TRIAD Online Fall 2017.pdf by Michigan Osteopathic Association

DOMOA.ORG VOLUME 28: ISSUE 4, 2017

13th Annual Autumn Scientific Convention Highlights TURN TO PAGE 13

TABLE OF OF CONTENTS CONTENTS FEATURES 09 Spartan Street Medicine Launches in Downtown Lansing

Care is What We DO: The Peru Global Outreach Project

MOA Autumn Convention: Session Highlights

Bariatric Surgery: Not the Easy Way Out, But the Most Successful Way to Regain Health with Obesity

Governor Snyder Makes Appointment, Reappointment to the Michigan Board of Audiology

The Core Institute Expands, Adding First Spine Physician and DO to Michigan Team

MOA Provides Healthcare Perspective to Greg Kelser Camp

Objective Review of Potential Risks in a Medical Practice Can Be Beneficial Contributed by The Doctors Company

Why Not Create a National ID Card for Healthcare Professionals?

To Live Well

DEPARTMENTS 05 07 08 22 28 31

President’s Page CEO’s Message Component News Legislative Express DO Faces: 16th Annual MSAE Diamond Awards Advertiser Index

VISIT MOPAC AT CONVENTION - SATURDAY, NOVEMBER 4

WE NEED YOUR OPINIONS!

Which of these advocacy issues matters to you most?

• GME Funding • Safe Opioid Use • Physician Wellness • Vaccinations • Auto No-Fault Insurance • Fighting Human Trafficking • Maintenance of Certification Come fill out our survey at the MOPAC booth! MAIL A CHECK: 2445 Woodlake Circle, Okemos, MI 48864 DONATE ONLINE: domoa.org/joinmopac

IT’S HAPPENING HERE Hail to a new era of care. To an award-winning network of doctors and specialists. To being champions of every single person who turns to us.

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PRESIDENT’S PAGE

n my role as president of the Michigan Osteopathic Association, one of my biggest responsibilities is to advocate on issues that affect our communities and our profession. As physicians, we are in a unique position. Policies that make our profession stronger benefit the communities we serve in.

This issue of the TRIAD is “Care is what we DO.” And “Care” comes in many forms. We see our colleagues giving their time to programs like Medical Mission Peru, or Detroit Street Care. But sometimes the “Care” we can DO is advocating on the health issues and policies facing our communities. JOHN SEALEY, DO, FACOS MOA PRESIDENT

Currently, the MOA advocates on many community health issues. From vaccination efforts to patient safety, the MOA works with various stakeholder groups to promote health policies and engage in public awareness campaigns. In recent weeks, I have been traveling to Washington D.C. to meet with legislators and policy makers to advocate for continued funding for the Teaching Health Center Graduate Medical Education (THCGME) program. This program is the only federal program dedicated to training medical residents to go into primary care in medically underserved areas. Michigan, like many states, is facing a primary care physician shortage. This problem is especially dire in areas that are already underserved. The THCGME program is set to expire. But U.S. House Bill 3394 facilitates expansion of the program by funding entirely new centers and new programs at existing THCGMEs. In September, I traveled to Capitol Hill to speak in front of the National Coalition on Health Care (NCHC) about the urgency of preserving this valuable program. The response I received was positive. Legislators on both sides of the isle see the benefits in H.R. 3394 and in an era of unknowns in healthcare, it is refreshing to see both parties working together on programs as vital as the THCGME program. It is an interesting time to be involved in health policy. Healthcare represents about 1/6th of the U.S. economy. As physicians, it is vital that our voices heard. At a time when healthcare is in such a state of upheaval, the MOA has never been more involved with engaging legislators and policy makers in an effort for sound health policy. It is my honor to serve as president of our organization in such a challenging time. My hope is that we can continue to provide input and leadership that results in an environment where physicians can do what they do best. Care.

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CEO’S MESSAGE

his year marks the 125th year of osteopathic medical education. The story of A.T. Still being inspired through tragedy to develop a new philosophy of medicine is well-known in our circles. What was once viewed as a radical approach is now seen as common sense science. Today, there are over 102,000 DOs in the United States and one in four U.S. medical students are enrolled in a college of osteopathic medicine. From the beginning, the osteopathic philosophy was ahead of its time. KRIS NICHOLOFF CEO AND EXECUTIVE DIRECTOR

In 1892 when Dr. Still opened the first osteopathic medical school, the American School of Osteopathy in Kirksville, Missouri, the first graduating class was 27 percent female. Today, women make up nearly 50 percent of the osteopathic medical students across the country. More than 50 percent of today’s practicing DOs are younger than 45 and are more likely than other physicians to work in rural and underserved communities. The philosophy of osteopathic medicine has historically fostered inclusion and made sacrifices to serve those in need. We are in an era where healthcare is going through probably the greatest shift in how physicians practice medicine. The changes are moving at such a rapid rate, this is probably not a healthcare model A.T. Still would recognize. But he would recognize the efforts DOs make in serving their communities, and other communities less fortunate. He would certainly recognize that his philosophy has held true. This issue of the TRIAD has the theme of “Care is what we DO.” We hope to recognize just some of the dedication and sacrifices our DOs make to help others. Whether it is volunteering at a remote clinic in Peru’s Amazon Basin or serving the homeless on the streets of Detroit, our DO’s find ways to better their communities. During my time in our association I have had the good fortune to interact with some amazing folks. People who are constantly giving. Giving back to their profession. Giving back to their communities. Giving back to the next generation of osteopathic physicians. Here at the MOA we celebrate 125 years of osteopathic medicine and salute those who make the words — “Care is what we DO,” ring true.

Here at the MOA we celebrate 125 years of osteopathic medicine and salute those who make the words “Care is what we DO” ring true.

