THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 119 / NO. 6
November / December 2020
MICHIGAN LICENSURE REQUIREMENTS, MSMS EDUCATION AND CME OFFERINGS
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FEATURES & CONTENTS November / December 2020
04
President's Perspective S. BOBBY MUKKAMALA, MD
06
How Does Our Supreme Court's Invalidation of the Governor's Executive Orders Effect Physician Practice and Workplace Safety? DANIEL J. SCHULTE, JD
08
Practical Implications of DOL’s Change to FFCRA ‘Health Care Provider’ Definition JODI SCHAFER, SPHR, SHRM-SCP
10
Protect your adult patients from vaccine-preventable diseases! ALYSSA STROUSE, MPH
14
17
COVID-19 Is Changing Liability Risks and Litigation in Healthcare BILL FLEMING, COO, THE DOCTORS COMPANY
DEPARTMENTS 30 Welcome New Members
FEATURE
Michigan Licensure Requirements, MSMS Education and CME Offerings BY MICHIGAN STATE MEDICAL SOCIETY
STAY CONNECTED!
The Michigan State Medical Society offers continuing medical education courses for members in all levels of their careers. Due to the COVID-19 pandemic, we are striving to be more creative and adaptable so that we are able to offer important CME in both a timely and safe manner. Story begins on page 17.
NOVEMBER / DECEMBER 2020 |
michigan MEDICINE®
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MICHIGAN MEDICINE® VOL. 119 / NO. 6
perspective
Chief Executive Officer JULIE L. NOVAK Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Publication Design STACIA LOVE, REZÜBERANT! INC. rezuberant.com Printing FORESIGHT GROUP staceyt@foresightgroup.net Publication Office Michigan Medicine® 120 West Saginaw Street East Lansing, MI 48823 517-337-1351 www.msms.org All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast. Postmaster: Address Changes Michigan Medicine® Trisha Keast 120 West Saginaw Street East Lansing, MI 48823
Michigan Medicine®, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan. The MSMS Committee on Publications is the editorial board of Michigan Medicine® and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors. Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine® reserves the right to accept or reject advertising copy. Products and services advertised in Michigan Medicine® are neither endorsed nor warranteed by MSMS, with the exception of a few. Michigan Medicine® (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2020 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. ©2020 Michigan State Medical Society
4
michigan MEDICINE®
Michigan physicians have been pushing themselves harder than ever in 2020. The pandemic has advanced the pace of our work in many areas, from patient treatment and telemedicine to the constantly-shifting regulatory frameworks in which we operate. In this issue of Michigan Medicine®, we’ll dig deeper into a few of the many continuing education issues we’re beginning to explore as a profession. Implicit bias. Human trafficking. Opioids. There’s a lot on our collective plate and, in many ways, it seems only tangentially related to our primary focus on patient care. To help ensure we’ve got a clear understanding of the many new issues to which we must attend, it’s important to bring you up to speed on all the matters that, well, matter. As physicians, we are a first line of defense for our patients. We may be among the
first to notice the subtle indicators they present, not only in the form of disease, but also in the form of the physical and emotional markers that may indicate other significant—but likely hidden—challenges. Ensuring we are prepared to recognize those markers, and know what they mean, is essential. Imagine, for instance, a patient with poor physical and oral health. Is it an illness, or could it be this patient is a victim of human trafficking? Is a flat affect a sign merely of depression, or of possible opioid addiction? As physicians, we are expected to know these things, to anticipate the issue and take appropriate action. But in these cases, as in countless others, the answers are never clear. But the issues are real, and they are pressing. The National Human Trafficking Hotline statistics for 2017 include 8,524 cases reported and 26,557 calls received. That’s a 13 percent increase over the prior year.
By S. Bobby Mukkamala, MD, MSMS President
Michigan is not exempt from these alarming trends. In 2017, 309 cases of human trafficking were reported to the helplines from Michigan, an increase from 251 reported cases in 2016. Opioids were involved in 46,802 (a rate of 14.6) overdose deaths in 2018—nearly 70% of all overdose deaths. Michigan physicians need to attend to these issues carefully, given that in 2018, our state’s providers wrote 62.7 opioid prescriptions for every 100 persons compared to the average U.S. rate of 51.4 prescriptions. And finally, it’s known that COVID-19 is more than four times more prevalent among black patients than among their white neighbors. Thus, Governor Whitmer has directed the implementation of implicit bias training within the state’s medical community.
S. BOBBY MUKKAMALA, MD (GENESEE COUNTY) MSMS PRESIDENT
These issues are significant. And while this last notion, that of implicit bias in our work, may be a particularly challenging notion for us to confront—both individually and collectively—it is important that we do so. As one metro Detroiter recently put it, “If you’re not actively, aggressively fighting racism 100 percent of the time, then you are part of the problem.”
“As physicians, we are a first line of defense for our patients. We may be among the first to notice the subtle indicators they
As medical professionals, we can never afford to be part of the problem. We must avail ourselves of every possible opportunity to learn and grow, no matter how uncomfortable it may be.
present, not only in the form of disease, but also in the form
This is the intent of the training requirements for the state of Michigan, and it is a good one. We believe that, throughout this issue, you’ll find opportunities that spark your interest and lead you to the kinds of growth that will make you a better physician, leader and human being.
of the physical and emotional markers that may indicate other significant—but likely hidden—challenges.”
It’s a journey that matters, and I’m glad it’s one we’re completing together.
S. Bobby Mukkamala, MD (Genesee County) MSMS President
NOVEMBER / DECEMBER 2020 |
michigan MEDICINE®
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ASK OUR LAWYER
How Does Our Supreme Court's Invalidation of the Governor's Executive Orders Effect Physician Practice and Workplace Safety? By Daniel J. Schulte, JD, MSMS Legal Counsel
Q:
How does Michigan Supreme Court’s invalidation of all the Governor’s COVID-19 Executive Orders affect physician practice? Do physicians have the same workplace safety obligations to their employees?
