Michigan Medicine, Volume 116, No. 3 by Michigan State Medical Society

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY Â» VOL. 116 / NO. 3

May/June 2017

Exploring Emerging Models of Care Hitting the Medical Landscape

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FEATURES & CONTENTS May/June 2017

Two Tracks, One Way Forward: How Health Information Exchange Can Help Meet MACRA Requirements BY BRIAN MACK

CANDOR Toolkit: The Right Tools to Do the Right Thing After an Adverse Event BY ROBIN DIAMOND, MSN, JD, RN Contributed by The Doctors Company

COLUMNS 04 President's Perspective

BY CHERYL GIBSON FOUNTAIN, MD

BY DANIEL J. SCHULTE, JD

BY JACKLYN CHANDLER, M.S.

BY JODI SCHAFER, SPHR, SHRM-SCP

BY JIM C. NIEDZINSKI, AIFÂ®

07 Ask Our Lawyer

08 MDHHS Update

12 Ask Human Resources 30 WealthCare Advisors

COVER STORY

Exploring Emerging Models of Care Hitting the Medical Landscape

DEPARTMENTS 21 Welcome New Members 21 In Memoriam 22 MSMS Medical Opportunities 28 MSMS Educational Courses

STAY CONNECTED!

BY SARAH OMBRY FOR MSMS | COVER & FEATURE PHOTOS: LUKE ANTHONY PHOTOGRAPHY

Technology, creative delivery models, and a fresh look at age-old services are equipping physicians with a whole new toolbox to get the job done. (Story on page 16.)

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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, REZĂ&#x153;BERANT! INC. rezuberantdesign@gmail.com Printing FORESIGHT GROUP staceyt@foresightgroup.net Cover & Feature Story Photography LUKE ANTHONY PHOTOGRAPHY www.lukeanthonyphoto.com 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. ÂŠ2017 Michigan State Medical Society

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Innovation and new ways of thinking are the cornerstone of growth in every successful industry. Research and advancing technology has opened doors in the medical field that lead to higher quality care, while patient needs change and evolve. Focusing on those needs has led to new models of care, and a rapidly changing health care landscape.

By Cheryl Gibson Fountain, MD, Michigan State Medical Society President

his edition of Michigan Medicine discusses new and emerging delivery models of health care. As physicians, we are constantly striving to better serve our patients, and while the goals of medicine haven’t changed, patient expectations have.

It’s a brave new world. In this issue, we’re taking an in depth look at a variety of delivery models being used by fellow physicians. Demands from patients and needs from physicians have shaped and evolved the medical landscape over the years.

CHERYL GIBSON FOUNTAIN, MD, MSMS PRESIDENT

Evolving patient-physician relationships and an increased physician demand for efficiency has lead to the successful integration of many of these models into standard practice. Also highlighted will be some of the emerging technologies utilized today. Supplementing personal and staff knowledge with technology improves the quality of care we deliver, and patient satisfaction. With the help of technology, patients now have more ways to keep tabs on their own health and hold themselves more accountable for making healthy decisions. If you’ve been thinking about changing things up at your practice or are interested in some new ways physicians are practicing, this edition of Michigan Medicine will offer some enlightening ideas. The only thing moving faster than the evolution of health care delivery models and technologies are patients’ expectations. “It’s a brave new world out there. By prioritizing patients’ needs, physicians are ensuring it’s a healthier one, too.”

“Increased demand for personalization, flexibility and efficiency have required physicians and other health care professionals to think outside the box when it comes to the way we provide care, whether it’s changing the way we schedule appointments, or the way we monitor vital signs.”

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ASK OUR LAWYER

New Asset Protection Trusts By Daniel J. Schulte, JD, Michigan State Medical Society Legal Counsel

Q: I have been told in the past that there is no reasonable way in Michigan of sheltering assets from a malpractice plaintiff using a trust. Has the law changed in this area recently? Is it now possible?

Contact Kim Burley, Director of Recruitment, at 517-827-3149 or kim.burley@corizonhealth.com.

You are correct that we and other lawyers have advised in the past when asked that the effectiveness transferring assets to a trust to defeat the claims of malpractice or other creditors is suspect. There was a time when the use of so called asset protection trusts was thought to be effective due to the significant hurdles the trust agreements imposed on creditors seeking to enforce judgments against the settlor of the trust and its beneficiaries. Typically these trusts are expensive to set up and require assets to be transferred to foreign banks and other financial institutions, subject to foreign laws. In recent years, federal and some state courts have found ways to minimize the effectiveness of these trusts as creditor protection devices by ordering the settlor of the trust to return the assets of the trust to the United States (or specifically to the State of Michigan) or ordering the settlor, a trustee, or both, to spend an indeterminate time in prison on a contempt charge. These cases have significantly decreased the attractiveness of these trusts as asset protection trust devices. There is a new Michigan law that changes things in this area. On December 5, 2016 Michigan’s Qualified Dispositions in Trusts Act (the “Act”) was signed into law, taking effect February 5, 2017. This new law provides for the creation of a Domestic Asset Protection Trust (“DAPT”). A DAPT is an irrevocable trust that can be used specifically for shielding assets from judgements and other claims of creditors. The transferor of the assets may not be the trustee of a DAPT but any other individual (family member or not) residing in Michigan or a Michigan entity (limited liability company, corporation or partnership) may be the trustee.

The transferor of the assets can be the beneficiary of a DAPT and may retain other rights over the assets, such as: Directing investments; Removing and replacing a trustee; Controlling distributions; Receiving income and/or principal distributions; and Directing how the assets are to be distributed following the transferor’s death. If properly established, the Act provides that the transferor’s creditors may not reach assets transferred to the trust once a two year period has passed since the date of transfer (there are exceptions applying when the transferor is in bankruptcy or there has been fraudulent concealment of the assets transferred). The Act provides Michigan physicians with a valuable way to shield assets from malpractice and other creditors. The use of a DAPT could be incorporated into a physician’s estate planning and asset protection strategy along with the use of investments in tenancy by the entities property, IRAs, 401(k)s and other qualified plans, the purchase of insurance, etc. To make the best use of this new opportunity a DAPT should be created and funded in advance of creditor claims, not after. Advanced planning in this area is a must.

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

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MDHHS UPDATE

Hepatitis A Vaccine and International Travel By Jacklyn Chandler, M.S., Outreach Coordinator, MDHHS Division of Immunization

Travelers are an important population because of their movement, the potential exposure to diseases outside their home country, and the risk that they will either bring non-endemic diseases into their country of origin or spread non-endemic diseases to the countries they visit. In 2016, U.S. airlines carried an all-time high number of passengers â&#x20AC;&#x201C; with 103.9 million international travelers. Ever-increasing travel to destinations in Asia and in Africa place travelers at risk for a variety of travel-related conditions including malaria, yellow fever, measles, and other tropical or vaccinepreventable infections. Compound this with travel vaccine shortages (e.g., yellow fever) and limited travel vaccine education or preparedness. Travel-related illnesses have direct public health effects.

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ealth care providers (HCP) are encouraged to practice their role in preventing infection. Many travelers do not seek pre-travel medical care, which may diminish the benefits created by those travelers who do seek care. Even if a practice is not designated as a travel medicine clinic, it still has a responsibility to assess, recommend, and administer recommended vaccines, as well as documenting administered doses in the Michigan Care Improvement Registry (MCIR). If the practice doesnâ&#x20AC;&#x2122;t have hepatitis A vaccine, patients should be referred to a local health department or a pharmacy that carries the vaccine. Âť

Hepatitis A is a vaccine-preventable disease. While the hepatitis A vaccine is recommended as part of the routine childhood vaccination schedule, most adults have not been vaccinated and may be susceptible to the hepatitis A virus. According to the Michigan Care Improvement Registry (MCIR), 56 percent of children who were 19 to 35 months of age as of December 31, 2016, had received two doses of hepatitis A vaccine. With low vaccine coverage across populations, infection persists in a community.

