THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY
May / June 2018
Prior Authorization A top issue affecting Michigan health care
ALSO INSIDE
Immunization disparities in Michigan children Page 8
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FEATURES & CONTENTS May / June 2018
08
MDHHS Update BY RACHEL POTTER, DVM, MS AND CRISTI BRAMER, MPH
22
Study Shows Nurse Practitioners and Physicians Face Similar Liability Risks BY DAVID B. TROXEL, MD Contributed by The Doctors Company
COLUMNS 04 President's Perspective
BY BETTY S. CHU, MD, MBA
06 Ask Our Lawyer
BY DANIEL J. SCHULTE, JD
10 Ask Human Resources
BY JODI SCHAFER, SPHR, SHRM-SCP
12 Health Care Delivery
COVER STORY
14
BY STACEY HETTIGER
DEPARTMENTS 15 Welcome New Members 24 MSMS Educational Courses 28 In Memoriam 29 MSMS Medical Opportunities
Prior Authorization: A top issue affecting Michigan health care BY NICK DELEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY
Physician organizations and reformers alike are working harder than ever to change a system that is negatively impacting patients’ well-being.
STAY CONNECTED!
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michigan MEDICINE 3
MICHIGAN MEDICINE® Chief Executive Officer JULIE L. NOVAK
Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Graphic Design STACIA LOVE, REZÜBERANT! INC. rezuberantdesign@gmail.com Cover and Feature Photos LUKE ANTHONY PHOTOGRAPHY lukeanthonyphoto.com Printing FORESIGHT GROUP staceyt@foresightgroup.net Publication Office Michigan Medicine 120 West Street East Lansing, MI 48823 517-337-1351 www.msms.org All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast. Postmaster: Address Changes Michigan Medicine Hannah Dingwell 120 West Street East Lansing, MI 48823
Michigan Medicine®, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan. The MSMS Committee on Publications is the editorial board of Michigan Medicine and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors. Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine reserves the right to accept or reject advertising copy. Products and services advertised in Michigan Medicine are neither endorsed nor warranteed by MSMS, with the exception of a few. Michigan Medicine (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2018 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110. Single copies, $10. Printed in USA. ©2018 Michigan State Medical Society
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perspective
By Betty S. Chu, MD, MBA, Michigan State Medical Society President
®
Prior authorization. The phrase itself conjures images of endless paperwork, confusing websites, and frustrated patients who desperately need care. Insurer PA requirements frustrate providers and hit practices nationwide with billions in annual compliance costs. It is the kind of red tape that delays critical treatment for thousands of patients daily, drives patients away from medicines that work toward lower cost, less effective alternatives, and produces poorer health outcomes.
Our patients deserve better. In this edition of Michigan Medicine® you’ll hear from providers from across the state about their experiences with prior authorization, why change is so important, and what your Michigan State Medical Society is doing to make a difference for your practice. You’ll
BETTY S. CHU, MD, MBA MSMS PRESIDENT
learn about the role pharmacy benefit managers—or PBMs—play in the process, and you’ll read about recent revelations that have arbitrary PA procedures in the crosshairs of policymakers. You’ll also learn about opportunities to engage and educate lawmakers in Lansing and Washington, D.C., to bring them up to speed and to create in them allies for Michigan patients and physicians. It is my distinct honor to serve as the 153rd President of the Michigan State Medical Society, and it was wonderful seeing so many of you in Dearborn last month. I’m proud of the work you’re doing in your communities, and proud of the work MSMS is doing every day, as a leader for real reforms that put our patients first. I look forward to working alongside you.
Betty S. Chu, MD, MBA MSMS President
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ASK OUR LAWYER
Retention of Medical Records: Following a Sale to a Health System By Daniel J. Schulte, JD, Michigan State Medical Society Legal Counsel
Q:
I am considering retirement and have an offer from a health system to purchase my practice. The health system does not want to take possession of all my paper records and is even suggesting that I maintain my electronic records following the sale. Is this typical? What should my purchase agreement contain to protect my interests?
Buyers of medical practices are often careful not to become the custodian/owner of medical records except to the extent the medical records are actually needed to provide treatment to the patients of the acquired practice. Buyers today are actively excluding from the purchased assets any medical records of inactive patients (what constitutes inactive would be defined in the purchase agreement after negotiation). Your health system may only want to extract records from your EHR on an as needed basis (i.e. when a patient appointment is scheduled following the sale and then only those records relevant to the ongoing care of the patient are extracted). Every buyer has its own reasons for being selective in determining the medical records that it acquires. The reasons typically are an avoidance of the burdens and expense that comes with maintaining these records. You should understand that to the extent you remain the owner of medical records all these burdens and this expense remains with you. Even though you are retired you must maintain these records and provide copies and accountings of disclosures to patients and others in accordance with Michigan’s Medical Records Access Act, HIPAA and other applicable law. A detailed review of these requirements is outside the scope of this column but is available to members in the Health Law Library on the MSMS website.
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When negotiating medical record issues with your buyer you should make sure that the purchase agreement clearly addresses:
Timing
Retained Rights
To the extent you are retaining medical
Identification
tinuing right to access, copy, etc. them
You should make sure the purchase agreement allows you to not only use the records that you retain but that you will have access to the records that are transferred to the buyer. This may be necessary to defend malpractice claims, if a health insurer or plan wants to perform a post payment audit, etc.
The identity of the records that are being transferred to the buyer and those that you are retaining must be clearly set forth. Identification should be made by patient name, date of service or both.
records and the buyer wants some conthe length of time the buyer may do so should be expressly stated.
Transfer The buyer should not have the open ended right to require you to transfer
Notice
copies of medical records at any time it
All patients (active and inactive) should receive a notice that you are retiring and that your practice is being sold. This notice should also include where the patient’s medical record will be kept and who the patient should contact to obtain a copy. Buyer’s usually accept this responsibility because they want the opportunity to contact the seller’s patients to insure the relationship is maintained.
chooses. Instead, the circumstances (e.g. the patient scheduling an appointment, notice of a billing audit being received,
DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL
etc.) allowing the buyer to require you to retrieve, copy and transfer records should be expressly stated. The amount of time you have to comply with a request and liability for any costs associated with the transfer should also be spelled out.
