AWARD-WINNING
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January/February 2015 • Volume 114 • No. 1
What is Physician Leadership? Jeff Holmes, MD of Alma Family Practice
IN THIS ISSUE • A Look at Independent Practices • Physicians Making a Difference by Influencing Change • Physicians in Non-Traditional Roles • Physicians Running for Office
MichiganMedicine
January/February 2015 • Volume 114 • Number 1
AWA R D - W I N N I N G M A G A Z I N E O F T H E M I C H I G A N S TAT E M E D I C A L S O C I E T Y
COVER STORY 10 What is Physician Leadership? This issue of Michigan Medicine takes a look at several physicians who lead the present and future of Michigan health care. From the President of the University of Michigan to a State Representative, these physicians are driving change in our state. They have set an example of physicians who passionately lead teams, universities, organizations and communities. They define what it means to be a physician leader.
A Look at Independent Practices Physicians Making a Difference by Influencing Change Physicians in Non-Traditional Roles Running for Office
FEATURES 16 Take Financial Leadership in 2015 BY NATHAN MERSEREAU, CFP ®, AAMS Since the beginning of the year is a good time to review your financial roadmap, here are some tips to consider as you enter 2015.
COLUMNS 2 Ask Our Lawyer BY DANIEL J. SCHULTE, JD 2014 HIPAA Enforcement Actions Show You Must Take Documentation Requirements Seriously
Executive Director JULIE L. NOVAK Committee on Publications LYNN S. GRAY, MD, MPH, Chair, Berrien Springs MICHAEL J. EHLERT, MD, Livonia THEODORE B. JONES, MD, Detroit BASSAM NASR, MD, MBA, Port Huron STEVEN E. NEWMAN, MD, Southfield Managing Editor KEVIN MCFATRIDGE Email: KMcFatridge@msms.org Publication Office Michigan State Medical Society PO Box 950, East Lansing, MI 48826-0950 517-337-1351 www.msms.org All communications on articles, news, exchanges and classified advertising should be sent to the above address, attn: Kevin McFatridge.
Display Advertising GRETCHEN CHRISTENSEN 2779 Aero Park Drive, Traverse City, MI 49686 888-822-3102, Fax: 989-892-3525 Email: Gretchen@vpdemandcreation.com Design JOSEPH MCGURN, Village Press, Inc. Printing VP Demand Creation Services, Traverse City, MI Postmaster: Address Changes Michigan Medicine Hannah Dingwell PO Box 950, East Lansing, MI 48826-0950
6 Professional Liability Update
BY DAVID B. TROXEL, MD Diagnostic Error Identified as the Most Common Allegation in Malpractice Lawsuits
HIT Corner MDCH Update
8 BY STEPHANIE VAN KOEVERING Lock and Key
18
FROM THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Protecting Persons Aged 65 Years and Older Against Pneumococcal Disease
24 President’s Perspective
BY JAMES D. GRANT, MD On Being a Leader
DEPARTMENTS 19 New MSMS Members
19 Obituaries
20 MSMS Foundation Conferences
22 The Marketplace
The mission of the Michigan State Medical Society is to promote a health care environment which supports physicians in caring for and enhancing the health of Michigan citizens through science, quality, and ethics in the practice of medicine.
Michigan Medicine, the official magazine of the Michigan State Medical Society, 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 Michigan State Medical Society 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 2015 it is published in January/February, March/April, May/June, July/August, September/October and November/December. Second class postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110. Single copies, $10. Printed in USA. © 2015 Michigan State Medical Society
A S K
O U R
L A W Y E R
2014 HIPAA Enforcement Actions Show You Must Take Documentation Requirements Seriously BY DANIEL J. SCHULTE, JD
QUESTION:
The HIPAA privacy rule requirements and the new HITECH Act requirements all seem silly for a small medical practice to be expected to comply with. Conducting a risk assessment, documenting security procedures and training employees – really? We are just a five person medical practice. Am I really expected to do all this? What is the likelihood I will be penalized if I do not? ANSWER: The requirements you are referring to are all aimed at heighten protection of medical record information (with emphasis on electronic medical record information. You may believe that these requirements are overkill for your practice, however you must comply (there is no small practice exception) and 2014 enforcement activDoing the right ity shows these laws are being enforced and those thing after a security found not to be in combreach will not be pliance are being sanctioned with significant good enough. If you financial penalties. Concannot demonstrate sider what happen in the following cases. that you have The first involves a small health plan that conducted a risk leased digital copiers. assessment, adopted The copiers (as all digital copiers do) contained a security policy and hard drives storing much otherwise complied of the information copied. When the lease of with HIPAA/HITECH the copiers expired the you will face large health plan turned them in and leased new ones. financial penalties. The problem is that the health plan did not think to delete the information (which contained protected health information) on the hard drives first. The copiers were re-leased to another party (which turned out to be the CBS Evening News – I am not making this up). It discovered that the copiers had protected health information on their hard drives and reported to the agency responsible 4
for HIPAA enforcement, the Health and Human Services Office of Civil Rights (“OCR”). OCR investigated and found that the health plan had not conducted the risk assessment (if it had it might have know about the hard drives of the copiers) or adopted any security policy (that would have included a policy of removing records from equipment before disposal). OCR fined the heath plan $1,215,780 and mandated it comply with a “corrective action plan” requiring it to do what was required by HIPAA/HITECH. The second involves a dermatology practice. An employee of the practice took a thumb drive home from the office to do some work at home. The thumb drive contained 2,200 patient records and was stolen from her car. The practice properly reported the loss of the thumb drive in compliance with HIPAA/HITECH and took all reasonable steps to recover the thumb drive. OCR investigated and ultimately fined the practice $150,000. Why? Because the investigation revealed that the practice had not conducted a security assessment (which would have included an assessment of the risk of letting employees take electronic records home) or adopted an electronic security policy (which should have prohibited employees from taking this information out of the office in an unencrypted format). In addition to the fine, OCR mandated that the practice comply with a corrective action plan that, like the health plan in the case above, required it to comply with all the requirements of HIPAA/HITECH. MICHIGAN MEDICINE
What these cases tell us is that OCR is now taking enforcement action against large (this is all we saw years ago) and small plans and health care providers. They also tell us that doing the right thing after a security breach will not be good enough. If you cannot demonstrate that you have conducted a risk assessment, adopted a security policy and otherwise complied with HIPAA/HITECH you will face large financial penalties that will make you wish you had in addition to having to meet the requirements you were trying to avoid. MM Daniel J. Schulte, JD, MSMS Legal Counsel, is a member of Kerr, Russell and Weber, PLC.
ED I T O R’ S NO T E: If you have legal questions you would like answered by MSMS legal counsel in this column, send them to: Kevin McFatridge, Michigan Medicine, MSMS, 120 West Saginaw Street, East Lansing, MI 48823, or at KMcFatridge@msms.org.
