MOA TRIAD Vol. 27 Issue 2, 2016 by Michigan Osteopathic Association

VOLUME 27 ISSUE 2 SUMMER / FALL 2016

MOA Hosts Town Hall On Combating the

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TABLE OF CONTENTS FEATURES

CEO Spotlight: David Jahn, CEO War Memorial

CMO Spotlight: Everyone’s Destiny is Healthcare

MACRA Is Here: It’s Time to Get Onboard

CANDOR Toolkit: Physicians Now Have the Right Tools to Do the Right Thing After an Adverse Event

Contributed by the Doctor’s Company

Protecting Adults: Are You Meeting the Standards for Adult Immunization Practice?

Combatting the Opioid Crisis: MOA Hosts Town Hall

Best Practice: How to Handle Negative Online Reviews

Scientific Research Exhibit Winners

DEPARTMENTS 5

President’s Page

DO Faces: Spring Convention, House of Delegates

Social Media Highlights

Dean’s Column

Advertiser Index

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PRESIDENT’S PAGE

forging new paths together ince 1898, the Michigan Osteopathic Association (MOA) has advocated on behalf of osteopathic physicians, and I am honored to become this organization’s 118th president. Over 118 years our profession has undergone tremendous changes, including basic health care, technology and the social issues

our communities face. We are still leaders not only in helping our members navigate the world

BRUCE WOLF, DO, FAOCR

of 21st century medicine, but in helping them support the communities they serve. This leadership was clearly seen at the Town Hall and Luncheon on Opioid Abuse at the MOA’s 117th Annual Spring Scientific Convention. The discussion panel was diverse, reflecting the many areas the opioid crisis is affecting. While the input and feedback represented a wide range of perspectives, there was a common goal of stopping the opioid epidemic. These committed and knowledgeable professionals are working to make our communities healthier, and the MOA is proud to support them in their mission.

As a new generation of DOs enters the world of healthcare it is paramount that we continue to provide leadership on social issues.

We need to continue our push for safe opioid use, work to raise the number of people who are vaccinated, and lower the school’s vaccination waiver rates. We must take measures to keep this generation safe from the diseases of centuries past. And when the issue of safe and affordable drinking water affects our communities, we must provide an educated approach to solving the problem and addressing the long-term effects. It is critical that we work together wherever necessary, because collaboration is an integral part of forging new paths in the world of medicine. I look forward greatly to serving as President of the MOA this year and I hope to help advance the cause of DOs statewide as we continue to forge ahead to make Michigan a happier and healthier place to live. BRUCE WOLF, DO, FAOCR, IS THE PRESIDENT OF THE MICHIGAN OSTEOPATHIC ASSOCIATION AND MAY BE REACHED BY EMAIL AT: WOLFBRUSH@COMCAST.NET

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There’s more to McLaren McLaren Health Care, with 12 hospitals and more than 350 facilities providing a comprehensive array of medical services, is committed to engaging with our physicians to provide quality, evidence-based care to patients. Whether it’s investing in leading-edge technology or operating state-of-the art facilities, McLaren works collaboratively with physicians and clinical teams to make a real difference in the lives of the patients we serve. We thank the many dedicated osteopathic physicians among our more than 40,000 network providers and extend an open invitation to other osteopaths to find out why there’s more to McLaren.

Get to know us at mclaren.org.

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CEO SPOTLIGHT David Jahn, War Memorial Hospital A good CEO understands their community and David Jahn, CEO of War Memorial Hospital in Sault Ste. Marie, is a good one. David Jahn is no stranger to the ways of the U.P. and the native “Yoopers” as he received his B.S. in Business Administration/Accounting from Michigan Technological University and his Masters degree in Business Administration from Lake Superior State University.

David Jahn

“You can make a difference for your community… it’s all about the patients.” David Jahn

“You can make a difference for your community… it’s all about the patients. Yes, we all have to drive the financial results but truly we are here for the patients,” Jahn said. “As I tell people everybody who comes into our facility is someone’s mother, father, sister or brother and we all have expectations on how we want our mother or father treated medically.”

Aside from a strong sense and value for the community War Memorial treats, Jahn also understands and manages the business aspects of running a hospital well, keeping them ahead of the curve on issues like electronic medical records (EMR) and health information exchange (HIE). Under Jahn’s guidance, War Memorial continues to be a leader in implementing EMR systems for patients and physicians. “We are currently embarking on upgrading our current system to the new version which will take about a year and a half to do and cost $5 million,” Jahn said. “We need to have an efficient and effective electronic health record not only for the patient’s benefit but for the provider and the caregivers benefit as well.” Aside from staying ahead on EMR and HIE, Jahn and War Memorial work hard on being the best possible provider for their patients medically and financially. “Five years ago we might’ve had one person responsible for quality and now we have five full time people responsible for tracking, measuring and making sure we use best practices, evidence based medicine, that sort of thing,” Jahn said. All the hard work Jahn and War Memorial have done and continue to do is paying off as more and more people are staying local for procedures that in the past had left the area. “Our market share continues to go up so I assume that means we’re retaining more of the procedures that used to go out because our population base hasn’t grown,” Jahn said. In the end, it all comes back to the people War Memorial Hospital treats. “Most of the people that come in, we know. It is rewarding to be able to put out a good product… we feel that the best local healthcare decisions are made by local people. We know the dynamics, we know the culture and we know the expectations,” Jahn said. As long as David Jahn is in charge at War Memorial Hospital, “Yoopers” are in good hands.

