THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 116 / NO. 4
July / August 2017
ALSO INSIDE
Rise Up with MDPAC! Pages 16-17
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FEATURES & CONTENTS July / August 2017
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Maximize success under MIPS by employing a Qualified Clinical Data Registry (QCDR) BY THE AMERICAN MEDICAL ASSOCIATION WITH CONTRIBUTION BY STACEY P. HETTIGER
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Take Note: How Medical Scribes Are Trained–And Used–Varies Widely BY JEFFREY A. GOLD, MD Contributed by The Doctors Company
COLUMNS 04 President's Perspective
BY CHERYL GIBSON FOUNTAIN, MD
BY DANIEL J. SCHULTE, JD
BY STEPHANIE COLE, RN, BSN, MPH
BY JODI SCHAFER, SPHR, SHRM-SCP
BY NATHAN MERSEREAU
06 Ask Our Lawyer
08 MDHHS Update
14 Ask Human Resources 30 WealthCare Advisors
COVER STORY
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DEPARTMENTS 15 Welcome New Members 15 In Memoriam 16 MDPAC: Rise up 24 MSMS Medical Opportunities 28 MSMS Educational Courses
QUALITY PAYMENT PROGRAMS BY NICK DE LEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY
New models of care are lowering costs while improving patient outcomes and physician satisfaction. Innovative payment models are moving those improvements – and savings – to the next level.(Story on page 18.)
STAY CONNECTED!
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MICHIGAN MEDICINE Chief Executive Officer JULIE L. NOVAK Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org
perspective
Graphic Design STACIA LOVE, REZÜBERANT! INC. rezuberantdesign@gmail.com Printing FORESIGHT GROUP staceyt@foresightgroup.net Publication Office Michigan Medicine 120 West Saginaw Street East Lansing, MI 48823 517-337-1351 www.msms.org All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast. Postmaster: Address Changes Michigan Medicine Hannah Dingwell 120 West Saginaw Street East Lansing, MI 48823
Michigan Medicine, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan. The MSMS Committee on Publications is the editorial board of Michigan Medicine and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors. Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine reserves the right to accept or reject advertising copy. Products and services advertised in Michigan Medicine are neither endorsed nor warranteed by MSMS, with the exception of a few. Michigan Medicine (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2017 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. ©2017 Michigan State Medical Society
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CHERYL GIBSON FOUNTAIN, MD, MSMS PRESIDENT
“Physicians are on the cutting edge, leading a health care transformation that’s about putting patients and value over volume. We’re honored to stand alongside you in that important cause.”
By Cheryl Gibson Fountain, MD, Michigan State Medical Society President
®
Health care is changing. What patients expect, the way state and federal governments regulate health care, the way physicians deliver care and the way they’re being reimbursed are in a state of constant evolution. Physicians dedicate their lives to meeting the needs of patients, fighting for reforms that put patients first, and pursuing technologies and innovations that create healthier people and communities. Those are the constants patients count on and physicians deliver. The truth is, they’re nearly the only constants in today’s health care marketplace.
“Physicians dedicate their lives to meeting the needs of patients, fighting for reforms that put patients first, and pursuing technologies and innovations that create healthier people and communities.”
Earlier this year, Michigan Medicine featured a cover story highlighting a number of the new and emerging ways Michigan physicians are practicing – and a few old ones, as well. This issue, we’re taking the next step, examining the rapidly evolving reimbursement landscape. As the article says, “new models of care are generating better patient outcomes, lower costs, and better professional satisfaction. New payment models offer patients and physicians the opportunity to move those improvements – and savings – to the next level.” Despite broad variety in health care delivery models, payment models have long and largely been a one-trick pony. Whether you’re a family physician or an oncologist, a rural, solo practitioner or part of a giant, big-city, multi-site practice, fee-for-service has long dominated the payment landscape.
That’s changing, and fast. Capitation arrangements. Accountable Care Organizations. Patient Centered Medical Homes. Physician-focused alternative payment models, provider and facility bundling, and a host of other reimbursement alternatives are rewriting the way physicians make a living, and the way they deliver care. Physicians are on the cutting edge, leading a health care transformation that’s about putting patients and value over volume. We’re honored to stand alongside you in that important cause.
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ASK OUR LAWYER
Direct Claims for Payment from No-Fault Insurers By Daniel J. Schulte, JD, Michigan State Medical Society Legal Counsel
Q: I often treat automobile accident victims. Getting my patient’s no-fault insurer to pay has always been a challenge. I understand this may be more difficult following the Covenant Medical Center v. State Farm Mutual Automobile Insurance Company case. Can you please explain what was decided in this case and what it means for physicians owed money for their services provided to auto accident victims?
Contact Kim Burley, Director of Recruitment, at 517-827-3149 or kim.burley@corizonhealth.com.
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In this case Covenant was owed $43,484.80 for services it provided to a patient injured in an automobile accident. It sent its bills to the patient’s no-fault insurer, State Farm. When State Farm refused to pay, Covenant sued. Without Covenant’s knowledge, this patient also sued State Farm seeking no-fault benefits to pay for the injuries he suffered in the same accident. State Farm settled with the patient agreeing to pay the patient $59,000.00. The patient agreed to release State Farm from “all allowable no-fault expenses and any claims … .” State Farm claimed the release it obtained from the patient extinguished any obligation it had to pay Covenant. Covenant claimed the release did not extinguish its claim for payment because State Farm had notice (it had received the bills) of Covenant’s claim for payment prior obtaining the patient’s release. The Court of Appeals agreed with Covenant. It held that because State Farm did not apply to the circuit court for an order directing how its $59,000.00 payment should be allocated, Covenant’s claim for payment was not discharged. State Farm appealed and the Michigan Supreme Court on May 25, 2017 reversed without addressing whether the patient’s release could or did discharge State Farm’s obligation to pay Covenant. Instead, the Court painstakingly examined the no-fault act and held that healthcare providers have no right to sue their patient’s no-fault insurer for payment of their bills. This result is a dramatic departure from decades of Court of Appeals case law holding that healthcare providers may assert a direct cause of action against a no-fault insurer to recover their patient’s benefits for payment of their bills.
The law has changed and unless physicians take action with their no-fault patients it will likely be more difficult to get paid for these services. The Court was careful to point out that its decision does not affect either:
(1) the physician’s recourse directly against patients for payment; or (2) the patient’s ability to assign his/her right to past or presently due no-fault benefits. Following Covenant it is more important than ever to identify those patients whose services are or may be covered by no-fault insurance. If physicians do not have these patients assign their no-fault benefits (to the extent of the amount currently owed past and current services) there will be no way to make the no-fault insurer pay them directly. This leaves physicians with having to collect from the patient after he/she has collected from the no-fault insurer. The best practice would be to have the patient sign an assignment of benefits form each time services are provided covering fees for the services then being provided and past services. Assignments of future benefits are prohibited by MCL 500.3143. The assignment is not subject to ERISA because the benefits are through a no-fault insurance policy and not an employer sponsored health plan. The following is typical assignment language: “To the extent of the charges for today’s services and all services I have received in the past arising from or related to my [insert date of accident] automobile accident, I hereby irrevocably assign and transfer to [insert name of practice] all my right, title and interest in and to all benefits paid, payable or available to me under any no-fault automobile insurance policy naming me as an insured or otherwise providing me coverage.” DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL.
A New Patient’s Journey Can Start Anywhere. Word of mouth and insurance compatibility are only half of the story. MSMS members can get the full picture with a free downloadable guide at Officite.com/July/MSMS.
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MDHHS UPDATE
Protect Michigan Children and Teens from Vaccine-Preventable Diseases By Stefanie Cole, RN, BSN, MPH, Pediatric Immunization Nurse Educator, Michigan Department of Health and Human Services (MDHHS), Division of Immunization As families begin preparing to send their kids back to school this fall, the Michigan Department of Health and Human Services (MDHHS) wants to remind healthcare providers to ensure their pediatric and adolescent patients are protected from vaccinepreventable diseases. Healthcare providers should vaccinate their patients according to the Advisory Committee on Immunization Practices’ (ACIP) recommended immunization schedules.1 It is equally important for providers to vaccinate children and teens with all ACIP-recommended vaccines as it is to vaccinate them on time, according to the schedule.
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y vaccinating children according to the ACIP schedule, those patients will have all the vaccines required by Michigan law for school and daycare entry. In early 2017, MDHHS updated the school and daycare vaccine requirements documents and made easy-to-read pieces targeted specifically to healthcare providers, schools/daycares, and parents.2 These documents can be accessed on the MDHHS website and include print-friendly black and white versions. As a reminder, healthcare providers should only provide parents with medical immunization waivers when needed for true contraindications. Refer parents to their local health department for all non-medical waivers. It is important, now more than ever, to educate parents on the importance of vaccines for their children. Despite some beliefs that vaccine-preventable diseases are a thing of the past, these diseases are currently circulating in Michigan. As of May 17, Michigan has confirmed two cases of measles that were epidemiologically linked. From January 1 to April 22, 61 people in the United States were reported to have measles.3 As of May 17, Michigan has reported 35 cases of mumps including an outbreak on a college campus. In the United States, over 2,500 cases of mumps were reported from January 1 to April 22.4 Since these vaccine-preventable diseases are very contagious and are easily transmitted through respiratory droplets, it is especially important to vaccinate children and teens to protect them in school settings.
