Michigan Medicine®, Volume 118, No. 3

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THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 118 / NO. 3

May / June 2019

msms.org



FEATURES & CONTENTS May / June 2019

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May is Hepatitis Awareness Month STEFANIE COLE, BSN, RN, MPH

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Understanding the Independent Contractor Relationship. Who Qualifies? BY JODI SCHAFER, SPHR, SHRM-SCP

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MSMS Regulatory Advocacy BY STACEY HETTIGER, MSMS

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Wearable Medical Devices Give Abundant Data—and Risks BY MIRANDA FELDE, MHA, CPHRM

COLUMNS 04 President's Perspective

BETTY S. CHU, MD, MBA

06 Ask Our Lawyer

FEATURE

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DANIEL J. SCHULTE, MSMS LEGAL COUNSEL

DEPARTMENTS 22 In Memoriam 28 MSMS Educational Courses 30 Welcome New Members

Fresh Faces on the Frontlines of State Departments Work to Support Physicians BY NICK DELEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY

STAY CONNECTED!

Last November’s elections swept to power a new governor who selected new department directors—each with an important role to play in the way Michigan physicians treat patients. Read more beginning on page 14.

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MICHIGAN MEDICINE® VOL. 118 / NO. 3 Chief Executive Officer JULIE L. NOVAK Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Publication Design STACIA LOVE, REZÜBERANT! INC. rezuberant.com Printing FORESIGHT GROUP staceyt@foresightgroup.net Publication Office Michigan Medicine® 120 West Saginaw 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® Trisha Keast 120 West Saginaw 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 2019 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. ©2019 Michigan State Medical Society

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perspective


By Betty S. Chu, MD, MBA, Michigan State Medical Society President

®

Colleagues, The relationship between a physician and his or her patients is among our nation’s most intimate and important, and it’s influenced by numerous external factors. Here in Michigan, three state departments in particular impact the way physicians practice medicine, keep the lights on and treat patients. The Michigan Department of Health and Human Services (MDHHS), the Department of Licensing and Regulatory Affairs (LARA), and the state Department of Insurance and Financial Services (DIFS) each has a role to play in the ways physicians practice and patients obtain the health care they need. This year, spinning out of last fall’s elections, each also features new leadership. In this edition of Michigan Medicine®, we profile these departments and their new Directors. You’ll learn about some of the specific ways the state interacts with physicians – from partnering to combat the opioid crisis, to Healthy Michigan, physician training, and auto no fault insurance reform. You’ll also get to know the individuals at the helm of each department, and even learn a little bit about the political appointment process. The Michigan State Medical Society and its members – partners like you – are on the ground in Lansing interacting with these departments each day. Helping them understand a physician’s commitment to patients, role and responsibilities in health care couldn’t be more important. We hope you’ll take the chance to get to know the new Directors, learn a little more about what makes them tick, and about the initiatives that impact the way you practice medicine. As I complete my tenure as your President, I’d like to thank the staff at MSMS for their support and all of their efforts on behalf of Michigan’s physicians! It has been a pleasure serving you. I’ve appreciated the opportunity to connect with so many physicians and advocate on behalf of our profession and our patients.

BETTY S. CHU, MD, MBA MSMS PRESIDENT

“In this edition of Michigan Medicine® you’ll learn about some of the specific ways the state interacts with physicians – from partnering to combat the opioid crisis, to Healthy Michigan, physician training, and auto no fault insurance reform.”

Sincerely,

Betty S. Chu, MD, MBA MSMS President

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ASK OUR LAWYER

Physician Self-Regulation By Daniel J. Schulte, J.D., MSMS Legal Counsel

Q:

I have always believed that self-regulation was an important characteristic of any profession. I realize that selfregulation is a part of the medical profession. This includes the voluntary reporting of our own illegal or unethical

conduct and that of our fellow physicians. However, the methods and availability of reporting mechanisms are not well known. Can you advise us of the ways to report illegal and unethical conduct?

What follows is a list of some of the more common mechanisms used by physicians in the self-regulation of the profession. The list is not meant to be complete, instead it sets forth the most common methods of reporting illegal or unethical conduct.

Michigan’s Public Health Code MCL 333.16222(1) requires that a physician having knowledge of another licensed health professional’s violation of the public health code or having committed and act or omission that could be grounds for discipline has a duty to make a report to the Michigan Department of Licensing and Regulatory Affairs (“LARA”). The allegation packet and other information to do so is available on LARA’s website: https://www.michigan.gov/documents/ lara/BPL-LAD-100_523225_7.pdf. The duty to report includes knowledge of any of the grounds for discipline listed in MCL 333.16221 which includes a variety of personal disqualifications (incompetence, substance abuse, a mental or physical inability to practice in a safe manner, conviction of certain felonies and misdemeanors, adverse licensure actions in other jurisdictions, etc.), the commission of prohibited acts (various forms of fraud, false and misleading advertising, etc.), unprofessional conduct, violations of laws applicable to the health professions, etc. This duty to report is subject to only one exception. A physician who learns that another health professional has committed an act requiring reporting as a result of providing physician services to that health professional is prohibited from making disclosure of information learned in the course of that physician-patient relationship.

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MSMS Judicial Commission Section 7 of the MSMS Bylaws and the rules and procedures of the MSMS Judicial Commission establish a mechanism for the reporting, investigation and potential discipline of members who violate the Principals of Medical Ethics of the American Medical Association, engage in unprofessional or dishonest conduct as proscribed by Michigan’s Public Health Code, commit a felony or violate or disregard the MSMS Bylaws, principals, rules or regulations of MSMS, the Judicial Commission or the American Medical Association. Section 7.30 of the MSMS Bylaws limits the Judicial Commission’s authority to: (1) reprimanding a member; (2) suspending or expelling a member; or (3) for a grievous offense making a recommendation to the Board of Medicine to revoke the member’s license.

The Judicial Commission does not have jurisdiction over non-members (and will mediate a grievance against a nonmember only if he/she voluntarily agrees to participate).

OIG’s Self Disclosure Protocol Physicians may self-report to the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) violations of federal laws for which civil monetary penalties may be imposed. These include violations of the Medicare and Medicaid laws/ regulations and the fraud and abuse laws (e.g. the anti-kickback statute, False Claims Act, etc.) other than the Stark Law (see below for Stark Law selfreporting) violations using the OIG’s Self-Disclosure Protocol. More at: https://oig.hhs.gov/compliance/ self-disclosure-info/protocol.asp

Stark Law Self-Reporting A similar self-referral disclosure protocol is available for violations of the Stark Law’s prohibition on physician self-referral. More at: https://www.cms.gov/medicare/ fraud-and-abuse/physicianselfreferral/ self_referral_disclosure_protocol.html

Medical Staff Bylaws If you are on a hospital or other medical staff you should carefully review the medical staff bylaws and any applicable policies and procedures. These documents frequently contain requirements for both self-reporting your violations of rules and policies of the medical staff and may also require your disclosures of the violations of others on the medical staff.

DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF

KERR RUSSELL

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MDHHS UPDATE

May is Hepatitis Awareness Month By Stefanie Cole, BSN, RN, MPH, Immunization Nurse Educator, Michigan Department of Health and Human Services Division of Immunization

May is Hepatitis Awareness Month and May 19th is Hepatitis Testing Day in the United States. The Centers for Disease Control and Prevention (CDC) and MDHHS would like to bring awareness to viral hepatitis.

Hepatitis is a disease that affects the liver. Millions of Americans are living with chronic hepatitis and may not know it. Often, people do not show any symptoms, or they have a flu-like illness. Without a blood test they may never know they are infected with hepatitis but still can infect others.

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Over 900 people in Michigan

Over 2 million people in the U.S.

Over 3.5 million people in the U.S.

have been infected with Hepatitis A virus (HAV) since August 2016.

are chroncially infected with Hepatitis B virus (HBV).

are chroncially infected with Hepatitis C virus (HCV).

has been around since 1981 and is very safe and effective. Those at risk of HBV infection need hepB vaccine. Contact your doctor or LHD to see how you can get tested and get hepB vaccine.

www.mi.gov/hepatitisB

recommended to treat pregnant women for HCV infection, but early testing and diagnosis are key to identifying infection. Current treatments consist of a daily pill regimen and have greater than a 90% cure rate. Contact your doctor or LHD to see how you can get tested and to get hepA and hepB vaccine.

Hepatitis C virus (HCV)

For more information about HCV transmission and ways to protect yourself and your loved ones go to:

Hepatitis A virus (HAV) Hepatitis A virus (HAV) has been in the news and has infected over 900 people in MI since August 2016; 80% of those infected were hospitalized and 28% died from complications of being infected with HAV. Several states surrounding MI are also experiencing HAV outbreaks. Hand washing and hepatitis A (hepA) vaccine is key in preventing infection. Contact your doctor or local health department (LHD) to see how to get hepA vaccine. For more information about HAV transmission and ways to protect yourself and your loved ones go to: www.mi.gov/hepatitisaoutbreak

Hepatitis B virus (HBV) Over two million people are chronically infected in the U.S and over 4,000 people die every year due to the complications of having HBV. HBV is most commonly transmitted sexually or at birth from mother-to -child. In 2017, there was an increase in acute HBV infections in MI which may be related to an increase in opioid drug use. Infants born to HBV infected women need hepatitis B (hepB) vaccine and hepB immune globulin (HBIG) at birth, a complete hepB vaccine series and post-vaccination serologic testing. All babies need hepB vaccine within 24 hours of life. HepB vaccine

For more information about HBV transmission and ways to protect yourself and your loved ones go to:

Over 3.5 million people are chronically infected in the U.S. Sharing infected injection drug use equipment is a primary risk factor for HBV and HCV. In MI from 2005 to 2017, the number of cases of chronic HCV among young adults aged 18-29 years increased over 476%. There is no vaccine to protect against HCV, however those with HCV should get hepA and hepB vaccine and work with a specialist to determine if they are a candidate for treatment. The number of women of childbearing age infected with HCV continues to rise as a result of the opioid and heroin epidemics. Perinatal HCV is becoming an increasingly important public health issue. It is estimated that perinatal HCV infection occurs in 5 to 15% of babies born to HCV-infected mothers. Currently, there is no intervention to reduce the risk of vertical transmission of HCV and it is not

www.mi.gov/hepatitis

Additional resources: https://gettested.cdc.gov/ www.cdc.gov/hepatitis/ hepawarenessmonth.htm www.cdc.gov/hepatitis/ heppromoresources.htm www.michigan.gov/hepatitis

To determine if you are at risk of getting hepatitis go to: www.cdc.gov/hepatitis/RiskAssessment/index.htm

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ASK HUMAN RESOURCES

Understanding the Independent Contractor Relationship. Who Qualifies? By Jodi Schafer, SPHR, SHRM-SCP, Human Resources Management Services, LLC

Q:

I just brought another physician into my practice. She is right out of medical school and I spend a lot of time developing her skills. I currently pay her through accounts payable, as an independent contractor. I was told to

set it up this way by my accountant years ago when I brought in my first associate doctor. However, this new associate has requested to go on payroll as employee. Her husband is an attorney and she told me that according to her husband, she does not qualify as an independent contractor. Is she right? How does one qualify as an independent contractor? What are the advantages of keeping her as an independent contractor? By the way, my other associate is fine with the current arrangement.

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Independent contractor status is governed by Internal Revenue Service (IRS) regulations, and therefore regulated by the IRS. It really is a tax issue.

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here are definitely advantages to paying your associates as independent contractors. You don’t have to pay payroll taxes on their earnings, or unemployment insurance or even worker’s compensation. Independent contractors are also exempt from most employment and labor laws. However, if you are going to pay them as contractors you have the burden to prove that the parameters of the working relationship qualify as such in the eyes of the IRS. It is not the job you are testing but the business relationship. It all centers around the amount of control the practice has over her work; both behavioral control and financial control. The more control you have as the practice owner, the less control she has and therefore is not truly ‘independent’. Here are some questions to get you started thinking.

Does the practice control (or have the right to control) the worker’s duties and how those duties are carried out? How dependent is she on your practice for patients? Do you control her hours? Is she expected to follow the practice’s work rules and procedures?

Does the practice control the business aspects of the worker’s job? Does the associate work for other medical practices? Does she have the right to decline work? Does she set her own schedule?

Who incurs the costs associated with doing business? Does she pay for any of the supplies she uses? Do you deduct money for these expenses? Do you reimburse her for expenses she incurred for the practice?

Does the worker have a written employment contract or access to employee benefits such as a pension plan, insurance, or vacation pay? Are you contributing to her 401K or other type of retirement account? Does she receive paid time off, a uniform allowance, CME reimbursement, professional memberships, licensing fees, etc.?

Will the relationship continue and are the duties the worker performs a key aspect of the business? Is this a short-term relationship or do you expect the person to stay and perform medical services similar to the services provided by the office as a whole? The IRS has a form (SS-8) that you can use to test the relationship in more depth. It’s a rather long form to complete and no one factor on the test is more indicative of employee status than another. However, as I said earlier, the more control you have as the practice owner, the less likely she should be classified as an independent contractor. When it comes to the IRS, it’s always best to err on the side of caution. A further consideration for you is that

your new associate has requested that she be paid as an employee. Unless you can provide her with your testing documentation that definitively shows otherwise, she may go to either the IRS or the Department of Labor with her concerns, which could trigger an investigation.

“If you are unable to defend the independent contractor relationship, what you end up paying in steep fines, back taxes, interest and other retroactive damages will far outweigh the initial cost savings.” If you are unable to defend the independent contractor relationship, what you end up paying in steep fines, back taxes, interest and other retroactive damages will far outweigh the initial cost savings. The penalties for misclassifying a worker can be huge. As they say, if it looks like a duck, walks like a duck and quacks like a duck…. Is it really worth it? I’d put her on payroll and convert your other associate as well if the working relationship is similar.

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HEALTH CARE DELIVERY

MSMS Regulatory Advocacy By Stacey Hettiger, Director Medical and Regulatory Policy, The Michigan State Medical Society

When talking about MSMS advocacy, it’s natural to think of the many legislative battles fought over the years. MSMS is known for championing physicians’ interests and working against legislation that negatively impacts patients, physicians, and the ability to deliver, access, and pay for health care. MSMS advocacy; however, is much more extensive.

