MICHIGAN MEDICINE by Stacy Love, Designer

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 120 / NO. 3

May / June 2021

INCREASED COMPETITION How smart digital strategies can help

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p resident 's Competitive Analysis in a Digital Framework I am honored to submit the first of my President’s Letters as the 156th President of your Michigan State Medical Society. There is no stronger voice for Michigan’s physicians and patients. Competition. As physicians, we’ve been wired for it. All through school, residency and beyond, we know what it takes to get ahead. But once we’ve entered practice, our competitive instincts start to abate slightly. We become more comfortable with our skills, our patients, and our care teams. When excellent care giving becomes our sole professional mission, it becomes easy to focus all our dogged personal and intellectual energy on our patients, rather than on a race to the top of our unique health care markets. Plus, collaboration just feels better than competition. At the Michigan State Medical Society, we’re all about collaboration. But we also recognize the benefits of competition when it comes to boosting patient experiences and outcomes. We know it’s often competition that drives innovation, boosts quality, and supports a robust health care marketplace for our entire state.

PINO D. COLONE, MD (GENESSEE COUNTY) MSMS PRESIDENT

Right now, our state’s physicians are grappling with a number of dynamic forces that impact their practices in profound ways. The introduction of open notes for patients, the ongoing uncertainty around the pandemic, and the shifting marketplace for telehealth combine with other ongoing issues to put pressure on our work. We have been forced to redesign our digital infrastructures and look for new ways to engage with our patients online. Telehealth demands the same qualities of an in-person visit: your undivided attention, the years and expertise of your training, and your expert medical assessment and diagnosis, and should be reimbursed as such. We must also be honest with ourselves about where we stand in our respective health care marketplaces. What are we building, and for whom? How can we deliver extraordinary patient experiences while ensuring the transparent sharing of information? In this issue of Michigan Medicine®, we’ll explore that all-important competitive analysis in the context of a new digital framework. Patients today find us online, not in the phone book. What do they see when they come looking? How can we make sure it’s truly representative of our work? How do we verify a online review, knowing one negative review may cost you patients and damage your reputation? These are among the many questions we’ll try to answer—but we recognize it is only the beginning. Each physician has a good deal of work to do in the months and years ahead. So read on, then check in with us. At MSMS, we’ve got your back—and we’ll be a resource every step of the way. No matter what your competitive analysis looks like.

PINO D. COLONE, MD, MSMS PRESIDENT

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FEATURES & CONTENTS May / June 2021

12 Increased Competition:

How Smart Digital Strategies Can Help

With all the high-tech innovations at a physician’s disposal in 2021—and with the threat of pandemic still lingering—stopping to focus on the competitiveness of an individual practice may strike providers as a low priority. But changing federal requirements, coupled with COVID-induced changes in how business gets done, is raising the bar. And fast. (Story begins on page 12.)

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Can Patients Waive Malpractice Claims? DANIEL J. SCHULTE, JD

COVID-19: A Call for Innovation and Leadership in Healthcare RICHARD E. ANDERSON, MD, FACP THE DOCTORS COMPANY

MICHIGAN MEDICINE® VOL. 120 / NO. 3 Chief Executive Officer JULIE L. NOVAK Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Publication Design STACIA LOVE, REZÜBERANT! INC. rezudesign.com Printing FORESIGHT GROUP staceyt@foresightgroup.net

FFCRA Paid Leave Extension–What Changes Were Made?

ALSO INSIDE 27 NEW & REINSTATED MEMBERS 28 EDUCATION

JODI SCHAFER, SPHR, SHRM-SCP

STAY CONNECTED!

Michigan Pediatric Vaccinators Are Superheroes TERRI S. ADAMS BSN, RN

Publication Office Michigan Medicine® 120 West Saginaw Street East Lansing, MI 48823 517-337-1351 www.msms.org All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast. Postmaster: Address Changes Michigan Medicine® Trisha Keast 120 West Saginaw Street East Lansing, MI 48823

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

Can Patients Waive Malpractice Claims? By Daniel J. Schulte, JD, MSMS Legal Counsel

I practice in a high-risk specialty. I think it is

safe to say that I and other physicians who practice this specialty face more than our share of malpractice claims. At a seminar I recently attended a company was selling a “program” they say will protect me against malpractice claims. The program materials include a release and waiver contract that I would have patients sign. This contract provides that the patient will never sue me for malpractice in consideration for my agreement to provide my services. Does this approach work? Why have we not always done this to avoid malpractice claims?

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Patient waivers of malpractice liability were addressed by the Michigan Court of Appeals in a 1994 case (Cudnick vs. William Beaumont Hospital). The patient in that case signed an agreement prior to receiving treatment containing the following language: “I hereby release the physicians and staff of the Department of Radiation Oncology and William Beaumont Hospital from all suits, claims, liability, or demands of every kind and character which I or my heirs, executors, administrator’s [sic] or assigns hereafter can, shall, or may have arising out of my participation in the radiation therapy treatment regimen.”

he patient then received radiation therapy at Beaumont Hospital. He later sought treatment for back pain and a post radiation ulcer burn was discovered in the area where he received radiation therapy. A short time later the patient died. The patient’s estate sued alleging Beaumont Hospital negligently provided the radiation therapy and that this negligence contributed to the patient’s death. The trial court dismissed the case ruling the agreement signed by the patient prior to receiving the radiation therapy precluded the patient’s estate from pursuing this malpractice case.

