MICHIGAN MEDICINE

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 120 / NO. 1

January / February 2021

New in Town: Fresh Faces Join Michigan Legislature msms.org

Saluting Saluting our our partners partners at at Michigan Michigan Medicine Medicine for for their their outstanding outstanding clinical clinical leadership. leadership.

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Blue Cross Blue Shield of Michigan is proud of our longstanding partnership with Blue Cross Blue Shield of Michigan is proud of our longstanding partnership with Michigan Medicine through our Collaborative Quality Initiative (CQI) program, which is Michigan Medicine through our Collaborative Quality Initiative (CQI) program, which is internationally recognized for improving the value of health care delivery. This portfolio internationally recognized for improving the value of health care delivery. This portfolio of over 15 statewide initiatives has touched the lives of nearly five million Michigan of over 15 statewide initiatives has touched the lives of nearly five million Michigan patients. Groundbreaking CQI best practices have been shared in over 30 countries on patients. Groundbreaking CQI best practices have been shared in over 30 countries on five continents, broadly impacting the quality of health care delivery to patients across five continents, broadly impacting the quality of health care delivery to patients across the globe. Learn more at valuepartnerships.com. the globe. Learn more at valuepartnerships.com.

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p resident 's New Year, New Beginnings Happy New Year from everyone at the Michigan State Medical Society!

The Near Year means new beginnings and that’s certainly true for Michigan’s legislature. Last November, Michigan’s voters went to the polls, ushering in 28 new members of the Michigan state House of Representatives.

In this edition of Michigan Medicine®, we introduce you briefly to the new names and faces around the state Capital this year. We’ll also reintroduce you to the Legislative leaders in the state Senate and House who will be responsible for shepherding policy through Michigan’s legislative bodies in the New Year.

Lastly, we’ll highlight the growing Government Affairs team here at MSMS— a group doing the important work of making sure the voice of our member physicians is heard and represented in the development of policy and regulations impacting Michigan’s medical community and the patients we serve.

S. BOBBY MUKKAMALA, MD (GENESEE COUNTY) MSMS PRESIDENT

The start of the New Year is always a time for hope and optimism about what lies ahead—it’s a fresh year and a fresh start, an opportunity to reset, readjust, and reengage with our lives and our work with a renewed sense of purpose and enthusiasm—I believe these things have never been truer as we head into 2021.

No one has been left unaffected by the tremendous challenges 2020 has presented, but physicians have obviously borne a unique and particularly heavy burden throughout this global pandemic. The challenge of trying to understand, treat, and ultimately prevent a novel, infectious, deadly disease has obviously fallen on the medical and science communities. For much of the past several months, that has been grueling, taxing work, however, we continue to persevere, and finally there appear to be light at the end of the tunnel.

Every day, we learn more about how to effectively treat those with COVID-19 and our medical researcher have developed effective vaccines that are now being administered to millions across the country. 2021 can and should be a better year for everyone in large part because of our hard work as physicians. Take a moment to take some pride in that fact—it’s been well-earned. And best of luck to everyone on what I’m sure will be a better 2021.

Sincerely,

BOBBY MUKKAMALA, MSMS PRESIDENT

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FEATURES & CONTENTS January / February 2021

11 New in Town: Fresh Faces Join Michigan Legislature

As 2021 begins, little has changed from a public policy perspective. Michigan continues to confront the lingering effects of COVID-19 and the many interrelated issues the pandemic brought to light. An array of innovative economic and strategic actions will be required to continue bringing the state back to full strength. Fortunately, Michigan’s new Legislature appears ready to meet these challenges. (Stories begin on page 11.)

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President's Perspective: New Year, New Beginnings S. BOBBY MUKKAMALA, MD

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COVID-19 Vaccine as a Condition of Employment JODI SCHAFER, SPHR, SHRM-SCP

MICHIGAN MEDICINE® VOL. 120 / NO. 1 Chief Executive Officer JULIE L. NOVAK

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Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org

Recent Approval of Settlement in BCBS Anti-trust Case Bodes Well for Positive Changes to the Health Care Marketplace DANIEL J. SCHULTE, JD

Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Publication Design STACIA LOVE, REZÜBERANT! INC. rezuberant.com

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COVID-19 Vaccines Are Here: What You Need to Know!

Printing FORESIGHT GROUP staceyt@foresightgroup.net Publication Office Michigan Medicine® 120 West Saginaw Street East Lansing, MI 48823 517-337-1351 www.msms.org

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All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast.

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Postmaster: Address Changes Michigan Medicine® Trisha Keast 120 West Saginaw Street East Lansing, MI 48823

Interstate Licensure for Telehealth Can Fuel Medical Practice Growth CHAD ANGUILM, DAVID L. FELDMAN, MD, AND REMI STONE, JD, THE DOCTORS COMPANY

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ALSO INSIDE 25 WELCOME NEW MEMBERS 28 EDUCATION

Michigan Medicine®, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan.

The MSMS Committee on Publications is the editorial board of Michigan Medicine® and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors.

Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine® reserves the right to accept or reject advertising copy.

Products and services advertised in Michigan Medicine® are neither endorsed nor warranteed

by MSMS, with the exception of a few.

Michigan Medicine® (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2021 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110.

Single copies, $10. Printed in USA. ©2021 Michigan State Medical Society

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ASK OUR LAWYER

Recent Approval of Settlement in BCBS Antitrust Case Bodes Well for Positive Changes to the Health Care Marketplace

By Daniel J. Schulte, JD, MSMS Legal Counsel

Q:

I read something recently about a billion-dollar settlement in a case against the Blue Cross Blue Shield Association and many of the state Blues plans. Can you give us some detail and an idea what this may mean for physicians?

The invalidation of the Governor’s COVID-19 Executive Orders does very little, if anything,

T

to change physician practice and workplace safety in this pandemic environment.

he case you are referring to was brought against the Blue Cross Blue Shield Association and several Blues plans including Blue Cross Blue Shield of Michigan. It has been pending for years in an Alabama federal court. The Plaintiffs alleged that the Blue Cross Blue Shield Association and several Blues plans entered into anticompetitive agreements in violation of the federal antitrust laws that prohibit contracts, combinations, or conspiracies that unreasonably restrain trade. They claim these agreements restrict compe-

tition among the Blue plans, resulting in geographic market allocations. A subgroup of Plaintiffs consisting of hospitals, physicians, and other health care providers further alleged that the Blues plans agreed to fix prices for their services.

Following several years of discovery the Plaintiffs moved for summary judgment asking the judge to rule that the Blue Cross Blue Shield Association’s agreements with the Blue plans violated the antitrust laws. Significantly, the Plaintiffs argued that these agreements amounted to territorial allocations and

“The Plaintiffs moved for summary judgment asking the judge to rule that the Blue Cross Blue Shield Association’s agreements with the Blue plans violated the antitrust laws...

The court granted the plaintiffs’ motion.”

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price fixing and therefore should be viewed as per se or automatic violations of the federal antitrust laws. The court granted the Plaintiffs’ motion in part finding that many of the alleged restraints were subject to per se review under the antitrust laws. The practical effect of this ruling was that the Blue Cross Blue Shield Association and other defendants were not allowed to present any defenses (e.g., that procompetitive effects of the conduct outweigh the anticompetitive effects, a lack of market power and other detailed factual and economic defenses that are typically employed when there has not been a finding of per se violations) to these per se violations. Instead, the Plaintiffs were left only having to prove the amount of damages. The ruling was appealed to the Eleventh Circuit Court of Appeals and Blue Cross Blue Shield’s request for reversal was denied.

In early December, the Alabama federal district court judge granted preliminary

approval of a $2.67 billion settlement.

In addition to the payment of this sum, the Blue Cross Blue Shield Association and the other defendant Blues plans reportedly have agreed to make several changes to their operations. These changes include the elimination of several terms contained in the trademark licensing agreement between the Blue Cross Blue Shield Association and the state Blues plans. These terms currently: (1) limit the amount of “non-Blue” business that a Blue Cross licensee can have outside of the service area for which it possesses the Blue mark; (2) limit the ability of an out-of-state Blues plan to bid for insurance business against a “home” Blues plan for larger employers (those with over 5,000 employees that also meet certain dispersion criteria); (3) restrict the ability of a Blues plan to acquire another Blues plan member, making such restrictions permissible only to the extent that the restrictions are “reasonably necessary to prevent

the impairment of the value of the Blues marks or the competitive or efficiency of Blues branded business”; and (4) would greatly restrict the ability of the Blues plans to utilize “most favored nations” clauses in their provider contracts. The proposed settlement would also create a 5-person “monitoring committee” that would oversee compliance with the terms of the settlement for a period of 5 years.