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MDHHS UPDATE
Immunization Disparities in Michigan Children By Rachel Potter, DVM, MS and Cristi Bramer, MPH Division of Immunization, Michigan Department of Health and Human Services
Health equity has been described as the principle underlying a commitment to eliminate, or at least reduce, health disparities.1 Health disparities, as defined by Healthy People 2020, are “… a particular type of health difference that is closely linked with economic,
The National Immunization Survey-Child (NIS-Child)
T
he National Immunization SurveyChild (NIS-Child) is a telephone survey of parents or guardians of children aged 19 through 35 months in the United States from whom sociodemographic, health insurance, and vaccination information are gathered. An additional survey is mailed to the respondent’s vaccination provider to collect dates and types of all administered vaccines. The NIS-Child allows us to assess health disparities in immunization coverage nationally and in Michigan.
Health disparities identified by the most recent 2016 NIS-Child were consistent with previous years:
Coverage in the United States for most vaccines was lower among black children compared with white children, children living below the federal poverty level compared to children living at or above the poverty level, and children who were uninsured or covered by Medicaid compared to children with private insurance.
NIS-Child coverage estimates for Michigan also identified statistically significant disparities in immunization coverage, for example:
social, or environmental
Children living below the poverty level have lower coverage than children living at or above the poverty level:
disadvantage.”2
• 73.3% (+/- 12.7) have received 4 or more DTaP vaccines compared to 90.9% (+/- 4.7). • 67.4% (+/- 13.8) have received 4 or more pneumococcal conjugate (PCV) vaccines compared to 89.0% (+/- 5.7). • 48.6% (+/- 14.6) have received the full series of rotavirus vaccines (either 2 or 3 doses, depending on product administered) compared to 86.2% (+/- 6.1). 55.8% (+/- 12.7) of children living in an MSA central city had completed the 4313314 vaccination series (4 DTaP, 3 Polio, 1 MMR, Hib full series [3 or 4 doses], 3 HepB, 1 Varicella, and 4 PCV) compared to 84.9% (+/- 7.7) of children living in an MSA non-central city.
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Michigan Care Improvement Registry Michigan Care Improvement Registry (MCIR) data also show disparities by maternal race (Figure 1). Immunization coverage among children whose mother is black is consistently lower than coverage among children of white, American Indian and Asian/Pacific islander mothers. These disparities quantitate our distance from health equity and indicate that the immunization safety net in the U.S. and
Michigan is not reaching all children. An important component of the immunization safety net is the Vaccines for Children (VFC) program. There are over 1,250 VFC providers throughout Michigan that provide free vaccine to uninsured, under-insured, Native American and Medicaid-eligible children who would otherwise have less access to these important vaccines.
Help us address these disparities by becoming a VFC provider (www.michigan. gov/vfc) or ensure you know the VFC providers in your area. Your Local Health Department is also a good resource on the VFC program and methods to address disparities in your community. The MDHHS Division of Immunization has applied for a funding opportunity that would allow us to better understand the knowledges, beliefs, and challenges among parents in poverty that create the observed disparity. We look forward to working with you to understand and improve immunization disparities in Michigan. REFERENCES: 1 Braveman P, What are Health Disparities and Health Equity? We need to be Clear. Public Health Rep. (2014); 129(S2):5-8. 2 HealthyPeople.gov. Disparities [cited 2012 Nov 20] Available from: URL: http://www.healthypeople.gov/2020/about/disparitiesAbout.aspx.
Figure 1: 4313314 Vaccination Coverage Among Children 19 through 35 Months by Mother's Race, MI, MCIR, 6/30/13 - 12/31/17
3 Hill HA, Elam-Evans LD, Yankey D, Singleton JA, Kang Y. Vaccination Coverage Among Children Aged 19–35 Months — United States, 2016. MMWR (2017);66:1171–1177.
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ASK HUMAN RESOURCES
Quality Interview Questions Improve Hiring Outcomes By Jodi Schafer, SPHR, SHRM-SCP
Q:
I find the interview process is such a challenge. I hire the people I think will do the best job based upon an interview, but I never really know how she or he will actually perform. Everyone I interview tells me that they work hard, are organized and are dedicated. Yet, after I hire them they rarely live up to their claims. What can I do to make my interview questions more productive?
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The goal of an interview is to determine if a person has the ability to do the job AND if this person will be a good fit for your practice. There are several things you can do to make an interview more successful, but a lot of it hinges on the questions you ask. It is important to include a mix of fact-based questions, behavioral questions and scenario questions. I’ll give you an example of each of these to get you started.
Fact-based Questions A fact-based question typically has to do with something a person has listed on their resume. So, you might say:
Tell me about your most recent position and why you are no longer employed there… or
What was your process for collecting payments and following up on outstanding balances? Fact-based questions are very specific and provide information that is verifiable.
Behavioral and Scenario Questions Behavioral and scenario questions provide insight into how a person thinks by asking:
What would you do if… or
What have you done when…
The answers to these questions are more difficult to prove, but if you ask enough of them you can look for patterns in the answers. A common scenario question might be…
If a patient called and was upset about a recent procedure that I (the doctor) had performed and I wasn’t available to take the call, what would you do/say to the patient? The candidate’s ability to provide exact language, show empathy and compassion, extract details that would be helpful for the return call, etc. are the difference between a good answer and a great answer.
The interview process should be a twoway discussion; a conversation with someone you just met. If you make them feel comfortable, they will open up to you more. The more they talk, the more you learn about them and the better your chance of making a good hire. The hiring process is essentially hit or miss. You are making major decisions based upon limited information; yet, if you ask the right questions you can increase the size of the target—giving you a better chance of hitting it!
Regardless of question type, be sure to prepare your interview questions in advance. Design the questions to help you determine if the person can do the work AND has the right personality for the job.
Asking unorthodox questions can help you assess personality and gain insight from the answers given. You might ask: What do you do for fun? This can give you a treasure trove of information. Do they like to be alone or with others? Is what they do active or sedentary? Are they involved with team sports? Do they like to be indoors or outdoors? Do they like to go to the casino? There is no right or wrong answer, yet it opens up room for conversation and allows for a person’s true passion to shine through.
What do you like to read and what are you currently reading? This will give insight as to their initiative. People who read regularly, no matter what the material, generally are more intelligent. If they tell you they don’t have time to read, you may want to ask how they are going to be able to stay current on the job. There is rarely a job that does not require a person to have some up-to-date knowledge.
