The Award-Winning Journal of the Michigan Osteopathic Association S U M M E R 2020
UNIFICATION IN TIMES OF TRIAL:
FROM COVID-19 RESPONSE TO HEALTH EQUITY
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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. At Coverys, we illuminate unforeseen risks so you can focus on patient satisfaction and reduce exposure to malpractice claims. As a premier provider of medical liability insurance, Coverys’ data insights and risk recommendations will help you provide optimal healthcare outcomes that you can see clearly. Very clearly. To learn more, visit Coverys.com or call our East Lansing office at 800.313.5888, and select option 3 to speak with a representative.
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CONTENTS
In Every Issue 05 President’s Page 20 Coverys 22 Healthcare Partners of Michigan
26 Eye on Advocacy
FEATURES 07
Health Equity: Addressing Health Disparities and Systemic Racism in Healthcare
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Safe Schools, Healthy Students Act Contributed by Parent Information Network
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27 Advertiser Index
Origami Brain Injury Rehabilitation Center Welcomes New Medical Director, Dr. Marcy Schlinger, DO Contributed by Origami
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Better Together: MOA Coronavirus Response Highlights
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Why You Need a Business Valuation Contributed by Maner Costerisan
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When ‘less is more’: Study of lung-collapse treatment draws international attention
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MOA Learning Center: On-demand CME Offerings
MICHIGAN MOA OSTEOPATHIC ASSOCIATION 3
PRESIDENT'S PAGE
A YEAR LIKE NO OTHER J E F F R E Y PO S T L E WA I T E, D O, F ACO O G, M B A P R E S I D E N T M I C H I G A N O S T E O PAT H I C A S S O C I AT I O N
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y term as President of the Michigan Osteopathic Association certainly began like no other, with a virtual swearing-in ceremony as part of our House of Delegates and the traditional opening remarks for our virtual convention delivered via Zoom. I am proud to say we pivoted from what would have been our 121st in-person Annual Spring Scientific Convention to a virtual format in a matter of weeks.
Jeffrey Postlewaite, DO, FACOOG, MBA
The House of Delegates convened, virtually, on May 30,2020, with over 100 delegates logging in to a Zoom webinar. Speaker of the House, Craig H. Bethune, DO, adroitly managed the proceedings as effectively as he manages the live, in-person meetings. In June, the MOA delivered 14 AOA Category 1-A CME credits to over 500 “attendees” on the new MOA Learning Center online educational platform. The platform can host live events and on-demand CME courses, and I encourage our members to participate in upcoming events and explore the on-demand CME offerings. As COVID-19 cases continue to be reported, the in-person Autumn Convention has been converted into an online CME event. We fully anticipate returning to the Amway Grand Plaza next fall, but for now we are placing the safety of our members, staff and exhibitors above all by offering CME in the virtual format of our Learning Center. The American Osteopathic Association (AOA) has also transitioned in-person meetings to virtual meetings in 2020. The Executive Committee of the AOA Board of Trustees has voted to host OMED 2020 as a virtual conference, rather than the live event scheduled Oct. 15-19. The AOA has announced the special meeting of the AOA House of Delegates (HOD) planned for Oct. 13-14 will be held virtually. As our governments, both state and federal, attempt to address issues reverberating from COVID-19, I cannot stress enough—now more than ever -we need to invest in our profession. Donate to MOPAC. As legislation is crafted to address reopening our economy and create options for how physicians can treat patients, the MOA needs to ensure our legislators are representing osteopathic physicians. No matter what the rest of 2020 has in store, I want to impress upon our membership that the MOA will be there to support our physicians and the communities they serve. T R I A D | S P R I N G 2020
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HEALTH EQUITY
ADDRESSING HEALTH DISPARITIES AND SYSTEMIC RACISM IN HEALTHCARE B Y B R I T TA N Y B O G A N, F AC H E, C P P S, S E N I O R V I C E P R E S I D E N T O F S A F E TY & Q U A L I TY, M H A, A N D E X E C U T I V E D I R E CTO R, M H A K E Y S TO N E C E N T E R
The events of the past several months have highlighted and amplified the systemic racism that is a persistent and widespread problem in our society. The disproportionate impact of COVID-19 on people of color has called out, in yet another example, the racial disparities that exist in access to healthcare and health outcomes.
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s a patient safety and quality organization, the MHA Keystone Center has long been committed to this call – addressing health disparities is a foundational concept that shapes all our quality improvement and safety efforts. We believe healthcare systems are the epicenter for leading these efforts by providing resources, educational tools and best practices to confront and overcome the disparities and inequities within their communities.
through MHA.org, is a tool that incorporates elements of safety culture with the five principles of high-reliability organizations – preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resiliency and deference to expertise. In addition to this, we’ve shared an article with our membership that debunks the seven common misconceptions about health equity.
To that end, we’re dedicated to supporting hospitals and caregivers by offering structure and actionable steps to ensure the healthcare system is active and transparent in addressing disparities and implicit bias.