THIS FEATURE ARTICLE WAS WRITTEN BY MICHIGAN OSTEOPATHIC ASSOCIATION STAFF. SUBMISSIONS FOR CEO SPOTLIGHTS CAN BE SENT TO: TODD ROSS, MANAGER OF COMMUNICATIONS, TROSS@DOMOA.ORG

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The Michigan Health & Hospital Association proudly serves as the unified voice for hospitals across the state. Every day, our hospitals provide lifesaving care that supports the health and well-being of our patients, their families and our communities. • More than 7 million people in Michigan benefitted from hospitals’ voluntary community benefit services and programs, which include free and reduced-fee healthcare clinics and immunizations, assistance with prescription drug costs and community health education programs, support groups and screenings. • Michigan hospitals serve as economic engines in their communities by providing nearly 227,000 jobs throughout the state. • Michigan hospitals are investing time and effort in preparing the next generation of healthcare professionals through educational efforts, research, and graduate medical education programs. Learn more about how hospitals are leading Michigan to better health at www.mha.org. Data based on MHA fiscal year 2014 community benefits and economic impact reports.

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CMO SPOTLIGHT

“IF

I have seen further it is only by standing on the shoulders of Giants.” For those who have heard me speak they know that I enjoy what I refer to as quotable quotes. The quote above is attributed to Isaac Newton. I am in a wonderful position to be able to follow the work of so many to contribute to the great work the Michigan Health & Hospital Association (MHA) Keystone center has provided to patients throughout the state and in reality throughout the nation.

GARY ROTH, DO, FACOS, FCCM, FACS

“If I have seen further it is only by standing on the shoulders of Giants.” isaac newton

Patient safety and quality improvement were not part of our vocabulary when I attended Kirksville College of Osteopathic Medicine in the late 1970s, nor was it something we were taught during our post-graduate education. As a cardiovascular surgeon and now the Chief Medical Officer for the MHA, I have been able to transition my career to being a voice in reducing patient harm. My father, Gilbert Roth, DO passed in June. As I was preparing remarks for his eulogy, which in many ways as would have preferred was more of a “roast,” I described his love of family, dogs, and his profession, especially as a pioneer of pediatrics, caring for children. Upon listening to this recurring theme among those who spoke at the graveside it hit me like a stack of bricks, I actually started my patient safety and quality education as a young child hearing my dad’s recurring conversations on the phone. He was always most frustrated when the care provided to his young patients was not optimal or as he knew could be delivered. It was always about safe, competent, quality care. In 1999, the landmark study by the Institute of Medicine estimated up to 98,000 Americans die in hospitals each year as a result of medical errors. This was a gross underestimation, Makary et al suggested Medical Care to be the third leading cause of death1. The MHA Keystone Center in partnership with the Joint Commission’s Center for Transforming Healthcare has partnered with a number of Michigan healthcare facilities on a three year educational journey towards becoming High Reliability Organizations (HRO). Additionally, eight of the hospitals have embarked on a “deeper dive” over the three years, led by their respective executive teams to reach the state of Zero Harm. HROs are organizations that manage safety hazards extremely well and do so consistently over extended periods of time, they have succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity. Examples of HRO environments include the nuclear power industry, aircraft carriers, commercial aviation and even amusement parks2. What you are not seeing in this list is healthcare! The Board of Trustees of the MHA unanimously committed to highly reliable care delivered to any patient that is cared for by all of our member’s healthcare teams throughout the state. I look forward to describing the opportunities we have to deliver the care every patient deserves and sharing our experiences. Most certainly we all recognize “Everyone’s Destiny is Healthcare”3 therefore this journey of what I will describe as High Reliability must be a destiny—a destiny to Zero Harm. Makary MA, Daniel M. BMJ, 2016;353:i2139. Weick KE, Sutcliffe KM. Managing the unexpected: assuring high performance in an age of complexity. San Francisco: Jossey-Bass; 2001 3 Personal conversation Dave deBronkast 1 2

GARY L. ROTH, DO, FACOS, FCCM, FACS, IS THE CHIEF MEDICAL OFFICER FOR THE MICHIGAN HEALTH & HOSPITAL ASSOCIATION AND IS BOARD CERTIFIED IN CARDIOTHORACIC SURGERY, PERIPHERAL VASCULAR SURGERY AND SURGICAL CRITICAL CARE. SUMMER / FALL 2016 | TRIAD

MACRA IS HERE: IT’S TIME TO GET ONBOARD I guess the healthcare profession can’t lay claim to having more acronyms than other industries, but we sure have our share. There’s a new one you’re hearing more about – and maybe fearing: Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

he MACRA makes three important changes to how Medicare pays those who give care to Medicare beneficiaries. These changes create a Quality Payment Program (QPP) which:

• Ends the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services

Aimed at modernizing Medicare Provider payments, the MACRA includes Medicare-based Incentive Payment System (MIPS) and Alternate Payment Models (APM) as new payment approaches with a major focus on quality. The MIPS is a new program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one single program in which Eligible Professionals (EPs) will be measured on: • Quality • Resource use • Clinical practice improvement • Meaningful use of certified EHR technology (That patient registry and e-Prescribing combination used for MU Stage 2 Attestation may be out the door.) The APMs give CMS new ways to pay health care providers for the care they give Medicare beneficiaries. For example: • From 2019-2024, CMS will pay some participating health care providers a lump-sum incentive payment;

• Makes a new framework for rewarding health care providers for giving better care not more just more care

• An increased transparency of physician-focused payment models; and

• Combines CMS’s existing quality reporting programs into one new system

• Starting in 2026, offering some participating health care providers higher annual payments.

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“Now, MACRA’s goal is to move the healthcare community toward paying for value and better care. Is it an attainable goal?”