The invalidation of the Governor’s COVID-19 Executive Orders does very little, if anything, to change physician practice and workplace safety in this pandemic environment.
6
T
he Michigan Supreme Court, in a fractured opinion, held on October 2, 2020 both that the: (1) Governor lacked authority under the Emergency Management Act of 1976 to issue or renew Executive Orders related to the COVID-19 pandemic beyond the Legislature’s approved extension through April 30, 2020; and (2) Emergency Powers of the Governor Act of 1945 is an unconstitutional delegation of legislative authority to the executive branch. The net effect of these rulings is that the Governor never had the authority to issue any Executive Orders under either law after April 30, 2020. The Governor’s office and others initially reported that the October 2, 2020 rulings did not take effect until the end of October. The Michigan Supreme Court has since ruled that this is incorrect. All
michigan MEDICINE® | NOVEMBER / DECEMBER 2020
the COVID-19 Executive Orders have been invalid and legally unenforceable since October 2, 2020.
“All other workplace safety regulations, orders of state and local public health departments, and valid orders of other state agencies remain legally enforceable and must continue to be complied with.” All other workplace safety regulations, orders of state and local public health departments, and valid orders of other state agencies remain legally enforceable and must continue to be complied with. For example, valid mask mandates issued by state and local public health
masks, issued on October 4, 2020,
“The best advice for medical practices is to continue
imposes the same requirements as the
to maintain their COVID-19 procedures even though there are
153. In the event of conflict between
Governor’s Executive Order EO 2020applicable state and local public health
no longer Executive Orders mandating some or all of them.”
department
orders,
residents
and
businesses should follow the more stringent order which applies, until public health authorities issue other
departments are legally enforceable as
have or may have COVID-19. The
are OSHA and MIOSHA workplace
EEOC “Pandemic Preparedness in the
guidance.
safety standards for COVID-19. The
Workplace and the Americans with
Michigan
Health
Disabilities Act,” guidance can be
Medical practices, healthcare facilities,
and Human Services quickly issued
found at: https://www.eeoc.gov/laws/
an order on October 5, 2020 which,
guidance/pandemic-preparedness-
like EO 2020-153, generally requires
workplace-and-americans-disabilities-
businesses to refuse entry to those who
act.
Department
of
fail to properly wear a mask.
The best advice for medical practices is to continue to maintain their
2020 ruling also does not impact an
COVID-19 procedures even though
employer’s obligation to comply EEOC
there are no longer Executive Orders
standards
mandating some or all of them.
to
COVID-19.
Employers may continue to conduct confidential temperature checks and daily symptom screenings without running afoul of the Americans with Disabilities Act (“ADA”). Guidance issued by EEOC on March 21, 2020, encourages employers and employees to follow guidance from the CDC as well
see what, if anything, their local public health departments are doing on the subject of face masks. Some counties (like Macomb County) have said that
The Supreme Court’s October 2,
relative
business and residents should check to
The MDHHS order does not explicitly require medical practices, healthcare facilities or businesses to post signs instructing customers to wear masks, but they should continue to do so. In contrast, Ingham County Health Department order 2020-21 mandating
they will not require that masks be worn, while others (like Wayne County) have said that they will not mandate masks at this time and will wait to see whether the legislature and Governor can agree on a consistent statewide approach to masks. Oakland County issued a mask mandate order, but rescinded it after MDHHS issued its order. DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL
as state/local public health authorities on how best to slow the spread of COVID-19
and
protect
workers,
customers, clients, and the general public. This guidance further provides that because the relevant public health authorities have acknowledged the community spread of COVID-19, employers are entitled to conduct temperature checks of employees as well as ask employees questions about their symptoms to determine if they
NOVEMBER / DECEMBER 2020 |
michigan MEDICINE®
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ASK HUMAN RESOURCES
Practical Implications of DOL’s Change to FFCRA ‘Health Care Provider’ Definition By Jodi Schafer, SPHR, SHRM-SCP, Human Resources Management Services, LLC
Q:
When the Families First
Let me start by reviewing the recent changes to the DOL’s
Coronavirus Response Act
guidance. On September 16, 2020, The U.S. Department
(FFCRA) first became effective, I chose to exempt my practice from offering
of Labor, revised and clarified workers’ rights and employers’
this type of leave because health care
responsibilities under the Families First Coronavirus
providers and first responders were
Response Act, including the definition of “health care
given this option. Now I see that I
provider” for the purposes of exempting a business from
might have to re-evaluate my policy in light of the Department of Labor’s
complying with paid leave provisions under the Act. As a
revised guidance. My question is, how
result of this change, an employer can no longer apply the
do I determine which employees are
definition of “health care provider” to their place of business
eligible for FFCRA leave and which ones are not? Even if I can continue
as a whole, but rather, must evaluate the specific job duties
to exempt certain positions from
of the employee requesting the leave when determining
FFCRA, should I?
whether or not to provide FFCRA benefits. In the Frequently Asked Questions section of the DOL’s website, the new guidance defines “health care provider” as: “Anyone who is a licensed doctor of medicine, nurse practitioner, or other health care provider permitted to issue a certification for purposes of the FMLA,”
OR “Any other person who is employed to provide diagnostic services, preventive services, treatment services, or other services that are integrated with and necessary to the provision of patient care and, if not provided, would adversely impact patient care.”