Many of the specific details of the settlement are not yet known publicly.

How these changes required by the settlement will directly or indirectly affect Michigan physicians and other health care providers across the country is not yet known. Legal counsel will continue to monitor the case and provide updates as additional information becomes known.

DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL

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ASK HUMAN RESOURCES

COVID-19 Vaccine as a Condition of Employment

By Jodi Schafer, SPHR, SHRM-SCP, Human Resources Management Services, LLC

Q:

With a possible Coronavirus vaccine on the horizon I am wondering if there are any laws in Michigan that would prohibit an employer from

requiring a new employee or an existing employee from getting the vaccine as a condition for continued employment.

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arring an employment contract or collective bargaining agreement to the contrary, it is legal to make vaccination a condition of employment in an at-will state like ours. It is not uncommon to read handbook language that requires an employee to be up-todate on their vaccinations, including the annual flu shot, as a condition of employment. In fact, many employers have had similar policies in place for years, especially in the health care space. The administration of this policy, however, requires further discussion.

First and foremost, if you are considering a push to have all of your employees vaccinated for COVID-19 once it becomes available, you will need to inform your staff of this decision in advance. Don’t just mention it in passing though. You’ll want to draft a clear, legally sound policy to let all staff (both existing and future new hires) know that being vaccinated for Coronavirus will become a condition of employment. Think through who will be monitoring employees’ compliance with this policy and how employees will prove they have been vaccinated. Are you going to allow a grace period for employees to comply? Are you going to issue reminders? If you have a small office then it may not be that difficult to manage this process. However, if you have a larger group or multiple locations then

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“If you are considering a push to have all of your employees vaccinated for COVID-19 once it becomes available…you’ll want to draft a clear, legally sound policy to let all staff (both existing and future new hires) know that being vaccinated for Coronavirus will become a condition of employment.” you’ll want to spend some time thinking through a tracking system and perhaps a point person to make this policy effective.

Understand that while this policy may be broadly enforced, your desire to stop

the spread of the virus does not trump an employee’s right to request an accommodation or an exemption for religious and/or health-related reasons.

There are some employees with sincerely-held religious beliefs that could conflict with being vaccinated. This opposition would most likely be to vaccines as a whole, not the Coronavirus vaccine specifically. However, since religion is protected under the Civil Rights Act, employers would be obligated to grant accommodations (which may include an exemption) unless doing so would pose an undue hardship. “Under Title VII [of the Civil Rights Act], the undue hardship defense to providing religious accommodation requires a showing that the proposed accommodation in a particular case poses a “more than de minimis” cost or burden…Costs to be considered include not only direct

monetary costs but also the burden on the conduct of the employer’s business.

For example, courts have found undue hardship where the accommodation diminishes efficiency in other jobs, infringes on other employees’ job rights or benefits, impairs workplace safety, or causes co-workers to carry the accommodated employee’s share of potentially hazardous or burdensome work.”1

REFERENCE 1 https://www.eeoc.gov/laws/guidance/questions-and-answers-religious-discrimination-workplace#:~:text=Title%20VII%20requires%20employers%20to,accommodated%20without%20an%20 undue%20hardship.&text=An%20accommodation%20would%20pose%20an,operation%20of%20 the%20employer's%20business

Driven by results.

As counsel to the MSMS community for over 70 years, we know how to help physicians.

DETROIT

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T R OY

kerr-russell.com

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MDHHS UPDATE

COVID-19 Vaccines Are Here: What You Need to Know!

Alyssa Strouse, MPH, Adult and Adolescent Immunization Coordinator, MDHHS Division of Immunization PLEASE NOTE: Information in this article is updated as of December 17, 2020. Due to the nature of the rapidly evolving COVID-19 pandemic and COVID-19 vaccines, this information may have changed since that date.

A

rrival of the COVID-19 vaccines are bringing hope for change and a possible end to the COVID-19 pandemic. In order to bring about this change, health care professionals are urged to get the vaccine and to encourage others to do so (https://www.aha.org/press-releases/202012-15-aha-ama-and-ana-urge-health-care-professionals-take-covid-19-vaccine.) To combat this pandemic, we must obtain high rates of vaccination within the U.S population.

As COVID-19 vaccines become more widely available, it is the job of health care and public health professionals to advocate for COVID-19 vaccine and to encourage the public to obtain this safe, effective vaccine.

On December 11, 2020, the U.S. Food and Drug Administration (FDA) issued the first Emergency Use Authorization (EUA) (https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019covid-19/pfizer-biontech-covid-19-vaccine) for a vaccine in the prevention of COVID-19 in individuals 16 years of age and older.

This EUA allows the Pfizer-BioNTech COVID-19 Vaccine to be distributed in the U.S. effective immediately. This was a critical step in making COVID-19 vaccine available as quickly as possible.

On November 30, 2020 ModernaTX submitted an EUA request to the FDA for their COVID-19 vaccine. The FDA has yet to issue an EUA for Moderna’s vaccine, however we anticipate that this will be coming in the next few days. Due to the fact that initial supply of the vaccine is limited, the Centers for

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Disease Control and Prevention (CDC) recommended that priority groups be established. On December 3, 2020, based on recommendations from the Advisory Committee on Immunization Practices (ACIP) (https://www.cdc.gov/ vaccines/acip/), an independent panel of medical and public health experts, CDC recommended that COVID-19 vaccine be allocated to health care personnel and long-term care facility residents first. Read the entire Morbidity and Mortality Weekly Report (MMWR) here: https://www.cdc.gov/mmwr/volumes/69/wr/ mm6949e1.htm?s_cid=mm6949e1_w.

Although the COVID-19 vaccines were made more quickly than other vaccines, the safety of the vaccines were of utmost priority. No steps were omitted in the process of developing these safe, effective vaccines. Phase III trials for COVID-19 vaccines have been as large as those for other vaccines, including tens of thousands of participants. COVID-19 vaccines will be approved using the FDA’s EUA process, rather than the typical Biologics Licensing Application (BLA) process due to the emergency being faced as a result of the pandemic. The main difference between these processes is that under the EUA process the vaccine can be approved more quickly, however companies are required to continue monitoring trial participants, even after the EUA is issued, and submit subsequent findings to the FDA. For more information on the safety of COVID-19 vaccines, as well as additional frequently asked questions, visit the Children’s Hospital of Philadelphia's COVID-19 Vaccines FAQ at https://www.chop.edu/centers-programs/ vaccine-education-center/making-vaccines/ prevent-covid.

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As the COVID-19 pandemic continues to change, CDC and the Michigan Department of Health and Human Services (MDHHS) are working diligently to keep health care providers and the public informed. For more information from CDC on Coronavirus Disease and Vaccines, visit https://www.cdc.gov/ coronavirus/2019-ncov/vaccines/index.html.

In addition, MDHHS has created a website, www.michigan.gov/COVIDvaccine, to keep Michiganders up-to-date on COVID-19 resources, as well as information regarding the prioritization and distribution of COVID-19 vaccines.

This website includes an interactive COVID-19 dashboard where health care providers and the public can track the number of providers enrolled in Michigan’s COVID Vaccination Program, the number of COVID-19 vaccines shipped, and the number of doses administered in Michigan. The vaccination data provided on this COVID-19 Vaccine Dashboard is from data reported to the Michigan Care Improvement Registry (MCIR). As part of the COVID Vaccination Program, providers are required to report COVID19 vaccination data to MCIR.

Over 40,000 brave volunteers have stepped up to make COVID-19 vaccines a reality.

Now it is time for health care professionals to roll up their sleeves and set the tone for promoting vaccine confidence and putting an end to COVID-19.