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Despite some vaccines not being required for school entry in Michigan, they still protect against important diseases that can make children and others extremely sick. Examples of these vaccines include hepatitis A, meningococcal disease, and influenza. In the past year, Michigan experienced a large hepatitis A outbreak that included a high proportion of hospitalizations and even some deaths.5 Children are routinely recommended to receive 2 doses of hepatitis A vaccine separated by at least 6 months when they are 12-23 months of age. However, healthcare providers can catch-up children 2 years of age and older using this 2-dose schedule.
I Vaccinate Campaign Through a collaborative effort with the Franny Strong Foundation, MDHHS is raising awareness of the importance of protecting Michigan children from vaccine-preventable diseases with the I Vaccinate Campaign. This campaign provides parents with credible, easy-to-understand information on the importance of following the recommended immunization schedule. The I Vaccinate campaign has included TV and radio ads, print materials, digital ads, and a variety of other media channels. As a healthcare provider, you can support the I Vaccinate campaign on Facebook and Twitter by engaging in positive conversations to help reinforce the importance of timely immunizations. You can also refer your patients who may want more information on immunizations to the I Vaccinate website at www.ivaccinate.org.
Another important example is meninflu vaccines. The 2017-18 flu vaccine will gococcal disease. MenACWY vaccine contain a new H1N1 strain, the first protects against the A, C, W, and Y sestrain change since the 2009 pandemic.6 rogroups of N. meningititidis. This vacIt will be critical to protect children and cine is required for 7th graders to attend teens from a new strain that they’ve never school (recommended age of administrabeen vaccinated with before. In Michition is 11-12 years). However, healthcare gan during the 2016-17 flu season, there providers may forget that a second dose were five pediatric flu deaths reported as of MenACWY is routinely recommendof May 13. Influenza pediatric deaths can ed for teens at 16 years of age to boost be prevented by vaccinating children aged their immune systems before they enter 6 months and older and ensuring pregthe college setting. There is also meninnant women receive flu vaccine while they gococcal B vaccine which protects against are pregnant to help protect their infants disease caused by serogroup B. This vacwhen they are too young to be vaccinated cine is recommended for certain highthemselves. Do not miss an opportunity risk children beginning at age 10 years. to vaccinate this flu season. Providers should also discuss this vaccine with parents of teens aged 16-18 years Health Heroes has been providing flu (regardless of presence of a high-risk convaccine free of charge at school-based flu dition) and provide education vaccine clinics for a few years on meningococcal B disease in Michigan and will continue Health Heroes to determine if this vaccine to do so in 2017-18 throughshould be administered to has been providing out the state. School-based provide additional menin- flu vaccine free of vaccine clinics can help take gococcal disease protection some of the burden off pribefore college. In addition charge at school- vate providers to vaccinate all based vaccine to the ACIP immunization their patients with flu vaccine. schedules and footnotes, clinics for a few Remember to check the Michhealthcare providers can find years in Michigan igan Care Improvement Regmore vaccine-specific recand will continue istry (MCIR) for every patient ommendations at www.cdc. at every visit to determine gov/vaccines/hcp/acip-recs/ to do so in 2017- which vaccines are needed. All 2018 ‌ vacc-specific/index.html. vaccines administered to perAs children and teens begin to come in for their back-to-school and sports physicals, don’t forget to take advantage of every vaccine opportunity and begin to vaccinate with flu as soon as your office receives
sons less than 20 years of age (including flu vaccine) must be entered into MCIR within 72 hours of vaccine administration. For more information on MCIR, visit www.mcir.org.
The Vaccines for Children (VFC) program is a federally funded program that supports nearly 1,300 providers in Michigan. Providers who are enrolled in the program are able to offer eligible patients vaccines at no cost. Eligibility includes those under 19 years of age who meet at least one of the following criteria: 1) Medicaid eligible or enrolled, 2) uninsured, 3) American Indian or Alaska Native, or 4) underinsured (i.e., has insurance that does not cover the cost of vaccines). The VFC program has been protecting children for over 20 years. Based on a report about the benefits of immunization during the VFC program era 19942013, CDC estimates vaccination of children born between 1994 and 2013 will prevent 322 million illnesses and 732,000 deaths.7 Private practices and clinics who are interested in becoming a VFC provider should contact their local health department for more information on enrolling. Thank you for all you do to educate your patients about immunizations, protect your patients from vaccine-preventable diseases, and ensure that they are healthy and ready to get back to school! References 1 Centers for Disease Control and Prevention (2017). Immunization Schedules. https://www.cdc.gov/vaccines/ schedules/index.html 2 Michigan Department of Health and Human Services (2017). Immunization Waiver Information. http://www.michigan.gov/
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HEALTH INFORMATION TECHNOLOGY (HIT) ALERT
Maximize success under MIPS by employing a Qualified Clinical Data Registry (QCDR) By The American Medical Association with contribution by Stacey P. Hettiger
Successful reporting of several key components is critical to maximizing your performance under the new Quality Payment Program’s (QPP) Meritbased Incentive Payment System (MIPS). It is important to recognize that Medicare payments in 2019 are based on reporting in 2017. Currently, physicians can do minimal reporting, reporting for 90 consecutive days, or full year reporting in order to be held harmless or earn incentives under MIPS. If you have not done so already, it is important that you begin to understand and plan your reporting strategy now.
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MIPS performance components There are four performance categories to MIPS: 1. Quality 2. Resource use (referred to as “cost”) 3. Meaningful use of certified EHR technology (referred to as “advancing care information” or “ACI”) 4. Clinical practice improvement activities (referred to as “improvement activities” or “IA”) In 2017, eligible physicians must report to CMS on three of these four components: quality, ACI, and CPIA. CMS will collect resource use data from administrative/claims data. Therefore, physicians will not have to separately report on this category. For the 2017 performance year, a physician’s MIPS final score will not include a cost score as that category will be weighted at zero percent.
Quality reporting The quality performance category under MIPS replaces the Physician Quality Reporting System (PQRS) and streamlines some of the reporting requirements. Physicians will need to report on six measures for fifty percent of their eligible patients. Of the six measures, one must be an outcome measure. This is a reduction from the nine measures required under PQRS and CMS eliminates the domain requirement. Physicians will receive credit toward their total quality score for each measure they successfully report. Furthermore, CMS encourages and recognizes the cost to report through electronic sources by offering potential additional incentives when reporting through a QCDR.
Improvement Activities (IA) IA is a new performance category under MIPS to promote ongoing improvements and innovation in clinical activities. Physicians must select at least one CPIA from
90+ proposed activities, many of which may already be underway in your practice, but to receive full credit a physician or group may have to select multiple IA depending on their weight and practice size.
Tips for successful reporting under MIPS via QCDRs
Some of the activities include: • Completing modules in the AMA STEPSForward™ program • Participating in a QCDR • Utilizing patient experience data to improve practice • Participating in the Transforming Clinical Practice Initiative (TCPI) • Being designated as a Patient-Centered Medical Home
QCDRs offer a single-stop mechanism for collection and submission of your data to CMS to satisfy reporting under MIPS. A good QCDR will actively partner with you to improve the quality of care. CMS provides a list of QCDRs to help you find a partner available at https:// qpp.cms.gov/docs/QPP_2017_ CMS_Approved_QCDRs.pdf.
Employing a Qualified Clinical Data Registry (QCDR) QCDRs are a key feature of MACRA and the MIPS reporting method. A QCDR is a CMS-approved entity that collects clinical data for the purpose of patient and disease tracking. This approach fosters improvement in the quality of care provided to patients. A QCDR is different from a qualified registry because it is not limited to measures within the Quality Payment Program. The data submitted to CMS via a QCDR includes reporting on all patients, regardless if the patient is a Medicare beneficiary or not. QCDRs can be utilized for reporting across three performance categories: Quality, ACI, and IA. The list of 2017 approved QCDRs is available at https://qpp.cms.gov/docs/ QPP_2017_CMS_Approved_QCDRs. pdf. This list includes detailed information from each QCDR, including contact information, the measures, activities and performance categories they support, services offered, and costs incurred by their clients. If looking to utilize a QCDR to satisfy IA, it will be necessary to reach out to your vendor to determine what IA they can support.
Speak with your electronic health record (EHR) vendor to understand how the EHR will facilitate MIPS reporting. Find a QCDR with measures that are relevant to your patients and how you practice medicine. Measures that lessen the burden of reporting are preferable. Measures calculated using data taken directly from your EHR will decrease this burden. Another early step is to contact your specialty society to ask if they offer a QCDR solution. Some QCDR stewards are quality improvement organizations (QIOs) or involved in the Transforming Clinical Practice Initiative (TCPI).
