TriAd FAll 2012 volUME 23 ISSUE 4
ThE AWARD WINNINg JoURNAl oF ThE MIchIgAN oSTEoPAThIc ASSocIATIoN
AdVOCACy
iN ThiS iSSUE: • FiTTiNg AdVOCACy iNTO yOUr LiFE • 2012: hEALTh CArE POLiCy rEViEW • E-PrESCriBiNg mALPrACTiCE riSkS • TiPS FOr SUrViViNg OPEN ENrOLLmENT SEASON TRIAD, FAll 2012
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We created the Tribute Plan to provide doctors with more than just a little gratitude for a career spent practicing good medicine. Now, the Tribute Plan has reached its five-year anniversary, and over 22,700 member physicians have qualified for a monetary award when they retire from the practice of medicine. More than 1,300 Tribute awards have already been distributed. So if you want an insurer that’s just as committed to honoring your career as it is to relentlessly defending your reputation, request more information today. The Michigan State Medical Society exclusively endorses our medical professional liability program, and we are a preferred partner of the Michigan Osteopathic Association. To learn more about our program benefits, including the Tribute Plan, call our East Lansing office at (800) 748-0465 or visit www.thedoctors.com/tribute.
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TABLE OF CONTENTS
FEATURES
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Advocacy 101: Making a Difference
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The MOA’s Advocacy Program
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2012: A Review in Health Care Policy
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Fitting Advocacy Into Your Life
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E=Prescribing Malpractice Risks
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Tips for Surviving Open Enrollment Season
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10 Tips for Effective Advocacy
DEPARTMENTS 24
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Editor’s Notebook
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President’s Page
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AMOA News
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D.O. Spotlight
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Student Spotlight
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Intern-Resident Spotlight
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Inside the AOA
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Dean’s Column
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Advertiser Index
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The future of Michigan is looking healthier than ever.
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e d i tor’s noteboo k
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by Bruce A. Wolf, D.O.
cannot remember a time during which so much in health care is changing. From the Patient Protection and Affordable Care Act to the latest advancements in electronic health records, the health care industry is going through a significant transformation. Policymakers need to better understand how these changes affect the reason we became physicians: patient care. In order to do that, we must advocate. This issue of TRIAD is focused on advocacy. That word has such a broad meaning and, as physicians, we struggle with time, resources and, even, what being an advocate means. Mirriam-Webster defines “advocate” as “one that pleads the cause of another;” or “one that defends or maintains a cause or proposal.” It is our responsibility to help policymakers understand. Afterall, if we aren’t communicating to them, the health care delivery system will change without any guidance from us. Essentially, if “we don’t speak up for ourselves, no one else will.” In this issue of TRIAD, it is our hope that we have outlined how you can become involved as an advocate for your profession. Whether it’s an hour a month or an hour a year, our legislators need to hear from you. One of the most basic levels of how you can be an advocate is to learn who represents you from the local, state and national levels. I remember the first time I met with my local state Representative. I wasn’t sure what to do, but after some sound advice from a couple of colleagues, I quickly became prepared. After I scheduled an appointment, I took the time to visit his office and discuss a couple of pertinent issues that were happening at the time. He heard my views, asked a couple of questions, which I was able to answer very easily, and that was it. I was hooked from that point. My relationship with my Representative has been maintained to this day. Once you make these contacts, you just may become their go-to person on the issues you spoke about and, perhaps on broader issues, too. The key is to focus on how those issues will affect the public. During this election, many issues and political offices will be decided. I ask that you participate by speaking up. You will be an advocate for yourself, your family and your profession. Bruce A. Wolf, D.O., is TRIAD co-editor-in-chief and a member of the MOA Board of Trustees. He can be reached at BWolf@dmc.org.
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SAVE THE DATE
MOA’s 114th Annual Spring Scientific Convention May 15-18, 2013 | Novi, MI.
NEW LOCATION: Suburban Collection Showplace, Novi, MI. 30 hours of AOA category 1-A CME anticipated | Online registration will begin in January. Watch www.mi-osteopathic.org for the latest updates.
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P R E S ID E N T ’ S P A G E
The times they are a-changin’
by Edward J. Canfield, D.O.
Whether or not you agree with the Supreme Court’s recent decision to uphold the Patient Protection and Affordable Care Act (PPACA), it is now the law of the land and we have to live within the reality. However, questions remain: What does it mean to our patients? What does it mean to physicians? What does it mean to our health care teams? The fact is we really don’t yet know. This will be sorted out as the PPACA is implemented. But one thing we know for sure is the changes will be broad and medicine as we have known it will continue to evolve. As a family physician, I have found the dramatic changes over the last several years to be onerous and difficult. Electronic medical records, e-prescribing, certified medical homes, administrative services organizations, physician hospital organizations, audits and the requests from insurance companies, Medicare and Medicaid have made many seasoned physicians question how they will continue to work within the system, retire or leave the system all together. How all of these changes will be paid for, no one yet knows. At this point in the history of medicine, it is more important than ever before that physicians have a seat at the table to advocate for our patients, our practices and our profession. We need to become more active in the political process and our association to be sure our voices will be heard. If the changes over the last several years have taught us anything, it is that if we don’t do something, something will be done to us. We need to be out front. We need to lead. I am very proud to be involved with the Michigan Osteopathic Association (MOA) and their team, led by Kris Nicholoff, CEO and executive director. The MOA is in constant contact with state and national leaders and learns the issues early so we can act appropriately. Additionally, MOA committees, chaired by our board members, work on specific issues from government affairs to ethics and everything in between to ensure your MOA responds quickly. While your involvement requires a commitment and, at times, may be difficult, your MOA continues to work to protect you and your patients. No one has all the answers, but we continue to work toward solutions. Your MOA is at the table! MOA President Edward J. Canfield, D.O. is a family physician in Sebewaing, MI. He may be reached at ejcanfield.do@gmail.com.
