TRIAD Online Spring 2018

The Award-Winning Journal of the Michigan Osteopathic Association S P R I N G 2018

ADVOCACY ISSUES AFFECTING PATIENT CARE

ALSO INSIDE

119TH ANNUAL SPRING SCIENTIFIC CONVENTION May 17-20, 2018 30-33 CME Approved 750+ Attendees

MICHIGAN OSTEOPATHIC ASSOCIATION

w w w. D O M O A . o r g

michiganosteopathic

MichiganDOs

m i c h i g a n - o s t e o p a t h i c- a s s o c i a t i o n

GROWTH

INNOVATION

PROGRESS

Moving forward with McLaren As one of Michigan’s largest and growing health care systems with more than 52,000 contracted providers and a delivery network covering the entire lower peninsula of Michigan, our strength can be attributed to our ability to excel at the very human element of medical care.

We understand that health care must be provided by physicians and other medical professionals who are devoted to healing the sick, relieving pain and advancing research.

We are thankful for the dedication and service of the more than 9,000 osteopathic physicians in Michigan whose contributions make a difference each and every day in the quest to bring the latest technologies and innovations to the communities we serve.

Find out how you too can move forward with McLaren.

To learn more about opportunities around the state, visit JoinMcLaren.org.

One of the largest health care systems in Michigan with 350 facilities, 13 hospitals and more.

CONTENTS

Think Spring

Thursday, May 17 - Sunday, May 20, 2018 1500 Town Center Southfield, MI 48075

IN EVERY ISSUE 05 President’s Page

FEATURES

07 CEO’s Message

Opioid Update: 06

New Laws and Regulations for 2018

26 Component News

08

“I Vaccinate” campaign

27 Advertiser Index

10

119th Annual Spring Scientific Convention

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A Comparison: Michigan Auto No-Fault and a Traditional Tort Liability Insurance System

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Lettuce Live Well

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Working to Improve Hospital Transparency

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Michigan Health Link: Michigan Complete Health

22

EHRs Can Advance Good Medicine – If Doctors Are Aware of the Risks

Contributed by The Doctors Company

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Social Determinants of Health: Why Ask?

Contributed by Healthcare Partners of Michigan

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New NewMOA MOAWebsite Website &&Event EventRegistration Registration Upgrade Upgrade The The Michigan Osteopathic Association Michigan Osteopathic Association(MOA) (MOA) has has transitioned to atonew website transitioned a new websiteand and membership database.

Visit www.domoa.org membership database.

Visit www.domoa.org (same address) to view thethe new design. (same address) to view new design.The The system has has sentsent all all MOA members system MOA membersananemail emailtoto password newsite. site. resetreset theirtheir password forfor thethe new We hope to provide a more intuitiveonline online We hope to provide a more intuitive environment, making it easier to access profile environment, making it easier to access profile information, pay membership dues and register information, pay membership dues and register for events. for events.

With the new system, the website

With the new system, the website can detect whether you are using a can detect whether you are using a computer, tablet or smartphone, and computer, tablet smartphone, and will adjust the or display to fit your willdevice. adjust the display to fit your device.

If you are an MOA member experiencing

If you are an MOA member difficulties accessing the experiencing login area of the site, difficulties accessing login area of the site, please contact us atthe 517-347-1555. please contact us at 800-657-1556.

Instructions for Online Convention Registration

Instructions for Online Convention Registration 1. Visit www.DOMOA.org/spring2018 There you can find details on the convention, a link to reserve a hotel room and full agenda.

1. Visit www.DOMOA.org/spring2018

There you can find details on the convention, a link to reserve a hotel room and full agenda.

2. Make sure you are logged in to receive member discounts!

2. Make sure you are logged in to receive member discounts!

3. Verify all information 4. Select from Registration Options

3. Verify all information

5. Select meals, extra programs and activities.

4. Select from Registration Options

6. Make payment. Ensure registration by fully completing the online process.

5. Select meals, extra programs and activities. andbydetails on pages 10 process.

- 13. See you in Southfield!

6. Convention Make payment.highlights Ensure registration fully completing the online

Convention highlights and details on pages 10 - 13. See you in Southfield!

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T R I A D | S P R I N G 2018

PRESIDENT’S PAGE

T

his issue of the TRIAD is focused on “Advocacy Issues Affecting Patient Care.”

For 119 years the Michigan Osteopathic Association has advocated on behalf of osteopathic physicians and quality care for their patients. In thinking of that history, I truly believe there would be no better time to serve as your president.

In healthcare, we live in a time of change. Technology is changing the way we interact with patients, and patients are armed with knowledge culled from the internet. Advancements in medicine are changing our approach to medicine. Healthcare policy is changing the way patients receive care.

John Sealey, DO, FACOS MOA PRESIDENT

One thing that hasn’t changed is advocacy.

Advocating for the issues surrounding healthcare policy, laws and regulations has been, and will always be, paramount for the MOA. During my 2017-18 term as president of the MOA, I have been active on a variety of issues. Recently, I traveled to Washington, D.C. to meet with legislators regarding funding for the Teaching Health Center Graduate Medical Education (THCGME) Program, protecting medical student access to Student Loan Programs and The Good Samaritan Health Professionals Act. In reviewing the issues, the pros and cons, and the possible outcomes, one thing really resonated with me—the people who develop healthcare policies really need us. As physicians, residents, interns and medical students, we offer a perspective that is essential when it comes to creating policies that determine the way physicians are educated, trained and practicing medicine.

Recently, the State of Michigan passed a series of bills regarding prescribing controlled substances. In an effort to reduce the role prescription medicine plays in the opioid crisis, legislators designed bills with great intentions. However, medical associations and healthcare providers were not consulted. The bills became public acts. As the details of the new regulations were shared within the healthcare community, several issues became immediately apparent. Patient access to quality care and addiction treatment issues were not addressed in the original bills. Fortunately, the MOA and several other healthcare associations organized a response. The Michigan Department of Licensing and Regulatory Affairs (LARA) was receptive to the issues, and changes and clarifications are forthcoming.

Not all advocacy efforts will find success. Why am I excited to be president of our association in this day and age? Because I believe we live in an era where our expertise, perspective and strength in numbers can help develop healthcare policies that make sense in terms of practicing medicine and can succeed in providing quality patient care.

