TRIAD Winter 2019: The Evolution of Technology, Blending the new with the old

The Award-Winning Journal of the Michigan Osteopathic Association W I N T E R 2019

The Evolution of

TECHNOLOGY Blending the new with the old

ALSO INSIDE 2018 Autumn Scientific Convention Recap

MICHIGAN MOA 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

lawsuits

insurance coverage concerns accountable care

financial pressures

cyber security

patient demands

patient care

EHRs

big data

shifting FDA regulations

risk of medical errors

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CONTENTS MOPAC VOLUNTEERS MARIA RUEDISUELI, OMS - I AND MAT THEW MERANDA, OMS - II

Columns 05 President’s Page

FEATURES

23 Coverys

08

MOA Increases Social Media Presence, Electronic Communications

24 Healthcare Partners of Michigan

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AMOA News

13

2018 Autumn Scientific Convention Recap

17

Embracing Technology to Bring Our World within Reach

18

MHA Podcast Episode Covers Health Information Sharing

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MiHIN Shared Services

26 Eye on Advocacy 27 Advertiser Index

MICHIGAN MOA OSTEOPATHIC ASSOCIATION 3

A B O U T T H E COV E R The photo used on the cover of this issue, and the ones featured here, were captured at the 1989 Spring Convention at the Dearborn Hyatt. It was the first year the MOA (at the time MOAP&S) had implemented the "computer-café” in order to facilitate physicians completing their evaluations electronically. Pictured on the cover is MOA staff and past president Henry F. Olen, DO (1968-69).

In Memory of Henry F. Olen, DO

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he MOA would like to express our deepest sympathies to the Olen family for their recent loss. Henry F. Olen, DO of Grand Rapids, passed away peacefully on November 29, 2018 at the age of 95. Dr. Olen attended Union High School, Grand Rapids Junior College and the University of Minnesota - Army Specializing Training Program, and was a World War II veteran. He received his medical degree from the Kansas City College of Osteopathic Medicine in 1949 and interned at Grand Rapids Osteopathic Hospital. Dr. Olen was among the founding fathers of Grand Rapids Osteopathic Hospital, as chief of staff and was active in the transition into what is now Metro Health. He had a thriving general practice in Grand Rapids for over 20 years and served as the deputy director of the Kent County Health Department for 10 years then worked as the director of medical education at Saginaw Osteopathic Hospital. He returned to Grand Rapids to work at Kent Community Hospital and finished his medical career caring for veterans at the Grand Rapids Home for Veterans into his mid 80's. Dr. Olen was a tireless advocate in the advancement of osteopathic medicine as past president of the Kent County Osteopathic Association, the Michigan Osteopathic Association and a Trustee of the American Osteopathic Association Board.

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PRESIDENT’S PAGE Technology has surrounded us as medicine changes in the information age. Some might say it has engulfed us.

A Lawrence L. Prokop, DO, FAAPM&R, FAOCPMR-D, FAOASM MOA President

bout 150 years ago, the height of technology included a metal tube with a flare on the end. This early stethoscope augmented the physician’s ability to listen to the heart, lungs and abdomen. Today we have electronic stethoscopes which will count the seconds for us, record blood flow, and allow hearing-impaired physicians to listen to all that moves within the body. Much has changed over the decades, but the purpose of the profession remains the same: for a physician to evaluate a patient with a problem and treat it appropriately to improve the person’s life.

The evolution of technology has many benefits to improve the practice of medicine.

Computer systems can improve information transfer between referring and consulting physicians and among treating clinicians. Research to find newer and more appropriate treatments can be performed in minutes on our computers instead of hours in a medical library. Even medical records, often an undesirable side of our practices, become more complete, more legible, and with the voice activated dictation easier and less expensive to complete. Advances in computer-based technology have improved our diagnostic abilities and allow for a greater array of treatment options for patients.

These benefits do not come without potential problems. Patients frequently complain of physicians paying more attention to the computer in the room than to the patient.

One danger to the convenience of computers is the ease of copying previous chart notes and paste them into the current chart note. In discussing this with many residency trainers in multiple specialties across the country, this is becoming a significant problem when there is no qualification in the new chart note as to how things have changed or why they have stayed the same. A seemingly small oversight then damages the primary benefit of the medical record, knowing the current status of the patient and how the patient is progressing to better plan future treatment. In addition, technology lures physicians to rely on its data rather than talking with the patient, physically examining the patient and treating the patient. For instance, fluoroscopic technology allows us to inject many painful structures in a patient with back pain. This may be done diagnostically and therapeutically. However, when the problem is an underlying somatic dysfunction these techniques will not perform the OMM and therapeutic exercise to fix the underlying problem. When used together, the patient can benefit to a greater extent than when only the technologically advanced treatment is used.