Are you an active member of a local professional organization? Which one and how do you participate? This question assesses professional drive. Do they take a proactive approach to their own professional growth and development or do they view their role as just another job?
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HEALTH CARE DELIVERY
Comparing AMA and MSMS Data on Prior Authorization By Stacey Hettiger
As a mechanism for health plans to control costs, Prior Authorization (PA) requires providers to obtain approval before performing a service to qualify for payment. Health insurers frequently require prior authorization for pharmaceuticals, durable medical equipment and medical services. The inefficiency and lack of transparency associated with prior authorization costs physician practices time and money. The lengthy processes may also have negative consequences for patient outcomes when treatment is denied or delayed.
On the following pages is a comparison of data collected through recent surveys administered by American Medical Association (AMA) and Michigan State Medical Society (MSMS).
AMA Survey Methodology
MSMS Survey Methodology
• 24-question, web-based survey administered in December 2016
• 12-question, web-based survey administered in July 2017
• Sample of 1000 practicing physicians drawn from M3 panel
• Sample of 600 Michigan physicians drawn from MSMS members and non-members
• 40% primary care physicians / 60% specialists
• 30% primary care physicians / 70% specialists
2016 AMA Prior Authorization Physician Sur Survey Methodology • Sample screened to ensure that all participating
physicians: • 24-question, web-based survey administered – Are currently practicing in the United States 2016 –December Provide 20+ hours of patient care per week • –Sample Complete of PAs1000 duringpracticing a typical practice week physicians drawn from
M3 panel
• 40% primary care physicians/60% specialists
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Physician Perspective on PA Burd
• Sample refined to ensure that all participating physicians are currently in active practice in in Michigan Question: How would you describe
• Sample screened to ensure that all participating
the bu associated with PA for the physicians and s practice?
6%
”In the last week, how long on average did your practice need to wait for a PA decision from health plans?“
Average Waiting Time for PA Responses AMA
MSMS
7% 3%
Less than 1 hour
A few hours
6%
15%
11% 8%
More than a few hours, less than 1 business day
33% 35%
1-2 business days
20% 22%
3-5 business days
6%
More than 5 business days
Nearly 75% report waiting at least 1 business day. 38% report waiting at least 3 business days.
16%
7% 10%
Don’t know
0
20
40
60
80
100
PERCENT OF RESPONDENTS
Physician Perspective on PA Burdens
”How would you describe the burden associated with PA for the physicians and staff in your practice?“
6% 75%
■ Low or extremely low ■ Neither high nor low ■ High or extremely high
18%
92%
3% 5%
■ Low or extremely low ■ Neither high nor low ■ High or extremely high
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”For those patients whose treatment requires PA, how often does this process delay access to necessary care?“
Care Delays Associated with PA AMA
MSMS
1% 3%
Don’t know
44%
Often or always
90% AMA 94% MSMS
24%
and
46%
Sometimes
report care delays
70% 1%
Never or rarely
3% 0
20
40
60
80
100
PERCENT OF RESPONDENTS
PA Staffing Burdens
2% Don’t Know ”Do you have staff members who work exclusively on PAs?“
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3% Don’t Know
Yes 34% No 64%
Yes 38% No 59%
Welcome New Members Barry
Kalamazoo
Saginaw
William Sanders, DO
Glenn Dregansky, DO
Kristi Murphy, MD
Clinton
Kent
Angela Pinheiro, MD, JD
Joseph Drumm, DO
Genesee
Livingston
Theodore Fellenbaum, MD
Rajan Krishnan, MD
Manar Hammoud, MD Zouheir Fares, DO
Macomb
Jagdish Mirchandani, MD
Vasilis Pozios, MD
David Fernandez, MD
Gogebic Christopher Pogliano, MD
Grand Traverse Cyrus Ghaemi, DO
Oakland Despina Walsworth, MD
Arvind Patel, MD Adam Cote, DO
St. Clair Suzanne Ross, MD
Washtenaw Sarina Meikle, MD
Wayne Oronde White, MD
Phillip Kraft, MD Harvey Ager, MD Marian Ibrahim, MD
Kathryn Krezoski-Evans, DO
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FEATURE STORY
A top issue affecting Michigan health care
Pictured: Dr. Mary Marshall
Opaque. Arbitrary. Capricious. The red tape and bureaucracy health insurance companies force medical practices to navigate to secure prior authorization to access life and health saving medicines, treatments, and equipment for their patients engender anything but warm feelings from Michigan’s physician community. 16 michigan MEDICINE
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Prior authorization requirements frustrate providers, exasperate patients, and slam practices nationwide with billions in compliance costs annually. Worse, it’s the kind of red tape that delays critical treatment for thousands of patients daily, drives patients away from medicines that work toward lower cost, less effective alternatives, and produces poorer health outcomes. It's a system that’s negatively impacting patients’ well-being, and one physician organizations and reformers are working harder than ever to change.
What is Prior Authorization? Depends Who You Ask.
T
o hear health insurers tell it, prior authorization is simply a process used to ensure medicines, treatments, and therapies are safe and appropriate for individual patients. Physicians and medical societies like the Michigan State Medical Society and the American Medical Association are quick to point out, though, that patient safety is hardly health insurers’ primary focus.
