The Award-Winning Journal of the Michigan Osteopathic Association S P R I N G 2019
MICHIGAN MOA OSTEOPATHIC ASSOCIATION
w w w. D O M O A . o r g
michiganosteopathic
MichiganDOs
m i c h i g a n - o s t e o p a t h i c- a s s o c i a t i o n
lawsuits
insurance coverage concerns accountable care
financial pressures
cyber security
patient demands
patient care
EHRs
big data
shifting FDA regulations
risk of medical errors
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CONTENTS
Think Spring
www.domoa.org/spring2019
Thursday, May 16 - Sunday, May 19, 2019 1500 Town Center Southfield, MI 48075
Columns 05 President’s Page
FEATURES 11
120th Annual Spring Scientific Convention
Connection
17
Former MOA Student Trustee Named National Student DO of the Year
27 Advertiser Index
18
Health Equity - The Role of the Hospital
Contributed by Michigan Health and Hospital Association
20
MSUCOM Global Outreach Program
22
Patient Engagement: Challenges & Strategies
Contributed by Coverys
24
We Need a Code of Empathy
Contributed by Healthcare Partners of Michigan
08 Ask Our Lawyer 26 Component
MICHIGAN MOA OSTEOPATHIC ASSOCIATION 3
Michigan Osteopathic Association
Fulford Legacy Conference ))
Michigan Osteopathic Association 2445 Woodlake Circle, Okemos, MI 48864 domoa.org | P 517-347-1555 | F 517-347-1566
BAS I C PE RC US S I O N C OUR S E
Conference Fulford Legacy Friday, Nov. 22) )- Sunday, Nov. 24, 2019
BAS I C PE RC US S IO N COUR S E
)
)
Sheraton Detroit Novi Hotel (Ballrooms A-B) November 22 - 24, 2019 21111 Haggerty Road, Novi, MI 48375
Sheraton Detroit Novi Hotel 23 AOA Category 1-A credits anticipated. This course describes the power of healing concepts which expand on the Agenda & registration at www.domoa.org/fulford
Michigan Osteopathic Association
teachings of Andrew T. Still, DO. Instructed by Richard W. Koss, DO, Michigan Osteopathic Association 2445 Woodlake Circle, Okemos, MI 48864
who first attended Dr. Fulford’s percussion course in 1987 before domoa.org | P 517-347-1555 | F 517-347-1566
23 NMM-Specific AOA Category 1-A Credits
completing his residency in Osteopathic Manipulative Medicine at A.T. Still University-Kirksville College of Osteopathic Medicine (ATSU-KCOM), Missouri.
Legacy The basic percussion “hammer”Conference course Dr. Koss worked alongside Dr. Fulford to design and teach Fulford ))
)
BA S I C on PE C U S S I& Oosteopathic N C O U R S Ethe Basic and Advanced Percussion Hammer courses for over is based theRphilosophy eight years up to his passing in 1997. Since then, Dr. Koss November 22 - 24, principles practiced by 2019 Robert C. Fulford, DO, has lead trainings internationally on Fulford’s philosophy of Sheraton Hotel authorDetroit of “TouchNovi of Life: The Healing 23 AOA Category 1-A credits anticipated. osteopathic healing and the use of the Fulford Percussor. Power of the Naturalat Life Force” and Prerequisites: Agenda & registration www.domoa.org/fulford ”Are We on the Path?”
Attendees must have completed a 40-hour introductory cranial course taught by an Osteopathic Practitioner so that they have developed the hand sensitivity and anatomical understanding necessary to successfully understand the course materials.
Early Bird registration until Nov. 1 at www.domoa.org/fulford
Credit card payment taken by phone, fax or online. Checks accepted by mail, made payable to MOA.
PREREQUISITES: By registering, I certify that I have or will have completed required courses (described on reverse) before the conference _____ Initial FRIDAY 8 AM - 6 PM
Speakers:
Name ________________________________________________________________________________ Richard W. Koss, DO, C-SPOMM, C-ACOFPAOA Number __________________________________ SATURDAY 8 AM - 6 PM (to appear on badge)
William H. Stager, DO, MS, MPH, FAAFP, FAAMA, FAAO, FACOFP dist. Phone Number _________________________________________________ Email address ____________________________________________________________ SUNDAY 7:45 AM - 3 PM
PAYMENT:
OPTION 1 - Credit card
MasterCard
Visa
Discover
OPTION 2 - Check #_____________ Made payable to MOA
Cancellation Policy: Requests for refunds by October 31, 2019 and will entitle registrant to a full refund less a $200 fee.
Name on credit card ____________________________________________________________
Early Bird registration until Nov. 1 at www.domoa.org/fulford
Credit card number _________________________________________________________________Exp. date ______ /_______ CVVpayable code _______________ Credit card payment taken by phone, fax or online. Checks accepted by mail, made to MOA. Billing Address ____________________________________________________________ City ________________________________ State________ Zip _______________
PREREQUISITES: By registering, I certify that I have or will have completed required courses (described on reverse) before the conference _____ Initial Travel & Lodging: Name ________________________________________________________________________________ AOA Number __________________________________ For out-of-state travel, closest airport: Sheraton Detroit Novi Hotel (to appear on badge) Detroit Metropolitan Wayne County Airport (DTW) 21111 Haggerty Rd, Novi, MI 48375 Phone Number _________________________________________________ address ____________________________________________________________ 18.6 miles from Sheraton, transportation not included Reservations: $139/room + tax if made by Oct. 22 - CallEmail 248-349-4000 Call hotel to coordinate special assistance (wheelchair access, accommodations, etc.)
PAYMENT:
OPTION 1 - Credit card
MasterCard
Visa
Discover
OPTION 2 - Check #_____________ Made payable to MOA
Statement of Policy: Accreditation: TheforMichigan Association is accredited by the (AOA) to provide osteopathic Cancellation Requests refundsOsteopathic by October 31, 2019 and(MOA) will entitle registrant to aAmerican full refundOsteopathic less a $200Association fee. continuing medical education for physicians. MOA designates this program for a maximum of 23 AOA Category 1-A credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in this activity.
