THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 119 / NO. 5
September / October 2020
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FEATURES & CONTENTS September / October 2020
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President's Perspective S. BOBBY MUKKAMALA, MD
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Contracts Rarely Provide for Adequate Remedies When Software or Technology Fails DANIEL J. SCHULTE, JD
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Personal Phone Use at Work – A Blessing or a Curse? JODI SCHAFER, SPHR, SHRM-SCP
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Liver Awareness Month and the Importance of Influenza Vaccination MICHELLE DOEBLER, MPH, AND PAT FINEIS
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FEATURE
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Wearables Offer Wealth of Data During COVID-19, but Liability Risks Remain THE DOCTORS COMPANY
DEPARTMENTS 26 Welcome New Members 28 MSMS Educational Courses
Medicine's Great Leap Forward in Michigan BY NICK DELEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY
How an unforeseen pandemic is transforming primary care practice – and what’s needed to keep the momentum going. Story begins on page 14.
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MICHIGAN MEDICINE® VOL. 119 / NO. 5
perspective
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. rezuberant.com Printing FORESIGHT GROUP staceyt@foresightgroup.net 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 2020 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. ©2020 Michigan State Medical Society
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“While telehealth has been around for the better part of a decade now, the COVID-19 pandemic is what thrust the technology from its infancy straight into the limelight.”
By S. Bobby Mukkamala, MD, MSMS President
If there is one positive to glean from our collective experience with COVID-19, it would be that this pandemic has highlighted just how resilient, adaptive, and innovative we are as a people. In a very short period of time, COVID-19 changed just about everything about daily life. Almost overnight, the standard rhythm of most ordinary, everyday occurrences either changed dramatically or ceased entirely, and the world of medicine was no exception. However, the need to see patients and deliver quality care never ended. Instead, physicians adapted, and what did change was the mode through which we
S. BOBBY MUKKAMALA, MD (GENESEE COUNTY) MSMS PRESIDENT
deliver care. While telehealth has been around for the better part of a decade now, the COVID-19 pandemic is what thrust the technology from its infancy straight into the limelight. Over the past several months, thousands of patients across the country likely logged their first ever telehealth visits with their physicians. And for providers and patients alike, the general experience has been overwhelmingly positive. In this edition of Michigan Medicine®, physicians from across the state reflect on their recent experience more fully incorporating telehealth services into their practice, the benefits the technology provides to both patients and physicians, the challenges to come practices will face in maintaining this new foothold in a post-pandemic world, and the tremendous promise telemedicine holds for the not-so-distant future.
S. Bobby Mukkamala, MD (Genesee County) MSMS President
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ASK OUR LAWYER
Contracts Rarely Provide for Adequate Remedies When Software or Technology Fails By Daniel J. Schulte, JD, MSMS Legal Counsel
Q:
Years ago I purchased an electronic back up service from a well-known national company. I was the victim of a ransomware attack which rendered me incapable of accessing the medical records stored on the computer hardware
in my office. When I contacted the company I purchased back up services from I was told that they had failed to back up my records as they promised. The information they had stored had somehow become corrupted. The disruption to my practice and the resulting financial loss was significant. This company claims that all I can recover from it is three months of fees I paid for the backup service. How can this be?
A complete review of the contracts you entered into would be necessary to directly answer your question. The company you are doing business most likely included a provision limiting its liability to you for damages you incur related or connected with a failure of its product to perform as represented.
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he limitation provision is sometimes absolute (i.e. there is no obligation to compensate you under any circumstances). Other times, the amount of the obligation is limited to what would be an unacceptably low amount that bears no relationship to the actual amount of the damages you have incurred (e.g. three months of fees you paid for the backup service). Such a damages limitation is objectionable. A purchaser should reasonably be able to expect that when a product fails to produce as represented and causes foreseeable damages to be incurred that the seller will compensate the purchaser accordingly. This company may have taken it a step further and included a provision where
michigan MEDICINE® | SEPTEMBER / OCTOBER 2020
it disclaimed any warranties in addition to the damages limitation. Such a provision states that the company makes no warranty (express or implied) that its product will function as it has been represented to function or even that it is free of defects. The company may have, in addition, included a provision that disclaims any warranty that would otherwise be provided by law and disclaimed liability for its own negligence or other actions or inactions. If a seller has so little faith that its product or service will do what it is represented to do that it expressly states it will not stand behind it, you should look for another seller. The best way to avoid the situation you are in is to carefully review your contracts when purchasing technology or software.