January/February 2015
Volume 114 • Number 1
MICHIGAN MEDICINE
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Michigan State Medical Society the Voice of Michigan Physicians OFFICERS
DIRECTORS
President JAMES D. GRANT, MD, Oakland
District 1 MOHAMMED A. ARSIWALA, MD, Wayne PETER BAUMANN, MD, MPA, Wayne T. JANN CAISON-SOREY, MD, MSA, MBA, Wayne CHERYL GIBSON FOUNTAIN, MD, Wayne THEODORE B. JONES, MD, Wayne JAMES H. SONDHEIMER, MD, Wayne J. MARK TUTHILL, MD, Wayne District 2 AMIT GHOSE, MD, Ingham DAVID T. WALSWORTH, MD, Ingham District 3 JOHN J.H. SCHWARZ, MD, Calhoun District 4 STEPHEN N. DALLAS, MD, MA, Kalamazoo LYNN S. GRAY, MD, MPH, Berrien District 5 ANITA R. AVERY, MD, Kent DAVID M. KRHOVSKY, MD, Kent TODD K. VANHEEST, MD, Ottawa District 6 S. “BOBBY” MUKKAMALA, MD, Genesee JOHN A. WATERS, MD, Genesee District 7 BASSAM NASR, MD, MBA, St. Clair District 8 DEBASISH MRIDHA, MD, Saginaw THOMAS J. VEVERKA, MD, Saginaw District 9 RICHARD C. SCHULTZ, MD, Grand Traverse
President-Elect ROSE M. RAMIREZ, MD, Kent Secretary JOHN E. BILLI, MD, Washtenaw Treasurer VENKAT K. RAO, MD, Genesee Speaker PINO D. COLONE, MD, Genesee Vice Speaker TBD Immediate Past President KENNETH ELMASSIAN, DO, Ingham
B OA R D OF DIRECTORS Chair DAVID A. SHARE, MD, MPH, Washtenaw Vice Chair S. “BOBBY” MUKKAMALA, MD, Genesee
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District 10 MARK C. KOMOROWSKI, MD, Bay District 11 JAMES J. RICE, MD, Muskegon District 12 CRAIG T. COCCIA, MD, Marquette District 13 JEFFREY E. JACOBS, MD, Houghton District 14 SANDRO K. CINTI, MD, Washtenaw JAMES C. MITCHINER, MD, MPH, Washtenaw DAVID A. SHARE, MD, MPH, Washtenaw District 15 ADRIAN J. CHRISTIE, MD, Macomb BETTY S. CHU, MD, MBA, Oakland SCOT F. GOLDBERG, MD, MBA, Oakland MICHAEL A. GENORD, MD, MBA, Oakland DONALD R. PEVEN, MD, Oakland DAVID P. WOOD, JR., MD, Oakland Ex-Officio EDWARD G. JANKOWSKI, MD, Wayne F. REMINGTON SPRAGUE, MD, Muskegon Young Physician PAUL D. BOZYK, MD, Wayne Resident MICHAEL J. EHLERT, MD, Wayne Student NICOLAS K. FLETCHER, Kent
January/February 2015
Volume 114 • Number 1
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P R O F E S S I O N A L
L I A B I L I T Y
U P D A T E
Diagnostic Error Identified as the Most Common Allegation in Malpractice Lawsuits BY DAVID B. TROXEL, MD, MEDICAL DIRECTOR, THE DOCTORS COMPANY
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roblems related to diagnostic error are the most common allegation in medical malpractice claims, according to industry sources such as the PIAA’s Data Sharing Project.
The Doctors Company reviewed 7,438 claims closed from 2007–2013. The claims involved 10 medical specialties: pediatrics, emergency medicine, internal medicine, family medicine, hospital medicine, cardiology, general surgery, gynecology, orthopedics, and obstetrics. Twenty-five percent of these claims (1,877 claims) were diagnosis-related. The analysis then focused on the variance between these medical specialties in the incidence of alleged diagnosis-related error and the specific diagnoses involved.
Overall, 34 percent of nonsurgical specialty claims were diagnosis-related (the number one allegation in these claims). For surgical specialties, 14 percent were diagnosis-related (the third most common allegation in these claims). The top five diagnoses for each medical specialty’s diagnosis-related claims involve commonly encountered conditions with differential diagnoses that are well-known to most physicians. For example, in family medicine, which had the largest number of diagnosis-related claims of all 10 specialties (417 claims, or 37 percent of all claims), the top five diagnoses involved lung cancer (4.3 percent), acute MI (4.3 8
percent), breast cancer (4.1 percent), colorectal cancer (3.6 percent), and prostate cancer (3.4 percent). By comparison, in emergency medicine, with 242 diagnosis-related claims, or 58 percent of all claims, the top five diagnoses involved fractures (13.4 percent), acute CVA (13.4 percent), acute MI (5.4 percent), meningitis (4.5 percent), and appendicitis/spinal epidural abscess (each 2.5 percent). In orthopedics, which had 215 diagnosis-related claims, or 13 percent of total claims, the top five diagnoses were post-op infection (11.2 percent), bone and soft tissue cancer (5.6 percent), compartment syndrome (4.2 percent), fracture malunion (3.3 percent), and pulmonary embolism (2.3 percent). Furthermore, 52 percent of the top diagnoses are found repeatedly in different specialties; e.g., acute MI appears in emergency medicine, internal medicine, family medicine, hospital medicine, and cardiology. This suggests that knowledge deficiency is not the primary cause of diagnostic error and that other factors play an important role. The following are some of the factors that can lead to diagnostic errors. Physicians should keep these factors in mind when making a diagnosis to reduce risks and enhance patient safety: • First-impression or intuition-based diagnoses. • Narrowly focused diagnoses influenced by a known chronic illness. • Failure to create a differential diagnosis. • Impaired synthesis of diagnostic data from various sources, such as medical history, physical examination,
diagnostic tests, or consultations. • Failure to order appropriate diagnostic tests. • Context errors. • Failure to follow diagnostic protocols. • System-related errors, such as poor communication or electronic health record design flaws. • Human-factor errors, such as impaired judgment, fatigue, or distractions. In an effort to better understand the causes of diagnosis-related error, the Institute of Medicine has appointed a Committee on Diagnostic Error in Health Care. The committee will examine a range of topics, such as the epidemiology of diagnostic error, the burden of harm and economic costs associated with diagnostic error, and current efforts to address the problem. The committee will propose solutions that may include definitions and boundaries, educational approaches, behavioral/cognitive processes and cultural change, and health information technology. To achieve the desired goals, the committee will devise conclusions and recommendations that will propose action items for key stakeholders. MM David B. Troxel, MD, is secretary of the Board of Governors and medical director of The Doctors Company. Dr. Troxel is clinical professor emeritus, School of Public Health at the University of California at Berkeley. He is past president of the American Board of Pathology and the California Society of Pathologists. He serves as chairman of The Doctors Company Foundation and as a member of the Patient Safety and Technology Committees at The Doctors Company. The Doctors Company is the exclusively endorsed medical liability carrier of the Michigan State Medical Society (MSMS). We share a joint mission of supporting
For More Information For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety. MICHIGAN MEDICINE
January/February 2015
Volume 114 • Number 1
MICHIGAN MEDICINE
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H I T
C O R N E R
Lock and Key As part of the Michigan Healthcare Cybersecurity Council, MSMS supports physicians in their efforts to affordably safeguard and manage crucial patient data BY STEPHANIE VAN KOEVERING
W
hen it comes to the digitization, management and safety of medical records, Michigan health care providers have a complex and costly puzzle to solve.