Name on credit card ____________________________________________________________
Credit card number _________________________________________________________________Exp. date ______ /_______ CVV code _______________ 4
T R I A D | S P R I N G 2019
Billing Address ____________________________________________________________ City ________________________________ State________ Zip _______________
PRESIDENT’S PAGE Patient Focused Care
T
his issue of The Triad is directed toward Patient Focused Care. This is why our profession exists. As osteopathic physicians we have been trained in this approach for our practices since medical school. The core of our profession is and always has been the care of patients in need. Our training is to focus on the patient care. Our osteopathic research and literature have a long history of being heavily weighted toward patient centered outcomes and improved treatments.
Lawrence L. Prokop, DO, FAAPM&R, FAOCPMR-D, FAOASM MOA President
To their credit, the Michigan Osteopathic Association (MOA) and Michigan State University College of Osteopathic Medicine (MSUCOM) have supported extracurricular volunteer projects for the medical students which give them the experience of meeting with real patients in need of care, learning patient focused care. One of these venues is the Spartan Street Medicine program. In this program, our students (under physician supervision) interview and examine patients who have no other access to healthcare and who are often homeless. As the students interview patients, they learn how to search for the medical clues to come up with the diagnosis and treatment. They also learn how to listen to the needs of the individuals seeking help. They get a very practical education in paying attention to those individuals and how their lives and health are affected by family history, nutrition, good personal choices and bad personal choices. They learn that there is much more to the art and practice of osteopathic medicine than learning what is in the textbooks. They learn that focusing on the individual patient will prove much more valuable than time with a textbook. I have been fortunate to work with the students in this environment. I’ve witnessed the excitement and the pride students have when they realize the impact these experiences have on not only shaping them as physicians, but in giving back to the patients.
Most of us entered Osteopathic Medicine to take care of patients. The specialties may differ but the underlying purposes the same. Most of us entered osteopathic medicine to take care of patients. The specialties may differ but the underlying purposes the same. During our careers we deal with a huge amount of stress not discussed in medical school. From loan repayments to continuing medical education requirements, to staff and personnel issues, much of our professional lives are taken up with non-patient care needs. It is my hope for all of us that we periodically take time to remember and relive that excitement that we felt the first time we talked to patients and understood their story about their lives and their healthcare needs. Doing this can improve our evaluations and our treatments. It can show our patients how much we care. This will increase the likelihood of the patients following the treatment plans we develop for them. It enriches us and renews us to be patient focused. This is truly practicing medicine osteopathically. TRIAD
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JOIN OUR COMPASSIONATE TEAM
metrohealth.net/careers Contact: Linda.Gommensen@metrogr.org | 616.252.5289
MICHIGAN OSTEOPATHIC ASSOCIATION
15th Annual Autumn
SCIENTIFIC CONVENTION
24 AOA 1-A credits November 8-10, 2019 Amway Grand Plaza, Grand Rapids w w w.domoa.org/gr2019
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OBGYN Specialty Session International Medicine LARA Requirements Neurology
Scientific Research Competition Dermatology Lifestyle Medicine Risk Management
Patient Satisfaction in the ED/Hospital
Pediatrics
Celebrating Brain Injury Awareness Month Brain injury is often referred to as an “invisible� injury or disability since the effects of the injury are not always visible or immediately evident. However, to anyone who has suffered a brain injury, or to those that care about someone who has, the effects of brain injury are complex and can pervade many aspects of the individual’s life. We are proud to join brain injury survivors, caregivers, and supporters in celebrating Brain Injury Awareness Month. For decades, the Brain Injury Association of America (BIAA) has led a nationwide public awareness campaign during the month of March to de-stigmatize brain injury through outreach and education. According to the Brain Injury Association of Michigan (BIAMI), in Michigan alone, 58,500 people sustain a brain injury each year. The truth is that no one plans for a brain injury, but brain injuries can happen to anyone, at any time. Please join us this month as we spread awareness and educate others on the definition of brain injury, its causes, and where to seek proper rehabilitative care.
What is a Brain Injury? Just as there are no two people alike, no two brain injuries are the same. An acquired brain injury is an injury to the brain that has occurred after birth; these injuries are not a result of heredity, nor are they congenital or degenerative. There are two types of acquired brain injuries, non-traumatic and traumatic. A non-traumatic brain injury is caused by damage to the brain by internal factors, such as lack of oxygen, exposure to toxins, pressure from a tumor, and so on. A traumatic brain injury is an injury to the brain that is caused by an outside force or impact that is sudden and damaging.
Common Causes of Brain Injury? Common causes include, but are not limited to, stroke, falls, tumors, motor vehicle accidents, sports, assaults, and more.
Brain Injury Recovery Following a brain injury, it is imperative to receive the proper rehabilitative care. Brain injury survivors can experience an array of cognitive, physical, and emotional/ behavioral challenges. These symptoms can often concur feelings of hopelessness in survivors and caregivers, but there is hope. The goal of brain injury rehabilitation is to maximize function and encourage survivors to achieve their fullest potential. Origami Brain Injury Rehabilitation Center brings together a team of experts in order to tailor a care plan to the needs of each survivor. At Origami, survivors and their support systems are an essential part of the interdisciplinary team and the rehabilitation journey. Origami Brain Injury Rehabilitation Center is a 501(c)(3) non-profit organization located in Lansing, Michigan. Origami provides comprehensive rehabilitation care for survivors of brain injuries and their families. Through their compassionate and innovative services, Origami creates opportunities and transforms lives. TRIAD
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ASK OUR LAWYER
BEWARE PATIENT EMAIL COMMUNICATION B Y DA N I E L J. S C H U LT E, J.D., M OA L E G A L CO U N S E L
Q:
Patients are increasingly asking me to communicate appointment reminders, test results and even diagnosis and treatment information. Some of my colleagues advertise the capacity to email and otherwise communicate with patients electronically. What are the legal issues involved with sending/ receiving diagnosis, treatment and other medical record information by email?