Adoption of the MACRA, which was signed into law on April 16, 2015 is gradual, with phase-in from 2015 to 2021. It already helped avert the 21% reduction to Medicare in 2015. Now, MACRA’s goal is to move the healthcare community toward paying for value and better care. Is it an attainable goal? I think so – and here’s why: the MACRA calls for increased quality, efficiency and clinical practice metrics that existing models such as the Patient-Centered Medical Home (PCMH) support. In fact, the MACRA highlights the model as fully meeting the requirements of the clinical improvement system (MIPS) and as an eligible alternative payment entity. Michigan primary care physicians has been at the vanguard of transformation activities that lead to the creation of the PCMH model. Funding for creating PCMHs has been provided primarily by BCBSM’s Physician Group Incentive Program (PGIP) which has focused on quality and cost. There are other higher financial stakes with MACRA – both gains and losses. For example, MACRA introduces a performance assessment, with greater penalties than currently exist for not meeting performance standards. There’s also more public reporting and transparency emphasized under MACRA – but also discussion of the potential for one reporting deadline down the road. Physicians who are competitive by nature and have a whip sharp clinical and support staff in place may relish the challenge, though. But there’s pushback. Doomsday reports say independent or small physician practices will be forced to sell-out to health systems as yet one more incentive pay plan threatens their small office capabilities and disincentives their interest in following new “suggested” guidelines. Biases aside, it is getting increasingly difficult for solo or small physician practices to go it alone without the support of a larger physicians’ organization providing infrastructure and direction on the myriad provider and government reimbursement rules. That’s why many are indeed moving to umbrella groups or opting for a hospital purchase of their practice, but is that absolutely necessary? For solo and small practices to survive and perhaps thrive under MACRA, I suggest the following 5 considerations and action steps.

Action Steps to Survive & Thrive Under MACRA 1. Contact the MOA and ask about their new suite of services provided by DOsTogether. 2. With interoperability, technology and EHR comprising a significant factor in determining reimbursement, get your tech house in order. Schedule an assessment by a DOsTogether practice transformation coach. 3. If not currently accepting Medicare patients, analyze this from both a business and physician responsibility approach – is now the time to expand your practice to Medicare patients? 4. Analyze your Quality and Resource Use Reports (QRURs) especially the 2014 mid-year and 2014 annual QRUR. Are you aware of how your practice fared under the Value-Based Payment Modifier (VBPM)? What do your HEDIS and STARS scores look like? Need assistance? Contact the MOA and ask about services provided through DOsTogether. 5. Consider achieving PCMH designation through BCBSM PGIP (Value Partnerships). Contact the MOA and ask about transformation services and coaching available through DOsTogether.

While we live in a complicated era of physician oversight, keep in mind that fighting meaningful change has never moved the profession or patient care forward. To get more information about the MACRA QPP check the MOA website. There are webinar and workshop offerings already available.

Ewa Matuszewski is CEO of Medical Network One, a Michigan-based physicians’ organization which was established as a physician service provider in 1981 and now serves approximately 750 primary care and specialty care physicians in Michigan and Ohio. SUMMER / FALL 2016 | TRIAD

CANDOR TOOLKIT: PHYSICIANS NOW HAVE THE RIGHT TOOLS TO DO THE RIGHT THING AFTER AN ADVERSE EVENT BY ROBIN DIAMOND, MSN, JD, RN, SENIOR VICE PRESIDENT OF PATIENT SAFETY AND RISK MANAGEMENT, THE DOCTORS COMPANY

In the past, hospitals and physicians could appear cold and distant after adverse events. The fear of malpractice lawsuits created a culture in which physicians were expected to avoid most contact with a patient or family who might have reason to sue—and physicians certainly weren’t supposed to accept blame. Even when a well-meaning physician wanted to acknowledge the tragedy and express concern, hospitals sometimes discouraged the conversation because they were afraid the doctor’s comments would implicate the hospital in a malpractice case. The actual effect of this way of thinking was just the opposite of what hospitals and doctors desired. Rather than shielding them from liability, patients and family members perceived this culture of silence as callous and uncaring, in some cases encouraging them to file lawsuits. That was then. Over the past decade the healthcare community has embraced the idea that saying “I’m sorry this happened,”

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or at least acknowledging that an unanticipated adverse event occurred with genuine sympathy and concern, can go a long way toward healing the relationship between the healthcare provider and patient. Physicians have moved progressively toward a culture that expects an adverse event—a medication error, for instance, or a death during routine surgery—to be followed by a full disclosure of the facts to the patient and family. Hospital administrators and physicians both can say they’re sorry for what happened and even acknowledge they made a mistake in some circumstances when a clear-cut error has occurred that could have been prevented.

This is not just the right thing to do; it also helps the hospital and physicians avoid malpractice litigation, especially the lawsuits motivated not by actual errors or substandard care but by patients and family members who were left angry and abandoned. Now we have not just the right idea, but the right way to execute it.