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Opioid Update: New Laws and Regulations for 2018 On December 27, 2017, several new requirements aimed at combating the opioid epidemic were signed into law by Lt. Governor Brian Calley. The Michigan Osteopathic Association (MOA), the Michigan Academy of Family Physicians (MAFP) and the Michigan State Medical Society (MSMS) have partnered to offer an analysis of the new requirements, the implications and details on enforcement.

The Opioid Alert document and other resources are available at www.domoa.org/opioids.

Due to the concern over the new regulations from a number of physicians, the MOA and MAFP offered a survey designed to gain feedback on the concerns and the specific areas of confusion.

The survey had over 100 respondents from a wide range of physicians and practice managers. The responses gathered were organized and presented to the Michigan Department

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of Licensing and Regulatory Affairs (LARA) in a conference call on March 7, 2018. Participating on the call was Kim Gaedeke, Director Bureau of Professional Licensing under LARA, along with members of the MOA Safe Opioid Use Task Force. The productive call resulted in answers from LARA addressing many of the concerns from the survey.

More importantly, the line of communication between LARA and the MOA has been established.

Moving forward, LARA and the MOA will periodically share information to ensure the regulations and the MAPS system can work to reduce prescription abuse while allowing reasonable access to pain management for patients. LARA will be issuing new instructional materials and guides to help make MAPS easier to navigate.

IF YOU WISH TO PROVIDE YOUR INPUT ON THE ISSUES RELATED TO MAPS, PLEASE CONTACT: TODD ROSS MANAGER OF COMMUNICATIONS TROSS@DOMOA.ORG

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November 16 - 18, 2018 Amway Grand Plaza, Grand Rapids 20+ AOA Category 1-A CME credits anticipated.

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T R I A D | S P R I N G 2018

• Email Alerts

CEO’S MESSAGE THE NETWORK OF ADVOCACY

W Kris Nicholoff

e are in an era where healthcare policy is in constant flux. Regulations are governing everything from what a physician can discuss with a patient to how patient data is stored. The requirements on a doctor’s time has never been greater. So how does a doctor stay involved in healthcare policy and keep up with the day-to-day responsibilities of being a physician? By staying connected to a network of colleagues and healthcare experts.

CEO and Executive Director

As someone who has devoted over 30 years to governmental affairs, I can assure you there are no short cuts. There are no quick fixes that can solve a complex issue with any lasting success. I have learned that developing and relying on a network of experts, stakeholders and policy makers is what drives long-term solutions.

The theme of this issue of the TRIAD focuses on advocacy. While the theme “Advocacy Issues Affecting Patient Care” can cover a plethora of issues, the philosophy remains the same. When it comes to advocating on issues affecting osteopathic physicians, my job is to examine the issue, determine the best strategy and assemble the network of people who can address the issue. This involves meeting with legislators, healthcare leaders, other associations and, most importantly, the physicians who are directly affected.

The Michigan Osteopathic Association has been in the advocacy business since 1898.

Long before smartphones, Electronic Health Records, social media and a vast network ripe for misinformation, the MOA has advocated for physicians and the patients they serve. As the technologies and issues change over time, the one ingredient that remains constant is— you. If you are reading this, you have a stake in the game. Whether you choose to join the efforts of an MOA committee, become a delegate to the MOA House of Delegates or contribute to an action alert letting your legislators know your opinion on a specific healthcare policy, individual involvement is what makes up the fabric of advocacy.

I encourage each physician to find a balance where involvement in the issues that matter to you can occur at the same time you are practicing medicine. At the same time, I would like to thank the countless people who are behind the advocacy efforts of the MOA. We have made great strides in so many areas, but we know things are constantly moving.

While we don’t know the next issue that will cause upheaval in healthcare, but we do know we have the network of advocates to take on challenge and succeed.

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“I VACCINATE” CAMPAIGN HELPS MICHIGAN PARENTS PROTECT THEIR KIDS FROM VACCINE-PREVENTABLE DISEASES When childhood immunization rates drop, the health of the entire region, state, and nation is threatened. Recent examples of the reemergence of vaccine-preventable diseases – chicken pox, mumps, measles and pertussis – can be found in Michigan, bordering states, and nationwide. Michigan largely ended public education on vaccinations in the mid-2000s. Following this, Michigan’s childhood immunization rates dropped to among the worst in the nation – ranking 44th for children ages 19 months to 35 months, according to the 2015 National Immunization Survey.

I

n March 2017, state and national public health experts, physicians, hospitals, and a private foundation launched the “I Vaccinate” campaign to help parents protect their children from vaccinepreventable diseases that still pose a risk in Michigan communities. Support is provided by the Michigan Department of Health and Human Services (MDHHS) and the Franny Strong Foundation.

The I Vaccinate campaign, designed with input from Michigan mothers, provides the facts and resources parents need to make informed decisions about vaccinations. The campaign includes advertising, as well as a parent-focused, Michiganspecific website (IVaccinate.org) and social media communities (Facebook, 8

T R I A D | S P R I N G 2018

“The I Vaccinate website provides easy-to-understand, credible medical answers to common vaccine questions to empower parents to make the choice to protect their child – and the children around them – from vaccinepreventable diseases.”

Twitter, Instagram, YouTube) which empower parents and physicians alike to discuss the importance and safety around vaccines.

Most parents today have never seen first-hand the devastating consequences that vaccine-preventable diseases have on a child, a family or

community. Vaccination is one of the best ways parents can protect infants, children, and teens from 16 potentially harmful diseases. Vaccine-preventable diseases can be very serious, may require hospitalization, or even be deadly — especially in infants and young children.

“As parents, we want to do everything we can to keep our children safe, and the amount of information about vaccines available online can be overwhelming,” said Veronica McNally of the Franny Strong Foundation, an organization she and her husband Sean founded after losing their 3-month-old daughter to whooping cough in 2012. “The I Vaccinate website provides easy-to-understand, credible medical answers to common vaccine questions to empower parents to make the choice to protect their child – and the children around them – from vaccine-preventable diseases.”