The Court of Appeals reversed. In doing so it looked to other states that have considered whether a patient’s waiver future malpractice claims is enforceable. Courts in the majority of other states have held such waiver of agreements invalid and unenforceable when:

(i) the subject of the agreement is a business of a type generally thought suitable for public regulation; (ii) the party seeking the waiver is engaged in performing a service of great importance to the public which is often a matter of practical necessity for some members of the public; (iii) the party seeking the waiver holds himself/herself out as willingly to per-

form the service for any member of the public who seeks it; and (iv) the party seeking the waiver has superior bargaining power. The Court of Appeals found that all these factors were present. Clearly, hospitals and medical professionals are subject to extensive public regulation. The providing of medical services is of great importance to the public and a matter of practical necessity for patients. Physicians hold themselves out to the public as willing to provide their services to the public at large. Patients who are ill and in need of diagnosis and treatment have less bargaining power than the physicians from whom they are seeking care.

“The Cudnick case stands as binding precedent that, if challenged in court, would make invalid and unenforceable agreements seeking an advanced waiver of suits, claims, liability, demands, etc arising from medical services.”

The Cudnick case stands as binding precedent that, if challenged in court, would make invalid and unenforceable agreements seeking an advanced waiver of suits, claims, liability, demands, etc arising from medical services. The Court of Appeals was careful in its opinion to state that its ruling should not be construed as rendering invalid and unenforceable releases executed after the initiation of a malpractice lawsuit pursuant to a settlement for due consideration will be valid and enforceable (and routinely are).

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

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ASK HUMAN RESOURCES

FFCRA Paid Leave Extension—What Changes Were Made? By Jodi Schafer, SPHR, SHRM-SCP, Human Resources Management Services, LLC

I’m confused about the Families First Coronavirus Response Act (FFCRA) leave. I know that last spring paid leave under FFCRA for coronavirus-related reasons was mandated for our practice. Guidance came out piecemeal and we

ended up offering to all of our staff so we didn’t have to pick and choose. I thought it ended in December, but now I am seeing information about it being extended through September. Is this mandatory? Do the banks reload if the employee used up all of their time last year? Help!

You are correct that the mandate to offer paid sick leave and paid family leave under FFCRA expired on December 31, 2020. However, there was an extension granted to the payroll tax credit portion of FFCRA which allowed eligible employers to voluntarily continue offering paid FFCRA leave through the end of March and utilizing the payroll credits to get reimbursed for those leaves.

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his initial extension didn’t change any of the other FFCRA provisions. However, the recently enacted American Rescue Plan, a stimulus package worth $1.9 trillion dollars, resulted in not only another extension of tax credits for FFCRA leave but also key changes to the policy language itself.

employee leave banks will RELOAD on April 1st, even if the employee had exhausted their FFCRA hours previously. Other changes to the newly revised FFCRA language include additional reasons for paid leave and the maximum length of leave granted. First, let’s review the reasons an employee could request paid sick leave and paid family leave under the old plan:

Beginning April 1st and ending on September 30th, 2021, employers with less than 500 employees will be allowed to continue offering paid leave under FFCRA. This is a voluntary program, not mandatory as it was in 2020. The tax credits will continue to be the reimbursement mechanism, so those have been extended again – this time until the end of September. Unlike before,

“Two weeks (up to 80 hours) of paid sick leave at the employee’s regular rate of pay where the employee is unable to work because the employee is quarantined (pursuant to Federal, State, or local government order or advice of a health care provider), and/or experiencing COVID-19 symptoms and seeking a medical diagnosis; or

Two weeks (up to 80 hours) of paid sick leave at two-thirds the employee’s regular rate of pay because the employee is unable to work because of a bona fide need to care for an individual subject to quarantine (pursuant to Federal, State, or local government order or advice of a health care provider), or to care for a child (under 18 years of age) whose school or child care provider is closed or unavailable for reasons related to COVID-19, and/or the employee is experiencing a substantially similar condition as specified by the Secretary of Health and Human Services, in consultation with the Secretaries of the Treasury and Labor; and Up to an additional 10 weeks of paid expanded family and medical leave at two-thirds the employee’s regular rate of pay where an employee, who has been employed for at least 30 calendar days, is unable to work due to a bona fide need for leave to care for a child whose school or child care provider is closed or unavailable for reasons related to COVID-19.”

The revised FFCRA language in the American Rescue Plan adds three additional qualifying reasons to paid sick leave. These include: Obtaining a COVID-19 vaccine; Recovering from any illness or condition related to the COVID-19 vaccine; or Seeking or awaiting the results of a COVID-19 diagnosis or test if either the employee has been exposed to COVID-19 or the employer requested the test or diagnosis

It’s not just paid sick leave that has been affected. Paid medical leave has been expanded to 12 paid weeks vs. 10 paid weeks and the qualifying reasons for paid medical leave now include any of the reasons found under paid sick leave. This means that an employee could potentially be out for 14 paid weeks (2 weeks of paid sick leave + 12 weeks of paid medical leave), assuming the employee had not previously used any paid family leave under FMLA rules. As of the writing of this article, the Department of Labor has not yet released guidance to aid employers and employees in interpreting these new rules. What we do know is that this continues to be a voluntary program. As such, the thinking is that you can decide to enact none, all, or a portion of it as you see fit, so long as your decision doesn’t discriminate in favor of highly compensated employees, full-time employees or on the basis of employment tenure. Be sure to check the Department Labor website for real-time guidance and answers to frequently asked questions if you are planning to continue offering FFCRA leave in your practice.