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COMPONENT NEWS YOUR LOCAL DO FAMILY. UPCOMING COMPONENT MEETINGS Oakland County Osteopathic Medical Association and Oakland County Medical Society invite you to attend

An Afternoon of Wellness Friday, September 29, 2017 Walsh College, 3838 Livernois Road, Troy, MI 48083

Keynote Speaker • Roger Smith, MD

Panel Discussion: Avenues to Treatment Panelists: • Robert G. G. Piccinini, DO, DFACN • Jodie Eckleberry-Hunt, PhD, ABPP, • Drew Shrimplin, MA

Breakout Sessions: Relieving Stress in the Work Environment with Yoga/Meditation • Stacy Bishop & Laurie Jerris, Detroit Meditation Group AOA Taskforce on Physician Wellness Update • Robert G. G. Piccinini, DO, DFACN, Psychiatrist & Taskforce Chair Enriching the Clinician Experience: Actions for Satisfaction • Debra Davidson, MJ, ARM, CPHRM, CPPS, Patient Safety/Risk Management Department, The Doctors Company

Credit: This program is designated for a maximum of 3.5 AOA Category 1-A credits as well as 1.5 AMA PRA Category 1 credit.

Contact: Call OCOMA at (517) 512-4307 or email cearles@DOMOA.org

TO SHARE YOUR COMPONENT NEWS, MEETINGS AND EVENTS IN TRIAD, EMAIL TODD ROSS AT TROSS@DOMOA.ORG.

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SPARTAN STREET MEDICINE LAUNCHES IN DOWNTOWN LANSING

partan Street Medicine (SSM), a MSUCOM student-run organization, is bringing medical students and physicians together to regularly provide basic health services directly to our underserved community members in the day shelters and on the streets of Lansing, MI. The purpose of the effort is to connect patients to primary care for sustainable maintenance of their health and well-being. With 5 clinics already performed, and more scheduled, SSM is quickly making a difference in downtown Lansing.

JOIN THE TEAM! The Spartan Street Medicine program is looking for attending physicians! If you are an empathetic physician who is passionate about serving the under-served, SSM is looking to have you on the team. The role is laid back, with low time-commitment (4 hours x 1 day /month or bimonthly). SSM can work around your schedule. They also need PCPs to whom they can refer patients for sustainable care. If you practice in the Lansing area, and can accept referrals of patients, please contact SSM at feldpa65@gmail.com or (989) 388-2651.

“We strive to adapt our patient-centered model to overcome socioeconomic barriers to care and meet the unique needs of each patient we serve.” Brianne Feldpausch, SSM Director

SPARTAN STREET MEDICINE Student Association College of Osteopathic Medicine Michigan State University

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THE PERU GLOBAL OUTREACH PROGRAM

CARE IS WHAT WE

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Fighting disease, sickness and patient ailments on any given day keeps a doctor’s office busy. It can be a stressful, frustrating and seemingly un-ending battle. We would like to take a moment to recognize that what physicians are tasked to deal with is a true show of character. Now, try to imagine caring for these patients in a third world country; lacking clean water, modern technology and any standard of medical care we have in the United States today. Well, that’s exactly what 103 physicians, medical students and nurses did in Peru over the summer. For 7 days in August, the Peru Global

Outreach Program participants provided care to patients in Iquitos Santa Rosa and while on the Amazon River to the villages of Nuevo Uchiza, Santa Victoria and Iquique. “The Peru Global Outreach Program assembles selfless medical students, residents, doctors and other vital medical personnel to expand access to care on an international scale. I am humbled by the program’s evergrowing participation, which transcends directly into better health for our global community.” Joseph Gorz, DO. Dr. Gorz has been involved with the Peru Global Outreach Program since 2009, and today serves with Dr. Gary Willyerd and Dr. Shane Sergeant as trip coordinators. Article continues on page 12

Read the blog, learn more, and donate at: peruglobaloutreach.com

Thank you to Vicki Athens and Jill Neff for sharing their beautiful photography of the Peru Global Outreach Program. Cover photo credit: Jill Neff

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PERU – continued from page 10

Approximately 2,400 patients were treated with medical supplies valued at between $120,000 and $150,000. The top 10 illnesses and diseases treated were tinea, parasites, chronic back pain, headaches, gastritis, anemia, diabetes and related complications, malnutrition, hypertension and a myriad of women’s health issue including sexually transmitted infections, urinary tract infection and prolapsed uterus. First time traveler, Theresa Sitto, recalled her experience in the group’s official blog, stating, “Today I had the opportunity to work with the pediatric population and the obstetric/ gynecological patients and it was truly incredible. As a person who is very sensitive to the heat – the smiles of my patients, their hugs of gratitude and their true depth of love for us was incredible and it didn’t matter how hot it was. The gifts they have given me cannot be lost or broken.” The Peru Global Outreach team was greeted by village leaders with gifts of gratitude for their work. Outside of patient care, participants were also taken on tours to learn about the environment of their patients. One such group learned the various medicinal benefits of rainforest plants from a local shaman (natural medicine man) as well as other cultural demonstrations of blow dart guns and the art of extracting fibers from palm trees for weaving from villagers. With another successful trip completed, the group plans to expand and improve its current efforts. There is currently consideration for building a pavilion to establish a year-round clinic. In addition, research projects performed in Peru may provide important improvements in care and standard of living for patients. Research topics include HPV, water quality and ultrasound technology. For more information, contact David Ulery, Multimedia Coordinator. 12

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Friday, Nov. 3 â&#x20AC;&#x201C; Sunday, Nov. 5, 2017 Amway Grand Plaza, Grand Rapids 20-22 AOA Category 1-A Credits Overflow Hotel Reservations: Please call the JW Marriott booking line at 888-844-5947 or go to www.DOMOA.org/jwmarriott by Oct. 5 to get MOA discounted rate of $219 + tax. The JW Marriott is a full-service, luxury hotel connected to the Amway Grand Plaza via the Skywalk.