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T
here has been a significant trend to increase physicianpatient communication by the use of email, internet portals and other electronic means. This trend will likely continue with the further development of the interoperability of electronic health records, e-prescribing methodologies and other uses of health information technologies to control healthcare costs, increase efficiency, promote pay for performance and generally to expand access to medical care. The use of email to communicate with patients is not without regulation or risk. HIPAA’s Security Rule must be complied with and you should consider the effect email messages might have on your ability to defend yourself in a malpractice case.
HIPAA’s Security Rule sets forth administrative, technical and physical security procedures to required to be implemented by covered entities (e.g. physicians) to ensure the confidentiality of electronic protected health information. This information includes most medical record information maintained, transmitted, etc. in an electronic form, like emails. Your practice must meet the Security Rule’s Standards by adopting its Implementation Specifications (guidelines for how each Standard may be met). Which Standards will apply to your practice and the Implementation Specifications you should employ to meet those Standards will vary depending on the size, available resources, etc., of your practice. One such Standard applicable to patient
emails is the Transmission Security Standard. This Standard requires the use of measures to prevent unauthorized access to electronic protected health information when that information is communicated electronically. The most used method to comply with the Implementation Specifications for the Transmission Security Standard is encryption. The specification requires use of software or a third party service to encrypt patient emails (i.e. converting them into unreadable text that is later converted back into comprehensible text when received by the patient). You do not want to be the physician who shares protected health information via an unencrypted commercial email service. If this information is breached in some way you will be required to comply with HIPAA’s breach notification rule (the details of which are outside of the scope of this article but may include public notice of the breach, paying for credit
monitoring services for patients, etc.) in addition to becoming potentially liable for fines and damages. In addition to insuring the security of information in an email during transmission, you must consider the use of this type of communication in medical malpractice litigation. Your emails to patients can and will be used as evidence. Whether you messages will help or hurt your defense will depend on the content of the email, the propriety of its use in a given situation, etc. Physicians communicating with patients regarding their diagnosis and treatment by email should ensure that their messages contain clearly written, complete and appropriate information. Using the same acronyms, abbreviations, shorthand descriptive terms, etc., that you would in documenting something in a patient’s medical record will likely not be viewed as appropriate in an email to a patient. Any misunderstanding or misinterpretation by the patient that
results will certainly be used against you in malpractice litigation. All of your email communication with a patient should be retained in the patient’s medical record. The inclusion of these communications in the medical record is necessary to ensure your complete knowledge for subsequent treatment decisions and the treatment decisions of other physicians providing treatment to the patient. Finally, it is a best practice to include an auto-reply message on your system so that patients are aware you may not respond to their message immediately and letting them know that if they are experiencing what they believe to be an emergency situation to go to an emergency room without delay.
Daniel J. Schulte of Kerr, Russell and Weber, PLC, is a Certified Public Accountant as well as an attorney, and serves as MOA Legal Counsel. Contact Daniel at dschulte@kerr-russell.com
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We’ve got plans to cover all of yours. At Blue Cross Blue Shield of Michigan and Blue Care Network, we appreciate our health care providers for all they do in helping us provide access to quality, affordable care for the people of Michigan. We’d like you to know that you can also rely on us for your health care coverage. Learn more at bcbsm.com. GROUP HEALTH PLANS | INDIVIDUAL PLANS | DENTAL | VISION | BCBSM.COM
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R081363_Ad_SummerTRIADMagazine.indd 1
R081363
6/29/18 9:35 AM
Michigan Osteopathic Association
120th Annual Spring
Scientific Convention May 16-19, 2019 Westin Southfield Detroit 1500 Town Center, Southfield, MI 48075 Registration & Agenda at www.domoa.org/spring2019
RESERVATIONS: Call 888-627-8558, mention MOA Convention for discounted rate of $135.  Before your visit, be sure to check out: visitdetroit.com
Local attractions within 30 minutes of the Westin! Tigers Baseball Greenfield Village Henry Ford Museum Greektown Detroit MotorCity Casino Eastern Market Somerset Collection Detroit Zoo Motown Museum
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CME INFO Scan-In Times: THURSDAY, MAY 16
ACLS / BLS Offered as al-a-carte options, not part of regular convention
Afternoon: 3:30 – 7 PM
registration. Limited spots available. All instructional material
FRIDAY, MAY 17
updated with latest AHA Guidelines for CPR & ECC.
Morning: 6:30 AM – 1:15 PM Afternoon: 1:15 – 6 PM
SATURDAY, MAY 18 Morning: 6:30 AM – 1:15 PM Afternoon: 1:15 – 6 PM
SUNDAY, MAY 19
BASIC LIFE SUPPORT (BLS) CERTIFICATION 3 AOA 1-A Credits Friday, 7 - 10 am
Morning: 7 AM – 12 PM Afternoon: 12 PM – 4:30 PM
Process: Scan the bar code on your name badge to receive CME credit during designated times. Attest your participation by completing the mandatory online evaluations at www.domoa.org/eval. Upon completion, your CME certificate will be available to print or save to desktop for your records. MOA will submit CME to the AOA by July 1, 2019.
Details: • 32 AOA Category 1-A credits offered Thursday-Sunday • Specialty credits offered AOBIM, AOBEM, AOBFB, AOBNP, ABOD, AOBNMM, AOBPmR, AOBPR • 3 FREE additional AOA 1-A Category 1 credits available for completing Outcomes Measurement Survey that will be emailed two weeks post-convention.
Please visit www.domoa.org/CME for more information. AOA Statement of Accreditation: The Michigan Osteopathic Association (MOA) is accredited by the American Osteopathic Association (AOA) to provide osteopathic continuing medical education for physicians.
