The Spring 2020 TRIAD: Healthcare Challenges and Opportunities for 2020

The Award-Winning Journal of the Michigan Osteopathic Association S P R I N G 2020

HEALTHCARE

CHALLENGES & OPPORTUNITIES

OF THE 2020s

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

PAT I E N T C A R E QUALITY OUTCOMES

FOCUS ON WHAT MATTERS MOST WITH COVERYS. Quality outcomes for better patient care are more easily achieved when distractions are reduced.

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Very clearly.

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Medical Lia b i l i ty In s u ra n c e • B u s i n e s s A n a l y t i c s • R i s k M a n a g e m e n t • E d u c a t i o n COPYRIGHTED. Insurance products issued by ProSelect® Insurance Company and Preferred Professional Insurance Company®

CONTENTS

In Every Issue 05 President’s Page

FEATURES

20 Coverys

07

An Innovative Program for Healthcare Boards

25 Healthcare Partners

09

121st Annual Spring Convention Preview

13

Marie's Story

26 Component

Contributed by Origami

Connection

15

New Payment Models Do Not Change the Standard of Care

17

Are You Getting the Most from Your Financial Reporting Software?

19

Critical Shortage of Home Care Workers Threatens Patient Care

23

Blue Cross Takes Action to Help Members During the Coronavirus Outbreak

of Michigan

27 Advertiser Index

MICHIGAN MOA OSTEOPATHIC ASSOCIATION 3

MICHIGAN OSTEOPATHIC ASSOCIATION

121st Annual Spring

SCIENTIFIC CONVENTION Thursday, May 14 - Sunday, May 17, 2020 30+ AOA Category 1-A Credits Anticipated SESSION HIGHLIGHTS: • OMM • Business of Medicine • Cardiology • Womens Health • Psychiatry & Addiction • Genetic Determinants of Disease • Functional & Integrative Medicine • Neurology • Office Emergencies • Workplace Violence • Infectious Disease • HIV/AIDS • Domestic Violence • Risk Management Licensing Requirements • Pain & Symptom Management • Human Trafficking • Florida Requirements

SPONSORED IN PART BY:

Includes education requirements for Michigan License Renewal.

EARLY BIRD REGISTRATION DEADLINE APRIL 13,2020 WWW.DOMOA.ORG/SPRING

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

PRESIDENT'S PAGE

“APPROVE MY CARE” CAMPAIGN B Y C RA I G G L I N E S, D O, M OA P R E S I D E N T

O

ne of the values the Michigan Osteopathic Association (MOA) provides is legislative advocacy. Each year offers challenges—some new issues and some are familiar issues. The year 2020 is already providing new challenges where the MOA can provide support and raise awareness on an issue that greatly impacts both physicians and patients.

Craig Glines, DO

“The Michigan State Senate has recently held to committee hearings regarding prior authorization. Senate Bill 612 will go a long way towards easing the confusion and delays providers and patients encounter due to prior authorization requirements.”

The Michigan State Senate has recently held committee hearings regarding prior authorization. Senate Bill 612 will go a long way towards easing the confusion and delays providers and patients encounter due to prior authorization requirements.

In response to SB 612, the MOA has launched the “Approve My Care” campaign.

Approve My Care is an effort to connect with physicians, patients and families on the issues surrounding prior authorization. The campaign includes a mobile website (www.approvemycare.org), Facebook advertisements and a social media campaign to raise awareness and collect stories of people who have experienced delays and denials with prior authorization requirements.

The Michigan Senate Bill 612 would require insurers to: • Post prior-authorization requirements on their public website. These requirements should be described in detail, use easily understandable language, and be based on peer-reviewed clinical review criteria.

• Post statistics regarding prior-authorization on their website.

• Ensure that any adverser determination is made by a licensed physician who practices in the same specialty as the provider who would normally perform or prescribe the treatment in question.

• Respond to “urgent” requests within 24 hours and “non-urgent” requests within 48 hours. If requests are not responded to in that timeframe, they are considered granted.

The American Osteopathic Association (AOA) has joined our effort in Michigan by utilizing their voter advocacy tools. To date, 115 DO’s have used the tool to contact their legislators.

As president of the MOA, I am urging our members and supporters to take action. Use the links on this page to review the issue. Then, contact your legislators and let them know you support SB 612. Our patients deserve timely care and as physicians, we can use more time to treat our patients and less time dedicated to navigating complex requirements.

Be sure to share the link to “approvemycare.org” with friends and colleagues.

Your support is greatly appreciated.

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MHA KEYSTONE CENTER. MEMBER HOSPITALS & HEALTH SYSTEMS. STATE & NATIONAL QUALITY & SAFETY EXPERTS. Together, we are part of something important. We’re supporting healthcare providers to achieve excellence in the outcomes desired by the people they serve. Engaged hospitals see significant improvements in quality and safety outcomes after implementing evidence-based, data-driven best practices.

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 MHA Keystone Center Annual Report and hear stories about how hospitals are improving quality and safety in healthcare online at www.mha.org.