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AMOA NEWS
A
by Dana Borenitsch
s I’m into my first year as president of the Advocates for the Michigan Osteopathic Association (AMOA), I am truly grateful for the support I’ve received from my fellow advocates and our osteopathic physicians. I am excited about what we stand for, the encouragement and support we provide osteopathic medical students and our spouses. Our major goal is to promote osteopathic medicine to the public. The AMOA is very proud to be personally involved in representing the osteopathic profession in a variety of venues. We distribute magnets promoting our website, which inform every one of our current information and activities, including: • The advocates attend D.O. Day on the Hill in Washington, D.C. • Two of our chapters participate in annual breast cancer runs/walks in various locations. • The Macomb advocates are active in the preparation and serving of meals at the Salvation Army several times a year. • The Saginaw advocates represent the osteopathic profession at local health fairs. • One of our advocates attend Michigan legislative meetings keeping us current on any medical information being discussed in Lansing. Many of our Michigan Advocates are past presidents of the national board and remain actively involved. We are very proud of Nancy Granowicz who will be installed this year as the president of the Advocates for the American Osteopathic Association (AAOA). The AMOA sponsors a variety of fundraising activities, including: the Tree of Peace, Proscripts, and a raffle during our annual meeting. Some of the proceeds provide the freshman osteopathic medical students with flash drives and various scholarships. We also purchase an advertisement in the Michigan State University/Michigan Osteopathic College Foundation (MOCF) Ball program and provide the way for several students to attend. Several of our advocates work closely with the Student Advocates Association, our osteopathic students, planning various activities that benefit their spouses and provide activities for their entire family. They have some of their own great fundraising programs and offer many give-a-ways during their activities. I consider myself fortunate to be a part of this wonderful group. Everyone adds their own God-given gifts that benefit so many others! My motto for the year is by Charles Allen: “Remember that you are needed. There is at least one important work to be done that will not get done unless you do it.” This is so true! I want to sincerely thank you if you are already involved. Those of you who aren’t yet involved, now is the time! We have so much fun, and are awaiting your friendship. You are SO important to this organization! Dana Borenitsch is the president of Advocates for the Michigan Osteopathic Association. She can be reached at dborenitsch@hotmail.com.
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c oN cRAIg MAgNATTA, D.o.
raig Magnatta, D.O.’s more than three decade career as a family practice physician is not an unfamiliar tale. While he was in medical school at the Michigan State University College of Osteopathic Medicine, he began his involvement with the Michigan Osteopathic Association. He’s served on the organization’s board and is a past president, all while managing a clinic in Oxford and another in Rochester Hills. His commitment to his profession, however, doesn’t stop with his practice. “I’ve always felt that I was given the opportunity to become a physician and I always felt that I needed to be actively involved and advocate for osteopathic physicians through my whole career,” he explains. “Now I’m even more interested in advocacy because my son is an osteopathic family resident in Traverse City and I want to try to make the health care fi eld a better place for physicians coming up in the next generation.” Magnatta plays an active role in working with legislators and others to understand the unique challenges and needs of physicians, and to help ensure the next generation of physicians, like his son, are able to provide the best care possible to their patients. To Magnatta, the dual role of physician and advocate is a positive one. “Being involved as an advocate is a change of pace from caring for patients. I think it not only stimulates interest in advocacy but also rekindles the interest in providing care to your patients.” Magnatta admits advocacy is easy to ignore for physicians, but he has found making it a priority is a matter of proper planning. “I try to schedule meetings with the organizations I’m involved with in the morning before offi ce hours or in the evening after offi ce hours and then possibly on weekends. I like to take care of patients and have busy practices. I don’t want to give that up to be an advocate so I try to arrange my schedule so that I continue to care for patients and still have time to interact with legislators when needed.” Magnatta sees the value in advocating on behalf of all physicians, but particularly primary care. As a primary care physician himself, he sees fi rsthand the struggles and is able to relay these experiences directly to legislators and others. “We need to advocate for physicians in general, but especially with the impending primary care shortage, all physicians need to advocate for primary care.” Thanks to Magnatta’s proactive efforts, he is working to create an environment from which his son and all future physicians can benefi t.
cRAIg MAgNATTA, D.o. IS A PRIMARy cARE PhySIcIAN WITh clINIcS IN oxFoRD AND RochESTER hIllS. hE cAN bE REAchED AT MAgNATTAc@Aol.coM.
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STUdENT SPOTLighT
oN STEvE PRoPER mSUCOm d.O.-Phd PrOgrAm STUdENT STEVE PrOPEr (righT) WiTh hiS mENTOr dr. JOhN LAPrES, ASSOCiATE PrOFESSOr, BiOChEmiSTry & mOLECULAr BiOLOgy dEPArTmENT AT miChigAN STATE UNiVErSiTy.
Steve Proper is not your average medical student. Now in his seventh year of the D.O.-PhD Program at Michigan State University College of Osteopathic Medicine (MSUCOM), Proper spent his fi rst post-graduate year working on his PhD, his second and third years in a traditional medical school environment and is now in the lab wrapping up his PhD. When he fi nishes this fall or spring, he’ll head out to complete his rotations and fi nish the D.O. degree. Add on top of that his undergraduate degree from one of the nation’s top engineering schools, Kettering University, and you’ve got a unique perspective on medicine. “When I was in undergrad I did several rotations in laboratories -- indoor air chemistry, immunotoxicology, it was all biomedical related,” he explains. “I was interested in doing research but also very interested in going to medical school. I really do enjoy interacting with patients and educating them. I thought that doing any one of the things by itself might not give me what I wanted.” Originally from Lansing, returning to MSUCOM was coming back to familiar territory, but with a different perspective after Kettering’s unique schedule of three months in class and three months in a co-op year round. “I think having a co-op is important -- that’s why I went to Kettering in the fi rst place. That was really vital to going down this road.” When Proper goes home at the end of the day, however, he doesn’t just dive into his books. He dives into the legislative process, recognizing the critical role students can play. “Advocacy is important to me,” he says. He has served on the Michigan Osteopathic Association’s Education Committee, has been involved in the annual conference and has attended Michigan D.O. Day and rallies at the State Capitol. “I think the most fun isn’t necessarily standing out on the Capitol lawn. The biggest thing is talking to legislators and giving them your perspective,” Proper says. “I think they listen to students even more than physicians because we’re still seen as ‘innocent’ and not having agendas.” Proper thinks it’s critical students step up and play an active role with their legislators. “I think students need to recognize they have a lot of power when it comes to advocacy. So many just say ‘I’m a student who cares what I think?’ but that’s the wrong perspective. You have more power than you think. For other people it’s just about the politics but in the eyes of the legislator a student walking in the door means a lot. Not enough students are getting involved because they feel too overwhelmed by just learning but they do have a stake in this. When they get an email they should spend a few minutes and realize that it is going to affect them and they do have powerful opinions in the minds of legislators. “Regardless of the issue there is a way that they can make an impact.” STEvE PRoPER IS A SEvENTh-yEAR STUDENT IN MSUcoM’S D.o.-PhD PRogRAM. hE cAN bE REAchED AT PRoPERST@MSU.EDU.