“Michigan’s low immunization rates threaten the health of all residents, and now we’re seeing the unfortunate return of vaccine-preventable diseases because misinformation is leading some parents not to vaccinate,” said Dr. Eden Wells, MD, chief medical executive with MDHHS. “We

know parents have questions and they want to do what’s best to protect their children. The I Vaccinate campaign helps them make an informed decision to protect their children and others around them.”

December 2017 data from the Michigan Care Improvement Registry shows that only 56.2 percent of Michigan toddlers aged 19 through 35 months are up to date on all of their recommended vaccinations.

While it will take time to change this trend, you play a pivotal role as a provider in educating your patients and addressing their concerns about vaccination. The I Vaccinate website has excellent resources for answering questions and citing the science behind the safety of vaccines.

Since the campaign launch in March 2017, the I Vaccinate website has been visited more than 73,000 times, averaging around 1,800 visits per week.

While progress has been made, there’s still room for improvement in Michigan communities.

YOUNG CHILDREN LESS THAN 3 YEARS OLD: • Only 56.2 percent of Michigan toddlers aged 19 through 35 months are up to date on all of their recommended vaccinations, according to data from MCIR from December 2017.

• In the U.S., 71.3 percent of children 19 through 35 months living in major cities are up to date on their vaccinations (7 series), compared to 55.8 percent in Michigan.

• In Michigan, 64.7 percent of 5-month-old children were up to date for the recommended vaccines, but this number drops to 54.4 percent for 7-monthold children, according to MCIR data from January 2018.

SCHOOL-AGED CHILDREN: • During the 2016-17 school year, Michigan had the 12th highest exemption rate for kindergartners in the nation, with 3.7 percent of parents simply choosing not to immunize their children.

• In 2016, Michigan had 20 counties with a vaccine waiver rate of 5 percent or more among kindergartners.

• Only 38 percent of Michigan teens aged 13 to 18 years are up to date on all of their recommended vaccinations, according to data from MCIR from December 2017.

I Vaccinate is a public health education campaign to help parents in Michigan protect their children from vaccine-preventable diseases. Designed with input from Michigan mothers, I Vaccinate provides the facts about vaccinations that parents need.

According to Michigan Care Improvement Registry (MCIR) data from December 2017, only 56% of Michigan toddlers are up to date on their vaccinations.

With your help, we can educate more parents—and protect more children. Please encourage your patients to the get the facts they need at IVaccinate.org.

TRIAD

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CME INFO Scan-In Times: THURSDAY

Afternoon: 3:30 – 7 PM

FRIDAY

May 17 - 20, 2018 Westin Southfield Detroit 1500 Town Center, Southfield, MI 48075

Registration & Agenda at www.domoa.org/spring2018 Hotel reservations: Call 888-627-8558, mention MOA Convention for discounted rate of $125.

Before your visit, be sure to check out: VisitDetroit.com

Speakers Bureau Recall Workshop (4 CME) Sunday, 12 – 4 pm Windover Room Moderator: Mary Goldman, DO Speakers: Saroj Misra, DO, FACOEP; Marissa Rogers, DO

New Workshop!

Training to optimize presentation skills, including: - Selection of engaging topic and title - Power-point - Organization to increase recall and retention.

Participation in this course will be noted during the speaker selection process for future conventions.

Morning: 6:30 AM – 1:30 PM Afternoon: 1:30 – 6:00 PM

SATURDAY

Morning: 6:30 AM – 1:30 PM Afternoon: 1:30 – 6:00 PM

SUNDAY

Morning: 7:00 AM – 12 PM Afternoon: 12:00 PM – 4:00 PM

Process: Scan the bar code on your name badge to receive CME credit during designated times. Attest your participation by completing the mandatory online evaluations at www.domoa.org/eval.

Upon completion, your CME certificate will be available to print or save to desktop for your records. MOA will submit CME to the AOA by July 1, 2018.

Details: • 32 AOA Category 1-A credits offered Thursday-Sunday • Specialty credits offered AOBIM, AOBEM, AOBFB, AOBNP, ABOD • 3 FREE additional AOA 1-A Category 1 credits available for completing Outcomes Measurement Survey that will be emailed two weeks post-convention.

Visit www.domoa.org/CME for more information.

CME Accreditation: The Michigan Osteopathic Association (MOA) is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. The Michigan Osteopathic Association designates this program for a maximum of 32-35 AOA Category 1-A credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in this activity.

EVALUATIONS www.domoa.org/eval Username: [your AOA#] Password: moacme

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T R I A D | 2018 S P R I SNPGR2018 ING - CONVENTION PREVIEW

LARA REQUIREMENTS* OFFERED

CONVENTION SPONSORS

2 - 6 pm, Algonquin Ballroom | 4.0 credits

Platinum Sponsors

*Meets Michigan licensing requirements for pain & symptom management, human trafficking for physicians and other health care providers.

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Opioid Prescribing: Safe Practice, Changing Lives (AOA CO*RE REMS) —William Morrone, DO, MS, FACOFP By attending this REMS course, you will be equipped to: • Accurately assess patients with pain for consideration of an opioid trial • Establish realistic goals for pain management and restoration of function

Strategic Partner Sponsorships

• Know how to manage ongoing therapy with ER/LA opioids • Initiate opioid treatment (IR and ER/LA) safely and judiciously, maximizing efficacy while minimizing risks • Monitor and re-evaluate treatment continuously; discontinue safely when appropriate • Counsel patients and caregivers about use, misuse, abuse, diversion, and overdose • Educate patients about safe storage and disposal of opioids • Demonstrate working knowledge and ability to access general and specific information about opioids, especially those used in your practice Presented by the American Osteopathic Association in partnership with the Collaborative for REMS Education (CO*RE), supported by an independent educational grant from the ER/LA Opioid Analgesics REMS Program Companies (RPC).

LARA R 338.143

Educational Grants American Osteopathic Association

Pain & Symptom Management: Minimum 3 hours per 3-year period.

(Effective December 2017) Applies to all physicians, including residents, whether or not they are in active practice (ex. retired, administrative, academic teaching, etc.)