FEATURE

New in Town: Fresh Faces Join Michigan Legislature

As 2021 begins, very little has changed from a public policy perspective.

Michigan continues to confront the lingering effects of COVID-19 and the many interrelated issues the pandemic brought to light. An array of innovative economic and strategic actions will be required to continue bringing the state back to full strength.

Fortunately, Michigan’s new Legislature appears ready to meet these challenges.

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ichigan’s executive branch and Senate will remain in place until 2022, at minimum, and the Republican party has retained control of the state House with 25 percent of its members arriving new this year. This level of experienced leadership will help ensure policy leaders can hit the ground running, so to speak, when it comes to advancing the initiatives necessary to take Michigan further in the years to come.

The Michigan State Medical Society is proud to serve as the recognized voice for our state’s medical community, and we look forward to advancing the needs of our state’s physicians and patients with all state policy leaders. We trust this resource will be useful as you get to know your own local legislator in the days and weeks to come.

2021 INCOMING HOUSE LAWMAKERS District 3: Shri Thanedar, Democrat

District 8: Stephanie Young, Democrat

Thanedar is a business owner, scientist, and author.

He emigrated from India to the U.S. in 1979 and has since completed his Ph.D. in Chemistry and grown a pharmaceutical and chemical research services company from just three employees to more than 450.

He launched a second, 50-employee pharmaceutical company in 2010. Thanedar previously ran in the 2018 Michigan gubernatorial primary.

Young has 30 years of public service under her belt, as former executive director of the Community Education Commission, neighborhood city hall manager for three Detroit mayors, outreach manager for Detroit Area Agency on Aging, and the chief of staff and legislative liaison for three state representatives. She is an active board member for numerous southeast Michigan nonprofits. Young holds a bachelor’s degree from MSU.

District 4: Abraham Aiyash, Democrat

District 10: Mary Cavanagh, Democrat

Aiyash was born and raised in Michigan, the son of Yemeni emigrants. He has served as training and political leadership director of Michigan United, a Hamtramck city commissioner, a state House staffer, and surrogate for Bernie Sanders during the 2020 presidential campaign. He is an active mentor for refugee children and holds a degree from Michigan State University.

District 7: Helena Scott, Democrat A lifelong Detroiter, Scott has 15 years of experience as a community and labor organizer. She has worked for Southeast Michigan Jobs with Justice and as a training coordinator for the League of Woman Voters (LWV) of Detroit. Scott is active in the Coalition of Labor Union Women and the NAACP. She holds a bachelor's degree in psychology from Marygrove College.

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Before coming to the Michigan Legislature, Cavanagh served as director of project development for New Start Construction Company. She was born in Redford Township, Michigan, and pursued her undergraduate education at Wayne State University.

District 13: Tullio Liberati, Democrat Liberati is a lifelong Allen Park resident. For the past two decades, he has operated Liberati and Sons Construction. He attended Wayne State University.

District 21: Ranjeev Puri, Democrat Puri has worked professionally as a business manager at Fiat Chrysler since 2013. After work hours, he has been active in numerous political and community organizations. He has a master’s degree from the Booth School of Business at the University of Chicago.

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District 22: Richard Steenland, Democrat A lifelong resident of Roseville, Steenland has previously served as Roseville city clerk, council member, and mayor pro tem. He is Accredited City Clerk through the State of Michigan and the past President of the Macomb County Clerks Association. He has an associate degree from Macomb Community College.

District 27: Regina Weiss, Democrat Weiss comes to the Michigan Legislature with a great deal of classroom teaching experience. She has served as a high school English and social studies teacher in the Detroit Public Schools Community District. She graduated with a bachelor's degree from Valparaiso University in 2009.

District 37: Samantha Steckloff, Democrat Steckloff has been involved in politics since college, when she became the youngest city youth advisor in the country while earning a degree in political science at Purdue University. She has served on the Farmington Hills City Council for two terms. She also participates in numerous non-profit boards and commissions at the local level.

District 38: Kelly Breen, Democrat Breen is an attorney and Novi City Council member.

She has been affiliated with numerous Michigan non-profit and advocacy organizations, including the Michigan Municipal League, the Southeast Michigan Council of Governments, and others. She holds a bachelor’s degree from MSU and a J.D. from Wayne State University Law School.

District 45: Mark Tisdel, Republican

District 59: Steve Carra, Republican

District 95: Amos O’Neal, Democrat

Tisdel grew up in Michigan and has served on the Rochester Hills City Council for the past eight years. He is a licensed insurance agent who specializes in medical liability. He also serves on the Older Persons’ Commission Governing Board and is Government Youth Council Liaison. He has a journalism degree from Drake University.

For the past three years, Carra has worked for State Rep. Steve Johnson. Previously, he was a research assistant at Acton Institute. He holds degrees in economic and political science from Western Michigan University.

O’Neal has been active in Saginaw-area community leadership for many years, having served on the county commission, city council, and as mayor pro tem. He also is engaged in many local nonprofit and civic initiatives. He holds a bachelor’s degree from Northwood University.

District 47: Robert Bezotte, Republican A Vietnam War veteran with 33 years of law enforcement experience and 10 years of corporate involvement, Bezotte is a former county commissioner and Livingston County sheriff. He has been educated at the FBI National Academy and Eastern Michigan University.

District 48: David Martin, Republican Martin has served has Genesee County commissioner since 2016 and was a member of the Davison City Council from 2009-2013. He has a military and security background and served in the U.S. Air Force from 1979 to 1999. David holds a degree in Homeland Security from Keiser University.

District 55: Felicia Brabec, Republican Brabec is a clinical psychologist who has delivered clinical services at the University of Michigan and as a high school social worker and coach. She earned a bachelor's degree from St. Mary's of Notre Dame in 1995, a master's degree from Boston College in 1997, and a Ph.D. from the Illinois School of Professional Psychology in 2003.

District 56: Thomas (“TC”) Clements, Republican Clements came to Michigan from Florida and Maine.

Clements’ career experience includes working as the owner of a travel agency and as the chief operations officer of a manufacturing firm. He has also worked as a police officer, reaching the rank of Deputy Chief of Police. Most recently, he has served as Bedford Township Trustee.

District 58: Andrew Fink, Republican Born in Superior Township, Michigan, Fink earned an undergraduate degree from Hillsdale College in May 2006 and a law degree from the University of Michigan in May 2010. He served as an officer in the United States Marine Corps from 2010 to 2016. He has a private law practice in Hillsdale.

District 60: Julie Rogers, Democrat

District 96: Timothy Beson, Republican

Rogers comes to the Legislature from the Kalamazoo County Commission, where she has served as chair.

She also has been a member of the board of directors of the Michigan Association of Counties, a member of the National Association of Counties’ Health Policy Steering Committee, and part of the 2019 class of Women in Government. Professionally, Rogers works as a physical therapist.

Beson owns a family market in Bay City and has served as a school board member for Bangor Township Schools. He has a degree in business management from Saginaw Valley State University.

District 104: John (“JR”) Roth, Republican

District 61: Christine Morse, Democrat Morse has been a member of the Kalamazoo County Commission since 2018. She holds a bachelor's degree from Michigan State University and a law degree from Wayne State University Law School. Her career experience includes working as an attorney from 1999 to 2002.

District 70: Pat Outman, Republican Farmer. Excavator. Construction trade worker. All these words have applied at one time or another to Pat Outman, who is an active member of the Montcalm County community. He serves on the County Farm Bureau and is active in county-level Republican politics.

He has a bachelor’s degree from Ferris State University.

District 73: Bryan Posthumus, Republican

A lifelong resident of northern Michigan, Roth has spent his career in the Traverse City tourism industry.

He also has served on the Grand Traverse County Parks and Recreation Board and the county Republican party. He holds an associate's degree from Northwest Michigan College.

District 105: Ken Borton, Republican For more than 40 years, Borton has run a small real estate and property management business. He also has chaired the Otsego County Board of Commissioners and helped lead various county associations at the state and national levels. He is a graduate of Liberty University.

District 107: John Damoose, Republican Damoose is a broadcaster, producer and author with credits that include the Christian Broadcasting Network and the 700 Club. He co-authored “Red Sky in the Morning” with Dr. Bill Bright and is active in several non-profit organizations. Today he leads 45 North Productions and is active in the Harbor Springs community. He has a degree in political science from the University of Michigan.