AN INNOVATIVE PROGRAM

H

ealthcare providers are reconfiguring to meet the changing demands of their patients, contend with competition from nontraditional players who are edging into the provider space, engage with community partners to improve health, and use technology to develop clinical infrastructure and patient-engagement applications. Hospital boards are dealing with an evolving “big picture” and have to be active, engaged and, most importantly, informed.

Hospitals and health systems must invest in their board members to ensure the highest level of competencies to meet the challenges of a constantly evolving landscape. An outstanding board member needs broad knowledge, strategic thinking and an ongoing commitment to leadership excellence.

FOR HEALTHCARE BOARDS The Michigan Health & Hospital Association designed this rigorous and comprehensive offering to provide educational opportunities in governance leadership through a powerful combination of expert faculty, specially designed curriculum and interaction. The MHA Excellence in Governance Fellowship is highly collaborative in nature, bringing “I have returned over and over again to the governance concepts learned in the Fellowship. In retrospect I would not have wanted to navigate some of the tough decisions I’ve encountered as a board member without the training I received in the program.” [ GRADUATE FELLOW ]

fellows together in a variety of learning formats, including retreatlike interface, virtual communications and dialogue, and peer learning circles.

The MHA believes that the CEO and board member partnership is key to any successful healthcare organization. Because we are committed to fostering this partnership, CEOs of the selected fellows receive regular communication and information to support the fellow in his or her study.

One-day, in-person classes are augmented by 90-minute virtual sessions to give board members the opportunity to fit this valuable learning into their busy schedules.

Deadline for applications is June 12, 2020. For more information, please visit www.MHA.org or contact Erin Steward at esteward@mha.org.

The Organizational Value

Individual Value

• Superior board capacity through the development of advanced governance knowledge and skills

• An exceptional experience that provides the skills and knowledge to advance the mission and vision of the organization beyond the ordinary

• Board members with highly developed leadership skills • Board members who know how to be relevant and engaged • Board members who are ambassadors and champions for the organization and the chief executive • Connected board members with a vast network of peers to help with challenging governance issues • Board members who are thoughtful — not reactionary — and understand the roles and responsibilities of the board and the CEO • Board members with broad competencies and a mission focus that translates into bottom-line results

• An unparalleled opportunity to exchange ideas and explore challenges and solutions with trustees and healthcare experts • An opportunity to study trends in governance and healthcare and their significance to hospitals and the community • An understanding of pragmatic and practical ways to identify and implement board actions that enhance organizational effectiveness • A network of governing board colleagues to call on when challenges arise • Limited class size for maximum interaction, learning and peer-to-peer exchange

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MICHIGAN OSTEOPATHIC ASSOCIATION

121st Annual Spring

SCIENTIFIC CONVENTION May 14-17, 2020 • Westin Southfield Detroit Registration & Agenda at www.domoa.org/spring

RESERVATIONS

EXHIBIT DATES & HOURS

Call 888-627-8558 and mention MOA Convention for discounted rate of $135.

Exhibitors are welcome to choose

Before your visit, be sure to check out: visitdetroit.com These local attractions within 30 minutes of the Westin!

• Tigers Baseball • Greenfield Village • Henry Ford Museum • Greektown Detroit • MotorCity Casino • Eastern Market

individual days or stay for all three!

CONVENTION SPONSORS Diamond

THURSDAY, MAY 14: 3 – 6 PM FRIDAY, MAY 15: 7 AM – 6 PM SATURDAY, MAY 16: 7 AM – 6 PM

Strategic Partners

VISIT EXHIBITORS, WIN PRIZES! Physicians are encouraged to collect stickers from exhibitors as proof of participating. Completed slips can be entered in prize drawings of your choice. Winners will be announced

• Somerset Collection

Saturday of Convention.

• Detroit Zoo

If you are interested in donating a

Sponsors & Education Partners

• Motown Museum

prize for the drawing or have other

American Academy of Osteopathy American Osteopathic Association Coverys Healthcare Partners of Michigan Kerr Russell Maner Costerisan Origami Brain Injury Rehabilitation Center Yoga Everywhere LLC – Amanda Wallace

questions about exhibiting contact: Cyndi Earles Director, MOA Service Corporation E cearles@domoa.org P 517-512-4307

SRE Sponsors MSUCOM PhD-DO Award

T RTI R A IDA D| S | PSRPI R NIGN 2020 G 2020

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CME INFO Scan-In Times: THURSDAY, MAY 14 – 4 to 7 PM FRIDAY, MAY 15 – 6:30 AM – 6 PM SATURDAY, MAY 16 – 6:30 AM – 6 PM SUNDAY, MAY 17 – 7 AM – 4 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, 2020.

Details: • 30+ AOA Category 1-A credits offered Thursday-Sunday • 3 FREE additional AOA 1-A Category 1 credits available for completing Outcomes Measurement Survey that will be emailed two weeks post-convention.

Please visit www.domoa.org/ CME for more information.

AOA Statement of Accreditation/ MOA Designation Statement: The The Michigan Osteopathic Association(MOA) is accredited by the American Osteopathic Association (AOA) to provide osteopathic continuing medical education for physicians.The MOA designates this program for 30+ AOA Category1-A credits and will report CME with the extent of the physician’s participation in this activity.

