MOA TRIAD Vol. 28 Issue1, 2017 by Michigan Osteopathic Association

VOLUME 28 ISSUE 1

MACRA: WHAT TO DO? CHANGING TECHNOLOGY, ELECTRONIC HEALTH RECORDS, MACRA AND MORE

DOMOA.ORG

Every day in Michigan hospitals, lives are touched … a woman learns from her doctor that she’s now cancer free…a nurse helps bring a baby into the world … a researcher makes a new discovery … and the list goes on. Behind every individual there is a personal story about why healthcare matters to them. We want to share those stories. #MiCareMatters is a social media hashtag campaign designed to promote the exceptional, often lifesaving care that is both given and received throughout Michigan. Through photos, videos and testimonials, #MiCareMatters gives you a platform to tell those stories in an impactful way.

Step 1: Tell Your Story

We invite you to join the conversation by telling your story. The hashtag can be used from a variety of perspectives, including:

Every day, I get to bring new babies into the world and make sure they and their mothers are healthy. Nothing matters more.

The care provider/hospital staff perspective Why are you passionate about healthcare? How does the work you do make in difference in the lives of patients/your community? The patient perspective Why does healthcare matter to you? Share a specific story about how access to quality care changed, or even saved, your life. The Michigan “Mi” perspective Why is access to quality healthcare important to our state? How has the Healthy Michigan Plan made a difference?

#MiCareMatters

Step 2: Share Your Story on Social Media Ask yourself any of the above example questions as a way to begin thinking about why healthcare matters to you. Record a video, snap a picture, write your story, etc., and share on Twitter, Facebook and Instagram along with the hashtag #MiCareMatters directly in the post.

Step 3: Spread the Word Encourage others you know to share their story under #MiCareMatters. Follow the hashtag and share others’ stories that inspire you. Visit www.mha.org/micarematters to learn more.

Leading Healthcare

TABLE OF CONTENTS FEATURES 7

MACRA 14

Osteopathic Research: Up to $25,000 in research grants available for students and residents

I'm All for Telehealth: Are YOU Ready?

Prescribing Opioids Safely: How to have difficult patient conversations

Contributed by The Doctors Company

ONIH awards MSU researcher $8.4 million grant to develop first malaria treatments

13 Starting a trauma registry can boost OMT research

MACRA: What Should I Do?

A Faster Way of Detecting Bacteria Could Save Your Life

The Osteopathic Medical Scholars Program

Michigan Dental Registry

DEPARTMENTS 5

CEO’s Message

DO Family Faces

Dean’s Column

Advertiser Index

Thursday, May 18 - Sunday, May 21, 2017

SESSION HIGHLIGHTS: • Emergency Medicine • Opioid Management

Westin Southfield Detroit NEW LOCATION!

1500 Town Center, Southfield, MI 48075 Reservations: Call 888-627-8558, mention MOA Convention for discounted rate of $115.

• Cardiology • Diabetes • Geriatrics • ACLS/ BLS/ PALS Certification • Business of Medicine • Domestic Violence • Hospitalist Medicine • OMM • High Risk Patients • Behavioral Health

T H A N K YO U TO O U R P LAT I N U M S P O N S O R S

• HIV/ AIDS See the full agenda at DOMOA.ORG/SPRING2017

30 - 33 AOA Category 1-A CME credits anticipated

The Michigan Osteopathic Association is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. The Michigan Osteopathic Association designates this program for a maximum of 30-33 of AOA Category 1-A credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in this activity. Outcomes Survey: 3 additional AOA Category 1-A credits may be earned by participating in a post-convention survey emailed to attendees.

Registration and details at DOMOA.org/spring2017

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CEO’S MESSAGE 2017 holds so many unknowns in healthcare. There is no shortage of prognosticators offering their insight and opinions seem to cover the spectrum. My view is that on a local, state and federal level, healthcare policy is more in flux than at any point in my (lengthy) career. The repeal of the Affordable Care Act (ACA) will dominate the headlines as replacement legislation continues to be drafted, debated and voted on. But beyond the national headlines our DO’s face many challenging issues. KRIS NICHOLOFF CEO AND EXECUTIVE DIRECTOR

In these changing times, the work of the MOA is important to your profession. The MOA represents a wide variety of physicians. And no matter your specialty or practice, the future will bring legislation and policies that directly affect you. We are working hard to insure the voice of the DO is represented. In state government, we are pleased to report some recent appointments of DO’s to state boards: MOA Board Member Craig Glines, DO, of Riverview, has been appointed by Gov. Rick Snyder to the Michigan Board of Osteopathic Medicine and Surgery. The 11-member board assists the Michigan Department of Licensing and Regulatory Affairs with overseeing the practice of more than 8,200 osteopathic doctors. Gov. Rick Snyder also appointed Michael Kolinski, DO, of Kalamazoo, to the Michigan Board of Athletic Trainers. Housed within the Department of Licensing and Regulatory Affairs, the 11-member board assists in overseeing the licensure and practice of athletic trainers.

Legislative advocacy and contributing to healthcare policy is vital to our association. By collaborating with groups who share our positions, and making our expertise available to legislators, we can contribute to shaping policies beneficial to osteopathic physicians and healthcare in general. Now, more than ever, we look for strength in numbers. If you are looking to share your insight and expertise, please contact me. The MOA is always seeking DO’s who can take part in the policies that rule your profession. Whether it’s participating on MOA committees, sharing your knowledge with policy makers or offering your opinion on legislative issues, I welcome your input. Now, more than ever, you have a chance to shape your profession.