When Bad Things Happen to Good Doctors The Agency for Healthcare Research and Quality (AHRQ) developed the Communication and Optimal Resolution (CANDOR) Toolkit with the input of healthcare professionals who studied the different tools, policies, and procedures in use at various hospitals, including the disclosure resources offered by The Doctors Company. David B. Troxel, MD, medical director at The Doctors Company, served on the oversight committee, and I served on the technical advisory committee, which assessed expert input and lessons learned from AHRQ’s $23 million Patient Safety and Medical Liability

grant initiative launched in 2009. The CANDOR Toolkit then was tested in 14 pilot hospitals across three U.S. health systems: Christiana Care in Delaware, Dignity Health in California, and MedStar Health in the Baltimore/Washington, DC, metropolitan area. “CANDOR is one of the most important patient safety programs to be released in the last 10 to 15 years,” said David Mayer, MD, vice president of quality and safety at MedStar Health and one of the originators of the toolkit. “CANDOR promotes a culture of safety that focuses on organizational accountability; caring for the patient, family, and our caregivers; fair resolution when preventable harm occurs; and most importantly learning from every adverse event so our health systems are made safer.” This tool is just as useful for doctors as for hospitals. When a hospital is sued, physicians who were involved in the case will likely be named in the suit, whether they are employed by the hospital or not. Even though the CANDOR Toolkit is designed for hospitals, physicians should become aware of the valuable resources available to them in this toolkit, such as the videos that demonstrate how to have an effective disclosure conversation and tools that help doctors assess their own interpersonal communication skills. The toolkit facilitates communication between healthcare organizations, physicians, and patients while promoting a culture of safety, said John Morelli, MD, vice president of medical affairs at Dignity Health’s Mercy General Hospital in Sacramento, California. “The CANDOR Toolkit helps our caregivers improve how we rapidly communicate with patients and families when harm occurs. Consistent with our mission and values, we have always communicated with compassion and empathy; however, the toolkit provides a framework to respond quickly and in a learned manner to patients and families while also offering support to our caregivers.”

CANDOR calls for a prompt response and specific actions after an adverse event. Within one hour, specially trained hospital staff should: • Explain the facts, and what might still be unknown, to patients and family members. • Contact the clinicians involved and offer assistance, because the stress and grief of the healthcare professionals can easily be overlooked in these incidents. • Immediately freeze the billing process to avoid further stressing the patient with a bill for the services that may have caused harm. CANDOR calls for the hospital to complete a thorough investigation within two months, keeping patients and relatives fully informed along the way. When the investigation is complete, the patient and family are provided with the findings and engaged in a discussion of how the healthcare organization will try to prevent similar adverse events in the future.

possible. We also suggest they go to their hospital administration to find out what the hospital’s disclosure process is and how closely it follows the CANDOR plan, because a cooperative approach is ideal. Working in harmony with the hospital is easiest in a closed system, where the physician is employed and insured by the hospital. Even when the hospital and physician are in adversarial positions and limited in communication, both parties still can adhere to the best practices outlined in the CANDOR program. The philosophy and actions outlined in the CANDOR Toolkit can help hospitals and physicians avoid malpractice litigation, but even when the matter cannot be resolved and goes to trial, the fact that the patient and doctor talked early on can make a huge difference in the outcome of the case. Patients tend to pursue litigation with a vengeance when they think the doctor doesn’t care, but they tend to be much more reasonable when they can see that the physician is a human being with emotions, regret, and sympathy for the patient.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/ patientsafety.

Encouraging Open Communication The investigation will not always find that the physician or other clinicians failed to meet the standard of care, and in those cases the patient and family members can still benefit from understanding what happened. In many cases, they will not sue despite their loss because they are satisfied that the hospital and physicians did their best and were forthcoming with information. The Doctors Company encourages physicians to disclose and speak to patients about unanticipated events as early as

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PROTECTING ADULTS: ARE YOU MEETING THE STANDARDS FOR ADULT IMMUNIZATION PRACTICE? JACKLYN CHANDLER, M.S., OUTREACH COORDINATOR, MDHHS DIVISION OF IMMUNIZATION

aking sure your adult patients are up-to-date on vaccines recommended by the Centers for Disease Control and Prevention (CDC) and the Michigan Department of Health and Human Services (MDHHS) gives them the best protection available from several serious diseases and related complications. The National Vaccine Advisory Committee (NVAC) recently revised and updated the Standards for Adult Immunization Practice to reflect the important role that all healthcare professionals play in ensuring adults are getting the vaccines they need. These new standards were drafted by the National Adult Immunization and Influenza Summit (NAIIS) of over 200 partners, including medical associations, state and local health departments, pharmacists associations, federal agencies, and other immunization stakeholders1. What makes adult immunization a priority for leaders in medicine and public health? Every year, tens of thousands of adult Americans suffer serious health problems, are hospitalized, and even die from diseases that could be prevented by vaccines2. These diseases include shingles, influenza, pneumococcal disease, hepatitis A, hepatitis B-related chronic liver disease and liver cancer, HPV-related cancers and genital warts, pertussis (“whooping cough”), tetanus and more. Adult vaccination rates are extremely low. For example, coverage rates for Tdap and zoster vaccination are less than 30% for adults who are recommended to receive them3. In Michigan, even high risk groups are not getting the vaccines they need – only 30.6% of adults younger than 65 years old who are high risk for complications from pneumococcal disease are vaccinated4. Make it clear to your patients that vaccination is important because it not only protects the person receiving the vaccine, but also helps prevent the spread of certain diseases, especially to those that are most vulnerable to serious complications, such as infants and young children, elderly, and those with weakened immune systems. Immunizing adults creates healthier communities and protects the places in which we live, work, and play. 14

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Adults trust their healthcare provider to advise them about important preventive measures. Most health insurance plans provide coverage for recommended adult vaccines. Furthermore, research indicates that most patients are willing to get vaccinated if recommended by their provider5, 6. However, many patients report their healthcare providers are not talking with them about vaccines, missing critical opportunities to immunize7.

