THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 117 / NO. 1
January / February 2018
www.msms.org
TYPE 2 DIABETES CAN BE PREVENTED OR DELAYED. You can help. That bold statement can be a lifesaver for your high-risk patients who are among the 84 million adults with prediabetes (an A1c level of 5.7–6.4 percent). Here’s how to help: Visit preventdiabetesstat.org to download a free toolkit that enables physicians and care teams to: Screen patients for prediabetes*
Refer eligible patients to a National DPP lifestyle change program
Follow patients’ progress in the program Teaching high-risk patients how to make lifestyle changes by participating in an evidence-based National Diabetes Prevention Program (DPP) is shown to prevent or delay the development of type 2 diabetes. Screen, Test, Act – Today! * Establishing systematic identification and referral can help you meet Quality Payment Program and Patient Centered Medical Home objectives.
© 2017 American Medical Association. All rights reserved. 17-175156:11/17
FEATURES & CONTENTS January / February 2018
10
Flu Prevention Starts and Ends with You: MDHHS Urges You to Continue Vaccinating Patients Against the Flu BY JALYN INGALLS, MA
18
The Quality Payment Program: What You Need to Know for 2018 BY BETH HICKERSON, MEDICAL ADVANTAGE GROUP Contributed by The Doctors Company
COLUMNS 04 President's Perspective
BY CHERYL GIBSON FOUNTAIN, MD
06 Ask Our Lawyer
BY DANIEL J. SCHULTE, JD
08 MDHHS Update
BY STEFANIE COLE, BSN, RN, MPH
20 Ask Human Resources
COVER STORY
12
BY JODI SCHAFER, SPHR, SHRM-SCP
DEPARTMENTS 22 In Memoriam 23 Welcome New Members 24 MSMS Educational Courses 28 MSMS Medical Opportunities
MACRA: Looking Toward 2018 BY AUTHOR NAME FOR THE MICHIGAN STATE MEDICAL SOCIETY
What Have We Learned? Where Do We Go from Here? A lot has changed. Then again, some things never do.
STAY CONNECTED!
JAN / FEB 2018 |
michigan MEDICINE 3
MICHIGAN MEDICINE® Chief Executive Officer JULIE L. NOVAK
Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Graphic Design STACIA LOVE, REZÜBERANT! INC. rezuberantdesign@gmail.com Printing FORESIGHT GROUP staceyt@foresightgroup.net Publication Office Michigan Medicine 120 West Street East Lansing, MI 48823 517-337-1351 www.msms.org All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast. Postmaster: Address Changes Michigan Medicine Hannah Dingwell 120 West Street East Lansing, MI 48823
Michigan Medicine®, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan. The MSMS Committee on Publications is the editorial board of Michigan Medicine and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors. Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine reserves the right to accept or reject advertising copy. Products and services advertised in Michigan Medicine are neither endorsed nor warranteed by MSMS, with the exception of a few. Michigan Medicine (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2018 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110. Single copies, $10. Printed in USA. ©2018 Michigan State Medical Society
4 michigan MEDICINE | JAN / FEB 2018
perspective
By Cheryl Gibson Fountain, MD, Michigan State Medical Society President
®
Another year has come and gone. It was an important year for Michigan’s physician community, too. Lawmakers in Lansing spent the year debating everything from physician supervision of anesthesia to the proposed changes in the state’s automobile insurance system that would have capped payments for Michigan health care providers. Attempts to change or repeal the Affordable Care Act came and went in Washington, D.C. Back at home, and in physicians’ offices across the state, Michigan health care providers also spent the year implementing the Medicare Access and CHIP Reauthorization Act, or MACRA. Now, like the holidays, the first year of MACRA is in the books. In this month’s edition of Michigan Medicine®, we dug deep into the federal government’s latest reporting requirement and incentive program. With a year’s experience under their belt, Michigan physicians are facing a fresh wave of changes to the system. Providers and practices are examining where they’ve been, preparing for the future, and jumping head first into MACRA year two. The most important question, heading into year two of the program, is “what’s next?” The biggest takeaway from the 2018 final rule is that CMS might actually “get it.” The most substantive changes to the program are designed around simplifying requirements, exempting even more small practices, and more gradually easing providers into the system. Hard work on the part of Michigan physicians and their administrative staffs have produced results. So has the hard work of your Michigan State Medical Society, which works closely day in and day out with federal regulators and local practices alike, to make success more achievable than ever. In this edition of Michigan Medicine, you’ll hear from providers and staff on the front lines of MACRA implementation. You’ll hear what went right, what physicians are up against, and what the program will look like in 2018, as we enter year 2. You’ll also learn a little bit about what MSMS can do to help your practice succeed! Dig in today. We look forward to hearing from you soon. Happy New Year from staff, Board of Directors, and everyone at the Michigan State Medical Society.
CHERYL GIBSON FOUNTAIN, MD, MSMS PRESIDENT
In this edition of Michigan Medicine®, you’ll hear from providers and staff on the front lines of MACRA implementation. You’ll hear what went right, what physicians are up against, and what the program will look like in 2018, as we enter year 2.
JAN / FEB 2018 | michigan MEDICINE
5
ASK OUR LAWYER
Increasing the Tax Deferral Benefits of Your IRA By Daniel J. Schulte, JD, Michigan State Medical Society Legal Counsel
Q: My largest asset is my IRA. My spouse died last year. I have 4 children who are all gainfully employed and reasonable financially sound. My desire is to leave what is in my IRA to my children in equal shares. Will they have to pay tax on their share upon my death or is there a way it to be received by them tax free?
6 michigan MEDICINE
| JAN / FEB 2018
Most physicians take full advantage of the tax deferred savings a 401(k) plan or other qualified plan offers while working. Upon retirement the amount accumulated is typically transferred (“rolled over”) to an IRA and the deferral of taxes on the balance and the earnings continues (tax is only imposed on the Required Minimum Distributions taken by the IRA owner once age 70.5). If married the IRA owner can leave the IRA to a surviving spouse who can roll it over into an IRA yet again and continue the tax deferral even longer. Nothing lasts forever. If upon the death of the surviving spouse the IRA assets are divided equally and a share is left to each of the couple’s children the tax due on each share will have to be paid. There are very few ways to continue the tax deferral upon the surviving spouse’s death.
One such way to continue the tax deferral is to create an IRA trust(s) to be the primary beneficiary of your IRA instead of naming your children individually as beneficiaries. If you create a single IRA trust with your 4 children as the beneficiaries the Required Minimum Distribution (i.e. the amount the IRS requires to be distributed and taxed annually) the IRA would be required to make to the IRA trust annually would be computed using the age of the oldest of the 4 children. Alternatively, you could create 4 IRA trusts (one for each child) to be the IRA beneficiaries. In this case, the age of each child would be used for purposes of computing the Required Minimum Distribution to each IRA trust (instead of the age of the oldest child).
IRS regulations require that each IRA trust must: (1) be valid pursuant to state law; (2) be irrevocable; and (3) have as a beneficiary(ies) individuals that are identifiable (i.e. alive on the date of the IRA owner’s death). In addition, there are administrative requirements that must be met on an ongoing basis including the providing of certain documentation to the trustee(s) no later than October 31 of the year following the year of the IRA owner’s death.
The principal benefit to using an IRA trust(s) as your IRA beneficiary is being able to stretch the IRA’s Required Minimum Distributions over the longest period of time possible (and therefore prolonging the tax deferred compounding of the IRA’s earnings). There are other benefits. If the IRA distributions are paid to an IRA trust (properly drafted to include “spendthrift” provisions) there will be greater protection from claims of the beneficiary’s creditors, especially in the event of the beneficiary’s filing for bankruptcy. The Required Minimum Distribution being paid to an IRA trust(s) provides also provides the IRA owner a greater degree of control over these assets. Instead of the distributions going straight to the beneficiary they will be held in trust, subject to the trust’s terms and administered by a trustee. This could be advantageous if there are beneficiaries who are minors, have special needs. An IRA trust also pro-
vides the ability to control who the successor beneficiaries will be. As you can see there is a way to avoid the immediate taxation of your IRA assets upon your death. In your case, having 4 financially sound children who are not in immediate need of these assets, an IRA trust may make good sense. You should engage and attorney experienced in these matters to incorporate this into your estate plan.
DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL
JAN / FEB 2018 |
michigan MEDICINE 7
michiganMEDICINE 8 michigan MEDICINE
|| JAN JAN // FEB FEB 2018 2018
MDHHS UPDATE
Vaccine Update from the Advisory Committee on Immunization Practices By Stefanie Cole, BSN, RN, MPH, Pediatric Immunization Nurse Educator, Michigan Department of Health and Human Services, Division of Immunization
T
he Advisory Committee on Immunization Practices (ACIP) met on October 25-26, 2017, to discuss several vaccines and vote on vaccine recommendations, including herpes zoster, mumps, and the childhood and adult immunization schedules for 2018.
Previously, there was only one vaccine recommended for the prevention of herpes zoster1 (shingles) and its related complications – Zoster Vaccine Live (ZVL), known as Zostavax®2 by Merck. Herpes Zoster Subunit vaccine (HZ/su), known as Shingrix®3 by GlaxoSmithKline (GSK), is a new adjuvanted recombinant vaccine to prevent shingles approved by the U.S. Food and Drug Administration on October 20, 2017, for intramuscular administration in adults aged 50 years and older. Unlike Zostavax®, Shingrix® is inactivated and a 2-dose schedule separated by 2-6 months. In clinical trials, Shingrix® had 97% vaccine efficacy against herpes zoster in adults aged 50-69 years and 91% vaccine efficacy against herpes zoster in adults aged 70 years and older.4, 5 In addition, Shingrix® had 91% vaccine efficacy in adults aged 50 years and older against postherpetic neuralgia (PHN), a painful complication of shingles, and 89% vac-
cine efficacy against PHN in adults aged 70 years and older.4, 5 Among these age groups, protection from Shingrix® was maintained at 85% or higher for 4 years after vaccination. ACIP voted that HZ/su vaccine is recommended for preventing shingles and its related complications in all healthy adults aged 50 years and older, including those adults who have previously received ZVL. ACIP also voted in favor of preferring HZ/su over ZVL for prevention of shingles and its related complications. Once ACIP’s recommendations for HZ/ su have been approved by the director of the Centers for Disease Control and Prevention (CDC), they will be published in Morbidity and Mortality Weekly Report (MMWR) expected in early 2018. ACIP also voted on use of mumps-containing vaccine during a mumps outbreak. Persons previously vaccinated with 2 doses of mumps-containing vaccine6 who are identified at increased risk for mumps during an outbreak should receive a third dose of mumps-containing vaccine to help prevent against mumps and its complications.
The new schedules and footnotes will be available at the end of January or beginning of February on https://www. cdc.gov/vaccines/schedules/index. html. Ensure you read the footnotes along with the schedules for important vaccine information. REFERENCES: 1 Centers for Disease Control and Prevention (2017). Shingles (Herpes Zoster). https://www.cdc.gov/ shingles/ 2 U.S. Food and Drug Administration (2017). Zostavax. https://www.fda.gov/BiologicsBloodVaccines/ Vaccines/ApprovedProducts/ucm136941.htm 3 U.S. Food and Drug Administration (2017). SHINGRIX. https://www.fda.gov/BiologicsBloodVaccines/ Vaccines/ApprovedProducts/ucm581491.htm 4 Lal, H., et al. (2015). Efficacy of an Adjuvanted Herpes Zoster Subunit Vaccine in Older Adults. New England Journal of Medicine, 372(22), 2087-2096. doi: 10.1056/NEJMoa1501184 5 Cunningham, A., et al. (2016). Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older. New England Journal of Medicine, 375(11), 1019-1032. doi: 10.1056/NEJMoa1603800 6 Centers for Disease Control and Prevention (2013). Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). https://www.cdc. gov/mmwr/preview/mmwrhtml/rr6204a1.htm
Lastly, ACIP voted on the 2018 Recommended Immunization Schedules for Children/Adolescents and Adults.
JAN / FEB 2018 |
michigan MEDICINE 9
MDHHS UPDATE
Flu Prevention Starts and Ends with You: MDHHS Urges You to Continue Vaccinating Patients against the Flu By Jalyn Ingalls, MA, Influenza Outreach Coordinator, Michigan Department of Health and Human Services Division of Immunization
Influenza vaccination efforts in clinical settings should continue throughout the entire flu season, as the flu vaccine will still provide ample protection from influenza throughout the winter and spring months. Healthcare providers often turn in their flu vaccine after the holiday season and stop vaccinating patients against the flu. This practice leads to many missed opportunities to protect patients from influenza.
T
he majority of flu vaccinations administered in Michigan and documented in the Michigan Care Improvement Registry (MCIR) are during October and November, with a sharp decline in the number of doses administered after December. In the U.S., flu activity most often peaks in February but flu always continues circulating through the spring months. Healthcare providers should reduce missed opportunities for flu vaccine and continue to strongly recommend and offer flu vaccine to all patients aged six months and older throughout winter and spring when flu activity is still at increased levels (see Figure 1 on page 11). Each flu season, the virus that is predominately circulating can change as the season progresses. By administering flu vaccine to patients now, you are protecting them not only from what is currently circulating in the community but from viruses that may not be circulating until April or May. According to MCIR data for the 2016-17 flu season, only 26.2 percent of Michigan residents received flu vaccine. Seasonal posters promoting flu vaccine in winter and spring can be ordered free of charge at the MDHHS Clearinghouse at http:// healthymichigan.com/ by clicking Enter, Immunizations, item IM136. Let’s all strive to continue vaccinating against flu well into 2018 to protect our Michiganders!
10 michigan MEDICINE
| JAN / FEB 2018
201641 201642 201643 201644 201645 201646 201647 201648 201649 201650 201551 201652 201701 201702 201703 201704 201705 201706 201707 201708 201709 201710 201711 201712 201713 201714 201715 201716 201717 201718 201719 201720 201721 201722 201723 201724 201725 201726 0
0.5
3.0
2.5
2.0
1.5 201638 201639 201640 201641 201642 201643 201644 201645 201646 201647 201648 201649 201650 201551 201652 201701 201702 201703 201704 201705 201706 201707 201708 201709 201710 201711 201712 201713 201714 201715 201716 201717 201718 201719 201720 201721 201722 201723 201724 201725 201726
Influenza Doses Administered (MCIR Data) 200000
150000
3.5
3.0
100000
2.5
50000
2.0
1.5
1.0
MMWR Week
Doses
4.5 3.0
1
4.0 2.5
0.9
3.5 2.0
0.8
1.5
0.7
1.0
0.6
0.5
0.0
1.0
0.5
0.0 %ILI
Percent of Patients with ILI
4.5 3.5
4.0 3.0
0.5
0.4
0.3
JAN / FEB 2018 |
2.5
2.0
1.5
1.0
4.0 0.9
3.5 0.8
Percent of Patients with ILI
250000 4.5
4.0
0.5
0.0
0.0
%ILI
MMWR Week
Doses %ILI Figure 1: Influenza Vaccine Doses Recorded Flu Season 4.5 in MCIR and Percent of Patients with Influenza-like Illness (ILI) at Michigan ILINet Sites, 2016-17 1
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
0.2
0.1
0
%ILI
michigan MEDICINE 11
12 michigan MEDICINE
| JAN / FEB 2018
FEATURE
What Have We Learned? Where Do We Go from Here? Value over volume. We hear it all the time, whether it’s marketing
Where We’ve Been
slogans for home goods (“Using less never felt so good!”) or a
Electronic prescriptions. Physician quality reporting systems. Meaningful use. Value-based payment modifier. Physicians have seen policy wonks with big purse strings try to legislate provider behavior since the advent of government purse strings.
pitch from big box retailers to provide customers with one-stop shopping alternatives. It’s an idea whose time has clearly come, and one that’s arrived with a roar in the health care marketplace.
T
he federal government and private insurers now strive to create systems that drive down health care costs while simultaneously improving patient outcomes. The goal, ultimately, is to treat patients less because they’re healthier.