The bottom line for insurance companies is cost, says Doctor Mary Marshall, a family physician from Grand Blanc, and the President-elect of the Michigan Academy of Family Physicians. What they don’t look at is the personal side of it. Physicians and practice managers understand all too well how the system works. A patient comes to the office for treatment. The physician examines the patient and wants to prescribe a medicine, perform a treatment, or set the patient up with new medical equipment. But, there’s a catch. The patient’s insurance company very often requires physicians to obtain prior authorization before the insurer agrees to cover the cost of the medicine or treatment. The more expensive (and, often more effective) the medicine or treatment, the more likely the insurer will require prior authorization. That sets physicians and their staffs off on a sometimes dizzying quest navigating prior authorization requirements that differ from insurer to insurer, and worse, inside each insurer from product and plan to product and plan. Checking formularies, moving through step therapies, finding the right forms, chronicling the patient’s medical history for insurance company bureaucrats, printing and filling out paperwork, sending faxes—sometimes to learn that the authorization was denied, leading to a far-too-lengthy appeals process. Erin Bishop is the Revenue Cycle Manager at Associated Retinal Consultants (ARC), a practice employing 19 physicians at 16 locations across the state of Michigan. She sees every day how difficult the process can be for physicians and their patients. (continued on page 18)
“The bottom line for insurance companies is cost. What they don’t look at is the personal side of it. We want patients to be encouraged and engaged in their health care. We don’t want this to be a challenge. They have enough challenges already.” MARY MARSHALL, MD
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When we work with fifty-plus payers, it takes a whole position itself just to go through their sites on a monthly basis to see if their policies have changed. For some insurers, it’s virtually impossible to find out what’s covered and what isn’t. Some payers don’t have forms, and many won’t let you do the request online. It’s a system that seems explicitly designed to delay care and payment, but for many patients, that’s just not possible. If our physicians have to do a laser to repair a retinal tear, the patient needs to have that procedure today, says Beverly Zwicker, the Credentialing and Contracting Specialist at ARC. You can’t let things like that go. Doctor Marshall is familiar with that frustration, and with the harm it can cause patients. It’s quite interesting how much control insurance companies have over what medications the patient gets, said Doctor Marshall. That’s not good for patients. It’s not fair. Switching medicines, even generic for generic, there can be a 30 percent difference in efficacy. We want patients to be encouraged and engaged in their health care. We don’t want this to be a challenge. They have enough challenges already. The numbers, though, say prior authorization requirements are becoming a bigger challenge than ever.
Trending Up – PA Requirements are On the Rise
A
40. Similarly, 47 percent of respondents submit more than 10 PA requests for medical services – labs, procedures, medical equipment, imaging, etc. – with more than 13 percent submitting 40 or more weekly.
ccording to a 2017 poll by the Medical Group Management Association, 86 percent of physicians nationwide said that the number of prior authorization requests demanded by health insurers had increased over the previous year. That number was four points higher than the result of the same poll taken in 2016.
With each request taking anywhere from an hour to four hours of staff time to complete, the time and expense connected to this singular task can add up fast. Thirty-five percent of practices reported spending 11 or more hours weekly simply processing prior authorizations. Glenn Dregansky, DO, is the the program director for the Family Medicine residency at Western Michigan University Homer Stryker M.D. School of Medicine. He’s familiar with the impact of insurers’ prior authorization requirements as both a family physician and as an academic training Michigan’s next generation of providers. He doesn’t mince words.
Closer to home, the Michigan State Medical Society in 2017 conducted a large-scale statewide survey on the impact of prior authorization. MSMS spoke with roughly 600 physicians – both primary care and specialists, from huge multi-site practices and hospitals to rural solo practiof practices tioners – from one corner of the state to the next, and the reported spending results paint a startling picture 11 or more hours about the negative impact of weekly simply prior authorization on Michigan patients. processing prior
35%
Prior authorization is the bane of existence of the primary care doc because we have to devote so much effort to meet the requirements of third party payers if we are going to serve our patients, he says.
authorizations. More than 91 percent of physicians surveyed by MSMS described the burden associated with prior The rules are not clear, each insurer has a authorization on staff and physicians as high different process, and physicians are left in or extremely high. the dark. ‘No, you can’t do that test.’ Why not? ‘It doesn’t meet the criteria. What are Forty-six percent of respondents said they’re the criteria? ‘We can’t tell you.’ submitting more than 10 prescription Often times, patients don’t get the care. If medication prior authorization requests per you give up, the insurance company gets week, with 11 percent submitting more than money, and the patient doesn’t get care. Cost is a driver in all of this. It has become increasingly clear that insurers aren’t the only ones who benefit at patients’ expense. Pharmacy Benefit Managers, or PBMs, have fallen under growing scrutiny for their role in the process, with many physicians quick to identify them as culprits behind formulary changes. The way the health plans determine their formularies is most often their contractual relationships with their PBMs, says Doctor Dregansky. Formularies differ from plan to plan to plan, based on the insurer’s contractual relationship with their PBM. Every health plan has their own formulary based on those contracts.
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“Why not just get rid of the whole layer, recognizing most prior authorization requests are approved anyways? Everyone, especially patients, will be happier. And healthier. IRENDE KAZMERS, MD
PBMs are drug pricing middlemen who critics claim artificially inflate the cost of drugs. They negotiate purchases from pharmaceutical companies, then turn around and facilitate the sale of the medicine to pharmacists and, eventually, patients.
authorization at one physician hour per week, 13.1 nursing hours per week, and another 6.3 clerical hours weekly. Prior authorization grinds doctors into dust because it’s not why we went into medicine, Doctor Dregansky said.
The process may be doing By negotiating copay prices worse to patients. with health insurance companies, and telling pharThirty-eight percent of responmacies how much they will dents to the MSMS survey report that long reimburse for medications, report their practice waits, on PA processes are average, three or more business they have a tremendous amount of influence over the to blame for some days just to get an answer for cost of prescription drugs. a prior authorization request. patients simply The result is a system deIn the meantime, patients get signed to incentivize insurers abandoning thier sicker and more frustrated, to push patients towards lowtreatment. their conditions progress, and er cost generics, where PBMs their fuses get shorter. generate huge profits – and scandal. That’s in keeping with brand new numbers Many of the prices PBMs negotiate are published this spring by the AMA, showsignificantly higher than the actual price of ing prior authorization contributing to an the medicine being prescribed to patients. astounding 92 percent of care delays. RePBMs use a process called a clawback to searchers found nearly every provider delay pocket the difference in the inflated price. in the United States is associated with inThe pricing practice has led to class action efficiencies and administrative issues with lawsuits across the United States, and an the current prior authorization process. outcry from patients, pharmacists, and
78%
physicians.
Prior authorization mandates are a big part of that process, with patients and their physicians paying the price.
The Impact – Sicker Patients, Exasperated Physicians The American Medical Association cites a 2011 study indicating that interactions with insurers cost practices a staggering $82,975 annually – per physician. Additional estimates peg the costs of prior
Not surprisingly, these delays too often have a devastating impact on patient care. Sixty-one percent of providers believe PA requirements create significant negative health outcomes, and 78 percent report that long PA processes are to blame for some patients simply abandoning their treatments. Health insurers have created a nightmarish perpetual motion process where insurance companies institute prior authorization requirements to drive down spending, leading patients to get sicker or abandon care, worsening health care needs and driving up costs, leading to even more prior authorization requests. Patients just want to get off the hamster wheel and get better.