You should be aware at the outset what the limitations on damages are and what, if any, warranties are being made regarding the performance and suitability of what it is you are purchasing. Why would anyone purchase a product or service when the company selling it is unwilling to stand behind it with a warranty and/or is unwilling to make its customer whole in the event that the customer suffers damages resulting from the failure of the product or service to function as it was represented to function? The answer is likely that these damage limitation and warranty disclaimer provisions are buried in the fine print and that purchasers do not con-
template the meaning of the provisions until after a disaster, when it is too late. You should have an attorney review your contracts and assess your position. You may have claims against the company you purchased backup services from based on your contracts and misrepresentation, fraud and other common law theories. In addition, the conduct of your backup service provider may constitute a deceptive trade practice and be actionable pursuant to the Michigan Consumer Protection Act (this law also allows the Michigan Attorney General and prosecuting attorneys to file lawsuits for deceptive trade practices).
DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL
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ASK HUMAN RESOURCES
Personal Phone Use at Work – A Blessing or a Curse? By Jodi Schafer, SPHR, SHRM-SCP, Human Resources Management Services, LLC
Q:
Smart phones are everywhere, and I must admit they are helpful in the operation of my practice. I use mine to look up drug interactions, set up referrals and even schedule patients. The problem I am facing is the wasted time
employees spend on their phones on non-job-related activities. I know that members of my staff spend work time on social media, playing games, and texting because I’ve caught them doing it. I have even caught my partner playing a game on his phone between patients. What can I do to stop this from happening?
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Technology is a blessing, but it can also be a curse. What we gain in efficiency we can lose in control. This is an area that will certainly cause problems with your staff. In order to assert any type of control, you will need a policy on the use of personal phones and mobile devices in the workplace.
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efore you write this policy, you need to ask yourself this question: How much do you need to control the use of personal phones verses how much do you want to control the use of personal phones? This will help you decide how this policy should be written and, more importantly, how it is administered. Here are some policy options and the pros and cons that can result.
Option 1: Do nothing. PRO: You don’t have to do anything. CON: The problem continues and possibly escalates.
Option 2: Write a simple policy that explains the concern and discourages employees from using their personal phone for non-work-related activities – without any real consequences for failure to comply. PRO: You have formally expressed your concerns. CON: You don’t have any mandates that require formal action to be taken, nor any consequences for those who fail to comply.
“…ask yourself this question: How much do you need to control the use of personal phones verses how much do you want to control the use of personal phones?” Option 3: Write a policy that discourages the personal use of personal phones during working hours and indicate the consequences for failure to comply. PROS: It lays out your expectation clearly and indicates the consequences. It allows you to address employees who are misusing their work time without punishing everyone else in the process. CONS: It will be difficult to administer and you will find yourself violating your own policy, rendering it useless.
Option 4: Write a policy that forbids the use of personal phones during work hours for any reason. Instruct all communication to be done through the office phones and email system. PROS: Easy to administer. Employees will have to sneak around if they want to use their phone because you can require that they keep it in their car or in their locker during work hours.
When writing the policy, you must make sure it can be administered. Think first about how you are going to actually find out if the employee is violating the policy. This will be especially difficult since you use your personal phone for the practice. How will you know when an employee is using it for the benefit of the practice and when are they not? You are not going to be able to check the phones of your employees every day without some concerns over privacy rights. This is a problem that will be a challenge to resolve. If you choose to write a policy, you will need to consider if you are willing to actually terminate an employee for violating the policy. My bet is that the answer is no. And if not, you should not write a policy that indicates termination as a consequence for violations. I recommend that you start small and see how your staff reacts. Make it a culture change for the benefit of the patients rather than a mandate from above.
CONS: You will likely have a revolt. Personal phones have become an extension of our bodies and your employees will want to have access to theirs, especially for emergency purposes. This ‘one size fits all’ policy will be viewed as a punishment by those staff who have not been misusing their work time on their personal phones.