This aim would be counterintuitive in any other marketplace, but it has a bit of merit in health care. The clerk at Best Buy can’t wait for his customers to walk back through the door, but the ultimate goal of the physician community isn’t to sell a new appliance every few months – it’s to see their patients care managed more effectively via strategies such as preventive care rather than long term complications from chronic conditions or emergency care.
That’s a goal physicians share with payers, including the Centers for Medicare and Medicaid Services (CMS), which is as eager to contain costs as anyone. They’ve been trying to do so for years via a litany of programs, some of which have worked better than others. The latest of these is Medicare's Quality Payment Program (QPP) which is the by-product of the Medicare Access and CHIP Reauthorization Act, or MACRA. Last year, Michigan providers entered the brave new world of MACRA’s QPP reporting requirements. Now, with a year’s experience under their belt, they’re facing a fresh wave of changes to the system. Providers and practices are examining where they’ve been, preparing for the future, and jumping head first into MACRA year two.
A lot has changed. Then again, some things never do.
MACRA is only the latest government iteration of “carrot versus stick.” In the 2019 payment year, the program promises eligible clinicians as much as a four percent boost in payments if they perform well, and up to a four percent decrease in Medicare Part B if they fall behind the new model and its multi-faceted reporting requirements. This swing will move to +/- nine percent by 2022. Michigan physicians spent 2017 rolling up their sleeves, implementing the system, and adjusting to its requirements. Surprisingly (at least to federal regulators), “value over volume” isn’t nearly as easy as it sounds. Congress approved MACRA in 2015 as an attempt to further goals set by the U.S. Department of Health and Human Services (HHS) to link traditional, fee-for-service Medicare reimbursement models to value-based outcomes. The government’s initial goal was to link 50 percent of Medicare payments to some type of alternative payment model and 90 percent of all traditional Medicare payments to quality or value in medicine. The following year, CMS released a “final rule”. (continued on page 14)
JAN / FEB 2018 |
michigan MEDICINE 13
On Nov. 2, 2017, CMS released its final rule for year two of MACRA, directing physicians on changes and adjustments to the program for 2018.
“The regulation, when you get into the nitty gritty, is complex,” says Hettiger. “Conceptually, though, what MACRA is asking of people– physicians are already doing a lot of the work. Success in the program is about figuring out how to formalize recognition of that work and finding the best way to do that with the least amount of administrative burden.”
The thousands of pages of rules were borne out of a desire to modify physician behaviors. The jury’s still out on how successful they have been – or Last October, Doctor Kate ever could be.
Stacey Hettiger is the Director of Medical and Regulatory Policy at the Michigan State Medical Society. She works as a liaison between physicians and state and federal regulators, and specializes in reimbursement and policy issues related to health care, including MACRA. “The regulation, when you get into the nitty gritty, is complex,” says Hettiger. “Conceptually, though, what MACRA is asking of people– physicians are already doing a lot of the work. Success in the program is about figuring out how to formalize recognition of that work and finding the best way to do that with the least amount of administrative burden.”
What We’ve Learned Still, myriad complexities are inevitable when a massive federal government attempts a sweeping regulation of an industry operating in every community and serving better than 323 million potential patients across 3.8 million square miles. The thousands of pages of rules were borne out of a desire to modify physician behaviors. The jury’s still out on how successful they have been – or ever could be. Hettiger insists there’s a path to success for Michigan physicians. The secret for providers, she says, is to focus on what they’re already doing well, alignment, and areas in which they are prioritizing improvement. “We’ve been pleasantly surprised that many physicians are already doing the things that qualify under the program,” says Hettiger. “A number were justifiably concerned with how they were going to participate, and when we sat down and looked at what they were doing, we realized they were meeting criteria already.”
14 michigan MEDICINE
| JAN / FEB 2018
Hard work on the part of Michigan physicians and their administrative staffs have produced results, but that may be more a testament to their dedication and commitment to their patients, than the effectiveness of the mammoth firstyear implementation rule.
Goodrich, the chief medical officer of CMS’s Center for Standards and Quality, conceded at a MACRA summit that the payment model focused too much on performance and too little on outcomes. “It is still too heavily weighted on process measures,” she offered. The admission was in line with complaints by the Medicare Payment Advisory Commission, a congressional advisory panel, which is on record arguing the system weighs too heavily on performance measurements, like whether appropriate tests are ordered, and not nearly enough on actual patient outcomes. Jim Mitchiner, M.D., MPH is an attending physician in the emergency department at St. Joseph Mercy Hospital in Ann Arbor, Michigan. He’s also the medical director at MPRO, a Michigan nonprofit organization and national leader in health care quality improvement and medical review. “The whole idea of focusing more on value over volume sounds very good on paper, but value is a somewhat nebulous term and it’s difficult to measure it,” says Mitchiner. “It’s difficult because there are so many variables with patient care. In a lot of respects value is subjective rather than objective. Doctors treat patients, not numbers.” Mitchiner is responsible for the overall medical direction of MPRO’s quality improvement activities and medical review process. He also provides medical supervision to Medicare clinical projects under the CMS contracts.
That experience and expertise has placed him on the front lines of MACRA implementation discussions from one corner of the state to the next. A member of the Michigan State Medical Society’s board of directors, he’s a regular forum moderator and participant at professional conferences and training sessions. He’s an expert on the system, its strengths and its limitations.
A study published in 2016 in the Annals of Internal Medicine found that physicians spent only 27 percent of their office day on direct clinical face time with patients, and nearly 50 percent of their day filling out electronic health records and performing other tasks at the desk.
“In 35 years of practice, I’ve learned medicine is often about sitting down and talking to the patient, finding out what their concerns are, what they’re worried about, what’s going on in their life. That has as much to do with improving their health as medications, procedures or therapies, but it doesn’t always show up the same way on Medicare reporting systems,” Mitchiner said.
“There’s no doubt MACRA has increased the administrative burden placed on physicians,” says Mitchiner. “Keeping track of quality measures, dealing with reporting via their EMR, enhanced charting, electronic prescribing, answering patient emails – all are taking time from patient care. Organized medicine is justifiably concerned about the impact of these regulations on physician wellness and burnout.”
As a result, many physicians remain understandably frustrated, and, a year after implementation, experts in the field worry about the possibility of professional burnout.
Nobody wants that, including CMS, and an early analysis of the year two rule indicates they’re taking steps to address physicians’ concerns.
The Only Constant is Change The most important question heading into year two of the program is: “what’s next?” The biggest takeaway from the 2018 final rule is that CMS might actually “get it.” The most substantive changes to the program are designed around simplifying requirements, exempting even more small practices, and more gradually easing providers into the system. Advisory Board is a global best practices firm specializing in the use of research and technology to improve performance of health care organizations. They’ve poured over the new rule with a fine-tooth comb and, in early November, published an analysis by Tony Panjamapirom, Ph.D. and Rob Lazerow. Researchers concluded that the biggest overall trends were a focus by the (continued on page 16)
The most important question heading into year two of the MACRA program is: “What’s next?”
JANJAN / FEB/ FEB 20182018 | michigan | michiganMEDICINE MEDICINE
15
new Trump administration on payment reform that isn’t dissimilar to the previous administration’s, and a broad move to reduce the regulatory burden on providers. That move will be seen most clearly by smaller practices and sole providers.
“Regulators are also providing bonus points for small practices and providers treating complex patients. There’s some needed recognition of some of the difficulties small practices have in meeting all of the requirements and jumping through all the hoops.”
“The biggest change is probably the recognition of small practices and their ability to participate, and make sure they’re able to participate successfully.”
Bonus points are being made available to eligible clinicians in practices with 15 or fewer clinicians for simply submitting data on at least one performance category. Providers with complex patient populations are being offered bonus points as well, to maximize Medicaid reimbursements in 2019.
“The biggest change is probably the recognition of small practices and their ability to participate, and make sure they’re able to participate successfully,” says Hettiger. “While the program's structure or format continues to be the same, we are seeing that the low volume threshold is increased significantly, meaning there are many more who will qualify for an exception from participating.”
CMS adopted a temporary policy ensuring physicians in areas affected by the nation’s numerous hurricanes and other natural disasters in 2017 are not required to submit last year’s Merit-Based Incentive Payment System (MIPS) data, and automatically avoid penalties in 2019.