Not only are today’s medical practices focused on providing high quality, efficient patient care, but they now are charged with developing seamless electronic health record (EHR) systems that allow patients and providers alike to access key data from anywhere in the world. At the same time, medical practices are also charged with protecting their records from hackers and the many other threats to the confidentiality and privacy of patient health records. “It can be overwhelming,” says Dara Barrera of MSMS. Barrera, who manages the Society’s efforts in the area of practice management and health information technology, has seen many practices struggle to find the technology answers they need at a price they can afford. Barrera says that is why MSMS is so
pleased to be an active member of the Michigan Healthcare Cybersecurity Council (MHCC). First founded in June 2013, the MHCC works to help protect Michigan’s health care infrastructure from cybersecurity threats. “We don’t come together just to talk with other health care security experts in Michigan – we come together to develop and deliver consistent solutions to common challenges all health care companies and practices in Michigan are faced with every day,” says Doug Copley, Chairman of the MHCC. The MHCC is an independent, public-private partnership in the State of Michigan involving hospitals and health care systems, payer organizations, physician organizations, the Michigan Department of Technology, Management
How to Begin Thinking About Data Security Perform a risk assessment. Where do threats and vulnerabilities exist for your patients and/or your practice? Inventory your protected health information. What kinds of sensitive data do you have? Where does it exist? Develop a security strategy. Once you know what kinds of data you have, it’s time to think about how to protect it. Train employees. Make sure everyone in the organization – from the top physician to the receptionist at the door – are prepared to follow key protocols. Implement processes, technologies, and policies. Put the right tools in place as soon as you can, and make sure they’re being used. Have an incident response plan ready. Be prepared in the event a breach does occur. Source: Healthcare IT News
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and Budget, the Michigan Department of Community Health, the Michigan Health and Hospital Association, the Michigan Health Information Network, and MSMS. The Henry Ford Health System and its affiliate, the Health Alliance Plan of Detroit, have been involved in the MHCC since its origin. “We recognized the need for information security initiatives early on,” says Meredith Phillips Chief Information Privacy and Security Officer at HFHS. “In a system the size of ours, security has to be an important part of everything we do.” Phillips says any large organization faces both internal and external threats. “It’s not just the hacker sitting in his basement somewhere in the world, working ten times as hard as we do to gain control over our data,” Phillips says. “There are internal threats as well – processes that need improvement, employees that need better awareness of data risks.” To combat data concerns, HFHS has made privacy a focus, combining its patient privacy and computer security functions into a single team operation. The team works to help turn each of HFHS’ 23,000 employees into what Phillips calls “mini-investigators.” “There is a vast human and cultural component involved in protecting patient privacy,” Phillips says. “Heightening sensitivity and fostering stronger organizational dialogue – these are critical areas of focus that all teams have to specifically focus on each day.” Phillips and Copley agree that Michigan’s health care sector is only beginning to grapple with the implications of 21st century technologies. As Copley told a Michigan Senate panel last January: Hospitals, clinics, and health plans are faced with the challenge of improving patient outcomes, maintaining quality, providing more convenient and personal January/February 2015
care, allowing patients to track their own health, allowing providers seamless access to patient data regardless of their location or device, and working with health information exchanges to provide data across organizations. Meanwhile, health care organizations must make sure all the data is appropriately controlled and safeguarded from the ever-increasing range of threats, including cyber threats – all while reducing costs. The MHCC is currently developing guidance in three subject areas: the security of medical devices, the development of a common security framework, and strategies for monitoring threats and managing incidents as they occur. Previously from the financial services sector, Copley indicates that the health care industry has a “less mature” ability to detect and respond to cybersecurity attacks, which may be one reason patient medical records are cited as being more valuable on the black market than financial data. He cites a report indicating that in 77 percent of cases, the average time from hacker attack to data breach was measured in minutes, while in 78 percent of cases, the time from initial
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attack to discovery of a compromise was measured in weeks and months. “Attacks can take many forms,” Barrera said. “From credit card fraud and identity theft to attempts to hack someone’s medical devices, it’s all out there. There are lots of resources available to help support physicians in addressing these challenges, and the MHCC is going to help ensure hospitals, clinics, and physicians can determine which solutions are best for them.” Barrera says the first step for any physician interested in getting a better handle on cybersecurity is to become more educated about requirements and risks. “We have resources available to help make sure individual practices get the tools and resources they need,” Barrera says. “Some of the larger facilities in Michigan also have expressed their willingness to
collaborate and share information. We anticipate the development of tools, white papers, and other support down the road.” The MHCC meets quarterly and offers what it calls “shout-outs” when a particular threat, strategy, or solution is identified. “These virtual ‘shout-outs’ are useful when the news media begins reporting a new virus or computer risk,” Copley says. “The panel immediately goes into action, with folks throwing out ideas and strategies for addressing it. When the Shellshock threat surfaced, the MHCC pulled together first via a shout-out, then a conference call to develop guidance and discuss best practices in identifying and mitigating the risk.” MM The author is a Michigan-based freelance writer.
For More Information Information about the MHCC is available by contacting Dara Barrera at 517-336-5770 or djbarrera@msms.org. The MHCC has also established its own website: www.mihcc.org.
MICHIGAN MEDICINE
11
eadership
What is
Physician Leadership?
T
John Bizon, MD, FACS
Michael Genord, MD
Bruce Muma, MD, FACP
Donald Condit, MD
Jeff Holmes, MD
Phillip Wise, MD, FACS
Jerome Finkel MD, MHA, FACP
Mark S. Schlissel MD, PhD
his issue of Michigan
Medicine will take a look at several physicians who lead the present and future of
Michigan health care. From
the President of the University
of Michigan to a State Representative,
A physician leader is a physician advocate.
these physicians are driving change in
They advocate for their patients and communities by
our state. They have set an example of
advocating for health care reform at a state and national
physicians who passionately lead teams,
level. Physician leaders know the influence they can have with their expertise and unique experiences, and do
universities, organizations and communities.
everything they can to make a difference.
They define what it means to be a
A physician leader has great mentors.
physician leader:
Physician leaders become great leaders with the guidance
A physician leader puts their patients
of mentors throughout their career. From freshman year of college to the last day of their residency, they surround
first and foremost. Physician leaders take
themselves with leaders in their specialty.
care of their patients one broken bone or
A physician leader is a mentor. One of the
sore throat at a time. They know the
most important roles for a physician leader is mentoring
impact they have on each one of their
their team and setting an example for others in their specialty. They know the impact their mentors had on
patients and the trust that their patients
them, and strive to inspire their mentees in the same way.
hold in them. They validate this trust
Physician leadership is not defined by a title, educational
by providing the best care possible for
background or letters following a name. Communities
each individual patient.
trust physicians to take care of them as patients and to lead the future of health care. With this trust comes individual responsibility of all physicians to step up as the leaders of their community.
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January/February 2015
A Look at Independent Practices The Road to Independent Success
F
people and always trying to help them was the main ingredient for success,” he said. In addition, Doctor Holmes’ residency program provided an opportunity to gain skills in running and managing an office. Specifically, the seminars and meetings discussed useful and necessary concepts that he has since implemented, concepts that have allowed his practice to flourish.
or Phillip Wise, MD, FACS, of Urologic Consultants, PC and Jeff Holmes, MD, of Alma Family Practice, the paths to becoming successful independent practitioners started with unique sources of inspiration.