Posthumus is a fourth-generation farmer. He holds a bachelor’s degree from MSU and has spent his career working as a farmer and consultant. Today, he is managing partner at the largest farmer owned and operated hopyard in the state of Michigan, which supports the state’s emerging microbrew sector.

District 83: Andrew Beelerm, Republican Beeler is a graduate of the U.S. Naval Academy, and served in the United States Navy from 2010 to 2019.

Andrew began pursuing his Masters in Public Policy at the University of Chicago, but opted to return to Michigan with the 83rd district House seat became available.

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MSMS 2021 LEGISLATIVE PRIORITIES The following are the legislative issues we are prioritizing in 2021. The majority of our resources and efforts will be dedicated to action on these issues.

Prior Authorization and Step Therapy Reform

Team-Based Care/ Scope of Practice

The prior authorization process diverts valuable resources away from direct patient care, can delay the start or continuation of necessary treatment, and can negatively impact patient health outcomes. Step therapy, also known as fail first, is another practice that disrupts patient care by requiring patients to try other therapies before being approved for the treatment that their doctor originally prescribed. MSMS will work closely with the Legislature, regulators and stakeholders on ways to streamline, standardize and make the prior authorization and step therapy process more transparent, clinically appropriate, and evidence based.

Patients are best served by a teambased approach that provides the maximum amount of choice for their care while ensuring that they benefit from the additional training and expertise having a physician on the team.

A highly functioning health care team is the best way to serve patients while addressing the other access issues, not legislation that creates silos. MSMS will continue to promote the role of the physician as the leader of the health care team and oppose any efforts to expand allied health professionals scope of practice that may put patients at risk.

POLICY OBJECTIVE: Reform prior authorization and step therapy with a focus on clinical validity, continuity of care, transparency and fairness, and timely access and administrative efficiency.

and safety of patients by opposing efforts of health care practitioners to seek licensure or recognition to perform tasks or procedures for which they lack the education, training or experience.

ACTION: Advocate for legislation to reform prior authorization and step therapy, including efforts that promote transparency, appropriate clinical decision-making, and timely processing of requests.

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POLICY OBJECTIVE: Protect the health

Telemedicine While telemedicine provided an avenue for health care providers to safely treat patients during the COVID-19 pandemic, it has proven to be an effective care delivery method that ensures convenient and timely access to patients. Further, regardless of whether a patient receives care in-person or virtually, the standard for medical care does not change. Before the outbreak of COVID-19 insurers previously covered telemedicine visits to varying extents, however, there were often obstacles such as low reimbursement, restrictions on where the patient can be located, and types of services covered. While payers did respond by removing some of the regulatory and administrative burdens during the pandemic, these policies are now reverting to pre-pandemic times.

POLICY OBJECTIVE: Achieve telemedicine parity for payment and services.

ACTION: Proactively promote phy-

ACTION: Advocate for legislation that

sician-led, team-based care efforts, including holistic approaches to scope of practice and licensure that meaningfully address care.

ensures payment and service parity for the use of telemedicine services in clinically-appropriate scenarios.

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Graduate Medical Education

Auto No-Fault Reform

Studies repeatedly demonstrate that one of the best ways to recruit and retain physicians is via local medical schools and residency programs.

Graduate Medical Education (GME) helps fill the gap in under-served areas by providing extremely low-cost care to those most in need. Michigan has been a leader in expanding medical school class sizes to address the projected demand for physician services, it is imperative that we continue to fund GME slots to allow these future physicians to learn here in Michigan, train here in Michigan, and stay here in Michigan.

Michigan was a leader in providing care to those injured in auto accidents by virtue of our no-fault statute. For 40 years, Michigan required drivers to purchase coverage in the event of a catastrophic injury. Unfortunately, in 2019, Michigan approved a sweeping change to the no-fault law, which will, among other things, have serious consequences for victims of car accidents who will need access to trauma and rehabilitation care. In addition, the new law will burden taxpayers by allowing the injured to be shifted to the Medicaid program, and it will also increase the uncompensated load and regulatory burden on physicians and facilities.

POLICY OBJECTIVE: Recruit and retain

medical talent in Michigan through an emphasis on GME funding models that appropriately reflect the health care needs of the state.

POLICY OBJECTIVE: Pursue appropriate standards and criteria for utilization review

through the Department of Insurance and Financial Services’ (DIFS) rulemaking process, including procedures for: • Acquiring necessary records, medical bills, and other information concerning the treatment, products, services, or accommodations provided; • Allowing an insurer to request an explanation for and requiring a physician, hospital, clinic or other person to explain the necessity or indication for treatment, products, services or accommodations provided, and; • Appealing determinations.

ACTION: MSMS will continue to work with its partners in the Coalition for Protect-

ing Auto No-Fault (CPAN) on reforms that bring fairness to insurance rates, increase transparency, crack down on fraud, reduce lawsuits and lower health care prices for accident victims.

ACTION: Advocate for state funding for

innovative initiatives, like MIDOCS, which seek to place high need specialties in underserved areas of the state.

michiganMEDICINE® JANUARY JANUARY/ /FEBRUARY FEBRUARY2021 2021 | | michigan MEDICINE®

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2021 MSMS LEGISLATIVE & REGULATORY PLATFORM The following provides an overview of some of the top issues that comprise the MSMS legislative and regulatory advocacy platform in 2021. These are the ongoing issues we are monitoring annually on behalf of our 15,000 physician members.

Insurance and Regulatory Advocacy Support mental health parity Advocate for adequately sized physician networks Regulate narrow networks Ensure appropriate access to telemedicine Advocate regulation of silent PPO/rental networks Reduce unnecessary administrative costs Ensure payment and service parity for telemedicine

Public Health and Prevention Restore Michigan’s helmet law Support vaccine availability and oppose efforts to weaken Michigan’s vaccine laws Reduce prescription drug diversion Promote policies advancing health equity goals Reduce childhood environmental hazards Support efforts to reduce unintended pregnancies Support school-based nutrition and exercise standards Reduce gun violence through health screening, patient counseling and expanded access to mental health services

Medicaid Seek funding parity with Medicare Oppose taxes that are limited only to physicians

Professional Liability Preserve existing tort reforms Advocate for higher negligence thresholds in medical liability cases Eliminate the lost opportunity doctrine Restore legislative intent of tort reforms related to meaningful caps on noneconomic damages Restore legislative intent of tort reforms related to court rules and procedures to level the playing field for physicians Seek pilot projects of medical courts and other non-judicial alternatives to the tort system

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Seek funding sources that are fair and sustainable Support state funding for the Healthy Michigan Plan Ensure access to physician-directed care

Insurance Contracting Reform

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Limit retroactive audit timeframes Support adequate disclosure of fee screens Support appeals process that includes independent reviews Prohibit down-coding in purposes of determining medical necessity

Physician Supply and Training Increase graduate medical education funding at state level Minimize burden of medical school debt

Scope of Practice Support education over legislation as the means of increasing scope of practice Oppose independent prescriptive authority by non-physicians Support the physician-led, team-based approach to health care Support patient right-to-know/health professional credentials disclosure Advocate for liability relief for legislatively mandated standards of practice

2021 MSMS LEGISLATIVE ACTION AGENDA & STRATEGIES 2021 MSMS Legislative Action Agenda

Strategies for Accomplishing Action Agenda Work closely with county medical societies,

These specific items align with MSMS's legislative priorities. The majority of our resources and efforts will be dedicated to the following action items:

physician specialty societies, stakeholder groups and other partners to promote legislative agenda.

Continue grassroots efforts on prior authorization

Advocate for legislation to reform prior

and step therapy reform with the Health Can’t Wait Coalition.

authorization and step therapy, including efforts that promote transparency, clinically appropriate decision-making, and timely processing of requests.

Facilitate physician lobbyist meetings.

Advocate for payment and service parity for the use

Facilitate physician engagement with new lawmakers

of telemedicine.

in 2021.

Advance health equity by advocating for policy

Meet regularly with lawmakers and staff to foster

changes necessary to support public health, address structural determinants of health, and reduce health inequities.

relationships, particularly leadership and health policy committees.