“Regulators are also providing bonus points for small practices and providers treating complex patients. There’s some needed recognition of some of the difficulties small practices have in meeting all of the requirements and jumping through all the hoops.”
Of course, the 2018 final rule isn’t all about simplification.
The previous participation exemption for physicians with 100 or fewer Medicare Part B patients annually, or less than or equal to $30,000 in Part B allowed charges, has been expanded dramatically. Beginning this year, providers and groups with less than or equal to $90,000 in applicable charges or those seeing 200 or fewer Medicare Part B patients will be exempt from MACRA reporting requirements. All told, that means another 123,000 clinicians – the majority of whom work at small or solo practices, or who practice in rural settings – can opt out without penalties. There are other simplifications as well.
Requirements surrounding specific electronic health records systems have been eased and mandated upgrades have been pushed back, to lower the cost of entry for providers.
It attempts to double the number of physicians in the Advanced Alternative Payment Model track to make the MIPS track more competitive. Data completeness requirements are also set to rise in 2018, forcing providers to prioritize quality performance improvement and cost control efforts.
What’s a Physician to Do? Making progress often starts with the smallest step. MACRA isn’t going away, so providers might as well figure out how to make the system work for them – and their bottom lines.
Beginning this year, providers and groups with less than or equal to $90,000 in applicable charges or those seeing 200 or fewer Medicare Part B patients will be exempt from MACRA reporting requirements.
16 michigan MEDICINE
| JAN / FEB 2018
Doctor Mitchiner regularly gaps or things your practice counsels physicians to focus could do better? Goals that The AMA and on three foundational tasks are meaningful to you? OpMSMS regularly to maximize their Medicare portunities to automate? offer training reimbursements and mini“The next step is to figure sessions and mize their headaches. Docuout how to take what the ment your work so you can seminars to unpack government is asking under lean on your administrative the complexities MACRA, and match it with staff to meet reporting rearound reporting those goals. It might be inquirements, automate as and reimbursement. cremental. It might not all much as possible, from conbe at once. The thresholds dition-specific discharge inare low enough, providers may be able structions to preprinted forms and other to work on only a couple things and still documents, and decompress – take a little avoid penalties.” time out for yourself and your family to The American Medical Association and keep your head above water. the Michigan State Medical Society reguThat’s in line with the advice offered by larly offer training sessions and seminars to Stacey Hettiger, the compliance pro with unpack the complexities around reporting the Michigan State Medical Society. and reimbursement. What’s more, they offer similar educational opportunities for “The key to success in MACRA is for a non-clinicians and office staff. physician to understand his or her patient population, and to understand their own professional goals when it comes to the care they’re providing,” she says. “Are there
staff,” Mitchiner counsels his fellow physicians. “There are all kinds of seminars and training programs sponsored by MSMS providing assistance to physicians and staff to help keep them up to date.” The Medical Society makes staff available to walk physicians, practice managers, and additional office employees through MACRA's app and provide tips and highlights to make success possible. They can also connect providers with resources, agencies, and entities receiving federal dollars to help practices get up to speed. It’s important to remember that physicians, even sole providers, aren’t in this alone.
“It is always a good idea to keep abreast of what MSMS is doing with educational activities for physicians and their office
JAN / FEB 2018 |
michigan MEDICINE 17
The Quality Payment Program: What You Need to Know for 2018 By Beth Hickerson, Quality Improvement Advisor, Medical Advantage Group
Almost a year ago, Congress established the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). While designed to improve patient health outcomes, encourage practices to spend wisely, minimize the burden of practice participation, and be fair and transparent, the program has been difficult for many medical practices to implement.
T
he government recently announced 2018 changes to this program. But don’t be dismayed. Many of these changes add flexibility and higher exemption requirements—welcome news to medical practices. Medical practices will be most affected by changes made by the Centers for Medicare and Medicaid Services (CMS) to the Merit-Based Incentive Payment System (MIPS), one of two QPP tracks. Some of the major changes to MIPS that practices should be aware of follow.
Important general MIPS changes/updates include: Performance threshold to avoid penalties increased from 3 points to 15 points. This can be achieved solely by maxing out points in the Improvement Activities category. Virtual groups participation option offered. Virtual groups are composed of solo practitioners and groups of 10 or fewer eligible clinicians (eligible to participate in MIPS) who come together “virtually” with at least one other such solo practitioner or group to participate in MIPS for a performance period of 12 months. Low-volume threshold increased. More small practices and eligible clinicians in rural and Health Professional Shortage Areas (HPSAs) are exempt from MIPS participation. » 2017 threshold: </= $30,000 or 100 patients » 2018 threshold: </= $90,000 or 200 patients Five bonus points added to the final score of clinicians in small practices. These points will be added automatically for providers in practices with 15 or fewer clinicians. Up to five points added to the MIPS final score for providers caring for complex patients. CMS will use a combination of Hierarchical Condition Categories and counts of dually eligible patients (Medicare and Medicaid) to assign a complex patient bonus to the MIPS final score for applicable providers. Extreme and Uncontrollable Circumstances provision added for providers impacted by natural disasters. In 2017, providers in identified areas (e.g., hurricanes Harvey, Irma, and Maria) will automatically avoid a penalty for payment year 2019 without submitting any performance data. Beginning in 2018, providers must submit a hardship exception application to qualify.
18 michigan MEDICINE
| JAN / FEB 2018
MIPS Quality category changes: Quality reporting period increased to 12 months. Providers must be ready to start tracking quality measure data on January 1, 2018, to fully report in the Quality category in 2018. MIPS performance improvement incorporated in scoring quality performance. Up to 10 points will be added to the Quality category score for statistically significant performance improvement at the category level between 2017 and 2018. Data completeness standards increased to 60 percent. Providers submitting quality measures via claims must report on at least 60 percent of their Medicare Part B patients. Providers submitting via registry, QCDR, or Electronic Health Record (EHR) must report on at least 60 percent of all denominator eligible patients, regardless of payer. No changes for CMS web interface and Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS submission methods. Minimum scoring on measures that do not meet case minimum standards reduced to one point for large practices (16 or more providers). Caps on scoring limits on “toppedout” measures have changed. Six “topped-out” measures have been given a cap of seven performance points, rather than 10.
MIPS Advancing Care Information category changes: Incentives added to encourage the use of 2015 edition Certified Electronic Health Record Technology (CEHRT). Providers have been given a full year extension on the use of 2014 CEHRT and can continue to report the 2017 Advancing Care Information Transition Objectives and Measures. However, providers who elect to use 2015 edition CEHRT in 2018 will earn bonus points. Exclusions added for the E-prescribing and Health Information Exchange base measures. Individuals or groups with fewer than 100 patients in the denominator for these measures may claim an exclusion and not report them. These new exclusions are retroactive to the 2017 reporting year. New Advancing Care Information hardship exception added for clinicians in small practices. Practices with 15 or fewer eligible clinicians can apply to have their Advancing Care Information category score re-weighted to the Quality category. New Advancing Care Information hardship exception option added for clinicians whose EHR was decertified. Automatic re-weighting of the Advancing Care Information performance category score to Quality added for ambulatory surgical center (ASC)-based MIPS eligible clinicians. This change will be retroactive to the 2017 performance year.
Category weights have changed, even though the four reporting categories and requirements remain the same:
1 Quality: 50% 2 Advancing Care Information: 25% 3 Improvement Activities: 15%
MIPS Improvement Activities category changes: Total number of approved Improvement Activities increased from 92 in 2017 to 112 in 2018. Additional CEHRT-related Improvement Activities made available. This increases options for earning Advancing Care Information bonus points. Patient-Centered Medical Home (PCMH) certification threshold changed for full Improvement Activities credit. Tax Identification Numbers (TINs) must have 50 percent of their practice sites certified as PCMHs to receive automatic full credit in the Improvement Activities category.