Upon graduating from Osteopathic Medical school, students received the D.O. degree.

With this comes the responsibility to stay up-to-date for our patients’ benefit. Technology can augment our continuing education, improve our diagnostics and treatments, and even ease our medical records burdens. What technology cannot serve as is physician interaction with patients for evaluation and treatment. Technology is a tool for better practice.

Doctor-patient relationships are means for better healing. Patients benefit from a collaboration of both. The Michigan Osteopathic Association is dedicated to keeping our members updated on new technology, especially informatics. We will continue to inform members of new information to augment older tried and true information. As we move forward in our careers, we should be blending the new and better with the old and better to make the best for our patients.

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Join MOPAC Donate online: www.domoa.org/MOPAC Mail enclosed MOPAC contribution card with your payment to:

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Protecting and caring for our patients and this profession

It’s what we must DO.

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A M P L I F Y YO U R VO I C E .

goes beyond the office.

MOPAC Michigan Osteopathic Association 2445 Woodlake Circle Okemos, MI 48864 Corporate/business contributions are prohibited.

KVALSUND NAMED N AT I O N A L ACA D E M Y O F M E D I C I N E F E L LOW Michelle Kvalsund, an assistant professor in the Department of Neurology and Ophthalmology, has received a 2018 National Academy of Medicine Fellowship in Osteopathic Medicine.

Michelle Kvalsund, DO, MS 2018-2020 Osteopathic Medicine Fellow

T

he two-year fellowship provides Kvalsund the opportunity to collaborate with eminent researchers, policy experts and clinicians from across the country.

During her fellowship she plans to gain a working view of the processes of the National Academy of Medicine and exposure to multidisciplinary perspectives involved in global health and nutrition policy making.

Kvalsund is a global health neurologist with special interest in the intersections between neurologic health and illness, nutrition and tropical diseases. An MSU College of Osteopathic Medicine alumna, she completed her neurology residency at Vanderbilt University Medical Center in 2013 and returned to her alma mater to complete neuro-epidemiology and clinical neurophysiology fellowships in the MSU Department of Neurology and Ophthalmology in 2015.

She is based in Zambia nine months per year, where she conducts research on neuropathies and serves as an honorary lecturer within the University of Zambia School of Medicine and is director of Electromyography Services at the University Teaching Hospital.

NAM Fellows are chosen based on their professional qualifications, reputations as scholars, professional accomplishments, and relevance of current field expertise to the work of the NAM and the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine. They help facilitate initiatives convened by the National Academies to provide nonpartisan, scientific, and evidence-based guidance to national, state, and local policymakers, academic leaders, health care administrators and the public.

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I watch him while he’s sleeping.

I worry when I’m away.

I put locks on every cabinet, gates on every set of stairs.

I pad sharp corners.

I interrogate babysitters.

I protect.

I defend.

I vaccinate.

Outbreaks of vaccine-preventable diseases like whooping cough and measles are still a risk, because many children aren’t vaccinated. Don’t pass up a safety precaution that could save your child’s life. Vaccinate today.

M OA I N C R E A S E S

SOCIAL MEDIA PRESENCE, ELECTRONIC COMMUNICATIONS Technology often gets a bad reputation, but mostly because it forces change. Adapting to a new routine requires old habits are broken, which simply is not natural. After the initial adjustment is made however, there are many benefits to the increase in technology, especially when it comes to communication.

T

he world seems to move at a faster pace these days, no doubt due to the instantaneous ability to send and receive information. Decisions can be made between people across town or across the country in the same amount of time; invoices can be paid with the click of a button; people can work on projects with everything they need at their fingertips. Because of all this, we are busier people! It is our job at the MOA to cut through that busy day to keep you updated on what matters, and to stay connected.

We are striving to deliver messages to you in varying ways, hoping to be seen and heard. A couple of current and upcoming developments are helping us do that.

New website: www.domoa.org

messaging. In order to stay relevant with younger members, MOA has developed the Instagram account “@ michiganosteopathic.” We’re excited to add this platform to our other social profiles, Facebook and Twitter.