S CIENT I FI C RE S E ARCH CO MP E T I T I O N The Michigan Osteopathic Association hosts a Scientific Research Exhibit (SRE) at both the Spring and Autumn Conventions. These competitions provide osteopathic medical students, residents, fellows and attending level physicians an opportunity to present their medical and scientific research to our profession. The SRE event demonstrates the very best of what osteopathic medicine is and reaffirms the profession’s commitment to the advancement of science in osteopathic medicine.

Please visit www.domoa.org/sre for information regarding SRE submissions, sponsorship opportunities and call for judges.

Exhibits T.C.'s

Oral Presentations

Friday, May 15: 7:30 am – 11:30 am Portage Auditorium (4 credits)

MDs: The MOA is approved by the Michigan Board of Medicine as an acceptable provider of CME (LARA-LMD-700).

Nurses: The MOA is approved by the Michigan Board of Nursing as an acceptable provider of CME (LARA-LNR-700).

E VA L U AT I O N S

www.domoa.org/eval Username: [your AOA#] Password: moacme 10

T R I A D | S P R I N G 2019 2020

Save the date!

MOA Autumn SRE Competition Saturday, November 7, 2020 Amway Grand Plaza, Grand Rapids

ACLS / BLS 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.

BASIC LIFE SUPPORT (BLS) CERTIFICATION 3 AOA 1-A Credits Friday, 7 - 10 am ADVANCED CARDIOVASCULAR LIFE SUPPORT (ACLS) CERTIFICATION 10 AOA 1-A Credits Friday, 10 am - 5 pm & Saturday, 8 am - 12 pm ADVANCED CARDIOVASCULAR LIFE SUPPORT (ACLS) RE-CERTIFICATION 4 AOA 1-A Credits Saturday, 8 am - 12 pm

WOMEN of EXCELLENCE WOMEN of Please join us EXCELLENCE for a reception honoring Please join us for a reception honoring women leaders in the medical field.

4 - 6 pm

women leaders in the medical field.

Board of Trustees Room

Please join us for aMay reception Friday, 18 honoring women leaders in the medical field. (second 4 - 6 floor) pm

Friday,15 All are welcome, noMay ticket Friday, May • 18required.

4-6 pm Board of Trustees Room

Board of(second Trustees floor) Room Sponsored by (second floor) All are welcome, no ticket required.

SESSION HIGHLIGHTS Full agenda topics & speakers at www.moaspring.com

FRIDAY

SATURDAY

Cardiology Update 7:30 - 11:30 am (4 Credits)

Genetic Determinates of Disease

Lipid Update

9:30 - 11:30 am (2 Credits)

David Strobl, DO

Symptom Based Differential Felix Rogers, DO

Cardiac Imaging for the PCP Matt Wilcox, DO

Pulmonary Hypertension Chad Link, DO

Panel Discussion with Dr. Strobl, Dr. Rogers, Dr. Wilcox, and Dr. Link

LARA Requirements 2 – 6 pm (4 credits)

Building Pathways in Pain Management: Advancing the Future of Chronic Pain Management Annette Carron, DO, FACOI (Educational Partner: American Osteopathic Association) The overall goal of this program is to improve the quality of life for patients with chronic pain by providing education on the pathophysiology of chronic pain, evidence-based treatment options and emerging treatment modalities that should be considered in managing these conditions.

Opioid Use Disorder Jonathan Beaulac, DO

Genetic Determinants of Disease, Including Autism Genetic Testing, Yes or No? Andrea Amalfitano, DO, PhD Dean, MSUCOM

Functional and Integrative Medicine 2 - 6 pm (4 Credits)

Lifestyle Medicine: Game Changers in Chronic Disease Robert Breakey, MD

Heart Disease Prevention & Reversal Joel Kahn, MD

Vitamin C Research Ramona Wallace, DO

Diabetes Reversal and Dietary Modification Carolyn Trapp, DNP

SUNDAY Breakfast & CME

Human Trafficking

7 - 8 am (1 Credit)

Alan Janssen, DO, FACOEP-D

Infectious Disease Hot Topics!

Coronavirus, Flu Season and More

LARA R 338.143 – 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.)

Sponsored by

LARA R 338.120 Training on Human Trafficking (One-time requirement)

Anthony Ognjan, DO, FACP

Physician and Patient Protection Series 8 am – 12 pm & 12:15 – 4:15 pm (8 Credits) Updates on treatments for your patients while considering risk for the provider. Stress, risk and situation management in the health care workplace.

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Creating Opportunities.

Creating Opportunities.

Transforming Lives.

Transforming Lives.

Offering the theregion’s region’sbroadest broadestspectrum spectrumofof Offering neuro-rehabilitationservices. services. neuro-rehabilitation Origami provides comprehensive comprehensiverehabilitation rehabilitationfor foradolescents adolescentsand andadults adults with neurological Origami provides with neurological dysfunction through throughtheir theirresidential, residential,outpatient, outpatient,and andcommunity community based programs. dysfunction based programs.