This is a modified article from the American Medical Association ‘s STEPS Forward™ practice-based initiative. The goal of STEPS Forward™ is to provide physicians with proven strategies that can improve practice efficiency and help achieve the Quadruple Aim — better patient experience, better population health and lower overall costs with improved professional satisfaction. There currently 43 modules from which to choose. These modules cover a variety of topics impacting patient care, workflow and process, professional well-being, leading change, and technology and finance. Visit https://www.stepsforward.org/ to learn more about STEPS Forward™.
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Take Note: How Medical Scribes Are Trained— And Used—Varies Widely By Jeffrey A. Gold, MD, Professor of Medicine, Director of Simulation, Oregon Health and Science University
The widespread adoption of electronic health records (EHRs) has led to a number of unintended consequences—particularly a negative effect on doctor satisfaction and practice workflow. Medical practices have tried many different solutions to help alleviate the burden, and one of the most common solutions is the adoption of medical scribes.
S
cribes are now the fastest growing medical field. However, in spite of this rapid growth, there is little standardization in training scribes or defining their appropriate function with the EHR. Though studies have lauded the potential benefits of scribes for nearly 30 years,1 the number of scribes is rapidly increasing today because of the need to untether the doctor from the EHR. According to one survey, nearly 20 percent of physicians now use scribes, with 10 percent planning on hiring scribes in the near future.2 Estimates suggest that the number of scribes will grow almost five-fold by 2020 to over 100,000, with one scribe for every nine physicians.3 Reports document scribe use in almost every practice setting and across a wide variety of specialties. How does this affect the delivery of care? A number of studies suggest that scribes can enhance physician efficiency, improve physician satisfaction, and increase billing in a variety of clinical settings. Patient satisfaction can also increase, due to improved physician-patient interactions during office visits.
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A Lack of Training and Standardization In spite of the rapid growth and potential benefits of scribes, the healthcare community has generated very little regulation or standardization for scribe training, and researchers haven’t conducted any assessment of scribes’ ability to safely interface with the EHR. Recently, The Joint Commission stated that, at a minimum, all scribe-generated orders must be signed by a provider prior to implementation and that organizations must document the competency of scribes for the functions the organization deems appropriate.4 The Joint Commission also went so far as to require authentication of all EHR entries from a licensed practitioner.5 Scribes are considered a distinct group, but that group’s composition is varied. Scribes have a wide variety of backgrounds, including premed students and certified medical assistants.6 Dedicated scribe organizations, which provide scribes for individual practices and healthcare organizations, may train recruits on basic medical terminology, note structure, documentation, and EHR basics. Other scribes may receive on-thejob training from the doctor who is their
employer. There is no licensure requirement for scribes. Most healthcare organizations set up their own training that is specific to local clinical workflows and dependent on the level of scribe functionality deemed appropriate by the organization.6 Once embedded in the organization, scribes may perform a variety of functions, including doing pure transcription of the encounter, using templates or macros within notes, placing orders, finding information in the EHR for the doctor, or even responding to patient messages.7 Unfortunately, few rules or standards currently exist that designate appropriate scribe activities.
Survey Shows Variable Roles and Functions To better understand the role and functionality of scribes, The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, and Oregon Health and Science University (OHSU) conducted a national survey of The Doctors Company’s members.
This survey, with 335 respondents, suggested that scribes are supplied from different sources, have disparate backgrounds, and their training is highly variable: 55 percent of scribes trained by doctor. 44 percent of scribes lack prior experience. Only 22 percent of scribes have had any form of certification. Around 24 percent of practices that use scribes hire them as employees. Nearly 13 percent of practices use scribe staffing agencies.
The study also revealed wide variability in the tasks scribes are performing, including pure note writing, data entry (such as updating allergies), data extraction (such helping the doctor find information in the EHR), and order entry. A survey of a cohort of risk managers across the U.S. found a similar variance in scribe activities but significant differences between the two groups in what is considered in-scope for scribes.
The Risk of ‘Functional Creep’ The combination of rapid growth in scribe use, lack of standardized training, variability in scribe experience, and variability in both EHR exposure and EHR workflows raises the concern that scribes may introduce potential negative unintended consequences to either workflow or documentation. Only one study to date has been conducted on the quality and accuracy of scribe-generated notes. To address this, OHSU is currently investigating the use of virtual, video-based simulation to assess the quality of scribe-generated notes and to provide practice-specific training.
In addition to concern over the wide The chart below shows the percentage of variance in scribe activities, healthcare respondents in both groups who identiproviders are worried about “functional fied particular activities as appropriate creep”—scribes being granted the authorfor scribes. ity to perform more complex functions in the EHR over time. Scribes will slowly assume more and more complex EHR tasks, such as order entry, data finding, data inPercentage of Respondents Who Identified terpretation, and entering of other data Particular Activities as Appropriate for Scribes elements besides general notes. Given the already large number of negative safety isScribe Activity Doctors (%) Risk Managers (%) sues associated with these complex EHR functions, it’s imperative that the healthEntering history 85 87.5 care community create methodology to Entering review of systems 77.8 62.5 ensure scribes can be effectively trained and their competency assessed for safe and Entering vitals 89.8 79.1 effective use of the EHR.
Entering allergies
89.8
87.5
Entering labs
83
54.2
Entering medications
84.7
79.2
Entering physical exam
61.3
66.7
Entering orders
47.2
25
Entering imaging
76.1
54.2
References
Entering progress notes
63.1
62.5
1 Allred RJ, Ewer S. Improved emergency department patient
Entering care plan
60
62.5
Emerg. Med. 1983;12(3):162-3. PubMed PMID: 6829994.
Assisting in EHR navigation
86.3
91.7
Locating information in EHR
87.5
91.7
Responding
44.9
20.8
Performing research
60.2
23.5
Providing translation services
64.8
20.8
Signing physician notes
11.3
8.3
Workflow optimization
78.4
58.3
Participate in decision making
15.3
0
Dr. Gold is director of the OHSU Simulation Center, program director of the Pulmonary Critical Care and Critical Care Fellowships, and associate director of the Adult Cystic Fibrosis Center at OHSU.
flow: five years of experience with a scribe system. Ann. 2 Martineau M, Brookstone A, Stringham T, Hodgkins M. Physicians use of EHR systems 2014. AmericanEHR. http:// www.americanehr.com/research/reports/Physicians-Use-ofEHR-Systems-2014.aspx. Accessed May 11, 2017. 3 Gellert GA, Ramirez R, Webster SL. The rise of the medical scribe industry: implications for the advancement of electronic health records. JAMA. 2015;313(13):1315-6. doi: 10.1001/jama.2014.17128. PubMed PMID: 25504341. 4 Clarification: Safe use of scribes in clinical settings. The Joint Commission Perspectives. 2011;31(6):4-5. 5 The Joint Commission. Critical Access Hospitals Manual, HR: Scribe - Compliance with Joint
*Statistically significant (Chi-Square) differences noted
Commission Standards. https://www.jointcommission. org/standards_information/jcfaqdetails.
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ASK HUMAN RESOURCES
Trust, but Verify … The Value of Reference Checking By Jodi Schafer, SPHR, SHRM-SCP
Q
We’ve stopped doing reference checks on new hires because I felt like the people that were listed as references over-exaggerated the good qualities and weren’t honest. However, I’ve recently had a string of bad hires and I’m starting to rethink my position on this. I’m not sure a reference check would have made any difference, but it couldn’t have hurt. Any advice for me if I decide to start calling Let me tell you a quick story to illustrate how a simple phone call to a past employer saved one of my clients from making a huge hiring mistake…
This particular client had hired me to interview a person that he was very excited about for his front desk/receptionist position. He, like you, had sworn off reference checks a long time ago because he didn’t trust the information he was given during these calls. During my phone interview with the candidate she indicated that her current employer was experiencing financial difficulties and had encouraged her to start looking elsewhere. However, when I pushed her to get her current boss’s contact information for the sake of a reference check she was hesitant to give it to me. It turns out that her boss didn’t really know she was looking and she didn’t want me to upset the apple cart by calling him. While I was able to connect with a few of her other work colleagues and previous supervisors, the fact that she over-exaggerated her current boss’s knowledge of her job search bothered me. I decided to dig deeper and talk with the only other company listed in the ‘Experience’ section on her employment application. The candidate had not listed anyone from that company on her reference list, but I had her supervisor’s name and telephone number which was enough to get me started. It took me three calls over the course of one-week to finally connect with someone. I wasn’t able to get any information beyond job title, dates of employment, pay rate and eligibility for rehire. However, that was enough to realize that she had over-stated her annual salary by about $10,000! I called the candidate and asked her to explain the pay discrepancy. She gave me a lame excuse, so I then asked her to provide me with a copy of a recent check stub to verify her current employment and wages (in lieu of the phone call to her boss that she had asked me not to make). As you can imagine, the check stub never materialized and we chose to continue searching.