Advocate for expanded access to evidence-based,

non-opioid therapies and evidence-based treatment for opioid addiction.

Pursue legislation that makes maintenance of

certification voluntary.

Advocate for state funding for innovative health

care workforce initiatives, like MIDOCs, which seek to place high need specialties in underserved areas of the state.

Advocate for appropriate utilization review

standards and criteria under Michigan’s new auto no-fault law.

Proactively promote physician-led, team-based care

legislative and regulatory efforts, including holistic approaches to scope of practice and licensure that meaningfully address care.

Prioritize grassroots engagement, including:

• Lansing Lobby Days

• Doctor of the Day

• Very Influential Physician (VIP) Advocate Program

• In-district "Coffee Hour" lobby day Align MDPAC fundraising strategy with MSMS

legislative agenda.

Promote member usage of Engage website, including

Action Center.

Deploy targeted and meaningful Action Alerts to engage physician members on issues.

Provide regular legislative updates to membership and county medical societies.

Oppose unfunded mandates that could—through

additional financial or administrative hurdles— undermine physicians' ability to care for patients.

JANUARY JANUARY// FEBRUARY FEBRUARY2021 2021 | |

michigan michiganMEDICINE® MEDICINE® 17 17

Michigan’s State House and Senate Select New Leaders for the 2021-2022 Session

Representative Jason Wentworth (R-Farwell)

W

ith Republicans retaining the majority in the House of Representatives, Rep. Jason Wentworth (R-Farwell) was selected by his caucus to serve as the new Speaker of the House for the 101st Legislature, replacing the term-limited Lee Chatfield.

Wentworth is an Army veteran, former law enforcement official and thirdterm legislator representing Michigan’s 97th House district, which encompasses residents of Clare, Gladwin, Arenac and part of Osceola County. Prior to being elected to the House in 2016, he was the East Central Michigan Regional Coordinator for the Michigan Veterans Affairs Agency.

The new role should be a comfortable fit for Wentworth, who previously served as second-in-command as speaker pro-tempore during the most recent legislative session. Throughout his time in public office, Wentworth has been an outspoken Pro-Life and 2nd Amendment advocate. He also played a key role in reforming Michigan’s no-fault auto insurance laws in 2019 as Chair of the Select Committee on Reducing Care Insurance Rates.

Representative Donna Lasinski (D-Scio)

O

ne the other side of the aisle, House Democrats selected Rep. Donna Lasinski (D-Scio) to lead the caucus through the 2021-2022 legislative session.

Lasinski is now serving her third term representing the 52nd House District, which encompasses northern and western Washtenaw County, including Chelsea, Dexter, Manchester, Saline and Whitmore Lake. Lasinski is a member of Tax Policy and Insurance Committees, and she also serves as minority vice chair of the Energy Policy Committee.

In her previous two terms, Lasinski has proven to be a vigorous advocate for Michigan’s environment and its schools. During her first term, Lasinski fought and won for stricter clean-up standards for 1,4 dioxane and cosponsored legislation to set safe PFAS standards for drinking water.

While Wentworth has not yet offered many specifics on policies or legislative priorities for the House in the coming year, he has made a point to indicate that the House will continue to partner with the Senate, House Democrats and Governor Whitmer to address the needs and concerns of Michigan’s residents.

Lasinski has always been committed building strong schools and providing students everywhere with resources they need to reach their full potential, so much so, that she’s made a career out of it as the President of ThinkStretch, LCC, a K-12 education company she founded specializing in programming designed to stop summer learning loss and increase retention. The company currently operates in 38 states. She has also served as the Treasurer of the Ann Arbor School Board, Director of the Washtenaw County Association of School Boards and various other education engagements over the years.

“Going forward this caucus will continue to lead on important issues” said Wentworth. “We will continue to pursue bold reforms. And we will continue to deliver real results for the people who put their faith in us. We will never stop fighting for the people of this state.”

“I am honored to have earned the trust and support of my colleagues to be the next Democratic Leader-elect,” said Lasinski. “I am looking forward to working together in the 101st Legislature to build an agenda and set a strategy to deliver results for the people of the state of Michigan.”

Wentworth resides in Farwell with his wife and three daughters.

Lasinski resides in Scio with her husband Mike and their three boys.

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The start of the New year also marks the start of a new legislative session for Michigan’s Legislature, and leading the way for the state House and Senate are some new faces — and some familiar ones.

Senator Mike Shirkey (R-Clarklake)

M

eanwhile, Sen. Mike Shirkey (R-Clarklake) will continue to serve as Senate Majority Leader through the 2021-2022 session, a post he’s held since January 2019.

First elected to the Senate in 2014, Shirkey represents the residents of Michigan’s 16th Senate district which is made up of Branch, Hillsdale and Jackson counties. Shirkey has previously served as the chair of the Senate Health Policy and the Michigan Competitiveness committees, and he currently chairs the Government Operations committee. Prior to his election to the Senate, Shirkey served two terms in the state House where he was instrumental in passing the expansion of Medicaid in Michigan as well as the effort to make Michigan a Right to Work state.

Shirkey has also had an impressive career outside of the Legislature. An engineer by trade, Shirkey is the founder and owner of Orbitform, a specialty engineering and manufacturing company headquartered in Jackson.

Orbitform is a leading designer and manufacturer of forming, fastening, joining and assembly equipment for use by other manufacturing companies. Shirkey founded Orbitform in 1984, and today the company supports over 100 jobs in the Jackson community. Prior to starting to his business, Shirkey spent 13 years working for General Motors in various engineering and management roles.

Looking ahead to 2021, the Shirkey-led Senate is expected to continue focusing its efforts on providing relief for families, communities and businesses impacted by COVID-19 and will continue to work on policies to make Michigan the best possible place for families, talent and job creators.

Shirkey and his wife, Sue, are proud parents to three children and grandparents to several more.

Senator Jim Ananich (D-Flint)

T

hings are also holding steady for the top of the party on the other side of the aisle, with Sen. Jim Ananich (D-Flint) set to return to lead the Democrats as Senate Minority Leader.

Ananich represents the 27th State Senate district, which includes the city of Flint and much of Genesee County—a position he has held since 2013 when he won a special election to fill the seat. Following his reelection to the Senate in 2014, Ananich was selected his peers to serve as Senate Minority Leader. He was again selected to lead the caucus in 2018 and holds the distinction of being the first to be elected leader of a senate caucus more than once in the era of term limits. Much of Ananich’s time in the Senate has been devoted to helping his community overcome the Flint water crisis—an ongoing disaster that began near the start of Ananich’s career in the Senate.

Before his time in in the Senate, Ananich represented his community as a member of the Michigan House of Representatives. He also served four years on the Flint City Council.

Prior to becoming a legislator, Ananich was an educator, teaching civics and government at Carman-Ainsworth and Flint Community Schools.

Ananich resides in Flint with his wife, Andrea, and their son, Jacob.

Learn more online!

Michigan House: www.house.michigan.gov Michigan’s Senate: www.senate.michigan.gov

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MSMS Government Affairs Team Works to Transform Physicians’ Voices into Michigan Public Health Outcomes If 2020 has taught us anything, it’s about the importance of voice.

Whether it’s a public health official or an underrepresented member of our society, there are voices all of us must hear and heed if we’re going to grow stronger as a state.

A

mong those many diverse voices is one that should feel closer to each of us, and it’s one that comes from a local physician.

Each of us looks to our health care providers for information, support and personal attention so when it comes to making important choices to preserve a person’s well-being, it’s quite often a physician’s voice that matters most.

The challenge comes in making sure that influence is heard. Together, 15,000 individuals can certainly generate a lot of noise. But without a uniting force, it’s often just that—noise.

The Michigan State Medical Society prides itself on serving as that unifying entity for Michigan’s physicians, giving a clear and strengthened voice to the over

BENJAMIN LOUAGIE, MSMS CHIEF OPERATING OFFICER

“It’s our job to aggregate the knowledge, experiences, views and voices of our state’s 15,000 physicians and amplify them within the state legislature.”

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| JANUARY / FEBRUARY 2021

15,000 members across the state who are united in their efforts to better serve and advocate for the needs of their patients and the Michigan medical community.