• preoccupation with failure
The Reliability Culture Implementation Guide, which can be accessed
The five principles of high- reliability organizations: • reluctance to simplify • sensitivity to operations • commitment to resiliency • deference to expertise
The article outlines the significance of social determinants of health as it relates to health equity and the demographic and socioeconomic conditions that are often overlooked, or misunderstood, by health systems. I encourage you to take advantage of these resources as we collectively strive to achieve health equity and improve population health by meeting the needs of all patient populations, regardless of race, ethnicity, gender, age, sexual orientation, education, culture, heritage, religion, location, physical ability or socioeconomic status. Through our own member-facing community site, the MHA Keystone Center offers events, webinars and workshops designed to address cultural competency and provide strategies to reduce healthcare disparities. By using the Health Equity Organizational Assessment, MHA Keystone Center members can assess their organization’s current activity and identify areas for improvement as it relates to addressing disparities. We also plan to release a comprehensive guide later this summer to support members in ensuring that every person in every community receives high-quality, equitable and safe care. T R I A D | S P R I N G 2020
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The MHA Salutes Michigan’s COVID-19 Heroes Thank you to our front-line workers
www.mha.org
Safe Schools – Healthy Students Act Overcoming the COVID-19 public health crisis means taking meaningful steps to protect our students and schools from vaccine preventable diseases. The devastation wracked by the virus reminds us what happens when a vaccine is not available to prevent its spread. Thankfully, many of the world’s most serious diseases are vaccine-preventable. Now is the time to ensure good record keeping of immunization status is extended for students through high school so that in the event of an outbreak, the response can be tailored, appropriate and accurate. It’s time for the Safe Schools – Healthy Students Act.
What Does the Safe Schools – Healthy Students Act do? Today, state law requires students provide proof of vaccinations before entering kindergarten, 7th grade, or before entering a school for the first time. Senate Bills 979-981 require parents or students provide a certificate of immunization in 12th grade, too. The bills direct MDHHS to reference the immunizations recommended by the CDC Advisory Committee on Immunization Practices when revising the state's immunization certificate.
What Doesn't the Safe Schools – Healthy Students Act do? Senate Bills 979-981 do not remove or change the right of parents to exempt their children from any immunization due to religious or philosophical reasons.
Now – more than ever – it’s time to protect students. Immunizations offer protection from preventable diseases and outbreaks. They’re safe, proven and effective. Unfortunately, even before the COVID-19 public health crisis, Michigan experienced a resurgence in vaccinepreventable diseases in part due to factors such as under immunized persons and global travel. As parents, educators and policymakers carefully consider reforms needed to safely reopen schools, colleges, and universities, voters overwhelmingly support strengthening the state’s laws requiring childhood vaccinations. While this legislation does not require additional vaccines, it is an important step forward in strengthening public health policies and will help to keep our schools safe.
Over the past five years, Michigan has seen the following preventable and 1 life-threatening infections: 32 meningitis cases 2834 cases of whooping cough 214 cases of mumps, and 69 cases of the measles
According to a recent poll by EPIC-MRA:
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71% of voters think Michigan’s laws should be stronger and require more vaccinations, and 65% of voters support a requirement that students be fully immunized before attending state colleges and universities.
[1] https://www.michigan.gov/documents/mdhhs/WSR_52-2019_675582_7.pdf [2] The statewide poll was conducted by EPIC-MRA and commissioned by the Michigan Council for Maternal and Child Health on behalf of the Parent Information Network. 600 sample. +/-4.0% MOE. Polling dates: January 9-January 12, 2020. Conducted by live interviewers – included 30% cell phones.
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ORIGAMI BRAIN INJURY REHABILITATION CENTER
WELCOMES NEW MEDICAL DIRECTOR, DR. MARCY SCHLINGER, DO With a strong foundation of over 28 years of experience and leadership in this community, Dr. Marcy Schlinger, DO, brings a strong collaborative approach to medical care and a passion for helping individuals reach their full potential.
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pecializing in Physical Medicine and Rehabilitation (PM&R), Dr. Schlinger owns a full-time private practice in Okemos, Michigan. She remains a Clinical Associate Professor for the Department of PM&R, Michigan State University College of Osteopathic Medicine (MSUCOM), and a faculty member of MSUCOM’s Continuing Medical Education Department. A true Spartan, Dr. Schlinger attended and graduated from Michigan State University College of Osteopathic Medicine.
“I am excited to work with the extraordinary team of professionals at Origami,” Schlinger said. “Origami is an extremely valuable resource in this community, and I welcome the opportunity to continue the legacy of excellence in client care and recovery as together, we further the mission of Origami.” 10
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Marcy Schlinger, DO
Dr. Schlinger received her BS in Nursing in 1977 from Wayne State University in Detroit, Michigan. In 1986, she enrolled at Oakland University for pre-medical studies, and in 1992 she graduated from Michigan State University College of Osteopathic Medicine (MSUCOM) as a Doctor of Osteopathy. She completed a PM&R Residency at the University of Minnesota in 1996 and was a Fellow/Instructor in Electrodiagnostic and Musculoskeletal Medicine at MSUCOM’s Department of PM&R from 1996 to 1997. Dr. Schlinger is Board Certified by the National Board of Osteopathic Medical Examiners, the American Board of Physical Medicine and Rehabilitation, the American Board of Electrodiagnostic Medicine and the American Osteopathic Board of Physical Medicine and Rehabilitation. In 1997 Dr. Schlinger became an Assistant Professor in the Department
of PM&R at Michigan State University, College of Osteopathic Medicine, where she lectured and taught residents general rehabilitation and EMG’s in an outpatient general rehab medicine practice. Dr. Schlinger continues to practice and teach clinical Electrodiagnostic Medicine at the McLaren Greater Lansing Neurodiagnostic Lab. In 2003, Dr. Schlinger opened a full-time private practice in Okemos where she continues to practice.