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A ON ADAM HUNT, D.O.
dam Hunt, D.O. grew up in Troy, Michigan but his academic career gave him a global perspective. After completing undergrad at the University of Michigan and obtaining Master’s Degree in International Health at Johns Hopkins University, Hunt spent a year and a half doing research in Bangladesh. “It helps me think a little more globally and gives me a better cultural perspective on understanding where people are coming from and appreciating there are different backgrounds and people want different things,” he says of his time abroad. Hunt wasn’t always set on being a physician. “In one way or another I’ve always been interested in medicine. When I came out of undergrad I wasn’t really sure which track I wanted to take,” but after he completed his graduate degree and research he enrolled at Michigan State University College of Osteopathic Medicine (MSUCOM). Hunt spent his clinical years at McClaren Oakland and stayed on for residency. He is currently a second-year resident in emergency medicine and family practice. He also currently serves on the board of the Oakland County Osteopathic Association and has been involved with the American Osteopathic Association. “There’s really more to the medical field than just being a doctor,” he says. “You have to protect your patients, the communities you serve and you need to protect your profession.” To Hunt, that means playing an active role in the Michigan Osteopathic Political Action Committee, or MOPAC, and visiting the Capitol to work with legislators. “There are always bills going through that will protect how you practice as a physician. I think people need to know that we’re at a difficult place as far as our profession goes. There are a lot of people who are trying to take away how we do business, how we practice medicine. I don’t want nonmedical professionals to dictate medicine -- lawyers, legislators. What we do now will pay dividends in the future.” Hunt’s interest in politics blossomed in college. “I really got into politics when I was president of the student government association. In a way, I got brought into the fold and a lot of people realized I was interested in this stuff. I do enjoy it,” he says. “I really like being a physician and I think it’s important for us to protect our profession. It’s going to be what we make of it in the future.” And Hunt challenges others to join him in shaping that future. “I feel that more physicians need to step up. The people that I work on committees with are obviously very dedicated to similar things that I am, but as a whole I think we need more advocacy and we need more people to be involved.” Adam Hunt, D.O. is currently a second-year resident in emergency medicine and family practice program at McClaren Oakland. He can be reached at adamhunt45@gmail.com. TRIAD, Fall 2012
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ADVOCACY 101 Ma king a Differ ence By Kate Tykocki, APR
This article is the first in a series of three that focuses on legislative advocacy, featuring interviews with Michigan Osteopathic Association CEO/Executive Director Kristopher Nicholoff, MOA Lobbyist and Principal and Founder of McKinney & Associates Kevin McKinney and Stephen Bell, D.O., a member physician and local elected official. Legislative advocacy is an essential component of the Michigan Osteopathic Association’s (MOA) work on behalf of physicians, and common language for most professional associations, but it’s also a source of confusion and at times derision for many physicians. What is advocacy, and why do we need it? “I would say advocacy is establishing a trusting relationship with a policy maker,” explains Kevin McKinney, principal and founder of McKinney & Associates and a lobbyist for the MOA. “This would be the goal so that that legislator will seek advice and opinions on various health care related policies under consideration in the legislature.” This is done in a variety of ways, from personal meetings and phone calls to attending fundraisers and events, but primarily focuses on building trust and advocating for the best interest of physicians and patients. “Just because you’re not interested in politics does not mean politics isn’t interested in you,” says Stephen Bell, D.O., a Monroe County Commissioner. “Most doctors would just assume be uninvolved and quietly go about their business and see their patients. They’ll gripe at a medical staff meeting, they’ll gripe in the doctor’s lounge but they won’t get out and do something about it and they certainly won’t spend any money on it.” Given the issues facing physicians today, that syndrome is extremely worrisome. “We are information brokers,” says McKinney. “We provide information to the policy maker who is not aware of the intricacies of providing patient care. If they don’t know it, they’re 18
TRIAD, Fall 2012
not going to take it into account as they’re looking at legislative proposals. It’s no longer a situation of ‘can you participate’ it’s a situation of ‘you can’t afford not to.’” The range of issues affecting physicians spans from a host of specific bills and packages to topics we hear frequently in the news such as Medicare and auto no fault. “There are always these scope of practice issues we must be on top of,” explains Kristopher Thomas Nicholoff, CEO/ Executive Director of the MOA. “Those are key when dealing with who is approved to provide what type of medical service or treatment. With our ever-changing economic conditions as they’re attached to health care and health care reform there are always the financial aspects of delivering quality medical
1
FEATURE
care. From Medicaid and Medicare to private insurance -- those areas we have to continually stay on top of in an ever-changing environment.” Staying on top of key issues is one of the MOA’s primary roles for its members, but physicians must also play an active and complementary role. “The appendix is not going to remove itself. We have to do it,” says Bell. “How many people know their commercial loan officer or the president of the bank,” asks McKinney. “A policy maker has far greater impact on your professional life than the banker. How many of you know your legislator well enough that you can call them up and get a response? That’s very few.” Building that relationship isn’t as challenging as it sounds. “As a doc we have credibility that I think is almost unrivaled,” says Bell. “Because of the education we’ve had, because of the commitment we have to our patients and our community. We have a lot of credibility but we don’t do anything about it. It is not that tough. You just have to be available.” At the end of the day, advocacy isn’t so different from practicing medicine itself. It’s focusing on what’s best for the patient, and as Bell adds, “It’s a matter of making sure we as physicians act as a voice for our patients because nobody else knows, and nobody else cares, the way we do.”