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michigan MEDICINE® | NOVEMBER / DECEMBER 2020
T
he first category is fairly straight-forward and would include the licensed providers in your practice (NPs, PAs, PTs, MDs or DOs). The second category is more ambiguous. It would certainly include your nurses, medical assistants, CNAs, phlebotomists, laboratory and surgical technicians – positions that are clinical in nature and whose primary job functions include diagnosis, treatment and/or prevention. However, it would no longer include the clerical, administrative and ancillary staff on your team. Even though you could make the argument that your scheduler, for example, is ‘integrated with and necessary to the provision of patient care’, they would mostly likely be viewed as similar to those specifically excluded under this revised definition, i.e.: “records managers, billers, IT professionals, HR personnel, consultants” etc.
The real impact of this new definition of “health care provider” is that employers need to evaluate the essential functions of the employee’s job before deciding if the exemption applies – which leads to the second part of your question. Just because you can exclude some employees from utilizing FFCRA leave, should you? You need to weigh the pros and cons of this decision very carefully. What is the likelihood of your employees all needing to take leave at the same time? Unless there has been an exposure incident in the practice, the chances of this are slim. Even if an employee is not eligible for paid FFCRA leave, it doesn’t prevent them from being out of work for a COVID-related reason. Do you want to give an employee an incentive to lie on their health screening form if they knew that admitting to symptoms would cause them to be off (possibly with no
pay)? Could you cover an employee’s shift if they needed to be out unexpectedly? Does it make a difference if they were clinical or clerical? If you are required to offer paid FFCRA leave to some employees and could manage offering it to all – knowing that you will recoup the wages paid out in the form of a tax credit – then you should consider just making it available to all, regardless of job duties. The goal is to protect your employees, your patients and your reputation in the community, so while you CAN continue to exempt some positions from FFCRA, it may not make good business sense to do so going forward.
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MDHHS UPDATE
Protect Your Adult Patients from Vaccine-preventable Diseases! Alyssa Strouse, MPH, Adult and Adolescent Immunization Coordinator, MDHHS Division of Immunization
Every year thousands of adults in the United States become seriously ill and are hospitalized because of diseases that vaccines can help prevent. Even though many adults may have received the vaccines they needed as a child, protection from some vaccines has likely waned over the years. Many adults are also at increased risk for vaccine-preventable diseases due to their job, lifestyle, travel, or other health conditions. It is especially important considering the COVID-19 pandemic that adults at increased risk for vaccine-preventable diseases are protected.
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michigan MEDICINEÂŽ | NOVEMBER / DECEMBER 2020
A
ccording to the Centers for Disease Control and Prevention (CDC), routine vaccination is an essential preventive care service for children, adolescents, and adults, including pregnant women, that should not be delayed because of the COVID-19 pandemic.1 Further, evidence indicates that a strong provider recommendation is the number one predictor in whether a patient chooses to vaccinate. Therefore, it is essential that healthcare personnel provide strong recommendations for all Advisory Committee on Immunization Practices (ACIP)-recommended vaccines at every age. Healthcare providers should take steps to ensure that their patients continue to receive vaccines according to the Standards for Adult Immunization Practice. Older adults and adults with underlying medical conditions are at increased risk for preventable disease and complications if vaccination is deferred. Influenza vaccine is recommended for all persons aged 6 months and older. During the COVID-19 pandemic, reducing the overall burden of respiratory illnesses is crucial to protect vulnerable populations at risk for severe illness, the healthcare system, and other critical infrastructure. Healthcare providers should use every opportunity during the flu season to administer influenza vaccines to all eligible persons, especially those at increased risk including adults 65 years and older, pregnant women, and persons with certain underlying medical conditions.2 Vaccination of pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can decrease the risk for influenza and pertussis among
pregnant women and their infants. ACIP recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered at any time during pregnancy. According to CDC, pregnant women who receive a flu vaccine reduce their risk of being hospitalized with influenza by an average of 40%. (2) ACIP also recommends that women receive Tdap during each pregnancy, preferably during the early part of gestational weeks 27–36 to maximize the maternal antibody response and passive antibody transfer to the infant.3 Infants less than 2 months old are too young to be protected by the childhood pertussis vaccine series and therefore susceptible to increased morbidity and mortality due to pertussis. In infants younger than 1 year of age who get pertussis, about 50% will require hospital treatment, 61% will experience apnea, 23% will develop pneumonia and 1% will die.4 Adults age 65 years and older are at increased risk for influenza and pneumococcal disease due to weakened immune systems. According to CDC, between 70% and 85% of seasonal flu-related deaths have occurred in people 65 years and older, and between 50% and 70% of seasonal flu-related hospitalizations have occurred among people in this age group.5 Further, pneumococcal disease is the leading cause of serious illness worldwide and can be deadly for older adults. CDC estimates that pneumococcal pneumonia will kill about 1 in 20 older adults who get it. There are two pneumococcal vaccines available, PCV13 (pneumococcal conjugate vaccine) and PPSV23 (pneumococcal polysaccharide vaccine), to protect adults 65 years and older from pneumococcal disease.
Vaccines are not just for children. It is crucial that all persons, especially adults, are protected against vaccinepreventable diseases. Routine vaccination prevents illnesses that lead to unnecessary medical visits, hospitalizations, and further strain on the healthcare system. During this influenza season, influenza vaccination will be paramount to reduce the impact of respiratory illnesses in the population and resulting burdens on the healthcare system during the COVID-19 pandemic. (1) MDHHS may be able to provide flu vaccine for those that are interested, please visit www.michigan.gov/flu for more information.