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ayer advocacy is non-stop. MSMS staff meets regularly with the Centers for Medicare and Medicaid Services (CMS), Michigan Medicaid, and Michigan’s third-party payers to discuss global and trending payment, process, and delivery issues. Additionally, MSMS’s Reimbursement Advocate, Stacie J. Saylor, CPC, CPB, provides one-on-one assistance to help resolve claim delays and denials, as well as billing and policy questions. Regulatory advocacy often goes handin-hand with legislative advocacy. Often, following the adoption of legislation, the details and aftermath of implementation requires MSMS staff to meet with Department officials and participate in the rules promulgation process. For example, MSMS regularly comments on Medicare Physician Fee Schedule (PFS) rules, which provide annual updates to payment policies, payment rates, and quality provisions for services provided to Medicare beneficiaries. Regarding the Fiscal Year 2019 Medicare PFS, several of the issues for which MSMS advocated were considered favorably by CMS, including: A delay in CMS’ proposal to collapse the payment rates for eight office visit services for new and established patients down to two each. Documentation administrative efficiencies such as focusing on the interval history since the previous visit, eliminating the requirement for physicians to re-document information on the patient’s chief complaint and history that has already been documented in the patient’s record by practice staff or by the patient and removing the need to justify providing a home visit instead of an office visit.

At the state level, MSMS has been busy working to ensure rules promulgated by the Departments of Health and Human Services (MDHHS) and Licensing and Regulatory Affairs (LARA) address physician and patient safety concerns.

Bona Fide Prescriber-Patient Relationship In 2018, MSMS and many other health care stakeholders collectively advocated for reasonable exceptions to the definition of a “bona fide prescriber-patient relationship” included in the controlled substances prescribing package passed by the Legislature in December 2017. While well-intentioned, the original rules language proposed by LARA did not fully address the unintended consequences resulting from a statutory definition that severely restricts the ability to provide quality care to patients in a variety of common clinical situations such as call coverage, transitions of care from a hospital to a nursing home or hospice, and emergency situations when the patient needs to be immediately stabilized. Ultimately, revisions to the Michigan Board of Pharmacy’s Controlled Substance rules consistent with the stakeholder’s recommendations were finalized and took effect immediately upon filing with the Office of the Great Seal on January 4, 2019. MSMS Legal Counsel has prepared a Legal Alert detailing the statutory bona fide prescriber-patient relationship requirement, the administrative rule exceptions, and suggested best practices for compliance. The related rule change is as follows:


R 338.3161a Prescribers must be in a “bona fide prescriber-patient relationship” before prescribing a controlled substance listed in schedules 2 to 5. Exceptions allowing a prescriber to prescribe a controlled substance listed in schedules 2 to 5 without first establishing a bona fide prescriber-patient relationship are recognized in the following circumstances: • When a prescriber is providing on-call coverage or cross-coverage for another prescriber who is not available and has established a bona fide prescriber-patient relationship with the patient, as long as the prescriber or an individual licensed under article 15 of the act, reviews the patient’s relevant medical or clinical records, medical history, and any change in medical condition, and provides documentation in the patient’s medical record. • When the prescriber is following or modifying the orders of a prescriber who has established a bona fide prescriber-patient relationship with a hospital in-patient, hospice patient, or nursing care facility resident and provides documentation in the patient’s medical record. • When the prescriber is prescribing for a patient that has been admitted to a licensed nursing care facility or a hospice and completes the tasks required in subrule (2)(a) and (2)(b) in accordance with the nursing care facility or hospice admitting rules and provides documentation in the patient’s medical record. • When the prescriber is prescribing for a patient, and the tasks required in subrule (2)(a) and (2)(b) are complied with by an individual licensed under article 15 of the Public Health Code and the prescriber provides documentation in the patient’s medical record. • When the prescriber is treating a patient in a medical emergency, as defined in the rule.

Licensed Midwives MSMS partnered with the Michigan Section of the American College of Obstetrics and Gynecology, Michigan Council for Maternal and Child Health, Michigan Council of Nurse Practitioners, American Nurses Association Michigan, Michigan Affiliate of the American College of Nurse-Midwives, and Michigan Health & Hospital Association to share our mutual concerns that proposed rules governing licensed midwives (a.k.a., direct-entry midwives) and home births will not adequately protect the health and safety of mothers and babies. Our organizations were united with a common goal of increasing the likelihood of safe deliveries and post-partum care for mothers choosing home births and their infants. Together, MSMS and the above-mentioned organizations submitted a letter and grid with several suggested amendments to the proposed rules, provided testimony at the public hearing, and shared evidence-based protocols. At the time of this article’s writing, this rules set is under consideration by the Michigan Legislature’s Joint Committee on Administrative Rules.

Poisonings Due to Use of Prescription or Illicit Drugs Most recently, MSMS joined with the Michigan Health & Hospital Association, Michigan Osteopathic Association, Michigan Council of Nurse Practitioners, and Health Care Association of Michigan to offer recommended changes to rules regarding the Reporting of Poisonings Due to Use of Prescription or Illicit Drugs. These rules would replace emergency rules addressing the increase in poisonings due to prescription and illicit drug overdoses that are set to expire shortly. The intent is to provide the Michigan Department of Health and Human Services (MDHHS) with data to help guide and evaluate a public health response to the opioid epidemic. Pursuant to the proposed rules, MDHHS will use reported data to identify drugs associated with overdose injury and death, and to guide and evaluate public health response to the opioid epidemic. This will include planning and targeting of resources and interventions to populations and geographies of high need.

This rules set was modeled after rules related to injury reporting and non-medicinal chemical poisoning reporting. The rule makes it possible for MDHHS to require reporting of this information from health care providers and facilities when needed. The reporting request to providers could come in two ways:

Routine Surveillance Data Request Specific Event Investigation Request The rule promulgation process on the permanent rules is expected to be completed on or before April 26, 2019.

Upcoming rules for which MSMS advocacy is expected include, but are not limited to, Board of Medicine, Board of Osteopathic Medicine and Surgery, and retail/ adult-use marijuana regulation. Keep an eye out for further messaging on MSMS advocacy efforts on all fronts.

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FEATURE

FRESH FACES on the FRONTLINES OF STATE DEPARTMENTS WORK TO SUPPORT PHYSICIANS

PHOTOS BY: LUKE ANTHONY PHOTOGRAPHY

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The physician-patient relationship is among society’s most important, but rarely in practice does health care remain so intimate.

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myriad of external interests necessitates additional layers of input that influence the downstream delivery of health care. Physicians, clinicians, and medical schools determine best practices. Researchers develop new medicines and treatments, while pharmaceutical companies, payers and others determine what they will cost and who will pay for them. State and federal governments have their say, too, passing laws and enacting policies – in the service of their constituents – that regulate the way medicine is practiced, what is or is not considered health care, and how services are regulated and reimbursed, among other things. Here in Michigan, three state departments have particular and important connections to the practice of medicine. Last November’s elections swept to power a new governor who selected new directors to lead each department, and a new legislature tasked with approving her selections.