The Fight for Reform So what’s the answer? Physicians believe prior authorization has outlived its always dubious usefulness – most would like to see the entire process go away. Why not just get rid of the whole layer, recognizing most prior authorization requests are approved anyways, asks Irene Kazmers, MD, a Northern Michigan rheumatologist and member of the Michigan State Medical Society Liaison Committee with Third Party Payers. Everyone, especially patients, will be happier. And healthier. We looked at two months of treatments, and 95 percent of our prior authorization requests were approved at the end of the day – sometimes after three or four appeals, says Doctor Kazmers. Unfortunately, that process can take weeks, or sometimes months. We prescribe these medications because our patients need them for their care. We follow established expert guidelines as to when they are indicated. The bureaucratic delays inherent to the cumbersome prior authorization process cause prolongation of our patients’ pain and suffering and leaves them vulnerable to permanent joint and in some cases organ damage that could have been avoided had the recommended medication been accessed at the time it was ordered by the care provider. Health insurers don’t appear in any hurry to change. That’s led reformers in Washington, D.C. and in states across the nation to spearhead reform efforts designed to rein in costs, simplify paperwork and eliminate bureaucratic hurdles that keep patients from the treatment they need. In 2013, Michigan lawmakers took one step, enacting legislation creating a universal prior authorization form to replace roughly 1,000 pages of duplicative forms that varied from one insurance product and plan to the next. The reform was the result of months of work by MSMS physician leaders, staff, and government affairs team members, and a broad coalition of physicians and health provider organizations. It demonstrated both how effective physicians can be when they work together, and at the (continued on page 20) MAY / JUNE 2018 |
michigan MEDICINE 19
same time, how difficult it can be in state government to secure even the most common-sense reforms. Other states are picking up the reform banner, too. Some have required insurers to abandon the fax machine and implement electronic prior authorizations. Lawmakers in Arkansas, Delaware, Ohio, Virginia, and Washington have instituted state mandates that insurers respond within 48 hours to prior authorization requests regarding urgent care. The American Medical Association recently published a set of 21 Prior Authorization and Utilization Management Reform Principles designed to put patients first. They serve as a map for reformers in the industry and in halls of power who want to ensure patients have timely access to treatment, while reducing administrative costs to the health care system. Ensuring the clinical validity of PA requests. Steps to ensure continuity of care. Transparency and fairness reforms. Moves to guarantee timely access and administrative efficiency for practice compliance staff, and establishing alternatives and exemptions for physicians who do their jobs well. A couple of principles may get us out of this problem, says Doctor Dregansky. One is consistency, and the other is transparency. If doctors know the rules and can find the rules, they’ll follow the rules.
There are three approaches that can help move the ball down the field towards that ultimate reform goal. Talk to the health insurers, partner with other physicians through specialty societies and MSMS to amplify your voice, and then talk directly to your state lawmakers. JULIE NOVAK, MSMS
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”A couple of principles may get us out of this problem. One is consistency, and the other is transparency. If doctors know the rules and can find the rules, they’ll follow the rules. GLENN DREGANSKY, DO
Reformers have their work cut out for them. Tackling a problem this size is never easy, but that doesn’t mean it’s impossible, says Julie Novak, CEO, Michigan State Medical Society. There are three approaches that can help move the ball down the field towards that ultimate reform goal. Talk to the health insurers, partner with other physicians through specialty societies and MSMS to amplify your voice, and then talk directly to your state lawmakers.
Those experiences – and your expertise – matter. Nearly every day the legislature is in session, a lawmaker in Lansing introduces a piece of legislation because someone in his or her district approached their office with a concern, out says Novak.
Reach to MSMS... for tips and solutions to many common PA-related problems.
Prior authorization almost always creates an adversarial situation between physicians and insurance companies. It can be easy in situations like those to forget that every step providers are taking in the process requires a corresponding step by insurers.
As easy as it is to be cynical about politics, the truth is state Senators and Representatives value your input, and they’re constantly looking for opportunities to make a dent for their constituents. Talk to them.
Physicians who may worry about interacting with lawmakers, or how to refine and focus their own experiences into a call for change can also find help through MSMS, its staff and partners.
If a physician or staff at the practice identify an opportunity to simplify or improve a process, or spot a mistake or a broken website, share those things with the insurer, advise watchdogs. Admittedly, common ground won’t typically be easy to find.
In the meantime, open and proactive communication with patients remains essential. Walking them through the process, explaining delays, and directing them to the right resources won’t make the problem go away, but it can make it a little less harmful.
That’s why organizations like MSMS are so important. By banding together and speaking with a unified voice, doctors are able to tackle bigger problems more efficiently. MSMS also employ industry leading experts whose job it is to help with everything from simplifying your paperwork process to leveraging your experiences in a massive legislative push.
The Michigan Department of Insurance and Financial Services also offers patients a direct link to share their complaints and problems with health insurers. Physicians are advised to make that link available to their patients. Let them know they have allies in their health care journey, and that there’s no one who cares more about their well-being than their physician.
Reach out to the MSMS. Their staff work every day helping practices navigate the prior authorization process, and they have experience, tips, and solutions to many common PA-related problems.
[=]
SOLID ADVICE.
REAL SOLUTIONS. FOR HEALTH CARE BUSINESS.
At The Health Law Partners, our unparalleled knowledge of the business of health care is coupled with timely, practical solutions designed to maximize value. The HLP attorneys represent clients in substantially all areas of health law, with particular emphasis on: • Licensure & Staff Privilege Matters • Health Care Litigation • Health Care Investigations • Civil & Criminal False Claims Defense • Stark, Anti-Kickback, Fraud & Abuse, and Other Regulatory Analyses • Physician Group Practice Ancillary Services Integration and Contractual Joint Ventures • Appeals of RAC, Medicare, Medicaid and Other Third Party Payor Claim Denials and Overpayment Demands • Health Care Contractual, Corporate, and Transactional Matters • Compliance & HIPAA
TheHLP.com [284.996.8510] MAY / JUNE 2018 |
michigan MEDICINE 21
Study Shows Nurse Practitioners and Physicans Face Similar Liability Risks By David B. Troxel, MD, Medical Director, The Doctors Company
The Doctors Company analyzed 67 claims—written demands for payment—against nurse practitioners (NPs) that closed over a six-year period from January 2011 through December 2016.
T
hese claims arose in family medicine (FM) and internal medicine (IM) practices. To provide context, we compared the NP claims with 1,358 FM and IM claims against physicians that closed during the same time period. If a claim was against both the FM or IM physician and the NP, we eliminated it from this study to avoid counting the same claim twice.