Origami President & CEO, Tammy Hannah, says, “With Dr. Schlinger joining our team, we are excited for the opportunity to deepen our community partnerships further and enhance our strong commitment to positive outcomes for those we serve.”
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.
origamirehab.org
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.
Info@OrigamiRehab.org Info@OrigamiRehab.org
517-455-0264 517-455-0264
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OrigamiRehab OrigamiRehab
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BETTER TOGETHER MOA CORONAVIRUS RESPONSE HIGHLIGHTS B Y K R I S N I C H O LO F F, C E O A N D E X E C U T I V E D I R E CTO R, M OA
The Michigan Osteopathic Association (MOA) has a long history of standing out in times of trial. Since 1898, this organization has fought for physicians and quality patient care. The year 2020 has brought some of the biggest challenges I have personally experienced as CEO and Executive Director of the MOA. While we may not be completely out of the woods when it comes to COVID-19 matters, I can say with certainty that we are ready to face them. Over the past several months, it has been my privilege to work with providers, medical staff, state officials and MOA personnel to handle curve ball after curve ball thrown our way.
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am proud to lead an organization that was called upon by its members and government officials for resources to help navigate these hard times. I believe that we responded with innovative thinking, adaptive practices and extraordinary teamwork. Below is an overview of the efforts that were put forth during the last four months of the pandemic. I am especially excited to announce the success our first-ever online CME program which was the result of cancelling the 121st Annual in-person Spring Scientific Convention. It is through the hard work of our physician-led Education Committee and dedicated staff that we were able to provide an exceptional learning opportunity regardless of the current climate. We will again be offering an online program in place of the Autumn Convention, November 7-8, 2020. More details of projects listed here can be found on our website, as well as shared through our social media outlets which I hope you use to connect with us.
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COVID-19 Response Included: Creation of a Physician Practice Playbook that along with a professional video created for MOA – 10 Steps of COVID-19 and Preparing to Return to Work – allows a practice to take the online test and upon passing, the staff can print our certificates of completion for their files in case of audit. Presentation by Emily Hurst, DO at the PPRAC meeting regarding her first-hand experience of working through COVID-19, expressing the emotions of all of our front line members. In attendance were the leaders of Michigan Osteopathic Association, Michigan State Medical Society and Blue Cross Blue Shield of Michigan. PPE Care Packages delivered to members and non-members; PPE catalog hosted on MOA website
Training and Utilizing your Entire Care Team (FREE) Developing a Plan to Reopen Your Practice (FREE) Creating a Disaster Plan for Your Practice (FREE) Documenting and Coding after “Seeing” Your Patients (FREE) Tri-County Newsletter month of April and May dedicated to communicating resources for providers Newsletter to component society presidents across the state, at least once per quarter COVID-19 resources added to MOA the website, including COVID-19 Updates, Physician Wellness featuring guided yoga sessions, and a Practice Section including education on telehealth, coding, finances and more Form developed on MOA website to collect CME COVID-19 hours, expanded in May to include PA’s and Nurses
Met with seven independent POs to promote the MOA; will be meeting quarterly in the future Provided help to our physicians using Telehealth for the first time Live streaming of 16 hours of CME credit sessions to replace May in-person Convention with over 500 attendees Online Planning Sessions: » The Business of Medicine Session » Practice Care Team training » Personal Business of Medicine for Residents » First year in practice physicians, Legislative Town Hall Conducted the business of the MOA House of Delegates online in May, with over 100 participants. Policy which was passed will shape legislation here in the state of Michigan as well as several pieces to be forwarded to the national level
As we know, these difficult times may not be behind us. That’s why it is important to remember that we are stronger together. The MOA cannot provide the highest level of service to our members and stakeholders without your involvement. If you are already a member, we appreciate you. We ask that you continue to let us know how to best serve you, and participate in MOA activities. Additionally, by sharing the MOA’s mission with your colleagues, we hope to build an even stronger DO family. Lastly, I would like to thank each of our healthcare workers for their tireless and selfless efforts to provide hope and healing during the pandemic. The bravery and compassion for others stretches beyond what you could have imagined during any training. We are grateful to each and every one of Michigan’s healthcare heroes.