(CONTINUED ON PAGE 16)

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The Michigan Department of Health and Human Services (MDHHS), the Department of Licensing and Regulatory Affairs (LARA), and the state Department of Insurance and Financial Services (DIFS) each in different and important ways impact the way physicians practice medicine and the way patients obtain the health care they need. From implementing and overseeing Medicaid and the Healthy Michigan Plan, to professional licensing, the never-ending battle over automobile no-fault insurance reform, and the fight against opioid addiction, each department and each new director has an important role to play in the way Michigan physicians treat patients.

The Process Meet with stakeholders Speak with outgoing administration Interview departmental staff Invite individuals to serve Announce appointments

A new governor’s oath of office on the steps of the state Capitol represents only the first step in the state’s regular and formal transition of political power. Once the inauguration is over, the real work of political transformation process begins.

GOVERNOR’S OATH OF OFFICE

Among a new governor’s first moves in office, is the shepherding of new directors into their roles leading the state’s various departments. It’s hardly a turnkey process.

PRIOR TO INAUGUARATION, NEW GOVERNOR AND TEAM:

FORMAL APPOINTMENTS

SENATE PERFORMS “ADVICE AND CONSENT“ OVERSIGHT PROCESS

NEW DIRECTORS ASSUME THEIR DEPARTMENTAL ROLES

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Selecting the individuals who will oversee operations for some of the state’s biggest staffs and most important missions begins even before the Governor is sworn in. The governor and her transition team meet with stakeholders, speak with the outgoing administration, and even interview departmental staff. Decisions are made, individuals are asked to serve, and announcements are delivered to the legislature and the media. Following the first of the year come formal appointments, and the state Senate performs an oversight role called “advice

and consent.” The state Constitution grants the Senate the power to reject by a majority vote certain individuals within 60 days of their appointment. The new Senate Majority Leader Mike Shirkey formed a 5-member Advice and Consent committee, chaired by Senator Peter Lucido, a Macomb County Republican, and tasked it with researching, interviewing, and vetting the governor’s nominees. Among the individuals brought before the committee – and permitted to assume their leadership roles without objection – were new Michigan Department of Health and Human Services Director Robert Gordon, Department of Insurance and Financial Services Director Anita Fox, and Department of Licensing and Regulatory Affairs Director Orlene Hawks. Today, each leads a major state department playing a critical role in the health care process.


MICHIGAN DEPARTMENT OF

HEALTH AND HUMAN SERVICES Perhaps no department intersects more frequently with the state’s patient and physician communities than MDHHS. The department works to provide opportunities, services, and programs that promote a healthy, safe, and stable environment for state residents by developing measurable health, safety, and self-sufficiency outcomes to reduce and prevent risks, foster healthy habits, and improve lives. That’s a big list, and an even bigger responsibility. MDHHS operates four adult psychiatric hospitals and another for residents under 18. It oversees Medicaid plans for the state of Michigan. It’s also responsible for enacting the Healthy Michigan Plan. Robert Gordon became the MDHHS Director on January 14, and oversees health care programs, Children’s Protective Services, food assistance and many other statewide health initiatives. An attorney who once clerked for U.S. Supreme Court Justice Ruth Bader Ginsberg, Gordon is a veteran of the U.S. Department of Education and the U.S. Office of Management and Budget under President Barack Obama. He was once described as the quarterback for the President’s evidence-based policymaking initiatives, connecting program funding with quality service delivery. For Gordon, helping connect patients with health care providers is a family business. (CONTINUED ON PAGE 18)

Robert Gordon, Director, Michigan Department of Health and Human Services

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(CONTINUED FROM PAGE 17)

“I grew up around public health watching my father help those in need find the right path in order to be successful,” said Gordon. “He was a psychiatrist at Bellevue in New York, but he also worked with a non-profit organization that helped homeless individuals with mental health and substance abuse issues transition into housing.”

100,000 colon cancer screenings, and 37,000 obstetric visits or deliveries, antepartum, or postpartum care. That’s good news for patients, and the department insists it’s good news for providers, too. MDHHS estimates, for instance, that hospitals have experienced a reduction in uncompensated care of approximately $2.8 billion since the program’s inception.

He took the lessons his father taught him and has developed a remarkable personal record of public service. Improving health care access has been a consistent focus.

While Healthy Michigan, Medicaid, and similar programs focus on patients’ access to care, the department also offers and coordinates programs and initiatives to better fill the provider pipeline.

“During my years working for the Obama Administration, I helped drive legislation that created the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program,” said Gordon. “The program works to improve the health of at-risk children through evidence-based home visiting programs, and it’s one of the successes I am most proud of from that time.”

“We work with Michigan physicians in a strong health care ecosystem—mature Managed Care Organizations with significant expertise, high-quality and dedicated providers, from hospitals to community mental health organizations, and outstanding universities across the state,” said Gordon.

Now at MDHHS, Gordon says his first goal is improving health for all Michiganders. He’s quick to point to the importance and success of the Healthy Michigan Plan, with roughly 670,000 enrollees across the state. According to the Department, through last September the plan covered at least one primary care visit for a million different enrollees – 10.5 million primary care visits in total. It’s funded 370,000 mammograms, 2.4 million dental visits, 935,000 preventative care appointments,

Among MDHHS’ partnerships with providers are the Michigan State Loan Repayment Program, and a new initiative in the pipeline called MiDOCS. “Designed to improve health care services in underserved communities, the Michigan State Loan Repayment Program assists employers in the recruitment and retention of medical, dental and mental health primary care providers who continue to demonstrate their commitment to building long-term primary care practices in underserved communities designated as Health Professional Shortage Areas,” said Gordon.

“Since becoming director, I have visited several locations including county offices, a hospital and our labs, and I found that every office has passionate and dedicated staff who want to serve the state as effectively as they can. I feel one of my most critical jobs is to help clear obstacles. ROBERT GORDON, DIRECTOR, MDHHS

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Program participants can receive up to $50,000 tax-free to pay off their educational debt, in exchange for a two-year commitment to practice where patients have the least access. Since 1991, more than 1,000 providers have participated in the program. MiDOCS sets even more aggressive goals. The program is a partnership between MDHHS and four Michigan medical schools with a target of developing 500 additional physicians by 2029 to work in underserved areas. The program will add select Graduate Medical Education residency slots in targeted communities, and offer up to $75,000 in loan repayment to each participant in exchange for a two-year post-residency practice commitment. Together, with the rest of its responsibilities, MDHHS is firmly entrenched as state government’s central player in health care. Gordon is determined to see the department meet its goals with creative partnerships, and two eyes fixed on results. “Since becoming director, I have visited several locations including county offices, a hospital and our labs, and I found that every office has passionate and dedicated staff who want to serve the state as effectively as they can,” said Gordon. “I feel one of my most critical jobs is to help clear obstacles. “To do so, we need to fix systems that are not working; cut waste and spend smarter, treating taxpayers’ money like it is our own; and we need to use evidence in our decisions and make that evidence public.” The Michigan Department of Insurance and Financial Services (DIFS) also plays a critical role in the state’s health care system. DIFS is the state agency tasked with overseeing 26 HMOs, 139 domestic and 1,447 foreign insurance companies, and more.