Visit OrigamiRehab.org OrigamiRehab.orgto tolearn learnmore moreabout aboutOrigami’s Origami’sprofessional professional and specialized Visit and specialized services including includingdriver driverrehabilitation, rehabilitation,serial serialcasting, casting,and andvision vision therapy. services therapy.

12

Info@OrigamiRehab.org Info@OrigamiRehab.org

517-455-0264 517-455-0264

OrigamiRehab.org OrigamiRehab.org

OrigamiRehab OrigamiRehab

T R I A D | S P R I N G 2020

MARIE'S STORY

S

urvivors of brain injury, their families, and their supporters are facing difficult times, and the fight is far from over.

On June 11, 2019, Michigan’s auto no-fault insurance changed forever, threatening the sustainability of brain injury providers like Origami Brain Injury Rehabilitation Center and the longevity of rehab for the catastrophically injured.

“Following a brain injury, there are many different things that go into the care of the individual. You are dealing with someone’s whole person and who they are. To meet all of those needs, you have to have a team. It is a common misconception that health insurance covers comprehensive care and that is not the case,” shared Origami’s Director of Rehabilitation, Amanda Carr.

Origami’s team sees firsthand the support that auto no-fault benefits provide Michigan families. While the benefits of this law have supported many individuals our team serves, one client story that illustrates the significance of these benefits well is our client, Marie.

is that this kind of injury is like pulling the plug on the person.” When Marie became responsive, her family focused on accessing the resources that Marie would need to recover.

“In Marie’s situation, without auto no-fault, she would not have been able to receive the comprehensive rehabilitation services and quality of care that she really deserves,” said Origami’s Director of Rehabilitation, Amanda Carr.

When Marie arrived at Origami, she went through a variety of basic cognitive-linguistic assessments and scored in the severe range on each one. “For Marie, being at Origami and getting the services that she needs, allows us to help her progress. Marie has some pretty big personals goals and it is really nice to see her work towards those,” said Marie’s Speech-Language Pathologist, Linda Wells.

“Life benefit with Michigan’s Auto NoFault has allowed us to provide Marie the care she needs, without worry.

Policymakers need to step back and realize how much value Michigan’s current benefits provide local families.

They can’t put it in the same context as someone who has lived through it,” said Marie’s husband, Dave.

Without the expertise of organizations like Origami, people like Marie would not receive the care they deserve to regain a new quality of life. Origami’s President & CEO, Tammy Hannah, calls us all to stand together to do all we can, to ensure survivors of catastrophic auto accidents continue to receive the care they need. Contact Origami at OrigamiRehab.org to learn how you can join this important fight.

Origami Brain Injury Rehabilitation Center is a 501(c) (3) nonprofit organization. Origami provides comprehensive rehabilitation for adolescents and adults with neurological dysfunction through their residential, outpatient, and community-based programs.

With their compassionate and innovative services, Origami creates opportunities and transforms lives.

At the school bus stop in Haslett, Michigan, Marie and her 13-year-old daughter were struck by a hit and run driver. Marie sustained many severe injuries, including a traumatic brain injury that altered the course of her life.

For weeks, Marie was on life support and in a coma. Marie’s husband Dave looks back on the challenging time stating, “For all intents and purposes, she was gone. The truth of the matter T R I A D | S P R I N G 2020

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NEW PAYMENT MODELS DO NOT CHANGE

THE STANDARD OF CARE

by Daniel J. Schulte, JD, MOA Legal Counsel

Q:

I am in private practice but am also involved

in physician organizations and various programs in connection with my hospital affiliations.

More and more I am hearing about “pay for performance programs” and other new payment models. They all seem to have certain things in common.

They all involve data gathering/ sharing and increased scrutiny of utilization of diagnostic tools and prescriptions of drugs and other treatments. I would like to know whether participation in these new payment models affects my malpractice liability exposure. When accused of malpractice, are physicians whose diagnosis/treatment decisions that are subject to one of these new payment models judged differently than those physicians who are not?

NO.

There is only one standard of practice. All physicians alleged to have committed an act of malpractice are judged by this same standard of practice. You will be found to be liable for malpractice if you have not met this standard of practice. This standard of practice is expressed in a standard jury instruction providing that malpractice means doing something or the failure to do something that a physician of ordinary learning, judgement and skill would do under the same or similar circumstances. The exact standard of practice to be applied in any given case is one of the issues decided by the jury after hearing testimony from both the plaintiff’s and the defendant’s expert witnesses. Expert witnesses providing testimony in medical malpractice cases must meet specific statutory requirements. These requirements include that expert witnesses have a board certification that matches the board certification of the defendant physician when the claim arises from the practice of the relevant specialty.

There is no jury instruction taking into account the effect any particular payment model has on or should have on

your medical decision making. Nor is there any requirement that an expert witness consider the effect that a utilization review or other payment for performance model had or should have had on what you did or should have done in a case. The influence on your practice resulting from participation in such programs very likely will not be useable in defense of a malpractice claim.

Also bear in mind that the payment model you are subject to when diagnosing and treating a patient are unknown to the patient. Patient expectations when seeing you for their care do not vary from payment model to payment model. All patients expect the standard of practice to be met and that you independently exercise your professional judgement when making diagnosis and treatment decisions.