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is in the company you keep. Sparrow became the first health system in Michigan and one of the first five in the country to join the Mayo Clinic Care Network. This collaborative relationship is another way Sparrow continues to find innovative ways to deliver the finest healthcare to you. Sparrow.org/Mayo

Choose Wisely. Choose Sparrow.

WOMEN OF EXCELLENCE Nominations Open The Women of Excellence award is given on an annual basis by the Membership Committee of the MOA to recognize a female osteopathic physician who has provided exemplary leadership in the field of medicine. Nominations due by April 14, 2017 at domoa.org/womenofexcellence. The recipient will be honored at a reception during the Spring Scientific Convention at the Westin Southfield Detroit on Friday, May 19, 2017 at 4:30 pm. All are welcome to enjoy refreshments and camaraderie.

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OSTEOPATHIC RESEARCH UP TO $25,000 IN RESEARCH GRANTS AVAILABLE FOR STUDENTS AND RESIDENTS Treating tomorrow’s health concerns starts with today’s research projects. Apply by May 31 and make a significant contribution to osteopathic medicine with a research project.

PHYSICIANS IN TRAINING RESEARCH PROGRAM n

Up to $20,000 in researching funding available.

18-month grant period.

To support the research training of the profession’s emerging leaders, the AOA has created two separate programs to facilitate research on the osteopathic approach to practicing medicine by medical students and residents. Students and physicians in training with an interest in research are encouraged to apply for funding from the AOA. The deadline for current available grants is May 31, 2017. Grant recipients will make significant contributions to osteopathic medicine by conducting basic science, clinical, or health-services-related research projects.

Importance of research training Applying for a research training grant from the AOA is a great way to learn how to publish research and share new knowledge at the forefront of osteopathic medicine. Kathleen Ackert, OMS I, who attends the Philadelphia College of Osteopathic Medicine, has applied for a grant to monitor and study how first-year students deal with the stress of medical school.

Grants bolster mentorship A good mentor can make a world of difference for a young researcher just starting out. Recipients of the AOA’s research training grants are required to work with a mentor who is committed to the research topic and the applicant’s career development. “My primary mentor is from the anatomy department at PCOM and has been integral in helping me gather the resources I need,” says Ackert.

The fine print Here’s the breakdown of the requirements and funding available for the two programs:

Proposals must incorporate and address the osteopathic approach to practicing medicine. Preference will be given to proposals that use novel approaches and lead to results that can be translated into physician practices. While the AOA prefers novel approaches, supplemental projects of existing research studies will be considered for funding.

OSTEOPATHIC MEDICAL STUDENTS RESEARCH PROGRAM n

Up to $5,000 in research funding available.

6-to 12-month grant period.

Proposals must incorporate and address the osteopathic approach to practicing medicine. Funding will support supplemental projects of existing research studies only. Supplemental projects must have research questions and specific aims distinct from the existing study.

APPLICATION DEADLINE ( BOTH PROGRAMS ): MAY 31, 2017

For more information, visit Osteopathic.org or email AOA Research Manager Gloria Dillard, MPH, at gdillard@osteopathic.org or call (312) 202-8006.

“Having these opportunities so early shows us the benefits of doing research and hopefully will keep us involved throughout our busy future careers.” — Kathleen Ackert, OMS I

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THERE’S NO QUIT IN US. BECAUSE THERE’S NO QUIT IN YOU. There’s no quit in a patient who runs a marathon after hip replacement. Battles back after open-heart surgery. Or overcomes a stroke. People who never quit deserve a health care system with the same philosophy. That’s Beaumont. Thousands of medical minds working together as one—for one reason: you. Talk to a Beaumont Doctor. Beaumont.org

New name. Shared values. One purpose. Our new name is a sign of added strength. Our shared values open the way for serving the people of West Michigan with more choices for clinical expertise, easier access to it and smarter ways of caring for the whole person. Our purpose, as it’s always been, is an unwavering focus on the patient. For patient-centered care that goes to the next level, look to us.

Your health. Our passion. metrohealth.net

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I’M ALL FOR T ELEHEALTH. ARE YOU READY? BY EWA M. MATSZEWSKI

s one who has been assisting physician practices for more than a decade on practice transformation, the move to telehealth strikes me as among the most transformative events. I’m eagerly anticipating the implementation of telehealth product by members of the DO community. Why am I so excited, perhaps because it touches on all the hot buttons, such as access to care, near immediate – and the patient is likely calling from home or from work using their iPhone; clinical and social work team collaboration; and reduction of emergency department and urgent care visits.

