TRIAD Mobile | Winter 2019

The Evolution of

TECHNOLOGY

Blending the new with the old

PRESIDENT’S PAGE

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

About 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.

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!

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.

STATEWIDE, ELECTRONIC SHARING OF HEALTH INFORMATION

The Michigan Health

Information Network Shared Services is Michigan’s statedesignated 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.

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.

It’s 2018, and now more than ever, telemedicine makes it possible

to provide medical care for the benefit and convenience of the physician and patient alike, even when they aren’t in the same room – or even the same zip code. As with all advances inhealthcare, there are opportunities and risks that should be carefullyconsidered 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):

1. Credentialing

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 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 telemedicine services is located…

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

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.

EYE ON ADVOCACY

Michigan physicians are subjected to redundant,expensive, and low-valueMaintenance of Certificationprocedures. Doctors spend tensof thousands of dollars andridiculous amounts of time onbureaucratic red tape that addzero value to their patients, anddrive up the price of health care for everyone.

As physicians are alreadyrequired by Michigan law tocomplete 150 hours ofcontinuing medical educationcredits as a condition ofrelicensure every threeyears, Michigan OsteopathicAssociation supports efforts toreduce or rid our members ofthese cumbersome regulations.Recently, the Senate HealthPolicy Committee held a hearingon House Bills 4134 and 4135which would address the issue.At right is a copy of the memosent to communicate theMOA’s support from PresidentLawrence 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