The methods payors use to determine how to pay for physician services and how those payers attempt to assess the utilization of those services are changing. However, payment and utilization review changes by payors have not affected the standard of practice or the way physicians accused of malpractice will be judged.

Learn more updates at the MOA Spring Convention, May 14-17, 2020. Kerr Russell health care attorney Kathleen A. Westfall will be presenting on “Opportunities and Risks for Physicians in Emerging Models of Health Care Delivery.” Kerr Russell health care attorney and MOA legal counsel, Daniel J. Schulte, will also be presenting on contract review.

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Jessica Fleet, CPA (517) 886-9549 jfleet@manercpa.com manercpa.com

PRACTICES MADE PERFECT Solutions to take care of your business needs so you can stay patient focused.

Wealth Management Accounting & Tax Practice Valuations Technology Solutions

SAVE THE DATE!

AOA Annual Business Meeting July 16-19, 2020 Chicago Marriott Downtown Magnificent Mile

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T R I A D | S P R I N G 2020

The AOA’s Annual Business Meeting brings together more than 500 osteopathic physicians and medical students to consider proposed resolutions and enact AOA policy. Serve as a delegate to represent Michigan by being nominated at the MOA House of Delegates on May 14, 2020 at the Westin Southfield Detroit.

Find more information and a link to book a room at the Chicago Marriott on the AOA website.

ARE YOU GETTING THE MOST FROM YOUR

FINANCIAL REPORTING SOFTWARE? In today’s ever-changing technology environment, it’s easy to become overwhelmed in deciding what financial software is best for your business and corresponds with your needs.

Does it have all the functionality I need? What is my current solution missing? Is the reporting capability robust enough to provide valuable information? The list goes on and on.

I

n today’s healthcare industry there are several different options to make financial reporting for shareholders easy to read and more efficient. Transactional data by categories or dimensions, key performance indicators and dashboarding are just a few popular areas constantly being updated within software platforms. How a healthcare organization uses and presents this data may vary, but all three are areas to consider when researching new software.

Transactional data by categories or dimensions, key performance indicators and dashboarding are just a few popular areas constantly being updated within financial reporting software platforms.

Transactional data by categories or dimensions A practice with many different physicians and provider types may be questioning how to break down data most effectively. Accounting software now has the capability to record transactions by different dimensions such as provider, location and department.

Payroll, benefits and other expenses can then be allocated to specific providers and corresponding locations. On the revenue side, the practice can easily record collections received by provider based on periodic billing reports. A report can be created based on desired dimensions or filters to calculate the revenues and corresponding expenses a provider or location generates resulting in a net income to the practice. This data assists management in determining where profitable or unproductive areas lie.

maintaining and integrating this data with financial data in order to store important metrics in one place.

Examples of KPIs and other chosen statistical data might include days in accounts receivable, number of patient visits, cost per visit. The use of dashboards allows you to take KPIs and display them in either a report, graphical or list format. Graphical data can be beneficial to visually compare information by dimensional data or to follow the ebbs and flows of the organizational activity. Dashboards are extremely popular in today’s working environment to provide management and other decision makers with realtime data in a visual format.

Dashboarding

Key performance indicators

Consolidating data into one source can save significant amounts of time during report preparation as opposed to pulling information from varying data sources. The features listed above are just a few examples of how your software can provide you with useful data for consistent and concise reporting.

The goal is to determine a financial reporting software that streamlines processes and allows you to focus on the primary purpose of caring for patients.

While there are many different options available to healthcare providers, it is important to know your objectives and find the right fit.

Key performance indicators, or KPIs, may be available in most practice management software packages, but financial software is now capable of

For more information on accounting software or help with the right selection, please contact Maner Costerisan at tbograkos@manersolutions.com.

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JOIN OUR COMPASSIONATE TEAM

Advancing care where it matters most.

This is the best of both worlds. A trusted local health provider is now part of a world-class health system. A place where patients are treated like people; where top specialists are making game-changing advances; and where our focus is bringing the right care to the right place. Our story has only just begun.

metrohealth.net/recruiting

Metro Health- Michigan Medicine Obesity Symposium

Hope & Healing Brunch/Program

May 1, 2020, 8:00 am - 3:00 pm, JW Marriott

April 30, 2020 11:30 am - 12:30 pm Amway Grand Plaza Hotel

THIS ACTIVITY IS APPROPRIATE FOR:

Medical Students, Nurse Practitioners, Nurses, Physician Assistants, Physicians

IN THE FIELDS OF:

Cardiovascular Medicine, Endocrinology, Family Medicine, General Medicine, Internal Medicine, Orthopaedic Surgery, Physical Medicine & Rehabilitation, Primary Care, Pulmonology

ACCREDITATION AND CREDIT DESIGNATION

This activity has been planned and implemented in accordance with the accred-itation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Michigan Medical School and Metro Health Hospital. The University of Michigan Medical School is accredited by the ACCME to provide continuing medical education for physicians.