Still, push back is understandable, so let me address the naysayers first. Yes, the cloud-based software is HIPAA compliant; yes, third party payors are providing reimbursement for the face-to-face encounter; and no, physicians and other healthcare professional won’t necessarily be working more hours. Off-hour telehealth consultations may be handled by an outside healthcare professional, a collaborative service set up by one’s physician organization, or a contractual agreement with a health system. Wait a minute…that means my patient might be seeing a stranger! Yes, but isn’t the physician at the ER or urgent care also a stranger? How about this obstacle: my practice isn’t set up for telehealth. Okay, you’ve got me on that one. The fact is, telehealth is not necessarily designed for those who are not already on board with substantive practice transformation. Don’t let that discourage you, though. Use the advent of what will increasingly be wide-spread telehealth as the impetus to begin your practice transformation journey. It’s easier to do so today than it was for the pioneering physicians who took the leap of faith a decade ago and paved the way for those who follow. A significant benefit of telehealth, like the traditional primary care visit, is it works well in the context of the PatientCentered Medical Home Neighborhood (PCMH-N). That’s because immediate referrals can be made to the patient with healthcare professionals and agencies who collaborate

“Yes, the cloud-based software is HIPAA compliant; yes, third party payors are providing reimbursement for the face-to-face encounter; and no, physicians and other healthcare professional won’t necessarily be working more hours.”

through the “neighborhood.” The pharmacist can ask the patient to bring all of her prescriptions to the screen for medication reconciliation and review of potentially deadly prescription combinations. The new mom can avoid exposing baby to the germs in the pediatrician’s office to meet with a lactation specialist. How about mental health crises? Here’s where my plug for community organizations comes in. Community service agencies such as Common Ground or Oakland Family Services in Oakland County play a pivotal role in expanding treatment options for mental health conditions. With telehealth, agencies can be “triaged” in when a patient is experiencing anxiety or another serious mental health crisis, with an ultimate warm hand-off by the primary care physician to the appropriate healthcare provider or facility. Telepsychiatry has been around for a few years. It’s making a difference. For the aforementioned reasons, telehealth can also smooth the process in transitions of care, while keeping patients in transition out of the ER/hospital return cycle. Patients are ready for this next level of healthcare technology. If my enthusiasm for telehealth has sold you on its benefits to patient care, here’s what’s next. You’ll need a computer, a cloud-based virtual software program and training on how to properly use it. There must also be communication materials to educate your patient population on its availability and appropriate use, plus a signed memo of understanding. Not up to doing this solo? Partnering with a physician’s organization or DOsTogether may be the best way to implement and support telehealth in your practice.

EWA M. MATUSZEWSKI IS THE CEO AND A CO-FOUNDER OF MEDNETONE HEALTH SOLUTIONS AND A CHAMPION OF INNOVATIVE PRIMARY CARE AND CHRONIC CARE INITIATIVES. SHE CAN BE REACHED AT: EMATUSZEWSKI@MEDNETONE.NET

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PRESCRIBING OPIOIDS SAFELY: HOW TO HAVE DIFFICULT PATIENT CONVERSATIONS BY RONEET LEV, MD, CHIEF OF SCRIPPS MERCY EMERGENCY DEPARTMENT, CHAIR OF PRESCRIPTION DRUG ABUSE MEDICAL TASK FORCE, AND PRESIDENT OF INDEPENDENT EMERGENCY PHYSICIANS CONSORTIUM

Drug overdose is the leading cause of accidental death in the U.S., and opioids account for over 60 percent of those deaths.1

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The following tips can help when dealing with opioid requests and prescriptions:

Building a strong doctor-patient rapport can help facilitate tough conversations with patients about opioid prescriptions and reduce risks. Communication issues appear in 40 percent of malpractice claims, according to a study by The Doctors Company.2 Incomplete or unclear communication can compromise patients’ ability to understand the doctor’s instructions and, especially in the case of pain medications, also make them feel as if the doctor doesn’t care about their issues or concerns.

• The prescription drug monitoring program (PDMP) is a valuable tool; use it to learn about your patient’s prescription patterns, not just to check for doctor shopping.

hile opioids are effective pain medications when used in the proper setting, concerns arise when the patient’s condition lasts longer than three months, and prescribing more medication does not necessarily result in better pain control.

• Don’t make the mistake of jumping to conclusions that the patient is a drug seeker because the patient is there repeatedly for the same pain complaint. It could instead be a situation of missed diagnosis. Treat this patient like any other patient. Take a good history, including a very detailed medication history. Do a thorough physical examination. See if something was missed on previous visits.

• Medication refills for chronic conditions should have a medication agreement. ONE doctor and ONE pharmacy should prescribe controlled medication given for three months or more. This is true for dental pain,

fractures, fibromyalgia, cancer, anxiety, and ADHD. If you see a patient for the third month of a controlled medication, start a medication agreement if you plan on continuing this therapy. • Opioid withdrawal is uncomfortable but not life-threatening. New patients who present to a new pain specialist should not immediately be given the pain medications they state they need. A pain specialist typically completes thorough research before making medication recommendations and it could be two weeks before the patient is placed on a regular regimen. You may find it necessary to send a patient home without a pain prescription if that patient has already received one in the past month from a different provider. • When patients say that their medication is not working, ask the patient, “How are you taking the medication?” You’ll be surprised how many patients used 400mg of ibuprofen twice a day and it was not enough. Taking a detailed medication history and providing patient education about the right dosage, right timing, and side effects to be aware of is essential to medication safety. • When you hand a patient a prescription for a controlled medication, add a few words to let the patient know that these are serious medications: “I will give you a prescription for Norco. Please realize that this is a medication that can be abused. Keep it secure, take it only as prescribed, and do not drive if not fully alert.” • Be aware of the level of health literacy of the individual patient, and adjust your language appropriately. Ask patients to repeat back the information you gave to ensure they properly understand. • Communicate the risk of medication theft to patients. Patients who are on a chronic treatment plan should know to watch their medication as closely as they would their money.

The chart below shows examples of helpful answers for specific patient questions and situations: PATIENT

DOCTOR ANSWER

“Can I have something for pain?”