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MDHHS UPDATE

Michigan Pediatric Vaccinators Are Superheroes By Terri S. Adams BSN, RN, MM, Section Manager, Michigan Department of Health and Human Services (MDHHS) Division of Immunization

In a time of trying to ensure everyone 16 years of age and older are vaccinated with COVID-19 vaccine, how can we focus on childhood vaccinations? Just over one year ago, on March 11, 2020, The World Health Organization (WHO) declared the coronavirus a global pandemic. Since then, Michigan has seen a significant impact on our pediatric vaccination rates, which has been our kryptonite if you will. Until Michigan providers are able to vaccinate pediatric patients with COVID-19 vaccines, we must focus our efforts on getting children caught up on all the recommended vaccinations.

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s of March 2021, and according to Michigan Care Improvement Registry (MCIR) data, Michigan’s rate for children 19 to 36 months of age for the 4313314 series is 69.5% (assessing 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 HepB, 1 Varicella, 4 PCV). This is the lowest that the rate has been in several years. When two doses of hepatitis A vaccine are added to the series (43133142), the rate drops down to 54.6%. These rates reflect, why it is important to ensure patients continue to receive well-child exams and routine immunizations. It is easy to see the impact that COVID-19 has had on parents and caregivers in respect to routine appointments for well-child exams and vaccinations. Parents have fears about the transmission of illnesses and with the lack of COVID-19 vaccine to protect their children, it is understandable. It is up to the provider community to work together with parents, to assure parents that now is the time to get back on track with vaccinations. Parents need to know that physician offices have made great strides to keep families safe during their appointments.1 There are resources to assist with educating parents at MDHHS - COVID-19 Vaccine Provider Guidance and Educational Resources (michigan.gov). Also, the impact of COVID-19 has affected our local health departments (LHDs). They are overwhelmed with running COVID-19 mass vaccination clinics, completing contract tracing, and doing COVID-19 testing. Currently LHDs are struggling to conduct their routine vaccination clinics. Primary care physicians play a significant role

Until there is a COVID-19 vaccine approved for use in all children and an ample supply of vaccine available, providers must focus on getting Michigan children protected from vaccine preventable diseases. in vaccinating Michigan’s children and can help make sure our youngest Michiganders are fully vaccinated with all the routinely recommended vaccinations. Michigan’s rate for adolescents 13 to 18 years of age for the 1323213 series is 42.8% (assessing 1 Tdap, 3 Polio, 2 MMR, 3 HepB, 2 Varicella, 1 MenACWY, 2 or 3 HPV doses for both male and females). To demonstrate the important role that primary care physicians play in vaccinations, 79.2% of adolescents aged 13 through 17 years, who were vaccinated with HPV, reported receiving it in a doctor’s office, according to a recent NIS teen study.2 Currently with Michigan’s expanded priority groups, adolescents who are 16 years of age and older may be vaccinated with COVID-19 vaccine. The only vaccine currently approved for those adolescents 16 and 17 years of age is the Pfizer-BioNTech COVID-19 vaccine. The American Academy of Pediatrics (AAP) recommends everyone 16 years and older to get vaccinated against COVID-19 and continues to push for trials in younger children and teens.3 Until there is a COVID-19 vaccine approved for use in all children and an

ample supply of vaccine available, providers must focus on getting Michigan children protected from vaccine preventable diseases. This will protect and better prepare children for childcare, school, sports, and college. Research consistently shows that a provider’s recommendation to vaccinate is the single most influential factor in convincing parents to vaccinate their children.4 Assure parents that well-child exams and immunizations are both strongly recommended and important for their child’s health. In order to provide optimum protection, follow the Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention’s (CDC) full immunization schedule by administering all recommended vaccines not just the ones required for school.5 By doing this, the child will be up to date, parents will be thankful, and you will have provided the best defense possible until there is a COVID-19 vaccine indicated for all children. Vaccinating physicians have the opportunity to get children back on track and fully protected by employing their superpowers and vaccinating Michigan children!

RESOURCES 1 Interim Guidance for Routine and Influenza Immunization Services During the COVID-19 Pandemic (https://www.cdc. gov/vaccines/pandemic-guidance/index.html) 2 2016-2018 NIS-Teen data 3 AAP recommends COVID-19 vaccines for eligible teens | American Academy of Pediatrics (aappublications.org) 4 Technically Speaking: A Strong Provider Recommendation Matters. Don’t Just "Offer" HPV Vaccine to Parents for Preteens. Recommend It! (immunize.org) 5 CDC Immunization Schedules (https://www.cdc.gov/ vaccines/schedules/index.html)Dhs/0,5885,7-33973971_4911_4914_68361-344843--,00.html on January 26, 2021. 6 Bramer CA, Kimmins LM, Swanson R, et al. Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020. MMWR Morb Mortal Wkly Rep 2020; 69:630–631. DOI: https://www.cdc.gov/mmwr/volumes/69/wr/mm6920e1.htm on January 26, 2021.