MIPS Cost category changes: Episode-based measures eliminated from the Cost category score calculation. Only Total Per Capita Cost and Medicare Spending per Beneficiary (MSPB) measures will be used to calculate the Cost score. Automatic re-weighting of Cost score to Quality added for clinicians who do not meet minimum case standards requirements. Individuals and groups who do not receive a Cost score because they do not have enough attributed patients for either Cost measure will automatically have their 10 percent Cost points re-weighted to Quality. Improvement scoring added for Cost. Individuals or groups who demonstrate statistically significant Cost improvement between 2017 and 2018 will receive up to 1 percent added to their Cost category score. Practices that find these changes overwhelming may want to reach out for expert help with industry-leading best practices to maximize Medicare payments—visit medicaladvantagegroup. com for more information. For resources on MACRA and being successful in optimizing reimbursement, go to thedoctors.com/MACRA.
4 Cost: 10% CONTRIBUTED BY THE DOCTORS COMPANY (WWW.THEDOCTORS.COM)
JAN / FEB 2018 |
michigan MEDICINE 19
michiganMEDICINE 20 michigan MEDICINE|
|JAN JAN / FEB / FEB 2018 2018
ASK HUMAN RESOURCES
Preventing Harassment in the Workplace By Jodi Schafer, SPHR, SHRM-SCP
Q
In light of all the news of sexual harassment and as the managing partner of a large medical practice, I am concerned about the potential liability of sexual harassment. I have overheard and have actually participated in a little bit of banter between staff members and the partners that may be considered sexual in nature. I have never had any complaints about this banter but I’m worried that I could in the future. Let’s make sure that we have what we need in place to protect practice. What should I do to make sure we are protected?
S
exual harassment was established by a landmark US Supreme Court order from a lawsuit where an employee was expected to provide sexual favors to keep her job. This, the court said, created a hostile work environment and was a violation of Title 7 of the Civil Rights Act of 1964. The court ordered the Equal Employment Opportunity Commission, (EEOC) to write rules to address sexual harassment. Harassment guidelines have been expanded over the years to include all protected classifications, i.e. race, religion, gender, etc. A claim of harassment can be expensive in many ways. It can cause lost production, result in high legal fees, negatively impact team work, cause personal problems, and may likely cause turnover. If the claim is made public, it will be a public relations nightmare as we’ve seen on the news lately. To protect yourself and your practice, the first thing you need to do is make sure you have a thorough policy that outlines what harassment is and requires reporting of claims to management. Your policy must also explain that when members of leadership are presented with a claim they will ensure it is thoroughly and completely investigated. Upon the conclusion of the investigation any disciplinary action taken against any of the people involved must be documented. This includes claims that are made directly and those that are implied. Be aware, MOST CLAIMS ARE IMPLIED! Your liability is not reduced if the employee refuses to make a direct claim. Once a policy is established, it must be communicated to all staff. All members of the practice, especially all of the physicians and
leadership staff, should receive training that explains the different types of harassment, provides a review of the policy, identifies your reporting system and teaches all team members how to identify and address concerns that come to them. Attendance at this training must be mandatory and documented. The greatest concern I have based on your question is your current culture. Banter of a sexual nature will never be appropriate in the workplace. I am assuming that most of the support staff is female and most of the providers are male. If that is the case, you have an issue of power from the males over the females just by the nature of your jobs. Harassment, while not limited to male-female encounters, is all about power and control. It is imperative you do all you can do to eliminate any type of sexual intimidation. Perception and inappropriate behavior play big roles in harassment claims and if an employee perceives the banter to be offensive, then it is - even if they actively took part. It is common for employees not to report complaints when they have been harassed. They may hint or make comments about behaviors. They may ask other employees what they experienced. If they do come to a manager, they may ask that their concern be kept confidential. Essentially, they do not want to cause any problems. No matter, you must still conduct an investigation and if necessary discipline the perpetrator. All too often, this person was not the first or the only. It is imperative that harassment be taken seriously and much more than lip service be given to complaints, not matter how subtly they are made.
JAN / FEB 2018 |
michigan MEDICINE 21
IS YOUR WEBSITE READY FOR 2018?
Call 866-680-1345 to receive your FREE Website Review and Health Check Report
GET YOUR FREE WEBSITE HEALTH CHECK TODAY
1. CALL YOUR WEB PRESENCE ADVISOR They’re here to help your practice be the best it can be. Give them your website’s address, and they’ll use sophisticated diagnostic tools (and years of experience) to assess your strengths and potential weaknesses.
2. REVIEW YOUR RESULTS After diagnostics are complete, you’ll receive a detailed report. Your Web Presence Advisor will help break it down step by step, so you’ll know exactly where you stand.
(866) 680-1345 • Officite.com/Feb/MSMS 22 michigan MEDICINE | JAN / FEB 2018
3. MAKE A PLAN OF ACTION! Now that you have all the important information, what happens next? Whether you want better search engine rankings or stronger online reviews, we’ll help you set goals and give you the tools you need to reach them.
Websites and Online Marketing Solutions for Healthcare Practices
Welcome New Members Calhoun Alphonsus Okwereogu, DO
Genesee Joanne Christy, MD Candacy George, DO
Ashley Screws, MD
Saginaw
Laila Gharzai, MD
John Throop, MD
Kai Anderson, MD
Nadia Ginnebaugh, MD
Rachel Titus, MD
Mehela Ashraf, MD
Megan Iacco, MD
Daniel Watkins, MD
Abishek Bala, MD
John Joseph, MD
Cara Zokoe, MD
Kayla Balaj, MD
Caroline Kieserman Shmokler, MD
Hassan Beiz, MD
Ishani Kumar, MD
Nicholas Bertucci, DO
Tony Ljuldjuraj, MD
Vedang Bhavsar, MD
Daniel Lyons, MD
Livingston
Bryan Brazeau, MD
Vincent Ma, MD
Emily Gabbeart, MD
Joseph Contino, MD
Elizabeth Paluga, MD
Jeffrey Kutcher, MD
Meagan Crofoot, MD
Anne Sammarco, MD
Thomas Ferreri, MD
Laura Seewald, MD
Nusrat Javaid, MD
Lapeer
Sami Khan, MD
Zachary Hillman, DO
Ankur Mehta, MD Muhammad Miran, MD Chintan Patel, MD Ambreen Sattar, MD Chaitanya Vemulapalli, MD
Gogebic Mark Fuller, MD
Ingham Matthew Allswede, MD Sucheta Ambekar, DO Timur Baruti, MD Lindsey Bewley, DO
Macomb Omar Kashlan, MD Sherezade Khambatta, DO
Victor Gordon, MD
Fadi Shihadeh, MD
Preeti Gudimella, MD
Timothy Sims, MD
Victoria Haddad, MD
Michael Strong, MD
Tara Nelson, DO
Syed Hassan, MD
Megan Tuohy, MD
Marquette/Alger
Laura Hijazi, MD
Christopher Wallace, MD
Patrick Huffer, MD
Mali Him, MD
Christine Wang, MD
Lisa Long, MD
Asif Khan, MD
Max Wayne, MD
Tyson Luoma, DO
Sura Khuder, MD
Mark Castellani, MD
Mecosta/Lake/Osceola
Sohaib Mandoorah, MD
Helder Chin, MD
Ronald Kufner, MD
Jeffrey Milewski, DO
Lauren Gordon, DO Kevin Nguyen, DO
Isabella/Clare Jennifer Morse, MD
Kent Candace Brown, MD Dennis Bruce, MD Jordan Castle, MD Andrew Forsyth, MD Michael Foster, DO Philip Hartgerink, MD Nazima Kathiria, DO Nik Kolicaj, MD Stefan Margiewicz, MD Thomas Matelic, MD Andreea Moore, MD James Morrison, MD Deborah Pellegrini, MD Phillip Raduazo, MD