Agenda: www.moaautumn.com

What to do in Grand Rapids? www.experiencegr.com/moa2017

Early bird registration through October 13 at DOMOA.org/gr2017

PHYSICIAN WELLNESS CENTER at Autumn Convention P R I VAT E & G R O U P YO G A S E S S I O N S

Asana Class Guided Relaxation & Meditation

OMM

Treatments offered during certain hours

R E LA X & R E J U V I N AT E

Friday - Sunday!

TRIAD TRIAD 2017 2017| |ISSUE ISSUE44

For full agenda, visit www.MOAautumn.com

FRIDAY SESSION HIGHLIGHTS 12:25 PM

OPENING REMARKS & WELCOME John Sealey, DO, FACOS MOA President 12:30-1:30 PM

MACRA Ewa Matuszewski, CEO MedNetOne Solutions (with practice managers) 2:30-3:30 PM

RECOGNITION OF HUMAN TRAFFICKING VICTIMS LaClaire Bouknight, MD (Meets one-time state requirement) 4:30-5:30 PM

ADULT IMMUNIZATION AND VACCINE PREVENTABLE DISEASE Michael Klepser, PharmD, FCCP

RECOGNITION OF HUMAN TRAFFICKING VICTIMS For victims of human trafficking, a physician visit can be a life-changing event that sets into motion the process of escaping a captive situation. Human trafficking is a form of modern-day slavery in which victims are forced or coerced into submission by a trafficker for the purpose of engaging in commercial sex acts or other work against their will. “Physicians are one of the key groups that can actively find, see and identify these victims while they’re still in the process of being victimized,” says Alan Janssen, DO, the medical director at the emergency department of Genesys Regional Medical Center. Most sex trafficking survivors received medical treatment at some point while they were being trafficked, according to a 2014 study. About 88 percent of victims saw a healthcare provider and 63 percent sought treatment at a hospital or emergency room. Michigan ranks 7th among states in terms of human trafficking cases reported. The Michigan Department of Department of Licensing and Regulatory Affairs (LARA) has instituted new education requirements for health care providers. The Michigan Osteopathic Association (MOA) has a web page, “Stop Human Trafficking,” dedicated to the issue with resources and links for more information.

LINKS AND RESOURCES: National Human Trafficking Hotline at (888) 373-7888 This article includes excerpts from The DO article, “Identifying human trafficking victims: How physicians can help” by Ashley Altus. www.humantraffickinghotline.org

SCIENTIFIC RESEARCH EXHIBIT The Michigan Osteopathic Association will once again host a Scientific Research Exhibit (SRE) at the 2017 Autumn Scientific Convention. These competitions provide osteopathic medical students, residents, fellows and attending level physicians an opportunity to present their medical and scientific research to our profession. The SRE event demonstrates the very best of what osteopathic medicine is and reaffirms the profession’s commitment to the advancement of science in osteopathic medicine. Competition: Nov. 4, Amway Grand Plaza www.domoa.org/sre 14

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For full agenda, visit www.MOAautumn.com

SATURDAY SESSION HIGHLIGHTS 7-9 AM

Osteopathic Manipulative Treatment: Shoulder Pain, Rehabilitation & Manipulation Mary Goldman, DO and Lawrence Prokop, DO (breakfast session)

8 AM-12 PM

SRE Competition Judging & Awards 10:30-11 AM

Provider Wellness Zafar Shamoon, DO, FACOEP 11 AM-12 PM

Updates in Cardiology 2017 Kenneth Tobin, DO 12 -1 PM

Luncheon Product Theater by Novo Nordisk (Does not qualify for CME)

3:15-6:15 PM

Pain Management Workshop (Meets new Michigan pain & symptom management license requirement)

SUNDAY SESSION HIGHLIGHTS 8:30-9:30 AM

RTP / Concussions Edwin Kornoelje, DO, FAOASM 9:30-10:30 AM

CONCUSSIONS: RECOVERY STRATEGY FOR SAFE RETURN TO PLAY Mathew Saffarian, DO Over the past decade, concussion treatment has received increased attention from inside and outside of the medical community. It is estimated that 300,000 sport-related concussions occur each year in the United States. The precise definition of a concussion is the subject of much debate. However, medical professionals generally define a concussion as a mild traumatic brain injury that involves a complex pathophysiological injury that affects brain function. Loss of consciousness and a direct blow to the head are not necessary to cause a concussion. Common symptoms of a concussion include headaches, dizziness, fogginess, balance changes, visual changes, nausea, mood changes, and cognitive disturbance, among others. At present, there is no specific test that can be used to diagnose a concussion. Diagnosis is usually made with a detailed history and a thorough neuromuscular physical exam. Health care providers may use the Sport Concussion Assessment Tool (“SCAT 5”) as a guide in their evaluation. Any athlete that shows any sign of a concussion should be immediately removed from play to be evaluated by a medical professional. Most athletes recover from concussions in 10 -14 days. After an initial period of rest, recent studies show that athletes should begin light non-contact activity if their symptoms are mild and tolerable, instead of waiting for complete symptom resolution. Gradual return to play can occur over a 5 -7 day period of activity progression. Return to play begins with initiation of symptom-limited activity with regular activities of daily living, such as prolonged walking, that do not exacerbate symptoms. Gradual reintroduction into work and school can then begin. If symptoms do not progress or worsen, athletes are allowed to progress to light activity, such as jogging, cycling, or light weight lifting. The goal of this step is to increase heart rate and evaluate symptoms. Subsequently, progression into sport specific non-contact activity is started, adding movements related to the athlete’s sport, such as running, skating, etc. If the athlete tolerates sport specific activity, progression to non-contact drills and practice is initiated. This includes training drills that are more difficult and incorporate exercise, coordination, and cognitive tasks. If symptoms related to the concussion dissipate, and the athlete continues to tolerate progression, they may be cleared for a contact practice and, finally, game play. A health care professional should determine final clearance for contact activity. Each step in the return-to-play protocol should occur on subsequent days. If an athlete experiences worsening symptoms, he should not return to play and should instead seek further medical evaluation and treatment.