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You see, reference checks don’t have to be an empty exercise. They are a way of validating things that you think you learn during the interview process, including someone’s honesty and integrity. When deciding who to contact, don’t feel limited to the names the candidate provides you. You want to call people who directly oversaw this candidate and the signed release on the bottom of your employment application typically gives you the ability to do so. Avoid calling the HR Department if you can at all help it. HR won’t be able to tell you much more than dates, wage information and eligibility for rehire. This is important data to have and you should compare it against what was listed on the employment application, but the real bang for your buck is in speaking to someone who worked closely with the person you want to hire. Listen to what they say and what they don’t say. A good reference is able to list some short-comings/ weaknesses along with strengths and can do so with ease. If the reference is choosing their words very carefully or speaking in vague terms with no ability to give specific examples then beware. Ask good questions to get good answers. You want to know if the candidate was ever spoken to or disciplined for any reason. Ask about the candidate’s attendance record and reliability. Ask about whether or not they got along well with their coworkers. And last but not least, ask whether or not the person you are speaking with would rehire the candidate if given the opportunity to do so. This last question is a very telling one. If there is any hesitation in the answer, or the previous employer answers ‘no’ then consider that very seriously. Often times employers that are gun-shy about answering questions negatively, will answer this last question honestly and really that is all you need to know to make the call worthwhile.
Welcome New Members Berrien
Macomb
Calhoun
Marquette
Clinton
Oakland
Clarence Brown, Jr, MD, FAAD Martin Goins, III, MD Firas Riyazuddin, MD Genesee
Surya Thota, MD
MEMBERS OF THE MICHIGAN STATE MEDICAL SOCIETY REMEMBER THEIR COLLEAGUES WHO HAVE DIED.
Wei Su, MD
Ashok R. Prasad, MD Wayne County Medical Society, 4/20/17 Cynthia D. Ray, MD Wayne County Medical Society, 4/5/17
Renee Kniola, MD
Fran T. White, MD Genesee County Medical Society, 5/13/17
Lisa Barron, MD Robert Folberg, MD
Jack J. Ferlinz, MD Saginaw County Medical Society, 5/18/17
Saginaw
John Blebea, MD, MBA, FACS
Ingham
Carmen Ventocilla, MD Jackson
William Bunzel, DO Dashrath Gautam, MD Rebecca Innes, DO Samantha Lee, DO Kate Viola, MD, MHS, FAAD Kent
Timothy Hudson, DO John Iacobucci, MD Jeffrey Rosenthal, DO
In Memoriam
St. Clair
Michael Basha, DO, FCCP Rajat Prakash, MD Washtenaw
Jorge Gomez, MD Ingham County Medical Society, 4/18/17 Lloyd W. Moseley, Jr, MD Kent County Medical Society, 3/20/17 Ramesh Kumar, MD Wayne County Medical Society, 5/4/17
Ashlee Holman, MD Valerie Vaughn, MD
Robert A. Ackerman, Jr, MD Muskegon County Medical Society, 3/29/17
Wayne
Winslow Grosvenor Fox, MD Washtenaw County Medical Society, 3/18/17
Kalyna Jakibchuk, MD
To make gift or bequest to the MSMS Foundation contact: Rebecca Blake, Director, MSMS Foundation Phone 517-336-5729 or Email rblake@msms.org
Patients trust you. You can trust Kerr Russell. A successful practice requires more than talented individuals and a desire to heal. Let Kerr Russell provide the legal insight needed to manage and grow your business. ENTITY FORMATION • BUSINESS MATTERS • EMPLOYMENT CONTRACTS • PURCHASE / SALE OF OWNERSHIP INTERESTS • MALPRACTICE AND ALL OTHER COMMERCIAL LITIGATION • APPEALS • MEDICAL STAFF PRIVILEGE DISPUTES
HOSPITAL RELATIONS MATTERS • HEALTHCARE FRAUD DEFENSE •• LICENSING AND AND OTHER OTHER REGULATORY REGULATORY MATTERS MATTERS
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P A R T N E R S
For more information, please contact: Daniel J. Schulte dschulte@kerr-russell.com Patrick J. Haddad phaddad@kerr-russell.com
500 Woodward Avenue, Suite 2500 Detroit, Michigan 48226 T: 313.961.0200 / F: 313.961.0388
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JULY MAY / AUGUST / JUNE 2017 |
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Five Reasons to
BACK the PAC The Michigan Doctors’ Political Action Committee (MDPAC) builds and maintains strong relationships with lawmakers, as well as candidates running for political office. As the face of physicians, MDPAC bring medical knowledge into
Activate your political voice! The Michigan Doctors’ Political Action Committee (MDPAC) is the political arm of the Michigan State Medical Society. It is a bipartisan political action committee made up of physicians, their families, residents, medical students and others interested in making a positive contribution to the medical profession through the political process. MDPAC supports pro-medicine candidates running for political office in Michigan. Physician engagement is essential to the success of a pro-medicine legislature. Current and potential lawmakers want and need to hear from professionals in the field of medicine. Through MDPAC, you will activate your voice on the things most important to Michigan physicians.
discussions with political decision makers.
For more than three decades, MDPAC has mounted successful lobbying efforts on behalf of physicians. For example... MDPAC protects and strengthens tort reform, stopped the physician’s tax, and has
helped to stop the expansion of a non-physician’s scope of practice. MDPAC has power, prestige and respect! If you wake your sleeping giant, MDPAC could make rapid, positive change for physicians and patients. It could ease administrative pressures with the current prior authorization process, save you money
and time on your Maintenance of Certification, and advance public health issues.
Trial lawyers, insurance companies, and other political opponents raise massive sums of money. Medicine’s friends, through MDPAC, must dig deeper to raise equivalent or greater amounts of funds to advance Michigan
physician’s agenda.
Get started today at MDPAC.org
The current political landscape is uncertain. Only through a well-funded, unified voice will physicians and their patients’ interests be heard. MDPAC is that voice. Get your voice heard by contributing today at MDPAC.org
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Top 150 Michigan Political Committees January 1, 2017 to April 20, 2017
RANK 1 2 3 4 5 6 8
NAME OF POLITICAL COMMITTEE House Republican Campaign Committee Senate Republican Campaign Committee Michigan House Democratic Fund Michigan Senate Democratic Fund Realtors Political Action Committee Of Michigan Blue Cross Blue Shield of Michigan Political Action Committee Health Political Action Committee MI Health & Hospital Assoc.
11 14 15 18 19 20 21 26 29 30 31 33 36 44 49 76 77 81 85 96 97 110 115 124 141
Business Leaders For Michigan PAC Auto Dealers of Michigan Political Action Committee Michigan Credit Union League Action Fund Michigan Education Association Political Action Committee Michigan Association for Justice Justice PAC Health Care Association of Michigan Political Action Committee Michigan Chamber Political Action Committee Michigan Farm Bureau Political Action Committee Michigan Bankers Association MIBankPac - State Michigan McDonalds Government Association PAC Michigan Restaurant Association Political Action Committee Michigan Automobile Dealers Political Action Committee Michigan Beer and Wine Wholesalers State PAC Michigan Association of Health Plans Advocacy PAC (SuperPAC) MDA Dental PAC Michigan Association of Health Plans Political Action Committee Michigan Optometric Association Political Action Committee (SSF) Michigan Society of Anesthesiologists Political Action Committee Michigan Chiropractic Society PAC MI Podiatric Medical Assocation Political Action Society Michigan Council of Nurse Practitioners PAC Michigan Association of Nurse Anesthetists PAC Michigan Nurses Association Political Action Committee Health Alliance Plan PAC Michigan Physical Therapy PAC
MONEY RAISED 1/1/17 - 4/20/17 $817,422.75 $621,275.00 $410,576.82 $251,579.18 $216,719.79 $194,868.54 $156,786.26 $131,000.00 $113,790.57 $113,654.96 $82,543.11 $78,543.03 $77,145.00 $76,291.62 $63,745.15 $53,486.58 $52,200.00 $49,462.00 $46,405.00 $45,193.66 $30,674.07 $27,500.00 $16,841.46 $16,714.00 $16,093.72 $15,330.00 $12,585.58 $12,160.00 $10,496.35 $9,887.17 $8,754.57 $6,851.00
MDPAC: NOT RANKED IN TOP 150 SOURCE: Michigan Campaign Finance Network
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Physicians dedicate their lives to meeting the needs of patients, fighting for reforms that put patients first, and pursuing technologies and innovations that create healthier people and communities. Those are the constants patients count on and physicians deliver. The truth is, they’re nearly the only constants in today’s health care marketplace. Sweeping federal reforms are coming fast and furious. No sooner had physicians begun adjusting to new rules and regulations associated with the Affordable Care Act, Congress began discussing bills to replace it with equally comprehensive rules changes in the American Health Care Act. Ever-evolving Medicare and other federal requirements, state exchanges, and insurance company policies perform a never-ending regulatory dance with health care policies that vary across the 50 states and are at the constant whim of state assemblies and legislatures. Change is difficult in any field, but it’s particularly complicated in health care, where so many competing interests struggle to be heard, and where the stakes are so high. Michigan physicians are rolling with the regulatory punches while helping pioneer new models of care that more effectively meet the needs of patients and providers alike.