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Physician Recognition of Trafficking Victims —LaClaire Bouknight, MD, FACP By attending this training, you will equipped to: • Identify risk factors important in detecting patients likely involved in human trafficking • Understand the importance to the health professional in knowing the age of the patient • Understanding the likely health and mental health issues of a trafficking victim • Understanding mandatory reporting and the organizations that should be notified

LARA R 338.120

SRE Sponsors McLaren Macomb MSUCOM Statewide Campus System MSUCOM PhD-DO Award Council of Intern & Residents Sponsors TeamHealth Michigan State University Federal Credit Union _____________ Allure Vein Clinic Lettuce Live Well Michigan Occupational & Environmental Medicine Association (MOEMA) Oakland County Health and Human Services The Doctors Company

T R I A D | 2018 S P R I N G - CTORNI AVD E N T| I SOPNRPI NR GE V2018 IEW

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EXHIBIT DATES & HOURS

ACLS / BLS

Exhibit all four days or exhibit just one day—it’s up to you!

Offered as al-a-carte options, not part of regular convention registration. Limited spots available. All instructional material updated with latest AHA Guidelines for CPR & ECC.

Thursday, May 17 | 3-6pm Friday, May 18 | 7am-6pm Saturday, May 19 | 7am-6pm

BASIC LIFE SUPPORT (BLS) CERTIFICATION 4 AOA 1-A Credits Friday, 7 - 10 am

Sunday, May 20 | 7am-3:30pm

PRIZE DRAWING MOA is holding prize drawings during exhibitor times.

Physician registration materials will include one entry slip and an exhibitor room layout. MOA will provide exhibitors with unique identifying stickers. Physicians will collect these stickers as proof of visiting with exhibitors. Physicians will turn in the completed slips to be entered in prize drawings with winners announced at designated times.

ADVANCED CARDIOVASCULAR LIFE SUPPORT (ACLS) CERTIFICATION 11 AOA 1-A Credits Friday, 10 am - 5pm & Saturday, 8 am - 12 pm

Contact Cyndi Earles if you are interested in donating a prize for the drawing or have other questions about exhibits.

ADVANCED CARDIOVASCULAR LIFE SUPPORT (ACLS) RE-CERTIFICATION 4 AOA 1-A Credits Saturday, 8 am - 12 pm

Cyndi Earles Director, MOA Service Corporation E cearles@domoa.org P 517-512-4307

WOMEN of EXCELLENCE Contract Workshop Friday, May 18, 3:00 - 5:00 pm

Board of Governors/Board of Regents Bring contract for discussion and review.

Reception with Special Guest Speaker Friday, May 18, 6:00 pm Charlevoix A-B All are welcome, no ticket required.

Sponsored by

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T R I A D | 2018 S P R I SNPGR2018 ING - CONVENTION PREVIEW

SCIENTIFIC RESEARCH EXHIBIT COMPETITION The Scientific Research Exhibit (SRE) competition reached a record number of submissions in 2017 at both the Spring and Autumn Convention. This year, we are looking forward to a continued increase in participation and caliber of projects.

Poster presentations and oral presentations at Spring Convention are scheduled for Friday, May 18, 2018 from 7:30 am-11:30 am, prize awards will be announced following the competition.

For upcoming SRE Competition details, deadlines and more information please visit www.domoa.org/SRE.

M OA EDUCATION COMMIT TEE 2017-2018 Jeffrey Postlewaite, DO, MPH Department Director Patrick Botz, DO Department Director

POSTER AWARDS:

Mariam Teimorzadeh, DO

• Lawrence J. Abramson, DO, MPH First place - $1,000

Department Director

• Second place - $500

Aaron Ellenbogen, DO

• Third place - $250

Committee Co-Chair

• Outstanding Case Report - $250 R. Taylor Scott, DO

• Best DO-PhD Report - $500

Committee Co-Chair

(Sponsored by MSUCOM)

ORAL PRESENTATION AWARDS:

Kimberly Blom, MS, MSUCOM

• Case Report - $500

John Bodell, DO, FACOS

• Research or Quality / Patient Safety - $500

James Clinton, DO, FACP

SPECIAL RECOGNITION & AWARD — The Andrew Taylor Still (ANDY) Achievement Award may be presented to one outstanding Scientific Research Exhibit poster submitted to the competition at the MOA Annual Scientific Convention reflecting the best of osteopathic medicine principles and practice. The recipient of the ANDY is awarded a $1,500 prize plus a carved crystal piece. The ANDY is not awarded every year.

Nadine Elhage, MSUCOM Harold Friedman, DO Tiffany Garcia, MSUCOM Mary Goldman, DO Benjamin Heriford, MSUCOM Edward Jelonek, DO Francis Komara, DO Chad Kovala, DO, FACOEP Arpita Mohanty, MSUCOM William Morrone, DO, MS, FACOFP Anthony Ognjan, DO, FACP Amy O’Neill, DO Jessica Reid, MSUCOM Kathleen Rollinger, DO Jordan Skrivanek, MSUCOM Margaret Swenor, DO

T R I A D | 2018 S P R I N G - CTORNI AVD E N T| I SOPNRPI NR GE V2018 IEW

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A COMPARISON:

MICHIGAN AUTO NO-FAULT AND A TRADITIONAL TORT LIABILITY INSURANCE SYSTEM

BY KEVIN MCKINNEY

Legislation (HB 5517) has been introduced seeking to repeal the Michigan auto no-fault insurance law and replace it with a traditional tort liability legal system.

To better understand the differences, each system is summarized here.

The Michigan No-Fault Law Under current Michigan auto no-fault insurance law, every person (unless disqualified) who sustains bodily injury in a motor vehicle accident is entitled to certain “first-party PIP benefits,” payable regardless of who was at fault.

THESE PIP BENEFITS INCLUDE: 1. lifetime, uncapped medical and rehabilitation expenses, in-home attendant care, residential accommodations, transportation expenses, and related costs of care and recovery; 2. three years of wage loss benefits, currently capped at about $5,400 per month; 3. three years of domestic replacement service expenses capped at $20 per day; and 4. three years of survivor’s loss benefits, if a person is killed in a motor vehicle accident leaving surviving dependents.

Under Michigan’s no-fault system, injured victims receive PIP benefits from their own insurance company, regardless of how or why the accident happened. In limited situations, however, the person may be required to pursue PIP benefits from the insurance company of one or more of the drivers involved in the collision, such as a non-driver without automobile insurance.