Wayne
Asim Kichloo, MD
Muskegon Adam Walker, MD
Ryan Powell, DO Christopher Price, MD Satti Sethu Reddy, MD
Northern
Shelby Reitzel, MD
Megan Coggon, MD
Kyle Rutledge, DO
Thomas Ling, MD
Rajeev Sudhakar, MD
Oakland Kimberley Behrens DMD David Collon, MD Barbara Ducatman, MD Kevin Efros, MD
Gregory Sutton, MD
Asif Alavi, MD Andrea Apsey, MD Hadeel Assad, MD Umberto Berlasi, MD Monzer Chehab, MD Brandon Claxton, MD Michael Dominello, DO Brian Henk, DO Lakisha Holifield, MD Philip Philip, MD
Faiz Tuma, MD Melissa Victor, MD Quintisha Walker, MD Matthew Wolf, MD
Erlene Seymour, MD Paul Swerdlow, MD Ammar Taha, MD Anteneh Tesfaye, MD
Juanita Evans, MD
St. Clair
Amy Weise, DO,
Nena Kasmikha, MD
Stacey Tremp, DO
Ira Winter, MD
Lauren Law, DO
Abida Zafar, MD
Robert Wlodarski, MD
Cathryn Luria, MD Michael McCaughan, MD Lauren Murrill, MD Bryan Sofen, MD Randee Watson, MD
Washtenaw Sarah Allexan, MD Andrew Brod, MD Kayla Bronder, MD Ashvani Dass, MD
Emmanuel Reyes, MD
Ottawa
Rebecca DeLancey, MD
John Schneider, MD
Jean Ross, MD
Matthew Dellaquila, MD
JAN / FEB 2018 |
michigan MEDICINE 23
Educational Courses MSMS On-Demand Webinars: Educational Conferences — CME When You Want It! REGISTER TODAY! Balancing Pain Management and Prescription Medication Abuse Billing 101 The CDC Guidelines* CDL – Medical Examiner Course Choosing Wisely Part 1: Stewards of Our Health Care Resources Choosing Wisely Part 2: Change Strategies to Implement Choosing Wisely Claim Appeals Compliance in the Office Conscientious Objection Among Physicians* Credentialing From Physician to Physician Leader Health Care Providers’ Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities HEDIS Best Practices HIPAA Security and Meaningful Use Compliance Human Trafficking* ICD-10 (2018) and Routine Waiver of Copays ICD-10: What We Have Learned & What We Need to Know In Search of Joy in Practice: Innovations in Patient Centered Care Inter-professionalism: Cultivating Collaboration Legalities and Practicalities of HIT – Cyber Security: Issues and Liability Coverage – Engaging Patients on Their Own Turf: Using Websites and Society Media MACRA Webinar Series Managing Accounts Receivable Michigan Automated Prescription System (MAPS) Update* Opioids and Michigan’s Compensation Webinar Pain and Symptom Management* Patient Portals as a Tool for Patient Engagement Physician On-line Rating and Reviews: Do’s and Don’ts Preparing for the Medicare Physician Value-Based Payment Modifier Reading Remittance Advice The Role of the Laboratory in Toxicology and Drug Testing* Section 1557: Anti-Discrimination Obligations Understanding and Preventing Identity Theft in Your Practice Tips and Tricks on Working Rejections Treatment of Opioid Dependence* What’s New in Labor and Employment Law Year-End Wrap Up *Fulfills Board of Medicine Requirement
24 michigan MEDICINE
| JAN / FEB 2018
Complete Coding Updates for 2018 Date: Wednesday, January 3 Time: 9:00 am – 12:00 pm Location: MSMS Headquarters, East Lansing Intended for: Physicians, office administrators, coders/billers, and other health care professionals. Contact: Stacie Saylor 517-336-5722 or ssaylor@msms.org
2018 Spring Scientific Meeting Morning, afternoon and evening clinical courses available Date: Thursday, May 17 and Friday, May 18 Location: DoubleTree Hotel, Dearborn Note: Continental breakfast and lunch will be provided Intended for: Physicians and all other health care professionals Contact: Marianne Ben-Hamza 517-336-7581 or mbenhamza@msms.org
153rd MSMS Annual Scientific Meeting Morning, afternoon and evening clinical courses available Date: Wednesday, October 24 - Saturday, October 27 Location: Sheraton Detroit Novi Hotel, Novi Note: Continental breakfast and lunch will be provided. Intended for: Physicians and all other health care professionals Contact: Marianne Ben-Hamza 517-336-7581 or mbenhamza@msms.org
Visit www.msms.org/OnDemand for complete listing of On-Demand Webinars. Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.
Michigan's CME Licensure Requirements As previously reported by the Michigan State Medical Society, the State of Michigan, Department of Licensing and Regulatory Affairs announced in December of 2016 revised Medical Rules. With these new rules came new requirements for Continuing Medical Education. Significant changes to be aware of include: Training Standards for Identifying Victims of Human Trafficking – This is a one-time training that is separate from continuing education. Education on Pain and Symptom Management – Starting in December 2017, a minimum of three- hours of continuing education must be earned in the area of pain and symptom management every licensure cycle. Medical Ethics – A minimum of one-hour of continuing education must be earned in the area of medical ethics every licensure cycle.
CME modules are available online in the On-Demand Webinars (www.MSMS. org/ OnDemandWebinars) section of the MSMS website. This training will also be included at the 2018 Annual Scientific Meeting and SSM. Visit the LARA CME Requirements document at www.MSMS.org/ LARACERequirements for more information. New Categories of Continuing Medical Education The Board of Medicine has updated the previous six Categories of Credit into two categories. As before, each medical doctor is required to complete 150 hours of continuing medical education approved by the board of which a minimum of 75 hours of the required 150 must be earned in Category 1 activities. The following is a breakdown of the two Categories for licensure:
CATEGORY 2 A. Clinical instructor for medical students engaged in postgraduate training program – Maximum 48 hours B. Initial presentation of scientific exhibit, poster or paper – Maximum 24 hours C. Publication of scientific article in a peer-reviewed journal – Maximum 24 hours D. Initial publication of a chapter or portion of a chapter in a professional health care textbook or peer-review textbook – Maximum 24 hours E. Participation in any of the following as it relates to the practice of medicine – Maximum 18 hours 1. Peer Review Committee dealing with quality of patient care 2. A Committee dealing with utilization review 3. A health care organization committee dealing with patient care issues 4. A national or state committee, board, council or association
F. Until December 6, 2019, attendance at an activity that was approved by the Board of Medicine prior to December 6, 2016 - Maximum 36 hours G. Independently reading a peer-reviewed journal prior to December 6, 2016, that doesn't satisfy the requirements of Category 1, subdivision (A) - Maximum 18 hours H. Prior to December 6, 2016, completing a multi-media self-assessment program that doesn't satisfy the requirements of Category 1, subdivision (A) - Maximum 18 hours
CATEGORY 1 A. Activities with accredited sponsorship – Maximum 150 hours
More Information
B. Passing specialty board certification or recertification – Maximum 50 hours
If you have questions regarding the new CME requirements or the new categories of Continuing Medical Education, reach out to Brenda Marenich (bmarenich@MSMS.org), Director Physician Education and Leadership, MSMS at 517/336-5780.
C. Successfully completing MOC that does not meet requirements of (A) or (B) above – Maximum 30 hours D. Participation in a board approved training program - Maximum 150 hours
JAN / FEB 2018 |
michigan MEDICINE 25
www.MSMSInsurance.org
Committed to protecting Michigan physicians, MSMS Physicians Insurance Agency knows it’s your life. Your family. Your dreams. We focus onPhysicians you first Insurance and foremost, Committed to protecting Michigan physicians, MSMS Agency knows it’sthe yournovel life. Your family. dreams. We on you firstMichigan. and foremost, because we have idea thatYour protecting youfocus is protecting because we have the novel idea that protecting you is protecting Michigan.