Podcast: “Finding Health”

MOA is developing a podcast series to feature community health topics At the beginning of 2018, we launched and issues physicians face impactwww.domoa.org on a new platform. ing patient access to quality care.

With responsive design and updated Michigan State University College of fonts, graphics and colors to comOsteopathic Medicine (MSUCOM) municate more effectively with our will be a co-brand partner in sharing members and the public. All of our the perspective of osteopathic physiconvention information is organized cians. Guests will include represenon the site, with a new easier registratation from our Strategic Partners, tion process as well as work on safe with a target audience of the public opioid use and other advocacy issues. and physicians who have interest in We hope that you have enjoyed these community health issues. The title changes and our constant improve“Finding Health,” refers to the A.T. ments to the site.

Still quote, “To find health should be the object of the doctor. Anyone can Instagram: find disease.” The podcast will be @michiganosteopathic on the SoundCloud platform and be Recent revolutions in digital commudistributed via the Pulse newsletter, nications have driven image-based the TRIAD and social media.

We are striving to deliver messages to you in varying ways, hoping to be seen and heard.

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www.domoa.org/amoa

A DVO CAT E S F O R T H E M OA

FUNDRAISER BENEFITS ONGOING PROJECTS B Y A N G E LA KA LC E C, A M OA P R E S I D E N T

T

Angela Kalcec, AMOA PRESIDENT

he holiday season is a time when we pause to celebrate life and family, and honor our friends and loved ones.

In keeping with this spirit, the Advocates for the Michigan Osteopathic Association once again presented a special opportunity to remember that special person while supporting the programs of the Advocates.

The annual Tree of Peace was displayed in the lobby of the MOA building for the month of December.

With your support, it glowed brilliantly throughout the holiday with all dedications being listed in the Book of Honor displayed next to the Tree of Peace.

All proceeds of this fundraiser will benefit ongoing projects in support of the Osteopathic Profession. The Yellow Ribbon Suicide Prevention Program, the AMOA's Distracted Driving Simulator, and supporting our MSUCOM medical students and their families continue to be the projects that receive the most of our efforts. As always, our hope is to expand the reach of our osteopathic message to interested hospitals, service organizations and schools.

If you missed the fundraiser but still wish to give, please send a check to AMOA Tree of Peace, Attn: Pam Kolinski, 5077 Shane St, Kalamazoo, MI 49009.

THE AMOA PROVIDED A DISTRACTED DRIVER SIMULATOR TO THE AUTUMN CONVENTION. ATTENDES ENJOYED THE INTERACTIVE EXHIBIT ON THE DANGERS OF DISTRACTED DRIVING.

Advocates for the Michigan Osteopathic Association

AMOA The people behind the profession.

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MICHIGAN OSTEOPATHIC ASSOCIATION

14th Annual Autumn

SCIENTIFIC CONVENTION

CO N V E N T I O N R E CA P The MOA 14th Annual Autumn Scientific Convention attracted over 400 physicians, nurses, students and residents to Grand Rapids for the 3-day educational program that included an impressive lineup of presenters and topics. This years’ CME lectures began on Friday morning for the first time and offered 26 AOA Category 1-A credits.

The MOA would like to thank the MOA Education Committee for their amazing efforts which contributed to the exciting growth of this young convention in Grand Rapids. Save the date to attend next year at the Amway Grand Plaza, November 8-10, 2019.

( A B OV E ) E X H I B I TO R A N D M OA PA RT N E R O R I G A M I BRAIN INJURY REHABILITATION CENTER SPEAKS WITH PHYSICIANS ABOUT RECOVERY AS A JOURNEY.

( ABOVE ) PHYSICIAN WELLNESS CENTER VOLUNTEERS DRS. CHRISTENSEN, GOLDMAN AND PAT TERSON.

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MOAautumn.com

2018 MOA Autumn SRE Competition The MOA Scientific Research Exhibit (SRE) at the 2018 Autumn Scientific Convention provided osteopathic medical students, residents, fellows and attending level physicians an opportunity to present their medical and scientific research to our profession. Every fall, 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. And this year was no exception!