Doctor Wise has a bachelor’s degree in physics, which helps him in his approach to problem solving. As a water polo student-athlete at University of Southern California, Doctor Wise learned to be dedicated to a strict schedule. While in medical school, Doctor Wise was encouraged to learned Spanish in the maternity ward of USC Los Angeles County Hospital. Over the years he picked up on phrases that help him Phillip Wise, MD, FACS communicate with the Hispanic community, which has contributed to his success as an independent practitioner. Doctor Holmes’ father had a master’s degree in business management and his mother was the office manager of his office operations. “My parents emphasized that caring for
Jeff Holmes, MD
Advantages and Disadvantages to Practicing Independently Both doctors recognize that there are advantages and disadvantages to being part of an independent practice. “As a solo practitioner, all the decisions are yours alone,” said Doctor Wise. “There is no finger pointing, scapegoating or defensiveness, you make the decision and you live with the consequences. You can bask in the glory of a properly chosen electronic medical record or you might grovel in a poorly designed office. But you will get what you can afford, when you want.” Doctor Holmes adds, “I believe being an independent practitioner provides more flexibility in my practice, and the ability to respond to changes in the medical environment more rapidly and proactively. It also allows more opportunities to be involved with a variety of organizations.” MM
Advice for Future Independent Physicians As experienced physicians, Doctor Holmes and Doctor Wise share the following pieces of advice to those interested in pursuing a career as an independent practitioner, based on the lessons they’ve learned over the years: The most important focus for your practice should be your patients. Hire staff that are skilled, motivated and want to serve your patients, and hire enough staff to provide the service that patients need. Create a culture that centers on patient care, a culture that cares for staff, and a place that feels like family where everyone cares for each other. Empower the staff to make decisions about their positions so they feel a sense of ownership in the practice. Meet regularly to discuss changes staff may wish to implement and how that can improve the office, each other’s positions and ultimately patient care. Take a course in accounting, even at the community college level. Be careful with what you say to patients; they sometimes remember the most offhand comments, and forget the important ones.
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MICHIGAN MEDICINE
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Physicians Making a Difference by Influencing Change
A
s a physician, making a difference can hold many different meanings; making a difference in a patient’s life, making a change in health care or impacting the community as a whole.
Leading Change For Bruce Muma, MD, FACP, and Donald Condit, MD, MBA, making a difference means always challenging the system in order to improve the value of care for their patients. Doctor Muma, CMO for the Henry Ford Physician Network and medical director for Population Health for Henry Ford Medical Group, explains that with improvements to the system comes additional responsibility. Bruce Muma, MD, FACP With pressure from the community to reduce costs while improving care, Henry Ford Physician Network is now using real time data from electronic medical records to identify at risk patients and deliver critical information to physicians and their staff. “This is truly an exciting time to practice medicine but these enhanced electronic capabilities create greater complexity for physicians and simultaneously raise performance expectations,” said Doctor Muma. Doctor Condit, president of Kent County Medical Society, encourages growth and membership in the Kent County Medical Society in order to remain effective with advocacy at the state and national level. “I am concerned about the escalating cost of and the pressures bureaucracy places upon physicians,” he said. “While there is no question we all need to be responsible stewards of resources, I am concerned about the adverse consequences that economic pressures might have on the doctor-patient relationship. Physicians need to be first and foremost advocates for their patients.” One Sore Thumb at a Time Through their positions as physician leaders, both Doctor Condit and Doctor Muma affect change in the health care community, while making a difference for individual patients. “A fulfilling day for me means being able to take care of each patient, one sore thumb at a time or one broken wrist at a time,” said Doctor Condit. “I find it most rewarding to help hand surgical patients, which is my specialty, and I think many other physicians would say the same – being able to help a patient get through a medical problem is tremendously rewarding.” Looking up to Great Leaders Neither Doctor Condit nor Doctor Muma takes credit for their
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Doctor Condit on recent medical mission trip to El Salvador with a boy after surgery for a elbow burn scar contracture, with Doctor Jason Somogi, an orthopedic resident, the boy’s mom and a Salvadoran medical student.
individual success, instead attributing their successes to the mentors and leaders present throughout their careers. Doctor Condit looks up to Doctor John MacKeigan, who recently passed away, as a mentor, leader and friend. “I can remember him sending me a note just after I started practice welcoming me to town – before we had even met, 25 years ago. We shared a love of medicine, our families and sailing.” Doctor Muma reflects back on early leadership of The Henry Ford Health System, “Health care is truly a team sport so I would not claim individual credit for any particular accomplishment. The Henry Ford Health System has been committed to quality improvement since the late 1980s and was an early adopter of the teachings of William Edward Deming. I’ve had the opportunity to develop expertise in multiple improvement methodologies and work on the cutting edge of quality improvement.” Defining Physician Leadership Both humbled to be recognized as physician leaders in Michigan, they agree that leadership is driven by the commitment to do what is best for their patients. “Being a leader in the medical profession today means you’ve embraced the challenge of inspiring physicians to push beyond the boundaries of the current state,” said Doctor Muma. “This is not a quest for the faint of heart – it requires unusual courage and endless energy. I hope that I can be a catalyst for my physician colleagues to keep pushing beyond boundaries and building momentum for a better future.” Doctor Condit adds, “Within the Spectrum Health Medical Group, I hope to serve as an example of someone who is very committed and passionate about doing what is best for our patients. I also hope to help my colleagues be at their best as part of our team.” MM
MICHIGAN MEDICINE
January/February 2015
Physicians in Administrative Roles The University President Mark S. Schlissel, MD, PhD, always aspired to combine his education and talents and use them to make a difference in the world for others. Before taking over as the 14th president of The University of Michigan, Doctor Schlissel did this through clinical practice, teaching, mentoring and biomedical research. “I did not set out to become a university president, but rather I’ve risen to this position by taking Mark S. Schlissel MD, PhD advantage of unusual opportunities to contribute in a variety of different roles in the course of a long and satisfying academic career,” said Doctor Schlissel. “I am very grateful for the opportunity to serve the U-M community.” Doctor Schlissel’s training as a physician has helped him to develop skills in interacting with all different types of people and making decisions based on data and logic, while still appreciating the human component of complex situations. He further explains that it is very satisfying to take advantage of his education and training as a physician and scientist to help lead a prominent public research university. “The University of Michigan has an outstanding academic medical center, so my experience with multiple aspects of clinical medicine and biomedical research will help me lead the university in a way that maximizes the public good.”
The Vice President, CMO Although Michael Genord, MD, never aspired to be an executive in the insurance industry, he feels he is in the right place at the right time. “The insurance industry is exploring innovative ideas to improve the delivery of health care in the United States, and I am excited to bring my training and clinical experience to the conversation as CMO and Vice President of HealthPlus,” said Doctor Genord. Volume 114 • Number 1
Michael Genord, MD
Doctor Genord feels that as the medical environment changes, it is more important than ever that providers are engaged with the payers and hospital systems and working together to create value for the health care system. He worked to implement these ideals during his 16 years in private clinical practice, and now feels fortunate to have the opportunity to make change on a larger scale as CMO of HealthPlus. As a leader at HealthPlus and in the health industry, he strives to inspire his team and community every day. “In my first year at HealthPlus, our team has been very successful at decreasing inpatient utilization rates, reorganizing our care management teams and dealing with difficult pharmaceutical challenges,” he said. “I hope that my team is inspired by my passion and commitment to think differently in an effort to contribute to better outcomes and decreased cost burden for our members. Healthy members, access to resources and a cost effective system are our goals.”