REFERENCES 1 Centers for Disease Control and Prevention (CDC). (2020, June 9) Vaccination Guidance During a Pandemic. Retrieved from https://www.cdc.gov/vaccines/ pandemic-guidance/index.html 2 Centers for Disease Control and Prevention (CDC). (2019, September 24). Pregnancy and Vaccination: Toolkit for Prenatal Care Providers. Retrieved from https:// www.cdc.gov/vaccines/pregnancy/hcp-toolkit/index. html 3 Razzaghi H, Kahn KE, Black CL, et al. Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020. MMWR Morb Mortal Wkly Rep 2020;69:1391–1397. DOI: http://dx.doi.org/10.15585/ mmwr.mm6939a2 4 Centers for Disease Control and Prevention (CDC). (2017, June 29). Pregnancy and Whooping Cough. Retrieved from https://www.cdc.gov/pertussis/pregnant/ hcp/rationale-vacc-pregnant-women.html 5 Centers for Disease Control and Prevention (CDC). (2020, September 22). Seasonal Influenza (Flu): Flu & People 65 Years and Older. Retrieved from https://www. cdc.gov/flu/highrisk/65over.htm
NOVEMBER / DECEMBER 2020 |
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michigan MEDICINE® | NOVEMBER / DECEMBER 2020
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NOVEMBER / DECEMBER 2020 |
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13
COVID-19 Is Changing Liability Risks and Litigation in Healthcare Bill Fleming, Chief Operating Officer, The Doctors Company
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michigan MEDICINE® | NOVEMBER / DECEMBER 2020
Contributed by The Doctors Company
thedoctors.com
Across the spectrum of care, healthcare delivery is changing as the COVID-19 pandemic continues, creating additional pressures to maintain patient safety and shaping new liability risks for hospitals, group practices, and solo physicians.
U
nderstanding how these new risk exposures are unfolding—and how adverse events may be litigated in a courtroom environment also under strain—is the first step to taking protective measures.
Delay of elective procedures may be a source of increased litigation—many biopsies for cancer, for instance, have lately been delayed, and delay in diagnosis was already one of the most expensive areas of litigation pre-COVID19.
Mr. Fleming offers his expert insights:
Other delays in care many be linked to access issues. Telemedicine has been a lifesaver for many during this crisis, but some vulnerable patients may lack access. Infrastructure can also present a barrier to telemedicine care, as some do not have sufficient internet bandwidth for video visits.
What kinds of lawsuits do you expect to see linked to the COVID-19 pandemic? Extraordinary circumstances and a steady stream of directives (and revisions thereto) from state and local governments have pressed physicians, practices, and hospitals to practice medicine in ways they never have before—or to not practice medicine, when certain elective forms of care have been suspended by government action, often to conserve PPE and other resources. In spite of reasonable efforts under difficult conditions, it’s likely that some adverse events will be traced to this time. It is important to note that “elective” in this context does not mean unnecessary or optional. It includes important screening and diagnostic procedures such as colonoscopies, some cancer and cardiac surgeries, and most dental procedures.
Moreover, circumstances have forced physicians to use telemedicine in ways they usually might not. Telemedicine is ideally an adjunct to in-person care, and therefore not the best option for a first visit with a new patient, but during peak infection risk, exceptions had to be made. Among our infrequent telemedicine claims pre-COVID-19, misdiagnosis of cancer was the top allegation, and I can’t imagine that risk of misdiagnosis has decreased, given the spike in telemedicine usage under nonoptimal conditions. Also, I anticipate that some COVID-19related cases will focus on shortages of personal protective equipment (PPE)— those claims may come from patients or employees.
As you’ve said, providers are delivering care differently during COVID-19. How do these changes diminish or increase risks? In the crush of managing a public health crisis, many hospitals and practices have had to take temporary measures that impact patient safety: Some of these measures mitigate certain risks but may amplify others. Healthcare providers in hard-hit areas are working longer hours, sometimes with insufficient PPE, sometimes in large tents put up in parking lots or other overflow sites. In surge locations, staff from other departments may be covering in the emergency department (ED) or intensive care unit (ICU)—this could increase the risk of communication gaps. All of these resource-stretching measures, taken together, may add up to a risk profile that is more than the sum of their parts. While responding to health directives from state and local governments, as well as advisories from the Centers for Disease Control and Prevention (CDC) and other trusted sources, hospitals and practices will continue to experience unavoidable delays in treatment to all patients. Testing delays do not help. In addition, by patient preference, many routine checkups and tests have been delayed, not to mention routine procedures. Adverse events linked to these delays could affect physician liability. (CONTINUED ON PAGE 22)
NOVEMBER / DECEMBER 2020 |
michigan MEDICINE®
15
Contributed by The Doctors Company
thedoctors.com
What can physicians and practices do to protect themselves during the pandemic? Conscientious documentation becomes a witness for the physician in the courtroom. In the COVID-19 era, practices may benefit from documenting not only individual patient interactions, but how the practice is following CDC infection control guidelines and recommendations from state and local health authorities at particular points in time. This could be as simple as jotting a daily note in an electronic calendar.
How are courtroom changes during the pandemic challenging defense teams?
16
During trial, showing evidence must be done differently, so defense teams need solid technology skills in settings where counsel can publish exhibits to the jury using large screens. Some courts are taking 15-minute breaks every hour for better ventilation and cleaning. This breaks the momentum when an attorney is speaking with a witness, reduces the overall trial time per day, and prolongs the trial duration. Taking time out of a practice to participate in an extended trial can further stress a stretched practice.
Litigation stress places a burden on physicians at any time. How is this different during the pandemic?
A) In a recent medical malpractice suit, a physician member of The Doctors Company, with assistance of counsel and The Doctors Company’s support, secured a defense verdict despite many changes in the courtroom environment that could have posed problems if we had not been prepared to adjust.
Individual trials are taking longer, compounding delays from the existing backlog. This keeps physicians in limbo—and could even affect their credentialing. As previously reported by RAND, pre-pandemic, on average, physicians were already spending more than 10 percent of their careers living under the shadow of an open malpractice claim.