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FEATURE

INCREASED COMPETITION How smart digital strategies can help

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Accelerating scientific advancement. Cutting-edge research. Unprecedented numbers of treatment options.

ith all these high-tech innovations at a physician’s disposal in 2021— and with the threat of pandemic still lingering—stopping to focus on the competitiveness of an individual practice may strike providers as a low priority. But changing federal requirements, coupled with COVID-induced changes in how business gets done, is raising the bar. And fast. Today, Michigan physicians are working harder than ever to not only protect their patients’ health, but also to quickly adopt and assimilate new technologies into their practices. A new federal ‘open notes’ rule is now in effect, and practices are still thinking about ways in which the telehealth tools they adopted during COVID can be used over the long term. Providers that deploy these new technologies effectively will quickly become leaders in their markets. To keep pace, it’s important to ensure all new tools are used seamlessly in ways that enhance patient experiences. For physicians, that means understanding a practice’s competitive assets and liabilities as never before, so they can put their best feet forward.

(CONTINUED ON PAGE 14)

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It Begins with the Basics

ccording to the Henry J. Kaiser Family Foundation, there are nearly 41,000 physicians practicing in Michigan. Nearly half (46 percent) of them work in primary care, which means the competition for patients—particularly in the state’s urban areas—can be stiff. The first step to addressing competitive forces is simple: make a list. Nick Hernandez, MBA, FACHE, is CEO and founder of ABISA, a consultancy that helps devise and implement strategies that allow practices to remain competitive and solvent. He suggests compiling a list of practice competitors as a critical first step. “Most of the time, such a list is comprised of who your practice considers to be its chief competitors. However, there may be other health care organizations that indirectly compete with yours, perhaps ones outside of your catchment area that offer services such as telemedicine or niche treatment modalities that are aiming for the same patients,” Hernandez writes. “You will also want to include information on health care entities that may be entering your market in the coming year.

Once you have compiled the list, you can highlight those practices that will be the greatest challenge.” Other competitive challenges may be less easy to pin down but are equally important. Online-only telehealth providers (the old “doc in a box” model that existed a decade before COVID) and self-diagnosing patients also pose competitive issues for physicians. According to Consumer Reports, 65 percent of Americans rely upon Dr. Google for information about their symptoms, rather than pursuing the care options they may truly need. These are concerning trends for physicians who are trying to create patient-centered medical homes for their patients. Even though the use of these options may be difficult to quantify, it does provide valuable hidden feedback about what many patients are seeking—convenience. It is this expectation that is, in part, driving the expansion of open notes and telehealth in today’s marketplace. Hernandez suggests incorporating this type of feedback into a competitive market analysis.

“[It’s important for physicians to] compile an objective list of competitor strengths and weaknesses. Try to see the competition’s practice as though you were them. What makes their practice so great? If they are growing rapidly, what is it about their practice that’s promoting that growth?” NICK HERNANDEZ, MBA, FACHE, CEO AND FOUNDER OF ABISA

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65% of Americans rely upon Dr. Google for information about their symptoms, rather than pursuing the care options they may truly need. These are concerning trends for physicians who are trying to create patient-centered medical homes for their patients. CONSUMER REPORTS

“[It’s important for physicians to] compile an objective list of competitor strengths and weaknesses,” he writes. “Try to see the competition’s practice as though you were them. What makes their practice so great? If they are growing rapidly, what is it about their practice that’s promoting that growth?” Finally, Hernandez says it is important to look to the future by analyzing practice demographics, as well. “Is [your market] growing? If so, then there are likely quite a few patients left to go around. If on the other hand the market is flat, then the competition for patients is likely to be fierce. Your practice will find itself scrambling to win market share,” Hernandez writes. “The outlook portion of your analysis may seem like forecasting, but it is really a measure of trends. By the time you have done most of your research, you will have enough information to determine what the outlook really is.”

Where the Rubber Meets the Road: The Online Review

nce a practice’s competition has been evaluated, it’s time to do the trickier work of self-assessment. This is a challenging task, as it requires a level of objective analysis that can feel difficult to physicians and their staffs. Internal bias toward competitors and feelings of defensiveness can cloud thinking and result in an analysis that is skewed and, ultimately, inaccurate and unhelpful. However a physician chooses to rip off this particular band-aid, it’s not easy work. Many practices begin their analysis in the same place many of today’s patients do: they consult Google. They seek out star ratings and online feedback, searching for trends and comments that can help them understand their own strengths and weaknesses more fully. “This is tough, because many physicians find themselves frustrated about what people post,” says Dara Barrera, MSMS Manager, Practice Management & Health Information Technology. “It’s

90% of patients use online reviews to evaluate physicians. For 71 percent of patients, this is the first exposure they have to their physician’s practice. SOFTWARE ADVICE, 2020 SURVERY

“…many physicians find themselves frustrated about what people post [in a review.] It’s never about the quality of the medical care they’ve received, it’s usually about the wait time or the horrible receptionist. That’s really frustrating and is a major reason why physicians tend to put little stock in those reviews.” DANA BARRERA, MSMS MANAGER, PRACTICE MANAGEMENT & HEALTH INFORMATION TECHNOLOGY

never about the quality of the medical care they’ve received, it’s usually about the wait time or the horrible receptionist. That’s really frustrating and is a major reason why physicians tend to put little stock in those reviews.”