We included cases that closed within the study’s time frame regardless of how the claim or suit was resolved. This approach helped us to better understand what motivates patients to pursue claims and to gain a broader overview of the system failures and processes that resulted in patient harm. Our approach to studying these malpractice claims began by reviewing plaintiffs’/ patients’ allegations, giving insights into the perspectives and motivations for filing claims and lawsuits. We then looked at patients’ injuries to understand the full scope of harm. Physician and nurse practitioner experts for both the plaintiffs/patients and the defendants/nurse practitioners/physi-
22 michigan MEDICINE
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cians reviewed claims and conducted medical record reviews. Our clinical analysts drew from these sources to gain an accurate and unbiased understanding of the events that lead to actual patient injuries. Nurse practitioner or physician reviewers evaluated each claim to determine whether the standard of care was met. The factors that contributed to claims included clinical judgment, patient factors, communication, clinical systems, clinical environments, and documentation. Our team studied all aspects of the claims and, using benchmarked data, identified risk mitigation strategies that nurse practitioners and their physician partners can
use to decrease the risks of injury, thereby improving the quality of care. When NPs worked in FM and IM practices, the three most common claim allegations against NPs accounted for 88 percent of their total claim allegations. The top three allegations in claims filed against FMs and IM physicians accounted for 89 percent of their total claim allegations. The diagnosis- and medication-related allegation percentages were similar for both NPs and primary care physicians, while medical treatment–related allegations were more common for primary care physicians (see FIGURE 1). The small number of NP claims may lack statistical significance.
Contributed by The Doctors Company. For more information about the Nurse Practitioner Closed Claims Study, go to www.thedoctors.com/NPstudy. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
LIABILITY RISKS MAY / JUNE 2018 |
michigan MEDICINE 23
Educational Offerings MSMS On-Demand Webinars Webinars Offering CME: Balancing Pain Management and Prescription Medication Abuse: Chronic Pain and Addiction* CDL-Medical Examiner Course
FREE CME Webinars: Choosing Wisely Part 1 - Stewards of our Health Care Resources Choosing Wisely Part 2 - Change Strategies to Implement Choosing Wisely
From Physician to Physician Leader
Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities
HEDIS Best Practices
In Search of Joy in Practice: Innovations in Patient Centered Care
HIPPA Security and Meaningful Use Compliance Human Trafficking* Inter-professionalism: Cultivating Collaboration MACRA Series
Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media
— Key Things You Should Know About MACRA
— Roadmap for Getting Started
— MACRA: Alignment Strategy
— The Role of Documentation
Michigan Automated Prescription System (MAPS) Update (part of the Pain and Symptom Management Series) *
— Technology Survival Tips to Tackle MACRA
Section 1557: Anti-Discrimination Obligations
— Using QCDR as the Path to Change
Understanding and Preventing Identity Theft in Your Practice
— Navigating Need to Know Resources
— MACRA – Really? The Reasons Why
— MACRA’s Quality Payment Program: Highlights for 2018 Medical Ethics – Conscientious Objection among Physicians* Opioids and Michigan Workers' Compensation Webinar Patient Portals as a Tool for Patient Engagement Pain and Symptom Management Series*
MAPS Update and Opportunities (part of the Pain and Symptom Management Series) *
Coding and Billing Webinars Billing 101 Claim Appeals Complete Coding Updates for 2018 Compliance in the Office Credentialing
— Pain and Opioid Management 2017*
— The CDC Guidelines*
— Treatment of Opioid Dependence*
ICD-10 What We Have Learned & What We Need to Know
— The Role of the Laboratory in Toxicology and Drug Testing*
Managing Accounts Receivable
ICD-10 for 2017 & Routine Waiver of Co-pays
Physician Online Rating and Reviews: Do's and Don'ts
Reading Remittance Advice
Preparing for the Medicare Physician Value-Based Payment Modifier
Tips and Tricks on Working Rejections
What's New in Labor and Employment Law
Year-End Wrap Up
*Fulfills Board of Medicine Requirement
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Visit www.msms.org/OnDemand for complete listing of On-Demand Webinars. Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.
Educational Conferences – REGISTER TODAY! Spring Scientific Meeting
153rd Annual MSMS Scientific Meeting
Morning, afternoon and evening clinical courses available
Morning, afternoon and evening clinical courses available.
Date: Thursday, May 17 and Friday, May 18
Date: Wednesday, October 24 - Saturday, October 27
Location: DoubleTree Hotel, Dearborn
Location: Sheraton Detroit Novi Hotel, Novi
Note: Continental breakfast and lunch will be provided
Note: Continental breakfast and lunch will be provided.
Intended for: Physicians and all other health care professionals
Intended for: Physicians and all other health care professionals
Contact: Marianne Ben-Hamza 517/336-7581 or mbenhamza@msms.org
Contact: Marianne Ben-Hamza 517/336-7581 or mbenhamza@msms.org
A Day of Board of Medicine Renewal Requirements
22nd Annual Conference on Bioethics
Date: Wednesday, October 3
Date: Saturday, November 10
Time: 9:00 am – 2:45 pm
Time: 9:00 am – 4:30 pm
Location: MSMS Headquarters, East Lansing
Location: Holiday Inn, Ann Arbor
Note: Continental breakfast and lunch will be provided
Note: Continental breakfast and lunch will be provided
Intended for: Physicians, resident, students and
Intended for: Physicians, bioethicists, residents, students,
other health care professionals
other health care professionals, and all individuals interested in bioethical issues
Contact: Caryl Markzon 517/336-7575 or cmarkzon@msms.org
Contact: Caryl Markzon at 517/336-5755 or cmarkzon@msms.org
Visit www.msms.org/OnDemand for complete listing of On-Demand Webinars. Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.