“Yes, let me check your medical record for the best choice.”

“The medicines don’t work.”

“Can you please tell me how you take the prescription?”

“My prescription was stolen.”

“Did you file a police report?”

“I have chronic pain.”

“For your safety, you need your medications coordinated by one doctor and one pharmacy.”

“I received extra pain medications elsewhere.”

“Let’s do a drug specimen today.” “I see you received 20 pills from the emergency department, what happened?” “OK, to stay on the same schedule, this month I will write 100 tablets (120 minus 20).”

A case of clear doctor shopping

“I am concerned because your medications can be addicting. I am going to refer you to someone who can help with this.”

A case of need to stop an opioid prescription

“The medication no longer appears to be as beneficial as it once was. As the benefits of the opioids no longer outweigh the risks, we need to discontinue this approach and together find a safer and more effective means of dealing with your pain.”

Additional Resources Resources www.SanDiegoSafePrescribing.org www.thedoctors.com/askme3

References 1 Increases in drug and opioid-involved overdose deaths—United States, 2010-2015. Centers for Disease Control and Prevention. December 30, 2016. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm. Accessed January 26, 2017. 2 Patient-centered communications: Building patient rapport. The Doctors Company. http://www.thedoctors.com/ KnowledgeCenter/PatientSafety/articles/Patient-Centered-Communications-Building-Patient-Rapport. Accessed January 9, 2017. Contributed by The Doctors Company (www.thedoctors.com)

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ONIH AWARDS MSU RESEARCHER

$8.4 MILLION GRANT TO DEVELOP FIRST MALARIA TREATMENTS While the world waits for a vaccine against the ancient disease malaria, Terrie Taylor is working to save the lives of children who are currently afflicted by the deadliest form of the disease. Taylor, MSU University Distinguished Professor of internal medicine and an osteopathic physician, will use an $8.4 million grant from the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, to build on her groundbreaking research that was published in the New England Journal of Medicine in 2015. Taylor and her team discovered children with cerebral malaria develop massively swollen brains that are forced out through the bottom of the skull and compress the brain stem. The pressure causes the children to stop breathing and die. “Because we now know that brain swelling is the likely cause of death, we can focus on identifying new treatments,” Taylor said. “One intervention we will evaluate uses ventilators to breathe for the children. We know from studying children who have survived cerebral malaria that the brain swelling does go down after a few days. This tells me that if we can help them breathe, they may survive. It may be that simple to save children’s lives.” The second treatment Taylor will test is a saline solution to potentially shrink the brain swelling. Though medical researchers have developed effective drugs to kill the malaria parasite, efforts to treat the effects of the disease have been unsuccessful. If Taylor’s treatments are successful they will be the first developed for cerebral malaria. MSU President Lou Anna K. Simon said the grant will allow Taylor to continue her mission to save children’s lives.

“We are grateful to NIH for their support for this critically important research. Dr. Taylor and her team will now be able to use their discoveries about how malaria kills to develop treatments that will spare more families in Africa and beyond from its most tragic effects.” While increased efforts targeting malaria elimination and eradication have had some effect on malaria infection and illness, death rates from malaria are still too high.

As reported in the WHO World Malaria Report 2016,

malaria killed an estimated 303,000 children under 5 years of age globally, including 292,000 in the African region. “Cerebral malaria kills a child every two minutes,” Taylor said. “We, as a global community, should be concerned and support efforts to save these children even as we try to eradicate the disease.” Taylor and team will conduct their next phases of research in Malawi’s first pediatric surgery and intensive care unit scheduled to open in April. The new facility is being built by Raising Malawi, an organization founded by pop legend Madonna. Taylor’s battle against malaria, which she refers to as the “Voldemort of parasites,” has been waged since 1986. She has spent six months of every year in the African nation of Malawi, conducting malaria research and treating children. Source: Michigan State University College of Osteopathic Medicine

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Starting a

TRAUMA REGISTRY Can Boost OMT Research

BY VICKI MARTINKA PETERSEN

“There are ways to code data so what is made public is not identifiable. Research documents should always be kept on a secure computer or in locked drawers, as there has to be one document linking a patient’s name to their codified identification,” Dr. McCallister says. All research needs to go through an institutional review board in order to make sure these HIPAA protections are in place, she adds. Whether you DIY or use a formal registry, here are three key data points Dr. McCallister recommends tracking: • Patient characteristics in the registry should include demographics, injury patterns and severity of injury. This information helps distinguish cohorts and develop appropriate case matches.

• Note what OMT styles or techniques you performed, where on the body you used OMT, and any complications from treatment to enable future reproducibility of a study. “Even if an open treatment protocol is used instead of a specific treatment protocol, you should document what styles or techniques were used to allow for meaningful future meta-analyses,” Dr. McCallister says.

Adrienne McCallister, DO, used patient registries to research the effects of osteopathic manipulative treatment (OMT) on patients with traumatic brain injury (TBI). A patient registry is a roster of information collected on a group of patients, typically those who have the same illness, so their outcomes can be monitored for research or quality control.

• Record patient outcomes, such as length of hospital stay and where the patient went following discharge (i.e., home, rehabilitation facility).

hen examined together, the collective records from a group of patients can give physicians a bigger-picture view of treatment outcomes and pave the way for research studies that may ultimately lead to better patient care.