Because all injured victims receive PIP benefits without regard to fault, injured persons cannot sue at-fault drivers for any of those expenses. Therefore, Michigan drivers have no need to purchase extensive amounts of liability insurance to cover their potential tort liability.

However, under the current Michigan no-fault law, if a crash causes a victim to suffer a “threshold injury” (serious impairment of body function, permanent serious disfigurement, or death), the victim can recover certain “noneconomic loss damages” (i.e., pain and suffering, etc.) from the at-fault driver, if the victim is not more than 50% at fault for causing the crash.

Traditional Tort Liability Law Under a traditional tort liability system, victims injured in a motor vehicle accident can only recover compensation for their medical and rehabilitation expenses, related expenses for care and recovery, and loss of income from drivers found to be “at fault” (i.e., negligent) for causing the accident. If the injured victim cannot prove that one or more drivers were at fault, the victim cannot recover losses and expenses.

Moreover, under the doctrine of “comparative negligence,” the at fault driver can only be held liable to the extent of the percentage of fault attributable to him or herself. For example, if the injured victim is 40% at fault and the other driver is 60% at fault, the victim can only recover 60% of their losses from the at fault driver.

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Consider this example…

Al is driving his car and loses control avoiding a deer, or due to black ice, and hits a tree, causing injury to himself and his passenger, Mary.

Under a traditional tort liability auto insurance, Al is not entitled to recover anything, because there is no other at fault driver who can be sued. Mary can only recover her expenses and damages if she can prove that Al was “negligent,” i.e., at fault, for causing the crash. Even if Mary can prove Al was at fault, the amount Mary will be able to recover will largely be determined by how much liability insurance Al carried.

In Michigan, regardless of fault, Al and Mary are entitled to lifetime benefits for all reasonably necessary medical and rehabilitation expenses, in-home attendant care, and other allowable expenses, in addition to three years of wage loss and domestic replacement services. In addition, Mary can sue Al for noneconomic damages if Mary’s injury constitutes a “threshold injury.”

Frequently, the complex issues of fault require a lawsuit to resolve. Under a tort liability system, the injured victim’s ability to recover compensation for accidentrelated medical expenses, expenses of care and recovery, and noneconomic damages is a function of how much liability insurance coverage the at fault driver purchased.

In this regard, it is important to note that, in Michigan, drivers are required to only carry $20,000 of liability insurance—far too little to fully compensate any seriously injured victim. Because the at fault driver retains full personal financial liability for all expenses and damages suffered by victims, regardless of how much liability insurance coverage he or she purchased, anyone wishing to adequately safeguard their personal assets must purchase large amounts of liability insurance.

You decide if we have a voice.

Make a difference. Donate today.

MAIL A CHECK: 2445 Woodlake Circle Okemos, MI 48864

DONATE ONLINE: domoa.org/mopac

MOPAC

The Michigan Osteopathic Political Action Committee uses contributions from member supporters to elect pro-physician candidates.

Who is running your practice from the capital?

Make sure the osteopathic profession has a say.

TRIAD

| S P R I N G 2018

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WELLNESS ADVOCATES

CONNECTING PATIENTS TO RESOURCES & SERVICES As the world of medicine becomes increasingly fast-paced and cost-driven, there is a mounting pressure for physicians to focus on quick fixes and immediate returns when it comes to patient care.

A

s Osteopaths, we know that this rarely leads to the best patient outcomes, but we are forced to work within our system, creating the need for a wellness advocate—someone to help coordinate ongoing health and wellness resources for patients once they leave the office. Much like a social worker coordinates patient care both in and out of the hospital, we at Lettuce Live Well serve as wellness advocates, connecting your patients to key resources and services that they would be unlikely to access on their own.

Ongoing access to health programs and nutrition education is one of the greatest barriers to lasting wellness among the low-income demographic, and despite the plethora of programs

designed to address this disparity, so many of our nation’s best health resources go shamefully underutilized. We at Lettuce Live Well have made it our mission to bridge that gap, creating a network that allows individuals to more easily connect to the community programs that best fit their needs.

The ever-expanding world of health and wellness can be overwhelming to navigate, so we are here to serve as personal guides, helping patients connect to the right resources at the right time to make a positive change in their lifestyle. Our services are available free of charge to anyone who needs us, but they are essential to those that cannot afford the kind of individualized support they need to make a lasting change.

There is a deeply engrained notion that you have to be wealthy to be healthy, and indeed we see higher rates of lifestyle-preventable diseases in lower-income populations, but we believe that health should not be paycheck dependent, so we have made it our mission to bring healthy lifestyles within everyone’s reach.

So, let us help you help them. We want to join your team and help patients execute their wellness plan in the spaces between doctor visits where they live their lives. Whether it is teaching them how to shop healthy on a budget, connecting them with local free fitness opportunities, or providing personalized health coaching on a weekly basis, we are dedicated to ensuring that every person has access to the resources they need to achieve true and lasting wellness. ____________________________________ ABOUT LETTUCE LIVE WELL Here at Lettuce, we encourage healthy lifestyles through our free community programs and by connecting people with additional resources in their area. We offer individual and group health coaching, grocery store tours, children’s programs, employee wellness programs, and more. Each community provides differing programs, contact us to learn about what is offered near you!

333 Albert Ave Suite 212 East Lansing, MI 48823 Phone: (517) 898-1870 E-mail: info@lettucelivewell.org

Partner with us today at www.lettucelivewell.org 16

T R I A D | S P R I N G 2018

THERE’S NO QUIT IN US.

BECAUSE THERE’S NO QUIT IN YOU. There’s no quit in a patient who runs a marathon after hip replacement.

Battles back after open-heart surgery. Or overcomes a stroke. People who never quit deserve a health care system with the same philosophy.

That’s Beaumont. Thousands of medical minds working together as one—for one reason: you. Talk to a Beaumont Doctor. Beaumont.org

WORKING TO IMPROVE

HOSPITAL TRANSPARENCY

BY SAM R. WATSON, MSA, CPPS

“Transparency is becoming the norm.”

Peter Pronovost, intensive care specialist physician, Johns Hopkins Hospital

With the launch of two major initiatives in 2017, the MHA Board of Trustees has taken a leadership role in addressing the issue of data transparency for consumers as well as hospitalto-hospital sharing of improvement data.