Hepatitis A vaccination is recommended for: All children at age 12 months Close personal contacts (e.g., household, sexual) of hepatitis A patients Persons who use injection and non-injection illegal drugs Men who have sex with men Persons with chronic (lifelong) liver diseases, such as hepatitis B or hepatitis C. Persons with chronic liver disease have an elevated risk of death from fulminant hepatitis A Persons who are treated with clotting- factor concentrates Travelers to countries that have high rates of hepatitis A Family members or caregivers of a recent adoptee from countries where hepatitis A is common

According to 2015 National Health Interview Survey (NHIS) data, the estimated proportion of adult travelers (19 years and older) who received at least 2 doses of hepatitis A vaccine was only 16 percent. The overall adult population coverage for hepatitis A is even lower at 9 percent. The public Travelers are often at a higher risk of expohealth and infection control costs that go sure to diseases for which routine vaccines with outbreak response to vaccine-preventprovide protection – routine vaccines that able pathogens can be staggermany health care providers do ing to a community – consider stock. Stronger patient-proboth the financial and the social vider communication is needAccording to costs. When an outbreak enters 2015 NHIS data, ed in order to address this a community, like hepatitis A, it lack of patient awareness. This the estimated prompts extensive contact tracis particularly important in proportion of ing, intervention, and follow-up. communicating timing and

travelers (19 years availability of vaccines and Public health officials in the and older) who the intervals of vaccine series City of Detroit, Macomb, Oakland, and Wayne counties received at least 2 so that travel plans and daily and the Michigan Department doses of hepatitis life can proceed smoothly. In of Health and Human Services A vaccine was only order for HCP to make strong recommendations for adults (MDHHS) are reporting an 16 percent. to receive all needed vaccines, elevated number of hepatitis A they need access to educational opportucases in Southeast Michigan. From August nities that will update them on the most 1, 2016, to March 21, 2017, 107 cases of recent vaccination recommendations. lab-confirmed hepatitis A have been reported to public health authorities in these MDHHS will host a conference entitled jurisdictions. This represents an eight-fold Adult Immunization Summit: Healthier increase over the same time period a year Together on June 14, 2017. Additional earlier (n=13). Ages of the cases range from educational resources are available to pro22 to 86 years, with an average age of 45 vider offices, including free immunization years. Eighty-five percent of the cases have education sessions through the Physician been hospitalized with two deaths reportPeer Education Project on Immunization ed. Approximately one-third of the cases and the MDHHS Immunization Nurse have a history of substance abuse, and 16 Education program. The education sespercent of all cases are co-infected with sions through both education programs hepatitis C. No common sources of infecare approved for continuing medical edtion have been identified. ucation credit.

MDHHS presents:

Adult Immunization Summit June 14, 2017 Lansing Center, Lansing, MI An excellent opportunity to get updates on travel vaccines and other adult immunization topics. To register, please visit: http://register.mihealth.org/ AdultImmSummit2017 For more information, contact: Jackie Chandler, Outreach Coordinator, at ChandlerJ3@michigan.gov

Visit www.aimtoolkit.org then click “Information for Health Care Professionals” and “Education & Training” for complete information on available resources. Sources Bureau of Transportation Statistics. 2016 Annual and December U.S. Airline Traffic Data. Retrieved from https://www.bts.dot.gov/ newsroom/2016-annual-and-december-us-airline-traffic-data Centers for Disease Control and Prevention (CDC). Yellow Book Homepage. Retrieved from https://wwwnc.cdc.gov/travel/page/ yellowbook-home-2014 CDC. Clinical Update Announcement: Yellow Fever Vaccine Shortage. Retrieved from https://wwwnc.cdc.gov/travel/news-announcements/ yellow-fever-vaccine-shortage-2016 CDC. Immunization Schedules. Retrieved from https://www.cdc.gov/ vaccines/schedules/hcp/index.html CDC. Vaccination Coverage Among Adults in the United States, National Health Interview Survey, 2015. Retrieved from https://www.cdc. gov/vaccines/imz-managers/coverage/adultvaxview/coverageestimates/2015.html MDHHS. Press Release. (March 24, 2017). Continued Increase in Hepatitis A Cases in Southeast Michigan. Retrieved from http://www.michigan. gov/minewswire/0,4629,7-136-3452-407562--,00.html Unpublished data from the Michigan Care Improvement Registry (MCIR). Children 19-35 months, 2+ Hep A coverage, December 31, 2016.

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HEALTH INFORMATION TECHNOLOGY (HIT) ALERT

Two Tracks, One Way Forward: How Health Information Exchange Can Help Meet MACRA Requirements By Brian Mack

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) serves a two important functions: It repeals the Sustainable Growth Rate (SGR) for provider reimbursement and replaces it with a streamlined approach called the Quality Payment Program (QPP); and it authorizes MDHHS to implement initiatives designed to encourage providers in the transition from volume to value.

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he QPP includes two tracks for eligible Medicare clinicians—the Merit-Based Incentive Payment System (MIPS) path, and the Advanced Alternative Payment Model (APM) path. The requirements for each path differs somewhat, but both options include some degree of health information technology (IT) use for exchanging information across providers, supporting care delivery, meeting clinical quality goals, and streamlining reporting. The APM path is targeted primarily at clinician practices that are either already participating in Patient Centered Medical Home (PCMH) or Accountable Care Organization (ACO) pilot programs, or those who meet the requirements and are seeking to enroll. The health IT requirements associated with Advanced APMs are already included in the PCMH and ACO structures. In the case of MIPS, the Advancing Care Information (ACI) Performance Category is worth 25% of the total score, and replaces the Medicare Electronic Health Record Incentive Program, often referred to as “Meaningful Use”.

There are a handful of required measures in the ACI Performance Category that make up the base of the score. These include: Protect Patient Information Provide Electronic Prescribing Provide Electronic Access to Patients Send Electronic Summary of Care Documentation Request / Accept Electronic Summary of Care Documentation

In addition, there are multiple optional measures that clinicians may choose from to make up the remaining balance of the ACI performance score. Some examples of these include: Immunization Registry Reporting Provide Electronic Access to Patient-Specific Educational Information Care Coordination and Patient Engagement Through Secure Messaging Clinical Information Reconciliation The good news for Michigan physicians with regard to these requirements for 2017, is that many are ALREADY meeting them within the context of their existing workflows. As a Health Information Exchange service provider in the state, Great Lakes Health Connect (GLHC) facilitates the secure and seamless transmission of over a billion patient health record transactions each year. Our position as the integrator, aggregator, and distributer of this critical information offers us a unique view of how providers across Michigan are leveraging health information technology to meet the requirements within MACRA, while advancing the quality of care for their patients and communities in the process. Among GLHC’s service offerings is a closed-network Referrals platform used by nearly 1300 primary, specialty, and allied care offices across the state. The application provides a secure repository for sending and receiving referrals, and assists in closing gaps in the coordination and continuity of patient care. Practices

The MIPS path and the APM path both include some degree of health information technology.

and programs around Michigan make use of this tool to better serve the needs of their patients. In one notable example, Cherry Health, the largest Federally Qualified Health Center (FQHC) in the state, makes use of the Referrals platform to connect appropriate patients to the YMCA of Greater Grand Rapids’ Diabetes Prevention Program. Through this unique collaboration, underserved members of the community identified as “at risk” for developing Type 2 Diabetes by Cherry Health clinicians get direct access to services provided by the YMCA’s trained staff. The program includes ongoing care management services and lifestyle coaching that emphasizes healthy eating, physical activity, weight loss, and self-management skills with the goal of preventing the onset of the disease. This arrangement is also a great example of how Cherry Health is meeting the requirement for “Care Coordination and Patient Engagement through Secure Messaging” MIPS Improvement Activities performance measurement. Another example of how Michigan healthcare providers and organizations are already meeting MIPS measures is through immunization and disease registry reporting and the use of Michigan’s prescription drug monitoring program, the Michigan Automated Prescription System. Michigan’s immunization registry (Michigan Care Improvement Registry or MCIR) database is accessible to registered users with appropriate credentials via a secure website portal (www.mcir.org).

GLHC has facilitated the transmission of immunization records to MCIR as a basic service to their participating providers for several years. Beginning in 2016, GLHC expanded this service to include the ability to query a patient’s immunization records directly from an organization’s native electronic medical record environment. Today’s shift to value-based health care is designed to provide better patient outcomes, lower cost, and improve population health. Achieving these results requires a strong relationship between patient, payer, and provider, and is measured via quality reporting to reflect these efforts. A key to succeeding with value-based health care is being able to leverage data and analytics, having transition care collaboration, and having continual improvement in clinical care, documentation, and cost reduction. Despite the complexity of the requirements and the language involved, the key takeaways for providers in Michigan are 1) Don’t wait to get involved, and 2) Evaluate the requirements in the context of what your practice is ALREADY doing to ease the transition toward the full rollout in 2019.

Despite the complexity of the requirements and the language involved, the key takeaways for providers in Michigan are: 1. Don’t wait to get involved. 2. Evaluate the requirements in the context of what your practice is ALREADY doing to ease the transition toward the full rollout in 2019.

BRIAN MACK IS THE GREAT LAKES HEALTH CONNECT MANAGER OF MARKETING AND COMMUNICATIONS. FOR MORE INFORMATION, VISIT WWW.GL-HC.ORG. FOR MORE DETAILS ON MACRA, VISIT QPP.CMS.GOV.

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ASK HUMAN RESOURCES

Making Educational Assistance Programs Work for You By Jodi Schafer, SPHR, SHRM-SCP

My medical assistant wants to go back to school for a degree in nursing. She has asked me to pay for some of her classes. I am happy to do so, but would like some reassurance that she will continue to work for me after she completes her degree. Can I require that she remain employed with my practice for a certain amount of time or else pay me back for the cost of the classes?