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ThE mOA’s AdVOCACy PrOgrAm by kATE TykockI, APR
This article is the second in a series of three that focuses on legislative advocacy, featuring interviews with Michigan osteopathic Association cEo/Executive Director kristopher Nicholoff, MoA lobbyist and Principal and Founder of Mckinney & Associates kevin Mckinney and Stephen bell, D.o., a member physician and local elected official. and that’s where we would send them information to communicate with their legislator, at that point strengthening our grassroots communication level by having them convey specifi cally to the people that they know and who trust them so the relationships can build.” Nicholoff works with lobbyist Kevin McKinney and the team at MOA to stay on top of key legislative issues, determine strategies to help ensure the best interests of patients and physicians are protected, and then work to mobilize the membership to communicate with legislators. “We have a Council on Government Affairs that will analyze the bill and take a recommendation to the Board of Trustees,” explains McKinney. “From there we instruct the MOA lobbyists For decades, the Michigan Osteopathic Association (MOA) to espouse. If it’s an issue that needs local advocacy there will has been building a robust legislative advocacy program on be an Action Alert that will go out to all the members but not behalf of its members.
all the issues need immediate action by the local physicians.”
“We have redeveloped. We have strengthened,” explains To Nicholoff, the MOA, lobbyists and member physicians have Kristopher Thomas Nicholoff, CEO/Executive Director of the complementary roles in advocacy. MOA and a registered lobbyist. “We have created the D.O. “It’s a balance between communicating who to have play Connect program where we ask physicians to identify which what role. So there’s this balance that needs to be struck members of house and senate they know — whether as patient between the internal legislative staff, our lobbying fi rm and our physician, neighbor, friend, community member. And then we Council on Government Affairs and all of this needs to be done ask them if they will serve as a contact physician for the MOA in a timely manner, because issues oftentimes require a quick 20
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FEATUrE
mOPAC mAkES AdVOCACy POSSiBLE action where a quick position must be taken.” Nicholoff’s 20+ years working in legislative affairs have refi ned his take on advocacy. “It’s the only professional association in Michigan that D.O.s have solely representing all of osteopathic medicine so they look to us and the key is regularly being in front of them, keeping them aware and then asking them to advocate. It has to be constant and continuing communication because you can’t
A political action committee, or PAC, is an organized group of people that works to elect political candidates it believes will advance legislation in support of its cause. PAC refers to political committees registered with the Federal Election Commission (FEC). Michigan Osteopathic Political Action Committee (MOPAC)
get advocacy without awareness and you can’t get awareness
augments legislative activities by raising money to support
without communicating. We strive to make the best decisions
candidates for state offi ce who are responsive to the con-
and send the best message for our members so they can do
cerns of osteopathic physicians, enabling the profession to
what they do best and that is deliver osteopathic care to their
lobby for a wide variety of issues.
patients.” Separate segregated funds (SSFs), like MOPAC, are political committees established and administered by corporations,
BUSY FAMILY PRACTICE and/or CORNERSTONE ANCHOR BUILDING IN CENTRAL OAKLAND COUNTY ON MAIN ROAD.
labor unions, membership organizations or trade associations. PAC’s may only solicit contributions from individuals associated with the sponsoring organization. MOPAC political activities are funded by voluntary contributions of its members. Contributions are used to fund political programs and for direct support of pro-physician candidates. “Making an annual contribution to the MOPAC is making a contribution that only strengthens our voice,” explains MOA CEO/Executive Director Kristopher Thomas Nicholoff. “It can only help and we need that. For those that are members -- we thank them and we encourage others to support their MOPAC.” FoR MoRE INFoRMATIoN oR To coNTRIbUTE To MoPAc, coNTAcT MoA AT (800) 657-1556 oR E-MAIl JENNIFER MIllER, JMIllER@MI-oSTEoPAThIc.oRg.
248.224.1999 TRIAD, FAll 2012
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A REvIEW IN hEAlTh cARE PolIcy by kEvIN MckINNEy AND kATE TykockI, APR 2012 has been an active legislative year for physicians, and the Michigan Osteopathic Association (MOA) has been in the thick of several key issues at the State Capitol. Here’s a highlight of activities over this past year, why it happened and what it means for member physicians.
FIScAL YeAr 2012-13 BUdget MOA provided testimony in support of budget considerations to restore funding of Graduate Medical Education (GME), increase reimbursement levels for primary care physicians and continue funding of the Michigan Care Improvement Registry (MCIR). GME funding was eventually restored to FY 2012 levels, primary care physicians’ reimbursement was targeted to Medicare rates due to federal funding from the Affordable Care Act, and MCIR was funded at $2.1 million. Additionally, MOA worked with other interest groups to keep language out of the DCH budget bill that would prohibit using funds to enforce the public smoking ban.
medIcAL LIABILItY reForm PAckAge The Medical Liability Reform Package (SB 1115, SB 1116, SB 1117, SB 1118) is a series of bills designed to restore and improve the tort reforms of 1993 which have been eroded by the courts. It is also the intent to improve the liability environment
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in Michigan to aid in the retention and recruitment of physicians in the state. After four rather contentious hearings, the package will likely move out of the Senate Insurance Committee and through the Senate during lame duck with the opportunity for further advancement in the House. The MOA will be providing action alerts to its members at the critical time(s) for contacting both Senate and House members.
AdvAnced PrActIce regIStered nUrSe ScoPe oF PrActIce LegISLAtIon The Advanced Practice Registered Nurse Scope of Practice Legislation (SB 481) is pending in the Senate Health Policy Committee and currently undergoing review by a workgroup being facilitated by Senator Jim Marleau’s offi ce. The bill, as currently written, is problematic for physicians and many other stakeholders because of the expansive nature in which scope of practice changes are proposed. MOA’s priority is ensuring quality of care and access for the patient. Progress is slow in the workgroup with many diverse interests groups and opinions, but it is the will of the bill sponsor, Senator Mark Jansen, as well as the committee chairman to move the issue this year. It remains doubtful as to the House’s interest in taking up the legislation at this time unless there is an agreement reached.
FEATURE
State Licensing Board merger Governor Snyder’s administration remains quiet as to its support for the recommendation of the merger of the state licensing boards. No official word has been received from the Executive Office and legislation will not likely be introduced prior to the November election nor likely advanced in the lame duck session. MOA has expressed its strong opposition to such a merger of the various physician licensing boards.
prohibit health plans and insurers from seeking medical audits and requiring payments beyond one year of the time the claim was initially paid. There are exemptions made in case of fraud but would prohibit the insurer from seeking audits and repayment beyond the one year period and also prohibits insurers from offsetting against future payments or reducing other payments. The bills will likely see a hearing in the House Health Policy Committee this fall. MOA supports this legislation.