The University of Michigan Medical School designates this live activity for a maximum of 4.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

FOR QUESTIONS OR REGISTRATION, PLEASE CONTACT REBECCA CHAMBERLAIN AT RJCHAMBE@UMICH.EDU. 18

T R I A D | S P R I N G 2020

A BOND OF COMPASSION YOU CAN SUPPORT. No one provides more compassionate, expert patient care or comforts more families than NURSES… and they deserve to be honored!

Join us to celebrate the nursing journey toward Magnet designation, the most prestigious distinction a healthcare organization can receive for nursing excellence and high-quality patient care.

KINDLY RSVP TO:

EVENTS@METROGR.ORG

CRITICAL SHORTAGE OF HOME CARE WORKERS THREATENS PATIENT CARE

By Clare C. Luz, PhD, Assistant Professor, Michigan State University College of Osteopathic Medicine

The problem: The U.S. population is aging at an unprecedented rate. By 2030, nearly a quarter of the population will be over age 65 and, for the first time, this age group will outnumber children under age 18. The fastest growing

they work in the privacy of personal homes where conditions may be less than ideal. There are no federal PCA competency, professional, ethical or educational requirements.

segment of the population is the old-old, those age 85 and older. With age

The good news

comes an increased prevalence of multiple chronic conditions and a need

Just as the causes of the shortage are known, so are a number of solutions.

Decades of advocacy work are at long last getting traction, for multiple reasons including the boomers getting older. Efforts to address the shortage are now being aggressively undertaken, such as the work being done

by IMPART Alliance, led by Clare Luz, PhD, with the Michigan State University College of Osteopathic Medicine. IMPART, currently funded by the Michigan Health Endowment Fund, aims to help build an infrastructure in Michigan to support the direct care workforce. It is scaling up an evidence-based comprehensive PCA training program, establishing a PCA Professional Association and piloting a PCA technical training program for high school students in partnership with the Grand Ledge School District. Efforts at the state level are now ramping up with Michigan DHHS convening a Direct Care Worker Advisory Committee chaired by Luz and Alexis Travis, PhD, Senior Deputy Director, Aging & Adult Services Agency. Groups such as the Capital Area Health Alliance and partnerships across all settings where healthcare is provided is what will turn this crisis around and make quality of care possible.

for supportive services to remain at home, where most people want to live.

This seismic demographic shift comes at a time when there are fewer family caregivers and a drastic shortage of direct cazre workers who provide hands-on care to older adults and persons with disabilities.

What is a direct care worker and why is their work important?

This workforce includes a range of positions from certified nursing aides who are trained for work in institutional settings to unlicensed personal care aides, or PCAs, who work in client’s own homes. PCAs assist clients with tasks such as dressing, bathing, housekeeping, meal preparation and medication management. They are responsible for up to 80 percent of paid, hands-on care provided in private homes, residential settings and adult day care settings. They are in a pivotal position to monitor their clients’ status, recognize and report changes, improve their clients’ quality of life and health outcomes and to avert costly life-changing events such as falls, emergency department visits and hospital stays. Without their support, clients may face a nursing home placement or death and they should therefore be considered as important members of any care team.

How drastic is the PCA shortage?

Michigan currently needs 34,000 more home care workers. Further, the average turnover rate is about 82% which destroys continuity of care, keeps the system churned up and is extremely costly. Increased numbers are not enough. We need a stable home care workforce comprised of people who are skilled, care about their clients, and not only want to stay on the job but are given enough resources to do so. Michigan has a lot of good home-based programs but none of them can exist without a qualified workforce. Yet, home care workers continue to be marginalized. The average wage rate for a PCA is about $10 per hour. They receive few, if any benefits. Most do not have guaranteed hours and cannot make it on one income alone. They face a lack of respect with their work referred to as non- or low-skilled or in derogatory terms such as a “glorified butt wiper.” PCAs also face danger as

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WHY CONDITIONS ARE RIGHT FOR A TELEMEDICINE BOOM

By Judy L. Klein, CPHRM, FASHRM, Manager, Risk Management

F

ew people enjoy going

The Rise of Telemedicine

to the doctor’s office. If

Telemedicine, the practice of using technology to deliver healthcare remotely, started as a way to deliver care in rural areas. Since then, both consumers and providers have come to appreciate the benefits. According to Accenture’s 2018 Consumer Survey on Digital Health, 47% of people would prefer to see a doctor virtually than have to wait to see a doctor in person. This is a 2% increase from the previous year.

you’re sick, you’d rather

be at home and not around other people who are sick and possibly contagious. You go because you need treatment and maybe a prescription, but if you could get that from home, you probably would. Now, thanks to telemedicine, you can. Although the technology has been around for a while, its use has evolved rapidly and has taken off in 2019.

The conditions are right for a telemedicine boom!

Providers are also increasingly accepting of telemedicine. According to a survey from American Well, 1 in 5 doctors use telemedicine to care for patients. Among the doctors who are not currently using telehealth, 61% say it’s likely or very likely they’ll start by 2022.

The legal landscape is also paving the way for telemedicine. The Interstate Medical Licensure Compact (IMLC) provides a way for doctors to practice in multiple states – helpful for telemedicine, since virtual visits don’t need to be limited to a single state. Currently, 29 states, the District of Columbia, and the territory of Guam participate in the IMLC. Prior to IMCL, practicing in multiple states was more challenging.