Education assistance is a wonderful benefit to offer your employees. Opportunities for professional growth and advancement are key factors in employee motivation and engagement, so aiding your staff in these endeavors can be a win-win for you both. However, to truly get the mileage out of a policy like this, you will need to put some serious thought into how you want to structure this arrangement. REIMBURSEMENT PROGRAM I would start by offering an educational REIMBURSEMENT program, versus paying for the classes up front. Reimbursing for a class after completion affords you more control. You can require that an employee pass the class with a minimum grade or GPA and that they provide you with proof of completion before payment is made. You can specify that only courses from accredited training programs qualify for this benefit. Then determine how much you are willing to spend on these requests. Establishing an annual dollar limit helps you and your employee plan accordingly. Be sure to include a disclaimer that approval for reimbursement is subject to the availability of practice funds. Another area to clarify in this policy is when courses should be scheduled. Do you want your employee to miss work in order to take a class or would you prefer that they attend during non-work time?

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ELIGIBILTY REQUIREMENTS Once you determine the basic framework of your arrangement, you will need to determine who is eligible to request educational assistance. Will you offer this program to all regular employees, both full-time and part-time? Do you want to require that staff be employed with you for a certain amount of months/years before they can request tuition reimbursement? Regardless of how you choose to answer these questions, there are two qualifiers that you will certainly want to include. The first is that in order to be eligible for this program the employee must meet the performance expectations of their current position. The second is that there must be clear alignment between the employee’s educational ambitions and the practice’s needs. So, while you might approve your assistant’s request to pay for nursing courses, you could deny a request to reimburse for a dental hygiene degree. REPAYMENT CLAUSE Finally, you can require an employee to pay back tuition reimbursement dollars if they leave the practice within a certain period of time after completing a course/ program. Enforcing the pay-back can be a bit tricky though due to Michigan’s Wage and Hour laws, especially if you want to withhold the funds from an employee’ s last paycheck. According to the Michigan Wage and Fringe Benefit Act (MWFBA),

an employee must consent to payroll deductions at the time the deduction is taken. So, if your employee refuses to sign off on the repayment deduction at the time of termination/resignation, you will be unable to take it out of their paycheck. Even if they do consent, the total deduction cannot reduce the employee’s wages below the minimum wage threshold. Your best course of action to help ensure repayment of educational assistance dollars is to have an employee sign a consent form before you reimburse for any classes. Build this into the request/approval process when a staff member wants to access this benefit. Part of that consent form should clearly itemize the cost of the course (or the exact amount of the reimbursement if it is different from the total cost) and the repayment terms if the employee leaves the practice within a pre-established period of time. You will still need them to sign another deduction form at the time you want to withhold funds from their paycheck, but having the initial signed consent form to refer back to may go a long way towards obtaining this second signature. If the employee refuses to sign the final payroll deduction authorization or does not repay the outstanding balance in full through other means, you could always pursue a cause of action in court for breach of contract and attempt to collect the repayment amount that way.

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CANDOR Toolkit: The Right Tools to Do the Right Thing After an Adverse Event By Robin Diamond, MSN, JD, RN, Senior Vice President of Patient Safety and Risk Management, The Doctors Company

In the past, hospitals and physicians could appear cold and distant after adverse events. The fear of malpractice lawsuits created a culture in which physicians were expected to avoid most contact with a patient or family who might have reason to sue— and physicians certainly weren’t supposed to accept blame.

ven when a well-meaning physician wanted to acknowledge the tragedy and express concern, hospitals sometimes discouraged the conversation because they were afraid the doctor’s comments would implicate the hospital in a malpractice case. The actual effect of this way of thinking was just the opposite of what hospitals and doctors desired. Rather than shielding them from liability, patients and family members perceived this culture of silence as callous and uncaring, in some cases encouraging them to file lawsuits. That was then. Over the past decade the healthcare community has embraced the idea that saying “I’m sorry this happened,” or at least acknowledging that an unanticipated adverse event occurred with genuine sympathy and concern, can go a long way toward healing the relationship between the healthcare provider and patient. Physicians have moved progressively toward a culture that expects an adverse event—a medication error, for instance, or a death during routine surgery—to be followed by a full disclosure of the facts to the patient and family. Hospital administrators and physicians both can say they’re sorry for what happened and even acknowl-

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edge they made a mistake in some circumstances when a clear-cut error has occurred that could have been prevented. This is not just the right thing to do; it also helps the hospital and physicians avoid malpractice litigation, especially the lawsuits motivated not by actual errors or substandard care but by patients and family members who were left angry and abandoned. Now we have not just the right idea, but the right way to execute it.

When Bad Things Happen to Good Doctors The Agency for Healthcare Research and Quality (AHRQ) developed the Communication and Optimal Resolution (CANDOR) Toolkit with the input of healthcare professionals who studied the different tools, policies, and procedures in use at various hospitals, including the disclosure resources offered by The Doctors Company. David B. Troxel, MD, medical director at The Doctors Company, served on the oversight committee, and I served on the technical advisory committee, which assessed expert input and lessons learned from AHRQ’s $23 million Patient Safety and Medical Liability grant initiative launched in 2009. The CANDOR Toolkit then was tested in 14 pilot hospitals across three U.S. health systems: Christiana Care in Delaware, Dignity Health in California, and MedStar Health in the Baltimore/Washington, DC, metropolitan area. “CANDOR is one of the most important patient safety programs to be released in the last 10 to 15 years,” said David Mayer, MD, vice president of quality and safety at MedStar Health and one of the originators of the toolkit. “CANDOR promotes a culture of safety that focuses on organizational accountability; caring for the patient, family, and our caregivers; fair resolution when preventable harm occurs; and most importantly learning from every adverse event so our health systems are made safer.”

This tool is just as useful for doctors as for hospitals. When a hospital is sued, physicians who were involved in the case will likely be named in the suit, whether they are employed by the hospital or not. Even though the CANDOR Toolkit is designed for hospitals, physicians should become aware of the valuable resources available to them in this toolkit, such as the videos that demonstrate how to have an effective disclosure conversation and tools that help doctors assess their own interpersonal communication skills. The toolkit facilitates communication between healthcare organizations, physicians, and patients while promoting a culture of safety, said John Morelli, MD, vice president of medical affairs at Dignity Health’s Mercy General Hospital in Sacramento, California. “The CANDOR Toolkit helps our caregivers improve how we rapidly communicate with patients and families when harm occurs. Consistent with our mission and values, we have always communicated with compassion and empathy; however, the toolkit provides a framework to respond quickly and in a learned manner to patients and families while also offering support to our caregivers.”

CANDOR calls for a prompt response and specific actions after an adverse event. Within one hour, specially trained hospital staff should: Explain the facts, and what might still be unknown, to patients and family members. Contact the clinicians involved and offer assistance, because the stress and grief of the healthcare professionals can easily be over-looked in these incidents. Immediately freeze the billing process to avoid further stressing the patient with a bill for the services that may have caused harm. CANDOR calls for the hospital to complete a thorough investigation within two months, keeping patients and relatives fully informed along the way. When the investigation is complete, the patient and family are provided with the findings and engaged in a discussion of how the healthcare organization will try to prevent similar adverse events in the future.

Encouraging Open Communication The investigation will not always find that the physician or other clinicians failed to meet the standard of care, and in those cases the patient and family members can still benefit from understanding what happened. In many cases, they will not sue despite their loss because they are satisfied that the hospital and physicians did their best and were forthcoming with information.

the hospital’s disclosure process is and how closely it follows the CANDOR plan, because a cooperative approach is ideal. Working in harmony with the hospital is easiest in a closed system, where the physician is employed and insured by the hospital. Even when the hospital and physician are in adversarial positions and limited in communication, both parties still can adhere to the best practices outlined in the CANDOR program. The philosophy and actions outlined in the CANDOR Toolkit can help hospitals and physicians avoid malpractice litigation, but even when the matter cannot be resolved and goes to trial, the fact that the patient and doctor talked early on can make a huge difference in the outcome of the case. Patients tend to pursue litigation with a vengeance when they think the doctor doesn’t care, but they tend to be much more reasonable when they can see that the physician is a human being with emotions, regret, and sympathy for the patient. CONTRIBUTED BY THE DOCTORS COMPANY. FOR MORE PATIENT SAFETY ARTICLES AND PRACTICE TIPS, VISIT WWW.THEDOCTORS.COM/PATIENTSAFETY.

Center for Ethics and Humanities in the Life Sciences College of Human Medicine

Clinical Ethics Consultation Services Helping health professionals optimize the delivery of ethically sound care.

Clinical Ethics Consultation Training Workshops Develop and enhance your clinical ethics consultation skills in an interactive small-group environment.