“At the Michigan State Medical Society, it’s our job to aggregate the knowledge, experiences, views and voices of our state’s 15,000 physicians and amplify them within the state legislature,” said Benjamin Louagie, MSMS Chief Strategy Officer who leads all advocacy efforts for the organization. “We work hard to represent them well, adding important perspectives to crucial public policy discussions and helping advance the health of our state as a whole.”

It’s a critical job, and one that’s far bigger than any one person – something Louagie knows all too well. Thankfully, he has a growing government relations team behind him that has proven to be more than capable of carrying out this important work.

Joining that team is new Senior Director, Josiah Kissling. In his new role with MSMS, Kissling will lead state and federal advocacy efforts and serve as the organization’s chief lobbyist. With over a decade spent working in and around the Michigan legislature, Kissling brings the kind of extensive experience and familiarity with lawmakers and the legislative process that will undoubtedly strengthen MSMS’s ongoing advocacy efforts.

quickly and safely, and Stacey Hettiger, Senior Director of Medical and Regulatory Policy has been at the helm of that critical effort.

JOSIAH KISSLING MSMS SENIOR DIRECTOR

“I’m honored to do my part to work to strengthen [physicians’] voice and influence as they advocate for the needs of Michigan’s patients.”

Before joining MSMS, Kissling served as the legislative director for the Speaker of the Michigan House of Representatives, serving under both Speakers Tom Leonard and Lee Chatfield. Prior to that, Kissling served as budget director and deputy policy director for the Michigan House of Representatives.

“I couldn’t be more excited to be joining the team here at the MSMS,” said Kissling. “Our physicians are such a vital component of our communities, and I’m honored to do my part to work to strengthen their voice and influence as they advocate for the needs of Michigan’s patients.”

“MSMS members have learned a great deal since the first cases of coronavirus were diagnosed in our state,” said MSMS’ Hettiger. “Our state’s physicians have been dedicated to healing and sharing their challenges, opportunities and successes in battling this pandemic at all levels.”

BOBBY MUKKAMALA, MD, MSMS PRESIDENT

“MSMS works to amplify physician voices…not just during times of pandemic, but any time public health considerations are on the table.” pandemic, but any time public health considerations are on the table.”

STACEY HETTIGER, MSMS SENOR DIRECTOR OF MEDICAL AND REGULATORY POLICY

“Our state’s physicians have been dedicated to healing and sharing their challenges, opportunities and successes in battling this pandemic.”

That’s work that’s taken on an additional significance in the wake of COVID-19. More so than ever before, people are looking to physicians and their unique expertise to inform policy and decision-making in response to a global pandemic.

It’s work MSMS has always done, even before the pandemic. Indeed, MSMS is vocal on issues ranging from insurance coverage and regulatory requirements to physician education, professional liability, and public health and prevention. The organization has a long and distinguished history of advocacy on behalf of medical experts and the patients they serve.

MSMS member physicians are keenly aware of what works—and what doesn’t—in the fight against COVID19 and are eager to help support sound public policy decisions now and in the future. As a result, MSMS has been working closely with the governor, state agencies and the Legislature to ensure Michigan can move past this pandemic

“We’ve often heard Gov. Whitmer say she is using science and data to make critical public policy decisions, and it’s our organization that helps bring this crucial research, knowledge and experience to the table,” said MSMS President Bobby Mukkamala, MD. “MSMS works to amplify physician voices and experiences not just during times of

And sometimes hearing directly from the physicians themselves is what resonates most with lawmakers. That’s where Josh Richmond, senior director of physician engagement, and Scott Kempa, grassroots advocacy manager, come in. Together, the grassroots advocacy team works to recruit new physician members to the Michigan State Medical Society and then helps them to directly communicate and engage with lawmakers on the things that are most important to them.

State and federal government relations specialist Mary Kate Barnauskas and the lobbying professionals at Capitol Strategies Group round out the impressive and growing advocacy team at MSMS. “We couldn’t ask for a finer, more talented team of individuals to speak for our state’s physicians,” Doctor Mukkamala said. “They do a great deal of essential work for MSMS and have the benefit of the organization’s 156 years of speaking for our state’s physicians on their side.”

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Interstate Licensure for Telehealth Can Fuel Medical Practice Growth Chad Anguilm, David L. Feldman, MD, and Remi Stone, JD

When it comes to using telehealth to treat patients out of state, most physicians are mindful about licensure issues. But some are not aware that if you don’t have a license to practice medicine in a given state, it isn’t just malpractice: It’s a criminal offense.

and place of service provides ample opportunity to approach a national telehealth platform. If properly implemented, interstate telehealth care can fuel practice growth. Physicians have an incentive to understand both the risks and the benefits of practicing across state lines.

icensing restrictions have been eased to facilitate care during the pandemic, and the new normal of greater state-to-state cooperation for access to care may persist after the pandemic. Still, the savvy physician knows that many restrictions apply, and that understanding them reduces risk.

the physician with a question or a problem from another state while traveling.

In such a case, the physician can simply address the patient’s concerns, whether that’s by a phone conversation, a telemedicine visit, a recommendation to go to the emergency room where they are, or whatever is appropriate, according to their best clinical judgment. That’s just practicing good medicine.

State Laws vs.

Insurer Requirements

First-Time Visits vs.

Established Patients

But caution is required when planning for ongoing interactions with patients who will be across state lines from the physician as their regular routine, or when booking an initial interaction via telehealth with a new patient who is in another state.

Coverage from The Doctors Company follows our members wherever they practice in the U.S., provided they are acting within the scope of the law (which is where legal restrictions on state-to-state practice and insurance coverage overlap). But other insurers may have specific limitations about practicing in another state, independent of any legal restrictions.

L

When we talk about interstate licensure, we’re not concerned with a onetime interaction with an established patient who happens to be traveling. For instance, say a physician has recently seen a patient, perhaps performed a procedure. Thereafter, the patient calls

22 michigan MEDICINE®

That said, for practices interested in growing their patient base, the recent easing of restrictions related to licensure

| JANUARY / FEBRUARY 2021

In addition to distinguishing established patients from first-time patients, and distinguishing one-time interactions from long-term care plans, it’s important to separate restrictions imposed by state laws from restrictions imposed by a physician’s insurer.

Contributed by The Doctors Company

thedoctors.com

Many insurance companies will say that they want a physician’s coverage and practice to be in the state that they’re in, whether the physician is treating via telehealth encounter or in-person visit, because of differences in how a lawsuit is defended from state to state. There are differences in the plaintiffs’ bar, in the rules, in the judges, in the courts.

Physicians should make sure their insurer has the expertise to defend them wherever they practice.

The Interstate Medical Licensure Compact Commission The Interstate Medical Licensure Compact Commission (IMLCC) makes it easier for physicians to practice state to state. The compact is an agreement between states, and it requires the passage of legislation in any new state that wants to join. It currently includes nearly 30 states and territories. As of this writing, several states have introduced

legislation to join the compact, so that number could soon rise. The IMLCC doesn’t mean that if a physician has a license in one state, they can automatically practice in another, but it makes it easier. Through the IMLCC, physicians will still need to gather documents and pay fees, but the IMLCC will streamline the process.

(CONTINUED ON PAGE 24)

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Contributed by The Doctors Company

thedoctors.com

(CONTINUED FROM PAGE 23)

The IMLCC was launched in 2017, and by summer 2019, had already issued nearly 7,000 licenses. The great value of the IMLCC has been proven by the pandemic, and as telemedicine usage increases, we can expect to see only more physicians needing licenses in multiple states.

In addition to making life easier for physicians, the IMLCC improves health care access by making it easier for patients in rural areas, for example, to see specialists via telemedicine.

Prescribing across State Lines Additional caution is required when prescribing may be involved. During the first wave of the pandemic in the spring of 2020, many states temporarily waived various requirements affecting state-to-state licensure. This includes, in many states, the common requirement that physicians see a patient in-person first, before prescribing remotely. Many of those waivers persist to the present.

Controlled substances, especially, require caution when prescribing state to state, but in the spring of 2020,

the Drug Enforcement Administration (DEA) temporarily lifted some restrictions around prescribing controlled substances by remote visit to patients the physician had not met in person.