Polypharmacy in the Elderly Francis Komara, DO

Mathew R. Saffarian, DO has been with the Department of Physical Medicine and

11 AM-12 PM

Spine, EMG, and Sports Medicine physician and also completed his residency there.

Tension, Migraine and Cluster Headache Lauren Aymen, DO

Rehabilitation at Michigan State University for two years on staff as an Interventional This editorial is not meant to serve as professional medical advice, solely as a physician’s opinion as it relates to concussion treatment.

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For full agenda, visit www.MOAautumn.com

EXHIBIT HOURS

6:30 AM – 4 PM SATURDAY, NOVEMBER 4 Physicians have a chance to enter a prize raffle for visiting 5 exhibitors!

MOA AUTUMN SUB - COMMITTEE Patrick Botz, DO, Dept. of Education Director Jeffrey Postlewaite, DO, Dept. of Education Director Mariam Teimorzadeh, DO, Dept. of Education Director R Taylor Scott, DO, Education Committee Co-Chair Lawrence Abramson, DO, MPH Kimberly Blom, MS, MSUCOM John Bodell, DO, FACOS James Clinton, DO, FACP Mary Goldman, DO Edward Jelonek, DO Matthew Kennedy, MSUCOM Chad Kovala, DO, FACOEP Arpita Mohanty, MSUCOM Anthony Ognjan, DO, FACP Jordan Skrivanek, MSUCOM

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ON LINE IO N AT AT RREGISTRAT ISTTRATION AT OONLI NLLINE I NNE E RRE EEG GGIS RAT ION ON I S T RAT I ON AT DOMOA.ORG/GR2017 D OMOA.ORG/G RG/GR2017 DOMOA.O R2017 DOMOA.ORG/G R2017 ContactVirginia Virginia Bernero Bernero with Contact with Contact Virginia Bernero with Contact Virginia Bernero with questions at 517-347-1555 517-347-1555 ext 103 questions ext103 103 questions atat517-347-1555 ext or vbernero@domoa.org questions at 517-347-1555 ext 103 or vbernero@domoa.org or vbernero@domoa.org or vbernero@domoa.org EXPERIENCE GR! EXPERIENCEGR! GR! EXPERIENCE There’s lots toGR! do during your stay EXPERIENCE There’s lots lots to to do do during during your your stay stay There’s in Grand Rapids. Find out your more stay at There’s lots to do during in Grand Rapids. Find out more inexperiencegr.com. Grand Rapids. Find out more atat in Grand Rapids. Find out more at experiencegr.com. experiencegr.com. experiencegr.com. HOTEL RESERVATIONS: HOTEL RESERVATIONS: HOTEL RESERVATIONS: MOA rate of $136 per night (by Oct. MOA rate $136per pernight night (byOct. Oct. MOA rate ofof$136 (by HOTEL RESERVATIONS: 5) Call 800-253-3590 or visit Call 800-253-3590 orvisit visit(by Oct. MOA rate of $136 per or night 5)5)www.domoa.org/jwmarriott. Call 800-253-3590 www.domoa.org/jwmarriott. www.domoa.org/jwmarriott. 5) Call 800-253-3590 or visit www.domoa.org/jwmarriott.

You’re invited to the AMOA Reception at Autumn Convention.

4 - 6 pm Friday, November 3 Reserve Wine Bar

(directly accross the street from Amway Grand Plaza) Join the Advocates for the Michigan Osteopathic Association for cocktails & conversation. Hors d’oeuvres also provided. No RSVP required, spouses welcome!

PRACTICE CONFERENCE MANAGERS CONFERENCE PRACTICE PRACTICE MANAGERS CONFERENCE PRACTICEMANAGERS MANAGERS CONFERENCE FRIDAY, NOV. 333&& NOV. 4, 2017 FRIDAY, NOV. &3SATURDAY, SATURDAY, NOV. 2017 FRIDAY, NOV. SATURDAY, NOV. 4,4,2017 FRIDAY, NOV. & SATURDAY, NOV. 4, 2017 Amway Grand Plaza | Grand Rapids, MI Amway Grand Plaza | Grand Rapids, MI MI Amway Grand Plaza | Grand Rapids, MI Amway Grand Plaza | Grand Rapids, TO TOPPPIIICCCSSSTO TOBBBEEECOV COVEERERREED: E D: TO TO COV TO P I C S TO B E COV E RD:E D: ---Mobile Apps, Email & Patient Mobile Apps, Apps,Email Email && Patient Patient Mobile -Communication Mobile Apps, Email & Patient Communication Communication Communication --State Stateof ofMichigan MichiganUpdate Update - State of Michigan Update - State of Michigan Update --MACRA/ MIPS MACRA/ MIPS MIPS - MACRA/ - MACRA/ MIPS - NP/ PA Regulations NP/ PA PA Regulations Regulations --NP/ - Revenue - NP/ PACycles Regulations Revenue Cycles Cycles --Revenue - Insurance Update Revenue Cycles Insurance Update Update --Insurance - Recognizing of Human -Recognizing Insurance Victims Update Victims of of Human Human --Recognizing Trafficking Victims Trafficking -Trafficking Recognizing Victims of Human - Credentialing Trafficking -Credentialing Credentialing -- American Association of Medical - Credentialing American Association of Medical Medical --American Association Assistants (AAMA) Updateof Assistants (AAMA) Updateof Medical Assistants (AAMA) Update - American Association

Assistants (AAMA) Update $275 EARLY BIRD RATE UNTIL OCT. 13! OCT. 13! 13! $275 EARLY EARLY BIRD BIRD RATE RATE UNTIL UNTIL OCT. $275

$275 EARLY BIRD RATE UNTIL OCT. 13! 16

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For full agenda, visit www.MOAautumn.com

Strategic Partners

Sponsors

NEXTgen physicians

Educational Grants

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BARIATRIC SURGERY NOT THE EASY WAY OUT, BUT THE MOST SUCCESSFUL WAY TO REGAIN HEALTH WITH OBESITY

BY MINDY LANE, D.O. FACOS, FASMBS

t a recent ASMBS (American Society of Metabolic and Bariatric Surgery) meeting we learned that most people who are obese (Body Mass Index over 30) consider themselves “overweight.” In fact 89% of obese people do not consider themselves obese. Most parents are very reluctant to call their children obese and often use terms such as “husky”, “thick”, or “big-boned”. Welcome to the skewed perception of obesity that we as Americans face. If 69% of adults and as many as 30% of children in America are overweight or obese it just makes sense that our sense of a “healthy” weight has shifted. Only four out of ten obese people discuss obesity with their primary physicians. Lack of time, denial, complexity of the topic, are all potential reasons for the lack of discussion, while poor excuses.