Rising Demand for Convenience Consumers are demanding more convenient healthcare options. This trend has led to the rise of urgent care centers and retail clinics, and it will also contribute to the expansion of telemedicine.

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FREE TO MOA MEMBERS: AOA-QUALIFYING ONLINE COURSES COMPLIMENTS OF COVERYS AND PROVIDED THROUGH MED-IQ Duke Perspectives from the 2019 American Heart Association Annual Meeting

CGM 101: Strategies for Primary Care Providers and Ancillary Staff

Insulin Pumps: What the Primary Care Clinician Needs to Know

Overview:

Overview:

Overview:

This publication summarizes relevant abstracts and findings that were presented at the 2019 American Heart Association Annual Meeting held November 16 to 18 in Philadelphia, PA. In addition, Manesh Patel, MD, professor of medicine at Duke, provides expert insight on presented studies.

Join diabetes experts Alison Evert, MS, RD, CDE, and Anne Peters, MD, as they talk about how to start individuals with type 1 diabetes on continuous glucose monitoring from the primary care perspective. Learn more about the different devices, their benefits and limitations, how to interpret the data, and billing and insurance coverage considerations.

Join diabetes experts Anne Peters, MD, and Jay Shubrook, DO, to learn more about insulin pumps.

Find out about the many benefits and limitations of insulin pumps and how you can help interested patients with type 1 diabetes get started on this type of therapy.

Course available until 12/16/20.

Course available until 7/29/20.

Course available until 7/29/20.

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BLUE CROSS TAKES ACTION TO HELP MEMBERS DURING THE

CORONAVIRUS OUTBREAK

Blue Cross Blue Shield of Michigan and Blue Care Network, in line with Blues-affiliated plans across the country, will be taking action to ensure the health and safety of our members during the worldwide outbreak of a new coronavirus.

The disease caused by the new coronavirus is called COVID-19, and causes symptoms including fever, cough and shortness of breath. The number of cases of COVID-19 in the U.S. continues to increase daily as the new coronavirus spreads from state to state.

All diagnostic laboratory tests for COVID-19 when used in accordance with CDC testing recommendations will be fully covered by Blue Cross at no cost to the member. This measure will ensure patient testing and subsequent care is completed in an efficient, coordinated way with authorities at every level.

To ensure patients receive the right care at the right locations, Blue Cross will be waiving prior authorization processes for covered services related to COVID-19 — unless prior authorization is required to assure the availability of the treatment for persons in need consistent with CDC recommendations.

Prior authorization means a doctor, in certain cases, would file a request with a patient’s insurance company for certain prescription drugs, as well as for some medical and surgical procedures, before they are pursued as treatment.

Blue Cross will also be dedicating clinical staff to address medical service questions related to COVID-19.

As cases of COVID-19 continue to be reported across the U.S., Blue Cross is taking proactive measures to make sure all members have the medications and the care they need for illnesses and conditions beyond the coronavirus outbreak.

Access to prescription medications will be expanded to ensure patients do not experience shortages or difficulties filling their prescriptions. Early medication refill limits on 30-day prescription maintenance medications will be waived (consistent with a member’s benefit plan). Any additional charges that may stem

from obtaining a non-preferred medication for COVID-19 treatment will not be billed to the patient.

In anticipation of high demand at health care provider offices, Blue Cross will be expanding access to telemedicine and nurse/ provider hotlines.

Blue Cross offers the following options to access care remotely: Blue Cross Online Visits Using your smartphone, laptop or tablet, sign-up or log on to Blue Cross Online Visits account to quickly connect to a licensed health care provider over a secure, webbased video chat. You don’t need to make an appointment and you can talk to a doctor in 10 minutes or less. You can even get a prescription if you need it.

24-Hour Nurse Line At no cost to Blue Cross members, a registered nurse is waiting for your call anytime day or night. Able to help over the phone, they can answer your questions regarding symptoms and help point you in the right direction for any next steps in care.

More Information This is a rapidly developing situation and information is constantly changing and being updated as officials learn more about the virus. Blue Cross Blue Shield of Michigan staff are diligently tracking all updates regarding the disease’s activity, symptoms, travel restrictions and risk assessments from official sources.

For current Blue Cross information on the new coronavirus, please visit our blog.

The blog is updated three times per day with information verified

by Blue Cross clinical leadership. It includes information intended to help customers and members stay current on developments, guide in managing good health and addressing topics of concern.

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domoa.org/HCPM

ARE PAYER’S AIDING AND ABETTING OUTSIDERS?

By Ewa Matuszewski, CEO, MedNetOne

The venture capitalist will see you now. Unfortunately, it’s not the lead-in to a joke. It’s the next inevitable step in usurping the role of primary care.

A

s those of us long invested in the health-centered goals of the primary care community mark wins with the patient-centered medical home (PCMH), team-based care and care management strategies; as we dive deeper into the role that social determinants of health play in limiting access to care and optimal health and wellness – and offer practical solutions; as we find success with datadriven, population health strategies…the business people see dollar signs, instead.

Humana entered into an arrangement with a private equity firm to create primary care clinics focused on the Medicare Advantage and dual-eligible population.