MDHHS and the Michigan Osteopathic Association (MOA) are calling on all healthcare professionals to make adult immunizations a standard of routine patient care in their practice by integrating four key steps8: ASSESS immunization status of all your patients at every clinical encounter. This involves staying informed about the latest CDC recommendations for immunization of adults and implementing protocols to ensure that patients’ vaccination needs are routinely reviewed. Strongly RECOMMEND vaccines that patients need. Key components of this include tailoring the recommendation for the patient, explaining the benefits of vaccination and potential costs of getting the diseases they protect against, and addressing patient questions and concerns in clear and understandable language. ADMINISTER needed vaccines or REFER your patients to a provider who can immunize them. It may not be possible to

stock all vaccines in your office, so refer your patients to other known immunization providers in the area to ensure that they get the vaccines they need to protect their health. Coordinating a strong immunization referral network will reduce a substantial burden on your adult patients and your practice. If your adult patients do not have insurance, or if their insurance does not cover any of the cost of an immunization, check with your local health department to see if your patient qualifies for the following public vaccines: Td, Tdap, MMR, Hep A, Hep B or Zoster.

Informational brochures about immunization topics are available free of charge from MDHHS. A variety of materials is available, and can be ordered online at www.healthymichigan.com – click “Enter Site” and “Immunizations” to begin adding resources to your cart. In spring 2016, the “AIM Packet – Adult” was added: the contents focus on adults and include the immunization schedule, brochures, posters, and other educational flyers and resources for your practice. References:

DOCUMENT vaccines received by your patients. Help your office, your patients, and your patients’ other providers know which vaccines they have had by documenting in the Michigan Care Improvement Registry (MCIR). And for the vaccines you do not stock, follow up to confirm that patients received recommended vaccines.

National Adult and Influenza Immunization Summit (NAIIS). Organizations Supporting the NVAC Adult Standards. Accessed May 17, 2016.

Centers for Disease Control and Prevention (CDC). Reasons to Vaccinate. Accessed May 17, 2016.

Williams WW et al. Surveillance of Vaccination Coverage Among Adult Populations — United States, 2014. MMWR Surveill Summ 2016; 65(No. SS-1):1–36.

Centers for Disease Control and Prevention (CDC). Pneumococcal vaccination coverage among adults 18-64 years at increased risk and ≥65 years by State, HHS Region, and the United States, BRFSS, 2008 through 2014. Accessed May 17, 2016.

Additional educational resources are available to provider offices, including free immunization education sessions through the MDHHS Immunization Nurse Education program and the Physician Peer Education Project on Immunization. The education sessions through both education programs are approved for continuing medical education credit. Visit www.aimtoolkit. org – click “Information for Health Care Professionals” and “Education & Training” for more complete information9.

Ding H et al. Influenza Vaccination Coverage Among Pregnant Women — United States, 2014–15 Influenza Season. MMWR Morb Mortal Wkly Rep 2015; 64(36):1000-1005.

Malosh R et al. Factors Associated with Influenza Vaccine Receipt in Community Dwelling Adults and Their Children. Vaccine 2014; 32(16): 1841-1847.

Ylitalo KR et al. Health Care Provider Recommendation, Human Papillomavirus Vaccination, and Race/Ethnicity in the US National Immunization Survey. Am J Public Health 2013; 103(1): 164-169.

Centers for Disease Control and Prevention (CDC). Standards for Adult Immunization Practice. Accessed May 17, 2016.

Alliance for Immunization in Michigan (AIM). Education & Training. Accessed May 17, 2016.

The choice is yours.

Healthcare is changing a lot, but one thing remains the same: you still have the ability to choose your health plan, Physician, and hospital. And who you choose matters.

Choose Wisely. Choose Sparrow.

Choose Wisely. Choose Sparrow. 1.800. Sparrow | Sparrow.org 1.800. Sparrow | Sparrow.org

SUMMER / FALL 2016 | TRIAD

MOA Hosts Town Hall On Combating the

“It [opioid abuse] is a big picture issue, there’s no one answer, but what we have to do is come together as a community in legislature, medical community and law enforcement and help to find ways we can get rid of the addiction problem and help those that are addicted.” – Sen. Dale Zorn

At the Michigan Osteopathic Association (MOA) 117th Annual Spring Scientific Convention, a Town Hall & Luncheon was held by the MOA Task Force on Opioid Abuse in the state of Michigan and in partnership with Governor Rick Snyder’s Prescription Drug and Opioid Abuse Task Force. The event featured moderators Tim Skubick and Dr. David Neff, MOA Safe Opioid Task Force Member and Medical Consultant of the Michigan Department of Health and Human Services (MDHHS) as well as several panelists, including medical, legislative and law enforcement experts answering questions from an overflow crowd.

“We need to have education, education, education and continue to work on upgrading our systems as we can. But I think it is an issue of education… for all physicians, practitioners, pharmacists, the whole group.” – Rep. Edward “Ned” Canfield

“In our court, I have learned anecdotally, probably 80 to 85 per cent of the people that appear in our court on the criminal docket are there because they have problems with drugs. Usually it is either drug seeking behavior or has something to do with the crime they committed. What we try to do is to find out what is going on with the individual appearing before the court so we can make sure we are addressing them in a holistic fashion.” – Hon. Donald Allen, Jr.