For detailed information visit bioethics.msu.edu clinical.ethics@hc.msu.edu (517) 355-7550

The Doctors Company encourages physicians to disclose and speak to patients about unanticipated events as early as possible. We also suggest they go to their hospital administration to find out what

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Exploring Emerging » Models of Care « Hitting the Medical Landscape Patient-focused. Innovative. Groundbreaking. Just a few of the terms that come to mind when we think of the future of health care delivery models and methods across the United States. While the future of health care isn’t written, physicians’ underlying focus has never changed: they want the best care for their patients. Technology, creative delivery models, and a fresh look at age-old services are equipping physicians with a whole new toolbox to get the job done.

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One Click Away. A lot of these new models start with technological innovations. They’re changing the way physicians see patients, treat patients, monitor patients, and more. They’re putting more power than ever in the hands of patients, too. They’re even cutting wait times.

A 2014 Merrit Hawkins study found that the average wait for an in-person appointment with a physician is 18.5 days. To better serve patients and relieve the scheduling time-crunch, many physicians are embracing telemedicine and online visits. Technology has become an indispensable part of patients’ lives, and physicians’ as well. The world is better connected than ever and the Internet has made convenience an expectation.

Patients and physicians are increasingly drawn to telemedicine because of its convenience, cost-effectiveness, and quality of care. Grand Rapids based Answer Health on Demand is a telemedicine company which offers immediate urgent care visits 24/7/365 as well as scheduled visits with primary, pediatric, and specialty care providers. Patients are able to log on via smart phone, tablet, or computer and speak directly to a physician or provider via live video.

the average time required for an in-person physician visit is 121 minutes and includes travel, waiting, paying, completing paperwork and finally seeing a practitioner. With online visits, Answer Health on Demand has reduced that time to a mere 10 minutes and has eliminated travel time entirely. As a result, 92% of patients rate their online experience better or much better than an in-person encounter.

For practitioners, being online offers bene“Answer Health on Demand is a truly fits as well. “Telemedicine is being well-empatient-centric system. We are utilizing braced by our ER doctors,” said John Detechnology to get the right care veau, DO, MPH, physician in the right place at the right with Emergency Care Spetime,” said Barry Brown, MBA, cialists and Answer Health on Patients control Demand’s Medical Director. Executive Director of Answer the experience Health on Demand. “Patients “It’s a change of pace and lowby choosing the er level of intensity that allows control the experience by choosing the physician they physician they emergency medicine physicians wish to see at a time and place wish to see at a to utilize our skill sets in new that’s convenient for them.” time and place ways.” The company’s goals are two- that's convenient The online visitation is not meant to replace an in-person fold. First, offer patients imfor them. appointment, but to act as a proved access to affordable, supplement that offers flexibility to both high-quality, convenient online care. physicians and their patients. It also exSecond, provide independent physician practices throughout Michigan access to a pands access to care for patient groups robust telemedicine platform where they that statistics show stand to benefit the can see their own patients and coordinate most, including rural patients and college care within a collaborative network of students. practitioners. And they’ve had some pretty For young people away at college or startsizable results. ing a new career in a new town who haAccording to a 2015 study published by the American Journal of Managed Care,

ven’t yet established a local physician, online visits and video chat features with

their physicians back home make it easier to seek out the help they need without clogging up emergency rooms. Others may not have time during their standard workday to schedule an appointment. With the implementation of online visits and a physician’s willingness to extend hours, patients are able to speak with their doctor before or after their shift. Surprisingly, it’s population groups with the lowest access to technology that may benefit the most from telemedicine. Telemedicine is rapidly finding its way inside homeless shelters across the nation, offering service hours where patrons can speak with a physician via webcam. Telemedicine opens the door for both patients and physicians to have more control over their schedules. They choose when they are available for online consultations, whether it’s 8am or 8pm. Zipy Care is a Michigan based telehealth company striving to use technology to prevent emergency room visits before they happen. With startup help from business incubator, Ann Arbor Spark, Zipy Care has built a FDA registered, HIPAA compliant cloud-based software platform that allows monitoring of patients at home. “Medicare currently spends $100 billion per year on medical hospitalizations with 20% of patients driving 80% of the cost. (continued on page 18)

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(continued from page 17) The majority of these hospitalizations are preventable using our software,” said Waseem Ullah, CEO and co-founder of Zipy Care.

But not every emerging delivery model relies on a computer monitor or a smart phone.

Strength in Numbers. When a patient uses standard appearing Two nurses start checking vitals as a phyequipment like a blood pressure monisician begins speaking before a group of tor, glucometer or weight scale, the data is uploaded to the Zipy cloud. The patient’s 15 diabetic patients. She discusses diabetes medical team can then customize algomanagement topics and techniques, opens rithms that generate alerts with any abnorthe floor for patients to share their own mal values. The medical team then utilizes stories, and ends with a Q&A session. the secure video portal to adThe American Academy of Phydress any issues. If needed, geolocation technology allows an A study conducted sicians reports that group visits, also known as Shared Medical infield medic or nurse to be diby HIS Markit Appointments (SMAs), have rected to the patient’s location, projects patients nearly doubled over the last 10 and aid in performing a remote nationwide will years. Their efficiency allows a physical exam using connected make use of physician to see 15-20 patients devices and obtaining any tests over the course of two hours as 7 million to optimize patient care. telehealth visits opposed to 8-10 in the same These strategies have proven to time frame. An informational by 2018. decrease ER visits and hospitaland preventative supplement, ization costs by 50% while also they are not meant to replace one-on-one improving patient outcomes. visits between a physician and his or her Whether communicating with a nurse, patient, but offer an effective, preventative, fellow physician or patient at home, teleand collaborative experience for patients medicine offers a flexible element for phydealing with the same condition. sicians as they are able to work from the SMAs may not be appropriate for every comfort of their home or at their office. A kind of appointment, such as addressing study conducted by HIS Markit projects patients nationwide will make use of 7 drug or alcohol abuse, but have proven sucmillion telehealth visits by 2018, 20 times cessful with many chronic conditions – like more than the 350,000 visits in 2013. diabetes and high blood pressure.

Group visits can also be particularly helpful for pregnant women, who experience a variety of symptoms and changes throughout their pregnancies. With a mix of first time moms and seasoned parents, patients have the ability to get more perspectives and advice – both from their physician and other women who have experienced pregnancy before. Group visits help many patients realize that they are not alone in their condition or the battle with their illness. The open, discussion-based environment can be beneficial for patients who may forget a question they were planning to ask or get answers to things they may not have even thought about. After hearing the same questions over and over again throughout the day, physicians also often find shared medical appointments a good way to track local health trends and concerns. SMAs aren’t without their drawbacks, particularly when it comes to patient privacy. Most practices utilizing the model require patients to sign a privacy waiver, but there is no guarantee that people, symptoms and stories would not leave the group.

A Go-To Source at Any Time. Group visits aren’t your thing? Concierge medicine is offering a health care experience at the other end of the privacy spectrum. Concierge medicine provides patients with on-call access to their physician, day or night, the ability to schedule appointments more quickly and more often, and a deeper personal relationship with their primary care provider. It’s an appealing model to many physicians and patients, due in part to its relationship-building nature. Physicians are able to get to know patients, their families and their conditions in a more intimate and relaxed setting. Patients get more peace of mind knowing that they have the ability to not only contact their healthcare provider at any time but that they will not have to wait days or even weeks after scheduling an appointment to see their physician.

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Alternatively, there are serious cost barriers that face patients on a fixed income and those confronting the need for procedures for which they have not planned.

Emerging Technologies. Spanning the landscape of delivery methods is an emerging field of personalized and do-it-yourself technological advancements in the health care industry that are rewriting the playbook with every new development.

Mobile & Wearable Technology

According to Concierge Medicine Today, a medical news and information network specialized in concierge medicine and retainer-based care, there are currently between 5,000 – 5,500 practitioners engaging in concierge medicine services in the United States. This number is growing as public sentiment shifts toward a desire for a highly personalFree ized health care services.

the cost of their procedures, medications, labs, and other services at cost without going through a third-party payer. Many of these providers decline to accept insurance, and bill their patients up front for all services.