Nurses: The MOA is approved by the Michigan Board of Nursing as an acceptable provider of CME.
MOA Designation Statement: The MOA designates this program for a maximum of 32-35 AOA Category 1-A credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in this activity.
EVALUATIONS: www.domoa.org/eval Username: [your AOA#] Password: moacme
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ADVANCED CARDIOVASCULAR LIFE SUPPORT (ACLS) CERTIFICATION 10 AOA 1-A Credits Friday, 10 am - 5pm & Saturday, 8 am - 12 pm ADVANCED CARDIOVASCULAR LIFE SUPPORT (ACLS) RE-CERTIFICATION 4 AOA 1-A Credits Saturday, 8 am - 12 pm
Congratulations
to incoming President Craig Glines, DO, MSBA, FACOOG Wishing you the best in your year of leadership as 121th President of Michigan Osteopathic Association!
DEPARTMENT OF
LICENSING AND REGULATORY AFFAIRS
LARA REQUIREMENTS OFFERED
7:30 – 11:30 am
Meets Michigan licensing requirements for pain & symptom management, human trafficking for physicians and other health care providers (effective December 2017.) Applies to all physicians, including residents, whether or not they are in active practice (ex. retired, administrative, academic teaching, etc.)
Moderator: David Best, DO, MS, ABAM
LARA R 338.143 Pain & Symptom Management (Minimum 3 hours per 3-year period)
LARA R 338.120 Training on Human Trafficking (One-time requirement)
Opioid Epidemic Eight hours of specially designed education to help physicians navigate today’s pain management regulations and excel in patient care. Open to all healthcare professionals, call 517-347-1555 to learn more and register. (Meets 2018 MOA Safe Opioid Task Force Resolution)
• Better Manage Opioids for Pain • Minimize Risk for Tolerance, Dependence, Addiction & Overdose • Improve Practice & Risk Management • Breakdown of State Laws & Regulations
Opioid Update Part I (4.0 credits) • Understanding the Underlying Root Causes of the Opioid Epidemic in 2019 to Better Guide Practice Management Strategy: David Neff, DO • Effectively Managing Pain but Minimizing Risk throughout the Progressive Phases of Opioid Use: David Best, DO, MS, ABAM • When and How to Taper Opioids or Switch to MAT: William Morrone, DO, MS, FACOFP, DAAPM, ASAM • How to Establish an Opioid Practice Management and Risk Mitigation System: David Neff, DO
2 – 6 pm
Opioid Update Part II (4.0 credits) Moderator: William Morrone, DO, MS, FACOFP, DAAPM, ASAM • Human Trafficking Update: Merkeb Yohannes, Sr. Program Director, MI Coalition to End Domestic & Sexual Violence • Pain Management Strategies for the PCP: Joseph Masternick, DO, ABAM, ASAM • Heroin & the Fentanyl Crisis: William Morrone, DO, MS, FACOFP, DAAPM, ASAM • Q&A Panel Discussion: Dr. Masternick, Dr. Morrone, Dr. Neff, Dr. Best, M. Yohannes
P H Y S I C I A N W E L L N E SSSS CCEENNTTEERR Charlevoix Rooms (first floor) Charlevoix
All attendees and their guests welcome, All welcome, free free ofof charge! charge! OO SS TT EE O P A T H I C MANIPULATIVE TREATMENT MANIPULATIVE
Osteopathic Manipulative Treatment (OMT) Osteopathic (OMT) techniques techniquescan canfacilitate facilitateaahealing healing experience amongst convention attendees and spread knowledge of experience attendees and spread knowledge of this pain pain management tool. this
PRIVATE & & GROUP GROUP PRIVATE YOGA SESSIONS YOGA SESSIONS
Led by by Hilltop Hilltop Yoga Yoga Led Guided meditation, relaxation Guided meditation, relaxation and personalized techniques. and personalized techniques.
AT UU RR D D AY AY 88 am SS AT am -- 33 pm pm All participants participants required required to to sign All sign aa medical medical waiver waiver prior priortotoactivities activitiesininthe thePhysician PhysicianWellness WellnessCenter. Center.
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SCIENTIFIC RESEARCH COMPETITION The Michigan Osteopathic Association hosts a Scientific
Friday, May 17, 2019
Research Exhibit (SRE) at both the Spring and Autumn
Exhibits
Conventions. These competitions provide osteopathic medical students, residents, fellows and attending level physicians an opportunity to present their medical and scientific research to our profession. The SRE event demonstrates the very best of what osteopathic medicine is and reaffirms the profession’s commitment to the advancement of science in osteopathic medicine.
Please visit www.domoa.org/sre for information regarding SRE submissions, sponsorship opportunities and call for judges.
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7:30 am - 1:00 pm TC’s (lobby level)
Oral Presentations
7:30 – 11:30 am Portage Auditorium (4 credits)
Save the date! MOA Autumn SRE Competition Saturday, November 9, 2019 Amway Grand Plaza, Grand Rapids
EXHIBIT DATES & HOURS CONVENTION SPONSORS Platinum
Exhibit all four days or exhibit just one day—it’s up to you!
THURSDAY, MAY 16 | 3 – 6 PM FRIDAY, MAY 17 | 7 AM – 6 PM SATURDAY, MAY 18 | 7 AM – 6 PM SUNDAY, MAY 19 | 7 AM – 3:30 PM
VISIT EXHIBITORS, WIN PRIZES! Silver
MOA is holding prize drawings during exhibitor times. Physician registration materials will include one entry slip and an exhibitor room layout. MOA will provide exhibitors with unique identifying stickers. Physicians will collect these stickers as proof of visiting with exhibitors. Physicians will turn in the completed slips to be entered in prize drawings with winners announced at designated times. Contact Cyndi Earles if you are interested in donating a prize for the drawing or have other questions about exhibits. Cyndi Earles Director, MOA Service Corporation E cearles@domoa.org P 517-512-4307
Education Supporters Coverys Delta Dental MedNetOne Lettuce Live Well American Academy of Osteopathy Gilead
WOMEN of EXCELLENCE Please join us for a reception honoring women leaders in the medical field.