The Medical Director Jerome Finkel MD, MHA, FACP, explains that leadership has given him the opportunity and the privilege to participate in the transformation of Michigan’s health care system. As Medical Director of Greater Macomb PHO, he works with his team to reach the goal of creating a sustainable health care model, while improving quality, containing costs and improving both patient and providers’ experience of care. Jerome Finkel MD, MHA, FACP Doctor Finkel explains that having a background with a focus on quality and patient service as a base has been very important. “That base is then coupled with a forward thinking entrepreneurial approach and the willingness to try new things combined with both the desire and the ability to develop and work within a team.” With a dedication to teamwork and collaboration, Doctor Finkel explains that he tries to learn from everyone he interacts with and that, in a way, they are all his mentors. “I have been fortunate to have had many outstanding relationships both professionally and personally which have promoted my development. I believe strongly in the notion that there are heroes in every role and I have an appreciation for the unique contributions that each person can make to the organization and those around them. One of my favorite quotes, introduced to me during my residency by my then Resident Director is, ‘All of us are smarter than any of us.’” MM
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Running for Office A Conversation with State Representative John Bizon, MD
J
Part of Doctor Bizon’s responsibility as president of the Michigan State Medical Society was to advocate for Michigan’s patients and doctors in the capital city. This gave him the opportunity to walk into a legislator’s office and introduce himself as someone who represented the Michigan State Medical Society’s 15,000 physician members. “It seemed very obvious that if I wanted to make a significant difference in the state’s
ohn Bizon, MD, FACS, recently appointed State Representative of Michigan’s 62nd District, admits that it was only recently that he considered running for political office. He says that his experiences as past president of the Michigan State Medical Society is
perhaps what made him feel that this was something that could be accomplished. John Bizon, MD, FACS
So Where – and How – Does a Physician Get Started on a Path to Public Service? BY NICK DELEEUW Now is the perfect time to contemplate and begin taking the first steps toward a possible run for office in 2016. Different political offices have different candidacy requirements, but a few general guidelines may help as physicians contemplate public service: Talk to your spouse and family. While only one name appears on a ballot, a run for public office is always a family affair. Campaigns require a great deal of sacrifice and understanding from the entire family. And a win at the ballot box will mean lifestyle changes for years to come. These are major family issues, and being on the same page is a critical first step towards a successful candidacy. Decide what you want to run for, and when. Every two years, each seat in the state House of Representatives is up for grabs, along with each of the 14 seats in Michigan’s Congressional delegation. Michigan’s state Senate seats will not be on the ballot again until 2018. Mark your calendar. Visit Michigan’s Bureau of Elections online to learn about all of the state’s important filing dates. If you don’t take the necessary steps to meet filing deadlines and requirements, your name won’t appear on the ballot. Consider attending a “campaign school.” The American Medical Political Action Committee (AMPAC), the Michigan Republican and Democratic parties, as well as numerous nonpartisan organizations, routinely offer campaign schools for legislative candidates. Learning the ropes of a campaign from political professionals could make all the difference in your race. Meet with your caucus campaign team. If you are running for a seat in the state legislature, both the Republican and Democratic caucuses have legislative campaign teams that exist specifically to provide campaign training and to help you campaign effectively. Contact the Michigan State Medical Society and the American Medical Association. Both MSMS and the AMA offer experience, resources, and expertise that can help you in your run for office. New shoes. The most important thing a candidate for office can do during a campaign is to personally knock on residents’ doors, asking for votes. Invest in a few pairs of new, comfortable walking shoes. You’re going to need them! With the future of patient care on the line, Lansing and Washington, D.C. both desperately need to call a doctor. With these tips in mind, it may be time to ask yourself – are you willing to make a house call? The author is a freelance writer from Lansing, MI.
health care, it would have to be done not as a lobbyist, not as a person who was coming to visit the legislators in Lansing, but rather I would have to do it from the inside as a legislator myself,” he said. As Doctor Bizon begins to plan for his term as State Representative, he anticipates infusing his charge with his belief that changes are needed both in health care and education in our state. “I think that the system fails too many, that it is too expensive and lacks transparency and competition – we pay too much and we get too little. We need to do better as a medical community,” he said. “One thing that I learned when I was president of MSMS is that if you focus on the patients you typically will do what is right for the physicians and the community. I am hoping to expand that to include all of our constituents here in the state.” Doctor Bizon encourages physicians who are interested in running for office to be active in their communities. He explains, “For me, being active within organized medicine has proved to be very helpful.” Though his path was less traditional he says, “I find that most of the other politicians who have run for state office typically have prior legislative service at a school board or at the city commission or county commission level. Being active at those levels is often great training for moving on to a state office.” Doctor Bizon credits his experiences on the executive board of the Michigan Doctors’ Political Action Committee and chair of legislative policy for Michigan State Medical Society as training for his new role as a state leader. MM
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Take Financial Leadership in 2015 BY NATHAN MERSEREAU, CFP ®, AAMS
M
ost doctors have
review by examining expenses on your bank and credit card statements. If you find yourself spending more than you have coming in, or if you’re not saving enough to reach you goals, make choices that will free up cash flow. If you’re in retirement, carefully plan your spending, paying special attention to fixed income sources and how to take supplemental income from your portfolio. Make a list of your assets and liabilities and track your net worth. If you’re married, have a conversation with your spouse regarding your current financial status. Physicians often become busy and don’t take the time to communicate with their loved ones about their financial affairs. It’s important to have a clear contingency plan in place if one of you has health issues, dies or is disabled.
a shorter working life than other professionals who
are planning for their future. They often start saving later in life given the length and cost of medical school, receive little to no financial aid for their children’s educations and have fewer years for their retirement money to compound. This makes it crucial for physicians to plan early and carefully for their future and not make major financial missteps along the way. Since the beginning of the year is a good time to review your financial roadmap, consider these tips as you
enter 2015. Take Financial Inventory Given the rate of change in the health care industry, it’s more important than ever to have a financial contingency plan. Downward pressure on physician income continues and many factors could lead to a change in your situation. Start your financial
Remember, a well diversified portfolio may not win a sprint but it will help you win the marathon.
Maintain a Well-Diversified Investment Portfolio A lt houg h t he e c onomy i s improving, the stock market is near an all-time high and corporate profit s a re setting records, much uncertainty still remains. Therefore, this is not the time to make big bets. Physicians often take unnecessary risks with their money at the least opportune times. For that reason, make sure you are adequately diversified across various assets classes. Invest according to your risk tolerance
For More Information Want to avoid common investing mistakes? Request a copy of our white-paper Eight Mistakes Physicians Make with Their Money and How to Avoid Them by contacting co-author Jim Niedzinski at 888-958-1990 or download a copy from our website at www.wealthcareadvisors.com. 18
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and time frame. Rebalance your portfolio as needed, trimming back investments that have grown and reinvesting into the balance of your portfolio. Remember, a well diversified portfolio may not win a sprint but it will help you win the marathon. Update Your Estate Planning Documents Since the federal estate tax exemption is $5.43 million for 2015, people with less than this amount may feel that they are off the hook where estate planning is concerned. But estate planning is necessary regardless of net worth. Start by reading the documents you currently have in place. People may have died or been born since you signed the documents, or you might not feel the same as you once did about how your estate distribution is structured. Reading the documents will refresh your perspective and allow you to identify what you may want to update. Meet with an estate planning attorney to make sure your wills and trusts are in order. Draft an advanced health care directive and a durable power of attorney so health and financial decisions can be made if you’re incapacitated. Check the beneficiaries on your assets, especially your life insurance policies and retirement plans, and remember these designations trump your will and trusts.