We’ve seen firsthand how physicians facing a court hearing during COVID-19 need a legal team that is prepared for changes in depositions, jury selection, and the trial itself. For instance, depositions may be completed by video, with multiple screens for the attorneys, parties and exhibits, and jury selection may take place partly via written communication.
It is true that at any time, even the best of physicians could find themselves facing an unexpected lawsuit. And states around the country handle cases differently. That’s why our members are supported by legal teams with deep roots and expertise in members’ local venues. In addition, knowing that the stress of malpractice litigation affects physicians deep-
michigan MEDICINE® | NOVEMBER / DECEMBER 2020
ly, and knowing that preparation is the key to victory, we support our members through in-depth litigation preparation. Like the COVID-19 pandemic itself, pandemic-related risk exposures are fluid. Physicians, practices, hospitals, and systems are facing rapid changes in liability exposures at the same time as the dayto-day business of healthcare is changing under their feet. The Doctors Company is prepared to assist our members through lawsuits during these unprecedented times so that, even with changes in the courtroom, members can present their best defense.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered. Reprinted with permission. ©2020 The Doctors Company (thedoctors.com).
F
or more than 150 years, the Michigan State Medical Society (MSMS) has offered continuing medical education courses in both clinical education and practice transformation for members in all levels of their careers. The MSMS Foundation presents courses for members, their office staff, and executive leaders in health care. This year due to the COVID-19 pandemic, we have strived to be more creative and adaptable for our members so that we are able to offer important CME in both a timely and safe manner. We also offer a robust selection of on-demand webinars focusing on COVID-19 and the state of Michigan medical licensing requirements including human trafficking, medical ethics and pain management.
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michigan MEDICINEÂŽ
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CME REQUIREMENTS
Licensure Requirements
Categories of CME
Effective January 4, 2019, the Michigan Department of Licensing and Regulatory Affairs (LARA) announced an additional one-time training in opioids and controlled substances awareness.
The Board of Medicine has updated the previous six Categories of Credit into two categories. As before, each medical doctor is required to complete 150 hours of continuing medical education approved by the board of which a minimum of 75 hours of the required 150 must be earned in Category 1 activities. The following is a breakdown of the two Categories for licensure:
For Controlled Substance Licenses: Opioids and Other Controlled Substances Awareness Training Standards for Prescribers and Dispensers of Controlled Substances – This is a one-time training that is separate from continuing education for an individual seeking a controlled substance license or who is licensed to prescribe or dispense controlled substances. Visit https://msms.org/requirementsopioidscontrolled for details on required content. Licensees that prescribe or dispense controlled substances who renewed in 2019 must complete training by January 2023; renewals for 2020 by 2024, renewals by 2021 by 2025. Beginning in September 2019, completion of the training is a requirement for initial licensure. In December 2016, the Michigan Department of Licensing and Regulatory Affairs revised Medical Rules. Significant changes to be aware of include: • Training Standards for Identifying Victims of Human Trafficking This is a one-time training that is separate from continuing education. Licensees renewing for 2017 must complete training by renewal in 2020; renewals for 2018 by 2021, and renewals for 2019 by 2022. Beginning in 2021, completion of the training is a requirement for initial licensure. Visit https://msms.org/requirementshumantrafficking for details on required content.
Category 1 A. Activities with accredited sponsorship - Maximum 150 hours B. Passing specialty board certification or recertification – Maximum 50 hours C. Successfully completing MOC that does not meet requirements of (A) or (B) above. – Maximum 30 hours D. Participation in a board approved training program - Maximum 150 hours
Category 2 A Clinical instructor for medical students engaged in postgraduate training program – Maximum 48 hours B. Initial presentation of scientific exhibit, poster or paper - Maximum 24 hours C. Publication of scientific article in a peer-reviewed journal - Maximum 24 hours D. Initial publication of a chapter or portion of a chapter in a professional health care textbook or peer-review textbook - Maximum 24 hours E. Participation in any of the following as it relates to the practice of medicine: Maximum 18 hours 1. Peer review Committee dealing with quality of patient care
• Education on Pain and Symptom Management 2. A Committee dealing with utilization review Starting in December 2017, a minimum of three hours of continuing 3. A health care organization committee dealing with patient care issues education shall be earned. 4. A national or state committee, board, council or association • Medical Ethics F. Until December 6, 2019, attendance at an activity that was approved by the A minimum of one-hour of continuing education shall be earned. Board of Medicine prior to December 6, 2016 - Maximum 36 hours MSMS will offer these new requirements throughout the year including sessions at the Spring Scientific Meeting and the Annual Scientific Meeting. In addition,“ A Day of Board of Medicine Renewal Requirements” conferences will be offered in the spring and fall and will be solely focused on the four new requirements. On-demand webinars are also available online at www.MSMS.org/OnDemandWebinars.
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G. Independently reading a peer-reviewed journal prior to December 6, 2016, that doesn’t satisfy the requirements of Category 1, subdivision (A) - Maximum 18 hours H. Prior to December 6, 2016, completing a multi-media self assessment program that doesn’t satisfy the requirements of Category 1, subdivision (A) Maximum 18 hours
CME FOR COVID-19 CARE
Executive Order 2020-82 allowed the Michigan Department of Licensure and Regulatory Affairs (LARA) to recognize hours worked responding to the COVID-19 emergency as hours toward continuing education courses or programs required for licensure. The credit period was March 17, through June 9, 2020, but physicians may report those credits to MSMS any time before December 1, 2020, at https://www.surveymonkey.com/r/MSMSCOVID19. To date, nearly 2,000 physicians have submitted hours related to COVID-19.