44-6 - 6 pm pm Friday, May17 18 Friday, May Boardof of Trustees Trustees Room Board Room (second floor) (second floor)
SRE Sponsors
All are welcome, no ticket required.
McLaren Macomb MSUCOM Statewide Campus System
Sponsored by
MSUCOM PhD-DO Award
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At McLaren, we’re committed to providing high-quality, effective care. By developing best practices based on clinical outcomes and the latest research on health care quality and safety, we are not only improving outcomes but also lowering costs for patients and hospitals. That’s what it means to be doing what’s best. Learn more at mclaren.org
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FORMER MOA STUDENT TRUSTEE NAMED
NATIONAL STUDENT DO OF THE YEAR The American Association of Colleges of Osteopathic Medicine's Council of Osteopathic Student Government Presidents (COSGP) is proud to announce the winner of its 2019 National Student DO of the Year (SDOY) award: Taran Silva, fourth-year osteopathic medical student at Michigan State University College of Osteopathic Medicine (MSUCOM). The National SDOY award is presented each year to one osteopathic medical student who demonstrates superior leadership capabilities, robust research experience, and a strong commitment to community service.
T
aran Silva served as the Student Government Association President at MSUCOM, where he focused much of his efforts on policies and programs that place value on inclusion, diversity, and diversity appreciation within the osteopathic medical community. He represented MSUCOM on AACOM’s COSGP. Additionally, he served on the Board of Trustees for
the Michigan Osteopathic Association (MOA), where he represented his fellow students at the state level as a delegate for the MOA House of Delegates and at the national level as a Michigan delegate at the American Osteopathic Association (AOA) House of Delegates. Mr. Silva currently serves as the National Student Representative on AACOM’s Task Force on Professionalism and Ethics. He is passionate
Taran Silva, OMS-IV, MSU-COM
about global health and traveled to Guatemala four times, Peru twice, and Cuba twice with MSUCOM for international medical mission work during his medical education. In addition to his active engagement within the osteopathic medical profession, he serves as a 2nd Lieutenant in the United States Air Force.
A B O U T T H E AWA R D The Student DO of the Year (SDOY) award honors and recognizes an osteopathic medical student who is committed to the principles of leadership, community service, dedication, and professionalism. Each school hosts their own individual selection process to choose a student who has made outstanding contributions to the osteopathic profession. Each school then sends their nomination to the Council of Osteopathic Student Government Presidents National Selection Committee. The National Committee consists of representatives from the Student Osteopathic Medical Association (SOMA), the Society of Osteopathic Medical Educators (SOME), the American Association of Colleges of Osteopathic Medicine (AACOM), the Council of Interns and Residents (CIR), the Council of Osteopathic Student Government Presidents (COSGP), and the previous Student DO of the Year winner. The Student DO of the Year must be a full time student at a college/school of osteopathic medicine and cannot be a previous school nominee for Student DO of the Year. Award Amount: $1,000
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HEALTH EQUITY T H E RO L E O F T H E H O S P I TA L B Y B R I T TA N Y B O G A N, F AC H E, C P P S
A consistent challenge that many hospitals face is the large, daunting puzzle of ensuring health equity. Healthcare professionals agree that a person's race, ethnicity, gender, income, sexual orientation, neighborhood or other social condition should not play a role in the care they receive. Health equity must be a strategic goal in every hospital and incorporated into all improvement strategies, including quality, patient safety and population health, to improve health outcomes and the patient experience.
A
s a patient safety and quality organization, the MHA Keystone Center follows the famous framework for improvement outlined in Crossing the Quality Chasm: A New Health System for the 21st Century, which was published by the Institute of Medicine in 2001. This framework states that healthcare organizations commit to quality by ensuring patients receive safe, effective, patient-centered, timely, efficient and equitable care. Unfortunately, equity continues to be the most frequently overlooked aim. Studies report significant disparities in healthcare outcomes among race, age, language, ethnic and socio-demographic categories. Social determinants of health such as socioeconomic status, access to healthcare, education, and social and community context, all play a major role in creating longstanding disparities. Health systems and hospitals are often the leaders in their local communities when it comes to improving population 18
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health and overcoming disparities. It requires us to commit to meaningful initiatives across our healthcare efforts.
Key healthcare initiatives • Increase the prevalence of evidence-based preventive health services and health behaviors. • Improve quality of care and patient safety. • Advance care coordination across the healthcare continuum. For these strategies to be effective, hospitals must incorporate health equity into practice. The health system's role is to identify which disparities are impacting their patient population and then work in partnership with their communities to eliminate them. The MHA’s MiCareMatters campaign, launched in 2017, includes examples of these community partnerships across Michigan at micarematters.org.
We have also expanded our ability to reduce disparities through the Great Lakes Partners for Patients (GLPP) Hospital Improvement Innovation Network (HIIN), a partnership among the MHA, the Illinois Health & Hospital Association and the Wisconsin Hospital Association. Together, our mission is to provide resources, offer educational and networking opportunities, and share best practices and lessons learned around four key strategies: • Hospital preparedness to address health disparities through the consistent collection of accurate demographic data. • Use of patient demographic data to identify disparities within each community. • Development of proper interventions to address identified disparities. • Deployment of organizational resources needed to sustain the delivery of equitable care. I encourage you to take advantage of these resources made available by the GLPP HIIN as you pursue your hospital’s goal of achieving health equity. If we each work to eliminate disparities within our local communities, collectively we will come closer to achieving equity across Michigan and the Great Lakes region. Brittany Bogan, FACHE, CPPS, is the senior vice president of safety & quality, MHA, and executive director, MHA Keystone Center.