(TOP RIGHT ) SCIENTIFIC RESEARCH COMPETITION COMMITTEE MEMBERS TAYLOR SCOTT, DO AND KIMBERLY BLOM, DO TAKE ON THE TASK OF JUDGING THIS YEAR’S EXHIBITS WITH EXCITEMENT. (RIGHT AND BELOW) CONGRATULATIONS TO ALL OF THE SRE COMPETITION PARTICIPANTS. EACH YEAR, THIS EVENT HAS GROWN IN SUBMISSIONS TO EACH OF THE FOUR CATEGORIES: BASIC RESEARCH, CLINICAL RESEARCH, CLINICAL VIGNETTE OR CASE REPORT, QUALITY IMPROVEMENT (QI), PATIENT SAFETY (PS), OR HIGH-VALUE CARE (HVC). LEARN MORE ABOUT THIS AND THE SPRING SRE COMPETITION AT DOMOA.ORG/SRE.

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MOAautumn.com

Congratulations SRE Winners!

Evaluations and CME Information

First Place: Example of Delayed Life-Threatening Syncope Diagnosed Utilizing Cardiac CT Angiography (#10) Justin Kreuze, DO, Emergency Medicine PGY IV, Mercy Health Muskegon; Marc Ydenberg, MD, Lake Michigan Emergency Specialists; Ryan Offman, DO, Lake Michigan Emergency Specialists; Richard Downey, MD, Mercy Health Physician Partners-Cardiothoracic Surgery; David Dirk Bonnema, MD, Mercy Health Physician Partners, West Shore Cardiology

Evaluation website link: • Autumn Convention attendees can access the evaluation website at this link: data.express-evaluations.com/ eval/38060/web/

Second Place: Improving Mild Cognitive Impairment Prediction via Reinforcement Learning and Dialogue Simulation (#15)

Link to CME information:

Fengyi Tang1; Kaixiang Lin1; Ikechukwu Uchendu1; Hiroko H. Dodge2,3 , Jiayu Zhou1 1Computer Science and Engineering, Michigan State University 2Michigan Alzheimer's Disease Center, Department of Neurology, University of Michigan 3Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University

• www.domoa.org/cmeinfo

Speaker Presentations Some speakers have allowed us

Third Place: Special Considerations in Medical Management of a Patient with Longstanding Congenital Heart Defects and Subsequent Pulmonary Artery Hypertension (#7)

to share their presentations as PDF files via the following link:

Eric Sandrock, OMS IV, Ahmad Elkhatib, OMS IV, Eric Reilly, OMS IV, Michigan State University College of Osteopathic Medicine (MSUCOM); Sara Fawaz, DO, Department of Medical Education, Beaumont-Trenton Hospital; Zeinab Saghir, DO, Department of Medical Education, Beaumont-Trenton Hospital; Kevin Berlin, DO, Department of Cardiology, Beaumont-Trenton Hospital

• www.domoa.org/ autumnpresentations

Online Photo Album There were many friendly faces and great events at Autumn

Miscellaneous: Isolated Pleural Nocardiosis in an Immunocompetent Male (#3)

Convention! Check out our

Anila M. Rao, DO, PGY-1; Edward M. Chi, DO, PGY-2; Kathleen Jahoda, PA-C; Anthony Ognjan, DO, FACP, McLaren Macomb Medical Center

Facebook page to see if your photo is among them!

• www.facebook.com/ michiganosteopathic

E AV

THE DAT

E!

November 8-10, 2019 Amway Grand Plaza Hotel Grand Rapids, MI

MICHIGAN OSTEOPATHIC ASSOC S

SCIENTIFIC CONVENTION

14th Annual Autum

SCIENTIFIC CONVENTI

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MOAautumn.com

Physician Wellness Center Grows with New Partners Six treatment tables and a room of yoga mats were occupied by attendees and guests at the Autumn Convention, thanks to additional resources in the Physician Wellness Center. The American Academy of Osteopathy (AAO) provided administrative assistance and recruited physicians to perform Osteopathic Manipulative Treatment (OMT). Sherri Quarles, Executive Director of AAO, attended with her daughter Taylor to greet and coordinate participants. In addition, Hilltop Yoga (of Lansing and Chicago) instructors Jill and Laura guided yoga practice and meditation.

Drs. Christensen, Goldman and Patterson led a hands-on learning OMT session during the convention, and also continued the learning experience in the Physician Wellness Center. The MOA is pleased to offer this unique opportunity to relax and rejuvenate for attendees and their guests during our conventions. While educating physicians is a main priority, being mindful to combat burnout and its symptoms also has its place and focus. Over 50 people participated and experienced these essential pain management and wellness techniques.