Protect & Respect Wash your hands, social distance, and wear a mask to reduce the risk of transmission. #MASKUPMICHIGAN
MICHIGAN MICHIGAN OSTEOPATHIC OSTEOPATHIC ASSOCIATION ASSOCIATION
AUTUMN AUTUMN CME CME
17 AOA Category 1-A Credits 16+ AOA Category 1-A Credits New online New online CME program! CME program! November November 7-8, 2020: 7-8, 2020: Live Q&A, Live Q&A, interactions interactions duringduring presentations presentations
Registration, Registration, speakers speakers & topics: & topics: www.domoa.org/autumn www.domoa.org/autumn The Michigan The Michigan Osteopathic Osteopathic Association Association is accredited is accredited by the American by the American Osteopathic Osteopathic Association Association to provide to provide osteopathic osteopathic continuing continuing medicalmedical education education for physicians. for physicians. The MOA Thedesignates MOA designates this this programprogram for a maximum for a maximum of 17 AOA of 16+ Category AOA Category 1-A credits 1-Aand credits willand report willCME report andCME specialty and specialty credits credits commensurate commensurate with the with extent the extent of the physician’s of the physician’s participation participation in this in activity. this activity.
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HEALTH CARE DATA SECURITY IN THE COVID-19 ERA B Y J E F F R E Y A. M AY, K E R R R U S S E L L
Over the last few weeks, Google alone has blocked an average of 18 million COVID-19-related malware and phishing emails every day. Ransomware attacks are on the rise.
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ow, more than ever, health care operations are vital, so would-be attackers know that ransom payments are more likely to be made. Adding fuel to the fire, hospitals are pushed to (or beyond) their limits system, and administrators and service providers are tasked with protecting a substantially larger (uncontrolled) data environment. Nevertheless, providers must still use care in protecting patient data. Two potential vulnerability points are particularly noteworthy: temporary medical facilities, and remote workers. While necessary, the rush to provide patients with access to care has naturally resulted in a lack of proper IT infrastructure. And unsecured IoT devices – smart beds, wireless monitoring devices, etc. – along with unsecured home networks only exacerbate the problem. Where two months ago, a nefarious actor had to navigate a sophisticated security environment to access a hospital network, the same access may now be available through an unpatched wireless access point in a physician’s home office or through an unsecured computer in a temporary medical facility.
The following are just a few things for physicians and IT staff to keep in mind as we all navigate through this crisis: Protect home/remote network connections to the greatest extent possible. Make sure wireless access points are appropriately encrypted, by using, for example Wi-Fi Protected Access II (WPA2) with a preshared key (PSK). And never send confidential data over a public wireless network. Only connect to office networks using pre-approved devices and through a virtual private network (VPN). Further, do not install any unapproved software on a device that will connect to a company VPN. Microsoft recently warned of sophisticated ransomware attacks targeting hospitals by using gateway and VPN vulnerabilities. If possible, setup separate networks for your business and personal connections. Similarly, segment your network to keep IoT devices separate from other systems. Setup Multifactor Authentication (MFA) whenever available. When conducting virtual meetings – with patients or otherwise – use passwords and virtual “waiting rooms” to avoid eavesdropping and trolling. Lock down USB ports on computers in temporary locations. Check firewall and server configurations to ensure only approved ports and connection protocols are opened. Make sure default passwords have been updated to strong passwords for all devices and systems, including off-site IoT devices.
And finally, nothing can replace a comprehensive business continuity and disaster recovery program. Make sure your data is backed up regularly and stored offsite in a separate and secure location. And be sure to work with your technical and legal representatives to maintain compliance with regulatory and other requirements during these trying times. For questions relating to data privacy policies and cybersecurity, contact a Kerr Russell attorney. T R I A D | S P R I N G 2020
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WHY YOU NEED A BUSINESS VALUATION B Y J E F F R E Y P. A L L E N, C PA
So, you’re a successful business owner. Congratulations! However, after years of growing the business new challenges are ahead. Maybe getting older is making you think of retirement, a partner has grown restless with the current setup or an amazing financing opportunity has come along, allowing for growth. Whatever the reason, business owners often face the reality of having their business valued. In fact, there are many reasons why you may need a business valuation:
Business Sale It goes without saying when most people think of a business valuation, they are thinking about what a business will cost to purchase or the price to be paid to acquire it. A wellprepared business valuation will provide insight into the various reasons that underline the value arrived at by the analyst. Many assume you take
an earnings number, multiply it by some magical number and determine the value of a business. While earnings multiples can indeed be a factor in determining value, there are often many other critical aspects of the business to evaluate. Included in the “earnings” number could be several inappropriate items. The business may be operating much differently
than its peers who apply the same “multiple.” A good valuation analyst can dig deep into the weeds and provide exceptional insight into why the business is worth a certain amount.
Estate and Gift Tax You’ve finally built your empire and profits and cash flow are amazing. One problem, you’re getting up there in age and can’t keep building the company like you did in your younger years. It’s time to face the inevitable and make decisions about the future. Rather than selling to a stranger, transferring ownership to the next generation of the family may seem more appealing. Unfortunately, the Internal Revenue Service (IRS) doesn’t allow you to just “give away” the business to your family members. A business valuation is often required to properly gift ownership shares to others. Teamed with an exceptional tax advisor, the IRS can be satisfied, and taxes may be mitigated.