MHA KEYSTONE CENTER. MEMBER HOSPITALS & HEALTH SYSTEMS. MHA KEYSTONE CENTER. MEMBER HEALTH SYSTEMS. STATE & NATIONAL PATIENT SAFETYHOSPITALS EXPERTS. & MHA KEYSTONE CENTER. MEMBER HOSPITALS & HEALTH SYSTEMS. STATE & NATIONAL PATIENT SAFETY EXPERTS. STATE & NATIONAL SAFETY EXPERTS. Together, we are partPATIENT of something important. We’re changing Together, we are part of something important. We’re changing healthcare and improving patient safety and quality implementing Together, we are part of something important. We’rebychanging healthcare and improving patient safety and qualityby bydata. implementing evidence-based, best practices that are supported Our healthcare and improving patient safety and quality by implementing evidence-based, best practices that are supported by data. Our us to person-centered philosophy fuels our purpose and by work. It drives evidence-based, best practices that are supported data. Our person-centered philosophy purpose and work. It drives us to continually improve and buildfuels saferour and more reliable healthcare. person-centered philosophy fuels our purpose and work. It drives us to continually improve and build safer and more reliable healthcare. continually improve and build safer and(MHA) more Keystone reliable healthcare. Michigan Health & Hospital Association Center member Michigan are Health & Hospital Association (MHA) Keystone Center hospitals voluntarily participating in programs to improve themember quality Michigan Health & Hospital Association (MHA) Keystone Center member hospitals are voluntarily participating in programs to improve the quality and delivery healthcare by tacklingin big issues ontoaimprove daily basis. hospitals are of voluntarily participating programs the quality and delivery of healthcare tackling big issues on a daily basis. harm, Every day, we’re exploringby and innovative ways to prevent and delivery of healthcare bynew tackling big issues on a daily basis. Every day, we’re exploring new and innovative ways to prevent harm, reduce healthcare costs, and improve patient safety. Every day, we’re exploring new and innovative ways to prevent harm, reduce healthcare costs, and improve patient safety. reduce healthcare costs, and improve patient safety. TOGETHER, WE’RE MEETING THE CHALLENGES OF TODAY TO TOGETHER, WE’RE MEETING THE CHALLENGES OF TODAY TO TOGETHER, WE’RE MEETING THE CHALLENGES OF TODAY TO
Build a Safer Tomorrow and Beyond Build a Safer Tomorrow and Build a Safer Tomorrow and Beyond Beyond Read our MHA Keystone Center Annual Report and hear stories about Readhospitals our MHA Keystone Center Annual Report and hear stories how improving patient safety and healthcare qualityabout online Read our MHAare Keystone Center Annual Report and hear stories about how hospitals are improving patient safety and healthcare quality online at www.mha.org. how hospitals are improving patient safety and healthcare quality online at www.mha.org. at www.mha.org.
MSU COLLEGE OF OSTEOPATHIC MEDICINE
GLOBAL OUTREACH PROGRAM B Y G A RY W I L LY E R D, D O, A S S O C I AT E D E A N, M S U CO M - D E T RO I T
As the leader of the Global Outreach Program, I recruit students, physicians and community partners who provide basic healthcare and education to people in Peru, Guatemala, Cuba and other places in need.
Gary Willyerd, DO Associate Dean MSUCOM-Detroit
The program is part of a comprehensive educational experience offered by the College of Osteopathic Medicine and offers students diverse experiences, which lead to them becoming more skilled and adept physicians. Our mission is to provide basic healthcare. It's primary care, but we try to include all aspects including dental, vision, obstetrics and gynecology, pediatrics, dermatology, podiatry, internal medicine and more. We also want to give students hands-on experience under the supervision of licensed physicians.
Our first Peru cohort went to Lima in fall 2009 and the latest trip took place at the beginning of the fall semester 2018 in Iquitos, the capital of the Loreto region and the largest city in the Peruvian rainforest. We have access to an army base where students treat soldiers, and we are able to utilize the facilities for our patients as well. We spend time in the army hospital clinic, providing service in the poorest part of Iquitos. We also board the Amazon Queen, a floating clinic, which we take 25 miles down the Amazon River to care for people who might not otherwise see a physician. The only healthcare services these people typically receive require them to travel to Iquitos, where medical resources are difficult to find and costly. Despite a national healthcare system in Peru, there is a shortage of doctors, as well as the financial means to purchase medicine and medical supplies. I work with a growing list of individuals, businesses and organizations to recruit volunteers, medications, supplies and monetary donations. In 2018, students raised more than $30,000 for the trip, allowing us to bring new medications and supplies for the 2,207 patients we treated. What we didn't use, we left with the Peruvian physicians in hopes that all gets utilized.
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Not only do the residents of Peru benefit, but our students receive an array of clinical and research experiences. We conduct significant research regarding cervical cancer, one of the leading causes of cancer deaths among Peruvian women. We help collect samples that identify the human papillomavirus, or HPV, genotypes and work to determine whether the genotypes covered by the Gardasil vaccination are the same genotypes prevalent in Peruvian women with cervical cancer. We also work with a hospital to implement a program where women can be screened and receive information about surgical or medical treatments for HPV. Improving water quality among Peruvians who live along the Amazon River is another focus area for us. Students often see patients with gastrointestinal infections caused by bacteria and parasites, so we’ve partnered with
a local non-governmental organization to monitor and test water quality. Our research team also has designed a filter utilizing local resources that creates a sustainable solution to reducing or preventing water-sourced infections.
Years ago, I was passing a newsstand and saw a former student on the cover of a national magazine. The man and his wife had volunteered after a major Indonesian tsunami, traveling to offer medical assistance and any other ways they could help.
Looking ahead, our ultimate objective is to build a 'continuity clinic' where we can have one central place to see patients and store medical records. We also are currently working on a collaboration with the West Virginia College of Osteopathic Medicine to offer medical help and services twice a year instead of once a year between both institutions.