One Size Does NOT Fit All
D
espite broad variety in health care delivery models, payment models have long and largely been a one-trick pony. Whether you’re a family physician or an oncologist, a rural, one-woman provider or part of a giant, big-city, multi-site practice, fee-for-service (FFS) has long dominated the payment landscape. Seeing a patient, conducting a test, participating in surgery – each service is reimbursed with a specific fee. The more services a provider performs, the greater his or her reimbursement. An analysis published last year in Health Affairs and reported in Medscape, found that nearly 95 percent of all provider visits used fee-for-service payment methods in 2013. More recent reports and analysis show that number falling quickly across physician groups, especially among those treating Medicare patients, and that alternative payment models are on the rise.
That’s not surprising. Providers have long understood and railed against the inherent limitations of the FFS model, with its gross disincentives for efficiency and long Michigan physicians term results, and its lack of incentives for the kind are rolling with the of teamwork, integration, and preventative care regulatory punches that can keep small health problems from exploding into a costly, and dangerous health crisis.
while helping pioneer new models of care that more effectively meet the needs of patients and providers alike.
From blazing technological trails and developing new high-tech tools to better see and treat patients, to embracing community medicine, shared medical appointments, and free-market, pay-as-you-go practices, local health care leaders are challenging old ideas and forging tomorrow’s expectations of what a patient’s health care experience should look like.
Many new models of care are improving patient outcomes and professional satisfaction while lowering costs. Innovative payment models offer patients and physicians the opportunity to move those improvements – and savings – to the next level.
What payers, including private insurance companies and the federal government, understand is that the fee-for-service model also creates a lot of waste.
According to a 2012 report authored by Donald Berwick, MD, and Andrew Hackbarth, published in the Journal of the American Medical Association, avoidable health care spending accounts for at least 20 percent of total health care spending in the United States, representing as much as $992 billion in avoidable costs. Reducing this spending is in everyone’s best interests, including physicians. It’s led to a push for alternative payment models that put value over volume. CONTINUED ON PAGE 20
“Value-based care means providing the right care, based on best practice guidelines, not financial incentives that are volume based. That’s good for patients, and if it’s good for patients it’s good for physicians. I truly believe that.” — Betty Chu, MD, MBA —
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Value Over Volume
M
aria Han, MD, is a general internist and the Medical Director for Population Health at the University of Michigan Health System. The Population Health Office helps to coordinate the system’s efforts to improve value and find success with value-based reimbursement models. She’s got as much experience as just about anyone in the state pursuing alternative payment models that make sense for patients and physicians. The University of Michigan Health System employs a variety of payment models. Roughly 35,000 of the system’s primary care patients are covered under a primary care capitation arrangement. Other patients are covered under value-based arrangements where fee-forservice payment is supplemented with additional funding streams or payments based on quality and utilization metrics. Still others are covered under accountable care organizations and patient centered medical home models.
“Different payment models facilitate different care delivery models,” says Doctor Han. “In a traditional fee-for-service model, physicians are paid in a piecemeal way for each service they provide. The more they provide, the more they are paid. In value-based models, providers are paid, in part, for achieving specific outcomes around quality and utilization—for value provided for the patient.” Betty Chu, MD, MBA, has broad professional experience with the costs and benefits of both fee-for-service and alternative payment models as well. Doctor Chu is a practicing OBGYN and the Chief Medical Officer and Vice President of Medical Affairs at Henry Ford West Bloomfield Hospital. “The real purpose of new payment models is moving from volume to value,” says Doctor Chu, who also serves as the President-elect of the Michigan State Medical Society. “Models other than feefor-service focus on outcomes of care for patients. Value-based care means providing the right care, based on best practice guidelines, not financial incentives that are volume based. That’s good for patients, and if it’s good for patients it’s good for physicians. I truly believe that.”
“Different payment models facilitate different care delivery models… In value-based models, providers are paid, in part, for achieving specific outcomes around quality and utilization—for value provided for the patient.”
— Maria Han, MD —
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Payment Models
A
variety of new and evolving payment models are being employed by physicians across state and nation—with others on the horizon—and while success rates have varied, it’s in the best interests of patients, physicians, and taxpayers to find creative new solutions that work.
“Capitation simplifies reimbursement considerations for providers. It gives them the freedom to focus on providing the care that patients need and want, without having to think about how they will be paid for it later.”
— Maria Han, MD —
Accountable Care Organizations Among the most widely employed is the shared savings Accountable Care Organization, or ACO, model. Last January, Leavitt Partners in partnership with the Accountable Care Learning Collaborative identified 838 active ACOs nationwide, covering the care of an estimated 28.3 million patients. As an OBGYN, when Doctor Chu sees patients with private insurance, she sees them under a fee-for-service model. Additionally, her employed practice, the Henry Ford Medical Group also participates in the Next Generation ACO Model pioneered by the Centers for Medicare and Medicaid Services. Under the ACO model, multiple providers and facilities partner voluntarily to give beneficiaries more control over their own care, while utilizing a broader base of knowledge and specialties to find solutions faster and at a lower cost than before. Physicians, including groups like the Henry Ford Medical Group, are empowered and incented to share data with providers outside their building, to direct patients to the highest quality and most efficient specialists, providers, and facilities. When the ACO successfully improves the quality of care while driving down costs – finding solutions faster, minimizing unnecessary testing, reducing post-acute cost of care—it shares in the savings generated for the Medicare program.
In addition to shared savings, Doctor Chu says that by 2018, one-quarter of a hospital’s star rating will be based on their Medicare efficiency score. Performing better for patients—value over volume— means a higher rating. That’s a critical marketing tool as hospitals work to attract patients.
the state with more than 15,000 physicians participating.
payments to alternative payment models – ACOs, patient centered medical homes, and other models that bundle payments for episodes of care.
Risk pools, measuring and rewarding rates of resource utilization, and even providing additional payments for referrals offer physicians additional opportunities to make capitation work as well for themselves as it may for their patients.
Capitation
Capitation is a model covering millions of patients nationwide, under which managed care organizations pay physicians—typically primary care physicians The move towards ACOs and other alter- —a fixed amount for each patient he or native payment models has been gaining she takes on, instead of paying by the procedure. Capitation provides steam since approval of the Afphysicians a degree of flexifordable Care Act. By March of last year, the U.S. Depart- Finding the right bility and payment certainty, payment model while encouraging providers ment of Health and Human Services announced it had for each practice to treat their patients as efficiently and effectively as posreached a preliminary goal of is key. sible. tying 30 percent of Medicare
Private insurers are also jumping on the ACO bandwagon. The Leavitt Partners analysis found more than 17 million Americans covered by a commercial insurer employing the ACO model. Of course, ACOs are hardly the only player in the APM game. The largest payer in Michigan, Blue Cross Blue Shield (BCBSM) has their ACO version called Organized Systems of Care (OSCs). Thirty-eight OSCs have been formed across
“Capitation simplifies reimbursement considerations for providers,” said Doctor Han, the Population Health Medical Director. “It gives them the freedom to focus on providing the care that patients need and want, without having to think about how they will be paid for it later.” CONTINUED ON PAGE 22
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Resource Stewardship, Pay for Performance, and Shared Decision-Making Like ACOs and capitation, patient centered medical homes and bundled payment models also incentivize resource stewardship through shared decision making. Linking providers makes duplicative services and testing less likely. So do models that provide an up-front payment covering an entire health episode or hospital stay.
“Value-based care is much more complicated,” says Doctor Chu. “It’s based on outcomes, versus fee-for-service, which is completely transactional. There are a lot of physicians doing their best for their patients, but they don’t have the volume or the infrastructure to execute alternative payment models.”
A variety of additional alternative payment models are on the horizon, and physician advocates like the Michigan State Medical Society and the American Medical AssociaFinding the right tion are working day in and payment model day out to help physicians for each practice move over and beyond today’s is key. barriers of entry.
Patient centered medical homes may generate additional funds from payers to cover the salaries of support staff, including care coordinators, who help ensure patients are receiving the most effective testing and treatments at the most affordable prices.
Meanwhile, many government and private insurers are beginning to utilize pay for performance models that track quality and utilization of health care services and offer supplemental payments and even bonuses to providers who meet the established goals for their patient populations. That’s not to say these models are simple for the average physician to participate in or implement successfully.
“This movement is changing the landscape of how physicians practice. It’s moving us towards team-based care. — Betty Chu, MD, MBA —
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The result of their work, advocates say, will be healthier patients and more satisfied physicians.