Buy-Sell Agreements Many professional firms (physicians, lawyers, accountants, engineers, architects, etc.) promise promotions to up and coming staff. Many talented workers are eventually faced with the prospect of becoming a partner with the ability to “buy-in” to the firm. But how much should they pay? Likewise, when it’s time to retire and sell shares in the firm, how much should the retiring partner receive? Questions like these can often be answered in a well written buy-sell agreement. Many times, these agreements call for a formal business valuation or calculation of value. 16
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Divorce
Loans
After 25 years of marriage the world’s wealthiest couple, Jeff and MacKenzie Bezos called it quits in 2019. The estimated net worth of the couple at the time was $153.1 billion dollars representing 16% of the shares of Amazon. While it’s unexpected that many of us would ever need to determine how to divide this vast of a fortune, the truth remains for some that divorce may be imminent and assets will need to be valued to determine who gets what and how much. If shares in a closelyheld business are owned by one of the spouses, a business valuation will likely be required by the court.
Ever heard of a debt covenant? It’s a fancy term used in the banking industry that basically allows a bank to lend to a business if some sort of ratio(s) is(are) maintained while the debt remains outstanding. While some covenant requirements are straight forward, others may be more complex. Some lenders, especially if the Small Business Administration (SBA) is involved, may require a business valuation. Critical financing for future growth may be obtained with a proper business valuation.
Litigation
Many assume a business valuation is nothing more than a calculation that spits out a number (hopefully a really big one!). However, the valuation process is an extremely in-depth ordeal that examines a company’s, strengths, weaknesses, comparisons to industry peers, evaluation of management bench strength, workforce evaluation, leverage, excess owner compensation
Like it or not, lawsuits exist and sometimes we need professionals to assist. When a business has been harmed unfairly or when a minority shareholder has potentially been stepped on by a majority shareholder, a lawsuit often arises. Business valuations are often called for to determine damages or buy-out prices.
and non-operating assets or liabilities that are inside the business entity. A proper business valuation, while delivering a value, can also be used to learn other traits about the business and provide insight for ownership and management regarding matters such as these. If you’re in any of the situations above or think a business valuation may be something you could benefit from, it may be time to reach out to the professionals at Maner Costerisan. Call or email us, maner@manercpa.com, for a complimentary consultation.
Determining Strengths and Weaknesses Jeffrey P. Allen, CPA, is a principal at Maner Costerisan Certified Public Accountants who specializes in providing outsourced chief financial officer and controller services to business, not-for-profits and government entities. He also provides business valuation expertise and abilities to closely held businesses looking to buy, sell or gift ownership.
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
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WHEN ‘LESS IS MORE’ STUDY OF LUNG - COLLAPSE TREATMENT DRAWS INTERNATIONAL ATTENTION in NEJM Journal watch wrote that the study “serves as notice that the available evidence favors a ‘less is more’ approach.”
Dr. Peter Hahn
Treating patients at Metro Health – University of Michigan Health for certain types of sudden lung collapse, the three doctors noticed something interesting: Less-invasive treatments appeared just as effective as the usually recommended approach.
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eeing an opportunity to update treatment guidelines, they launched an ambitious review of 70 years of studies. Coauthors Dr. Sri Mummadi, Dr. Jennifer de Longpre’ and Dr. Peter Hahn, CEO of Metro Health, published their findings earlier this year in the Annals of Emergency Medicine. The study has since attracted widespread attention for commentary in other leading medical journals: the British journal BMJ, the New England Journal of Medicine’s NEJM Journal Watch and an upcoming issue of Ontario-based ACP Journal Club, published by the American College of Physicians. The review 18
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When air leaks from the lung and gets trapped in the chest wall, the pressure prevents the lung from inflating completely. It becomes impossible to fully inhale. When this occurs without an injury such as blunt trauma, it is called spontaneous pneumothorax – the focus of the study. Patients who are suffering spontaneous pneumothorax usually end up in the emergency room with chest pain and shortness of breath. Noting that the condition accounted for $1.4 billion in inpatient charges as recently as 2014, the authors observed that previous guidelines for the best initial treatment strategy were outdated and inadequate. When the three doctors worked together at Metro Health – University of Michigan Health, they saw success with innovations such as using very small chest tubes, as narrow as a coffee straw, to remove air pressure inside the chest of spontaneous pneumothorax patients. At the time, American guidelines favored largediameter chest tubes.
“Obviously, from a patient’s point of view, having a coffee straw inside the chest is much more easily tolerated than having a garden hose,” Mummadi said.
At the other end of the spectrum, British guidelines recommended removing the air with needle aspiration. This approach is less invasive but has a drawback: Patients must be observed for six hours or more before being discharged. This is not practical in an American emergency room setting.