There is always a reason not to save, but financially successful people consistently exhibit good habits. Develop the savings habit now and increase the amount over time. Do not overestimate stock-market returns and understand how investing works. Develop a reasonable strategy; regularly save into your portfolio and over time you will succeed. Update Your Financial Plan Financial planning is a process, not a one-time event. Inherent in planning is the use of many personal and economic assumptions about the future. These assumptions will change and will necessitate regular updating of your plan. By routinely analyzing the various aspects of your life and developing a financial roadmap, your chances of reaching your goals will improve dramatically. If you don’t have a financial plan, now would be a good time to create one. If it’s been a while since you looked at your plan, it may be time for a review. Make 2015 the year you gain clarity and confidence with your finances. MM
Be a Smart Saver It’s unlikely you will get rich by accident. People typically achieve financial independence through receiving an inheritance, experiencing a significant liquidity event such as selling a business, or saving money over a long period of time. Most people, including physicians, have the best chance of achieving financial independence by regularly saving money.
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The author is President of WealthCare Advisors, LLC – an MSMS joint venture.
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M D C H
U P D A T E
Protecting Persons Aged 65 Years and Older Against Pneumococcal Disease AN UPDATE FROM THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
A
long with winter weather comes flu disease and its complications, with the most common being pneumonia. It continues to be important to vaccinate all persons aged six months and
older throughout the flu season. In addition, providers now have an opportunity to protect their senior clients (aged 65 years and older) against pneumonia and invasive pneumococcal disease (IPD) using two separate vaccines – Pneumococcal Polysaccharide Vaccine (PPSV23) and Pneumococcal Conjugate Vaccine (PCV13).
While a recommendation to give PPSV23 to persons aged 65 years and older has been around since 1983, PCV13 was added into the recommendations for this age group in September, 2014. Why Add in PCV13? Using a different type of vaccination technology, a conjugate vaccine generally can provide better long-term protection because of the mechanism used to create an antibody response. While polysaccharide vaccines offer individual protection, they do not elicit a level of “herd immunity” provided by conjugated vaccines. Vaccine preventable disease burden, among this age group, estimates 2,600 PCV13 type IPD cases in 2013 and over 50,000 PCV13 type inpatient community acquired pneumonias (CAP). The results of a large PCV13 trial demonstrated a 75 percent reduction in vaccine type IPD and a 45 percent reduction in vaccine type non-bacterimic pneumonia.
Why Continue to Use PPSV23? Streptococcus pneumoniae is a bacterium that has more than 90 serotypes. PPSV23 includes 12 of the serotypes from PCV13, plus 11 additional serotypes. It has been shown to be 50-85 percent effective in preventing IPD in adults with healthy immune systems. Beginning September 19, 2014, the Advisory Committee on Immunization Practices (ACIP) has recommended that persons aged 65 years and older receive: • One dose of PPSV23, regardless of any previous dose(s) administered prior to age 65 years • One dose of PCV13, if no previous dose(s) was administered prior to age 65 years Here are some key points to remember in administering these doses: • PCV13 and PPSV23 cannot be administered at the same visit
CDC Immunization Course Coming to Michigan: June 16-17, 2015 The Epidemiology and Prevention of Vaccine-Preventable Diseases course will be held June 1617, 2015. The two-day course will be presented by immunization educators from the Centers for Disease Control and Prevention (CDC). A State Immunization Update given by MDCH staff will also be included. The class provides a comprehensive review of vaccine-preventable diseases and their respective vaccines. The course uses the Pink Book (also called the Epidemiology and Prevention of Vaccine-Preventable Diseases) as the backbone to the content. Participants will have numerous opportunities to ask questions. The class will be held at the Lansing Center in Lansing. CMEs and continuing education will be offered. MDCH is still in the early stages of planning. There will be a cost, but the amount has not yet been determined. As more details become available, updated information will be posted on the MDCH website at: 20 MICHIGAN MEDICINE www.michigan.gov/immunize > Health Care Professionals/Providers. Stay tuned!
• If a person is naïve to pneumococcal vaccination (no previous doses of PCV13 or PPSV23), give PCV13 first, then wait a recommended interval of 6-12 months before giving a PPSV23 dose • This allows the person to receive the PPSV23 dose at their next bi-annual or annual visit • Ensure minimum intervals between these doses are met: • If PCV13 is given first, PPSV23 may be administered 8 weeks later • If PPSV23 is given first, PCV13 cannot be administered until one year later • If a previous dose of PPSV23 was given (prior to age 65 years), another dose cannot be administered until five years later Michigan Department of Community Health staff has created a one-page handout that includes these key points. The “Use of Pneumococcal Vaccines (PPSV23, PCV13) for Adults 19 years and older” handout is posted on the MDCH website at: www.michigan.gov/immunize > Health Care Professionals/Providers > Quick Looks & Other Resources. Medicare Part B Under Medicare Part B, all persons who are naïve to pneumococcal vaccine or have an unknown vaccine history are covered for one dose of Pneumococcal vaccine. Medicare will also reimburse for an additional Pneumococcal vaccine dose for high risk persons, five years after the first dose. Medicare is currently reviewing a change to allow the September 2014 recommendation to be a covered benefit under Part B. Some Medicare Advantage plans may already be covering both vaccine doses. However, clients receiving a second pneumococcal vaccine dose should be alerted to these reimbursement issues; clients (or the provider) should check with an individual plan to determine coverage. MM Source: “Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine among Adults Aged ≥ 65 Years: Recommendations of the Advisory Committee on Immunization Practices” http://www.cdc.gov/ mmwr/preview/mmwrhtml/mm6337a4.htm January/February 2015
Welcome to These New MSMS Members Matthew Martin, MD, Kent Assadollah Mazhari, MD, Wayne Shannon McKeeby, MD, Kalamazoo Ryan Mitchell, MD, Kent Sandeep Mittal, MD, Wayne Dorian Moore, MD, Washtenaw Charlotte Moriarty, MD, Kalamazoo Samya Nasr, MD, Washtenaw Ellen Ozolins, MD, Oakland Latifa Pacheco, DO, Kalamazoo Russell Pacquette, MD, Midland Aditya Pandey, MD, Washtenaw Sneh Patel, MD, Kalamazoo
Julius Ramirez, MD, Kalamazoo Sireen Reddy, MD, Jackson Paul Romanoski, MD, Muskegon Lucille Saha, MD, MPH, Genesee Brian Sandler, MD, Macomb Imran Shafqat, MD, Kalamazoo Peter Shireman, MD, Grand Traverse Vick Sidhu, MD, Kalamazoo Michael Siegel, MD, Oakland Sukhpreet Singh, MD, Kalamazoo Matthew Sleziak, DO, Washtenaw Emily Smith, DO, Kalamazoo Krishna Sowjayna Pothugunta, MD, Oakland Amanda Springer, MD, Kalamazoo
Joshua Stewart, MD, Washtenaw Jared Sturgeon, MD, Genesse Joshua Suderman, MD, Kent Nabil Suliman, MD, Oakland John Szajenko, MD, Midland David Szaraz, MD, Wayne John Tanner, MD, Kent Randi VanOcker, DO, Kalamazoo Anish Wadhwa, MD, Jackson Alexander Witte, MD, Kalamazoo Stephen Witzke, MD, Ingham Hugh Wong, MD, Kalamazoo Sri Yadlapalli, MD, Wayne
OBITUARIES
The members of the Michigan State Medical Society remember with respect their colleagues who have died. Robert Black, MD
Wayne County Medical Society Died November 18, 2014.