Physician Focused Alternative Payment Models The American Medical Association and the Center for Healthcare Quality and Payment Reform (AMA and CHQPR) recently published a “Guide to Physician-Focused Alternative Payment Models” that identified the key causes of avoidable spending, and highlighted a variety of ways that changing the way physicians are reimbursed may lower costs, improve patient outcomes, as well as physician reimbursement rates. Finding the right payment model for each practice is the key. The most popular and widely discussed APMs incentivize cost saving by enabling providers to bill for lower-cost and bundled services. The AMA and CHQPR report identified a number of physician-focused APMs with the potential to take physician satisfaction to the next level.
Physician-Focused Bundling ACOs, advanced patient centered medical homes and other services often already combine resource stewardship with shared decision making, and giving physicians greater control over service bundling represents the next logical step in that payment model evolution. Multi-physician bundling empowers numerous physician practices that provide complementary diagnostic or treatment services with the ability to redesign their services to improve efficiencies, eliminate unnecessary tests, and more quickly find effective solutions for patients.
the highest quality outcomes, but over a longer period of time or treatment. The payment certainty of condition-based bundles provide physicians the flexibility to use the tools, treatments, specialists, and facilities they find most effective to treat an underlying condition in the long term, controlling the total spending associated with care for the condition. The better and most efficiently a physician treats his or her patient’s condition, the better his or her bottom-line.
Among the most common reimbursement complaints for many physicians is the lack of an adequate payment – and often no reimbursement at all – In a physician-facility bundle system, phyfor high-value services that drive down sicians are able to select the facilities at overall costs and keep patients healthiwhich they’ll perform certain procedures, er. Coordinating care with specialists or ensure continuity of care and the availabilwith other physicians in a practice, reity of any potential diagnostic or post-prosponding to phone calls from longtime cedure care, and work with the facility to patients dealing with a specific symptom deliver that care as well as possible. or condition, providing comprehensive educational materials and counseling to With a physician-focused episode bunhelp patients better manage their health dle, providers would be reimbursed or conditions, or even providbased on their handling of a ing transportation for patients patient’s specific health epIt’s up to to help them avoid costly trips isode. Providers are able to by ambulance to emergency physicians to work in collaboration with departments all add significant help determine specialists, specific facilities, value to patients and can drahealth care’s including recovery facilities, matically drive down overall way forward. and others to deliver the health care spending. highest quality care for his or her patient, while being specifically incented to deliver that care efficiently and at as reasonable a price as possible. Physicians may employ a more expensive diagnostic test or treatment at the outset, for instance, to avoid less effective, fail-first methods often preferred by insurers, with the goal of finding solutions more quickly and with fewer additional interventions. Patients would receive the highest quality care, at a lower overall cost, while physicians see higher reimbursement levels. Like the episode bundle, condition-based payment for services and broader condition-based bundles use natural incentives to drive down costs and deliver
Capitation models may offer physicians an incentive to provide one or more of these services to keep overall costs down, but direct reimbursements from payers or insurance companies for the services remain rare. Providing specific reimbursement for high value services could dramatically lower overall health care spending, and, more importantly, could make a dramatic difference in the health and safety of patients.
cations, and the better they perform, the better their reimbursement. “Alternative payment models make it financially simpler to provide services that have not traditionally been reimbursed by payers,” said Doctor Han. “Services like phone calls, portal messages, even transportation to a provider’s office have not routinely been covered by payers, but they ultimately result in improved health outcomes and reduced utilization. Alternative models make services like these more possible.” No two patients are exactly alike, and neither are any two practices. As a result, no one APM will be perfect for every physician or practice. People, places, specialties, the presence (or absence) of specific local facilities and specialists varies across the state. As state and federal governments and commercial payers strain to rein in costs, and physicians battle to deliver better outcomes for their patients, change is on the horizon – and it’s inevitable. “This movement is changing the landscape of how physicians practice,” said Doctor Chu. “It’s moving us towards team-based care. The physicians who are trying to do the best for their patients will always come out on top, and while not all models are successful in achieving the triple aim it’s imperative for physicians who are involved in the development of these, to provide input and advocacy. Unfortunately, there is no guide book on how to improve quality, and lower cost. It’s up to physicians to help determine health care’s way forward.”
Under the health care warranty model, patients may pay a little extra up front for greater long-term cost certainty. Physicians have the incentive to do the absolute best and most comprehensive job possible to help avoid potential compliJULY / AUGUST 2017 |
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MSMS Medical Opportunities msms.medopps.org
msms.medopps.org
MSMS Medical Opportunities has been connecting physicians with employers since 1944. It is a nonprofit program through the Michigan Health Council designed to simplify your job search by posting jobs that match your practice preferences. Learn more at msms.medopps.org.
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Bronson Healthcare Group Internal Medicine HopitalistNocturnist Kalamazoo/Battle Creek, MI
Bronson Methodist Hospital Internist Battle Creek, MI
Medical Opportunities ID #10767
Bronson Internal Medicine Fremont St. is seeking a BE/BC Internal Medicine Physician to join their hospital-employed outpatient practice located on the campus of Bronson Battle Creek Hospital. Practice currently consists of three Internists and one APP. Practice is open M-F, 8 am to 5 pm, but offers patients late night appointments, Minimal call required. Bronson is ranked among the best healthcare organizations in the nation for quality, safety, service, and patient, provider and staff engagement. • Competitive salary • Signing bonus • Annual quality bonus • Comprehensive benefits • Relocation allowance • CME allowance and PTO
Bronson Healthcare Group currently has multiple openings for Internal Medicine BC/BE physicians to join our existing physician group for the inpatient services at our facilities located in Kalamazoo and Battle Creek, MI. Coverage for both facilities may be required on a rotating schedule of days, weekends and nights. The position may include rounds with residents. This opportunity requires a medical degree, licensed or eligible for Michigan medical license, and prior completion of a residency in Internal Medicine.
Bronson Lakeview Internal Medicine, MD, DO Opportunity in MI-LOAN REPAYMENT Paw Paw, MI
Medical Opportunities ID # 12021
Medical Opportunities ID # 11733
Bronson Methodist Hospital Family Medicine Kalamazoo, MI
Bronson Lakeview Family Care – Internal Medicine has a full-time physician position with no weekend office visits. Patients of the practice have access to an onsite radiology, laboratory, physical therapy and specialty clinics. Additional services provided within the practice include; Social Worker and case management by the Practice Clinical Care Coordinator. Nurse Triage service is available after hours and on weekends. This provider would provide call coverage for the practice one weekday and share call with 4 additional providers for weekend and holiday coverage.
Bronson Family Medicine Shaffer St. in Kalamazoo, MI is seeking a board certified/eligible Family Practitioner to join their established family medicine practice. There is limited call with the other providers in the practice. Candidate will work alongside three family practitioners and two APPs. This will be a hospital-employed, outpatient only position. The practice is open M-F 8a-5p. Bronson offers a competitive salary, sign-on bonus, relocation assistance, annual quality incentive, profit sharing, CME Stipend, PTO and full comprehensive benefits.
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Medical Opportunities ID #12148
Cherry Street Health Services Physician Assistant Grand Rapids, MI Medical Opportunities ID # 12157 Cherry Health is an independent, non-profit Federally Qualified Health Center (FQHC) with a primary focus of providing high quality health services to those who have little or no access to health care, regardless of income or insurance status. Services provided by Cherry Health include primary care for adults and children, women’s health, dental, vision, behavioral health and substance use services, correctional health, five school based health centers and employee assistance for employers.
Cherry Street Health Services Nurse Practitioner Grand Rapids, MI Medical Opportunities ID # 12155 Full and part time opportunities available. Provide primary health care to patients including: health promotion, education, diagnosis, referral, consultation and treatment of common health concerns. Participate in development of standards of care, protocols, quality monitors and administrative functions. The clinics utilize a fully-integrated team approach. The successful candidate must be comfortable working with an underserved patient population.
Cherry Street Health Services Physician-MD/DO Hastings, MI Medical Opportunities ID # 12154 Provide direct primary care and treatment to patients, assisting with the development, implementing and monitoring of clinic policies procedures, and protocols. The successful candidate must be comfortable working with an underserved patient population including those served in a community mental health and federally qualified healthcare setting. This position will be located in Eaton County.
Are You An Employer? Add Medical Opportunities 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. Cherry Street Health Services Psychiatrist-MD/DO Grand Rapids, MI
Covenant HealthCare Pulmonary Critical Care Medicine, Pulmonology, MD, DO
Covenant HealthCare Urgent Care, Family Medicine, MD/ DO
Medical Opportunities ID # 12153
Medical Opportunity ID # 1922
Medical Opportunity ID # 5016
Full and part time opportunities available. Provide a full range of psychiatric services to patients, including: assessment, screening, diagnosis, and treatment. The Cherry Health model is to institute evidence-based practices and coordinate an interdisciplinary team including Nurse Practitioners, Physician Assistants, Social Workers and Registered Nurses. The clinics utilize a fully-integrated team approach with primary care, pharmacists, health coaches, nurses and case managers, in assessing and treating mental illness through a combination of psychotherapy, psychoanalysis, hospitalization and medication.