MICHIGAN DEPARTMENT OF

INSURANCE AND FINANCIAL SERVICES With a departmental vision to “foster a regulatory environment that protects consumers,” among other goals, DIFS has its work cut out for it – in particular as it tackles insurer practices that still too often stand between patients and the care their physicians know they need. Guiding the ship and its 350 employees since mid-January is Anita Fox. Fox is an attorney by trade, with three decades of legal experience, and a reputation as an authority in insurance coverage. In fact, she’s even taught insurance law at Michigan State University. “I (see) the DIFS Director position as a unique opportunity and challenge to take what I have learned in the private sector and apply it to public service,” said Fox. “DIFS’ focus is on consumer protection through its mission to ensure that the insurance and financial services industries are safe, sound, and entitled to public confidence, while providing a business climate that promotes economic growth. “DIFS protects the public in numerous ways, including investigating and shutting down fraudulent enterprises, those who issue false insurance certificates and those who abuse the medical reimbursement system.” Under Fox’s leadership, the department is aggressively investigating and combatting fraud in the insurance and financial (CONTINUED ON PAGE 20)

Anita Fox, Director, Michigan Department of Insurance and Financial Services

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michigan MEDICINE® 19


(CONTINUED FROM PAGE 19)

“DIFS protects the public in numerous ways, including investigating and shutting down fraudulent enterprises, those who issue false insurance certificates and those who abuse the medical reimbursement system.” ANITA FOX, DIRECTOR, DIFS

services sectors in partnership with the Attorney General’s office and law enforcement. DIFS is also focused on consumer protection through enhanced financial education and outreach. While her department’s role includes oversight of private insurers, Fox’s position also comes with responsibilities in current debates surrounding potential auto insurance reform. Fox says her initial goal is to learn all she can from the professionals within the department, industry groups, legislators, industry, and consumers to help identify and prioritize initiatives, which will include her role in evaluating

options for reducing auto insurance premiums in Michigan. Debate continues to rage at the state Capitol over proposals to reform Michigan’s Auto No-Fault Insurance Law, a national best practice that ensures motorists involved in a catastrophic automobile accident have access to the health care they need to put their lives and families back together again. Fox and DIFS are key players as the Whitmer administration considers options and crafts policies, making the department’s relationships with Michigan physicians as important as any.

Protecting patients. Protecting physicians.

MDPAC’s TOP ADVOCACY ISSUES: • • • • • •

Prior Authorization Reform Substance use (Opioids, Marijuana) Auto No-Fault Scope of Practice Administrative simplification Mandates

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| MAY / JUNE 2019

By contributing to the MDPAC, you will substantially enhance MSMS’s advocacy efforts, which promotes a pro-medicine agenda. By joining with other members, you create a constituency that represents your professional needs and concerns.

INVEST IN MDPAC.ORG


MICHIGAN DEPARTMENT OF

LICENSING AND REGULATORY AFFAIRS The state’s Department of Licensing and Regulatory Affairs (LARA) was established to ensure state regulations safeguard Michigan residents through a simple, fair, efficient and transparent regulatory structure. Director Orlene Hawks says LARA’s partnership with the physician community is essential to those efforts. “We rely on physicians to sit on our respective medical boards to provide leadership, expertise, and oversight for disciplinary actions against licensed health professionals,” said Hawks. “Our partnerships with professional associations like MSMS is crucial to improving our services, processes, and overall licensing framework in Michigan. We take a collaborative approach to professional licensing in Michigan meaning we listen and respond to the immediate needs and concerns of our physician community as it relates to their license.” Hawks has wide experience leading complex organizations within state government, serving under both Republicans and Democrats. Prior to joining LARA, she led the state’s Operation Excellence project dealing with MDHHS’s child protective services investigations, and spent five years as the director of the Office of Children’s Ombudsman. She also managed the Quality and Program Services section in the (Department of Community Health, and the Child, Adolescent and Family Health Services) section in MDHHS. (CONTINUED ON PAGE 22)

Orlene Hawks, Director, Michigan Department of Licensing and Regulatory Affairs

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michigan MEDICINE® 21


“The opioid crisis has infiltrated count-

CONTINUED FROM PAGE 21

less Michigan communities and harmed Now she’s tackling LARA, and she’s set

numerous families and individuals across

aggressive goals to eliminate regulatory

our state. LARA plays a significant role to

redundancies while improving licensure

combat this crisis on a statewide scale and

transparency, and modernize every single

provide appropriate services to individuals

one of the department’s licensing and reg-

suffering from substance use disorder.”

ulatory IT systems.

The department recently updated Sub-

“Every resident in Michigan has – in some

stance Use Disorders Service Program

manner – interacted with LARA during

rules, as well. Hawks says the new rules

their lifetime,” said Hawks. “Our licensees

improve patient care in substance use dis-

include individual professionals and facil-

order facilities in Michigan, eliminate un-

ities that require oversight in order to en-

necessary, burdensome and outdated rules

sure the health and safety of Michigan res-

to improve requirements to ensure they

idents. From childcare centers to hospitals;

operate in a safe, efficient, and cost-effec-

residential builders to physicians; LARA’s

tive manner.

oversight extends to almost all aspects of life in Michigan.”

“We have seen the number of opioid and controlled substance prescriptions steadily

Among its roles is oversight of the Mich-

decline in Michigan,” Hawks said. “We hope

igan Automated Prescriptions System

to continue this trend in the coming years

(MAPS), and work implementing state

by leveraging our statewide partnerships and

policy in the battle against opioid addic-

continuing our prevention efforts.”

tion and use.

Those partnerships are what make the most

“Michigan is currently combating a na-

important and effective work done by

tional public health crisis,” said Hawks.

LARA, MDHHS, and DIFS possible.

“The opioid crisis has infiltrated countless Michigan communities and harmed numerous families and individuals across our state. LARA plays a significant role to combat this crisis on a statewide scale and provide appropriate services to individuals suffering from substance use disorder.” ORLENE HAWKS, DIRECTOR, LARA

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| MAY / JUNE 2019

MEMBERS OF THE MICHIGAN STATE MEDICAL SOCIETY REMEMBER THEIR COLLEAGUES WHO HAVE DIED.

x PAUL CHIEH SUNG SHENG, MD LIVINGSTON COUNTY MEDICAL SOCIETY 2/13/19 RUSSELL G. SANDBERG, MD GENESEE COUNTY MEDICAL SOCIETY 2/13/19 BERT J. KORHONEN, MD KENT COUNTY MEDICAL SOCIETY 2/15/19 CARLTON L. COOK, MD LENAWEE COUNTY MEDICAL SOCIETY 2/20/19 FRED W WHITEHOUSE, MD WAYNE COUNTY MEDICAL SOCIETY 3/1/19 FRANK L. PETTINGA, MD MUSKEGON COUNTY MEDICAL SOCIETY 3/13/19 MARCY L. STREET, MD INGHAM COUNTY MEDICAL SOCIETY 3/22/19

x TO MAKE A GIFT OR BEQUEST PLEASE CONTACT: REBECCA BLAKE, EXECUTIVE DIRECTOR, MSMS FOUNDATION CALL 517-336-5729 OR EMAIL RBLAKE@MSMS.ORG


MAY / JUNE 2019 |

michigan MEDICINE® 23


Wearable Medical Devices Give Abundant Data—and Risks Miranda Felde, MHA, CPHRM, Vice President, Patient Safety and Risk Management Wearables are electronic devices worn on the body, often like a watch. Wearables can track patient data like heart rate, blood pressure, or blood glucose. They can also track activity level, e.g., counting steps. Promoters of wearables say that they could provide physicians with abundant data when caring for patients with chronic health issues. They also predict that combining wearables and gamification—e.g., competing with family members to see who can “score” the most steps in a day— may lead to improved health and better health outcomes. However, skeptics question whether gamification will really lead to healthier behaviors long-term. And questions abound about what to do with wearables’ data and how to protect it. Wearables bring promise, but also real risks for patient safety and physician liability.