1,880
published papers
12
selected studies
781
patients
3
treatments
Inspired to measure the different approaches, the three doctors undertook a meticulous worldwide search of medical studies. They reviewed 1,880 published papers, including some that had to be translated from Chinese and Korean. They focused on randomized controlled studies, the gold standard in science, finally selecting 12 for review. The studies involved 781 patients. The doctors then compared outcomes of the three treatments – needle aspiration, narrow-bore chest tube and large-bore chest tube – based on: • Efficacy – which treatment produces the most success • Safety – which treatment carries the least risk of complication
Using innovative Bayesian statistical techniques to blend the data, they found little difference in success rates. However, the researchers discovered that needle aspiration and narrow-bore chest tubes outperformed large-bore chest tubes on the safety metric. They propose that future studies undertake a direct comparison of needle aspiration and narrow-bore tubes. However, Mummadi also noted that modern narrow-bore tube design offers an additional advantage over the other two treatments. They can be fixed to the chest, allowing the patient to be discharged for later follow up in an outpatient setting. “Due to the improved design of these devices, we are able to discharge these patients from the ER without admitting to the hospital,” he said. “This means reduced risk of complications resulting from hospital stay.”
In 2018, Drs. Mummadi and Hahn were the first in North America to publish the results of a novel centralized pathway for all patients with pleural disease. Their findings were widely cited and incorporated into textbooks worldwide. Dr. Mummadi is now on faculty at the Cleveland Clinic. Dr. de Longpre’ joined Mercy Health Muskegon after completing her internal medicine residency at Metro and Dr. Hahn is a former Mayo Clinic pulmonologist and served as chief medical officer at Metro Health before becoming CEO. Hahn congratulated his co-authors for exploring opportunities for more patient-centric treatments.
“Our best work as physicians is inspired by patients and validated by science,” Hahn said. “This is how innovation and advances in health care become possible.”
JOIN OUR COMPASSIONATE TEAM
About Metro Health – University of Michigan Health As an affiliate of University of Michigan Health, Metro Health provides a world-class system of leading-edge healthcare services with its patient-centric, holistic approach. The 208bed hospital anchors Metro Health Village in Wyoming, Michigan, serving more than 250,000 patients annually. More than 61,000 emergency patients are treated each year at the hospital, a Verified Level II Trauma Center. Primary and specialty care services are provided at 30 locations throughout West Michigan. More than 500 staff physicians provide state-of-theart treatment for a full array of health needs, including for cancer, heart and vascular disease, stroke and trauma. As a certified Comprehensive Stroke Center and accredited Chest Pain Center, Metro Health provides specialty services that include neurosciences, pulmonology, gastroenterology, cardiology, endocrinology, OB/GYN, bariatrics, orthopedics and wound care. In 2020, Metro Health was the only Grand Rapids area hospital included among the "101 Best and Brightest Companies to Work For" by the National Association of Business Resources. The hospital is committed to promoting health and wellness through the Metro Health Hospital Foundation, Live Healthy community outreach classes and educational programs. For more information visit www.metrohealth.net, follow us on Twitter @MetroHealthGr and like the hospital on Facebook.com/MetroHealth
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
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ETHICAL ISSUES THE RISK MANAGER SHOULD CONSIDER IN A COVID-19 WORLD, PART I By Josh Hyatt, DH.Sc., MHL, MBE(c), DFASHRM, HEC-C
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s news of international response to COVID-19 gets reported, bioethicists are beginning to look at some critical responses and comment on the significant impacts they represent. These ethical dilemmas have a natural alignment with our strategic and operational duties as risk managers. Risk managers are being put on the front line of responding to ethical dilemmas, which may be challenges never faced before. With the news from Italy and other countries managing massive outbreaks, there are lessons risk managers should be aware of and prepare for in the U.S.
Rationing As we see the rates of infections climb, we can extrapolate there will be an increased need for medical treatment in which space, qualified personnel, and equipment will become coveted resources and fought for by providers, patients, families, and the community. It has been projected that at its current trajectory, the U.S. may need as many as 100,000 more ICU beds to manage the pandemic in the near future. In two weeks, Italy went from 322
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confirmed c ases o f c oronavirus t o 10,149 (number as of 3/11/20) and is facing unprecedented pressure on their healthcare resources. They are running out of staff to manage the volume and ventilators to manage the suffering of those experiencing respiratory distress. As resources dwindle, physicians are being forced to implement battlefield t riage t echniques a nd r ation medical treatment. As a result, the Italian College of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) published rationing guidelines that encourage distributing dwindling resources to those who are more likely to benefit and have the highest opportunity for recovery. This rationing includes lifesaving equipment, space in ICUs, human resources, and clinical time focused on those fortunate patients (continued). Click here to read more on how ethical issues effect risk managers and physicians alike.
FREE TO MOA MEMBERS: AOA-QUALIFYING ONLINE COURSES, OFFERED THROUGH COVERYS’ EDUCATION RESOURCE, MED-IQ. VISIT DOMOA.ORG/MEDED FOR ACCESS. Polypharmacy in the Elderly: Navigating Complexities in Care
Recent Changes in Newborn Screening: What, When, How, and Why
Overview: This interactive case-based activity discusses strategies to reduce inappropriate polypharmacy in the geriatric population. Links to useful resources are provided to help participants make clinical decisions for the patient, and expert faculty offer their perspectives on the latest evidence for deprescribing management decisions.