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Michigan Osteopathic Association

120th Annual Spring

Scientific Convention

Thursday, May 16 - Sunday, May 19, 2019 32+ AOA Category 1-A Credits Anticipated SESSION HIGHLIGHTS: • Endocrinology • Stroke • Cardiovascular Disease • Urology • Fulford Percussion OMT • Business of Medicine • Basic Acupuncture • Lifestyle Medicine • Community Medicine • Organ Donation Dermatology • Emergency Medicine • Violence Against Healthcare Workers

• Sexual Harassment in the Medical Workplace LARA - Michigan State Osteopathic Licensing Requirements • Pain & Symptom Management • Human Trafficking • Medical Ethics (MD’s only)

SPONSORED IN PART BY:

Includes education requirements for Michigan License Renewal.

REGISTRATION OPENS JANUARY 2019

WWW.DOMOA.ORG/SPRING2019

Login required for member discount. By default, your username is your AOA number. If you experience difficulty logging in, please call 800-657-1556.

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EMBRACING TECHNOLOGY TO BRING OUR WORLD WITHIN REACH

Years of experience, health needs assessments, and studies have shown that one of the largest barriers to health in a community is simply awareness. The messaging is getting lost, the marketing is not enough. Lettuce Live Well is here to put an end to that.

T

echnology and innovation are the future of medicine, and they can be one of a physician’s most valuable tools to improve patient outcomes by getting patients the resources they need.

Access is undeniably one of the biggest barriers to health among the lowincome demographic, but even among more affluent populations, so many of our nation’s best health resources go shamefully underutilized.

There are wellness resources, nonprofits, and organizations in every shade of the rainbow, designed to serve so many of the community’s most desperate needs, but despite their best efforts, their services often do not reach those who need them most. There are a myriad of factors that contribute to this, but time and time again the reason we hear is a simple one: people did not know how to find them.

Lettuce Live Well is here to change that. Embracing the power of technology to bring our world within reach, we have partnered with thousands of organizations nationwide to create a comprehensive health database cataloging every resource one could possibly need on their journey to wellness.

Simple and user friendly, our website is so much more than a search engine, it is a solution. It is a place to find personalized, local support for every aspect of your health.

Simply type in your zip code or city to have a complete listing of local health and wellness resources at your fingertips. Find out what is going on for the kids this weekend, get maps to your local parks and trails, find a physician who shares your philosophy, or discover the perfect exercise class that finally helps you take the first steps toward a healthier you. Connect with the nonprofits who will help your patients get to their medical appointments if they lack transportation, or the ones who will provide nutritional counseling for free if their insurance does not cover it. The benefits are as limitless as the possibilities.

By bringing every local health and wellness resource together into one convenient location, we are taking a major step towards getting those resources into the hands of those who need them most.

There is an undeniable gap between our nation’s health resources and the people they are designed to help, and only by joining hands can we bridge that gap and ensure people access to the tools they need to build happier, healthier lives. Partner with us today at lettucelivewell.org. ____________________________________ 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 TRIAD

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M H A PO D CA S T E P I S O D E COV E R S

HEALTH INFORMATION SHARING

H

A recent episode of the

ealthcare encompasses more than medicine, nurses, physicians and hospitals; it also includes a lot of data.

By collecting and securely sharing patient data, Michigan hospitals are working to improve efficiency and safety in healthcare for patients.

The episode features interviews with Tim Pletcher, executive director of the Michigan Health Information Network (MiHIN) and Jim Lee, the MHA’s vice president of data policy and data analytics, about the impact of information sharing on healthcare quality and safety.

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“MiCare Champions Cast”, the Michigan Health & Hospital Association (MHA) podcast on issues surrounding healthcare, covers the impact that health information sharing has on patient care.

The episode can be heard on SoundCloud or iTunes. To listen on a mobile device, subscribe to the “MiCare Champion Cast” with a podcast app, such as Apple podcasts, Google Play, Stitcher and more.

The podcast is part of the statewide #MiCareMatters campaign, which was launched in 2017 and aims to build a network of citizens – “MiCare Champions” – who want to engage in advocacy efforts to protect access to affordable healthcare services in Michigan.

Learn more MiHIN at MiHIN.org.

See more podcast episodes from the MHA and learn more about the #MiCareMatters campaign at MiCareMatters.org.