Universal Prior Authorization Forms
Health Insurance Exchanges
The MOA has proactively worked to develop and move forward with the adoption of Universal Prior Authorization Forms (SB 429, SB 430), and the issue may see action during the lame duck session. The two bills currently in the House Insurance Committee ask the Michigan Insurance Commissioner to work with health insurance companies to develop one single, electronic prior-authorization form to be used by all health-insurance companies and pharmacy benefit managers across Michigan.
SB 693 creates the MiHealth Marketplace act and establishes the clearinghouse for health benefit plans required under the Affordable Care Act. The bill passed the Senate but has died from lack of support in the House. No further action will be taken by the legislature until after the November election but the Administration will likely move forward with a Federal/ State exchange rather than a state established clearinghouse.
Sports Concussion Legislation Michigan is looking to join 38 other states in adopting Youth Sports Concussion Legislation (SB 1122 and HB 5697). The bills primarily target youth and recreational leagues and target coaches, parents and athletes about the signs and symptoms of a concussion; mandate a removal of play for anyone that is suspected of having had a concussion; and require the clearance by a qualified licensed health professional before that young athlete returns to play. Both bills are being pushed for adoption this fall. MOA supports these bills.
State Appropriation of Federal Health Information Exchange (HIE) With the counsel and assistance of the MOA IT Committee, MOA submitted a strong statement in support of the need for the legislature to quickly appropriate federal monies allocated to the state for HIE. Michigan needs to act now to insure the capture of all available federal funds for which our state is eligible. Joining MOA in concurring statements were the Michigan Health and Hospital Association and many sub state HIEs. MOA has been a strong supporter of the sub state or local HIEs as they are best positioned to work with local systems and resources to improve patient care delivery.
Auto No Fault Reforms The Auto No Fault Reforms being pushed by auto insurers, which dramatically impact providers and patients, remain on the House floor but auto insurers have not been able to garner enough Republican support on the bills thanks to the collective efforts of members of the Coalition Protecting Auto No Fault (CPAN). As an active member of CPAN, MOA opposes these reforms.
Medical Audit Bills HB 5908 and HB 5909 introduced in September would
Access to Medications MOA will facilitate a forum-style discussion with various stakeholders including patient groups and providers in late Fall to examine policies being implemented by insurance companies that require specialty tiers, fail first or step therapy in prescribing medications. Concerns center on the impact such policies have on the physician/patient relationship, patient’s compliance and affordability with the co-insurance (specialty tier) policies. TRIAD, Fall 2012
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FIT TING ADVOCACY INTO YOUR LIFE By Kate Tykocki, APR
This article is the third in a series of three that focuses on legislative advocacy, featuring interviews with Michigan Osteopathic Association CEO/Executive Director Kristopher Nicholoff, MOA Lobbyist and Principal and Founder of McKinney & Associates Kevin McKinney and Stephen Bell, D.O., a member physician and local elected official. Steve Bell, D.O. started his professional career as a teacher, but growing up the son of a physician in California, he knew there was more behind medicine than just managing a practice and seeing patients. “The government was doing a whole lot of things at the time with liability issues and insurance issues. When I went into medicine I understood the government gets highly involved and isn’t necessarily friendly to physicians. My first degree was history and I had an idea that if you were going to get something done you had to get involved.” After Bell graduated from Lake Erie College of Osteopathic Medicine, he interned at Henry Ford Wyandotte Hospital and did his residency at Oakwood Southshore Medical Center. His time in Michigan motivated him to choose to settle and grow his family in the state. The next step for him? Running for elected office as a Monroe County Commissioner, a position he has held since 2011. “You end up learning a little bit how they think on the dark side. But it’s not really a dark side, it’s a clueless side. They don’t understand and they’re doing their best and they listen to whatever voice comes to them and our voice isn’t the loudest.” So how do physicians help to strengthen their voice while still running a practice? “It’s all about choices. If you’re happy being run over by a system in which you’re not involved, keep doing what you’re doing,” says Bell, “but at some time you’ve got to get involved and make it a priority. I’ve got patients that tell me they can’t 24
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afford the meds to stop smoking but spend $15 a day on cigarettes. Clearly it’s a matter of where they want to spend their money.” Michigan Osteopathic Association (MOA) lobbyist Kevin McKinney suggests starting simple. “The best way is to advocate is to have a relationship with your legislator,” he explains. “It starts with an introduction and it starts with something as simple as letting that legislator know you are in the district, you are engaged in terms of policy, you are following the issues in Lansing and you’re interested in establishing an open dialogue or discussion. To do that is pretty basic and would require one to reach out to that policy maker. Start out by doing something like attending one of their coffee hours in the district, going to one of their local fundraisers. It could be something like reaching out and scheduling a meeting or breakfast with that legislator.” Other ways to get involved can be as simple as checking your email and include: • Reading MOA email UPDATEs that are sent out to MOA members. • Reading MOA email Action Alerts and completing the requested action. Typically this is as quick as sending an email or making a phone call. • Identifying your local, state and national legislators for your home or practice. Physicians can look up state legislators at http://www.legislature.mi.gov and Congressional delegates at http://www.house.gov/. • Visiting your legislators’ websites and signing up for email
FEATURE
alerts to stay up-to-date on their activities. • Calling or emailing your local legislator to introduce yourself, letting them know you are a physician and offering to answer any questions about medical or health policyrelated legislation. • Attending your local legislators’ coffee hours or an event to introduce yourself in person. • Making a contribution to the Michigan Osteopathic Political Action Committee (MOPAC) to join other physicians in having an impact. • Making a campaign contribution to your local legislators. • Participating in the MOA D.O. Connect (http://www. mi-osteopathic.org/DOConnect) program to facilitate dialogue with legislators you know personally or professionally. Small, ongoing advocacy efforts can make a big difference in the long run. “It is really easy to do this with minimal time and effort,” says McKinney, “but once you establish that relationship or that outreach, it’s not an automatic relationship. It’s built on trust and back-and-forth support. You can’t come to Lansing and advocate on one legislative issue then disappear. You can’t push hard on an issue with your legislator and when they come back seeking support on an issue or seeking a campaign contribution then disappear. You need to take it as a long term approach.” Physicians can look to the MOA to play a lead role, but ultimately it’s important physicians have complementary conversations with their legislators in addition to the formal advocacy efforts at the Association. “I think that docs have a lot to bring to the table,” says Bell. “We bring a sense of credibility, a sense of honesty. We’ve very