Scott Kuhnert, MD
Ingham County Medical Society Died December 5, 2014.
Marshall Shearer, MD
Washtenaw County Medical Society Died November 26, 2014.
I N M E M O RY If you would like to recognize a colleague by making a gift or bequest in their memory to the MSMS Foundation, please contact Rebecca Blake, Director, MSMS Foundation, 120 W. Saginaw St., East Lansing, MI 48823, Call 517-336-5729 or e-mail rblake@msms.org.
Alexander Ajlouni, M.D. Board Certified in Anesthesia and Pain Medicine Jeffrey J. Kimpson, M.D. Board Certified in Anesthesia and Pain Medicine Jeffrey J. Kirouac, M.D. Member, American Pain Society Member, American Academy of Pain Management John H. Traylor, M.D. Medical Director for St John Providence Hospital Pain Management Center Board Certified in Anesthesia and Pain Medicine
Affiliated with Northland Anesthesia Associates, P.C.
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Educational Conferences Patient Centered Medical HomeSupporting Patients through Population Health Date: Wednesday, March 4, 2015 Time: 9 a.m. to 3:30 p.m. Location: Marriot, Troy Contact: Caryl Markzon, (517) 336-7575 or cmarkzon@msms.org Note: Continental breakfast and lunch will be provided Intended for: Physicians, executives, office administrators and all other health care professionals
Compliance Essentials You Need to Know in 2015 Date: Wednesday, January 28, 2015 Time: 9:00 a.m. to 3:30 p.m. Location: Marriot, Troy Contact: Caryl Markzon, (517) 336-7575 or cmarkzon@msms.org Note: Continental breakfast and lunch will be provided Intended for: Physicians, executives, office administrators and all other health care professionals Beyond Checking the Box: Legalities and Practicalities of HIT Date: Tuesday, February 17, 2015 Time: 9:00 a.m. to 3:30 p.m. Location: Marriot, Troy Contact: Caryl Markzon, (517) 336-7575 or cmarkzon@msms.org Note: Continental breakfast and lunch will be provided Intended for: Physicians, PO Administrators, Practice Consultants, Office Administrators and all other health care professionals
Spring Scientific Meeting Date: Wednesday, May 13 and Thursday, May 14, 2015 Time: Morning, afternoon and evening sessions will be offered Location: The Henry in Dearborn Contact: Marianne Ben-Hamza, (517) 336-7581 or mbenhamza@msms.org Note: Continental breakfast and lunch will be provided. Intended for: Physicians and all other health care professionals
Physicians and Practice Managers…Thinking of Adding a Nurse Practitioner or Physician Assistant? Increase your time, revenue, patient’s access/satisfaction, hospital rounds, overall business. NP/PA providers can be incorporated into the practice in three ways: 1. Acute care with same day access/extended hours, 2. Physician partner on care team, 3. Or as a fully paneled provider in your practice. Locum Tenens, Temp to Permanent, Direct Hire. Call us at (734) 398-3444 regarding your NP/PA needs. We are here to help! We are a Michigan based company…in business to provide fully credentialed and committed healthcare practitioners where and when needed.
HCS Staffing staffinginfo@hcsgroup.com www.hcsstaffing.com
Annual Joseph S. Moore, MD, Conference on Maternal and Perinatal Health Date: Thursday, May 14, 2015 Time: 9 a.m. to 4:15 p.m. Location: The Henry in Dearborn Contact: Marianne Ben-Hamza, (517) 336-7581 or mbenhamza@msms.org Note: Continental breakfast and lunch will be provided Intended for: Physicians, nurses, residents, students, and all other health care professionals working with women and their infants • To Register Online: www.msms.org/eo • Mail Registration Form to: MSMS Foundation, PO Box 950, East Lansing, MI 48826-0950 • Fax Registration Form to: 517-336-5797 • Phone MSMS Registrar at: 517-336-7581
MSMS On-Demand Webinars: Education When You Want It! • Physician Executive Development Program, featuring The Doctors Company CEO Richard E. Anderson, MD • CDL-Medical Examiner Course • Summary of the Affordable Care Act • HIPAA Security Rule • End of Life Concerns and Considerations • Understanding and Preventing Identity Theft in Your Practice • Stepping Up to Stage 2 Please visit website www.msms.org/eo for a complete listing.
FREE MSMS “Lunch and Learn” Policy Webinars • MSMS “Lunch and Learn” Policy Webinars Visit www.msms.org/eo for complete details.
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T H E
M A R K E T P L A C E
Would You Like To Place A Classified Ad? The rate for classified advert ising in Michigan Medicine, including both print and online versions, is $1.60 per word, with a minimum of $65.00. All ads must be prepaid. Text for classified advertisements and advertising fee should be received no later than the first of the month proceeding the month of publication. All submitted ads must be typed. No handwritten or dictated ads will be accepted.
To place an ad call 888-822-3102 or email gretchen@villagepress.com.
Employment Opportunities MULTIDISCPLINARY WALK-IN CLINIC looking to hire a medical doctor in Tecumseh, Ontario (very close to Windsor) to start as soon as possible. Pharmacy and x-ray facilities available. All medical supplies/secretary/billing services provided. Please contact renacitron@hotmail.com or (519)980-8083.
RURAL OPPORTUNITIES IN SW MICHIGAN • Family Practice – outpatient • Internal Medicine (model is: 3 weeks IM outpatient, 1 week Hospitalist)
• Orthopedic Surgeon,
General Ortho but subspecialty is welcomed, employed, benefits, relocation, share call
Fully accredited 60 bed hospital, rehab unit, regional referral availability, wound clinic on campus. 2 hours to both Chicago and Detroit, close to Kalamazoo. Can be employed or income guarantee, full benefits, malpractice, relocation. Check us out at www.threerivershealth.org. Forward CV to: Cindi Whitney-Dilley – Inhouse Recruiter WhitneyRecLLC@aol.com (269) 506-4464
Equal Opportunity Employer
D I S C I P L I N A R Y A C T I O N S
Disciplinary actions of the Michigan Board of Medicine can be found at www.michigan.gov/lara/ 0,4601,7-15435299_63294_2752943008--,00.html
The Voice of Michigan Physicians The mission of the Michigan State Medical Society is to promote a health care environment which supports physicians in caring for and enhancing the health of Michigan citizens through science, quality, and ethics in the practice of medicine.