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The event began with a video message from Lt. Governor Brian Calley talking about the importance of combatting the opioid epidemic and commending the MOA and similar organizations on their work towards fixing the opioid problem. “Opioid addiction is a growing epidemic impacting Michiganders and our local communities. I commend the MOA for including this important topic in the 117th Annual Spring Scientific Convention,” Calley said. From there it turned to the discussion as Skubick and Dr. Neff started fielding questions for panelists. The questions were good and delved into topics like over prescription and how to be in good practices for prescribing opioids, medically assisted treatment (MAT) and legislative action being taken on all levels to help fight opioid addiction and help people in need of treatment. MOA CEO and Executive Director Kris Nicholoff spoke to the urgency and importance of such a discussion. “With opioid addiction being as dangerous and damaging as it is, having such a successful event like the Town Hall is a major point of progress as it continues to spur on the

discussion of how doctors, legislators and the justice system can help to make communities in Michigan safer and healthier,” Nicholoff said. Due to the amount of people and the time constraints, not all the panelist were able to express everything they wanted to talk about during the event so the MOA offered them a chance to speak uninterrupted on their YouTube channel (www.youtube.com/miosteo1898). The videos feature The Honorable Judge Donald Allen Jr. of the 55th District Court in Ingham County, State Representative Edward “Ned” Canfield, DO, State Senator Dale Zorn, the Michigan Health and Hospital Association (MHA) Keystone Center’s Sam Watson and current MOA board member, Dr. David Best, DO. The MOA will continue to work on education and legislative efforts to decrease the opioid addiction numbers facing our communities. Useful Links: MOA Opioid Resource Page: www.domoa.org/opioids Surgeon General Site: www.turnthetiderx.org CDC Guidelines: http://www.cdc.gov/drugoverdose/prescribing/guideline.html

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Transformation

SUMMER / FALL 2016 | TRIAD

BEST PRACTICE: HOW TO HANDLE NEGATIVE ONLINE REVIEWS

BY KATE SAMANO

A recent survey from Austin-based consulting firm Software Advice found that 77% of participants use online reviews as a first step in seeking out a doctor. Although receiving a less than positive review is never enjoyable, it does present a unique opportunity to use feedback (good or bad) to your advantage.

TRIAD | SUMMER / FALL 2016

The DO spoke with two physicians and a health care marketing expert, who provided their best advice on addressing online reviews, including what to consider when responding to a negative review, and why doing so is important.

What should physicians do if they get a negative online review? Amanda Kanaan, president and CEO of WhiteCoat Designs, a medical marketing consultancy, recommends three steps practices can take to manage their online reputation: • Claim your practice for all your online review profiles so you can participate in the conversation. • That means making sure all the information on the profiles is accurate, and being aware of what people are posting. • Bury negative reviews with more positive reviews. • Respond to negative reviews in a HIPAA-compliant, professional manner. Emergency physician Aaron Braun, MD, who has blogged about online doctor reviews, advises poorly reviewed physicians not to panic. “Being proactive and responding to negative reviews immediately will help your online reputation,” says Dr. Braun, the medical director of SignatureCare Emergency Center in Houston. Another way to “respond” is to provide good patient care, says family physician Ian Levenson, DO. “Positive interactions with patients will drive business within your practice,” says Dr. Levenson, who monitors his online ratings on ZocDoc.

What should physicians avoid when responding to online reviews? “Practices should be cautious in how they respond to negative reviews,” Kanaan says. “For HIPAA reasons, you should never discuss or reveal any

details about your patient’s care even if they solicit it via their review. It’s also unprofessional to publicly dispute the review. Instead, respond with a generic but sincere response.” Just because you received a negative review does not mean you have to defend yourself, says Dr. Braun. “You are not going to please everyone all the time. The best practice is to avoid public back-and-forth posting,” he says, noting that encouraging patients to call the practice so the conversation moves offline is usually the best approach.

Why should physicians take the time to respond to negative online reviews? Even if you haven’t created a Web presence for yourself, patients and other online directories are creating one for you, Dr. Braun notes. Kanaan says she always tells practices that customer service is the new public relations. “That means anytime a practice can show off their commitment to patient care by responding to an online review, it should be considered an opportunity—even if the review is negative.” Patients care more about the fact that physicians are listening and taking the time to respond than the fact that the negative review occurred in the first place, Kanaan notes. Dr. Levenson looks at marketing his practice in two ways. “Internal marketing is where you take care of your patients and make any interaction you have with them as positive as possible. External marketing, which includes responding to online reviews, allows you to generate new patients—those who look at reviews to find a doctor.”

Kate Samano is a publications specialist at the AOA. Reprinted from The DO, 2016, American Osteopathic Association. Reprinted with consent of the American Osteopathic Association.

SCIENTIFIC RESEARCH EXHIBITS

he Michigan Osteopathic Association (MOA) 117th Annual Spring Scientific Convention once again included the Scientific Research Exhibit (SRE). The SRE continues to grow, as this year the judges received a record number of submissions for the Spring Scientific Convention. The judges were overwhelmed by the quality and passion.

“The presentations were all really outstanding,” said Anthony Ognjan, DO, who participated as a judge for the Oral Presentation competition. “This is the second year for this category and we are seeing amazing progression. The judges really had a difficult time selecting the winners, because they were all very good.”