practical folks. We want to fix the problem -- that’s why we got into this line of work. That skill set is hugely useful.” For a physician like Bell, the time investment of being actively involved in our legislative process is well worth it. “It doesn’t take all that much time really. You meet with some people here and again. It’s the equivalent of missing a few golf games,” he says. “Yes, there’s a finite amount of time in our lives, but these are important things and they’re well worth doing. If we’re not prepared to make time for important things then we need to be prepared for them to go badly. You get what you put in, and, we have no right to complain about it. Don’t be surprised when things go away that you aren’t pleased about.” The MOA works hard to help make the advocacy process simple for physicians. MOA CEO/Executive Director Kristopher Thomas Nicholoff stresses, “We hear people say they’re busy and what we try to do is simplify it. Every week we are getting them the latest information or alerts as they break, so we’re trying to make it simple in getting them concise straightforward information, educating them on the latest issue and encouraging them to convey their position to their legislator through a simple email or phone call. We’re trying to keep it constant and continuous and making it available to the physician at arm’s reach. Within a click that they can send a quick comment to that legislator they know and or the legislator that represents them. The simpler we make the communication the more they are able to do something and not take too much time away from their business or practices. We’ve had physicians step up of late and are asking other physicians to strengthen our voice because it’s important and we’ve made it simple for them.” To get more involved in the MOA’s advocacy efforts beyond the steps above, contact Kristopher Thomas Nicholoff at knicholoff@mi-osteopathic.org. TRIAD, Fall 2012
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Make a Difference As a physician, your time and resources are limited. However, your political activism is essential to help elect candidates that represents you, Michigan’s osteopathic physicians. Every physician can make a difference in how candidates and elected officials view key-physician issues, who represents them at the state capitol, and the understanding of these issues by voters within their communities. No matter how small the effort, the key is that the effort is made to protect your profession. Here are just a few ways you, as a physician, can make a difference: Vote | Contribute to MOPAC | Host or Attend a Fundraiser | Host a Candidate at your Facility or Practice | Run for Office Host a Voter Registration Drive | Write an Op-Ed | Serve as a Media spokesperson | Get to Know Your Candidates Volunteer with a Political Campaign | Educate others on Key Physician Issues | Turn Out the Pro-Physician Vote
For more information on any of these political activities or to learn more about being politically active, visit www.mi-osteopathic.org or call (800) 657-1556.
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I N S ID E T H E A O A
You must engage in Advocacy. If you don’t, who will?
by LEANN FOX
People ask why advocacy is important in many different ways; does anyone really read my letters, why should I bother, they already know how we feel, they'll hear from someone else, they won't listen because they're a Democrat or Republican. Questions and statements like these are uttered by voters every day. What these questions say is that as overall political issue advocacy increases amongst the general public, the more complicated and partisan - and ultimately frustrating - it can become. However, as health care remains at the forefront of the national political conversation, it is more important than ever for physicians and the patients they treat, to engage in advocacy. A survey of the national political landscape would tell you that only 3 percent of Congress truly understands what a physician’s day-to-day life is really like – of the 535 Members of Congress, only 20 have ever practiced medicine. While lobbyists are well armed with the knowledge and details of health policy, the most powerful tool in a lobbyists arsenal is you, your story and how these policies affect voters in a state or district. Truthfully, the efficacy of advocacy efforts depends on a number of factors - at least two of which you cannot control, the elected official you are trying to influence and the quality of the opponent and their message. Persuasion is a complicated art and in politics, where both sides can be 'right' and truthful at the same time, delivering a compelling message is everything. In order to deliver the most compelling message you have to start with the basics and that means knowing your audience. Each elected official maintains a webpage outlining their position on key issues - particularly so called "hot button" issues. Your "target" legislator, and by extension their policy staff, have a voting record which will give you a blueprint for mapping out the type of message you need to deliver. It may not provide the entire picture; however, the congressional record and votes on specific bills provide important background. While your elected official may support a particular issue, they may not co-sponsor a bill or vote in favor of passage because of some underlying reason - for example, how a measure is paid for. This is where expert sources, such as your state or national professional organization, can help you sort through why someone who appears to support an issue you care for voted against it. Being armed with the issues and motivations of an elected official gives you the knowledge you need, however you still need to develop a relationship with the office – specifically the staff covering health care issues. This individual spends every day working on the issues that affect you and a solid relationship with them will provide you the access you need when important legislation comes up. Beginning a relationship is not a difficult proposition, it requires reaching out to the office regularly – both to ask for support or opposition and to thank them for their stance on an issue. You should also offer to be a resource to the office on health care issues, attend local events the legislator holds - such as town hall meetings, and send letters to the editor in support of votes and work a legislator has done. You will not always agree with the positions of your legislators, but a cordial working relationship with them is a necessary part of advocacy. Now more than ever, physicians must put past frustrations behind them and engage in advocating for their practices and patients. If you don’t do it, who will? Leann Fox is currently the American Osteopathic Association’s Director of Washington Advocacy and Communications. She may be reached at LFox@osteopathic.org. TRIAD, Fall 2012
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DEAN’S COLUMN
by William Strampel, D.O.