“There are things physicians can do to improve their star ratings, such as registering with review sites and keeping their profiles updated,” Barrera says. “The benefits of a strong web presence can be huge.”

Those reviews matter, however. A 2020 survey conducted by Software Advice found that 90 percent of patients use online reviews to evaluate physicians. For 71 percent of patients, this is the first exposure they have to their physician’s practice. This survey also found:

Barrera agrees with expert recommendations that suggest designating a practice team member to help monitor, support and advance a strong online presence. She also points to strong marketing tools that are specifically designed for health care providers.

• Forty-three percent of respondents said they were willing to go out of their insurance network to consult with a highly-reviewed provider. This underscores the importance of ensuring strong feedback from satisfied patients.

“There are customer relationship management software packages that help practices manage their interactions with patients,” Barrera says. “Many of these packages support event-based communication features that automatically send out emails asking for reviews after a visit or other interaction. This can support the number of positive reviews a practice receives and help make its website more visible to popular search engines.”

• Fewer than 10 percent of reviews are considered negative. This means the majority of reviews should be either positive or neutral, and therefore much easier to address.

(CONTINUED ON PAGE 16)

• Two-thirds of survey respondents say it is helpful when providers respond publicly—and appropriately—to online reviews.

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Taking It to the Next Level: Social Media

N “If a physician is starting from scratch and simply wants a social presence, then certainly a Facebook page is a great place to start.” NIKKI O’MEARA, DIRECTOR OF DIGITAL MARKETING, RESCH STRATEGIES

ikki O’Meara, Director of Digital Marketing for Lansing-based Resch Strategies, says social media also can be a positive asset for physicians.

“I have seen doctors on Facebook, Instagram, TikTok—you name it. But knowing how to move forward is really dependent upon the target audience, the goals of the physician practice, and the information to be shared,” O’Meara says. “If a physician is starting from scratch and simply wants a social presence, then certainly a Facebook page is a great place to start. I say page verses a simple account, because the physician(s) must act as the face of the practice and provide resources and guidance to their patients and the community at large.” Physicians also could consider using LinkedIn to communicate with their peers, according to O’Meara. “Depending on the area of specialization, LinkedIn can serve as a great way to share the latest research and advancements within a practice, which could translate into primary care referrals,” O’Meara says. “Twitter offers the same opportunity but should be used with caution. It is the most volatile of all social platforms, as issues tend to escalate quickly and get out of hand.” Barrera and O’Meara agree that market position and target audience should drive any effective social media and web-based strategy. “Really, it comes down to how each platform is used,” O’Meara says. “As long as the physician has a plan and strategy in place for their social presence, it shouldn’t matter which platform is chosen to tell the story of his or her practice and its work.”

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The Importance of a Strong Patient Portal

any Michigan physicians have made effective use of web-based portals and apps as tools for communicating information with patients. And thanks to the “Information Blocking” rule of the 21st Century Cures Act, adopted in 2016, certain categories of clinical notes must be made immediately available to patients, which makes electronic portals even more essential for physician practices. “While this is a requirement for providers, it also becomes a competitive asset,” Barrera says. “We know patients prize this information highly, so getting out in front with effective, easy-to-use tools that add convenience to their lives is going to be tremendously helpful.” A large-scale 2019 survey of patients showed about two-thirds believed they had benefited from reading the notes in their electronic health records (EHRs). According to a study in the Journal of Medical Internet Research, these patients said the notes helped them take better care of their health, remember their care plans, feel in control, and be better prepared for their office visits. “So now we have this requirement, which can feel challenging at first,” Barrera says. “However, in the long run, it becomes a support for positive patient outcomes and a strategic support for a more comprehensive online strategy. A well-informed, happy, healthy patient is also going to be a patient that rates their care highly and gives high marks to the provider that’s involved.” Barrera points to other web-based strategies for making patients’ lives easier, and says it is possible for physicians to evolve in remarkable ways.

“There are many secure tools available for use by physician practices, and it’s a sure bet Michigan patients are using many of them already. That means these technologies must factor into any meaningful discussion about practice competitiveness.”

substance-use disorder, physical abuse, driving privileges and suspicions about life-threatening illnesses. “I would recommend physicians work to make their patient portals and open notes as easy as possible for their patients,” O’Meara says. “This is about more than simply building the structure, it’s also about ensuring people understand how to use it and appreciate the value it adds to their care.”