Covenant Medical Group is the employed physician network of the Covenant Health System, consisting of more than 120 physicians, is seeking a Pulmonologist/ Intensivist to further expand our rapidly growing program. Covenant HealthCare employs over 4,000 people, representing 52 specialties, with a medical staff of more than 450 specialists.
Covenant HealthCare has 5 Urgent Care clinics: Saginaw (West SideState St.), Frankenmuth, Bay City, Saginaw Valley State Univeristy, Hemlock and we are looking for a full time physician with Urgent Care experience - both adult and children. 12 hour shifts.
Covenant HealthCare critical care physicians will enjoy a schedule that offers both IP/OP with dedicated time off/shift based schedule. Candidates must be fellowship trained in Pulmonary/ CC. Eligibility for medical licensure in the State of Michigan required.
Medical Opportunity ID # 4946
Cherry Street Health Services Director of Psychiatry Grand Rapids, MI Medical Opportunities ID # 11960 Provide leadership and direction to psychiatrists and psychiatric advanced practice professionals and direct program development for integrated behavioral healthcare. The Cherry Health model is to institute evidence-based practices and coordinate an interdisciplinary team including Nurse Practitioners, Physician Assistants, Social Workers and Registered Nurses. The clinics utilize a fully-integrated team approach with primary care, pharmacists, health coaches, nurses and case managers, in assessing and treating mental illness through a combination of psychotherapy, psychoanalysis, hospitalization and medication. Forty percent of the time will be allocated to administrative duties, and 60% to direct patient care.
Covenant HealthCare Family Medicine, MD/DO Medical Opportunity ID # 5019 Sebewaing Primary Care of Covenant HealthCare is seeking a Family Medicine physician to join an exceptional hospital employed outpatient practice. Enjoy a 4-1/2 day work week - NO HOLIDAYS, WEEKENDS OR HOSPITAL WORK! Located on Saginaw Bay in one of the strongest, safest communities in Huron County, Sebewaing is a great place to raise your family and practice big city medicine. http://huroncounty.com/ sebewaing/
Covenant HealthCare Hospitalist, MD/DO Our established hospital medicine program has experienced enormous success! Enjoy 15 FLEXIBLE SHIFTS PER MONTH!! We are interested in speaking with experienced FM, IM or Geriatricians who are interested in joining a tremendous network of physicians, state-of-the-art facilities and a quality of life second to none! Covenant has a strong participation with medical education as a major teaching hospital ito CMU including five (5) residency programs and medical students. We offer an extremely competitive base compensation with productivity. • One location Hospital • Excellent professional liability coverage with no tail obligation • Full benefits include retirement, life, health, dental, and vision • Relocation assistance • Excellent schools and year-round recreational activities • Close proximity to major airports H-1 Visa support
East Jordan Family Health Center Family Medicine, MD, DO East Jordan, MI Medical Opportunities ID # 472 Seeking Family Practice Providers looking for adventure in our small, but progressive clinics in beautiful North-West Lower Michigan. Who we are: 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 Practitioner 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.
Henry Ford Allegiance Health Pediatrics, MD/DO Jackson, MI Medical Opportunities ID # 8925 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.
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MSMS Medical Opportunities (continued)
Let your next job find YOU with MSMS Medical Opportunities msms.medopps.org
◆ Automatic Matching Receive email alerts each time an opportunity matches with your specialty and location preferences. ◆ Quick & Effective Applying to multiple health systems can be stressful and time consuming. On Medical Opportunities, your profile IS your application. Let in-house recruiters come to you. ◆ Endless Options With numerous practice settings and schedule choices available, you'll never run out of opportunities.
Henry Ford Allegiance Health Orthopedic Trauma Surgeon Jackson, MI
Henry Ford Allegiance Health Employed ENT Opportunity Jackson, MI
Henry Ford Allegiance Health Occupational Health Physician Jackson, MI
Medical Opportunities ID # 12100
Medical Opportunities ID # 9888
Medical Opportunities ID # 12099
Henry Ford Allegiance Health is seeking a BE/BC Orthopedic Surgeon with interest/experience in trauma (with or without a trauma fellowship) to join our full spectrum of fellowship-trained orthopedic physicians (hand/wrist, sports, total joint, foot/ ankle) in a robust, committed broadbased orthopedic practice.
Henry Ford Allegiance Health is seeking to employ a BE/BC, General Otolaryngologist to join two board-certified otolaryngologists in a well-established and thriving, broad-based practice offering an immediate patient base.
• Each physician averages 15-30 patients/day depending on surgical schedule
Valid Michigan medical license (MD or DO), Board Certified in Occupational Medicine with 2-5+ years post residency with strong familiarity with Michigan Workers Compensation rules and report writing requirements, and evidence-based approaches to effective surgical and non-surgical interventions for musculoskeletal injuries and illnesses. Strong clinical skills, communication, oral and written skills essential.
• The office offers 6 exam rooms, 5 Certified Medical Assistants, a scheduler and front desk staff.
Henry Ford Allegiance Health Neurologist, MD/DO Jackson, MI
• Call is 1:3 shared among the group.
Medical Opportunities ID # 12101
• 2 days/week and sees an average of 25-35 patients/day. • 10-15 scheduled surgery cases/ week, plus on-call cases • 18 exam rooms, one being a procedure room. • Physicians have Certified Medical Assistants and 11 office support/ front desk staff. Clinical and surgery scheduling staff are not shared; clerical staff are shared.
Consider the the following: • Clinic hours Mon-Fri 8:00-4:30p.
• Patient population: half adult/ half pediatric
• Office is open Monday - Friday, 8 a.m. - 4:30 p.m.
• Average of half the time spent in the OR
• Minor procedures can be performed in the office.
• Common procedures include: Audiogram, Adult Ear Tubes, Biopsy of Skin and Oral lesions, Cauterization of nose bleeds, Cerumen removal, Frenulectomy (tongue tie), Nasal Endoscopy and Laryngoscopy, Removal of Ear and Nasal Foreign Bodies.
• Call is 1:7 shared among private practice & employed providers.
• State-of-the-art microscopes and audio booths in office • EMR: NextGen / Switching to EPIC on August 5, 2017
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Seeking BC/BE Neurologist to join practice with 2.75 outpatient providers, 1 nurse practitioner and 1.75 inpatient neurology hospitalist. Neurology Hospitalists cover 44 of 52 weeks; eight weeks remaining are split among four (one private practice) providers. The Hospitalist is the feeder system for follow up care for outpatient Neurologist. • 7 exam rooms • 2 medical office supports (hiring for 3rd, part time) • 4 MAs • 1 NP rounds inpatient • Perform EMGs in the office • Botox injections, research and med trials by one provider
MidMichigan Health Flexible Schedule! Loan Repayment Potential! Mt. Pleasant, MI Medical Opportunities ID # 11381 Outstanding Opportunity for New or Practicing Family Medicine Physician! • $230,000 guaranteed salary for two years, plus more than $100,000 in bonuses available • Flexible schedule to accommodate work-life balance • Training stipend available • Physician-led organization with formal mentorship program • Team-based care with on-site case management, including medical social workers and RN care manager
MidMichigan Health Pediatrics-MD/DO Alma, MI Medical Opportunities ID # 11974 MidMichigan Health has the right opportunity for you that combine the best of both worlds: A successful career and a rewarding home life. An opportunity for a pediatrician exists at MidMichigan Medical Center-Gratiot, in Alma, in central Lower Michigan . MidMichigan Medical Center-Gratiot has a state-of-theart inpatient tower (constructed in 2008), with all private beds. Call is shared with two other physicians. In Alma, you would have immediate access to several subspecialists. Alma also is home to Alma College, a private liberal arts institution. It also is just 45 minutes north of Lansing and 15 minutes south of Mt. Pleasant, where the group has an office, in addition to its Alma office. In Mt. Pleasant, MidMichigan Medical Center-Mt. Pleasant includes primary and subspecialty care, an ER, ambulatory surgery, ancillary services and short-stay beds. It is a tremendous new building that also includes an outpatient pharmacy for patient convenience. The two employed pediatricians will share time between the two -or you may each have one location. You will determine that together.
Oaklawn Hospital General Gastroenterologist Medical Opportunities ID # 11933 Do you want a great worklife balance? Live in a warm and welcoming community? Work amongst stellar medical colleagues? Join the Oaklawn Medical Group!
FOR RENT Perfect accommodations for a Medical Professional Office located in Ortonville, Michigan. The office space is 1300 square feet in a modern, beautiful building. If interested call 248-627-5700.
Oaklawn Hospital is currently recruiting for a Board Certified General Gastroenterologist (prefer Fellowship trained) to join its rapidly growing Oaklawn Medical Group. • Employed by the Hospital; Clinic located within the hospital. • See apx 10+ patients/day with option for more, with already established surgical block times. • Doing upper & lower GI’s; colonoscopies, etc. • LPN support, with other support staff, clinical coordinator, site manager, etc. • Demonstrate ability to perform ERCP procedures. • Very light call schedule: 1:2 (possibly higher) • On average: 1-2 calls during the evening hours, and possibly the need to come into the hospital 1-2 times/month.