T

he effort aimed to improve the information about hospital quality that was previously the only option available to the public — which was outdated, difficult to understand, and irrelevant to patients.

2. The MHA Keystone Center will use unblinded quality improvement data in MHA-member meetings.

All data is drawn from existing data sources, such as the Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC NHSN), the Michigan Inpatient Database and Hospital Compare.

Visitors to the site will be able to easily identify whether a hospital is performing better or worse than expected for various quality measures. Visitors will also be able to compare hospitals side-by-side.

In addition, the data that the MHA Keystone Center had previously shared with membership had historically been blinded. Sharing unblinded data is critical because it gives hospitals the opportunity to understand their performance in relation to other facilities and will, in turn, facilitate learning and improvement.

To combat these issues and improve hospital data transparency, the MHA implemented two initiatives in 2017:

1. Update and enhance the publicly accessible website, www.VerifyMICare.org, by including data that is only six months in arrears.

The revised website was launched December 2017 and includes infection data, specifically central line-associated bloodstream infection, catheter-associated urinary tract infection, surgical-site infection, MRSA and Clostridium difficile. Additional measures include: mortality rates, length of stay, Cesarean section and early elective delivery rates.

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INCLUDE A CAPTION FOR THIS MAGE, OR PERHAPS A CALL OUT FROM THE TEXT EXPLAINING WHY IT IS HERE?

In order to ensure accuracy, Michigan hospitals will have the opportunity to preview their data before it’s posted with each update of the VerifyMICare.org website, and new measures will be added over time under the guidance of the MHA Board of Trustees. The data will be voluntarily submitted and will exclude event reports to the patient safety organization. Unblinded data will not be shared and/ or distributed outside of MHA-member meetings.

The updated VerifyMICare.org website is a perfect example of the leadership within Michigan hospitals and health systems, and their voluntarily efforts in various initiatives to improve healthcare safety and quality for patients.

Furthermore, it is a big step in the right direction to become transparent in our efforts and provide patients with valuable information.

INCLUDE A CAPTION FOR THIS MAGE, OR PERHAPS A CALL OUT FROM THE TEXT EXPLAINING WHY IT IS HERE?

Sam R. Watson, MSA, CPPS, is senior vice president of patient safety and quality at MHA Keystone Center. Questions may be directed to swatson@mha.org.

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MOA will develop a customized insurance program MOA a customized basedwill on develop your individual needs. insurance We offer: program based on your individual needs. We offer: • Health Insurance • Health Insurance • Vision service plan • Vision service plan • Delta Dental options • Delta Dental options • Medical Malpractice, Professional Liability • Medical Malpractice, Professional Liability • Life insurance • Life insurance • Long-term care insurance • Long-term care insurance • Long & short-term disability, group & individual options • Long & short-term disability, group & individual options • Home and auto insurance • Home and auto insurance • MOA Prescription Rx Drug Card • MOA Prescription Rx Drug Card

Get more info at DOMOA.ORG/INSURANCE • JRUEDISALE @ DOMOA.ORG • 1-800-657-1556 Get more info at DOMOA.ORG/INSURANCE • JRUEDISALE @ DOMOA.ORG • 1-800-657-1556 TRIAD

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MICHIGAN HEALTH LINK MICHIGAN COMPLETE HEALTH

The physicians who practice Osteopathic medicine, are known for taking a holistic approach to a person’s health and well-being. In Michigan, a federal pilot program for Medicare and Medicaid eligible patients, called MI Health Link, is bringing this approach to residents in ways that will provide patients with better care, fewer hassles and greater life freedom.

M

ichigan Complete Health, is currently delivering the program in Wayne and Macomb counties, and is working to become a leader in coordinating care and excellence for disadvantaged seniors and those with disabilities.

This program streamlines care delivery and billing for patients, their families and care providers.

While a number of other programs provide these same services, the Medicaid-Medicare program goes one step further. In the Osteopathic tradition, its focus goes beyond clinical needs.

With care that fits their needs, it makes life easier for people who want to continue living a full and active lifestyle. It preserves independence and enables individuals to remain vital in their communities and safe in their own homes.

Michigan Complete Health (MCH) coordinates and makes accessibility solutions, transportation services and nutrition education possible. These services and support mechanisms are delivered seamlessly through our work with providers and agencies within a person’s own community.

MCH is headquartered in Troy, Michigan, where the company employs a team of healthcare professionals who are dedicated to ensuring high-quality, personalized service as they connect members with healthcare providers throughout Wayne and Macomb

counties. MCH is one of seven health plans charged with implementing this pilot program in three areas of the state – Southeast, West Michigan and the Upper Peninsula.

MCH provides coordinated healthcare, pharmacy, vision and transportation services to members of the health plan. The company partners with physicians, specialists, hospitals, and other providers, such as pharmacy and vision providers, to ensure its members receive complete, quality healthcare.

Michigan Complete Health welcomes the opportunity to work with the Michigan Osteopathic Association and physicians serving patients in Michigan. MCH strives to make healthcare simple and convenient for the members it serves, while also helping make both Medicaid and Medicare billing easier for physicians’ offices so they can focus on providing the best, personalized care.

For more information contact Dennis Rogissart at 248-729-8902 or drogissart@centene.com.

Michigan Complete Health, Inc. is a subsidiary of Centene Corporation. Michigan Complete Health (Medicare-Medicaid Plan), a product of Michigan Complete Health, Inc. is a Medicare-Medicaid Plan (MMP) that contracts with both Medicare and Michigan Medicaid to provide the benefits of both programs to eligible enrollees in Macomb and Wayne Counties. The Plan delivers comprehensive healthcare services to MI Health Link enrollees. The demonstration is administered by the Michigan Department of Health and Human Services.

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Give Your Patients Your Complete Attention Financial matters can be distracting, but MSUFCU provides support through a team of business professionals. We offer customized accounts to fit your practice’s needs, which gives you the time to focus on what matters — your patients.

• Savings and checking accounts • Cash Back Visa Credit Card • ACH and remote deposit services • Merchant processing Contact MSUFCU’s Business Services department today. msufcu.org/business 800-678-4968 • 517-333-2424 ext. 2365

Federally insured by NCUA. All loans are subject to credit approval.