S Physicians Insurance Agency is uniquely qualified to offer our insurance portfolio to Michigan physicians, their families MSMS Physicians InsuranceAgency Agency uniquely qualifiedByto toknowing offer our our insurance theirday, families MSMS Physicians Insurance qualified offer portfolio Michigan physicians, families, office staff. We make it our business to knowisisuniquely your business. the unique issuestophysicians face every MSMS and office staff. We make it our business to know your business. By knowing the unique issues physicians face every day, MSMS and office staff. We make it our business to know your business. By knowing the unique issues physicians face every day, MSMS cians Insurance Agency: Physicians Insurance Agency:
• •
•
•
Physicians Insurance Agency: • Eliminates thefor need foror your practice contact insurers for billing Eliminates you your practice topractice contact forpurposes. billing purposes; •the need Eliminates the need for you ortoyour toinsurers contact insurers for billing purposes; • Hasaccess access the insurer's systems to add, terminate change aasubscriber's information withinwithin 24 hours, which • directHasto direct access to the insurer’s to add, terminate or change a subscriber’s information within 24hours, hours, Has direct thetoinsurer’s systems to systems add, terminate oror change subscriber’s information 24 removes the administrative burden from you and your staff; removeswhich the administrative burden fromfrom you and which removes the administrative burden youyour andstaff. your staff; • Will research claims inquiries and benefit questions for you or the subscriber, which will eliminate thefrustration frustration Will research claimsclaims inquiries and and benefit questions thesubscriber, subscriber, which will eliminate the • Will research inquiries benefit questionsfor foryou you or or the which will eliminate the frustration of of contacting a complex customer service center; and, contacting a complex customerservice service center; center. and, of contacting complex • a Handles allcustomer COBRA administration for groups with more than 20 employees, free of charge, thus removing Handles all COBRA administration for groups 20employees—free employees, freeofofcharge—thus charge, thusremoving removing • Handles all COBRA administration for groups withmore morethan than 20 another another administrative burden. with another administrative administrative burden. burden.
You always get more with MSMS Physicians Insurance Agency because we focus on you. You always getwith moreMSMS with MSMS Physicians Insurance Agency because we focus on YOU. ou always get more Physicians Insurance Agency because we focus on you. For more information or to request a quote for affordable, high-quality health For more information or to request a quote for affordable, high-quality health insurance, please connect with Ty at 877-742-2758 or tliggons@msms.org. insurance, please connect with Ty at 877/742-2758 or tliggons@msms.org.
For more information or to request a quote for affordable, high-quality health www .MSMSInsurance .orgTy at 877/742-2758 or tliggons@msms.org. insurance, please connect with
In Memoriam MEMBERS OF THE
Practices for Sale 1.5 Million Dollar Pediatric Gross Practice to be OFFERED CHEAP! After many years of practice, the doctor is passing on the torch to someone younger. Must be able to see 60 patients/day or have help. Must be Boarded in Pediatrics. The price is less than $100K. In 25 years of practice sales I have never seen a better buy. Building is being offered for less than assessment as well, flexible terms.
MICHIGAN STATE MEDICAL SOCIETY REMEMBER THEIR COLLEAGUES WHO HAVE DIED.
x
DAVID E. OJEDA, MD GENESEE COUNTY MEDICAL SOCIETY 10/2/17
x TO MAKE GIFT OR BEQUEST TO THE MSMS FOUNDATION CONTACT:
REBECCA BLAKE, DIRECTOR, MSMS FOUNDATION PHONE 517-336-5729 OR EMAIL RBLAKE@MSMS.ORG
Bordering Oakland and Wayne County PRIMARY/URGENT CARE Practice with potential to reach million dollar mark per year (again). Call Joe and find out more about what could be your flag ship or second practice! Highly visible, busy road. Set up for success, just need a Primary Care Doctor and maybe a Mid Level. Fabulous New Medical Space Livonia New concept in medical offices with indoor parking, multi-suite and specialty clinics with room for adult day care !! So much is being done with this building. Located central to Botsford, St Mary's, Providence Park. Offered at competitive rates. Dearborn – General Practice Semi-retired Physician has a 2-3 day practice 20-30 patients per week, $20,000 for practice or free when you lease or buy building. ENT with mostly Allergy Patients, Westland Hearing aid tenant and small general medicine tenant in building. Buy practice (asking $25K) and rent on short or long term agreement, very reasonable rates. Plenty of room and parking. White Lake Primary Care Practice On busy corner of M-59. Grosses $700,000 - $800,000 a year. Doctor has medical condition and needs to sell. Good insurance mix. Plenty of parking, nice facility, a must see if you are looking to expand your practice. Asking $200,000. Pediatrics in Westland near Canton 30 years, high volume, yes it does a big gross! A Pediatrician Physician can work into the practice and take over EARN and purchase transaction. Only a Boarded Pediatrician, potential to earn substantial income. Call Joe for details, Cell: 248-240-2141.
Looking for Part time/Full time Work as a Provider? Different locations available. Call Joe Zrenchik.
Joe Zrenchik, Broker 248-240-2141 (cell) • 734-808-0147 (eFax) bestdoctors@yahoo.com 248-919-0037(office) www.michiganmedicalpractices.com
Thinking about retirement, relocation or expansion of your medical practice? We have buyers and sellers for primary care, internal medicine and cardiology practices.
JAN / FEB 2018 |
michigan MEDICINE 27
MSMS Medical Opportunities msms.medopps.org
msms.medopps.org
MSMS Medical Opportunities has been connecting physicians with employers since 1944.
East Jordan Family Health Center Family Medicine, MD/DO East Jordan, MI
Henry Ford Allegiance Health Palliative Hospice Medical Director, MD/DO Jackson, MI
Medical Opportunities ID # 472
Medical Opportunities ID # 3899
Seeking Family Practice Providers looking for adventure in our small but progressive clinics in beautiful North-West Lower Michigan.
Join a very reputable, well-established (2002) and rapidly expanding employed group practice. Currently 1-1/2 board-certified geriatricians/ hospice & palliative medicine, 4-NPs, 1-RN, 1-MA, 1-LMSW and clinical support staff. Allegiance Senior Health Center is an outpatient clinic which offers primary geriatric care, comprehensive geriatric assessment, home care, inpatient and outpatient palliative care as well as coverage for our freestanding Hospice Residence and our Inhome Hospice Program.
Who we are
your practice preferences. Learn
A Federally Qualified Health Center (FQHC) with a strong sense of organization wide mission to serve the community health needs. Who you are: A Family Practioner who wants to be a part of the community, really wanting to feel you make a difference, and willing to be part of a team based care model actively engaged in removing barriers to care and improving health outcomes.
more at msms.medopps.org.
We seek Providers who:
It is a nonprofit program through the Michigan Health Council designed to simplify your job search by posting jobs that match
• Will help implement the mission, and values of our organization • Are looking to live a life and practice what you preach • Are not afraid to be personally involved with our patients • Are compassionate with patients and staff • Are able to work in a team based environment • Proficient in using an EMR and comfortable on a computerized system • Have completed, or soon to have completed, a physician or mid-level program and are certified by their governing board or association
Practice Information • Hours are M-F, 8-5p • No acute care or skilled nursing home involvement • Patient volume varies averaging 10-18 patients/ day per provider • Palliative care certification/experience is a plus • Primary call 1:4 with backup call for midlevels. All incoming calls are triaged via RN staffed messaging service. We offer a competitive compensation package with full benefits including: full health, dental, life and retirement benefits. Excellent recruitment incentives include: signing bonus, student loan repayment, $30K relocation incentive, CME time & allowance, paid moving expenses and more.
• Are board eligible or board certified We offer competitive wages, participation in Federal and State loan repayment programs, and superior benefits, including medical, dental, vacation time and 401k.
Are You An Employer? Add Med Opps to your list of trusted recruiting resources. Access candidate profiles, contact information and CVs. Let us give you a head start on your recruiting efforts with new candidates registering each month. Search and contact physicians, physician assistants and nurse practitioners who are actively seeking an opportunity near you.
28 michigan MEDICINE
| JAN / FEB 2018
Henry Ford Allegiance Health Pediatrics Opportunity, MD/DO Jackson, MI
Henry Ford Allegiance Health Adult Psychiatry, MD/DO Jackson, MI
Henry Ford Allegiance Health Neurologist, MD/DO Jackson, MI
Medical Opportunities ID # 8925
Medical Opportunities ID # 12692
Medical Opportunities ID # 12101
Henry Ford Allegiance Health located in Jackson, Michigan is seeking board certified or eligible Pediatric Hospitalists to join our experienced team. One full time or several part-time or per diem positions are available. Enjoy excellent work-life balance with flexible scheduling. The affiliation gives Henry Ford Allegiance Health greater access to new state-of-the-art technologies and data driven care models, and enable physicians and other clinicians from both systems to work together to develop innovative approaches to patient care. It will also help Henry Ford Allegiance Health expand its services strategically, and have better access to capital funding. By working together with HFHS, Henry Ford Allegiance Health can become more efficient, generating additional funds from Allegiance’s operations, that will stay in the Jackson community. We are adding a new innovation center (adding State of Art Simulation & Research Labs) Fall 2017, to a new Patient Surgical Tower that will add 66 private rooms, Fall 2018.