In Michigan the top five obese counties are Saginaw at 38.9%, Ionia at 38%, Muskegon at 35.8%, Eaton at 35.7% and Bay at 35.4%. These numbers were published on MLIVE in April of 2017. The ASMBS estimates 24 million Americans have severe obesity (BMI>35). Despite these staggering numbers, <1% of obese people seek Bariatric surgery for treatment. There remains a perception that diet and exercise provide the safest solution for weight loss despite staggering statistics demonstrating <10% of people are able to maintain weight loss. The effects of diet and regaining weight can actually be more deleterious to health than being overweight in the first place.

An ASMB fact sheet illustrates: Obesity has been linked to greater than 30 different diseases, including but not limited to, type 2 diabetes, heart disease, and certain cancers (esophagus, pancreas, colon and rectum, breast, endometrium, kidney, thyroid and gallbladder). It’s associated with a 50-100% increased risk of premature death compared to healthy weight people. The reduction in survival is 8-10 years for individuals with a BMI of 40-45 (comparable to smoking). The U.S. economic cost of obesity was $270 billion in 2011. The Center of Disease Control (CDC)

Top five obese counties in Michigan 1. Saginaw 38.9% 2. Ionia 38% 3. Muskegon 35.8% 4. Eaton 35.7% 5. Bay 35.4% Source: MLIVE, April 2017

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projects 42% of the population will suffer from obesity by 2030. Ninety percent of patients with type 2 diabetes are obese and type 2 diabetes accounts for 90-95% of the 29.1 million diabetes cases in the U.S. (CDC 2014).

Time and time again, study after study, bariatric surgery has been shown to be the most effective treatment for severe obesity. Over a decade ago the National Institute of Health (NIH) recognized that severely obese individuals (Body Mass Index of >35) have a greater resistance to losing and maintaining weight loss with conventional diet and exercise methods.

The NIH recognizes bariatric surgery as the only effective treatment for severe obesity. Bariatric surgery has the benefit of being able to hormonally alter the body’s set point. This is analogous to adjusting the thermostat in your home. Diet and exercise cannot do this. Without these powerful changes your body seeks to return to the “pre-set weight”. While most people can lose weight, this explains why they can’t maintain their weight loss.

While there are many misconceptions of Bariatric Surgery, following are two of the most common: 1. The chance of dying from Bariatric surgery is greater than the chance of dying from obesity. Data from the American Society of Metabolic and Bariatric Surgery (ASMBS) of – 60,000

Nutrient deficiencies after bariatric surgery are avoided with appropriate diet and vitamin supplementation. Guidelines for different types of bariatric surgery have been set by the ASMBS Nutritional experts. Comprehensive programs follow protocols for monitoring patient’s vitamins and minerals on a regular basis.

patients demonstrated the risk of death following

Calculating your Body Mass index is a simple Google search away. It’s a starting point. When you know where you stand, you know how instrumental bariatric surgery could be in adding years to your life or that of a patient.

50% after bariatric surgery).

bariatric surgery was .13 percent, less than that of gallbladder or hip surgery. Large studies supported by the ASMBS show significant reductions in mortality due to cancer (decreased by 60% after bariatric surgery), diabetes (decreased by 90% after bariatric surgery) and heart disease (decreased by

2. Bariatric patients have serious health problems caused by vitamin deficiency.

is in the company you keep. Sparrow became the first health system in Michigan and one of the first five in the country to join the Mayo Clinic Care Network. This collaborative relationship is another way Sparrow continues to find innovative ways to deliver the finest healthcare to you. Sparrow.org/Mayo

Choose Wisely. Choose Sparrow. TRIAD 2017 | ISSUE 4

GOVERNOR SNYDER MAKES APPOINTMENT, REAPPOINTMENT TO THE

MICHIGAN BOARD OF AUDIOLOGY Gov. Rick Snyder announced the appointment of Robert Borenitsch, DO of Saginaw as well as the reappointment of Nicole Ferguson, AUD of Mount Pleasant to the Michigan Board of Audiology. “I am deeply honored at my appointment to the Board of Audiology. I intend to do my best to maintain and improve the high quality of audiology as practiced in our state. I am especially honored to represent our Osteopathic profession in this capacity!” said Dr. Borenitsch. The nine-member board licenses and regulates audiologists practicing in Michigan. “I thank Robert and Nicole for their commitment and service to this board. Their experience will be a great asset to regulating audiology practices in Michigan,” Snyder said.

Borenitsch has his own practice which he opened in 1984, and is the president of the Saginaw Osteopathic Society. He holds a doctor of osteopathic medicine from the Chicago College of Osteopathic Medicine. He will represent those licensed to practice medicine or osteopathic medicine and surgery who hold a certificate of qualification from the American board of otolaryngology and replace Paul Hoff. Dr. Ferguson is the director of clinical education and services for audiology at Central Michigan University. She is the staff audiologist and tele audiology clinical champion at the Aleda E. Lutz VA Medical Center. She holds a bachelor’s degree and doctor of audiology from Central Michigan University. She will continue to represent audiologists. Dr. Borenitsch will serve the remainder of a four-year term expiring June 30, 2020. Dr. Ferguson will serve a four-year term expiring June 30, 2021. Their appointments are subject to the advice and consent of the Senate.