I called him to tell him how proud I was. He said his ability to respond to an international call for help was because he had been on a mission trip I had organized many years ago. That really had a profound effect on me — to think that I helped give someone the skills to go forward and help out like that — to go where the need is, no matter where it is or who it is. In many ways, I've saved lives and changed lives through the eyes of my students and our partners.
The Peruvian government does not direct care, but we involve them in what we are doing. We are welcomed in the community, and we receive hugs and thanks continually. People are so warm and appreciative — it's truly touching.
Gary Willyerd, DO is the associate dean for Michigan State University College of Osteopathic Medicine’s Detroit expansion site.
Join MOPAC Donate online: www.domoa.org/MOPAC Mail enclosed MOPAC contribution card with your payment to:
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It’s what we must DO.
A M P L I F Y YO U R VO I C E .
goes beyond the office.
MOPAC Michigan Osteopathic Association 2445 Woodlake Circle Okemos, MI 48864 Corporate/business contributions are prohibited.
PATIENT ENGAGEMENT
Challenges & Strategies
W
hen we explore the topic of patient engagement, we
often focus on what practitioners can do to involve patients in the healthcare process. But true patient engagement requires deliberate actions, decisions, and attitude shifts for patients as well.
The Center for Advancing Health (CFAH) has defined patient engagement as “actions individuals must take to obtain the greatest benefit from the health care services available to them.” (Emphasis added.) Health researchers Judith H. Hibbard and Jessica Greene take the definition a step further by addressing an additional component of the process known as “patient activation.” They explain that patient activation refers to patients’ willingness and ability to take steps to manage their health and care. This involvement can only happen when the patient understands their role in the care process and has the knowledge, skills, and confidence to adequately participate in their own healthcare. Yet even under a philosophy that the best healthcare requires active
participation from the patient, the burden of ensuring good health outcomes and avoiding risk still falls heavily on healthcare providers. New payment models, such as accountable care organizations (ACOs) and patient–centered medical homes (PCMHs), shift performance risk even more significantly to providers by requiring them to achieve specific quality or cost goals. Hospitals and health systems are accountable for patient outcomes over a longer continuum of care (e.g., the Medicare Hospital Readmissions Reduction Program). As healthcare becomes more complex, finding ways to meaningfully engage patients and their family members in the process is increasingly important.
Challenges to Patient Engagement Complexity of Healthcare Patients and families are faced with more responsibility for symptom management, medications, wound car – tasks that have typically been performed by professionals during longer hospital stays. Many patients and family members are unprepared or unwilling to take on what is now required of them. In a national sample,
researchers found that 12 percent of respondents thought they could remain passive recipients of care, and 29 percent felt they did not have basic facts or were not able to understand their treatment recommendations.
Attitudes In her article about doctor-patient relationships and patient engagement, CFAH writer Valerie DeBenedette suggests…
“Physicians set the tone for making the patient aware that they have some control over their health. … If the doctor conveys an all-knowing ‘I make the decisions’ attitude, the patient will revert to a passive role.” Patient attitude can be problematic as well. A recent study of patient perceptions revealed a widespread belief that more expensive care is always better and that patients have a general lack of understanding of the healthcare costs borne by their insurers and by society as a whole.
TO READ THE FULL ARTICLE CLICK: www.coverys.com/knowledgecenter/Articles/Patient-Engagement-Challenges-Strategies 22
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LEADING-EDGE CANCER CARE.
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domoa.org/HCPM
WE NEED A CODE OF EMPATHY By Ewa Matuszewski, CEO, MedNetOne
We have a Code of Conduct and
turn up a video on a code of
mpathy requires an individual to put him or herself into the shoes of another who is vulnerable in some way, perhaps due to illness, surgery, grief, depression, or even embarrassment. In the hospital or other type of healthcare or rehabilitation setting, patients may be at their lowest point of vulnerability. Responding to patient requests, or chastising patients with the following comments reveals an utter absence of empathy (in my experience, these are actual statements made by healthcare professionals to a patient):
empathy, but its views are
“I haven’t got time for that.”
relatively insignificant; plus, it
“I’ve got other patients to see.”
was preceded in search findings
“Your cognitive skills are poor.”
by ‘coding with empathy’ and
“You don’t want to get better.”
‘coding with compassion.’ I think
“Just sign here. I know the document is difficult to read.”
a Code of Ethics. Heck, for you history buffs, we even have the Code of Hammurabi. Why don’t we have a Code of Compassion, though? More specifically, a Code of Empathy? It wouldn’t be limited to the healthcare profession, but I can’t think of a better place to begin the codification process. Actually, a Google search did
that means the door is open for a movement on empathy in healthcare.
Why so harsh? Have physicians and healthcare professionals become so focused on data, dollars and the demands of some health plans that it’s impacting patient care? In the meantime, I’ve been considering responses to patient and family queries that reveal both empathy and honesty while setting a patient’s goals
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for recovery. Also remember that in a patient-centered medical home model an interprofessional team is engaged in the patient’s care.
“What type of goals shall we set today to get you closer to recovery?” This could be getting dressed, getting out of bed, using a walker to get to the bathroom or walking up and down the hallway, depending on the patient’s abilities.
“It’s too soon to say what you can or cannot do in the future; let’s take it a day at a time at this point.” (In other words, NEVER say never. If something is never to happen, it will be revealed in due time.)
“Don’t beat yourself up. You’re doing as well as can be expected this soon after surgery.” Empathy is fostered with peer to peer support. Empathy grows in an empathetic culture. Connecting with others during illness and recovery is critical to one’s ultimate health and well-being. Perhaps we need more empathetic role models in healthcare. Then the code of empathy would write itself. Or better yet, would not be required.
Powered by the Michigan Osteopathic Association
What is HCPM? Healthcare Partners of Michigan (HCPM) was established as a healthcare services organization in 2017 by MOA members. It was formed to support independent physician practices, to provide physicians an opportunity to participate in value-based reimbursement activities, quality improvement initiatives, and also to help reduce practice overhead costs by providing necessary infrastructure support.