Benefits of Wearables

S

ince 2013, the number of US consumers tracking their health data with wearables has doubled. And that number continues to rise: During the third quarter of 2018, the wearables market saw a nearly 60 percent increase in earnings over the prior year.

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Promoters of wearables believe wearables will drive the transition to intelligent care, whereby physicians have access to more data—in which they can identify actionable components. Florence Comite, MD, a New York endocrinologist who describes wearables as “almost like magic,” uses data from wearables to tailor her interventions for patients with chronic conditions. Wearables can help patients take action, too. In one recent study, diabetes patients using a wearable app showed randomized controlled trial results comparable or superior to patients taking diabetes medications.


Contributed by The Doctors Company

thedoctors.com

Promoters of such digital strategies hope that they will encourage healthy behaviors while requiring fewer office visits purely for monitoring purposes, thereby reducing healthcare costs while improving patient experience and engagement. For instance, David Rhew, MD, chief medical officer for Samsung, hopes that wearables can help patients move to the highest level of patient activation, Level 4.

Four Levels of Patient Activation Level 1: Predisposed to be passive. “My doctor is in charge of my health.” Level 2: Building knowledge and confidence. “I could be doing more.” Level 3: Taking action. “I’m part of my healthcare team.” Level 4: Maintaining behaviors, pushing further. “I’m my own advocate.” Some apps promote healthy behaviors with gamification. For instance, a user might compete with family or friends to take the most steps each day, either informally or through an organized group. Harvard professor Ichiro Kawachi, PhD, wrote in JAMA Internal Medicine that this is “an opportunity for clinicians to turn health promotion into an engaging, fulfilling and fun activity.” Sponsors hope that such groups can promote accountability, responsibility, and mindfulness about activity and health conditions.

Skepticism about Wearables It is too soon to say whether wearables will increase healthy behaviors and/or reduce office visits, thus lowering healthcare costs. Some studies have found that wearable devices have no advantage over other forms of goal tracking or social support in helping people meet their health and fitness goals. A 2016 study from the University of Pittsburgh, for instance, found that

“young adults who used fitness trackers in the study lost less weight than those in a control group who self-reported their exercise and diet.”

Risks of Wearables Though each device has its pros and cons, all wearables generate concerns for physicians, including:

Poor data quality – Data from wearables may or may not be reliable enough for medical use.

Data Fixation – Patients may fixate on

one number – steps per day, for instance – at the expense of other health variables, such as their diet, sleep habits, etc.

Lack of interoperability with electronic health records (EHRs) If a patient’s wearable cannot stream data to the patient’s EHR, then how can the physician’s practice securely acquire the data?

Data Saturation Physicians receiving patient data from wearables risk being soaked by a data fire hose. Physicians need a plan and a process to determine what measurements are relevant to a given patient.

Unclear physician responsibilities for collecting/monitoring/protecting data HIPAA applies to patient data collected by physicians, but differing state laws mean that a physician’s specific responsibilities for monitoring and protecting patient data vary by location.

Lack of data security and liability for physician Wearables are subject to cyberattack. In addition to presenting obvious risks to patient safety, this may also present liability risks to physicians—who may be expected to notify patients of recalls issued for their wearables.

Next Steps As more and more physicians are accepting—or requesting—their patients’ data from wearables, questions include: How can we tell when data from wearables is accurate? When it’s actionable? When it’s secure? Certainly, physicians interacting with data from wearables should independently confirm that data before changing a patient’s care, and should store data from wearables securely. For help implementing remote patient monitoring in your practice, see the American Medical Association’s (AMA’s) Digital Health Implementation Playbook. 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 considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered. REFERENCES Donovan F. Despite patient privacy risks, more people use wearables for health. Health IT Security. October 1, 2018. https://healthitsecurity.com/news/despitepatient-privacy-risks-more-people-use-wearables-for-health. Accessed November 28, 2018. Zaninello L. The wearables market is booming: Fitbit scares Apple and Google. Android Pit. November 26, 2018. https://www.androidpit.com/wearable-marketgrowth-fitbit-scares-apple-and-google. Accessed November 28, 2018. Eramo L. Do doctors care about your wearable data? Future Health Index. October 18, 2017. https://www.futurehealthindex.com/2017/10/18/doctors-care-wearabledata/. Accessed November 29, 2018. Rhew D, panel moderator. Disruptive digital health technology. A4M MMI World Congress 2017. Dec 14; Las Vegas, NV. Spil T, Sunyaev A, Thiebes S, van Baalen R. The adoption of wearables for a healthy lifestyle: Can gamification help? 50th Hawaii International Conference on System Sciences. 2017 Jan 4-6; Waikoloa, HI. https://pdfs.semanticscholar.org/ dacd/744f57cf9551fe012884697e735a2a9cd3a8.pdf. Accessed November 28, 2018. Berg S. “To boost physical activity in patients, make a game of it.” American Medical Association. February 27, 2018. https://www.ama-assn.org/delivering-care/publichealth/boost-physical-activity-patients-make-game-it. Accessed November 20, 2018. Ross E. Weight loss on your wrist? Fitness trackers may not help. National Public Radio. September 20, 2016. https://www.npr.org/sections/healthshots/2016/09/20/494631423/weight-loss-on-your-wrist-fitness-trackers-may-nothelp. Accessed November 28, 2018. O’Neill S. As insurers offer discounts for fitness trackers, wearers should step with caution. National Public Radio. November 19, 2018. https://www.npr.org/sections/ health-shots/2018/11/19/668266197/as-insurers-offer-discounts- for-fitnesstrackers-wearers-should-step-with-caution. Accessed November 28, 2018. Piwek L, Ellis DA, Andrews S, Joinson A. The rise of consumer health wearables: Promises and barriers. PLOS medicine. February 2, 2016. https://journals.plos.org/plosmedicine/ article?id=10.1371/journal.pmed.1001953. Accessed November 28, 2018. Donovan F. How does HIPAA apply to wearable health technology? Health IT Security. July 24, 2018. https://healthitsecurity.com/news/how-does-hipaa-apply-towearable-health-technology. Accessed November 28, 2018. Carman SL, Umhofer RH. Wearable medical devices can raise issues for healthcare professionals. Healthcare Analytics News. October 30, 2018. https://www.hcanews. com/news/wearable-medical-devices-can-raise-issues-for-healthcare-professionals. Accessed November 28, 2018.