WINNERS FROM THE MOA 117TH ANNUAL SPRING SCIENTIFIC CONVENTION First Place Roller Coasters and Renal Calculi David Wartinger, DO; Shannon Grochulski-Fries, Mark A. Mitchell, DO, Osteopathic Surgical Specialties, College of Osteopathic Medicine, Michigan State University Second Place A Retrospective Analysis of Prostate Cancer Detection Rate and Grade on Prostate Needle Biopsy Before and After the US Preventative Task Force Recommendations against PSA Based Screening Julie Carter, DO, Henry Ford Macomb Hospital, Beaumont Farmington Hills Hospital, McLaren Macomb Hospital, Michigan State University College of Osteopathic Medicine, MSUCOM Detroit Metro Urological Surgery Residency Program Third Place The Effectiveness of Preoperative Body Site Marking: A Comprehensive Literature Review Safi Mohammed, DO / Jared Davis, MS4, MSUCOM / Gregory McIntosh DO, Mclaren Macomb, Henry Ford Macomb, Beaumont Farmington Hills / Randy Chudler MD, Henry Ford Macomb Hospital Outstanding Case Report Median Arcuate Ligament Syndrome: An uncommon but underdiagnosed cause of chronic abdominal pain discovered in a patient misdiagnosed with Anorexia Nervosa William Powers, DO PGY-3, Detroit Wayne County Health Authority-Family Medicine Resident

Honorable Mention Sitting vs. Standing: The Impact of a Rounding Team Bedside Posture on Patient Experience Richard Bryce1,2,3, DO; Lisa Matero2, PhD; Fatima Beydoun1, OMS2; Mountaha Eidy1, OMS2; Rita Elias1, OMS2; Evan Gray1, OMS2; Almir Kalajdzic1, OMS2; Lama Kawar1, OMS2; Reem Khazaal1, OMS2; Israa Kenaan1, OMS2; Samaa Lutfi1, OMS2; Liala Al-Shatel1, OMS2; Anna Stala1, OMS2; Navya Talluri1, OMS2 1 Michigan State University, College of Osteopathic Medicine 2 Henry Ford Health System 3 Community Health and Social Services Center Honorable Mention Case The Sum of all Tears: A Rare Case of Mechanical Aortic Valve Thrombosis after Warfarin Cessation for Tear Duct Surgery Christopher Bradley, DO; Timothy Logan, DO; Mark Liwanag, DO, McLaren Macomb Best Oral Research Presentation Macrophages Contribute to Hypertension Development by Impairing the Pre-junctional Alpha-2 Adrenergic Receptor on Sympathetic Neurons Ryan Mui, Michigan State University College of Osteopathic Medicine, DO/PHD, Physician Scientist Training Program Best Oral Case Presentation It’s Never Too Late To Resynchronize Subir Shah, DO; Emmanuel Papasifakis, DO, Garden City Hospital

The SRE growth is impressive and the importance is recognized by MOA leadership. “I’m excited for scholarly activity which is one of the ACGME new requirements for our programs, our program directors and our residents,” said MOA Past President and current board member, Myral Robbins, DO, FAAFP FACOFP. “... and to see the students and the residents and the supervising faculty moving toward that is so gratifying and it’s great for our profession.” The MOA would like to thank all of the presenters and the judges for their time. We look forward to the Autumn Convention in Grand Rapids, Michigan, November 4-6, 2016.

SRE Participants reviewing poster competition. SUMMER / FALL 2016 | TRIAD

SPRING SCIENTIFIC CONVENTION

(L to R) Lawrence J. Abramson DO, MPH, MOA CEO Kris Nicholoff and MOA President, Bruce Wolf, DO, FAOCR

The Advocates for the Michigan Osteopathic Association had a record year.

Joe Gorz, DO and Bo Pang, DO, at the MOPAC table

Lawrence J. Abramson DO, MPH, (top left), Sam Watson, Executive Dir. MHA Keystone Center, Debra McGuire, CEO of MAFP and State Rep. Tom Cochran 20

TRIAD | SUMMER / FALL 2016

Town Hall panelists and moderator join MOA President-Elect, John Sealey, DO, FACOS and current President, Bruce Wolf, DO, FAOCR

The 117th Annual Spring Scientific Convention marked the inauguration of the 24Fifties

The Michigan State University College of Osteopathic Medicine (MSUCOM) hosted their annual reception at Big Fish

Another group shot of the MSUCOM Big Fish reception

SUMMER / FALL 2016 | TRIAD

HOUSE OF DELEGATES The delegates attending the 117th Annual Spring Scientific Convention took action on a record number of resolutions, awarded Presidential Citations, and honored Life Professionals.

MOA Past President, Robert G.G. Piccinini, DO, dFACN welcomes newly-elected MOA President, Bruce Wolf, DO, FAOCR

Delegates look on at the House of Delegates review of the resolutions

TRIAD | SUMMER / FALL 2016

Past President, Robert G.G. Piccinini, DO, dFACN presents John Floreno, DO, with a Presidential Citation

House of Delegates are all smiles for the camera

Charles W. Wang, MS, DO and daughter, Bonita Wang, DO

AOA CEO Adrienne White-Faines and AOA Past President, Eugene A. Oliveri, DO, FACG

SUMMER / FALL 2016 | TRIAD

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MOA ON SOCIAL MEDIA

ocial media has permeated our society. From pop stars to presidential candidates, grandmothers to teenagersâ&#x20AC;&#x201D;the various social platforms have become an essential form of communication. For the Michigan Osteopathic Association (MOA), social media platforms allow us to share news, issues and events in a cost-effective manner.

The MOA and MSU College of Osteopathic Medicine team up at Kelser Camp to promote healthy habits and healthcare as an academic focus.

Social media also allows the MOA to collaborate with our Strategic Partners. By sharing, re-Tweeting and linking to news from our partners, the MOA can provide value in getting important issues in front of our members and our followers. The various platforms have been used to promote a number of issues of importance to physicians and communities. This past spring, the MOA was awarded a grant from the Michigan Department of Health and Human Services to promote adult vaccination efforts. A requirement of the grant was to share Tweets, Facebook posts and YouTube videos. Because our social media had an established presence, we were able to approach the grant opportunity with confidence. Over the past year the MOA has used social media to raise awareness on a variety of issues including: Flint Water; GME Funding; Healthy Lifestyles; Maintenance of Certification; Opioid Crisis; Physician Fatigue; Save OMT; Vaccination Awareness; Zika Virus; and more.