Why Join? • Assist HCPM physicians transform their infrastructure by providing technology support • Guide HCPM physicians to develop quality improvement strategies focused on population health • Coach practices through the stages of becoming a Patient Centered Medical Homes (PCMH) • Provide in-office, multidisciplinary clinical care teams • Function as a liaison between physicians and payers, contract negotiations, reimbursement guidance & troubleshooting
Who can Join? Any licensed healthcare professional!
LEARN MORE: www.domoa.org/hcpm Contact 844-363-6763 | hcpm@domoa.org
COMPONENT CONNECTION Oakland & Macomb County Osteopathic Medical Associations present:
A DAY OF PHYSICIAN WELLNESS Develop a healthy strategy to maximize physician wellness in our personal and professional lives. 6 credits of AOA Category 1-A CME credits anticipated.
Friday, March 29, 2019 9:00 am - 4:00 pm Walsh College 3838 Livernois Road Troy, MI 48083 $50 pre-paid tickets, $60 at the door. Includes breakfast and lunch. To register, contact the OCOMA office at (517) 512-4307 or cearles@DOMOA.org
AGENDA
Pain is Inevitable, Suffering is Optional Gregg Stefanek, DO Exercise is Medicine: Incorporating Physical Activity Erica Ross, BS, ACSM Practicing Success George Azar Intuitive Eating and Other Non-Diet Approaches to Nutritional Wellness Rachel Brown, RD, MBA
Efficiency of Practice: Tips and Tools to Reduce Distraction and Improve Performance Joyce Tedford, RN, CPHRM Preventing Chronic Disease and Gut Health Elizabeth Swenor, DO Physician Wellness Starts with Refreshing Your Mindset Hodon Mohamed, DO
Accreditation Statement: The Michigan Osteopathic Association is accredited by the American Osteopathic Association to sponsor continuing medical education. The MOA has requested the AOA Council on Continuing Medical Education approve this program for (6) credits of AOA Category 1-A CME credits. Approval is currently pending. Outcomes Measurement Survey: Earn 1 free, AOA 1-A credit by participating in an outcomes measurement survey that will be emailed to attendees 2 weeks post-convention.
Ingham Osteopathic Association General Membership Meeting
Northern Michigan Osteopathic Association Summer Conference
1 AOA 1-A credit anticipated.
21-23 AOA 1-A credits anticipated.
June 13-16, 2019
Wednesday, April 23, 2019
6 pm dinner, 6:30 pm meeting start
Kellogg Hotel & Conference Center
East Lansing, MI 48823
Mission Point Resort, Mackinac Island, MI
Registration & agenda: www.domoa.org/nmoa-conference
Presentation:
Women’s Health: David Boes, DO
Contact:
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Virginia Bernero, 517-347-1555 ext. 103
T R I A D | S P R I N G 2019
Contact:
Melissa Budd, 517/347-1555 ext. 112
ADVERTISERS TRIAD STAFF
Beaumont............................................................................23
Kris T. Nicholoff, CEO and Executive Director Lisa M. Neufer, Director of Administration Todd Ross, Manager of Communications Virginia Bernero, Executive Assistant & Marketing Coordinator Melissa Budd, CME Program Manager
Blue Cross Blue Shield of Michigan.....................................10
2018-2019 BOARD OF TRUSTEES
Lawrence Prokop, DO, FAAPM&R, FAOCPMR-D, FAOASM, President Craig Glines, DO, MSBA FACOOG, President-Elect Jeffrey Postlewaite, DO, Secretary/Treasurer John Sealey, DO, FACOS, Immediate Past President
Department of Business Affairs - Directors Lawrence Prokop, DO, FAAPM&R, FAOCPMR-D, FAOASM, President Craig Glines, DO, MSBA FACOOG, President-Elect Jeffrey Postlewaite, DO, MPH, Secretary/Treasurer John Sealey, DO, FACOS, Immediate Past President Bruce Wolf, DO, FAOCR, Past President
Department of Socio Economics - Directors Kevin Beyer, DO Patrick Botz, DO
Department of Education - Directors Emily Hurst, DO Samia Cheema, DO, Resident
Coverys.................................................................................2 Fulford Legacy Conference....................................................4 Healthcare Partners of Michigan..........................................25 Kerr Russell...........................................................................9 McLaren Health Care...........................................................16 Metro Health.........................................................................6 MOA...................................................................................28 MOA Autumn Convention....................................................6 MOPAC...............................................................................21 Origami.................................................................................7
For advertising inquiries, please email Todd Ross at tross@domoa.org or call 800.657.1556.
Department of Membership - Directors Andrew Adair, DO, FACOFP Stephen Bell, DO, FACOI Matthew Meranda, OMS-II
Department of Healthcare Technology & Informatics - Director David Best, DO, MS, ABAM The osteopathic profession in Michigan is made up of osteopathic physicians, osteopathic hospitals and an osteopathic medical school. This TRIAD stands together to serve our patients and one another. TRIAD, the official journal of the Michigan Osteopathic Association, serves Michigan’s osteopathic community, including its osteopathic physicians, hospitals, medical school and patients. The Michigan Osteopathic Association will not accept responsibility for statements made or opinions expressed by any contributor or any article or feature published in TRIAD. The views expressed are those of the writer, and not necessarily official positions of MOA. TRIAD reserves the right to accept or reject advertising. The acceptance of an advertisement from another health institution or practitioner does not indicate an endorsement by MOA.
COMMUNICATIONS DEPARTMENT Michigan Osteopathic Association Communications Department 2445 Woodlake Circle, Okemos, MI 48864 Phone: 517.347.1555 Fax: 517.347.1566 Website: www.domoa.org Email: moa@domoa.org ©2019 Michigan Osteopathic Association
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C O M I N G I N 2019 MOA’s own Podcast, “Finding Health.” See page 12 for more info. Stay tuned!