DANA BARRERA

“We’re now seeing online scheduling, tools for online form submission by patients, telehealth and other leading-edge strategies for improving the patient experience,” Barrera says. “There are many secure tools available for use by physician practices, and it’s a sure bet Michigan patients are using many of them already. That means these technologies must factor into any meaningful discussion about practice competitiveness.” Of course, the effective implementation of open notes remains relatively new ground for many physicians to cover. “We are working with our member providers to help ensure their notes are clear, so patients can understand what they are reading,” Barrera says. “Jargon, acronyms, and other terms that could be misinterpreted need to be swapped out in favor of more easily understandable language.” According to the American Medical Association, physicians also must learn to effectively document challenging issues, such as obesity, mental health,

“I would recommend physicians work to make their patient portals and open notes as easy as possible for their patients… ensuring people understand how to use it and appreciate the value it adds to their care.” NIKKI O’MEARA

O’Meara suggests personal contact with patients through email, personal correspondence, and office conversations, if necessary. “Consider an FAQ document for patients that seem less tech-savvy and be sure to provide telephone support for people with questions,” she says. “If your practice is on social media or issues a periodic newsletter for its patients, these are great places to highlight the advancements you’re making. And, of course, your website should include resources for navigating through the EHR portal effectively.” (CONTINUED ON PAGE 18)

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Telehealth as a Competitive Advantage

In order for telehealth to be a lasting innovation:

Patient and physician demand for this service option needs to remain robust.

There must be permanent policy change at the federal level.

A strong reimbursement structure that values telehealth and makes it viable for the long term is needed.

nhancing patient care and convenience—and a provider’s market position—is part of the goal of a well-deployed telehealth strategy. What began as a narrowly-adopted innovation has become far more commonly utilized, thanks to a series of policy changes made during the COVID-19 pandemic last year. What happens after the pandemic is behind us, however, remains to be seen. “In order for telehealth to be a lasting innovation, a few things need to happen in kind of a cascading way,” says Stacey Hettiger, MSMS Senior Director, Medical and Regulatory Policy. “First, patient and physician demand for this service option needs to remain robust. This will, we presume, lead to the second item, which is permanent policy change at the federal level. This, in turn, will result in a strong reimbursement structure that values telehealth and makes it viable for the long term.” In particular, Hettiger notes that Medicare payment policies need to remain open to reimbursing a wider array of telehealth visits, and Health Insurance Portability and Accountability Act (HI-

PAA) restrictions need to be permanently made more telehealth-friendly. As a result of this federal leadership, private payers followed suit and opened up their own reimbursement models. “I’m sure this is going to be a topic of discussion for some time to come,” Hettiger says. “Congress is going to want to review the data and work to ensure a balance between equitable compensation, service quality, and convenience. We may see telehealth extended in some areas where physical examinations aren’t required, while it may be more limited in others.” There also may some differences in reimbursement rates, given the flawed assumption of many leaders that telehealth visits are less costly and/or time-intensive than face-to-face consultations. “Physicians and other health care providers know otherwise,” Hettiger says. “Part of our job during the coming months will be to share our experiences and offer compelling competitive arguments for the permanent extension of telehealth for Michigan patients.”

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Putting It All Together

he entrepreneurial side of health care practice is as much art as it is science. Knowing how to maximize and build upon a practice’s assets with fresh technologies and strategic supports requires an ear to the ground, as well as thoughtful, unbiased reflection and a nuanced understanding of patient experiences. It also requires a keen eye for online innovation. The days of looking for a physician in the yellow pages have long passed by; it’s now incumbent upon providers to know their markets and attract the most robust digital footprints. Practices must deliver a patient experience that is simple, convenient and of the highest possible quality at all levels.

The days of looking for a physician in the yellow pages have long passed by; it’s now incumbent upon providers to know their markets and attract the most robust digital footprints.

“A competent study of the competition can help reduce uncertainty and pave the way for strategic planning and business operations within your practice. Physi-

cian owners must be keenly aware of what competing practices are doing,” Hernandez writes. “Since managing a successful practice requires decision and action based on situational awareness, identification of your competition’s expectations and preparations is important.” As providers continue to move through a period of unparalleled uncertainty and change, there’s no better time to regroup around patient experiences. After all, it’s the best possible way to become what all practices should strive to become: a patient-centered medical home.

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

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MAY / JUNE 2021 |

michigan MEDICINE®

SAFEHAVEN™

PHYSICIAN AND PROVIDER WELL BEING PROGRAM Rediscover meaning, joy, and purpose in medicine.

SafeHaven™ ensures that physicians and health care providers can seek confidential assistance and support for burnout, career fatigue, and mental health reasons. In-the-moment telephonic support by a licensed counselor, 24/7

Legal and financial consultations and resources, available 24/7

Peer Coaching—talk with someone who has walked in your shoes that can help you grow both personally and professionally • Six sessions per incident • Physician or provider chooses coach from a panel of coaches

Counseling, available in either face-to-face or virtual sessions; addressing stress, relationships, eldercare, grief, and more • Six sessions per incident • Available to all extended family members

WorkLife Concierge, a virtual assistant to help with every day and special occasion tasks, 24/7

VITAL WorkLife App—Mobile access to resources, well being assessments, insights, and more

RESOURCES FOR YOU AND YOUR FAMILY MEMBERS SafeHaven™ includes Well Being Resources from VITAL WorkLife—confidential and discreet resources designed to reduce stress and burnout, promote work/life integration and support well being for you and your family.

TO LEARN MORE, VISIT

www.MSMS.org/SafeHaven To support the needs of physicians and health care providers struggling with stress, burnout, and the effects of COVID-19, the Michigan State Medical Society (MSMS) and VITAL WorkLife have partnered to offer a comprehensive set of well being resources and confidential counseling services for their use, SafeHaven™.

Activate Your Political Voice! Get started at mdpac.org he 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 issues important to Michigan physicians.