Build Your Business and Your Dreams Through Financial Planning MSU Federal Credit Union (MSUFCU) has over 80 years of experience providing financial products and services to a growing community of over 250,000 personal and business members. We are excited for the opportunity to serve the members of the Michigan Osteopathic Association and look forward to providing superior financial services to physicians, private practices, medical students, and healthcare partners across Michigan.

We are here to help you at all stages of your career. Whether you are starting a practice, improving your services, or maintaining a high level of care, MSUFCU will be with you every step of the way. We will work with you to provide financial education and determine the products and services best suited for you and your practice’s needs.

Growing Your Practice Starting or expanding a practice can be an expensive and daunting prospect, with various financial demands. To make this process easier, MSUFCU offers a range of flexible loan products that can be used to make key equipment and technological upgrades, manage your existing personal and private practice finances, and more. From private practice loans,

medical equipment loans, lines of credit for cash flow management, and a Business Cash Back Visa Credit Card, you can depend on MSU Federal Credit Union to work hard in developing and growing your private practice with peace of mind.

Putting Patients First Just as your patients are important to you, you are important to us. We care about the financial health of our members, finding the right solutions for your personal and business needs. When evaluating the needs of any practice, we want to help ensure that finances do not become a barrier to a high level of patient care.

A line of credit can provide the resources to make the right decision without concern for the practice’s short-term cash position.

As you look to make improvements and upgrade equipment, it is important to find a lender that knows how to meet those unique needs. Our loans have no pre-payment penalties, low fees, and as a credit union, we aim to offer competitive rates to help you achieve your dreams at a low cost. Focus on your patients and let us worry about the finances.

Visit msufcu.org/business or call 517-333-2365 for information. Contact our financial education team at FinancialEducation@msufcu.org to speak to a financial educator or schedule a presentation.

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EHRS CAN ADVANCE GOOD MEDICINE – IF DOCTORS ARE AWARE OF THE RISKS

BY DAVID B. TROXEL, MD, MEDICAL DIRECTOR, THE DOCTORS COMPANY

The EHR has introduced patient

Factors Behind EHR Errors

safety risks and unanticipated

For the most part, the EHR is a contributing factor in an EHR-related claim and not the primary cause. This and their low frequency (0.9 percent of all claims) suggest that EHRs infrequently result in adverse events of sufficient severity to develop into a malpractice claim.

“System factors (such as data routing problems, EHR fragmentation, and inappropriate drop-down menu responses) contributed to 50 percent of claims.”

When EHRs are a factor in a claim, the study showed that user factors (such as data entry errors, copy-andpaste issues, alert fatigue, and EHR conversion issues) contributed to nearly 60 percent of claims. As computer users, we all copy and paste.

Therefore, it's no surprise that timepressured physicians embrace the same habits when using EHRs.

responses) contributed to 50 percent of claims. EHR fragmentation was among the most prominent system factors, contributing to 12 percent of errors. This factor means that different components of a single patient encounter might not be located together in the EHR. Consequently, doctors must check in different places to find laboratory and x-ray results, histories and physicals, etc.—resulting in important information being overlooked or unidentified.

medical liability risks. According to a new study from The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, the number of EHR-related medical malpractice claims has risen over the past 10 years.

System factors (such as data routing problems, EHR fragmentation, and inappropriate drop-down menu

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Contributed by The Doctors Company thedoctors.com

“Nearly 20 percent of medical practices are using scribes to help untether physicians from the EHR.”

Re-Claiming the Doctor- Patient Relationship One overwhelming response to adjust to burdens introduced by EHRs has been the rapid growth of medical scribes. Nearly 20 percent of medical practices are using scribes to help untether physicians from the EHR. Yet, according to a survey of hundreds of physicians from The Doctors

Company, the lack of standardized training and variability in experience among scribes poses risks to data accuracy and delivery of care—which could increase liability for the patient and physician alike.

With or without scribes, lowering risk begins with each patient visit. At the beginning of each new session, doctors should inform patients of the purpose of the EHR and emphasize they are listening closely even though they might be typing during the appointment. Practices can set up treatment rooms so the patient can watch the screen and see what is being typed. It is also helpful to summarize or read the note to the patient to demonstrate that you have listened, and ask, “Do I have it right?”

What the Future Holds As with any challenge of major proportions, progress will take time.

But I'm optimistic that the EHR will evolve over the next 5 to 10 years and improve both the quality of medical care and patient safety.

Today, what I hear from The Doctors Company’s 80,000 member physicians is encouraging. Doctors are eager to “reclaim” their profession and refocus patient relationships amidst the new demands of today’s digital age. Into the future, new protocols, policies, and training programs must take these small successes to a large scale.

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Healthcare Partners

https://domoa.memberclicks.net/ healthcare-partners-of-michigan

OF MICHIGAN

SOCIAL DETERMINANTS OF HEALTH: WHY ASK?

BY EWA MATUSZEWSKI

Each word tells a story: Social.

Determinants.

Health.

Their intersection is undeniable, and slowly but surely, the primary care community is getting on board with a concept that the public health community has been grappling with for decades.

Social determinants of health may include: • Economic resources, including access to jobs that provide a living wage • Safe workplaces and safe neighborhoods • Quality of schools and availability for advanced education and training • Clean and safe water, air and food • Positive support systems through home and family relationships and extended social interactions

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An embedded care manager and pharmacist recently encountered a patient who was not taking her medications as prescribed. The issue wasn’t the medication or the patient, per se. It was the fact that her had no money for food. The words, “Do not take on an empty stomach,” were a barrier to her care plan. She was also having to choose between paying for rent or the medication, with not enough funds to cover both. Within 24 hours of finding out, the health care provider ensured this patient had groceries and rent assistance. A BandAid? Perhaps for now, but the lesson is the care manager understood that it was the social determinants of this patient’s health that impeded her ability to manage her condition. It wasn’t the medical care or treatment plan.

Rishi Manchanda, MD, MPH is a primary care physician, public health innovator and for the amazing work he does, my secret professional crush (not-so-secret anymore). His work is based in South Central Los Angeles. Dr. Manchanda has a powerful TED Talk exploring the role that social determinants of health play in patients’ care who are low income.