Free market hospitals, like the Surgery Center of Oklahoma, offer patients “a la carte” surgical opmarket, tions. Like a restaurant menu, all of the available procedures pay-as-you-go The model isn’t for everyone. Concierge medicine often re- healthcare clinics and their associated costs are simply listed on their website. quires a physician to be on call and hospitals Patients know the price they’ll 24/7 and may limit their overare making be charged – beginning to end all patient load. waves… – and can make their decisions The price of service is often a accordingly. significant barrier to entry for patients as Like some concierge providers, free marwell, especially those already experiencing ket healthcare clinics often charge a financial strains meeting their healthcare monthly fee for personalized care and and other basic needs. access to a physician. Unlike concierge services though, free market healthcare No Insurance, No Problem. clinic’s monthly costs act as a membership Amidst growing complexity and uncerfee with no copays at the time of appointtainty in the health care marketplace, ments. Most clinics offer pre-arranged, some physicians are embracing a return agreed-upon services upfront with addito a simpler time, when seeing the doctor tional services billed directly to the patient didn’t require a patient to navigate endless at cost. health insurance forms or comply with Many patients and providers find the complicated state and federal government model a breath of fresh air. The upfront mandates. cost breakdown, and the absence of hidden fees or surprise charges give patients Free market, pay-as-you-go healthcare control over the way they manage their clinics and hospitals are making waves, health care dollars. offering patients the option to pay for

With the integration of mobile phones and wearable technology into modern society, patients now have more information about their health than ever before. Medical mobile technology has become an incredible resource for both physicians and patients. Mobile apps and wearable devices have the ability to track steps and exercise, monitor weight and heart rates, observe sleep patterns, and much more. These capabilities allow patients to keep track of their own health data and plot a course for a healthier future. A recent Gallup poll found that about half of Americans are concerned about their weight – an understandable number, given reports from the CDC finding more than one-third of U.S. adults considered obese.

Smartphone apps that track calorie intake and activity levels are empowering patients to literally take the steps they need to improve their health. Other apps feature alert systems to serve as a consistent reminder to patients who need to take medication at a certain time every day. Some practices are jumping in on the mobile trend as well and offering appointment text reminders and confirmations to their patients.

(continued on page 20)

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(continued from page 19) Mobile apps and wearable devices allow patients greater access to their health information than ever before. Some are even equipped to share data with a patient’s physician, who may have suggestions or recommendations regarding diet, exercise, sleep patterns, or more. With reminders, motivations and user-friendly technology, patients are able to more easily take control of the lifestyle factors that influence their health.

Genetic testing. Family history is a critical component of a patient’s healthcare as well. Mainstream utilization of genetic testing holds remarkable promise for many patient groups, empowering physicians to tailor treatments and proactively address genetic risk factors. Genetic testing has also been particularly helpful for individuals who were adopted as children or didn’t know much about their family history. More effective preventative measures can be taken if a provider knows about a health history risk prior to an emergency.

The National Institute of Health is currently compiling the Genetic Testing Registry (GTR), an online resource that will provide a centralized location for test developers and manufacturers to submit information on their projects. Detecting a higher risk for diseases, guiding strategies for better health maintenance, offering more accurate diagnosis information and guiding treatment choices for varied conditions all promise to be a part of the latest wave of hyper-personalized medicine. “Employing new technologies and care models will be an incredibly positive supplement to physician knowledge,” said Haley Kamp, Program Manager at Answer Health on Demand. “By taking some of the pressure off of physicians, they are able to offer better care.” The only thing moving faster than the evolution of health care delivery models and technologies are patients’ expectations. It’s a brave new world out there. By prioritizing patients’ needs, physicians are ensuring it’s a healthier one, too.

H HE EA A LL T TH H

C CA AR RE E

Telemedicine continues to evolve as an innovative means of providing patients with enhanced access to quality medical care through the use of technology in medically appropriate circumstances. Although there is no universal definition, “telemedicine” is often used to describe the furnishing of clinical health care services to patients from distant sites through the use of electronic information and telecommunications technologies. Another term, “telehealth,” is commonly used to refer to a wider range of clinical and non-clinical health services furnished by technology.

LL A AW W

F F II R RM M

Wachler & Associates represents healthcare providers, suppliers, and other individuals in Michigan and across Wachler & Associates represents healthcare providers, suppliers, and other individuals in Michigan and across the country in virtually all areas of healthcare law, including but not limited to: the country in virtually all areas of healthcare law, including but not limited to:

• Appeals of Audits, Claim Denials, • and Appeals of Audits,Demands Claim Denials, Overpayment and Overpayment Demands • Billing and Reimbursement • Billing and Reimbursement • Stark Law, Anti-Kickback Statute, and • Healthcare Stark Law, Anti-Kickback Statute, and Fraud and Abuse Compliance Healthcare Fraud and Abuse Compliance • Corporate and Healthcare Transactions • Corporate and Healthcare Transactions • Licensure, Staff Privilege, • and Licensure, Staff Privilege, Credentialing and Credentialing • Physician Group Issues • Physician Group Issues • Regulatory Compliance • Regulatory Compliance • Healthcare Litigation • Healthcare Litigation

S E R V I N G S E R V I N G

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H E A L T H C A R E H E A L T H C A R E

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• Fraud and False Claims Defense • Fraud and False Claims Defense • Healthcare Investigations • Healthcare Investigations • Provider Participation Matters • Provider Participation Matters • HIPAA and HITECH Compliance • HIPAA and HITECH Compliance • Certificates of Need • Certificates of Need • Medicare & Medicaid Enrollment, • including Medicare Revocation & MedicaidAppeals Enrollment, including Revocation Appeals • Accountable Care Organizations • Accountable Care Organizations

P R O V I D E R S P R O V I D E R S

F O R F O R

O V E R O V E R

3 0 3 0

Y E A R S Y E A R S

Welcome New Members Clinton Joshua Takagishi, MD

Genesee Bala Aysola, MD Mohammed Syed, MD

Grand Traverse Megan Stilwill, DO

Ingham Tony Abraham, DO Anthony Agrusa, DO Abdulmohsin Ahmadjee, MD Syeeda Alam, DO Omar Albanyan, MD Noha Aljehani, MD Reem Almomani, MD Ahmad Alratroot, MD Hani Alsaedi, MD Weaam Alshenawy, MD Mohammad Alzawad, MD Lauren Anastos, DO Veronica Arbuckle-Bernstein, MD Nicholas Bair, DO Waseem Barham, MD Sowmya Barrela, MD Subash Bastakoti, MD Anita Bell, DO Jenny Bellodas Sanchez, MD Gaurav Bhalla, MD Lindsay Bliss, DO Lindsay Bliss, DO Laura Bohatch, DO Casey Bougie, MD Jagraj Brar, MD Jason Bunce, MD Allison Carlo, DO Jessica Carney, DO Samuel Carter, DO Gurveen Chahal, MD Nageshwar Chauhan, MD Filip Cheng, DO

George Chou, DO Samantha Clark, DO Georgette Cooke, DO Kathryn Das, DO Om Dawani, MD Prajwal Dhakal, MD Harmeet Dhaliwal, MD Ravinder Dhillon, MD Anthony DiCianni, DO Danielle, DOugherty, MD Crystal Drayer, MD Morgan Dudley, MD Mohammad El-Rifai, MD Mahmoud Elsayed, MD Dominic Femminineo, DO Jordan Fett, MD Alicia Filler, DO Nathan Fitton, DO Richard Fong, DO Tristan Fowler, DO Chintan Gandhi, MD Alexander Gill, MD Gregory Gilmour, MD Kemar Green, DO Stephanie Grondahl, DO Mohamed Hassanein, MD Ashley Holly, MD Christine Honer, DO Theresann Huprikar, DO Mian Iftikhar, MD Olayemi Jafojo, MD Issra Jamal, MD Helen Jaramillo Gutierrez, MD Armin Jewell, DO Stacy Jordan, DO Roohi Kahlon, MD Lilit Karapetyan, MD Christen Kegarise, DO Afshan Khan, DO Rohin Khanna, MD Mark Kidwell, DO Do Young Kim, MD Denise Kohl, DO

In Memoriam

THE MEMBERS OF THE MICHIGAN STATE

Amir Koldorf, DO Olha Krichevskiy, DO Shiho Kutsuwada, MD Tori LaFleur, MD Lizl Lasky, DO Xiao Ling, MD Jan Liu, MD Peter Liu, DO John Llewelyn, MD Michelle Loubert, DO Michael Lundin, MD Casey Lyons, DO Marta Makuszewski, MD Maral Malekzadeh, DO Garry Mann, MD Brandi Manning, DO Michael Masny, DO Thomas Murickan, MD Sarah Nangle, DO Divyesh Nemakayala, MD Joseph Nettleman, MD Konchok Norgais, MD Casey Noroyan, DO Sydni Oliveto, DO Chibueze Onyemkpa, MD Sagar Panthi, MD Megha Patel, MD Sarah Pearl, DO Lauren Peruski, DO Michael Phinn, DO Joseph Prinsen, DO Manoj Rai, MD Mandeep Randhawa, MD Matthew Rausch, MD Ryan Reece, MD Abigail Richeson, DO Justin Rutt, DO David Sabbagh, MD Abdul Safadi, MD Negar Salehi, MD Millicent Schratz, DO Justin Schultz, DO Syed Shah, MD