MAY / JUNE 2018 |
michigan MEDICINE 25
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Websites and Online Marketing Solutions for Healthcare Practices
Taylor/Dearborn Heights Area Family Practice Retiring physician wishes to sell family practice and building. Nearly 4000 sq.ft., 7 exam rooms, and a second suite for renters. Set up for multiple physicians. Priced to sell. Good visible brick building on high traffic road, edge of high population area. New listing, call for details. Two Suites in Royal Oak/Madison Heights, on Woodward! Multiple tenants in medical practices within building. Great location for specialist with potential for referrals. Leases are competitive. Two Podiatry Practices - MD Owned Provides good income to owner, has DPM and staff hired who will stay because of good business/income. If you do not buy it, either or both practices, perhaps you have friends or family that have a DPM degree. Lots of possibilities and good cash flow. Sterling Heights/Dearborn. URGENT CARE - Walk in Family Practice in Rochester Est. in 2000 needs quick sale. Health issues, family member, urges MD owner to sell short and sell fast. Industrial Medicine contracts included in sale, 3-6 months of transition. All equipment and Patient Records. Under $100,000 and open for offers. Potential to get right back into 1M gross. Sterling Heights Podiatry Practice Successful but doctor has two others! Nice office, location and patients but the other two are closer together. Priced under $80K and seller will finance. CLEAN Home Health Care License Open to offers. Cheap! Did over $400K in 2017. Dearborn General Practice Less than $10K! Right now, it is 2-3 days per week with 12-15 patients per day as retiring owner wishes not to grow. You could get it so cheap and, with a few more office hours, build it into a nice second income or a starter practice with a head start! All you have to do is lease the suite. Lease Opportunity Garden City Family Practice doing a big 7 day business has a private entrance suite to lease. Put your Specialty Practice in there, then don’t be surprised by the amount of referrals. Cardiology, Urology, Ob/GYN, Podiatry, Dental, Pain, etc. 2000ft. at $2500 gross. Must see. Near BUSY intersection, plenty of parking. ENT Office Practice to Boarded ENT - Continue the Lease Pick up patients, mostly hearing problems, for a 2nd office or part time income. The MD owner has realized he should have retired years ago. NP and Audiologist available. Glad to discuss details with interested party.
Looking for Part time/Full time Work as a Provider? Different locations available. Call Joe Zrenchik.
Joe Zrenchik, Broker 248-240-2141 (cell) • 734-808-0147 (eFax) bestdoctors@yahoo.com 248-919-0037(office) www.michiganmedicalpractices.com Thinking about retirement, relocation or expansion of your medical practice? We have buyers and sellers for primary care, internal medicine and cardiology practices.
MAY / JUNE 2018 |
michigan MEDICINE 27
In Memoriam
MEMBERS OF THE MICHIGAN STATE MEDICAL SOCIETY REMEMBER THEIR COLLEAGUES WHO HAVE DIED.
DOROTHY M. KAHKONEN, MD WAYNE COUNTY MEDICAL SOCIETY 2/24/18 JAMES A. GUNN, MD KENT COUNTY MEDICAL SOCIETY 2/24/18 JEAN M. MALOUIN, MD WASHTENAW COUNTY MEDICAL SOCIETY 3/10/18 ROBERT D. ALLABEN, MD WAYNE COUNTY MEDICAL SOCIETY 3/15/18
x TO MAKE A GIFT OR BEQUEST, CONTACT: REBECCA BLAKE, DIRECTOR, MSMS FOUNDATION 517-336-5729 OR EMAIL RBLAKE@MSMS.ORG
RUDI ANSBACHER , MD WASHTENAW COUNTY MEDICAL SOCIETY | 1/3/2018 Rudi Ansbacher, MD, earned his degree from the University of Virginia School of Medicine in 1959, and his MS degree from the University of Michigan in 1970. Throughout his career, he was committed to training female faculty members and preparing them for leadership positions. In 2014, the University of Michigan Medical School established the Rudi Ansbacher Women in Academic Medicine Leadership Program to accelerate the development of women in senior positions in academic medicine and health care. Doctor Ansbacher was very involved with the Michigan State Medical Society. He served as a member of the MSMS Board of Directors, serving from 1996 to 2005 as one of the District 14 Directors, from 2001-2003 as the Chair of the Scientific and Educational Affairs Board Committee, and from 2005-2006 as the Board Secretary. Doctor Ansbacher also served several years as a member of the MSMS Foundation Board of Directors. He was actively involved as a Delegate for the MSMS House of Delegates, representing Washtenaw county and served on several MSMS committees throughout his involvement. Doctor Ansbacher also served as Chair of the Physician Review Organization Board, a partner of MSMS.
FOR SOME OF OUR MOST ELITE SOLDIERS, THIS IS THE THEATER OF OPERATIONS. Becoming an emergency physician and officer on the U.S. Army health care team is an opportunity like no other. You can build a distinguished medical career by diagnosing and treating illnesses and injuries that require immediate attention. With this specialized team, you will be a leader – not just of Soldiers, but in critical health care. See the benefits of being an Army medical professional at healthcare.goarmy.com /kd60
For more information, call 313 - 441 - 1673, or visit healthcare.goarmy.com/kd60
©2016. Paid for by the United States Army. All rights reserved.
28 michigan MEDICINE
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MSMS Medical Opportunities msms.medopps.org
msms.medopps.org
Multiple opportunities at…
Behavioral Health Highlights
Henry Ford Allegiance Health
• Outpatient (Geriatrics, Child/Adolescent, Adult)
Jackson, MI
• Partial day programs (Intensive outpatient program) http://www.allegiancehealth.org/ services/behavioral-health/services/partialhospitalization-program
ID# 1007 - Rheumatology Physician MSMS Medical Opportunities has been connecting physicians with employers since 1944. It is a nonprofit program through the Michigan Health Council designed to simplify your job search by posting jobs that match your practice preferences. Learn more at msms.medopps.org.
ID# 4075 - Family Medicine Physician ID# 9888 - ENT Physician ID# 13333 - Infectious Disease Physician ID# 11775 - Behavioral Health Physician
Multiple opportunities at…
Adfinitas Health Marquette, MI
ID# 12100 - Ortho Trauma Surgeon Practice Highlights Henry Ford Allegiance Health partnered with
ID# 12918 - Nocturnist
Henry Ford Health Systems on April 1, 2016.
ID# 12919 - Intensivist
years of service. Henry Ford Allegiance Health
Henry Ford Health Systems just passed their 100 is entering their 100th year. This is very exciting
ID# 12920 - Hospitalist
time for Henry Ford Allegiance Health and our community.
ID# 12921 - Critical Care AP Provider
• Substance Abuse Services We have begun to redesign our behavioral health department now that we are growing rapidly with our GME residency program. We are looking for experienced providers with a strong passion for teaching, or psychiatrists that are looking to be clinical and spending time
Our Emergency room treats over 85,000+ visits annually, with 18,000 admits from those visits and over 13,000 ambulance visits.
supportive environment with an interest in
and managed inpatient group in the Mid-Atlantic
Education of medical students.