“Advocate.” At its root, it’s a word that means “someone called to,” and through its long history, it has come to signify “one who intercedes for another,” and “protector, champion, patron.” I think that’s a great definition to frame advocacy by osteopathic physicians. We often think of advocacy as strictly a political act, like working through our PAC to assist us getting legislation either passed or thwarted, depending on its potential impact. With the increasing complexity of society, the political process, health care, and health care financing, there is no doubt that this kind of advocacy on behalf of our profession is vital. We need to be educating those in government, business, and community about who we are, what we can give, and what we need. That’s very much part of keeping our profession healthy. But we also need to be strong advocates for our patients. I believe that osteopathic medicine is the best medicine for our nation – with its patient-centered approach, emphasis on both primary and specialty care, community integration, added skills of osteopathic manipulative medicine, and willingness to serve in underserved areas. To advocate for medicine that is best, is to advocate for the health of our patients. We also need to advocate for our future, by keeping our educational institutions strong, by helping to recruit top students for our schools, by supporting them with much-needed scholarships, and by mentoring them as faculty and role models as they being their clinical work. So do whatever you can wherever you can to support our profession, and to know and to meet the needs relative to the health of people in your community. Be aware of the resources needed for healthy individuals, families, and neighborhoods, and advocate for them in any way you can. Be a “protector, champion, patron” of good health for all. Thank you for all the ways you serve as an osteopathic advocate. William Strampel, D.O., is Dean of the Michigan State University College of Osteopathic Medicine. He can be reached at pat.grauer@hc.msu.edu.
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E-PrESCriBiNg mALPrACTiCE riSkS
D
riven by electronic health record (EHR) adoption and federal incentives, approximately 35 percent of physician offi ce practices currently use e-prescribing to send prescriptions directly to pharmacies. These systems allow quick access to drug formulary and eligibility information and to the patient’s prescription history. They also reduce costs by fl agging generic and “on-formulary” drugs. The systems may help with compliance problems, as approximately 20 percent to 30 percent of patients never pick up their prescriptions. Adding to these potential benefi ts is what ought to be the physician’s best friend: fl agging drug-drug interactions before they occur. However, there are always unanticipated consequences when new technologies are adopted—and the EHR is no exception. Real and potential liability risks are beginning to be recognized, and it is important for physicians to become familiar with them. Consider the following: • Doctors have access to data through e-prescribing community medication histories, which can expose the
physician to potential interactions with drugs prescribed by others. For example, Dr. A renews a medication, and his e-prescribing program sends an alert advising him that the medication could interact with another drug the patient is taking. He has not prescribed that drug, so his offi ce staff will have to contact the patient to identify who has prescribed it, and then Dr. A will have to contact Dr. X to “negotiate” which drug will be discontinued or changed. If failure to take action results in patient injury from a drug-drug interaction, Dr. A may be liable. • Doctors are responsible for clinical information they can reasonably access. There is increased access to e-health data from outside the practice through the practice EHR or Web site or through a health information exchange (hospital charts, consultant reports, and laboratory and radiology reports). • Meaningful use requires that EHRs provide e-prescribing drug information and clinical decision support. Clinicians should know the source of this information because it may confl ict with their specialty’s clinical standards of care or practice guidelines—and with information in TRIAD, FAll 2012
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FDA-approved drug labels and drug alerts (boxed warnings). • Drug-drug interaction lists are often so comprehensive and generate alerts with such frequency that they can become disruptive and annoying. Doctors may develop “alert fatigue” and ignore, override,
or disable them. However, if it smaller set of interactions most freis shown that following an alert quently associated with harm may would have prevented an adverse address this problem. However, patient event, the physician may EHR vendors may resist eliminatbe found liable for failing to follow ing the low-risk warnings, fearing it. Expert consensus lists or optithat doing so may increase their mized, clinically meaningful drugliability. drug interaction lists focused on a The PDR Alert Network is a free service that electronically delivers FDA Alerts (including FDA label changes and boxed warnings) to physicians and other prescribers. This Alert Network improves physician access to important and timely medication information, thereby improving patient safety and reducing medical liability. The PDR Alert Network resulted from a multiyear effort engaging the American Medical Association (AMA), medical specialty and state medical societies, professional liability insurance carriers, patient safety groups, manufacturers, and the FDA. It is governed by the iHealth Alliance, a nonprofi t board consisting of leaders from medical societies (including the AMA), university medical centers, the National Patient Safety Foundation, and professional liability carriers. It is dedicated to protecting the interests and privacy of patients and providers. In collaboration with the FDA’s Safe Use Initiative, PDR Network and medical professional liability carriers launched a national Know the Label campaign early in 2011. The campaign allows physicians to earn free continuing medical education (CME) credits by reviewing the FDA-approved labeling for the drugs they most commonly prescribe, then taking a short online test on the label’s content. PDR Network hosts the CME programs, and The Doctors Company provides the CME credits to all U.S. physicians at no charge. coNTRIbUTED by ThE DocToRS coMPANy. FoR MoRE INFoRMATIoN AboUT ERISk AND hoW To PRoTEcT yoUR PRAcTIcE, PlEASE vISIT WWW.ThEDocToRS.coM/PATIENTSAFETy.
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carrier plans, the result may be a signifi cant savings. If your practice’s group health plan is renewing this fall, now is an excellent time for you to consider a review of your current health care plan, with a comparison of competitive quotes from a variety of carriers. We encourage you to take advantage of this valuable complimentary Michigan Osteopathic Association (MOA) service. Also, be sure to ask about our exclusive freestanding vision and dental benefi ts available to all MOA members and their staff. If you currently offer Blue Cross Blue Shield of Michigan or Blue Care Network plans, you should participate in the MOA Blues sponsored program. There is no cost to you and you can keep your current BCBSM/BCN plan and renewal date. Not only do you receive fi rst rate customer service, your participation through the MOA Blues sponsored program supports your association and adds to MOA’s infl uence. There is strength in our growing numbers! The MOA insurance portfolio offers an extensive menu of product and services for all your insurance needs at all stages of your life; college student, recent grad, starting a practice or transitioning to Medicare, we can fi nd the plan for you. coNTAcT ThE MoA INSURANcE TEAM ToDAy! cAll DEvoNA AT 1.800.657.1566 ExTENSIoN 1 oR JUlIE AT 800.782.0712 ExTENSIoN 167 oR EMAIl AT MIT@MIoSTEoPAThIc.oRg
10 TiPS FOr EFFECTiVE AdVOCACy by ThE NEW yoRk cITy hAbITAT FoR hUMANITy 1. Deal with reality, not ideology. Pick policies that have broad support and a demonstrated effectiveness in achieving concrete results. Focus on very specifi c issues rather than vague goals. 2. Demonstrate signifi cant community-based support. Constantly demonstrate to elected offi cials that you represent many groups, institutions and voters in your community. 3. Know who the players are and who to target. You must fi rst determine whether the action you want government to take needs to be taken at the federal, state or city level. It is also important to know which committees and subcom-mittees will need to take action before your policy goal is adopted. Also, get to know not just elected offi cials, but also their staff members, who often do the “real” work and make major decisions. 4. Identify specifi c policy goals and a realistic strategy to achieve them. Figure out who, exactly, at what level of government will need to vote for the policy and then develop a person-by-person strategy to get them to take the actions you want. Politics is the art of the possible, so make sure to ask for something that may be diffi cult but not impossible for a politician to support. 5. Know your facts. Have at your fi ngertips as much relevant and resonant information as you can get. Then always have a one-page fact sheet with easy-to-understand charts and even photos that describe both the problem you want solved and specifi cally what actions you want the elected offi cial to take to solve it. 6. Keep it simple. Use language that everyone understands, even if they are not experts on your issue. Every communication you have — in person, by phone, or in writing — should have one basic message, e.g.: “There is a housing crisis; it can and must be solved; here’s what you can do.”