The key word here is “temporarily.”

Just as we lived within a patchwork of state-to-state restrictions before the pandemic, now we can expect those restrictions to return in a non-synchronized fashion. One state may restore restrictions next week, another not until next year. Physicians should inquire whether their local health authority and/or specialty association will be tracking as states lift these restrictions.

Physicians do not want to be surprised by a charge from the DEA.

Stepping Forward Although we face professional and legal risks when practicing medicine across state lines, these risks may be mitigated by administrative effort, and the rewards for doing so are substantial.

Those rewards range from the personal, enjoying the ease and satisfaction of being able to provide care from the comfort of, perhaps, a home office, to

“Although we face professional and legal risks when practicing medicine across state lines, these risks may be mitigated by administrative effort, and the rewards for doing so are substantial.”

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| JANUARY / FEBRUARY 2021

the business rewards of being able to offer telemedicine in multiple states— which is especially appealing given that some of the telehealth-friendly reimbursement rates introduced during the pandemic will persist.

In fall 2020, the Centers for Medicare and Medicaid Services (CMS) has added 11 new telehealth services that Medicare will reimburse for the duration of the pandemic. Meanwhile, commercial reimbursement rates are tightening the reigns on visit types deemed telehealth appropriate. Therefore, while pursuing interstate licensure for telehealth, as conditions continue to change, remember to keep a watchful eye on your major payers to ensure compliance.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Reprinted with permission. ©2020 The Doctors Company (thedoctors.com).

CHAD ANGUILM IS VICE PRESIDENT, IN-PRACTICE TECHNOLOGY SERVICES, MEDICAL ADVANTAGE, PART OF THE TDC GROUP OF COMPANIES. DAVID L. FELDMAN, MD, MBA, FACS, IS CHIEF MEDICAL OFFICER FOR THE TDC GROUP OF COMPANIES. REMI STONE, JD, IS REGIONAL DIRECTOR, GOVERNMENT RELATIONS, THE DOCTORS COMPANY, PART OF THE TDC GROUP OF COMPANIES.

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Ann Traynor, MD

David Meinhardt, MD

Asif Ishaque, MD

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Phani Deepthi Vadlamudi, MD

Nidhi Mishra, MD

Wayne Prokott, DO

Mark Rittenger, DO

Shreya Wachob, DO

Jean-Lucien Omekanda, MD

Senthil Ramaiyah, MD

Mary Slominis, MD

Michael Wertheimer, MD

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Michael Stack, MD

Lena Widman, DO

Michael Paulsell, MD

Ziauddin Syed, DO

Ahsen Tatar, MD

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Lester Yan, MD

Roberto Viguilla, MD

Cheryl Dwyer, DO

James Lewis, DO

Michael Yu, DO

James Ware, DO

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Chandy Ellimoottil, MD

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MIDLAND COUNTY

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Jeffry Chen, MD

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Danielle Graham, DO

William Michael Mellana, MD

William Davis, MD

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David Buzanoski, MD

Vesna Ivancic, MD

Elvira O'Brien, MD

Peter Knoester, MD Zachary Miller, MD Diana Nordlund, DO, JD Don Powell, DO

Terri Zomerlei, MD

Jessica West, DO Sameera Khan, MD Daniel Malach, MD Satyum Parikh, MD

Gayle Byker, MD

Pankaj Jandwani, MD

Frederick Ogwara, MD

Jansi Willoughby, MD

Querobin Calvan, MD

Thomas Johnson, MD

Maduabuchi Okoro, MD

Jansi Willoughby, MD

John Carr, MD

Robert Jones, MD

Nicholas Osborne, MD

Maria Chan, MD

Ayodeji Joshua, MD

Ferdnand Osuagwu, MD

MASON COUNTY

Madline Chembola, MD

Bosede Joshua, MD

Neehar Parikh, MD

Christie Riemer, MD

Michael Chen, MD

Phillip Kadaj, MD

Gregory Parish, MD

Sheree Clark, MD

Sanjeevkumar Kaul, MD

Stephen Pavlock, MD

MEDICAL (CRAWFORD/ GLADWIN/ KALKASKA/ MONTMORENCY/ OTSEGO/ ROSCOMMON)

Gail Colby, MD

Adeel Khan, MD

Michelle Pedersen, DO

Alonso Collar, MD

Sehrish Khan, MD

Danita Peoples-Peterson, MD

Monica Colvin, MD

Paula Klose, MD

Tammy Phillips, MD

Constantinos Constantinou, MD

Egle Klugiene, MD

Kerry Pierce, MD

Richard Bratton, DO

Gregory Daut, MD

Rajesh Kotecha, MD

Jack Pinney, MD

Casey Dauw, MD

Kenneth Krajewski, MD

Jamie Poliskey, MD

Jeremy Davis, DO

Michael Krogulecki, DO

Emil Putrus, MD

Rebecca DeLancey, MD, MPH

Natalie Kroll, DO

Ihtesham-ur Rahman, MD

Daniel Goodin, MD

Satyendra Dhar, MD

Margueritte Kuhn, MD, FACOG

Sandeep Rao, MD

Jemellee Jacala-Tadian, MD

Vincent Dimerc, MD

Michael Lauer, MD, FACC, FSCAI

Mohamed Refaat, MD

Lyndsy McMorrow, DO

Carlos Diola, MD

Isabelle Le, MD

Kathleen Regan, MD

Robert McMorrow, DO

Waleed Doghmi, MD

Otto Leiti, MD

Thomas Regenbogen, MD

Jeffrey Strickler, MD

Alex Dombrowski, MD

Michael Levin, MD

R. Kevin Reynolds, MD

Kevin Denlinger, DO Renee Fuller, MD

26 michigan MEDICINE®

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Maged Rizk, MD, PhD, FACC, FSCAI