MAY / JUNE 2019 |

michigan MEDICINE® 25


MEDICATION-ASSISTED TREATMENT (MAT): MEDICATION-ASSISTED TREATMENT MEDICATION-ASSISTED TREATMENT (MAT): Is it Right for My Practice? (MAT): Is it Right for My Practice?

Is itofRight for Myseeking Practice? This is education to meet the needs the population treatment of opioid use disorders. This is education to meet the needs of the population seeking treatment of opioid use disorders. ThisThis two-and-a-half-hour provides training and guidance for MAT in real-world practice is education to meetprogram the needs of the population seeking treatment of opioid use disorders. This two-and-a-half-hour program provides training and guidance for MAT in real-world practice settings and addresses concerns forprovides patient training management, compliance, and care This two-and-a-half-hour program and guidance for MATreimbursement in real-world practice settings and addresses concerns for patient management, compliance, reimbursement and care team development. settings and addresses concerns for patient management, compliance, reimbursement and care team development. team development. AGENDA

AGENDA AGENDA Addressing the Opioid Epidemic: It Takes a Team Addressing the Opioid Epidemic: It Takes a Team Lindsey Naeyaert, MPH Epidemic: It Takes a Team Addressing the Opioid Lindsey Naeyaert, MPH Lindsey Director Naeyaert,ofMPH Associate Associate Director ofIntegrated IntegratedHealth Health Associate Director of Integrated Health Michigan Primary Care Michigan Primary CareAssociation Association Michigan Primary Care Association

TheThe U.S. Drug Enforcement Roleinin U.S. Drug EnforcementAdministration’s Administration’s Role The U.S. Drug Enforcement Administration’s Role in Medication-Assisted Medication-AssistedTreatment Treatment(MAT) (MAT) Medication-Assisted Treatment (MAT) Kathy Federico, U.S. (DEA) Kathy Federico, U.S.Drug DrugEnforcement Enforcement Agency Agency (DEA) Kathy Federico, U.S. Drug Enforcement Agency (DEA)

Medication TreatAddiction: Addiction: Saving Saving Lives Lives One Medication toto Treat One Medication to Treat Addiction: Saving Lives One Person at a Time Person at a Time Person at a Time Cara Anne Poland, MD,MEd, MEd, FACP, DFASAM DFASAM Cara Anne Poland, MD, Cara Anne Poland, MD, MEd,FACP, FACP, DFASAM Medical Director, Spectrum Health Addiction Medicine Medical Director, Spectrum Medicine Medical Director, SpectrumHealth HealthAddiction Addiction Medicine CONTINUING EDUCATION

CONTINUING EDUCATION CONTINUING EDUCATION In support of improving patient care, this activity has been planned and In support of improving patient care,this thisactivity activity has has been planned In support of improving patient care, plannedand and implemented by Western Michigan University Homer Stryker M.D. implemented by Western MichiganUniversity UniversityHomer Homer Stryker Stryker M.D. implemented by Western Michigan M.D. School of Medicine and WMU College of Health and Human Services, School of Medicine and WMU CollegeofofHealth Healthand and Human Human Services, School of Medicine WMU College Western Regionaland AHEC. Western Michigan University HomerServices, Stryker Western Regional AHEC. Western Michigan University Homer Stryker Western Regional AHEC. Western University Homer Stryker M.D. School of Medicine is jointlyMichigan accredited by the Accreditation School of Medicine is jointly accredited by the Accreditation M.D.M.D. School of Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Continuing Education (ACCME), the Accreditation Council for PharmacyMedical Education (ACPE), and the American Nurses Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to(ACPE), provideand continuing education for the Council for Pharmacy Education the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Credentialing Center (ANCC), to provide continuing education for the healthcare team. Credit amount to change. healthcare team. subject Credit amount subject to change. Interprofessional Continuing Education Credit amount subject to change. Interprofessional Continuing Education This activity was planned by and for the healthcare team, and learners Interprofessional This activity wasContinuing planned byEducation and for the healthcare team, and learners will receive 2.5 Interprofessional Continuing Education (IPCE) credits receive 2.5planned Interprofessional Continuing Education (IPCE) credits Thiswill activity was for learning and change.by and for the healthcare team, and learners for learning and change. will receive 2.5 Interprofessional Continuing Education (IPCE) credits Physicians Physicians for learning and change. Western Michigan University Homer Stryker M.D. School of Medicine Western Michigan University Homer Stryker M.D. School of Medicine Physicians designates this live activity for a maximum of 2.5 AMA PRA Category 1 designates this live activity for a maximum ofM.D. 2.5 AMA PRA 1 Western Michigan University Homer ofCategory Medicine Credit(s)™. Physicians should claim Stryker only the creditSchool commensurate with Credit(s)™. should only the commensurate with1 designates thisofPhysicians live activity for aclaim maximum of credit 2.5 AMA PRA Category the extent their participation in the activity. the extent of their participation in the activity. Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

SELECT FROM THE FOLLOWING

SELECT FROM THE FOLLOWING WORKSHOP AND LOCATIONS SELECT FROMDATES THE FOLLOWING WORKSHOP DATES AND LOCATIONS WORKSHOP DATES AND LOCATIONS

Friday, 21, 2019 Friday, JuneJune 21, 2019 Friday, JuneBaker 21, 2019 College Baker College Baker College 8 a.m. to 10:30 8 a.m. to 10:30 a.m.a.m. 8 a.m. to 10:30 a.m. 100 Building Student Center 100 Building Student Center 100 Building Student Center 2800 Springport Rd. Rd. 2800 Springport 2800 Springport Rd. Jackson, MI 49202 Jackson, MI 49202 Jackson, MI 49202 Monday, August 5, 2019 Monday, August 5, 2019 Monday, August 5, 2019 Mercy Health Hackley Campus Mercy Health Hackley Campus Mercy Health Hackley Campus 7 a.m. to 9:30 a.m. 7 a.m. to 9:30 7 a.m. to 9:30 a.m.a.m. 1700 Clinton St., Room 1503 1700 Clinton St., St., Room 15031503 1700 Clinton Room Muskegon, MI 49442 Muskegon, MI 49442 Muskegon, MI 49442 Tuesday, August 27, 2019 Tuesday, August 27, 2019 Tuesday, August 27, 2019 Allegan General Hospital Allegan General Hospital Allegan 8 a.m.General to 10:30 Hospital a.m. 8 a.m. to 10:30 a.m. 8Michigan a.m. to 10:30 Rooma.m. Michigan Room Michigan Room 555 Linn St. 555 Linn St. Allegan, MI555 49010 Linn St. Allegan, MI 49010

Allegan, MI 49010

~ There is no cost to attend this workshop. ~ ~ There is~ no cost to attend this workshop. ~ Refreshments provided. ~ ~ Refreshments provided. ~ workshop. ~ ~ There is no cost to attend this

~ Refreshments provided. REGISTRATION LINK: ~ REGISTRATION LINK: https://bit.ly/2U4sXLS

https://bit.ly/2U4sXLS REGISTRATION LINK:

https://bit.ly/2U4sXLS CONTACT: Lisa Brennan CONTACT: Lisa Brennan 616-771-9497 616-771-9497