MOA Task Force member Dr. William Morrone on Overcoming Overdose fxn.ws/2bSTzfD #Stop Addiction #NaloxoneSavesLives #NoToHeroin

foxnews.com (AP Photo/Matt Houston) The Hon. Donald L. Allen, Jr. (55th District) comments on the opioid issue after the Michigan Osteopathic Associationâ&#x20AC;&#x2122;s Town Hall meeting.

Social media provides a cost-effective way to reach an increasingly mobile audience. We encourage our members and partners to join us on the social media platforms they are engaged in.

The MOA presence can be found on: Facebook www.facebook.com/michiganosteopathic Twitter @MichiganDOs (or visit www.domoa.org) YouTube youtube.com/miosteo1898 LinkedIn linkedin.com/company/ michigan-osteopathic-association SUMMER / FALL 2016 | TRIAD

DEAN’S COLUMN STRONGER CONNECTIONS ARE GOOD FOR THE INDIVIDUAL AND THE PROFESSION

t the MSU College of Osteopathic Medicine we teach students about how the body’s systems are interconnected. We teach about the connections between

WILLIAM STRAMPEL, DO, FACOI

form and function and focus on how good health and a healthy lifestyle are inextricably linked.

Regardless of where you attended medical school, as an osteopathic physician in training you learned the same lessons. We see the connections in our work every day and we value the human connections in our world. As physicians, we also need to remember the immense value of our connections with each other. Whether it’s working with colleagues in a clinic or practice, consulting with peers in a hospital or engaging in discussion at the House of Delegates, our interactions with other osteopathic physicians are important for our professional and personal growth. As you are reading about various connections in this issue of Triad, I would challenge you to think about how you are connecting with other DOs. Are you actively involved in your MOA? Do you support your alma mater, whether it’s MSUCOM or another college of osteopathic medicine? Is mentoring students or residents part of what you do? Becoming active in the profession and helping the next generation of osteopathic physicians build their skills and their confidence offers immense personal satisfaction while it helps the profession as a whole. It can also offer you with a professional boost and open the door to new opportunities. You don’t need to approach these opportunities with any particular goal in mind or with the need to see any one outcome. You also don’t need to make a major investment of time, just choose one thing that means something to you and do it. Give it your attention, do what you promise and see where it takes you. Who knows where one connection might lead?

WILLIAM STRAMPEL, DO, IS DEAN OF THE MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE. HE CAN BE REACHED AT LAURA.PROBYN@HC.MSU.EDU

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ADVERTISERS Beaumont Health................................................................ 2 TRIAD STAFF David Best, DO, Education Committee Patrick Botz, DO, Education Committee Larry Prokop, DO, Education Committee William Strampel, DO, Contributing Editor Kris T. Nicholoff, CEO and Executive Director Lisa M. Neufer, Director of Administration Todd Ross, Manager of Communications Cyndi Earles, Director, MOA Service Corporation Marc A. Staley, Manager of Finance Virginia Bernero, Executive Assistant & Advocacy Liaison 2015-16 BOARD OF TRUSTEES Bruce A. Wolf, DO, FAOCR, President John W. Sealey, DO, FACOS, President-Elect Craig Glines, DO, MSBA, FACOOG, Secretary/Treasurer Robert G.G. Piccinini, DO, dFACN, Immediate Past President Myral R. Robbins, DO, FAAFP, FACOFP, Past President Department of Business Affairs Craig Glines, DO, Secretary/Treasurer Myral Robbins, DO, Past President John Sealey, DO, President-Elect Department of Socio Economics Stephen Bell, DO, Trustee Andrew Adair, DO, Trustee Department of Education David Best, DO, Trustee Patrick Botz, DO, Trustee Larry Prokop, DO, Trustee Department of Membership Emily Hurst, DO, Trustee Matthew Bombard, DO, I/R Trustee Department of Healthcare Technology & Informatics Jeffrey Postlewaite, DO, Trustee Taran Silva, Student Trustee

Beaumont........................................................................... 4 Kerr Russell........................................................................ 4 McLaren............................................................................. 6 MHA.................................................................................. 8 MOA: • Transformation Academy............................................... 17 • Autumn Conference...................................................... 24 • Spring Conference......................................................... 24 • MOA Insurance............................................................. 24 Sparrow............................................................................ 15 The Doctor’s Company........................................Back Cover

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. TRIAD (ISSN 1046-4948; USPS 301-150) is published quarterly by the Michigan Osteopathic Association, 2445 Woodlake Circle, Okemos, MI 48864. Periodical postage paid at Okemos, MI 48864 and other post offices. Subscription rate: $50 per year for non-members. All correspondence should be addressed to: Communications Department, Michigan Osteopathic Association 2445 Woodlake Circle, Okemos, MI 48864 Phone: 517.347.1555 Fax: 517.347.1566 Website: www.domoa.org Email: moa@domoa.org POSTMASTER: SEND ADDRESS CHANGES TO TRIAD, 2445 WOODLAKE CIRCLE, OKEMOS, MI 48864.

FOR ADVERTISING INQUIRIES, PLEASE CONTACT TODD ROSS AT 800.657.1556 OR VIA EMAIL AT TROSS@DOMOA.ORG

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As a company founded by doctors for doctors, we believe that doctors deserve more than a little gratitude for an outstanding career. That’s why we created the Tribute® Plan—to reward our members for their loyalty and commitment to superior patient care with a significant financial award at retirement. How significant? The highest distribution to date is $138,599. This is just one example of our unwavering dedication to rewarding doctors.

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