Abdul Sharaf, MD Abdullah Sharaf, MD Zachary Shiver, DO Farashin Silevany, DO Samuel Simpson, MD James Stewart, DO Lauren Strady, DO Phani Surapaneni, MD Noah Thormeier, DO Nhat Trinh, MD Aaron Tyagi, MD Stephanie Vanderstelt, DO Mathew Vettathu, MD Jasmine Virk, MD Shreya Wachob, DO Sian West, DO Kelly Wisley, DO Sarah Wolf, MD Karine Yu, DO Marc Zafferani, DO George Zakhia, MD Stephanie Zguris, MD Stella Zhang, DO

Jackson

Marquette/Alger William Barker, DO Adam Butcher, MD Thomas Kates, DO Kathryn Lerche, DO James Sawyer, MD Riley Torreano, MD

Oakland Mary Elnick, MD Yuliya Malayev, DO John Nquyen, MD James Relle, MD David White, MD Young Yoon, DO Matthew Ziegler, MD

Saginaw Christopher Allen, MD Altamash Amin, MD James Fugazzi, MD Zeina Habib, MD Kirstan Meldrum, MD Fady Moustarah, MD

Dorothy Brown, DO Scott Shelton, DO

St. Clair

Kalamazoo

Washtenaw

Karen McFarlane, MD

Mark Goetting, MD

Kent John Deveau, DO, MPH Thomas Pfennig, DO Justin Simmons, DO Michael Vredenburg, DO Peter Zadvinskis, MD

Ashley Cobb, MD Colleen Mathis, MD Britiany Sheard Caple, MD Raymond Yeow, MD

Wayne Anthony Van Vreede, MD

Livingston

Motahar Ahmed, MD Teronto Robinson, MD Isaac Turner, MD

R. Jack Chase, MD, Kent County Medical Society, Died 3/3/2017 Sergio Q. Cuiso, MD, Muskegon County Medical Society, Died 1/30/2017 Edward J. Drogowski, MD, Oakland County Medical Society, Died 2/1/2017 Richard Gilmartin, MD, Lenawee County Medical Society, Died 2/15/2017 F. Alan Hutchinson, MD, Kent County Medical Society, Died 2/27/2017

MEDICAL SOCIETY REMEMBER WITH RESPECT

Walter G. Parker, MD, Wayne County Medical Society, Died 12/18/2017

THEIR COLLEAGUES WHO HAVE DIED.

RonaldLee Stuk, MD, Muskegon County Medical Society, Died 3/7/2017 Jay H. Veltman, MD, Kent County Medical Society, Died 3/16/2017 Felipe G. Videla, MD, Genesee County Medical Society, Died 2/21/2017

If you would like to recognize a colleague by making a gift or bequest to the MSMS Foundation in their memory, contact: Rebecca Blake, Director, MSMS Foundation, 120 W. Saginaw St., East Lansing, MI 48823 p: 517-336-5729 e: rblake@msms.org

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MSMS Medical Opportunities msms.medopps.org

Central City Integrated Health Nurse Practitioner-Psychiatry-Adult Detroit, MI 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.

Medical Opportunities ID # 11848 Provides advanced clinical nursing care to a selected population of clients. Assumes leadership and provides expertise for intake health history. Collaborates with Psychiatrist to provide psychiatric evaluation and team members to recommend program placement and coordinate interim treatment planning. Improves clinical staff quality of care through consultation with and education of nursing personnel, clients, and their significant others. Serves as preceptor for undergraduate and nursing graduate students.

Central City Integrated Health Psychiatry-Adult-MD/DO Full and Part Time Detroit, MI Medical Opportunities ID # 11846 Responsible to the Chief Psychiatrist at Detroit Central City Community Mental Health, Incorporated for the provision of specialized psychiatric services which include, but are not limited to: psychiatric evaluations, medication reviews, and consultation on an ongoing basis to the Treatment Team in the development and implementation of direct services.

Cherry Street Health Services Director of Psychiatry-MD/DO Cherry Street, MI Medical Opportunities ID # 11960 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.

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Henry Ford Allegiance Psychiatry-Core Facility/Substance/ Geriatrics Jackson, MI Medical Opportunities ID # 11775

Lansing Urgent Care Family Medicine-MD/DO Lansing, MI Medical Opportunities ID # 2280 Extraordinary Full Time Physician job

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.

opportunity with a world-class Urgent

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.

Practice or Emergency Medicine,

Lansing Urgent Care Physician Assistant-General, Urgent Care Lansing, MI Medical Opportunities ID # 2924 Incredible Physician Assistant full-time job opportunity with a world-class Urgent Care Company located in Lansing, Michigan. Our state-of-theart facility coupled with high patient volumes and professional staff is ideal for candidates seeking a fastpaced environment with a top-notch compensation and benefits package. The Lansing area offers a huge array of culture located near the beautiful campus of Michigan State University, recreational attractions, the State Capitol and quick access to Metropolitan areas such as Grand Rapids and Detroit. If you seek a career opportunity with a family owned, established, and ideal work environment – this is the place for you!

Care company located in Lansing, Michigan with six facility locations. The company is well established and is seeking a physician. State-of-the-Art facilities coupled with a professional staff is ideal for candidates seeking a fastpaced, team oriented environment with excellent compensation. Candidates are preferably board certified in Family have excellent bedside manner and work well with other physicians and mid-levels. Package offers competitive salary, impressive benefits, and CME reimbursement program.

ProMedica Monroe Regional Hospital Family Medicine Monroe, MI Medical Opportunities ID #9758 ProMedica Monroe Regional Hospital is looking for a full time family medicine physician in an area outside the city of Monroe as we continue to grow throughout the county. Our total service population is over 150,000. A great opportunity with plenty of management, marketing, and clinical support. Employment with ProMedica includes: • Competitive base salary with quality performance incentives • Full benefit package • Attractive signing bonus • Can use hospitalists at ProMedica Monroe Regional Hospital for all inpatient work • Quality specialists and support for all referrals Call shared with other employed FM physician - will take “no doc” ED call but refer to hospitalists

ProMedica Monroe Regional Hospital Academic Family Medicine Residency Physician Monroe, MI Medical Opportunities ID # 11294 ProMedica Monroe Regional Hospital is looking for an experienced academic family medicine physician to join their 6-6-6 Family Medicine Residency. The program is affiliated with the University of Toledo at ProMedica Monroe Regional Hospital in Monroe, Michigan. The new physician will be part time clinical practice to help build a patient base for the residency. Time will also be dedicated to academic responsibilities. The faculty physician will work closely with the Program Director to coordinate and oversee all activities related to the development of the residency infrastructure, including curriculum development and the recruitment of residents.

ProMedica Bixby Hospital Family Medicine/Internal Medicine Adrian, MI Medical Opportunities ID # 11524 Excellent opportunity for a BC/BE FM or IM physician to join a busy, well-established practice in Adrian, Michigan known for providing quality medical care in the community. Employment with ProMedica Includes: • Practice located on the campus of ProMedica Bixby Hospital • Out patient only • Hospital visits / Nursing Home visits are optional • Current practice consists of 4 physicians and 2 nurse practitioners • 1: 5 on call • EMR - EPIC • Attractive Signing Bonus • Relocation Reimbursement up to $10K • Comprehensive compensation package and excellent benefits including full medical, dental, vision, life insurance, short and long term disability, 401K match, CME allowance, and mal

Tuscola Behavioral Health System Psychiatry-Adult, MD/DO Caro, MI

Visiting Physicians Association Home Based Primary Care-MD/DO Lansing, MI

Visiting Physicians Association Home Based Primary Care-MD/DO Grand Rapids, MI

Medical Opportunities ID # 7307

Medical Opportunities ID # 9265

Medical Opportunities ID #9352

Provides psychiatric care and services to agency consumers including assessments and consultations, medication prescription and medication monitoring.

• Competitive base salary and aggressive quarterly incentive pay

• Income potential of $175,000 $215,000+

• Comprehensive benefit package including 401k with match

• Annual stipend for CME and license/ association dues

• Up-to-date for your tablet and company phone

• A+ rated Malpractice Coverage with tail coverage

• H1b Visa sponsorship

Visiting Physicians Association Home Based Primary Care-MD/DO Flint, MI

Visiting Physicians Association Home Based Primary Care-MD/DO Kalamazoo, MI

Medical Opportunities ID # 9351

Medical Opportunities ID #9354

• Competitive base salary and aggressive quarterly incentive pay

• Income potential of $175,000 $215,000+

• Comprehensive benefit package including 401k with match

• Annual stipend for CME and license/ association dues

• Up-to-date for your tablet and company phone

• A+ rated Malpractice Coverage with tail coverage

• H1b Visa sponsorship

Recommends referrals for specialized medical services to external sources as appropriate and provides psychiatric documentation to assist in accomplishing the referral. Ensures coordination of care with consumer’s Primary Care Physician and Medicaid Health Plan. Evaluates need for psychiatric hospitalization, assists with inpatient referrals when necessary and consults with CMH clinical staff and hospital staff regarding treatment needs and aftercare plans.