Dr. McCallister’s registry enabled her to develop a case report, recently published in The Journal of the American Osteopathic Association, that reviewed two patients with TBI who received OMT. Dr. McCallister found that the use of OMT improved somatic dysfunction for both patients. Following a case report, the next step is a retrospective analysis, which would also use a patient registry. “Unlike a case study that uses one or two patient cases to review an interesting outcome, a cohort retrospective trial looks at a group of patients for a given outcome and would be the next step to help answer a research question after you observe an outcome in a case study,” Dr. McCallister says. Dr. McCallister’s JAOA case report also included a section offering guidance on what to include in a patient registry and tips for using the data in research.

Key data to include If your hospital does not already maintain a registry, Dr. McCallister says even something simple like keeping a journal to jot down patient data can help physicians track a diagnosis.

Analyzing trauma registry results “A trauma registry can be a way to gather subjects for a cohort retrospective trial as a registry gathers together patients based on different variables of interest. Once you have a group of patients, you would investigate that data to try to answer your research question,” Dr. McCallister says.

HERE ARE THREE TIPS TO KEEP IN MIND WHEN COMBING THROUGH TRAUMA REGISTRY DATA: 1. Include at least 30 patients per cohort, the case report authors recommend. 2. Focus on blunt-trauma patients. Other types of trauma injuries, such as penetrating, occur less frequently and have characteristics different from blunt-trauma injuries. 3. When forming patient groups, data used for matching should not be statistically different between cohorts. Once the cohorts are matched, outcomes can be compared based on whether OMT was used, the case report authors say.

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MACRA:

WHAT SHOULD I DO? BY EWA M. MATUSZEWSKI

This year I’ve been invited to various MACRA workshops sponsored by EHR vendors, quality improvement software specialists, independent consultants not to mention professional societies and the mother ship, CMS. The titles alone were overwhelming. I’ve sat in on the “Nuts and Bolts of MACRA” not to mention “Putting Together the MACRA Alphabet Soup” or “MACRA, MIPS and APM in a Nutshell.” So, who exactly is the authority on MACRA? What is your level of comfort in being able to discuss the MACRA Quality Payment Program to someone who may be interested in learning about the program?

A little bit of background may be helpful. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and replaced it with a new approach to payment called the Quality Payment Program. The program rewards the delivery of highquality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS. MACRA marks a milestone in efforts to improve and reform the health care system. Building off the coverage expansions and improvements to access under the Patient Protection and Affordable Care Act (Affordable Care Act), the MACRA puts an increased focus on the quality and value of care delivered. THE QUALITY PAYMENT PROGRAM AIMS TO DO THE FOLLOWING:

(1) support care improvement by focusing on better outcomes for patients, decreased provider burden, and preservation of independent clinical practice. (2) promote adoption of Alternative Payment Models that align incentives across healthcare stakeholders. (3) advance existing efforts of Delivery System Reform, including ensuring a smooth transition to a new system that promotes high-quality, efficient care through unification of CMS legacy programs such as Meaningful Use and PQRS. 14

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In 2016, the MOA partnered with Practice Transformation Institute (PTI) to present a series of short webinars and inperson workshops on MACRA. Perhaps it was too soon to talk about MIPS and APM. Maybe the information was too overwhelming. It’s 2017 and time for you and your practice team to learn MACRA basics. You’ve heard the saying “the train has left the station.” Don’t run after the caboose when you have the opportunity of being the locomotive. You can begin slowly and progressively increase your knowledge of MACRA by attending a series of learning events. The first online interactive learning event takes place on April 17 at 6pm. So, who exactly is the authority on MACRA? It should be you! You should know the basics and after a bit of learning, provide snippets of accurate information. What is your level of comfort in being able to discuss the MACRA Quality Payment Program to someone who may be interested in learning about the program? After attending a few PTI webinars or in person workshops you should have a clearer understanding of MIPS, APM, and how incentives will align with high quality, efficient care. EWA M. MATUSZEWSKI IS THE CEO AND A CO-FOUNDER OF MEDNETONE HEALTH SOLUTIONS AND A CHAMPION OF INNOVATIVE PRIMARY CARE AND CHRONIC CARE INITIATIVES. SHE CAN BE REACHED AT: EMATUSZEWSKI@MEDNETONE.NET

UNDERSTANDING MACRA Participating in Medicare Payment Reform The Medicare Access and CHIP Reauthorization Act (MACRA) replaced the sustainable growth rate formula with the Quality Payment Program and 2 paths: the Advanced Alternative Payment Model (APM) and the Merit-based Incentive Payment System (MIPS).

Timeline for Participating

Choose a Track: APM or MIPS

2017 Performance Year

Pick Your Pace in MIPS

This year is considered a sort of transition year. Participants will record quality data and show how they used technology to support their practice.

-% Sending in no 2017 data means receiving a -4% payment adjustment in 2019.

March 31, 2018

• Comprehensive Primary Care Plus • Next General Accountable Care

• Medicare Shared Savings Program –

Submit Something

• Medicare Shared Savings Program –

Track 2

Submitting the minimum of 2017 data (such as one quality measure or one improvement activity for any point in 2017) means avoiding a downward payment adjustment for 2019.

Feedback Medicare will provide feedback about performance.

2019

Payment

Submit a Partial Year

Participants in MIPS who submitted data by the March 31, 2018, deadline may earn a positive MIPS payment adjustment for 2019. Those who participated in an Advanced APM in 2017 may earn the 5% incentive payment in 2019.