MHA KEYSTONE CENTER. MEMBER HOSPITALS & HEALTH SYSTEMS. STATE & NATIONAL PATIENT SAFETY EXPERTS. Together, we are part of something important. We’re changing healthcare and improving patient safety and quality by implementing evidence-based, best practices that are supported by data. Our person-centered philosophy fuels our purpose and work. It drives us to continually improve and build safer and more reliable healthcare.

Michigan Health & Hospital Association (MHA) Keystone Center member hospitals are voluntarily participating in programs to improve the quality and delivery of healthcare by tackling big issues on a daily basis.

Every day, we’re exploring new and innovative ways to prevent harm, reduce healthcare costs, and improve patient safety.

TOGETHER, WE’RE MEETING THE CHALLENGES OF TODAY TO

Build a Safer Tomorrow and Beyond Read our 2017 MHA Keystone Center Annual Report and hear stories about how hospitals are improving patient safety and healthcare quality online at www.mha.org.

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STATEWIDE, ELECTRONIC SHARING OF HEALTH INFORMATION

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he Michigan Health Information Network Shared Services is Michigan’s state-

designated entity to improve healthcare quality, efficiency, and patient safety through the sharing of electronic health information statewide. By connecting their electronic health record systems with the statewide network, healthcare providers can share information with other systems throughout the state, keeping everyone on a patient’s care team on the same page and wellinformed.

MiHIN is a nonprofit, public-private collaboration that includes stakeholders from the State of Michigan, health information organizations that serve Michigan, health systems and providers, health plans/payers, pharmacies, and the Governor’s Health Information Technology Commission.

MiHIN currently connects more than 150 hospitals, 4,700 practices, 40,500 organizations, and almost 140,000 healthcare professionals; truly uniting Michigan’s healthcare community.

MiHIN has many services and datasharing “use cases” to help Michigan’s healthcare community and patients exchange important information. Each service focuses on specific types of health information that can be exchanged through the network among members of a care team.

For example, admission notifications that are sent to doctors and other members of a care team through the statewide network when one of their patients is admitted to a hospital.

With MiHIN, Michigan’s health information technology community is working to build solutions to help combat the opioid epidemic; for example, MiHIN is pursuing population level surveillance projects with partners to identify opioid overdose density across Michigan zip codes.

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MiHIN is currently developing the Medical Information Direct Gateway (MIDIGATE®), a service that collects easy, affordable tools in one consistent, centralized location to help healthcare professionals find, view, use and exchange health information for their patients. The tools available through MIDIGATE ensure that electronic health information is more accurate and complete and improves care coordination amongst members of the care team. More information is available at https://mihin.org/midigate/.

MiHIN is also looking into opportunities to help Michigan patients use available technology to take more ownership of their own healthcare in consistent and dependable ways, which includes viewing their doctors, tests and test results, immunization records, and providing consent for sharing information.

For more than ten years, MiHIN has hosted the Connecting Michigan for Health conference in Lansing, Michigan, bringing together thought leaders and highlighting accomplishments from across the national health information technology community to help inform efforts in Michigan.

For more information about MiHIN and opportunities to improve health information sharing throughout the state, please visit https://mihin.org.

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TELEMEDICINE

Reducing the Risks

BY COVERYS RISK MANAGMENT

I

t’s 2018, and now more than ever, telemedicine makes it possible

1. Credentialing

to provide medical care for the benefit and convenience of

All practitioners providing telemedicine services must have the appropriate credentials and privileges. These qualifications should be verified by any organization where patients receive telemedicine services.

the physician and patient alike, even when they aren’t in the same room – or even the same zip code. As with all advances in

healthcare, there are opportunities and risks that should be carefully considered when developing or optimizing a telemedicine program.

How Is Telemedicine Used Today?

Telemedicine can be used in many ways and, where state laws allow, can include service lines such as telestroke, teleradiology, and telepsychiatry, and a growing number of specialized services. Rural and community hospital intensive care units are being monitored remotely by specialists located at regional referral centers, a practice called e-ICU. Remote home monitoring of congestive heart failure (CHF), hypertensive, and diabetic patients by consulting specialists from large healthcare systems is improving quality of life while lowering the number of hospital readmissions.