Tuscola Behavioral Health System Psychiatry-Child & Adolescent Caro, MI Medical Opportunities ID # 10509 Responsible for the provision of outpatient psychiatric services for children, adolescents and families. Provides face-to-face psychiatric evaluation as well as medication management and consultation services in a collaborative work environment focusing on integrated health care. Demonstrates knowledge of and actively supports culturally competent, recovery based practices. Knowledge and experience with diagnosing and treating an array of childhood mental, emotional and behavior disorders in a behavioral health facility or clinic. Medical Doctor or Doctor of Osteopathy. Consideration will be given to Foreign Medical Graduate candidates License to practice medicine or osteopathic medicine in Michigan required. Board certified or board eligible as a Child and Adolescent Psychiatrist. Michigan Controlled Visiting Physicians Association. Substance license and Drug Enforcement Agency registration.

Are You An Employer? Add Medical Opportunities to your list of trusted recruiting resources. Whether you are a private practice, a critical access hospital or a large health system, Medical Opportunities can aid you in finding the right candidate for your opportunities. Medical Opportunities delivers a customized matching algorithm connecting our database of candidates to your opportunities. 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.

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MSMS Medical Opportunities (continued)

Visiting Physicians Association Home Based Primary Care-MD/DO Marysville, MI

Visiting Physicians Association Home Based Primary Care-MD/DO Southfield, MI

Sparrow Medical Group Family Medicine/Internal Medicine Carson City, MI

Sparrow Medical Group Emergency Medicine-MD/DO St. Johns, MI

Medical Opportunities ID #9355

Medical Opportunities ID #9357

Medical Opportunities ID # 11819

Medical Opportunities ID # 1685

• Competitive base salary and aggressive quarterly incentive pay

• Income potential of $175,000 $215,000+

• Comprehensive benefit package including 401k with match

• Annual stipend for CME and license/ association dues

• Up-to-date for your tablet and company phone

• A+ rated Malpractice Coverage with tail coverage

Sparrow Carson Hospital, an affiliate of Sparrow Health System, is seeking a BE/BC Internal or Family Medicine physician for their hospital employed practice located in Carson City, Michigan. Outpatient only. Competitive salary with full benefits. Eligible for loan repayment programs and relocation assistance. Sparrow Carson Hospital and Sparrow Health System are fully committed to improving access to top quality medical care across Mid-Michigan.

• H1b Visa sponsorship

Visiting Physicians Association Home Based Primary Care-MD/DO Saginaw, MI

Visiting Physicians Association Primary Care-MD/DO (100% Outpatient) Troy, MI

Medical Opportunities ID #9356

Medical Opportunities ID #9358

• Competitive base salary and aggressive quarterly incentive pay

• Income potential of $175,000 $215,000+

Due to continuing growth, Sparrow Clinton Hospital (SCH) located in St. Johns, Michigan and an affiliate of Sparrow Health System has a full-time opening for a BC/BE emergency physician for a newly remodeled ED. SCH serves more than 14,000 patients per year, and features 8 private rooms with 2 dedicated trauma rooms. This is a great opportunity for a physician seeking a growing community-based position with the technology and support of Sparrow Health System. SCH delivers exceptional care and is recognized as a top performer in quality initiatives across the state of Michigan. Sparrow Health System is fully committed to improving access to top quality medical care across Mid-Michigan. Position is hospital employed. We offer excellent compensation and benefits in a diverse and family friendly community.

• Comprehensive benefit package including 401k with match

• Annual stipend for CME and license/ association dues

• Up-to-date for your tablet and company phone

• A+ rated Malpractice Coverage with tail coverage

• H1b Visa sponsorship

Sparrow Medical Group Geriatrics-MD/DO Lansing, MI Medical Opportunities ID # 5706 Sparrow Medical Group (SMG), a multispecialty physician group and the premier physician organization of Sparrow Health System (SHS), located in Lansing, Michigan, is seeking a dynamic BC/BE Geriatric Medicine physician to join a Geriatric practice located in the greater Lansing area. SMG delivers exceptional care and is recognized as a top performer in quality initiatives across the state of Michigan. SMG is fully committed to improving access to top quality medical care across MidMichigan. Position is hospital employed and outpatient based. We offer excellent compensation and benefits, including malpractice and tail coverage, in a diverse and family friendly community.

Let your next job find YOU with MSMS Medical Opportunities ◆ 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.

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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.

Bronson Healthcare Group Internal Medicine HospitalistNocturnist Kalamazoo and Battle Creek, MI

Bronson Healthcare Group Bronson Lakeview Family Care Internal Medicine-MD/DO Paw Paw, MI

Medical Opportunities ID # 10767

Medical Opportunities ID # 11733

Internal Medicine – Hospitalist / Nocturnist- 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 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.

Northwest Michigan Health Services, Inc. Nurse Practitioner - GP New Clinic Opening Manistee, MI

msms.medopps.org

Medical Opportunities ID # 11964 Northwest Michigan Health Services, Inc. is very excited to announce that we are opening a new clinic in Manistee, MI and are recruiting for a full time Family Nurse Practitioner. Northwest Michigan Health Services, Inc is a Federally Qualified Health Center, offering primary medical, general dentistry and behavioral health services for all ages in a community health setting. Qualifications: Licensed Nurse Practitioner in the State of Michigan, Ability to work independently, Community Health Experience preferred.

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 RELATIONS MATTERS MATTERS •• HEALTHCARE HEALTHCARE FRAUD FRAUD DEFENSE DEFENSE •• LICENSING LICENSING AND HOSPITAL AND OTHER OTHER REGULATORY REGULATORY MATTERS MATTERS

T R U S T E D

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

Established 1874

W W W.KERR - RUSSELL .COM

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IC System

20% discount for MSMS members on effective, ethical collections.

Kent Record Managment, Inc.

Discounts on shredding, scanning, online backup and recovery, vault media

MSMS Practice Solutions The MSMS saves physician members time and money through a variety of discount programs. From medical malpractice insurance to compliance issues, MSMS Practice Solutions finds ways to decrease your expenses while continuing to practice medicine.

A list of partners is shown here, but for the most up-to-date list, please visit

http://msms.org/PracticeSolutions

storage, digital preservation and hosted services.

Kohls Department Stores

Enjoy various discounts on selected merchandise every day.

LendKey

Refinance your student loans with LendKey and MSMS members get an exclusive $500 sign-up bonus.

Macys.com

MSMS members are able to shop and save through macys.com.

Magazine Subscription Services

MSMS’s Magazine Program saves you up to 50% off the usual subscription rates on hundreds of the most popular magazines.

MedTrust, LLC

MSMS members receive discounts on billing and coding services, as well as practice management assistance.

MSMS PARTNERS

Michigan Retailers Association

123Net Inc.

Discounts available to MSMS members on high-speed Internet, voice and data center services.

AccuShred

Discounts available to MSMS members on data destruction services.

Best Buy

Enjoy various deals on selected products every day.

Brooks Brothers

As a Brooks Brothers Corporate Member, you will receive an everyday 15% Savings* on regularly priced merchandise.

Coldwell Banker Hubbell BriarWood

MSMS physicians who buy or sell a home through the REAP program will receive a 10% discount.

CrosStar Network Solutions

MSMS members receive the lowest rate on merchant credit card processing.

Microsoft

Enjoy various deals on selected products every day.

MSMS Glove Program

MSMS’s endorsed glove program brings you high-quality products with the right fit and feel at an exceptional value.

MSMS Medical Opportunities

Looking for a job opportunity in Michigan? MSMS Medical Opportunities will simplify your search.

MSMS Physicians Insurance Agency

MSMS Physicians Insurance Agency is uniquely qualified to offer insurance to physicians, their families and office staff.

Office Depot, Office Max

Get BIG Savings on ALL your technology expenditures!

Receive discounts on office supplies, paper and toner, furniture, technology, off-site printing, facility resources, and more.

Desert River Solutions

Officite

MSMS members receive a 10% discount on their custodian of records service.

First Healthcare Compliance®

Discounted pricing on a comprehensive compliance program management solution to save you time and money.

Ford Motor Company

MSMS physicians may purchase or lease two new vehicles per year for roughly one percent above dealer invoice price.

GoNext (Travel)

Offers discounts on adventure, luxury, service and value in the travel industry.

Health eFilings, LLS

Receive a 10% discount on services that help you comply with PQRS, VBM and Meaningful Use eCQMs.

Hilton Worldwide

Book hotels and resorts directly with MSMS’s Hilton Affiliate Connection to make your trip more relaxing and affordable.

HotelStorm

Exclusive hotel discounts to MSMS members.

Enjoy various deals on selected products every day.

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MSMS members receive special discounts on complete Web Presence platforms.