Submitting 90 days or 2017 data means possibly earning a neutral or positive payment adjustment for 2019.

Flexibility at the Start

Not everyone in Medicare is part of the Quality Payment Program. Practitioners who bill Medicare less than $30,000 a year or see fewer than 100 Medicare patients a year are not in the program.

2-Sided Risk

Organization (ACO) Model

Practitioners must send in data to earn a positive payment adjustment under MIPS. Those participating in an Advanced APM should send data through the Advanced APM in order to earn the 5% incentive.

For the first year of the Quality Payment Program the theme is flexibility. Practices and providers pick their own pace. Those who are ready to start collecting performance data on January 1, 2017, can do so. Those who are not ready have until October 2, 2017, to start. No matter the start date, performance data needs to be sent in by March 31, 2018.

What Models Are Considered APMs? • Comprehensive ESRD Care –

No Participation

2018

Participants in the Advanced APM path who receive 25% of Medicare payments or see 20% of Medicare patients through an Advanced APM in 2017 will earn a 5% payment in 2019.

Submit a Full Year Submitting a full year of 2017 data means possibly earning a positive payment adjustment for 2019.

Track 3

• Oncology Care Model – 2-Sided Risk • Comprehensive Care for Joint Replacement Model

• Vermont Medicare ACO Initiative

New Models Being Added On December 20, 2017, CMS announced additional opportunities to participate in the Advanced APM path. The first four options below are mandatory care coordination models for hospitals in selected geographic areas. The last option is a new ACO model in the Medicare Shared Savings Program.

• Acute Myocardial Infarction Model • Coronary Artery Bypass Graft Model • Surgical Hip and Femur Fracture Treatment Model

Cycle of Payment Adjustment

• Cardiac Rehabilitation Incentive

Every year the maximum negative or positive payment adjustment increases.

• Track 1 + ACO Model

2019: ± 4%

2021: ±7%

2020: ±5%

2022: ±9%

Payment Model

Source: ajmc.com/newsroom/infographic-making-sense-of-macra TRIAD 2017 | ISSUE 1

DE TECTING BACTERIA COULD SAVE YOUR LIFE A faster way of

Sepsis, a serious, life-threatening infection occurring more commonly in hospitalized patients, is one of the medical problems Etchebarne focuses on in his studies. If not treated properly, septic patients may have only hours to live. Currently, millions of people die each year worldwide partly because a definitive diagnosis of the sepsis-causing bacteria often takes too long. “In-Dx has high sensitivity and specificity for detection of the most common infectious organisms which will help physicians quickly rule in or rule out specific offending bacteria,” Etchebarne said. “Knowing what your target is early in the fight against sepsis will be an invaluable advantage in helping maximize patient care strategies and outcomes.”

A Michigan State University researcher has developed a faster way to detect the bacteria causing patients to become sick — giving physicians a better chance to save their lives. Brett Etchebarne, an assistant professor of emergency medicine in the Michigan State University College of Osteopathic Medicine, has created a molecular diagnostic system that can identify dangerous bacteria such as E. coli, staph infections and even some superbugs. The test can produce results within two hours using blood, urine, spit, wound, stool or cerebral spine fluid samples from infected patients. Etchebarne is more than one year into a clinical trial that aims to validate his point-of-care diagnostic test, known as In-Dx, and his preliminary results already look promising. “So far, we’ve had nearly an 85 percent accuracy rate in identifying the exact bacteria using my diagnostic system,” Etchebarne said. “That’s from taking and analyzing around 300 clinical specimens and right now, urine and wound samples appear to be more accurate and produce faster results.” Today, patients generally have to wait days to get final test results. But the In-Dx testing of urine samples, for example, produces positive results in two hours from start to finish versus the days it can take for equivalent hospital lab tests. “If doctors were able to quickly single out the specific bacteria that a patient has, then often only one antibiotic would be needed and a much more targeted treatment could be given right away,” Etchebarne said. “Right now, multiple antibiotics are typically used because doctors don’t know what specific infection they have to fight until days later. This way of treating people is what helps create the drug resistance problem.” 16

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Etchebarne’s detection process is relatively simple for both the patient and physician. A sample is collected and concentrated into a smaller amount. After applying heat, which breaks down the sample cells, it’s then placed into the In-Dx testing panel and after 20 minutes of incubation time, the positive sample changes color, revealing the invading organism.

“By singling out the offending bacteria at the point-of-care, we can immediately improve a doctor’s ability to prescribe the right antibiotic, help minimize the drug-resistance problem that we face today and save lives.” — Brett Etchebarne, assistance professor of emergency medicine

“By singling out the offending bacteria at the point-ofcare, we can immediately improve a doctor’s ability to prescribe the right antibiotic, help minimize the drugresistance problem that we face today and save lives,” Etchebarne said. The In-Dx panel was designed with input from engineers including Bob Stedtfeld and Syed Hashsham, in MSU’s College of Engineering, to allow flexibility for use with microchip and smartphone technology. Additional collaborators on the project include Mary Hughes, chairperson of MSU’s Osteopathic Medical Specialties, and Jim Tiedje in the Department of Microbiology and Molecular Genetics, as well as Sparrow Health System and McLaren Greater Lansing, both hospitals located in Lansing, Michigan.