Symposium for Primary Care Medicine Friday and Saturday, November 3-4, 2017 The Diamond Banquet Center connected to the Hyatt Place Hotel at the Suburban Collection Showplace, Novi, Michigan For Primary Care Practitioners 15.5 Category 1-A AOA CME Credits 15.5 AMA PRA Category 1 Credit(s) ™ Specialty Credits Issued 7 Internal Medicine | 15.5 Family Medicine Featuring Self-Guided Chest X-Ray Virtual Workshop Sponsored by:

AT THE

TRIAD 2017 | ISSUE 4

THE CORE INSTITUTE EXPANDS ADDING FIRST SPINE PHYSICIAN AND DO TO MICHIGAN TEAM The CORE Institute recently announced the addition of fellowship trained interventional spine, sports medicine, and electrodiagnostic medicine physician Michael Slesinski, DO. He will care for patients at The CORE Institute’s Brighton and Novi locations in Michigan. “I am very excited to join The CORE Institute as the first interventional spine and non-operative sports medicine provider. I look forward to continuing the culture at The CORE Institute that focuses on patient care, education, and innovation. We have a great team approach to strive to provide the highest quality care possible.” Dr. Slesinski received his interventional spine, sports medicine, and electrodiagnostic medicine fellow-ship training from Michigan State University. During his fellowship, he served as an Assistant Professor in the

Department of Physical Medicine and Rehabilitation. Dr. Slesinski completed his physical medicine and rehabilitation residency at Michigan State University. He earned his Doctor of Osteopathic Medicine from Lincoln Memorial University in Tennessee and his bachelor’s degree from Alma College in Michigan. He serves as a volunteer on numerous community projects and is active as the Team Physician for the Lansing Lugnuts, a minor-league baseball team. He is active in research and has given multiple presenta-tions regionally and nationally. He is a member of several professional organizations including the Spine Intervention Society, American Society of Interventional Pain Physicians, American Academy of Physical Medicine and Rehabilitation, American Osteopathic Association, American Medical Society for Sports Medicine, and American Academy of Neuromuscular and Electrodiagnostic Medicine.

www.thecoreinstitute.com

Join the 228,000 hospital workers across Michigan in protecting healthcare and creating a healthier state. Become a MiCare Champion now at www.micarematters.org.

TRIAD 2017 | ISSUE 4

LEGISLATIVE EXPRESS

HOUSE BILLS 4425-4426 ince 1978, kindergarten and middle schoolchildren have been required to obtain an immunization certificate in order to attend school. But parents have been able to ask for a waiver on medical, philosophical or religious grounds. According to a House Fiscal analysis of the House Bills 4425-4426, Michigan had the sixth-highest rate of vaccination waivers in the nation before the 2015 waiver rule went into effect. Sponsors and supports of the bills reference government overreach and parental rights as reason for removing waiver these restrictions.

The pair of bills would: • Eliminate rules that require parents to get education about vaccinations if they want to get a vaccination waiver for their children. • Prohibit the state from enacting rules regarding vaccinations that are more stringent than state law. • Prohibit the state from imposing rigid rules on children in schools who aren’t immunized. • Have no effect on parents’ ability to ask for or get a waiver from vaccinations for their children. Medical experts throughout the country have defended the need for vaccinations, saying high vaccination rates are critical to preventing epidemics of highly contagious diseases such as whooping cough and measles.

REPRESENTATIVE BRETT ROBERTS STATE HOUSE DISTRICT 65 “Vaccines are safe, effective and save lives. Unfortunately, Michigan has one of the highest childhood immunization waiver rates in the United States, with outbreaks of preventable diseases happening far more often than they should. However, Michigan has made significant improvements in childhood immunization as a result of reforms that were designed to better educate Michiganders on the safety and importance of vaccinations. 18,000 additional kids were immunized, which is a great start, but there’s undoubtedly more work to be done. I’m proud to stand with parents, physicians, nurses, educators and health care providers across Michigan in support of life-saving progress.”

REPRESENTATIVE WINNIE BRINKS STATE HOUSE DISTRICT 76 “Immunizations have been proven to be one of the most successful and cost-effective public health tools for preventing diseases and death. They protect all of us, including our most vulnerable: babies, seniors, pregnant women, cancer patients, and individuals with immune system problems. The MDHHS rule has been a powerful tool that has helped us make huge strides in protecting the health wellbeing of our communities.”

ACCORDING TO A HOUSE FISCAL ANALYSIS OF THE HOUSE BILLS 4425-4426,

Michigan had the sixth-highest rate of vaccination waivers in the nation before the 2015 waiver rule went into effect. SPONSORS AND SUPPORTERS OF THE BILLS REFERENCE GOVERNMENT OVERREACH AND PARENTAL RIGHTS AS REASON FOR REMOVING WAIVER THESE RESTRICTIONS.

TRIAD 2017 | ISSUE 4

MOA PROVIDES HEALTHCARE PERSPECTIVE TO

On August 9, the MOA joined MSU legend Greg Kelser at his annual basketball camp. While the main purpose of the camp is basketball, there is a focus on academics that sets the Kelser camp apart.

of Osteopathic Medicine’s (MSUCOM) “Future DOcs,” a summer camp for high school upperclassmen eyeing a career as a DO and the Osteopathic Medicine Scholars Program for MSU undergrads.

The MOA presented to over 100 campers in small groups as they rotated through the stations on the fundamentals of basketball.

As the campers will soon be headed back to school, the event was a great opportunity for the MOA to highlight the importance of vaccinations, utilizing materials from the IVaccinate campaign the MOA is involved with.

Interaction with the campers included discussions about their futures - both in making healthy life choices and in pursuing an academic path toward healthcare. Campers learned about MSU College

This is the third year the MOA has been a part of the camp and once again the program featured volunteers whose enthusiasm quickly won over the upand-coming hoopers.