The possibilities for improving patient health through telemedicine are vast, though the parameters for pursuing such offerings for your patients are governed by the laws of your state and the states in which your patients reside. What follows are several suggestions for reducing the risks – to you and to your patients

– of telemedicine. These suggestions should be examined in the context of your own legal restrictions; telemedicine laws vary by state and the health professionals who offer such services to out-of-state patients are subject to the laws of both the home state and the remote state.

Reducing the Risks of Telemedicine: The Six Cs As telemedicine continues to grow and change, providers need to evaluate and reduce any associated risks, such as: • Negligence in credentialing • Scope of practice and regulatory issues (e.g., licensing, HIPAA, security) • Staff member training/competency at both sites (original/off-site) • Communication and documentation To reduce the risks of telemedicine, consider the following six guidelines (the Six Cs):

The Centers for Medicare and Medicaid Services (CMS) permits credentialing and privileging by proxy, provided certain requirements are met. The governing body of the hospital or critical access hospital (CAH) is responsible for making sure that the distant site hospital, CAH, or other entity meets the CMS requirements, usually in writing. The originating site may rely on the distant site’s verification of credentials and privileges as long as: • The distant-site hospital is a Medicare-participating hospital • The distant-site physician/ practitioner is privileged at the distant-site hospital providing the telemedicine services and provides a current list of those privileges • The individual holds a license issued or recognized by the state in which the hospital whose patients are receiving the tele- medicine services is located…

TO READ THE FULL ARTICLE CLICK: www.coverys.com/knowledgecenter/Articles/Telemedicine-Reducing-the-Risks TRIAD

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domoa.org/HCPM

EVALUATION & MANAGEMENT CHANGES

BY EWA MATUSZEWSKI

In July 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposal to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.

The calendar year (CY) 2019 PFS proposed rule was one of several muchanticipated rules that reflect a broader strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation. The comments “patients versus paperwork” became a battle cry.

By now you have heard that CMS presented several coding and payment changes to reduce administrative burden and improve payment accuracy for E/M visits.

Effective January 1, 2019 CMS will: • ALLOW practitioners to choose to document office/outpatient E/M visits using medical decision-making or time instead of applying the current 1995 or 1997 E/M documentation guidelines, or alternatively practitioners could continue using the current framework; • EXPAND current options by allowing practitioners to use time as the governing factor in selecting visit level and documenting the E/M visit, regardless of whether counseling or care coordination dominate the visit; • EXPAND current options regarding the documentation of history and exam, to allow practitioners to focus their documentation on what has changed since the last visit or on pertinent items that have not changed, rather than re-documenting information, provided they review and update the previous information; and • ALLOW practitioners to simply review and verify certain information in the healthcare record that is entered by ancillary staff or the beneficiary, rather than re-entering it.

To improve payment accuracy and simplify documentation, CMS introduced new, single blended payment rates for new and established patients for office/outpatient E/M level 2 through 5 visits and a series of addon codes to reflect resources involved in furnishing primary care and nonprocedural specialty generally recognized services. As an outcome CMS will apply a minimum documentation standard where Medicare would require information to support a level 2 CPT visit code for history, exam and/ or medical decision-making in cases where practitioners choose to use the current framework, or, as proposed, medical decision-making to document E/M level 2 through 5 visits.

In cases where practitioners choose to use time to document E/M visits, CMS will require practitioners to document the medical necessity of the visit and show the total amount of time spent by the billing practitioner face-to-face with the patient. Practitioners could choose to document additional information for clinical, legal, operational or other purposes, and they anticipate that for those reasons, they would continue generally to document medical record information consistent with the level of care furnished. However, we would only require documentation to support the medical necessity of the visit and associated with the current level 2 CPT visit code.

Learn More at the MOA Spring Convention Changes don’t have to be confusing. The MOA Business of Medicine workshop at Spring Convention will shed light on E&M changes, value-based reimbursement and other updates in primary care.

Convention dates are May 16-19, 2019, registration opens in January at www.domoa.org/spring2019.

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Powered by the Michigan Osteopathic Association

What is HCPM? Healthcare Partners of Michigan (HCPM) was established as a healthcare services organization in 2017 by MOA members. It was formed to support independent physician practices, to provide physicians an opportunity to participate in value-based reimbursement activities, quality improvement initiatives, and also to help reduce practice overhead costs by providing necessary infrastructure support.

Why Join?