7. Choose real results over confrontation. Nine times out of ten, you will get far better results meeting with elected offi cials face-to-face rather than picketing against them. In fact, confrontations often turn potential allies against your cause. Remember that opponents today on one issue can be allies tomorrow on another issue. 8. Convince the undecided. Don’t spend all your time “preaching to the converted.“ You will make much more progress focusing your energies on the
people who are still uninformed and/or unconvinced. 9. The media is the message. Use the mass media, free cable TV and community newspapers to get your message out and educate people on the issue. Public awareness will help build a constituency for your issue. 10. Repeat your basic message over and over (and over) again. (See rule #6.) Just because you’ve said your message before, don’t be afraid to repeat it until you get the right person’s attention.
Are you looking for an old style family doctor, but with a team of professionals, using modern knowledge and technology, to provide the best possible care for you and your family? Then come to a “medical home” where a team of health professionals work together to provide a new, expanded type of care. Our “medical home” team includes a doctor, physician’s assistant, registered nurse, and a health educator, as well as other health care professionals, like a nutritionist, psychologist, certified diabetes educator or exercise specialist. These team members are like having “health coaches” who help you get healthy, stay healthy, and get the care and services that are right for you. Our physicians are available 24/7 and even communicate by secure email. Same day appointments are always available and our doors open at 6:30am Monday through Friday plus we are open Saturdays! Country Creek Family Physicians invites you to come back home...
Country Creek Family Physicians 4986 Adams Rd. Rochester, MI 48306 Tel: 248.475.4301
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ADVERTISER INDEX
TRIAD Staff
Al Bourdeau Insurance Agency.............................................16
Bruce A. Wolf, D.O. & John Sealey, D.O., Editors-in-Chief Kevin M. McFatridge, Managing Editor
Association Benefits Company................................................6
John Bodell, D.O.; Vance Powell, D.O. & William Strampel, D.O., Contributing Editors
Brodsky Realty.....................................................................16
Kris T. Nicholoff, Executive Director Lisa M. Neufer, Director of Administration Kevin M. McFatridge, Manager of Communications Cyndi Earles, Director, MOA Service Corporation Shelly M. Madden, Manager of Membership
Country Creek Family Physicians.........................................33 Doc2Doc Training................................................................12 Blue Cross Blue Shield of Michigan........................................4
Marc A. Staley, Manager of Finance Carl Mischka, Advertising Representative
Health Law Partners.............................................................35
Keystone Millbrook, Layout and Cover Design 2012–2013 Board of Trustees Edward J. Canfield, D.O., President
Kerr Russell..........................................................................12 Keystone Pharmacy..............................................................16
Michael D. Weiss, D.O., President-Elect Kurt C. Anderson, D.O., Immediate Past President
MedNetOne Health Solutions...............................................26
Myral R. Robbins, D.O., FAAFP, FACOFP, Secretary/Treasurer George T. Sawabini, D.O., FACOFP, D.Ph, Past President
Med-Share Group.................................................................36
Lawrence J. Abramson, D.O., MPH & Bruce A. Wolf, D.O., Insurance Department
Michigan Clinic for Facial Pain, P.L.C...................................30
Gregory Harris, D.O. & Lawrence L. Prokop, D.O., Membership Department
MSU College of Osteopathic Medicine..................................16
Robert G.G. Piccinini, D.O., dFACN & Jeffrey Stevens, D.O., Continuing Education Department
MSU Federal Credit Union...................................................10
Leo E. Reap III & John W. Sealey, D.O., Public Affairs Department The osteopathic profession in Michigan is made up of osteopathic physicians, osteopathic hospitals and an osteopathic medical school. This TRIAD stands together to serve our patients and one another. TRIAD, the official journal of the Michigan Osteopathic Association, serves Michigan’s osteopathic community, including its osteopathic physicians, hospitals, medical school and patients. The Michigan Osteopathic Association will not accept responsibility for statements made or opinions expressed by any contributor or any article or feature published in TRIAD. The views expressed are those of the writer, and not necessarily official positions of MOA. TRIAD reserves the right to accept or reject advertising. The acceptance of an advertisement from another health institution or practitioner does not indicate an endorsement by MOA. TRIAD (ISSN 1046-4948; USPS 301-150) is published quarterly by the Michigan Osteopathic Association, 2445 Woodlake Circle, Okemos, MI 48864. Periodical postage paid at Okemos, MI 48864 and other post offices. Subscription rate: $50 per year for non-members. All correspondence should be addressed to: Communications Department, Michigan Osteopathic Association, 2445 Woodlake Circle, Okemos, MI 48864. Phone: 517.347.1555. Fax: 517.347.1566. Website: www.mi-osteopathic.org. Email: moa@mi-osteopathic.org. POSTMASTER: send address changes to TRIAD, 2445 Woodlake Circle, Okemos, MI 48864. ©2012 Michigan Osteopathic Association 34 TRIAD, Fall 2012
Pinkus Dermatopathology Laboratory..................................32 Premier MRI CT...................................................................14 The Doctors Company...........................................................2 University of Michigan School of Public Health....................14 Wachler & Associates PC.....................................................10
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TRIAD, Fall 2012