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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 discussions with political decision makers.

Activate your Take action now! Visit https://MSMS.org/engage political voice!

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

and become a “virtual lobbyist.” 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.

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

MAY / JUNE 2021 | and time on your Maintenance of Certification, and advance public health issues.

michigan MEDICINE®

COVID-19: A Call for Innovation and Leadership in Healthcare By Richard E. Anderson, MD, FACP, Chairman and Chief Executive Officer, The Doctors Company, and Leader of the TDC Group of Companies

Across the continuum of care during the COVID-19 pandemic, what has changed is not so much the direction of healthcare evolution, but its speed. For the next decade, we will all be carried along on a jet stream of change. Those who innovate and lead—moving their organizations forward as the landscape continues to change—will succeed, while those unable to do so will be left behind.

(CONTINUED ON PAGE 24)

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Contributed by The Doctors Company

thedoctors.com

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michigan MEDICINE®

(CONTINUED FROM PAGE 23)

Ask yourself a simple question: “Will the practice of good medicine in 2030 look the same as good medicine in 2020?”

efore the pandemic, we saw the confluence of a shortage of primary care physicians, the increasing scope of practice for allied health professionals, the widespread availability of retail healthcare and telemedicine, and a massive generational shift in the demographics of the medical profession. There will be no unringing this bell. For example: The pandemic has forced a growing majority of practices to offer telemedicine services. A study released by the American Medical Association (AMA) in February 2020, just before the pandemic hit the U.S. hard, revealed that telemedicine visits with physicians had already doubled from 2016 to 2019.1 With COVID-19, the number of patients reporting virtual healthcare visits leapt from 12 to 27 percent in less than three months, between late March and mid-May.2

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• As baby boomer physicians retire and medical students choose other specialties,3 a shortage of primary care physicians4 was already looming. Now, some primary care physicians have had to lay off staff or close their practices—We’ve seen nonemergency providers and specialties not related to COVID-19 suffer massive economic losses. Unsurprisingly, some primary care physicians are considering other professional options.5 • The increasing scope of practice for allied health professionals was an established trend—now dramatically accelerated by the crush of events. We can expect this to continue for nurse practitioners, physician assistants, and others. They will help to fill gaps in primary care, while primary care physicians can expect to practice at the top of their license more of the time. 6

The good news is we already possess much of the information we need to make adaptive decisions to protect patients, healthcare professionals, and organizations that serve the medical profession. However, healthcare professionals must seize this moment to show true innovation and to move forward.

True innovation has at least two stages: The first is generating novel and useful ideas and the second is applying those ideas.

Contributed by The Doctors Company

thedoctors.com

True innovation has at least two stages: The first is generating novel and useful ideas and the second is applying those ideas. Unless you apply and scale the idea, it’s just an idea. It’s not an innovation. For example, researchers in California7 are studying data from massive pools of volunteers who have offered their smart watch and smart ring information. The goal is to spot geographic clusters of people showing small boosts in heart rate, temperature, and so on—in an attempt to predict the next cluster of COVID-19 cases before people even know they’re sick. But it’s one thing to think this is possible, and another to actually do it. That’s the gap between idea and innovation. This pivot from idea to application at scale calls for leaders to reflect on how their style suits the moment. Most leaders have a clear style of leadership, but good leaders also know that one style cannot be expected to cover all situations. Individuals who perform well in one job or one decade may not do well in new leadership roles under different circumstances: Effective leaders must understand what is required at that particular time, not just what is comfortable. The new normal will evolve in the context of a decade that was already headed for extraordinarily rapid change. With

REFERENCES

The new normal will evolve in the context of a decade that was already headed for extraordinarily rapid change. a mindset of openness to opportunity and a willingness to accept new challenges, we can meet the demands for great healthcare. After all, pressed by COVID-19’s cascade of emergencies, many healthcare and healthcare-supporting organizations have assembled people, equipment, and processes that we would not have imagined possible even a few months ago. At the same time, the COVID-19 crisis casts a harsh light on some areas of healthcare that have fallen dramatically short of the nation’s needs. It is our collective responsibility to innovate to advance the practice of good medicine.

1 Physicians’ motivations and requirements for adopting digital health: Adoption and attitudinal shifts from 2016 to 2019. American Medical Association. Published February 2020. https://www.ama-assn.org/system/files/2020-02/ ama-digital-health-study.pdf 2 Brenan M. Use of low-contact commerce climbs in U.S. during pandemic. Gallup. Published on May 26, 2020. https://news.gallup.com/poll/311465/low-contact-commerce-climbs-during-pandemic.aspx?utm_ source=alert&utm_medium=email&utm_content=morelink&utm_campaign=syndication 3 Knight V. American medical students less likely to choose to become primary care doctors. Kaiser Health News. Published July 3, 2019. https://khn.org/news/americanmedical-students-less-likely-to-choose-to-become-primary-care-doctors/ 4 Japsen B. U.S. doctor shortage could hit 139,000 by 2033. Forbes. Published June 26, 2020. forbes.com/sites/brucejapsen/2020/06/26/us-doctor-shortage-could-hit-139000by-2033/#70bcd00d6815 5 Rovner J. Rapid changes to health system spurred by COVID might be here to stay. Kaiser Health News. Published June 8, 2020. https://khn.org/news/rapid-changes-to-health-system-spurred-by-covid-might-be-here-to-stay 6 Aguilera E. Facing doctor shortage, will California give nurse practitioners more authority to treat patients? Cal Matters. Published February 13, 2020. https://calmatters.org/projects/doctor-shortage-nurse-practitioners-california/ 7 Brodwin E. “We’re racing against the clock”: Researchers test wearables as an early warning system for Covid-19. STAT. Published March 26, 2020. www.statnews. com/2020/03/26/wearables-health-workers-coronavirus/

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).