Source: Michigan State University College of Osteopathic Medicine

THE OSTEOPATHIC MEDICAL SCHOLARS PROGRAM A valuable opportunity for aspiring osteopathic physicians

BY SUMAIRA HAI, MICHIGAN STATE UNIVERSITY

he Osteopathic Medical Scholars Program (OMSP) is a highly competitive mentoring opportunity offered to undergraduate students at Michigan State University who are serious about a career in osteopathic medicine. The OMSP was created in 2000 when then Dean Allen Jacobs, and Dean Norma Baptista created a program that would provide prospective osteopathic medical students with a community of peers who had the same interests and opportunities for academic success.

Admission into the program requires a high school grade point average of a 3.5 or higher, an ACT score of 28 or higher or a SAT score of 1280 or higher, a record of volunteerism, and a clear interest in medicine.

“OMSP has exposed me to so many things that just wouldn’t be as readily available if I weren’t part of the program. Medical school is tough, but I feel more confident and comfortable going into it because I’ve been exposed to the faculty for four years now. I knew who and where to go to for help.” — Aarthi Manjunathan, senior kinesiology major

Once admitted, students are given the option to waive the MCAT requirement and preferential admission into MSUCOM, so long as they maintain an overall and science grade point average of 3.5 and comply with all of the OMSP’s professional requirements. OMSP students have unique opportunities to connect with MSUCOM students and faculty members, meet admissions counselors, learn about ongoing research and explore the college’s counseling and other support resources. They are also allowed to attend osteopathic manipulative medicine sessions taught by current medical students and visit the anatomy lab. Aarthi Manjunathan, a senior kinesiology major and OMSP member credits the program for being the reason she feels prepared for medical school in fall 2017. “OMSP has exposed me to so many things that just wouldn’t be as readily available if I weren’t part of the program,” Manjunathan said. “Medical school is tough, but I feel more confident and comfortable going into it because I’ve been exposed to the faculty for four years now. I knew who and where to go to for help.” Since its inception, more than 300 students have participated in OMSP, 245 OMSP students have gone into MSUCOM and 56 are practicing physicians today. TRIAD 2017 | ISSUE 1

MICHIGAN DENTAL REGISTRY Tooth decay is the most common chronic disease impacting children today.1 With a growing understanding of the link between oral health and systemic health, the need for innovative approaches to enabling providers to optimize quality of care and help address this disease burden is growing. In 2016, Altarum launched a first-of-its-kind statewide oral health monitoring system, Michigan’s Dental Registry (MiDRSM), aimed at transforming the way medical and dental providers communicate regarding their patients’ oral health. MiDRSM is a web-based application that increases communication and transparency among the patient’s care team, allowing for better coordination in patient treatment and referrals across the medical and dental settings, positively impacting the quality of oral health care provided, and increasing early prevention among young patients. Medical and dental providers want to provide the best quality care possible for their patients, yet to date, coordinating care across these settings has had its own unique barriers. MiDRSM was born out of the need to establish a mode of communication between care providers that takes into account the significantly different technology environments of each setting. Through it, providers can document preventive oral health services provided, insert notes for the dentist to 18

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review, and place referrals directly to dentists who accept patients with Healthy Kids Dental coverage. Referrals are transmitted via fax to the dental office, and the dental office can then look up the patient record directly and update it as needed.

patients and identifying behavior risks, and referring patients to appropriate dental care, supporting communication between these providers will play a significant role in reducing duplicative care and improving quality of care.

This new tool can help providers engage in federal incentive programs. In early 2016, MiDRSM was classified by the Centers for Medicare and Medicaid Services (CMS) as a Meaningful Use Specialized Registry. MiDRSM houses valuable information related to a child’s access to and utilization of preventive oral health services in both the medical and dental environments, and currently there are more than 1,500 physicians and dentists that have attested to using the system. Data collected by the tool is submitted to the State of Michigan creating a valid, reportable data system for monitoring access to pediatric oral health services, and overall dental caries rates.

MiDRSM is available today on the State of Michigan’s Single Sign On (MILogin) & Allscripts Professional EHR. Sign up today and use MiDRSM to:

Care coordination is a key component to effectively improving oral health behaviors and reducing the burden of oral health disease in children. As primary care providers become more involved in the provision of preventive oral health services, counseling

As many as

MILLION CHILDREN go WITHOUT dental care each year in the U.S.

DOCUMENT AND TRACK PREVENTIVE ORAL HEALTH SERVICES AND TREATMENT

• Fluoride Varnish • Oral Screening Clinical Findings and Notes • Dental Treatment SUBMIT A REFERRAL TO A MEDICAID/ HEALTHY KIDS DENTAL-ACCEPTING DENTIST

• Search for a dentist using a distance- or match-based search • Review information about each dentist, including their hours of operation, languages spoken, and if they’re accepting new patients • Submit a referral directly to the dentist through MiDRSM 1. Benjamin RM. Oral Health: The Silent Epidemic.

Public Health Reports. 2010;125(2):158-159.