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MDHHS UPDATE
Liver Awareness Month and the Importance of Influenza Vaccination Pat Fineis, Perinatal Hepatitis B Coordinator and Michelle Doebler, MPH, Influenza Epidemiologist, Michigan Department of Health and Human Services- Division of Immunization
October is Liver Awareness Month and also kicks off the 2020-2021 influenza vaccination season. Liver Awareness Month was established to encourage people to identify potential risks and signs of liver cancer and learn how to prevent liver disease. Liver disease can be inherited (genetics) or caused by other factors that damage the liver including chronic viral hepatitis, parasitic infections or infections caused by influenza or other viruses. Early detection of liver cancer may be difficult because there is no recommended screening for liver cancer based on the American Cancer Society.1
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he liver is one of the largest organs in the body and is essential for digesting food and ridding the body of toxic substances. Over time, continuous damage to the liver can result in scarring (cirrhosis) which can lead to liver failure or even death. The American Cancer Society (ACS) estimates about 43,000 new cases of liver cancer will be diagnosed and over 30,000 people will die from liver disease in the United States in 2020.2 Viral hepatitis A, B, C, D and E can cause an acute, less than six-month, hepatitis infection. Viral hepatitis B and C can cause chronic, or a life-long, hepatitis infection. Often people infected with viral hepatitis may not show any signs or symptoms of having the virus until there is severe liver disease or other health consequences. Viral hepatitis symptoms may include fatigue, flu-like symptoms, dark urine, light-colored stools, fever and/or jaundice. Often and especially during flu season, people with viral hepatitis may go undetected unless they have a hepatitis blood test. For more information about testing, please contact your medical provider or local health department (LHD). Liver disease can be prevented by avoiding risky behaviors and making healthy lifestyle choices, including getting the hepatitis A (hepA) and hepatitis B (hepB) vaccines and all other age appropriate vaccines, including the flu vaccine. For more information about vaccines, please con-
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tact your medical provider, LHD, or go to www.michigan.gov/immunize. Annual flu vaccination is the best protection against influenza. During the upcoming 2020-2021 flu season, flu vaccination will be more important than ever to decrease the overall impact of respiratory illnesses and reduce the overall burden on the health care system. Immunizing providers and health care organizations will play an essential role in educating and vaccinating against influenza.
”…flu vaccine studies have indicated that flu vaccination can reduce children’s risk of flu-related pediatric intensive care unit (ICU) admission by 74 percent and can reduce an adult’s risk of being admitted to an ICU by 82 percent.“ Every year, flu vaccination prevents millions of illnesses and thousands of deaths. Additionally, flu vaccine studies have indicated that flu vaccination can reduce children’s risk of flu-related pediatric intensive care unit (ICU) admission by 74 percent3 and can reduce an adult’s risk of being admitted to an ICU by 82 percent.4 According to the Centers for Disease Control and Prevention (CDC), increasing flu vaccination by 5% in adults aged 65 years and older could prevent over 700,000 illnesses and 75,000 hospitalizations during a high severity flu season. The Advisory Committee on Immunization Practices recommends that all people aged 6 months and older, without contraindications, receive flu vaccination every year. However, flu vaccine coverage across the country remains below the Healthy People 2020 goal of 70 percent. According to data from the CDC, nationally only 49.2% of
those aged 6 months and older received flu vaccine for the 2018-2019 flu season, 20192020 flu season data will be available this fall.5 Michigan flu vaccination coverage estimates for the 2019-2020 flu season, using data from the Michigan Care Improvement Registry, were 31.2% for children aged 6 months through 17 years and 31.4% for adults aged 18 years and older. The 2020-2021 flu season will not be a typical flu season. In addition to the inherent unpredictability of the timing and severity of flu seasons, Michigan is also responding to the COVID-19 pandemic. The Michigan Department of Health and Human Services has developed resources and guidance on how to safely deliver immunizations during a pandemic at www. michigan.gov/vaccinesduringcovid. It has never been more important for all Michiganders to be immunized against influenza and all vaccine preventable diseases. By protecting our communities from vaccine preventable diseases, we can help our healthcare system manage the uncertainty of COVID-19. Now is the time to work together and keep Michigan healthy.