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[=]

SOLID ADVICE.

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At The Health Law Partners, our unparalleled knowledge of the business of health care is coupled with timely, practical solutions designed to maximize value. 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

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NEW & REINSTATED MEMBERS CALHOUN COUNTY

Michael Demers, MD

SAGINAW COUNTY

Thomas Farchone, MD

Nicole Faulkner, DO

Gayatri Shanker, MD

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GENESSEE COUNTY

Benedict Pellerito, MD

Naman Salibi, MD

John Hebert, MD

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ST. CLAIR COUNTY

William Goldstein, MD

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KALAMAZOO COUNTY

Jahir Ramos, DO

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Sussan Salas, MD David Davis, MD Majid Shaman, MD

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WASHTENAW COUNTY Barry Nathan, MD Michael Amlog, MD John Billi, MD Pasithorn Suwanabol, MD, MS Peter Farrehi, MD

OAKLAND COUNTY Susan Sauber, MD, FAAP

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Thank you for your ongoing support of organized medicine in Michigan.

MAY / JUNE 2021 |

michigan MEDICINE®

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 Human Trafficking Medical Ethics – Conscientious Objection among Physicians Medical Ethics – Confidentiality: An Ethical Review Medical Ethics – Decision Making Capability Medical Ethics – Eliminating Disparities in Health Care What Can You Do? Medical Ethics – Just Caring: Physicians and Non-Adherent Patients Medical Ethics – Racial Disparities in Maternal Morbidity and Mortality: A Persisting Crisis Medical Ethics – Reclaiming the Borders of Medicine: Futility, Non-Beneficial Treatment, and Physician Autonomy Pain and Symptom Management Series

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Balancing Pain Treatment and Legal Responsibilities MAPS Update and Opportunities Michigan Automated Prescription System (MAPS) Update Naloxone Prescribing Pain and Symptom Management 2020 Prescribing Legislation Tapering Off Opioids The CDC Guidelines The Current Epidemic and Standards of Care The Role of the Laboratory in Toxicology and Drug Testing Treatment of Opioid Dependence Update on the Opioid Crisis 2019

COVID-19 Webinars:

OTHER WEBINARS:

2020 Fall Symposium on COVID-19 Day One 2020 Fall Symposium on COVID-19 Day Two 24th Annual Conference on Bioethics AMA Advocacy and Physician Resources Best Practices for Implementation of Telemedicine 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 Medical Practices and Employment/ HR FAQs New Employment Policies for Practices New Waivers and Billing Changes for Telemedicine Race Inequalities and COVID-19: Contagion, Severity, and Social Systems Safe and Innovative Office Procedures for Seeing Patients Telemedicine and Other Technology Codes in a COVID-19 Environment Testing, Tracing and Tracking The Changing Health Care Landscape: Preventing Diabetes During and Beyond the Pandemic What Physicians Need to Know as Employers During the COVID-19 Pandemic

GRAND ROUNDS WEBINAR SERIES: A Review of COVID-19 Variants Coronavirus Relief – Overview and Updates

24th Annual Conference on Bioethics Coding Update for 2021 Evaluation Management Updates for 2021 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: The Missing Link for Comprehensive Medication Therapy Management Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media Medical Marihuana Law Medical Necessity Tips on Documentation to Prove it Non-Pharmacologic Management of Musculoskeletal Pain Syndromes Section 1557: Anti-Discrimination Obligations Sexual Misconduct – Prevention and Reporting Update on Chronic Fatigue Syndrome Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS 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 MAY / JUNE 2021 |

michigan MEDICINE®

2021 CONFERENCE SCHEDULE

A Day of Board of Medicine Renewal Requirements Date: September 14, 2021 Time: 8:00 am – 1:15 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

Grand Rounds

Annual Scientific Meeting

Dates: February 10, March 10, April 14, May 12, June 9, September 8, October 13, November 10, and December 8, 2021

Date: September 15-16, October 20-21, and November 17-18, 2021

Time: 12:00 – 12:45 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

Monday Night Medicine Dates: April 5, May 3, June 7, September 7, October 4, and November 1, 2021

Time: 3:00 – 6:00 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

24th Annual Conference on Bioethics Date: November 13, 2021 Time: 8:45 am – 3:00 pm

Time: 6:30 – 8:00 pm

Location: Virtual Conference

Intended for: Physicians and all other health care professionals

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

Spring Scientific Meeting

A Day of Board of Medicine Renewal Requirements

Dates: April 15-16, May 20-21, and June 17-18, 2021

Date: November 30, 2021

Time: 8:00 – 11:00 am

Time: 8:00 am – 1:15 pm

Location: Virtual Conference

Intended for: Physicians and all other health care professionals

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

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