MOCF BALL 2017 February 4, 2017 at The Henry, Dearborn

(L to R) Robert G. G. Piccinini, DO, dFACN, Stacy Byrnes, MOA President Bruce Wolf, DO, FAOCR, and Sheila Wolf

MOA President-elect John Sealey, DO, FACOS, and Past President, William G. Anderson, DO

MSUCOM Students gather at the 2017 MOCF Ball TRIAD 2017 | ISSUE 1

STUDENT LIAISON MEET & GREET January 23, 2017 in Brighton

MUC Campus Liaisons – (L to R) Faith Lincoln (2019), Jenifer Moceri (2019), Hannah Winget (2020), Jessica Greb (2020), Jackie Albosta (2019)

DMC Campus Liaisons – (L to R) Dan O’Connor (2019), Nick Foster (2019), Zainab Hammoud (2020), Daniel Doud (2020), Megan Denny (2020), Scott Anteau (2019), Mike Finkel (2020)

MSU COM Student Liaisons – Front row: Nick Foster (EL), Faith Lincoln (MUC), Jenifer Moceri (MUC), Jackie Albosta (MUC), Dan O’Connor (DMC), Colleen Reidy (EL). Back row: Ryan Owen (EL), Scott Anteau (DMC), Taran Silva (EL), Jason Oetman (EL), Devon Pyykkonen (EL) 20

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MSAE LEGISLATIVE & POLICY CONFERENCE February 15, 2017 at the Radisson Hotel, Lansing

MOA President-elect Dr. John Sealey addresses the conference

Dr. David Bell directs a question to former Lt. Gov. Dick Posthumus

ABOVE: â&#x20AC;&#x153;Opioids in the Workplace" panel featuring MOA Board members Dr. David Best and Dr. Stephen Bell

(L to R) Dr. Stephen Bell, Dr. Rachel Young, Dr. David Best, Dr. John Sealey, and MOA Executive Director Kris Nicholoff at the panel discussion on opioids TRIAD 2017 | ISSUE 1

DEAN’S COLUMN MSU COM INVESTIGATORS ARE MAKING GREAT STRIDES IN ADDRESSING HEALTH ISSUES Because we’re right around the corner from MOA’s annual Spring Scientific Convention, it made sense for me to focus this column on some of the great science coming from researchers within our college right now. BY WILLIAM STRAMPEL, DO

The MSU College of Osteopathic Medicine (MSU COM) is supporting the work of a number of talented investigators in many academic departments who are attacking global health challenges. These are just a few: Dr. Brett Etchebarne, an assistant professor of emergency medicine in our Department of Osteopathic Medical Specialties, has created a molecular diagnostic system that can identify dangerous bacteria such as E. coli, staph infections and even some superbugs. The test can produce results within two hours using blood, urine, spit, wound, stool or cerebral spine fluid samples from infected patients. Dr. Richard Neubig, chairperson of the Department of Pharmacology and Toxicology, is co-author of a new study that identifies a chemical compound and potential new drug that reduces the spread of melanoma cells by up to 90 percent. Dr. Zhiyong Xi, associate professor of microbiology and molecular genetics, will use a $1 million USAID grant to fight the Zika virus in Mexico. He’ll build a mosquito factory in Yucatan, Mexico like one that he runs in China. Xi breeds male mosquitoes infected with Wolbachia bacteria, a strain that is naturally found in many species of mosquitoes but is not dangerous to humans. When the infected males are released into the wild, they mate with females, which renders them sterile. He and his team will also seed Wolbachiainfected females to establish a viral-resistant population. Dr. Terrie Taylor, University Distinguished Professor of internal medicine and a professor in osteopathic medical specialties, recently received an $8.4 million grant from the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, to build on her groundbreaking research on cerebral malaria. There are many individuals, from graduate students through endowed professors, who are making great strides on solving huge medical challenges. Our college isn’t just preparing tomorrow’s best and brightest young physicians, we’re also finding ways to help people all over the world find and keep good health – just like A.T. Still wanted.

WILLIAM STRAMPEL, DO, IS DEAN OF THE MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE. CONTACT LAURA.PROBYN@HC.MSU.EDU. 22

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ADVERTISERS TRIAD STAFF David Best, DO, Patrick Botz, DO, and Larry Prokop, DO, Editors in Chief

Beaumont Health...................................................................8

William Strampel, DO, Contributing Editor

MSU College of Osteopathic Medicine.................................17

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 2016-17 BOARD OF TRUSTEES Bruce Wolf, DO, FAOCR, President John 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 Membership Co-Directors Emily K. Hurst, DO and Matthew C. Bombard, DO (IR)

Michigan Health and Hospital Association............................2

MOA 118th Spring Convention.............................................4 MOA Women of Excellence Nominations..............................6 NMOA Summer Convention...............................................23 Sparrow.................................................................................6 The Doctors Company........................................................24 University of Michigan Metro Health Network......................8

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

Department of Education Co-Directors David Best, DO, Patrick Botz, DO and Larry Prokop, DO Department of Socio Economics Co-Directors Stephen Bell, DO and Andrew Adair, DO Department of Healthcare, Technology and Informatics Jeffrey Postlewaite, DO and Taran Silva, Student 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. 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. ©2017 MICHIGAN OSTEOPATHIC ASSOCIATION

Northern Michigan Osteopathic Association

SUMMER CONVENTION J U N E 15 - 18, 2017 MISSION POINT RESORT, MACKINAC ISLAND CME, family activities, the island beauty & summertime fun. Join the NMOA for its annual Summer Convention! C M E S ES S I O N S Thursday 5:30 - 8:30 pm Friday 8:30 am - 6:30 pm Saturday 8:30 am - 4:00 pm Sunday 8:30 - 11:30 am 20 AOA Category 1-A CME credits anticipated.

AGENDA & REGISTRATION AT D O M O A .O R G/N M O A S U M M E R OR CALL 517-347-1555 EXT 112. TRIAD 2017 | ISSUE 1

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