TRIAD 2017 | ISSUE 4

OBJECTIVE REVIEW OF

POTENTIAL RISKS IN A MEDICAL PRACTICE CAN BE BENEFICIAL BY TED ABERNATHY, MD MANAGING PARTNER, PEDIATRIC & ADOLESCENT HEALTH PARTNERS

Research on the frequency and severity of malpractice claims underscores the importance of a thorough, objective practice review. While the number of claims against physicians has been dropping since 2003, the average cost of a claim—defined as a request by a patient for payment—has grown from $69,000 in 2003 to $100,000 today, according to The Doctors Company, the nation’s largest physician-owned medical malpractice insurer.

TRIAD 2017 | ISSUE 4

s managing partner of Pediatric & Adolescent Health Partners headquartered in Midlothian, Virginia, I felt we could benefit from taking a closer look at our practice to identify risk factors and gaps in patient safety protocols. Our practice was expanding and I wanted to ensure we had consistent operational systems in place across locations to foster patient safety. An assessment service offered by The Doctors Company provided our practice with a comprehensive checkup of key areas and a customized action plan. A patient safety/ risk manager spent more than half a day at our practice reviewing medical records and procedures for test tracking, appointment setting, telephone communication,

informed consent, and other areas. She reviewed records and diagnoses from each of our providers, and interviewed the entire staff and physicians. The findings were presented to clinicians and office administrators, and communicated to the entire 51-member staff. Our management team prioritized the recommended actions and implemented several enhancements.

Our customized action plan included: Setting up a system that allows staff to capture information digitally and send a summary of phone conversations with pediatric patients’ families within seconds via e-mail or text. This ensures the correct information is communicated to the caller without ambiguity, and becomes part of the patient’s EHR. Instituting periodic chart reviews to ensure diagnosis codes are supported and medical records accurately describe the patient’s symptoms and history. Starting a peer review committee as a means of ensuring continuous performance improvement. Using a digital system to better track patient referrals to specialists and whether patients were following through with appointments. Digitally tracking whether reports from ordered labs and other tests are getting back to the office. Changing from a handwritten system to a computerized one increases accuracy and assists with follow ups, which strengthens patient safety.

“

These changes have better equipped our practice to minimize risks and have enabled us to prove that the practice is grounded in patient safety.

”

Monitoring medications more accurately through a medication reconciliation process that documents at every appointment whether patients are continuing their prescribed regimen or have stopped or altered it. The responses are included in the patient’s EHR.

These changes have better equipped our practice to minimize risks and have enabled us to prove that the practice is grounded in patient safety. Based on management’s discussions with the staff, employees have more confidence that protocols and standards are working as intended, and feel more empowered to highlight opportunities for improvement and work together to achieve goals. By doing so, we can anticipate issues before they become problems, and can focus on what matters most—providing the best care to our patients. Contributed by The Doctors Company ( thedoctors.com )

TRIAD 2017 | ISSUE 4

WHY NOT CREATE A

NATIONAL ID CARD FOR HEALTHCARE PROFESSIONALS? BY EWA MATUSZEWSKI, CEO, MEDNET ONE HEALTH SOLUTIONS

When we think of doctors without borders, we think of war torn nations and third world countries ravaged by famine and illness. We think of dedicated physicians risking life and limb across national and international borders. We don’t think of state lines – do we? I certainly don’t. Yet the U.S. continues to operate with state-by-state laws when it comes to allowing physicians to practice medicine outside of their home state.

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7/10/17

8:54 AM

TOGE THER

ith Hurricane Harvey, Irma or Marie wreaking havoc and a state of emergency declared for Texas, Florida, Puerto Rico and the U.S. Virgin Islands, I shake my head and question why a patchwork of licensure rules determines the ability of our physicians to cross state or U.S. Territory lines in times of natural disaster. In Texas, the Texas Medical Board issued expedited temporary permits for out-of-state physicians to assist with Hurricane Harvey emergency response efforts, yet permits still needed to be applied for and submitted – and physicians needed to be sponsored by a licensed Texas physician. Expediting the process is a start, but wouldn’t even be necessary if there was a national registry of licensed physicians, listed by state and extended the privileges of practicing medicine in other states during times of crisis. The registry could require each physician to verify his or her listing, with cross-referencing by a state agency as a safeguard. In addition to being accessible online, the registry could issue a universal national physician identification card listing areas of practice. Have registry, have ID card, will travel.

Just what the doctor ordered. 26

TRIAD 2017 | ISSUE 4

The identification card could also come in handy when a medical emergency arises on airplanes. You may recall the story of the female African American physician on board a Delta flight from Detroit to Minneapolis who was shooed away by an airline flight attendant from helping a fellow passenger in distress because she was unable to show her credentials. In the meantime, a white male physician who showed no credentials was directed to the patient. Yes, this case appeared to be race-related rather than credential related, but a physician credential card – and perhaps an airline system that tagged physician passengers with their permission, could have made a difference. An online registry could serve as a double-check. A quick look at American history of why licensure varies state by state dates back to the Civil War, when the goal was to protect the public from medical incompetents. We’ve all the heard the lament, “But that’s the way we’ve always done it,” but this takes it to ridiculous extremes. Even telehealth can be impeded by inconsistent licensing laws. How can specialists such as psychiatrists at world-class health centers like the Cleveland Clinic consult with primary care or specialty care physicians in other states and be sure they aren’t inadvertently breaking a state law and practicing medicine in that state without a license? If the concept of a national registry and identification card for physicians was implemented and deemed effective, all we’d have to do next is let the DO’s do what they do best, care for the patient. Ewa Matuszewski is the CEO of MedNetOne Health Solutions, a physician organization based in Rochester, Michigan.