CONTACT: Lisa Brennan lisa.brennan@wmich.edu lisa.brennan@wmich.edu 616-771-9497

lisa.brennan@wmich.edu


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TheHLP.com [284.996.8510] MAY / JUNE 2019 |

michigan MEDICINE® 27


Educational Offerings MSMS On-Demand Webinars Webinars Offering CME: Balancing Pain Management and Prescription Medication Abuse: Chronic Pain and Addiction*

Webinars at No Cost to Members: Billing 101

CDL-Medical Examiner Course

Balancing Pain Management and Prescription Medication Abuse: Chronic Pain and Addiction*

Human Trafficking*

Claim Appeals

Medical Ethics – Conscientious Objection among Physicians*

Credentialing

Preparing for the Medicare Physician Value-Based Payment Modifier

Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities

Pain and Symptom Management Series*

HEDIS Best Practices

Opioid Town Hall (new in 2019) *

In Search of Joy in Practice: Innovations in Patient Centered Care

Pain and Opioid Management*

Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage

The CDC Guidelines* The Current Epidemic and Standards of Care* Treatment of Opioid Dependence* The Role of the Laboratory in Toxicology and Drug Testing*

Coding and Billing Webinars: Access to Medicare Changes to E&M Codes for 2019 and other Coding Updates Billing 101 Claim Appeals Complete Coding Updates for 2018 Credentialing Managing Accounts Receivable Reading Remittance Advice Tips and Tricks on Working Rejections

28 michigan MEDICINE®

| MAY / JUNE 2019

Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media MAPS Update and Opportunities* Michigan Automated Prescription System Update* Reading Remittance Advice Section 1557: Anti-Discrimination Obligations Sexual Misconduct – Prevention and Reporting (new in 2019) Update on Chronic Fatigue Syndrome Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS (new in 2019) Update on Chronic Fatigue Syndrome Part 2: Uniting Compassion, Attention and Innovation to treat ME/CFS (new in 2019) Prescribing Legislation* Tips and Tricks on Working Rejections *Fulfills Board of Medicine Requirement.


Visit 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.

Upcoming Educational Conferences – REGISTER TODAY! A Day of Board of Medicine Renewal Requirements

Documentation for MACRA & HCC

Date: Friday, May 3

Location: DoubleTree Hotel, Dearborn

Location: Radisson Plaza Hotel and Suites, Kalamazoo

Intended for: Physicians, Administrators, Office Managers, Coders, Billers and

Note: Continental breakfast and lunch will be provided.

all other health care professionals.

Intended for: Physicians and all other health care professionals.

Register: Online at msms.org/eo

Register: Online at msms.org/eo

Contact: Marianne Ben-Hamza 517/336-7581 or mbenhamza@msms.org

Date: Thursday, May 16

Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

2019 MSMS Annual Scientific Meeting 2019 Spring Scientific Meeting

Morning, afternoon and evening clinical courses available.

Morning, afternoon and evening clinical courses available

Date: Wednesday, October 23 - Saturday, October 26

Date: Thursday, May 16 and Friday, May 17

Location: Sheraton Detroit Novi Hotel, Novi

Location: DoubleTree Hotel, Dearborn

Intended for: Physicians and all other health care professionals

Note: Continental breakfast and lunch will be provided

Register: Online at msms.org/eo

Intended for: Physicians and all other health care professionals

Contact: Marianne Ben-Hamza 517/336-7581 or mbenhamza@msms.org

Register: Online at msms.org/eo Contact: Marianne Ben-Hamza 517/336-7581 or mbenhamza@msms.org

23rd Annual Conference on Bioethics Date: Saturday, November 2

Medical Necessity – Tips on Documentation to Prove it

Location: Holiday Inn, Ann Arbor

Date: Thursday, May 16

professionals, and all individuals interested in bioethical issues.

Location: DoubleTree Hotel, Dearborn

Register: Online at msms.org/eo

Intended for: Physicians, Administrators, Office Managers, Coders,

Contact: Beth Elliott at 517/336-5789 or belliott@msms.org.

Intended for: Physicians, bioethicists, residents, students, other health care

Billers and all other health care professionals. Register: Online at msms.org/eo Contact: Marianne Ben-Hamza 517/336-7581 or mbenhamza@msms.org

MAY / JUNE 2019 |

michigan MEDICINE® 29


Welcome New Members Alpena/Alcona/Presque Isle

Elena Gupta, MD

Livingston

Thomas Thornton, MD

Vishal Gupta, MD, PhD

David Alnajjar, MD

Eric Haynes, DO

Anas Al-Sheikh, MD

Genesee Sunilkumar Rao, DO

Grand Traverse/Benzie/Leelanau Robert Sprunk, MD

Ingham Archana Bhatt, MD Danielle Gainor, MD

Jackson

Elias Hazzi, MD JoAnn Hirth, MD Heather Jackson, DO Yasser Jamal, MD

Carey Vigor, MD David Alnajjar, MD Anas Al-Sheikh, MD Carey Vigor, MD

Everett Kalcec, DO Courtland Keteyian, MD Mirza Khan, DO Stephen Kirkner, DO Jordan Knepper, MD Ganesh Kudva, MD Anandeep Kumar, MD Frank LaMarca, MD

Aurif Abedi, MD

Amritraj Loganathan, MD

Iman Abou-Chakra, MD

Mahender Macha, MD, FACS

Abdullah Adnan, DO

Devin Malik, MD

Shana Ageloff-Kupetz, MD

Joel Miller, MD

Hesham Ahmed, MD

Macomb Allen Babcock, MD Robert Ginnebaugh, MD

Muskegon Regina Ramirez, MD

Oakland Marwa Ibrahim, MD Caitlyn Klaska, MD

John Mogerman, MD

Kerry Lee, DO

Shoshana Ambani, MD

David Moore, MD

Claire Peeples, MD

Ali Amin, MD

Matthew Moore, MD

Kathryn Reck, DO

Lawrence Narkiewicz, MD

Deepa Taggarshe, MD

Sylvia Anagnos, MD Madhu Arora, MD

Vinh Nguyen, DO

Michelle Aubin, MD

Maria Opolka, DO

Saginaw

Bruce Barbour, MD

Hasan Qutob, MD

Christopher Archangeli, CD

Azam Basheer, MD

John Schuster, MD

Onoriode Edeh, MD

Ryan Beekman, MD

Jonathan Schweid, MD

James Fugazzi, MD

Randy Bell, MD

Rubina Shaikh, MD

Kevin Lawson, MD

William Bivens, MD

Vincent Simonetti, MD

Roger Bloomer, MD

Erik Sinka, DO

Tuscola

Michelle Brewer, MD

Michael Somero, MD

Arshad Aqil, MD

Michael Burgess, DO

Eric Trimas, DO

Elizabeth Campbell, MD

Kate Viola, MD, MHS, FAAD

Washtenaw

Lesley Combs, DO

John Wald, MD

Matthew Vasievich, MD, PhD

Raechel Coombs, DO

John Walper, MD

Jessica West, DO

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