George Zainea, MD

Muhammad Ghani, MD

Naveen Sangji, MD

Naheed Rizvi, MD

Syed Zamir, MD

Kaushik Govindaraju, DO

Julia Savage, MD

Syed Rizvi, MD

Lindsay Zeeb, MD

Joshua Grant, MD

Drew Scoles, MD

Gregory Zivic, MD

John Hagan, DO

Stephen Seedial, MD

Russell Hyde, DO

Vandan Shah, MD

MUSKEGON COUNTY

Nicholas Katcher, MD

Kamran Shah, MD

Scott Ross, MD

Andrew Alwood, DO

Adeeba Khan, MD

Ruta Sharangpani, MD

Rami Safadi, MD

Neil Droppers, DO

Jacob Kolker, MD

Owen Stark, MD

Simpa Salami, MD

Andrew Fras, MD

Daniel Lin, MD

Javeria Syed, MD

Susan Sallach, MD, FACC

Blake Miller, DO

Wynee Lou, DO

Elias Taxakis, MD

Kenneth Mac Kinnon, MD

Miriam Thomas, MD

Vickie Mello, DO

Matthew Trese, DO

Mary Moore, MD

Robert Waller, MD, MS, FACEP, ABAMc

Lourdes Morales-Dopico, MD

Christian Wichterman, MD

Mary Oatey, DO

Joel Wilkie, MD

Sujal Patel, MD, FACS

William Young, MD

David Roden, MD George Roller, MD Richard Ross, DO

David Santini, DO

Lindsay Rudert, DO

Sasha Savage, MD

Avanthi Tudor , MD

Rachel Sawaya, MD

Robington Woods, DO

Zachary Sawaya, MD Linda Selwa, MD

NORTHERN MICHIGAN

Melwyn Sequeira, MD

Todd Hickox, DO

Gerald Serwer, MD

Ann Kuenker, DO

Asha Shah, MD

Carmen Ventocilla, MD

Pratima Sharma, MD James Shepich, MD

OAKLAND COUNTY

Oluwafemi Showole, DO

Soyoun Bark, MD

Maria Shvab, MD

Danielle Barnes, MD

Oluwakemi Soetan, MD

Marc Brodsky, MD

Akintayo Sokunbi, MD

Alison Lee, MD

Randolph Sosolik, MD

Donald Meier, MD

Denise Stadelmaier, DO

Saroj Misra, DO

Scott Stevens, DO

Dianne Plath, MD Majed Sahouri, MD

WAYNE COUNTY

Mohammed Saleem, MD

Andrew Bissonette, MD

Joseph Shawi, MD

Thomas Capobres, MD

Renee Sundstrom, DO

Brian Florek, MD

Brian Tesler, MD

Michelle Nguyen, MD

Muhammad Vasiq, MD

Dylan O'Reilly, MD

Jessica Winton Li, MD

WEXFORD/MISSAUKEE COUNTY

ST CLAIR COUNTY

Anne Broad, MD

Pietro Cavataio, MD

Cecilia Dietrich, MD

Antonino Colombo, MD

Chelsea Kirby, MD

Jeffrey Striebel, DO

OGEMAW/OSCODA COUNTY

Carolyn Swenson, MD

Spencer Bertram, MD

Monica Tadros, DO

Vincent DeMatio, MD

Travis Taylor, DO

David Hunter, MD

Anita Tekchandani, MD

Patrick Morse, MD

Gerald Tomasek, MD

Rachel Ransom, MD

WASHTENAW COUNTY

Shitanshu Uppal, MD

Asma Saboor, MD

Leslie Allen, MD

Dennis Van Dorp, MD

Richard Schulz, DO

Jesse Walker, MD

Mark Weber, MD

Julian Wan, MD

Kayla Stefanko, DO

ST JOSEPH COUNTY Luke Saski, MD, FACEP

Robert Arnold, MD Matthew Caid, DO Eric Davis, MD Karla Feretti Xavier, MD

Shengfu Wang, MD

SAGINAW COUNTY

Yu Wang, MD

Rikat Baroody, MD

Kyle Williams, MD

Katherine Battisti, MD

Carl Winegar, MD

Robert Battisti, MD

Kelly Wirsing, MD

Timothy Brown, MD

Karla Witzke, DO

Moonyoung Chung, MD

Taylor Wofford, MD

Erik Colegrove, MD

Ian May, MD

Andrew Wolford, DO

Tessa Dake, MD

Aditi Mitra, MD

Kara Wyant, MD

Amandeep Dhaliwal, MD

Deborah Peery, MD

Guangbin Xia, MD

Yolanda Fong, MD

Caitlin Porubsky, DO

David Yonick, MD

Franchesca Garcia-Robles, MD

Walter Sahijdak, MD

Anna Gladstone, DO Aazam Haleem, MD Timothy Hanley, DO Zachary Jarou, MD Matthew Macias, MD

We are delighted to welcome you all as new members of the Michigan State Medical Society.

Deepa Malaiyandi, MD

JANUARY / FEBRUARY 2021 |

michigan MEDICINE®

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MSMS ON-DEMAND WEBINARS The MSMS Foundation has a library of on-demand webinars available, many of which are free, making it easy for physicians to participate at their convenience to meet their educational needs.

Webinars that Meet Board of Medicine Requirements: A Day of Board of Medicine Renewal Requirements

Michigan Automated Prescription System (MAPS) Update

Human Trafficking

Naloxone Prescribing

Medical Ethics – Conscientious Objection among Physicians

Pain and Symptom Management 2020

Medical Ethics – Confidentiality: An Ethical Review

Prescribing Legislation

Medical Ethics – Decision Making Capability

Tapering Off Opioids

Medical Ethics – Just Caring: Physicians and Non-Adherent Patients

The CDC Guidelines

Medical Ethics – Reclaiming the Borders of Medicine: Futility, Non-Beneficial Treatment, and Physician Autonomy

The Current Epidemic and Standards of Care

Pain and Symptom Management Series

Treatment of Opioid Dependence

Balancing Pain Treatment and Legal Responsibilities

Update on the Opioid Crisis 2019

MAPS Update and Opportunities

28 michigan MEDICINE®

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The Role of the Laboratory in Toxicology and Drug Testing

COVID-19 Webinars:

Other Webinars:

2020 Fall Symposium on COVID-19 Day One 2020 Fall Symposium on COVID-19 Day Two AMA Advocacy and Physician Resources Best Practices for Implementation of Telemedicine

Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities HEDIS Best Practices In Search of Joy in Practice: Innovations in Patient Centered Care Integrating Pharmacists into Practice:

CARES Act Impact CARES Act Impact: Q&A with CPAs CARES Act Impact: Q&A with CPAs Part 2 Leading Through Crises: Financial Guidance and Strategies

The Missing Link for Comprehensive Medication Therapy Management Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage

Medical Practices and Employment/ HR FAQs

Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media

New Employment Policies for Practices

Medical Marihuana Law

New Waivers and Billing Changes for Telemedicine

Medical Necessity Tips on Documentation to Prove it

Race Inequalities and COVID-19: Contagion, Severity, and Social Systems

Non-Pharmacologic Management of Musculoskeletal Pain Syndromes

Safe and Innovative Office Procedures for Seeing Patients

Section 1557: Anti-Discrimination Obligations

Telemedicine and Other Technology Codes in a COVID-19 Environment

Sexual Misconduct – Prevention and Reporting

Testing, Tracing and Tracking

Update on Chronic Fatigue Syndrome Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS

The Changing Health Care Landscape: Preventing Diabetes During and Beyond the Pandemic What Physicians Need to Know as Employers During the COVID-19 Pandemic

Update on Chronic Fatigue Syndrome Part 2: Uniting Compassion, Attention and Innovation to treat ME/CFS

To register or to view full course details, visit https://connect.msms.org/Education-Events/On-Demand-Webinars.

Once registered, you will receive an email within 15 minutes with links to watch the on-demand webinar and to complete the survey evaluation.

Contact: Beth Elliott at 517/336-5789 or belliott@msms.org JANUARY / FEBRUARY 2021 |

michigan MEDICINE®

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ADVOCACY

Five Reasons to

BACK the PAC The Michigan Doctors’ Political Action Committee (MDPAC) builds and maintains strong relationships with lawmakers, as well as candidates running for political office.

As the face of physicians, MDPAC bring medical knowledge into

Activate your political voice!

The Michigan Doctors’ Political Action Committee (MDPAC) is the political arm of the Michigan State Medical Society.

It is a bipartisan political action committee made up of physicians, their families, residents, medical students and others interested in making a positive contribution to the medical profession through the political process. MDPAC supports pro-medicine candidates running for political office in Michigan.

Physician engagement is essential to the success of a pro-medicine legislature. Current and potential lawmakers want and need to hear from professionals in the field of medicine. Through MDPAC, you will activate your voice on the things most important to Michigan physicians.

discussions with political decision makers.

For more than three decades, MDPAC has mounted successful lobbying efforts on behalf of physicians.

For example... MDPAC protects and strengthens tort reform, stopped the physician’s tax, and has

helped to stop the expansion of a non-physician’s scope of practice.

MDPAC has power, prestige and respect! If you wake your sleeping giant, MDPAC could make rapid, positive change for physicians and patients. It could ease administrative pressures with the current prior authorization process, save you money

and time on your Maintenance of Certification, and advance public health issues.

Trial lawyers, insurance companies, and other political opponents raise massive sums of money.

Medicine’s friends, through MDPAC, must dig deeper to raise equivalent or greater amounts of funds to advance Michigan

physician’s agenda.

Get started today at MDPAC.org

The current political landscape is uncertain.

Only through a well-funded, unified voice will physicians and their patients’ interests be heard.

MDPAC is that voice.

Get your voice heard by contributing today at MDPAC.org

16 michigan MEDICINE

| JULY / AUGUST 2017

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The HLP attorneys represent clients in substantially all areas of health law, with particular emphasis on: • Licensure & Staff Privilege Matters • Health Care Litigation • Health Care Investigations • Civil & Criminal False Claims Defense • Stark, Anti-Kickback, Fraud & Abuse, and Other Regulatory Analyses • Physician Group Practice Ancillary Services Integration and Contractual Joint Ventures • Appeals of RAC, Medicare, Medicaid and Other Third Party Payor Claim Denials and Overpayment Demands • Health Care Contractual, Corporate, and Transactional Matters • Compliance & HIPAA

TheHLP.com [284.996.8510] JANUARY / FEBRUARY 2021 |

michigan MEDICINE®

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