16TH ANNUAL MSAE DIAMOND AWARDS September 14, 2017 • The Henry, Dearborn

We are proud to announce that at the recent Michigan Society of Association Executives 2017 Diamond Awards, our very own CEO, Kris Nicholoff, was inducted into the Michigan Association Hall of Fame. This award honors individuals who have excelled in the association KRIS NICHOLOFF CEO AND EXECUTIVE DIRECTOR

management profession. We can’t think of a more deserving boss, and steward of the osteopathic profession. Individuals selected to be part of the Michigan Association Hall of Fame will join a distinguished group who exemplify the very best in association management. Thank you to everyone who came out to join us in celebrating Kris’ lifetime accomplishment. ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

MOA at MSAE Diamond Awards

Awardee Kris Nicholoff and wife Heather

TRIAD 2017 | ISSUE 4

AOA ANNUAL BUSINESS MEETING July 17-23 â&#x20AC;˘ Chicago Marriott Downtown Magnificent Mile

More than 500 osteopathic physicians and medical students gathered to create AOA policy at the Annual Business Meeting in downtown Chicago. The MOA had a strong showing at the event. The meeting includes the AOA House of Delegates where the MOA contingent submitted 6 resolutions. Led by MOA President, John Sealey, DO, FACOS, the Michigan delegation was well-represented with over 50

delegates attending the HOD.

TRIAD 2017 | ISSUE 4

“The strength of the MOA's delegation was apparent. It is so gratifying to see our members ake the effort in preparing for the discussion.” “We were able to speak as one voice as we vetted the many issues before us in the caucus meetings. I want to thank everyone who participated in the process of bringing issues from our membership groups to actions by the AOA.” —Dr. John Sealey, DO, FACOS

PAGE 28 CAPTIONS 1 – President John Sealey, DO, FACOS & Cassandre Perard, DO 2 – Jasper Yung, DO; Andrew Adair, DO, FACOFP; Emily Hurst, DO

PAGE 29 CAPTIONS 3 – Gary Willyerd, DO & Bruce Wolf, DO, FAOCR

4 – William G. Anderson, I, DO 5 – Boyd Buser, DO addresses Michigan Delegate Caucus TRIAD 2017 | ISSUE 4

TO LIVE WELL As Osteopathic physicians, the complexities of

on workshops, and personalized nutritional support, our

our mission to facilitate health for the body,

programs encourage real, sustainable changes that impact

mind, and spirit could be condensed into that simple phrase: to Live Well. But, for the three

lives for years to come. Integral to the osteopathic profession is the partnership between patient and provider, where providers build a

million Michigan residents suffering from obesity

relationship with their patients and teach them how to

and its cadre of associated health conditions,

achieve and maintain health. We, at Lettuce Live Well,

that simple phrase often seems hopelessly

W out of reach.

want to become a part of that healthcare team. We will meet your patients anywhere and anytime through our nutritional coaching services, offered both in-person and online. We can help them learn to shop healthy on a bud-

e know that changing habits is

get at our grocery store tours, find them an accountability

not something that can be accom-

group among the 4,000 users of our health tracking sys-

plished with a 15-minute visit, a

tem, or connect them with the community program that

21 day fix, or a 90 day challenge;

best fits their needs.

it is a lifelong journey that starts with a single small step. Lettuce Live Well was founded not only to help people take that first step, but to walk hand-in-hand with them for the thousands of steps that follow it.

As is often the case, those who need these services the most have the least access to them, so all of our programs are offered at no cost to those who cannot afford them. But none of this would be possible without you, so please

Since our founding in 2014, Lettuce Live Well has been

consider partnering with us in our effort to change the

dedicated to providing access to education and resources

face of medicine through preventative care. Like you,

that individuals need to lead happier and healthier lives.

we believe that preventative medicine and caring for the

Together with our partner organizations, we offer a broad

whole person, both in and out of the office, is founda-

scope of health and wellness services, bridging the gap

tional to achieving true and lasting health. Only by work-

and connecting people to the resources they need to reach

ing together as a healthcare team and coming alongside

their health goals. Through interactive instruction, hands

our patients can we truly Live Well.

Come visit our booth at Autumn Convention! Saturday, November 4, 7:00 a.m. - 3:00 p.m. 30

TRIAD 2017 | ISSUE 4

ADVERTISERS TRIAD STAFF Patrick Bell, DO, and Larry Prokop, DO, Department Chairs William Strampel, DO, Contributing Editor Kris T. Nicholoff, CEO and Executive Director Lisa M. Neufer, Director of Administration Todd Ross, Manager of Communications Cyndi Earles, Director, MOA Service Corporation Marc A. Staley, Manager of Finance Virginia Bernero, Executive Assistant & Advocacy Liaison 2017-18 BOARD OF TRUSTEES John Sealey, DO, FACOS, President Lawrence Prokop, DO, FAAPM&R, FAOCPMR-D, FAOASM, President-Elect Craig Glines, DO, MSBA FACOOG, Secretary/Treasurer Bruce Wolf, DO, Immediate Past President Department of Socio Economics - Directors Andrew Adair, DO, FACOFP David Best, DO, MS, ABAM Department of Education - Directors Jeffrey Postlewaite, DO, MPH Patrick Botz, DO Mariam Teimorzadeh, DO, Resident Department of Membership - Directors Emily Hurst, DO Kevin Beyer, DO Augustine Nguyen, Student Department of Healthcare Technology & Informatics - Directors Lawrence Prokop, DO, FAAPM&R, FAOCPMR-D, FAOASM Stephen Bell, DO, FACOI 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.domoa.org Email: moa@domoa.org

Beaumont Health...................................................................6 Beaumont Health Symposium.............................................20 McLaren................................................................................2 Med-Share.............................................................................6 Michigan Health and Hospital Association..........................21 MOA...................................................................................31 MOPAC.................................................................................4 Sparrow Health System.......................................................19 The Doctors Company........................................................32 University of Michigan Metro Health Network......................4

For advertising inquiries, please email Todd Ross at tross@domoa.org or call 800.657.1556.

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90% YOUR MOA ANNUAL DUES ARE

TAX DEDUCTIBLE. Visit domoa.org/whatwedo to learn more about member features & benefits! Follow MOA on social media for industry news and other updates.

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