“Home is where health – and often, illness – begins.” Says Dr. Manchanda, proclaiming that zip codes may matter more than genetic codes in determining one’s health and wellness. Dr. Manchanda calls for more “upstreamists” in the healthcare community to increase efforts to examine the social determinants of health.

These upstreamists don’t treat symptoms; rather, they investigate and aim to resolve the root cause of illness or lingering ill health. They are generally not physicians, but clinicians, social workers, public health experts and even public interest attorneys.

Whatever their professional designation, we must identify them, recruit more and connect them to primary care physicians to ensure the health of at-risk populations. Its time to look outside of the walls of the doctors offices to truly understand and cure our patients.

Ewa Matuszewski, Senior Consultant for Healthcare Partners of Michigan (HCPM), will serve as a resource to provide information to members of the Michigan Osteopathic Association (MOA). www.domoa.org/hcpm

STAY in PRACTICE TRAINING & UPDATES FOR OFFICE MANAGERS • Strategies for Effective & Efficient Practice Management • Chronic Pain Management & Non-compliant Patients • Merging a Practice with a Health System • MACRA • Revenue Cycle Management • Hiring, Retention & Firing with Performance Evaluations

More info at:

WWW.DOMOA.ORG/PRACTICEMANAGERS May 17, 2018 Westin Southfield Detroit 6 CEU anticipated

Michigan Osteopathic Association

119th Annual Spring

Scientific Convention

Northern Michigan Osteopathic Association

SUMMER CONFERENCE J U NE 14 - 17, 2018 MISSION POINT RESORT, MACKINAC ISLAND CME, family activities, the island beauty & summertime fun. Join the NMOA for its annual Summer Conference!

TENTATIVE CME SCHEDULE Thursday 5:30 - 8:30 pm Friday 8:30 am - 6:30 pm Saturday 8:30 am - 4:00 pm Sunday 8:30 - 11:30 am

20 AOA 1-A CREDITS ANTICIPATED AGENDA & REGISTRATION AT D O M O A .O R G/N M O A S U M M E R OR CALL 517-347-1555 EXT 112.

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COMPONENT NEWS The Ingham Osteopathic Association (IOA) is proud to announce its newly elected leadership.

Rosemarie Tolson, DO assumed the Presidency as of August 2017, Sarah Denham, DO was elected as the new President-Elect at the IOA General Membership Meeting in November and Amy Keenum, DO was elected for Secretary/Treasurer in February of 2018.

President: Rosemarie Tolson, DO Dr. Tolson is a 1999 graduate of Michigan State Unversity College of Osteopathic Medicine.

She spent her third and fourth year of medical school as well as her family medicine residency at Garden City Osteopathic Hospital. In 2009, Dr. Tolson came to MSU to work in the Department of Family and Community Medicine and became an associate professor in 2017. She also serves as medical director of the office since 2016. At home are her three children and husband, Ron and they attend Saints Cornelius and Cyprian church in Bunker Hill Township.

President-Elect: Sarah Denham, DO Dr. Denham is a Board Certified Family Medicine physician, specializing in integrative and holistic care. She graduated with a double bachelor degree in science from Michigan State University in 2006. She continued her education at MSU College of Osteopathic Medicine, graduating with her medical school degree in 2011. After completing her family medicine residency, she has chosen to stay in the Greater Lansing area to provide care to those patients in search of a holistic integrative medicine physician.

Dr. Denham focuses on the cause of a problem rather than a quick fix. She loves to work with patients on improving their quality of life by working toward healthier habits and disease prevention. By using less medications and focusing on the true cause of illnesses, she applies her osteopathic practices and principles, aiding those that strive for a healthier life.

Shortly after starting her personal clinic, Dr. Denham was asked to return to McLaren Greater Lansing to become the Interim Program Director for the FM program she graduated from.

Dr. Denham worked to organize the program and improve resident education, helping it to become a more competitive program. She continues to work with the McLaren FM residents as Associate PD, working toward ACGME accreditation.

Secretary/Treasurer: Amy Keenum, DO, PharmD A 1991 MSUCOM alumna, Dr. Keenum returned to Michigan State University as chairperson of the Department of Family and Community Medicine. Dr. Keenum is a board-certified family medicine physician. Clinically she focuses on family medicine across the full spectrum of ages, including women’s care and Nexplanon placement. She enjoys seeing a diverse ethnic panel of patients and her main area of interest is health literacy.

Over the course of her 24-year career as a physician, she practiced as a rural primary care physician in Clinton, Tennessee, worked at the University of Tennessee Medical Center in Knoxville, Tennessee and Keweenaw Memorial Medical Center, in Laurium, MI. As a Fulbright scholar, she spent a year at the University of Malawi, College of Medicine. Dr. Keenum has written 28 peerreviewed publications, and has given 31 national and international and 19 regional conference presentations. She is currently the chair of editorial board of Osteopathic Family Physician, the journal sponsored by the American College of Osteopathic Family Physicians.

Share YOUR component news, meetings and events in TRIAD. Email tross@domoa.org.

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ADVERTISERS TRIAD STAFF

Beaumont............................................................................17

Stephen Bell, DO, and Larry Prokop, DO, Department Chairs

I Vaccinate.............................................................................9

Kris T. Nicholoff, CEO and Executive Director Lisa M. Neufer, Director of Administration

Kerr Russell.........................................................................25

Todd Ross, Manager of Communications

McLaren Health Care.............................................................2

Cyndi Earles, Director, MOA Service Corporation

Medical Opportunities...........................................................6

Marc A. Staley, Manager of Finance Virginia Bernero, Executive Assistant & Marketing Coordinator

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, FAOCR, 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

MSU Federal Credit Union..................................................21 MOA Insurance...................................................................19 MOA Autumn Convention....................................................6 MOA Practice Managers......................................................25 MOPAC...............................................................................15 NMOA Summer Conference................................................25 The Doctors Company........................................................28

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

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.

COMMUNICATIONS DEPARTMENT Michigan Osteopathic Association Communications Department 2445 Woodlake Circle, Okemos, MI 48864 Phone: 517.347.1555 Fax: 517.347.1566 Website: www.domoa.org Email: moa@domoa.org Š2018 Michigan Osteopathic Association TRIAD

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