We have full service for Behavioral Health: • Outpatient (Geriatrics, Child/Adolescent, Adult) • Partial day programs (intensive outpatient) • Inpatient Adult/Geri unit • Neuropsychology (only neuropsychology service in Jackson county) • Crisis Assistance • Addiction recovery center • Substance Abuse Services
Henry Ford Allegiance Health is seeking BC/BE Neurologist to join a reputable practice with 2.75 outpatient providers, 1 nurse practitioner and 1.75 inpatient neurology hospitalist.
We are looking to redesign our behavioral health department now that we are growing.
• 7 exam rooms
• Competitive salary package • Allegiance Health recently became the newest member of the Henry Ford Medical Group • EPIC EMR is currently being implemented as part of the partnership • 12-hour shifts • Average of 11 or 12 shifts per month for full time position • Nights, weekends and holidays shared equally • 9 bed Level II NICU caring for infants 32 weeks gestation and above where you work closely with NNPs support • Other responsibilities; include high risk delivery attendance, normal newborn care, inpatient pediatric care, Emergency Department consultation, and Pediatric Rapid Response team coverage • In house OB Hospitalists • Opportunities for teaching residents in Family Medicine, Psychiatry, Traditional Internship and Emergency Medicine, as well as Michigan State University medical students that rotate on inpatient pediatrics
Come live, work and play in the beautiful South Central Michigan. Jackson is a family oriented community with excellent schools, is in close proximity with two Big Ten Universities and provides affordable housing. Our four-season climate provides the perfect formula for unlimited year-round recreational activities.
The Neurology Hospitalists cover 44 of 52 weeks, and the eight weeks remaining are split among four (one private practice) providers. The Hospitalist is the feeder system for follow up care for our outpatient Neurologist. • 2 medical office supports (hiring for a 3rd who will be part time) • 4 MAs • 1 NP rounds inpatient • Perform EMGs in the office • Botox injections, research and med trials are being done by one of the providers Benefits, Compensation & Incentives
Henry Ford Allegiance Health Rheumatology, MD/DO Jackson, MI Medical Opportunities ID # 1007 Henry Ford Allegiance Health seeks a fourth BE/ BC Rheumatologist to join well-established and reputable practice (20 years). See the following: • Current board-certified Rheumatologists see an average of 24 patients/day and are scheduling new patients up to 6 months out. • Office equipped with 8 exam rooms and fully staffed with 2 LPN’s, office manager and receptionist / medical assistant / medical biller. • Limited call of 1:4. • We offer a very competitive salary, productivity bonus and signing bonus. • Paid benefits include: medical, dental, short and long term disability, life insurance, pension and 403b plan, four weeks vacation, one week CME. • Recruitment Incentives include paid interview expenses, moving expenses, malpractice insurance, student loan repayment up to $50K, a $30K relocation stipend if you purchase a home in Jackson County. EEO/AA
The compensation package includes a base salary with bonus opportunity, malpractice and health insurance, CME, PTO, and a 403(b). Henry Ford Allegiance Health also provides a housing incentive to any physician that relocates his/ her primary residence to Jackson County within the first year, student loan forgiveness, moving allowance, and a signing bonus. MED OPPS – CONTINUED ON PAGE 28
JAN / FEB 2018 |
michigan MEDICINE 29
MSMS Medical Opportunities msms.medopps.org
Henry Ford Allegiance Health Munson Psychiatry, MD/DO: Internal Medicine, MD/DO Core Faculty / Substance / Geriatrics Traverse City, MI Jackson, MI Medical Opportunities ID # 9723 Medical Opportunities ID # 11775 Excellent opportunity to take over a busy, The faculties are clinical psychiatrist responsible for supervision of the psychiatry residents and other trainees on psychiatry rotations. We have opportunities focusing on substance abuse, and geriatrics as well. We are redesigning behavioral health in our community and need to be sure candidates are interested in helping to build a ‘new’ academic program. Program is focusing on population health management, integration.
exceptionally lucrative, well-established, ambulatory, solo internal medicine practice in gorgeous Traverse City, MI. If you enjoy autonomy and are looking for an opportunity which will be immediately rewarding then this is for you! All inpatient care is handled by Hospitalist group.
Internal Medicine (11438) • Outpatient, Inpatient or a blend of both • Full-time & hospital employed Hospitalist (10013) • Skilled Care Unit (St. Mary’s of Michigan, Standish) • Full time & hospital employed Family Medicine (10014) • Full-time & hospital employed
transitioning his robust patient panel. Clinic is
• Practice located in Oscoda Orthopedic Surgery
large enough for 2 physicians and a mid-level, if
Clinical duties include a combination of inpatient, outpatient, and consult liaison work in psychiatric service and will include participation in research. Core Faculty will model professionalism, collaboration and teamwork with staff and other health professionals. The faculties are expected to engage in any or all areas of scholarship – discovery, teaching, integration, and application.
St. Joseph Health System Internal Medicine, Hospitalist, Family Medicine, Orthopedic Surgery, MD/DO Tawas, MI
Faculty members will contribute to the advancement of the discipline of Psychiatry as demonstrated by peer-reviewed funding; publication of original research or review articles in peer reviewed journals, or chapters in textbooks; publication or presentation of case reports or clinical series at local, regional, or national professional and scientific society meetings; or, participation in national committees or educational organizations.
Medical Opportunities ID # 12791
Administrative All faculty members will participate in some administrative activities as a function of other elements of the job (e.g., leading curriculum committees or task-forces, organizing education, QI teams, etc.) While the Program Director has primary responsibility for administration of the residency, the faculty will participate in resident and faculty or staff recruitment activities, program evaluation, accreditation work, as delegated.
provides primary and secondary care to patients
We have a full service for Behavioral Health.
Detroit, Lansing & Ann Arbor.
| JAN / FEB 2018
opportunities available:
Current physician will remain involved through
so desired. Clinic site is available for sale: lease,
30 michigan MEDICINE
St. Joseph Health System has the following
lease/buy, or buy.
St. Joseph Health System is a 49-bed acute care hospital in the beautiful Lake Huron shores rural area of Tawas City, MI! St. Joseph Health System offers a strong network of primary care physicians and specialists, with medical facilities in twelve locations, including three ambulatory centers and two walk-in-clinics. St. Joseph Health System serves five counties and totaling more than 87,700. In addition to a full range of traditional medical services, St. Joseph Health System offers more than 20 physician specialists. Truly a four-season wonderland, the Tawas Bay area has it all – boating, fishing, birding, hiking, kayaking, kite boarding, skiing, snowmobiling and more! Rural, family friendly orientated communities. Approximately 2-3 hours from
(10027) • General orthopedic • Located in a multi-specialty practice building • Full time & hospital employed Competitive compensation and a full comprehensive benefit package which includes malpractice coverage, relocation allowance, educational loan reimbursement allowance & sign on bonus.
[=]
SOLID ADVICE.
REAL SOLUTIONS. FOR HEALTH CARE BUSINESS.
At The Health Law Partners, our unparalleled knowledge of the business of health care is coupled with timely, practical solutions designed to maximize value. The HLP attorneys represent clients in substantially all areas of health law, with particular emphasis on: • Licensure & Staff Privilege Matters • Health Care Litigation • Health Care Investigations • Civil & Criminal False Claims Defense • Stark, Anti-Kickback, Fraud & Abuse, and Other Regulatory Analyses • Physician Group Practice Ancillary Services Integration and Contractual Joint Ventures • Appeals of RAC, Medicare, Medicaid and Other Third Party Payor Claim Denials and Overpayment Demands • Health Care Contractual, Corporate, and Transactional Matters • Compliance & HIPAA
TheHLP.com [284.996.8510]
RANKED 6TH IN THE NATION AND 1ST IN MICHIGAN.
• Make appointments • Transfer patients • Consult with physicians • Get patient information
M-LINE: 800-962-3555 24 hours a day, 7 days a week