Oaklawn Hospital Orthopedic Surgeon Medical Opportunities ID # 12132 Located in south central Michigan, Oaklawn Hospital is seeking BC/ BE Orthopedic Surgeon (to include total joints) to provide orthopedic care alongside other orthopedic providers and a great support staff. We are a hidden gem in Marshall, Michigan providing excellent health care for eight decades! Our 40+ primary care providers have the support of 20+ specialists and a team of 10+ psychiatry providers.
Making MACRA Work for You Tuesday, October 24, 2017
While it may seem difficult to embrace MACRA, MSMS will dig into the details and provide practical guidance every step of the way. Beginning with an overview of MACRA and practical steps to help you move forward, this conference will delve into aligning quality initiatives, technology, documentation, the use of tools such as Qualified Clinical Data Registries and key components of future Medicare payments. Helpful resources will be provided.
Speakers Leland Babitch, MD – What You Should Know About MACRA Holly Standhardt – Roadmap for Getting Started Stacey Hettiger – Aligning Quality Initiatives Jill Young, CPC, CEDC, CIMC – The Role of Documentation Under MACRA Dara Barrera – Technology Survival Tips to Tackle MACRA TBD – Using Qualified Clinical Data Registries to Your Advantage Stacey Hettiger – Navigating Need to Know Resources
The MACRA rates are: Member: $195; Non-Member: $275. Statement of Accreditation: The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. AMA Credit Designation Statement: The Michigan State Medical Society designates this live activity for a maximum of 5.25 AMA PRA Category 1 CreditsTM. Physicians should claim only credit commensurate with the extent of their participation in the activity.
Register online today at www.msms.org/eo
JULY / AUGUST 2017 |
michigan MEDICINE 27
2017 Educational Courses MSMS On-Demand Webinars: CME When You Want It!
MSMS Educational Conferences — REGISTER TODAY!
Date: Saturday, September 16
152nd Annual MSMS Scientific Meeting
Time: 8:30 – 11:45 am
Morning, afternoon and evening clinical courses available.
CDL – Medical Examiner Course*
Location: Prince Auditorium at Calvin College, Grand Rapids
Date: Wed., October 25 - Sat., October 28
Choosing Wisely Part 1: Stewards of our Health Care Resources
Note: Continental breakfast and lunch provided
Note: Continental breakfast and lunch provided.
Intended for: Physicians and all other health care professionals
Intended for: Physicians and all other health care professionals
Contact: Beth Elliott 517-336-5789 or belliott@msms.org
Contact: Marianne Ben-Hamza 517-336-7581 or mbenhamza@msms.org
Balancing Pain Management and Prescription Medication Abuse: Chronic Pain and Addiction Billing 101
Choosing Wisely Part 2: Change Strategies to Implement Choosing Wisely Claim Appeals Compliance in the Office Credentialing
Regional Scientific Meeting
Symposium on Retirement Planning
Location: Sheraton Detroit Novi Hotel, Novi
21st Annual Conference on Bioethics Date: Saturday, November 11
Date: Saturday, September 16
Time: 9:00 am – 4:30 pm
Time: 12:30 – 3:45 pm
Location: Sheraton Detroit Hotel, Ann Arbor
Engaging Patients on Their Own Turf: Using Websites and Social Media
Location: Prince Auditorium at Calvin College, Grand Rapids
Note: Continental breakfast and lunch provided
From Physician to Physician Leader
Intended for: Retired physicians, physicians planning for retirement, spouses, and office managers
Intended for: Physicians, bioethicists, residents, students, other health care professionals, and all individuals interested in bioethical issues
Contact: Caryl Markzon at 517-336-5755 or cmarkzon@msms.org.
Contact: Caryl Markzon at 517-336-5755 or cmarkzon@msms.org.
HEDIS Best Practices
Making MACRA Work for You
Practical Guidance for Health Care Compliance
HIPAA Security Rule
Date: Tuesday, October 24
Date: Wednesday, December 6
Human Trafficking Overview
Time: 9:00 am – 3:45 pm (Lunch provided)
Time: 10:00 am – 3:00 pm (Lunch provided)
Location: Sheraton Detroit Novi Hotel, Novi
Location: MSMS Headquarters, East Lansing
ICD-10: What We Have Learned & What We Need to Know
Intended for: Physicians, PO Administrators, practice consultants, office administrators, students, other health care professionals.
Intended for: Physicians, PO Administrators, practice consultants, office administrators, students, other health care professionals.
In Search of Joy in Practice: Innovations in Patient Centered Care
Contact: Caryl Markzon 517-336-7575 or cmarkzon@msms.org
Contact: Caryl Markzon 517-336-7575 or cmarkzon@msms.org
Cyber Security: Issues and Liability Coverage
Health Care Providers’ Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities
ICD-10 for 2017 and Routine Waiver of Copays
Inter-professionalism: Cultivating Collaboration Managing Accounts Receivable Opioids and Michigan Worker’s Compensation
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Register online at msms.org/eo or call MSMS Registrar at 517-336-7581.
Practices for Sale Rochester Hills Walk in Clinic
Reasonable monthly rent, successful business, current Physician is looking at going back into Industrial Medicine. History of over 1 million dollar gross. Very nice insurance mix, mostly internal medicine practice is up for best offer since the plan is to sell by June. 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. Jackson – Well Established Practice, Mostly Medicare
Nice 2700sq.ft building, large parking lot, favorable location. Good insurance mix, equipment. Will offer terms of all kinds on this $425-500K grossing business with good loyal patients. Conservatively operated for years. Reasonable offer for business, $160K building on land contract. ENT with mostly Allergy Patients, Westland
Hearing aid tenant in building, small general medicine tenant, 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 conditions 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. The Good Doctor Suddenly Died
St. Clair Shores near 9 Mile, 2500 sq.ft. clinic, 4 exam rooms, 180 active Internal Medicine Patients Medicare Patients. The heirs wish to make a win win deal for you. All the equipment including vascular/doppler/echo/ UltraSound. Call and ask about this one!
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 JULY / AUGUST 2017 |
michigan MEDICINE 29
WEALTHCARE ADVISORS
Asset Protection Strategies for Physicians By Nathan Mersereau, President, WealthCare Advisors Physicians are in a high-risk
Adequate Insurance Coverage
profession and need to be aware
When looking at malpractice insurance, consider strength of carrier, amount of coverage, and commitment to the physician market. Although availability and cost of malpractice insurance is a primary issue for physicians, the premium cost should be viewed as least important relative to the stability of the carrier and robustness of coverage.
of current and future liability threats. A comprehensive assetprotection program should be regularly reviewed with your team of legal and financial professionals to identify risks and coverage gaps. The following are just a few areas to examine.
Review the adequacy of all your insurance policies including life, disability, office overhead, auto, homeowner’s umbrella and employment practices coverage. Examine insurance coverage, or contractual indemnification provided by an employer or other third parties to identify any gaps not covered in a malpractice policy.
Maximize retirement plans Assets held in a tax-qualified ERISA retirement account protects you against creditors. Because a qualified plan is designed to provide income to individuals at retirement, income has yet to be constructively received, and ERISA provides an anti-alienation protection over all assets in the plan until they are distributed. However, once a retirement plan is rolled over to an IRA, things can change. There is unlimited creditor protection in the event of bankruptcy, but in all other scenarios creditor protection for IRAs now falls under state law limits. The amount of creditor protection varies by state and should be discussed regularly with your legal team since laws can change. For example, a few years ago the Supreme Court voted unanimously that inherited IRAs are not protected in bankruptcy like the previously mentioned plans.
Consider asset protection trusts Trusts can either be irrevocable or revocable and there are benefits to each. A revocable trust allows the grantor to control investment decisions, change trustees, veto distributions, and remain as an income and principal beneficiary of the trust. An irrevocable trust does not have these provisions. On the other hand, an irrevocable trust provides creditor protection while a revocable trust does not. However, a Domestic Asset Protection Trust (DAPT) provides the best of both worlds and could be ideal for physicians with a high income and net worth. A DAPT is an irrevocable trust that allows the trust’s Grantor to be a discretionary beneficiary and still have the ability to protect the trust assets from the Grantor’s creditors. A DAPT provides creditor protection, divorce protection, and replaces a prenuptial agreement for both the grantor and beneficiaries of the trust. 17 states now allow DAPT planning, including Michigan as of March 8, 2017.
Other Considerations Titling of assets, use of LLC’s, building equity in a personal residence, transferring ownership within a family are other topics to evaluate within a comprehensive asset protection review. Remember that liability planning needs to be balanced with other areas of estate and tax planning. One action to address liability exposure may create a detrimental impact in other areas of your planning. Don’t delay reviewing your asset protection strategies. You’ve invested a lot into your profession. Your risks are too high to ignore them.
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