Urgent Care Center is open daily for immediate psychiatric triage and now offers virtual “walk-in” service. 800.678.5500 (answered 24/7) | pinerest.org/urgent