Overview: This 15-minute, accredited CME publication reviews the current state of newborn screening (NBS) for lysosomal storage disorders (LSDs) and explores available methods for LSD analysis, focusing on Pompe disease (PD) and mucopolysaccharidosis type I (MPS I), the most recent LSDs added to the Recommended Uniform Screening Panel (RUSP).
Expires 10/28/20
Expires 2/18/21
Duke Perspectives From the American Academy of Orthopaedic Surgeons 2020 Annual Meeting Overview: This publication summarizes relevant abstracts and findings that were shared at the virtual American Academy of Orthopaedic Surgeons 2020 annual meeting. In addition, Samuel B. Adams, MD, associate professor of orthopaedic surgery at Duke University School of Medicine, provides expert insight on presented studies. Expires 6/7/21
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domoa.org/HCPM
A PHYSICIAN PRACTICE IS A SMALL BUSINESS B Y E WA M AT U S Z E W S K I, C E O, M E D N E TO N E
T
he emergence of a best practices playbook for physician practices following this pandemic
is likely as close as any primary care physician practice has come to having a strategic plan. Of course, a playbook or return-towork strategy is not a strategic plan. It is focused on health and safety for patients, practice teams, vendors and anyone who sets foot in a physician’s office. But if you haven’t considered adopting a broader strategic plan as an offshoot of a playbook, it’s advisable to do so now.
Learn from other industries. I was in the trenches with PCPs as they struggled with financial issues, staff layoffs, insufficient personal protection equipment and other COVID19 induced threats to a practice’s viability. Prior to the recent availability of guidance from national and state medical agencies and professional medical associations, which came far too late in my opinion, I turned to social media as part of my information
gathering process to create our own back-to-work manual. That’s where I “met” Gary Johnson, Chief Manufacturing and Labor Affairs Officer at Ford Motor Company. I don’t know Mr. Johnson, but I requested permission via LinkedIn to utilize the Ford Motor Company COVID-19 Playbook. He gave me permission and I incorporated some of the Ford Playbook foundational approaches into the primary care practice playbook made available to members of the Michigan Osteopathic Association. To pay it forward, this playbook, and a 12-minute video are now available online for use by physicians, dentists, other physician organizations, and the healthcare community at large. Lesson? In developing a strategic plan, look beyond healthcare to learn from industry titans like Ford, Lear and other companies who are emerging as back-towork leaders.
“In developing a strategic plan, look beyond healthcare to learn from industry titans like Ford, Lear and other companies who are emerging as back-to-work leaders.”
Create a new inventory mindset. Inventory isn’t just an added expense. It’s a lifeblood of your practice in the new era.Maintain a minimum 30-day supply of PPE and hand soap, hand sanitizer and janitorial supplies, including bleach and surface disinfectants. Welcome your cleaning company as a new member of your practice team. Some cleaning companies will not be able to make the transition to the new cleaning protocols. If yours can’t, find a new supplier and evaluate their service level regularly.
Commit to training and education. A major change to your current physician organization’s membership requirements might be mandatory adherence to a playbook and any other best practice regulations that are instituted for patient and practice team safety and third-party payor reimbursement, which is likely to expand payment of new or enhanced services as it did with telehealth visits. Change is coming rapidly in all directions. It’s a smart business decision to assess your team’s strengths and weaknesses CONTINUED ON PAGE 24… T R I A D | S P R I N G 2020
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and develop a training and education strategy accordingly. Continuing medical education is a given, but no longer sufficient. Find the gaps in your collective team’s ability to help run the business side of the practice; cross-train and upskill as necessary.
Get on board with EHRs and Telehealth. Speaking from the vantage point of a professional organization, the majority of physician offices with two or more providers have modern practices with electronic health record systems and HIPAA-compliant virtual consult capabilities. Moving forward, I ultimately see such technologies as being required. Seemingly overnight, a doctor’s practice has gotten significantly more complex and physicians need to be prepared and responsive.
Formalize a business recovery plan. Many physician practices got through the initial onset of this pandemic on a wing and a prayer. It wasn’t strategic – and for most it didn’t work well. Be
“From IT and billing to communications via website, social media, and direct patient outreach, be ready for a disaster with a business recovery plan…”
prepared for the next business disruption; whether it just hits your office (e.g. a fire, flood or death) or a pandemic that takes down whole sectors, document now everything that needs to be done to stay open or promptly re-open. From IT and billing to communications via website, social media and direct patient outreach, be ready for a disaster with a business recovery plan that minimizes disruption to patient care and the financial viability of your practice. This is also a good time to ensure that your legal and business advisors are meeting your needs. Your practice may need an attorney or CPA with deep experience in physician practices.
Lastly, expect physician groups to deploy care managers to perform practice audits and questionnaires for both the clinical providers and practice team to ensure compliance with new guidelines. We still need the old school touch of a physician, but the new normal demands business acumen, modern tools, multi-disciplinary teams, a focus on in-practice learning, and incorporation of measures that identify and respond to the social determinants of health. Payors and employer groups will be looking for these enhancements – and such actions will prepare us for future catastrophes.