Fall Symposium on COVID-19 – Now Online This webinar highlights Michigan's current status and next steps, science, policy and practice of the COVID-19 pandemic. The is a total of 7.5 AMA PRA Category 1 Credit(s)™ for both sessions. Presentations include:
General Overview of COVID-19 in Michigan Speaker: Natasha Bagdasarian, MD, Senior Public Health Physician, Michigan Department of Health and Human Services
Science and Clinical Side of COVID-19 Speaker: Sandro K. Cinti, MD, Professor of Infection Disease, Michigan Medicine
Treating Diabetes-Cardiology Patients with COVID-19 Speaker: Caroline R. Richardson, MD, University of Michigan Medical School
Cronavirus Vaccines 101 Speaker: Robert (Bob) Swanson, Director, Division of Immunization, Michigan Department of Health and Human Services
Contact Tracing and Tracking in Michigan Speaker: Jonathan Warsh, Chief of Staff, Michigan Department of Health and Human Services
COVID-19 Testing Options Speaker: Marty K. Soehnlen, PhD, MPH, PHLD(ABB), Director of Infectious Disease, Michigan Department of Health and Human Services
MI-COVID19 Comprehensive, Multi-Site Registry Speaker: Scott Flanders, MD, Program Director, Michigan Hospital Medicine Safety Consortium; Chief Clinical Strategy Officer at Michigan Medicine; and Professor of Internal Medicine – Hospital Medicine at the University of Michigan Medical School
Eliminating Disparities in Health Care Speakers: Rachel M. Bond, MD, FACC, System Director, Women's Heart Health, Dignity Health, Arizona; Assistant Professor, Internal Medicine Division of Cardiovascular Disease Creighton University School of Medicine, Chandler, AZ Keith C. Ferdinand, MD, FACC, FAHA, FNLA, FASH, Professor of Medicine, Gerald S. Berenson Endowed Chair in Preventive Cardiology, Tulane University School of Medicine Tulane Heart and Vascular Institute, New Orleans, LA
A Virtual Visit about Telemedicine Risks and Claims Speaker: Pamela S. Schremp, Assistant Vice President, Claims, The Doctors Company NOVEMBER / DECEMBER 2020 |
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OTHER FALL CONFERENCES
MSMS Foundation is offering 60.75 AMA PRA Category 1 Credit(s)™ with our Fall Virtual Conference lineup. All of the events will be held live online and available on archive afterwards.
24th Annual Conference on Bioethics: Moral Courage and Medical Professionalism
A Day of Board of Medicine Renewal Requirements
Saturday, November 14, 2020
5 AMA PRA Category 1 Credit(s)™
5.25 AMA PRA Category 1 Credit(s)™
Wednesday, November 18, 2020
This conference fulfills LARA’s requirement for three hours in the
This conference fulfills LARA’s requirement for one hour in
area of pain and symptom management, one hour in the area of
the area of medical ethics. Topics include: medicine and the
medical ethics, and 1-time human trafficking. It also fulfills the
Holocaust, medical care for immigrants and refugees, global
new (effective January 4, 2019) one-time license requirement
health work in dangerous regions, confronting racial injustice,
for opioids and other controlled substances awareness training
and rationing and resource allocation in a pandemic.
standards for prescribers and dispensers of controlled substances.
5.25
5
AMA/PRA CATEGORY 1 CREDIT(S) TM
For a complete list of MSMS Foundation education offerings, please visit: msms.org/Education
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IMPLICIT BIAS TRAINING
As part of her response to the COVID-19 pandemic and the disproportionate impact the virus has on people of color, Governor Whitmer issued Executive Directive 2020-7, requiring health professionals to take implicit bias training.
• Thus far, COVID-19 is more than four times more prevalent among black patients than among white patients. The hope is this disparity can be reduced through training designed to address unconscious bias by medical professionals. • As dictated by the directive, the Michigan Department of Legal and Regulatory Affairs (LARA) is required to consult with relevant stakeholders—including the Michigan State Medical Society—by November 1, 2020 to help determine relevant goals and concerns under the new rule. Through this process, MSMS will advocate for a flexible curriculum that allows any continuing medical education (CME) provider—such as local hospitals—to provide the required programming. • It will be at least a year before any new rules are officially promulgated, and even longer before any required training is developed and offered. In years past, any new mandated continuing medical education has had at least a three-year roll out.
Despite that long horizon, there are CME opportunities on racial inequality and implicit bias in the near term that our members can take advantage of, including: ◆ A Tele-Town Hall for Physicians with Jason Adam
Wasserman, PhD, available online now titled, “Race Inequalities and COVID-19: Contagion, Severity, and Social Systems” ◆ A session on Eliminating Disparities in Health Care
during the Fall Symposium on COVID-19 with Rachel M. Bond, MD, and Keith C. Ferdinand, MD. All of these CME opportunities were scheduled before Governor Whitmer issued her directive, and we encourage physicians and providers to participate in any these trainings. However, please note that they may not count toward any relicensure requirements, which will likely be dictated by official start associated with this new training requirement that has yet to be determined.
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ON-DEMAND WEBINARS
Online learning is a popular choice for physicians to earn CME, and MSMS continues to expand its online library. To date, MSMS has added 20 new webinars to its catalog including numerous options on COVID-19 and the mandatory content areas for relicensure. Many of these are free to members.