• Assist HCPM physicians transform their infrastructure by providing technology support • Guide HCPM physicians to develop quality improvement strategies focused on population health • Coach practices through the stages of becoming a Patient Centered Medical Homes (PCMH) • Provide in-office, multidisciplinary clinical care teams • Function as a liaison between physicians and payers, contract negotiations, reimbursement guidance & troubleshooting

Who can Join?

Any licensed healthcare professional!

LEARN MORE: www.domoa.org/hcpm Contact 844-363-6763 | hcpm@domoa.org

EYE ON ADVOCACY

T

oday, already-licensed Michigan physicians are subjected to redundant, expensive, and low-value Maintenance of Certification procedures. Doctors spend tens of thousands of dollars and ridiculous amounts of time on bureaucratic red tape that add zero value to their patients, and drive up the price of health care for everyone.

As physicians are already required by Michigan law to complete 150 hours of continuing medical education credits as a condition of relicensure every three years, Michigan Osteopathic Association supports efforts to reduce or rid our members of these cumbersome regulations.

Recently, the Senate Health Policy Committee held a hearing on House Bills 4134 and 4135 which would address the issue.

At right is a copy of the memo sent to communicate the MOA’s support from President Lawrence Prokop, DO.

December 12, 2018 Memorandum To: Honorable Members of the Michigan Senate From: Lawrence Prokop DO, President of MOA Re: House Bills 4134 and 4135 (Maintenance of Certification Bills) On behalf of the 9,953 licensed osteopathic physicians in Michigan, I write to express our strong support for House Bills 4134 and 4135 which address the issues surrounding maintenance of a national or regional specialty certification.

To many of our members, who have completed significant training including internships, residency programs and often times fellowships and have become board certified, the requirement to recertify is burdensome and time consuming, resulting in a significant disincentive for older physicians to continue practicing. With Michigan experiencing a shortage of physicians, especially in primary care in underserved areas, this MOC requirement by hospitals, health plans and health insurers in order to remain in their network and/or impacting reimbursement is a troublesome obstacle for physicians and threatens access to care for their patients. In addition, no peer reviewed research studies on MOC to conclude it has an effect on clinical outcomes that would justify these requirements.

The bills before you have strong support from many statewide physician organizations. Both bills were reported out of the Senate Health Policy Committee with unanimous support. And with HB 4135 being amended from its original introduction to only impact primary care physicians, we strongly urge your support for passage in the Senate.

Thank you for your consideration.

Lawrence Prokop, DO, FAAPM&R, FAOCPMR-D, FAOASM, President, Michigan Osteopathic Association

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ADVERTISERS TRIAD STAFF

Beaumont............................................................................22

Kris T. Nicholoff, CEO and Executive Director Lisa M. Neufer, Director of Administration Todd Ross, Manager of Communications Virginia Bernero, Executive Assistant & Marketing Coordinator Melissa Budd, CME Program Manager

Blue Cross Blue Shield of Michigan.....................................21

2018-2019 BOARD OF TRUSTEES

McLaren Health Care...........................................................16

Lawrence Prokop, DO, FAAPM&R, FAOCPMR-D, FAOASM, President Craig Glines, DO, MSBA FACOOG, President-Elect Jeffrey Postlewaite, DO, Secretary/Treasurer John Sealey, DO, FACOS, Immediate Past President

Metro Health.........................................................................6

Department of Business Affairs - Directors Lawrence Prokop, DO, FAAPM&R, FAOCPMR-D, FAOASM, President Craig Glines, DO, MSBA FACOOG, President-Elect Jeffrey Postlewaite, DO, MPH, Secretary/Treasurer John Sealey, DO, FACOS, Immediate Past President Bruce Wolf, DO, FAOCR, Past President

Department of Socio Economics - Directors Kevin Beyer, DO Patrick Botz, DO

Department of Education - Directors

Coverys.................................................................................2 Healthcare Partners of Michigan..........................................25

iVaccinate..............................................................................8 Michigan Health & Hospital Association.............................19 MOA...................................................................................28 MOA Spring Convention.....................................................15 MOPAC.................................................................................6

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

Emily Hurst, DO Samia Cheema, DO, Resident

Department of Membership - Directors Andrew Adair, DO, FACOFP Stephen Bell, DO, FACOI Matthew Meranda, OMS-II

Department of Healthcare Technology & Informatics - Director David Best, DO, MS, ABAM 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 ©2019 Michigan Osteopathic Association TRIAD

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C O M I N G I N 2019 MOA’s own Podcast, “Finding Health.”

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