Ewa Matuszewski is the founder of Practice Transformation Institute, an IACET-accredited teaching and training organization. IACET is the only standard-setting organization approved by the American National Standards Institute (ANSI) for continuing education and training.
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Michigan Osteopathic Association
Learning Center online options for CME
“Now more than ever we need exceptional online education. My experience with the MOA’s virtual programs has been extremely positive, and I am looking forward to another successful learning opportunity.” - R. Taylor Scott, DO
High value CME at your fingertips. AOA Category 1-A Credits
R E G I S T R AT I O N, S P E A K E R S & D E TA I L S www.domoa.org/meded O N G O I N G O F F E R I N G S: Call 517-347-1555 to update membership for price discounts. Pre-recorded presentations include live Q&A and interactions with speakers during scheduled times.
MICHIGAN OSTEOPATHIC ASSOCIATION
AUTUMN CME November 7 & 8, 2020
MICHIGAN OSTEOPATHIC ASSOCIATION
On-Demand CME 24/7 Accessibility to Programs
24/7 Accessibility
The Michigan Osteopathic Association is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. The MOA designates the Autumn CME and On-Demand CME programs for AOA credit and will report CME and specialty credits with the extent of the physician’s participation in this activity.
Michigan Osteopathic Association | 2445 Woodlake Circle, Okemos, MI 48864 | P 517-347-1555 | F 517-347-1566 | www.DOMOA.org
EYE ON ADVOCACY
COLLABORATING IN THE FIGHT FOR HEALTH W W W.F I G H T I N F E CT I O U S D I S E A S E.O RG
What Is Antimicrobial Resistance (AMR)? Antimicrobial resistance is a natural process that occurs when bacteria, viruses, fungi and parasites evolve so that existing medications used to treat related infections no longer work. As a result the germs are not killed and continue to grow.
The Partnership to Fight Infectious Disease (PFID) is a group of patients, providers, community organizations, business and labor groups, and health policy experts working to advance awareness and action on antimicrobial resistance. As an initiative of the Partnership to Fight Chronic Disease, PFID is focusing on the impact of this growing issue on our population and health care system. In particular, we will explore and advance solutions to address the threat of antimicrobial resistance and the need for new antimicrobial treatments. 26
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The COVID-19 crisis has reinforced the critical importance of treatments for infectious disease, as many of the deaths and severe cases involve not only the virus but also superimposed bacterial infections (sometimes hospital acquired “superbugs”) that then ultimately can, and often do, lead to death. Antibiotics and antifungal medicines play a critical role in the treatment of patients suffering from a pandemic, but our supply of effective medicines is dwindling due to antimicrobial resistance (AMR). According to the Centers for Disease Control and Prevention (CDC), today, more than 2.8 million drug-resistant infections occur in the U.S. each year and more than 35,000 people die as a result. And according to a recent GAO report , this may actually be an underestimate of the problem. AMR is a threat to all of us, especially those with chronic conditions. Without effective antimicrobial medicines, patients lose not just treatments for serious infections, but they also face significantly increased risks from many medical services that rely upon the effective prevention and treatment of infections. This includes: • organ transplantation • cancer treatments • many other major surgeries like joint replacements
• care of preterm infants and immunocompromised patients • other vulnerable patients.
GOALS OF THE PFID INCLUDE: Advocating for policy changes that would help activate and support research and development of new antimicrobial treatments to treat drug-resistant infections. Motivating broad change in the way antimicrobial medicines are prescribed, accessed, consumed, monitored, and paid for. Reinforcing awareness among all public and private stakeholders about the need for a pipeline of new antimicrobial medicines, the need for access to our existing medicines by providers and patients, the challenges of antimicrobial resistance to the practice of modern medicine, and AMR’s threat to the health of every person.
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
2020-2021 BOARD OF TRUSTEES Department of Business Affairs – Directors Jeffrey Postlewaite, DO, President David Best, DO, President-Elect Craig Glines, DO, Immediate Past President Lawrence Prokop DO, Past President Stephen Bell, DO, Secretary/Treasurer
Dpartment of Socio Economics – Directors Chad Kovala, DO Emily Hurst, DO
AOA Annual Business Meeting............................................26 Blue Cross Blue Shield of Michigan.......................................4 Coverys.................................................................................2 Healthcare Partners of Michigan..........................................24 Kerr Russell.........................................................................14 Maner Costerisan................................................................17 McLaren Health Care.............................................................6 Metro Health.......................................................................19 MHA.....................................................................................8 MOA Autumn Convention..................................................27 MOPAC...............................................................................14 Origami...............................................................................11
Department of Education - Directors Kevin Beyer, DO Adam Hunt, DO
For advertising inquiries, please email Todd Ross at tross@domoa.org or call 800.657.1556.
Department of Membership – Directors Jasper Yung, DO Samantha MacKay, Student Trustee Chad Kovala, DO
Department of Healthcare Technology & Informatics - Directors Andrew Adair, DO Ursula Bargouthe, DO, Intern/Resident Trustee 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 ©2020 Michigan Osteopathic Association T R I A D | S P R I N G 2020
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