FREE! COVID-19 On-Demand Webinars COVID-19: AMA Advocacy and Physician Resources CME Credits: .75 COVID-19: Best Practices for Implementing Telemedicine CME Credits: .75 COVID-19: CARES Act Impact CME Credits: 0.50 COVID-19: CARES Act Impact: Q&A with CPAs CME Credits: .75 COVID-19: CARES Act Impact: Q&A with CPAs 2.0 CME Credits: .75 COVID-19: New Employment Policies for Practices CME Credits: .50 COVID-19: New Waivers and Billing Changes for Telemedicine CME Credits: 1.0 COVID-19 and Race Inequalities: Contagion, Severity, and Social Systems CME Credits: .75 COVID-19: Safe and Innovative Office Procedures for Seeing Patients CME Credits: .75 COVID-19: Telemedicine and Other Technology Codes in a COVID-19 Environment CME Credits: 0.75 COVID-19: Testing, Tracing and Tracking CME Credits: .75 COVID-19: What Physicians Need to Know as Employers During the Pandemic CME Credits: 1.0
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michigan MEDICINE® | NOVEMBER / DECEMBER 2020
Webinars that meet Board of Medicine Requirements: Human Trafficking Medical Ethics – Conscientious Objection among Physicians Medical Ethics – Decision Making Capability Medical Ethics – Just Caring: Physicians and Non-Adherent Patients Pain and Symptom Management Series Balancing Pain Treatment and Legal Responsibilities MAPS Update and Opportunities Michigan Automated Prescription System Update Pain and Opioid Management Prescribing Legislation Tapering Off Opioids The CDC Guidelines The Current Epidemic and Standards of Care The Role of the Laboratory in Toxicology and Drug Testing Treatment of Opioid Dependence Update on the Opioid Crisis 2019 (Fulfills the 1-time training on opioids and other controlled substances awareness)
Coding and Billing Webinars: Medical Necessity Tips on Documentation to Prove it
Visit msms.org/OnDemandWebinars for complete listing of On-Demand Webinars. Register online at msms.org/eo or call the MSMS Registrar at 517-336-5789.
Webinars at No Cost to Members: Balancing Pain Treatment and Legal Responsibilities CARES Act Impact Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities HEDIS Best Practices Integrating Pharmacists into Practice: The Missing Link for Comprehensive Medication Therapy Management Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media MAPS Update and Opportunities Medical Necessity Tips on Documentation to Prove it Michigan Automated Prescription System Update Prescribing Legislation Section 1557: Anti-Discrimination Obligations Sexual Misconduct – Prevention and Reporting
Statement of Accreditations The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. AMA Credit Designation The Michigan State Medical Society designates this enduring material 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. AMA Credit Designation The Michigan State Medical Society designates this enduring material for a maximum of .75 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity. AMA Credit Designation The Michigan State Medical Society designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity.
Telemedicine and Other Technology Codes in a COVID-19 Environment Update on Chronic Fatigue Syndrome Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS Update on Chronic Fatigue Syndrome Part 2: Uniting Compassion, Attention and Innovation to treat ME/CFS What Physicians Need to Know as Employers During the COVID-19 Pandemic
Other Webinars: Michigan Medical Marihuana Law Non-Pharmacologic Management of Musculoskeletal Pain Syndromes
NOVEMBER / DECEMBER 2020 |
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JOINT PROVIDERSHIP
Michigan State Medical Society provides joint providership to accredit CME activities that are hosted by other institutions. Certification of your continuing education activity adds value to your education efforts.
MSMS is dedicated to facilitating innovative medical education that promotes evidence-based change, professional development, and improved patient outcomes. Approximately 5,000 physicians received CME through our program last year. O ur joint providership partners include specialty, regional, and national organizations. The application fee is based upon the total hours of credit available. MSMS provides all forms and templates. Unlike other providers, there is no additional per attendee charge. O ur team of leading medical educators have a proven track record of leveraging their expertise to help our partners grow their organizations and maximize the impact of their educational programming.
For more information and rates, please contact Brenda Marenich at 517-336-7580 or via email at bmarenich@msms.org. Â 24
michigan MEDICINEÂŽ | NOVEMBER / DECEMBER 2020
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24th ANNUAL CONFERENCE ON BIOETHICS
Moral Courage and Medical Professionalism Virtual Conference
November 14, 2020 8:45 am - 4:00 pm
Supported by Blue Cross Blue Shield of Michigan Foundation
michiganMEDICINE® 26 26 michigan MEDICINE® | | NOVEMBER NOVEMBER/ /DECEMBER DECEMBER2020 2020
Saturday, November 14, 2020 8:45 am
Welcome and Opening Remarks Jason Wasserman, PhD, Associate Professor, Department of Foundational Medical Studies, Department of Pediatrics, Oakland Beaumont School of Medicine, and Chair, MSMS Bioethics Conference 9:00 – 9:45 am
2:15 – 3:00 pm
Redefining Essential: Healthcare Workers and Pandemic Scarcity Andrew Shuman, MD FACS, Associate Professor, Department of Otolaryngology – Head and Neck Surgery, University of Michigan Medical School, Chief, ENT Section, Surgery Service, VA Ann Arbor Health System, and Chief, Clinical Ethics Service Center for Bioethics and Social Sciences in Medicine
Keynote Speaker – Nazi Doctors and Modern Medical Ethics: Lessons Learned from a Painful Legacy
3:00 – 3:45 pm
Matthew Wynia, MD, MPH, FACP Director, Center for Bioethics and Humanities, University of Colorado, Professor, University of Colorado School of Medicine and Colorado School of Public Health
3:45 pm
10:00 – 10:45 am
Jason Wasserman, PhD, Associate Professor, Department of Foundational Medical Studies, Department of Pediatrics, Oakland Beaumont School of Medicine, and Chair, MSMS Bioethics Conference
Selecting and Training Medical Students in an Era of Deprofessionalization Alexandra Vinson, PhD, Assistant Professor of Learning Health Sciences, Director of the Medical Education Scholars Program, University of Michigan Medical School 11:00 – 11:45 am
Asylum Seekers at the US/Mexican Border: Reflections from a Public Health Official Linda Hill, MD, MPH, Clinical Professor, Family Medicine and Public Health, UC San Diego 11:45 am – 12:15 pm
Lunch 12:15 – 1:00 pm
The Benefits and Challenges of Medical Mission Work in Sub-Saharan Africa Kenneth Peters, MD Chief, Department of Urology, Beaumont Hospital, Royal Oak J. Peter and Florine Ministrelli Distinguished Chair in Urology 1:15 – 2:00 pm
Racial Disparities in Maternal Morbidity and Mortality: A Persisting Crisis Courtney Townsel, MD, MSc, Assistant Professor, Obstetrics and Gynecology, University of Michigan
Student Rapid Fire Paper Session
Closing Remarks
Learning Objectives • Articulate the complex nature of medical professionalism from an ethical and sociological point of view. • Discuss the potential social obligations of physicians during times of social crisis. • Discuss the moral dilemmas between one’s obligations to self or family on the one hand, and one’s professional and social commitments on the other. • Identify and critique an ethical framework for the allocation of scarce resources. Statement of Accreditation The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. AMA Credit Designation Statement The Michigan State Medical Society designates this live activity for a maximum of 5.25 AMA PRA Category 1 CreditsTM. Physicians should claim only credit commensurate with the extent of their participation in the activity.