Palace Sports and Entertainment

Exclusive offers on select events at DTE Energy Music Theatre, Meadow Brook Music Festival, and The Palace of Auburn Hills.

PetSmart, Inc.

Special pricing available for MSMS members.

Physicians Review Organization

Providing effective external peer review services.

Professional Credential Verification Services (PCVS)

Provides primary source credentialing verification services for hospitals, physician practices, health plans, and more.

Swift Audit (ICD-10)

Receive a discount on SwiftAudit Search, a desktop and mobile-friendly web-based coding tool.

The Rybar Group

Innovative financial and operational solutions to ensure optimization of reimbursement while maintaining compliance.

Vera Bradley Designs, Inc.

MSMS members are able to shop and save on handbags, accessories, luggage, and paper and gift items at verabradley.com

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

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2017 Educational Courses MSMS On-Demand Webinars: CME When You Want It!

COLOR KEY TO COURSE AREAS

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

Practice Transformation

Billing 101

Clinical

CDL – Medical Examiner Course*

Leadership

Choosing Wisely Part 1: Stewards of our Health Care Resources

HIT

Choosing Wisely Part 2: Change Strategies to Implement Choosing Wisely

Billing and Coding

Claim Appeals

ON-DEMAND WEBINARS

Compliance in the Office

(excluding CDL – Medical Examiner* course)

Credentialing

Statement of Accreditation MSMS is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Cyber Security: Issues and Liability Coverage Engaging Patients on Their Own Turf: Using Websites and Social Media 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 Rule Human Trafficking Overview ICD-10 for 2017 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 Managing Accounts Receivable Opioids and Michigan Worker’s Compensation Patient Portals as a Tool for Patient Engagement Physician Online Rating and Reviews: Do’s and Don’ts Preparing for the Medicare Physician Value-Based Payment Modifier Reading Remittance Advice Section 1557: Anti-Discrimination Obligations Understanding and Preventing Identity Theft in Your Practice Working Rejections What’s New in Labor and Employment Law

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AMA Credit Designation The Michigan State Medical Society designates this online activity for a maximum of .50 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

CDL-MEDICAL EXAMINER COURSE* Statement of Accreditation This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Colorado Medical Society and Montana Medical Association. The Colorado Medical Society is accredited by the ACME to provide continuing medical education for physicians. AMA Designation Statement The Colorado Medical Society designates this internet enduring medical activity for a maximum of 9.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Educational Conferences – Visit msms.org/EO or call MSMS Registrar at 517-336-7581 for more information. Making MACRA Work for You

Regional Scientific Meeting

Date: Friday, May 5

Date: Saturday, September 16

152nd Annual MSMS Scientific Meeting

Time: 9:00 am – 3:45 pm

Time: 8:30 – 11:45 am

Morning, afternoon and evening clinical courses available.

Location: Amway Grand Plaza Hotel, Grand Rapids

Location: Prince Auditorium at Calvin College, Grand Rapids

Date: Wed., October 25 - Sat., October 28

Note: Continental breakfast and lunch will be provided

Note: Continental breakfast and lunch will be provided.

Note: Lunch will be provided. Intended for: Physicians, PO Administrators, practice consultants, office administrators, students, other health care professionals. Contact: Caryl Markzon 517-336-7575 or cmarkzon@msms.org

Annual Joseph S. Moore, MD, Conference on Maternal and Perinatal Health Date: Thursday, May 18 Time: 9:00 am - 4:15 pm Location: Somerset Inn, Troy Note: Continental breakfast and lunch will be provided Intended for: Physicians, nurses, residents, students, and all other health care professionals working with women and their infants. Contact: Marianne Ben-Hamza 517-336-7581 or mbenhamza@msms.org

Spring Scientific Meeting Morning, afternoon and evening clinical courses available

Date: Thursday, May 18 and Friday, May 19

Intended for: Physicians and all other health care professionals Contact: Beth Elliott 517-336-5789 or belliott@msms.org

Location: Sheraton Detroit Novi Hotel, Novi

Intended for: Physicians and all other health care professionals Contact: Marianne Ben-Hamza 517-336-7581 or mbenhamza@msms.org

Symposium on Retirement Planning

21st Annual Conference on Bioethics

Date: Saturday, September 16

Date: Saturday, November 11

Time: 12:30 – 3:45 pm

Time: 9:00 am – 4:30 pm

Location: Prince Auditorium at Calvin College, Grand Rapids

Location: Sheraton Detroit Hotel, Ann Arbor

Intended for: Retired physicians, physicians planning for retirement, spouses, and office managers Contact: Caryl Markzon at 517-336-5755 or cmarkzon@msms.org.

Note: Continental breakfast and lunch will be provided 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.

Making MACRA Work for You Date: Tuesday, October 24 Time: 9:00 am – 3:45 pm Location: Sheraton Detroit Novi Hotel, Novi

Practical Guidance for Health Care Compliance Date: Wednesday, December 6

Note: Lunch will be provided.

Time: 10:00 am – 3:00 pm

Note: Continental breakfast and lunch will be provided

Intended for: Physicians, PO Administrators, practice consultants, office administrators, students, other health care professionals.

Note: Lunch will be provided.

Intended for: Physicians and all other health care professionals

Contact: Caryl Markzon 517-336-7575 or cmarkzon@msms.org

Location: Somerset Inn, Troy

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

Location: MSMS Headquarters, East Lansing Intended for: Physicians, PO Administrators, practice consultants, office administrators, students, other health care professionals. Contact: Caryl Markzon 517-336-7575 or cmarkzon@msms.org

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WEALTHCARE ADVISORS

Your Estate Plan: Five Things to Do Right Now By Jim C. Niedzinski, AIF® If it has been longer than five years

2. REVOCABLE LIVING TRUST

4. ADVANCED MEDICAL DIRECTIVES

since your estate plan was reviewed, you

A revocable living trust is a separate legal entity created by you to own your assets. The trust will direct the transfer of these assets upon your death.

Advanced medical directives declare what medical treatment you would or would not like to receive, as well as appoint a Patient Advocate to make medical decisions on your behalf in the event you are unable.

need a check-up. Like your teeth or car, your estate documents require regular maintenance. The world is changing and so are you – new federal tax laws are enacted and state requirements are revised; children and grandchildren are born and homes are bought and sold. Your estate plan needs to keep up with the pace of change or your loved ones can be stuck with a handful of heartache. To prepare for your review, refresh yourself on the five key documents of a basic estate plan: 1. WILL A will directs who inherits your assets. While assets can also be passed to heirs via a revocable living trust (explained below), a will is always required to direct assets that may not have been titled to the trust. A will also names a legal guardian for minor children or dependents with special needs.

Unlike assets transferred via a will, trust assets avoid probate. Probate is a legal process that occurs after someone dies involving paperwork and court filings that add cost and delay to the settlement of your estate. Avoiding probate is also desirable if you’re concerned about privacy. Probated documents (e.g., the will, list of assets) become a matter of public record. While you may not be able to avoid probate completely, a trust can greatly reduce the number of assets that go through probate and simplify the process for those that do. A trust can also be crafted to provide additional protection after you pass away, potentially shielding your heir’s trust assets from divorce, creditors and mismanagement.

3. DURABLE POWER OF ATTORNEY A durable power of attorney (DPOA) enables you to authorize someone else to handle financial and legal matters on your behalf, such as paying expenses, managing investments, and filing taxes. There are two types of DPOAs: • Immediate – effective when executed • Springing – effective when you become incapacitated

There are three types of advanced medical directives, although what is allowed varies by state: • A living will allows you to approve or decline certain types of medical care • A health care DPOA allows you to appoint a representative to make certain medical decisions on your behalf • A Do Not Resuscitate order (DNR) directs medical personnel not to perform CPR if you go into cardiac arrest

5. LETTER OF INSTRUCTION A letter of instruction is an informal document that can be used to express your personal thoughts and directions on topics such as your burial wishes or where to find important documents. These instructions are only suggestions and are not legally binding. Unlike your will, a letter of instruction remains private and is therefore an opportunity to say things to heirs you would rather not make public. Contact us for assistance with establishing an estate plan or reviewing your current plan for possible updates and improvements.

Updating your estate plan doesn’t have to be painful. If you have an advisor team that you trust, contact them for a review of your estate plan. If you don’t have an advisor team in place, contact us for help: (248) 971-7509 or info@WealthCareAdvisors.com. Call or email now – it will take less time than you think!

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Advancing the practice of good medicine.

NOW AND FOREVER.

ANNOUNCING THE 2017 DIVIDEND FOR MICHIGAN MEMBERS The Doctors Company has returned nearly $400 million to our members through our dividend program—and that includes 10% to qualified Michigan members. We’ve always been guided by the belief that the practice of good medicine should be advanced, protected, and rewarded. So when our insured physicians keep patients safe and claims low, we all win. That’s malpractice without the mal.

Join us at thedoctors.com