Region. We are growing nationally and seeking
Come live, work and play in beautiful South Central Michigan. Jackson is a family oriented community with excellent schools; is in close
Adfinitas Health provides quality care in more
proximity with two Big Ten Universities; and
than 60 Acute and Post-Acute Care facilities
provides affordable housing. Our four-season
centered around providing continuity of care to
climate provides the perfect formula for
our patients and streamlined communication to
unlimited year-round recreational activities.
quality driven programs provide opportunity
• Addiction recovery center http://www. allegiancehealth.org/locations/henry-fordallegiance-addiction-recovery-center
providing excellent customer service and Adfinitas Health is the largest Physician owned
our primary care partners. Our innovative and
• Crisis Assistance
Emergency Room Highlights
high-quality patient care in a welcoming and
our team!
• Neuropsychology (only neuropsychology service in Jackson county) http://www.allegiancehealth. org/locations/henry-ford-allegianceneuropsychology
We seek candidates who share our vision for
Practice Highlights
to add Hospitalist and Post-Acute Providers to
• Inpatient Adult/Geri unit
We are not your average community hospital.
for clinical and leadership education to offer
We are the hidden gem of Jackson and the only
professional growth to our providers.
hospital in Jackson County, with the next smaller hospital being 20 miles north (St. Joes/Chelsea).
We have a Medical ICU, Surgical ICU, CUB (Cardiac Universal Bed), Radiation Oncology, Hematology/ Oncology, Full Service line of Ortho (total joint, hand/wrist, foot/ankle, sports, podiatry), Physiatry (PM&R), Neurology and Neurosurgery Service Lines, OT/PT, Certified Stroke Center, in January 2015 we brought on Interventional Radiology and the summer 2015 we developed a full service line for inpatient Physiatry (PM&R), we have an employed Dermatologist, and Plastic service lines. Compensation Package
Compensation Package
We are the only certified Level II Trauma Center
• BC/BE
Available upon contact with recruiter.
within a 40 mile radius between 94 and 127 HWY.
• Competitive package offered
Hundreds of Job Opportunities Where You Want to Work. Let your next job find you! Visit msms.medopps.org MAY / JUNE 2018 |
michigan MEDICINE 29
Opportunity at…
Opportunity at…
Opportunity at…
Gaylord, Michigan
Eaton Rapids, MI
Jackson, MI
McLaren Medical Group ID# 1271 - Family Medicine Physician
Eaton Rapids Medical Center ID# 13339 - Family Practice Physician
Thome PACE
12946 - Medical Director/Physician
Practice Highlights
Practice Highlights
Practice Highlights
McLaren Northern Michigan is seeking a Family Medicine physician to join 3 well respected providers in a long standing practice serving the Gaylord community . The ideal candidate will enjoy caring for all ages in an office culture offering collegiality and support.
Full Time Family Medicine Position in our rural health clinic. Beautiful new Medical Office Building 2018! Big enough to be of service, but small enough to care.
PACE® is a program that fulfills a wide range of healthcare needs of the elderly within the familiarity and comfort of their own homes and community. Through PACE®, teams of healthcare professionals who specialize in working with the senior community help participants and their family members make positive healthcare decisions and receive the care they deserve.
Lab and x-ray onsite, dedicated staff, flexible scheduling, outpatient practice with quick start up.
Key Qualifications • Board Certification • J1- visa will be considered Compensation Package
Key Qualifications Board Certified / Board Eligible in Family Medicine Compensation Package
• Competitive wages with superior benefit package • Great potential for this position to develop into a leadership role
• Generous salary w/ income guarantee • Robust benefit package
East Jordan Family Health Center Charlevoix County ID# 472 - Family Medicine Physician Practice Highlights Community health center in Charlevoix County. FQHC designation. On site pharmacy, x-ray, mental health counseling, substance abuse counseling, dental services, optometry services, and case managers. Join our 4 person MD/DO team and skilled PA/NP staff. Key Qualifications Board certified family medicine physician. Outpatient practice. Peds to geriatrics. Compensation Package • Competitive salary and benefit package • Loan repayment available • Paid vacation and CME • Enjoy a full-spectrum family medicine practice during the day, and relax on the Jordan River and Lake Charlevoix at night. Very attractive opportunity for a physician who desires to practice medicine in a non-corporate work environment. Join a team of physician's, APP's, and allied health staff who enjoy delivering rural health care to their friends and neighbors.
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• MD or DO • Current State of Michigan License • DEA registration
Opportunity at…
• Experience providing care to the elderly
Marshall, MI
• The Thome PACE Medical Director/ Primary Care Physician will:
Oaklawn Hospital
Opportunity at…
Key Qualifications
ID# 11150 - Internal Medicine Physician Outpatient Practice Highlights Known as the City of Hospitality, Marshall is a quaint family-town with a unique historic downtown. The schools are consistently ranked at the highest levels. Marshall is located at I-69/I-94 making it very accessible to patients and is conveniently located less than an hour from Ann Arbor, Lansing and Kalamazoo.
» provide direction to Thome PACE, related to the medical delivery of care by providers and ensure the delivery of quality health care services. » support and direct Thome PACE medicallyrelated committee work, and responsible for providing direct primary medical care to all participants of the program.
Key Qualifications Medical Doctor (MD) or Doctor of Osteopathic (DO) degree from an accredited medical school. Compensation Package • Competitive base salary plus Physician Compensation Plan • Commencement Loan • Student Debt Allowance • Moving Allowance • CME & expense budget • PTO-Paid Time Off • Health Benefits; Dental; Vision • Hospital employed; work alongside a great support staff and stellar colleagues
Are You An Employer? Add MSMS Med Ops to your list of trusted recruiting resources.
Advancing the practice of good medicine.
NOW AND FOREVER.
ANNOUNCING THE 2018 DIVIDEND FOR MICHIGAN MEMBERS The Doctors Company has returned more than $415 million to our members through our dividend program—and that includes 10% to qualified Michigan members. We’ve always been guided by the belief that the practice of good medicine should be advanced, protected, and rewarded. So when our insured physicians keep patients safe and claims low, we all win. That’s malpractice without the mal.
Join us at thedoctors.com
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