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January/February 2015
Family Practices
EMPLOYMENT OPPORTUNITIES Open Positions: [ MD/ DO/ DPM ] Primary Care • Pain Management • Psychiatry Podiatry • Ophthalmology • Wound Care
Residential Home Care, Inc.
Corporate Office: 11477 E. 12 Mile Road, Warren, MI 48093 Telephone: (586) 751-0200 • Fax: (586) 751-0414
Dr. Metropoulos, Medical Director Multiple providers needed for our growing practice. No Nights. No Weekends. No On-Call. Full-time or Part-time. Compassionate and skilled practitioners for providing quality care to elderly and disabled patients in their homes. Transportation provided for you, driven by medical assistant in company-owned vehicle. In-home diagnostics are available to assist you with the evaluation, diagnosis, and management of our patients.
m Dearborn Heights: Internal Medicine/Primary Care Practice. Newly remodeled, 6 exam rooms, break room, central lab, plenty of parking, very visible potential gross income of $400,000 annually w/current patient base. Asking $127,900 for practice and $268,900 for real estate. m Keego Harbor/Orchard Lake: Urgent care center – willing to sell all or part of the practice. Asking $117,500.00 for entire practice. Excellent location, totally remodeled 4 exam rooms, x-ray, easy access. Real estate also available. Three adjoined buildings, flexible terms. m Commerce Area: Oakland County. High traffic area, shorter hours still produces $500,000+. We offer a one year transition period, 30 years of office. Real estate also offered…priced right. m Mexican Town: Detroit. 20 year old Primary Care Clinic, staff is fluent in multiple languages, seller financing available, priced to sell, work as you pay terms, never in 25 years have I had the opportunity to offer more flexible terms. Price reduced to $589,000 for everything including real estate. m Lincoln Park: Walk-in clinic very visible, long established, seeing approximately 40 patients daily approx. gross income $800,000 asking $250,000 for practice and $350,000 for real estate. m Mack Ave. Detroit: High volume primary care clinic, under served area, Medicaid and Medicare pay a bonus fee schedule, receive up to $25,000 annually for your medical school loans, gross income is approximately $880,000 annually asking $250,000 for practice and $260,000 for real estate. m Belleville-Canton: Canton Primary Care Clinic, presently resently grossing in excess of $1 million annually, price reduced $100,000, asking $800,000 for practice and real estate, seller financing available.
Medical Buildings For Sale or Lease m Far West Side Detroit: Multi suite property fully leased, $60,000. Positive cash flow for owner. Very good condition, brick, single story. One suite opened up for your practice. 8,000 sq. ft., private parking. Asking $525,000, or lease at $1 sq. ft./mo.+utilities. m Garden City: Medical practice building, still has equipment, exam tables, EMR. About 1,200 sq. ft., three exams, basement storage, private packing. Asking $129,800 or $900/mo. lease. Seller will finance. m Pontiac: Large professional medical building. Three story, suites 500-5,000 sq. ft. Across from hospital, acres of parking. VERY REASONABLE rates/terms or buy building for $250,000.
Clinic opportunities available. If you are interested in more information, please call (586) 751-0200. Please mail, fax, or email us your CV today. Fax: (586) 751-0414 • Email: HealthNetWeb@aol.com
Serving Southeastern Michigan for 55 Years Volume 114 • Number 1
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For more details contact our practice specialist at Union Realty:
Joe Zrenchik, Broker 248-240-2141 (cell) joezrenchik@yahoo.com 248-919-0037 (office) Thinking about retirement, relocation or expansion of your medical practice? We have buyers and sellers for primary care, internal medicine and cardiology practices. 25
P R E S I D E N T ’ S
P E R S P E C T I V E
On Being a Leader BY JAMES D. GRANT, MD
C
learly, physicians are the leaders of the health care team. We were educated
and trained for that role.
But on the business and political sides of health care, maybe not so much. One reason is that the word “leadership” has a lot of different meanings. A “leader” in one area is not automatically a “leader” in another area. Requisite skill sets vary greatly for various situations. In determining what is best for a patient, we rely on a certitude that has been instilled in us since long before medical school. But when it comes to dealing with the massive changes we are now facing in health care delivery brought upon us by payers and the ACA including population health management, quality metrics, and patient satisfaction, we are suddenly on uncertain ground. The dollars and cents and the nuts and bolts of health care have shifted dramatically. It seems as if it’s no longer sufficient to be an excellent clinician and the leader of the health care team. Now we also have to be financial wizards, efficiency experts, technology experts, business people, and entrepreneurs, but not just for our selves, but for our practices. Being a leader in these settings requires not only the accumulation of a vast amount of new and ever-changing knowledge, but the development of new interpersonal skills that get our voices heard without being domineering, and thus, shut out of the conversation. The new paradigm in health care delivery demands a new way of being. It’s all about teamwork and there are a lot of captains, but we all need to be collaborative, cooperative, and constructive. This isn’t going to be easy. One of the biggest hurdles to overcome will be to step outside of our comfortable routines and commit the time and energy it takes to become a leader in the new health care delivery system.
26
The parameters of this column obviously do not permit a wholesale review of a step-by-step process required to become a leader. And to be honest, a defined step-by-step process for becoming a leader doesn’t exist. But there are hundreds of articles, books, and conferences on “leadership” available on the internet. You may want to start there. Read a lot. Take a class or two. Then get out of your comfort zone and raise your hand, step up, and take on a leadership position. Developing leadership
One of the biggest hurdles to overcome will be to step outside of our comfortable routines and commit the time and energy it takes to become a leader in the new health care delivery system. skills is kind of like in surgical residency, “See one, do one, teach one.” Quotations can be inspirational as well as educational. Here are a few that resonated with me and reinforce the message I want to get across about physician leadership in this new era. Maybe summing things up most succinctly is a quote from President John F. Kennedy, “Leadership and learning are indispensable to each other.” Simply being placed or stepping into a leadership position is not enough. It takes a lot of self-education to stay current and, of course, that takes extra time out of a day when you’re already up to your eyeballs in patient care and paperwork. But it’s essential. Being a leader requires a positive mindset. It requires you to be encouraging of
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others and about the future. As Napoleon Bonaparte noted, “A leader is a dealer in hope.” Those in the trenches who never look up at the sky seldom see the bright side. Remain optimistic. People will always need health care, it’s just going to be delivered and paid for differently. Fight for how you think it should be done. Once you do take on a leadership role, you likely will see a different, maybe hidden, side of yourself that you didn’t even know existed. It can become addictive. In many people, the more they have, the more they want. Or as Zig Ziglar positively put it, “When you catch a glimpse of your potential, that’s when passion is born.” When you step outside of yourself and see that you can make things happen, it reinforces the desire to do more. When you see that you can make a difference for yourself and others as a leader, you begin a snowball effect with those around you. As President John Quincy Adams observed, “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” You become the catalyst for a domino effect that builds in many directions. And what lesson on leadership would be complete without a quote from Winston Churchill? He pointed out that “Success is not final, failure is not fatal: it is the courage to continue that counts.” We have experienced so much change lately that takes the wind out of our sails, guts the joy of medicine, and sucks the life out of us. But we don’t have a lot of options other than to get involved and stay involved and make our voices heard. We need to be leaders with the courage to continue. MM Doctor Grant, a Royal Oak anesthesiologist, is President of the Michigan State Medical Society.
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