Visit msms.org/eo to register today! NOVEMBER / DECEMBER 2020 |
michigan MEDICINE®
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michigan MEDICINE® | NOVEMBER / DECEMBER 2020
Fix Prior Authorization Because Health Can’t Wait
Activate your political voice!
Support Senate Bill 612
Get started at mdpac.org
Prior authorization and step therapy/fail first requirements hamstring treatment, drive up nonadherence to medication and lead to diminished health. It’s onerous and needless insurance company bureaucracy, and it’s negatively affecting patients, physicians, providers and their practices.
The Michigan Doctors’ Political Action Committee (MDPAC) is the political arm of the Michigan State Medical Society. It is a bipartisan political action committee made up of physicians, their families, residents, medical students and others interested in making a positive contribution to the medical profession through the political process. MDPAC supports pro-medicine candidates running for political office in Michigan.
It’s time we cut out the red tape, because at the end of the day, health can’t wait. And now we can do just that. State lawmakers recently introduced SB 612, a bill that reforms the prior authorization and step therapy/fail first process by introducing new transparency, fairness and clinical validity requirements, ensuring our patients receive timely coverage decisions, and ultimately, the care and treatment they need.
Physician engagement is essential to the success of a pro-medicine legislature. Current and potential lawmakers want and need to hear from professionals in the field of medicine. Through MDPAC, you will activate your voice on the things most important to Michigan physicians.
Join MDPAC today!
This is the kind of reform our patients deserve—it’s time to put them first.
Five Reasons t
BACK the
Please contact your lawmakers today and urge them to support SB 612.
The Michigan Doctor Action Committee (M and maintains strong with lawmakers, as w dates running for po
As the face of physic
MSMS Engage – https://MSMS.org/engage
bring medical know discussions with p decision makers.
Activate your political voice!
For more than thre MDPAC has mount successful lobbyin behalf of physician
Connecting constituents and lawmakers is a critical and central function of grassroots advocacy. MSMS’ Engage gives users access to an editable, The Michigan Doctors’ Political Action Committee (MDPAC) is prefilled web-form letter sending system, which has become the easiest and most effective way fortheconstituents to contact theirSociety. lawmakers. political arm of the Michigan State Medical It is a bipartisan political action committee made up of Communicate, educate, engage, and activate on the things that are most important to Michigan physicians. With Engage, YOU become a “virtual physicians, their families, residents, medical students and others interested in making a positive contribution to the medical lobbyist,” so please familiarize yourself with Engage and take action now! profession through the political process. MDPAC supports pro-medicine candidates running for political office in Michigan. Physician engagement is essential to the success of a pro-medicine legislature. Current and potential lawmakers want and need to hear from professionals in the field of medicine. Through MDPAC, you will activate your voice on the things most important to Michigan physicians.
NOVEMBER / DECEMBER 2020 |
For example... MDPA strengthens tort refo the physician’s tax,
helped to stop the e non-physician’s sco
MDPAC has power, respect! If you wake giant, MDPAC could m positive change for p patients. It could eas pressures with the cu authorization proces
and time on your M Certification, and ad health issues.
Trial lawyers, insuran and other political op massive sums of mon
michigan MEDICINE®
Medicine’s friends MDPAC, must dig de equivalent or greate of funds to advance M
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physician’s agenda. The current political
Welcome New Members www.msms.org/Membership
Dickinson/Iron County
Muskegon County
Tiffany Darling, MD
David Van Winkle, MD
Eaton County
Northern Michigan
Anthony Marl, DO
Genesee County Faheem Ahmad, MD David Bergman, MD
Sarah Wolf, DO
Oakland County Leslie Caren, MD Gena Harrison, MD Brandon Trivax, DO
Ingham County
Ottawa County
Gertrude Hawkins, DO
Michael Cheek, MD Jon Hop, MD
Kalamazoo Academy of Medicine
Sara Kane-Smart, MD
John Munn, MD
John Khoury, MD
William Ranger, MD, FACS
Theodore Kostiuk, DO
Kent County
Jeffrey Stuk, DO
Aiesha Ahmed, MD Kurt Ashack, MD Eileen Axibal, MD Gregory Bever, MD Eric Chow, MD Alison Gehle, MD
Brian Paff, DO John Swartz, DO
Sagniaw County Eventure Bernardino, MD
St. Clair County Michael Paul, MD, FACEP
Antonia Henry, MD Erik Ratchford, DO
Wayne County
Haritha Reddy, MD
Keh-Chyang Liang, MD
Andrew Sochacki, MD Rebecca Van Valkenburg, DO
Macomb County Peter Lopez, MD
Marquette/Alger County Garrett Kerns, DO
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michigan MEDICINE® | NOVEMBER / DECEMBER 2020
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