Doing so will add to Humana’s existing senior primary care clinics, which have a multi-state footprint and were designed to lower healthcare costs while grabbing market share among the mighty senior population. It’s not just Humana, though, it’s a trend among large insurers and health systems. (I must add here that it irks me that the venture capitalists, private equity firms and other outliers are swooping in and tapping large insurers and employers, rather than seeking out partnerships with smaller practices who built the networks of primary care in this state – i.e., locally source healthcare.)

From urgent care clinics to variations of the pharmacy Minute Clinics and the extension of authority of advanced care practitioners (highly valued, respected and necessary members of the health care continuum, but not physicians), there’s a mission creep in primary care that seems to be excluding primary care physicians, or at least moving them down the patient care ladder. But what can we do about this dismantling of PCMH practices and the primary care community that built them? How can the primary care physician, even and perhaps especially, the private practice primary care physician, regain their authority and the sacred role they play in the physician patient relationship?

As the saying goes, “No one gives you power. You take it.” But can you take it back? I’m not sure there’s a saying for that, but here are some steps that can be taken:

PCPs need to band together in solidarity (their POs can help) against venture capitalists and other non-clinical opportunistic business dealmakers who aim to lure the coveted senor Medicare Advantage population through shiny new clinics. When patients believe their coordinated needs are being met, there is no incentive to leave a practice, regardless of age. A solidarity among primary care physicians can help stop a rush of seniors from seeking care elsewhere.

Medical societies need to lay off the politics and turn their attention, and spending of annual dues money, back to

physician members who seek guidance and advocacy for themselves and their patients on a holistic level. The trend is for medical societies to focus on a piece of the puzzle, such as pre-authorizations and administrative issues, often partisan in nature, that can be addressed by nonphysicians. Medical societies instead, can re-focus some of their attention on preserving and strengthening PCMHbased primary care.

Looking back to 2007, I was a presenter at a state conference held at the Dearborn Hyatt introducing the PCMH model. Several physicians walked out, complaining the fledgling movement would never gain traction and wasn’t worth their time. Well, they were obviously wrong; the PCMH model did take hold, thanks to its reinforcement of the value of the patient/physician relationship, solid foundational principles and the support of major insurers like Blue Cross Blue Shield of Michigan and PriorityHealth. But is it strong enough to hold up against all the outside money eager to invest in healthcare for profits, rather than patients?

If the greater primary care community doesn’t see what’s happening with the senior community (just for starters), they could be waiting in line behind their patients to see what the investors can offer them from what once was their very own primary care practice.

Don’t kid yourself, a threat to primary care is a threat to the medical profession as a whole.

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UPCOMING EVENTS The MOA is monitoring the situation regarding Coronavirus disease 2019 (COVID-19) as a community health emergency, and in regards to managing our own events. At the time of this publication, the 121st Annual Spring Scientific Convention will be held May 14-17, in Southfield, MI. The health and safety of attendees, speakers and exhibitors is the utmost concern to the MOA, as well as adhering to any recommendations made by the Michigan Department of Health and Human Services (MDHHS). At this time, all options are being examined.

In the meantime, meetings have been postponed or changed to teleconference meetings. Visit www.domoa.org for updated information. The MOA will continue to monitor the situation and relay updates as they are announced.

MICHIGAN OSTEOPATHIC ASSOCIATION

16th Annual Autumn

SCIENTIFIC CONVENTION

Join us in GR! November 8 - 10, 2019 Amway Grand Plaza Grand Rapids, MI 20 AOA Category 1-A CME credits anticipated.

The #DOfamily meets for the latest in osteopathic health & research updates at the Autumn Scientific Convention.

www.domoa.org/autumn

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June 18-21, 2020 Mission Point Mackinac Island, MI Join the NMOA for an opportunity to network with your colleagues, experience outstanding lectures, and engage with exhibitors on beautiful Mackinac Island.

www.domoa.org/nmoa

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

2019-2020 BOARD OF TRUSTEES Department of Business Affairs - Directors Craig Glines, DO, President Jeffrey Postlewaite, DO, President-Elect Lawrence Prokop, DO, Immediate Past President John Sealey, DO, Past President David Best, DO, Secretary/Treasurer

Department of Socio Economics - Directors Stephen Bell, DO Emily Hurst, DO

Department of Education - Directors Kevin Beyer, DO Adam Hunt, DO

Department of Membership - Directors Jasper Yung, DO Nathan Holmes, Student Trustee

Department of Healthcare Technology & Informatics - Directors Andrew Adair, DO Miles Medina, DO 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 Š2020 Michigan Osteopathic Association 27

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AOA Annual Business Meeting............................................16 Blue Cross Blue Shield of Michigan.....................................22 Coverys.................................................................................2 Healthcare Partners of Michigan..........................................24 Kerr Russell.........................................................................14 Maner Costerisan................................................................16 McLaren Health Care.............................................................8 Metro Health.......................................................................18 MHA.....................................................................................6 MOA Spring Convention.......................................................4 MOPAC...............................................................................14 NMOA Summer Conference................................................26 Origami...............................................................................12

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

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