REFERENCES 1 American Cancer Society. (2020). Liver Cancer. Retrieved from https://www.cancer.org/cancer/liver-cancer.html 2 National Cancer Institute. (2020). Cancer Stat Facts: Liver and Intrahepatic Bile Duct Cancer. Retrieved from https://seer.cancer.gov/statfacts/html/livibd.html 3 Ferdinands et al. (2014). Effectiveness of influenza vaccine against life-threatening RT-PCR- confirmed influenza illness in US children, 2010-2012. The Journal of Infectious Diseases. https://doi.org/10.1093/infdis/ jiu185 4 Thompson et al. (2018). Influenza vaccine effectiveness in preventing influenza-associated intensive care admissions and attenuating severe disease among adults in New Zealand 2012-2015. Vaccine. https://doi. org/10.1016/j.vaccine.2018.07.028 5 CDC. (2019). FluVaxView, 2018-2019 Flu Season. Retrieved from https://www.cdc.gov/flu/fluvaxview/ 1819season.htm
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FEATURE
michiganMEDICINE® 14 14 michigan MEDICINE® || SEPTEMBER SEPTEMBER//OCTOBER OCTOBER2020 2020
Medicine‘s Great Leap Forward in Michigan How an unforeseen pandemic is transforming primary care practice – and what’s needed to keep the momentum going.
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A dozen years ago, when Dara Barrera joined the Michigan State Medical Society’s staff, health information technology was still in its infancy. “I was helping teach physicians what it meant to hold a mouse and click,” says Barrera, who today serves as MSMS’ manager of practice management & health information technology. “From there, we’ve stepped into a world of electronic health records. Telemedicine. Artificial intelligence. And much, much more that’s still out there on the horizon. And it’s only been 12 years.” Barrera stands with MSMS on the front lines of a revolution—a whirlwind that’s taken on new life in the chaos of this year’s pandemic, and which promises many more rapid advancements in the decade to come.
Digital Telehealth Takes Hold According to the U.S. Centers for Medicare & Medicaid Services, more than 10.1 million Medicare beneficiaries have received a telehealth service between mid-March and early July. This is more than a 4,000 percent increase in claims, and represents a great leap forward for many primary care physicians and the people they serve. “We were able to keep people out of ERs and urgent cares, which mattered during the pandemic,” says Scott Moore, MD, a private pediatric practitioner in Washtenaw County. “It’s easier for patients in this interaction and way more efficient than trying to navigate an office. Right now, the less time you spend here, the better for everybody.”
But, like many other Michigan physicians, Doctor Moore already sees telehealth as a permanent part of his office workflow. “We’d been using it prior to COVID, albeit on a much smaller scale. But we’re pretty wedded to it, because people are busy and they don’t want to lose all this time going into the doctor’s office—but we still need to see them and be part of their lives so we can treat them most effectively,” he says. “We can have a lot of important conversations about developmental issues, parent concerns, and so forth via telehealth, and then when they come in it’s a pure exam with measurements, vaccines and so forth.” Doctor Moore’s partner and spouse, Misha Strauss Moore—who holds a Ph.D. in philosophy from Georgetown University—is more, well, philosophical about what telehealth consultation can do for primary care physicians and their patients.
“According to the U.S. Centers for Medicare & Medicaid Services, more than 10.1 million Medicare beneficiaries have received a telehealth service between mid-March and early July.”
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“Scott and I share the view that, in our practice, we want to ensure the patients under our care are receiving very comprehensive, high quality supports. We hope to know them and understand their needs, and we want to reach out to them,” she says. “We’re always connecting proactively, reaching out to schedule those vaccines and well visits and check-ups for chronic conditions. There’s a lot we do, and telemedicine is an incredible tool for connecting us with our families.” Doctor Misha Moore says the option also provides welcome relieve for the families they serve. “You don’t have to bundle up two or three kids—one of whom is sick—and drive somewhere and sit in a waiting room and then sit in the exam room and try and occupy them with crayons that you’re not sure you want them touching,” Doctor Moore says. “With telemedicine, we can take all of that out. That’s amazing.” Indeed, patient satisfaction among primary care providers offering telehealth services has skyrocketed. James Martin, DO, of Alliance Health in Shelby Township reports extraordinary feedback. “At Alliance, we check our patient satisfaction scores on basically a daily basis,” Doctor Martin says. “Once the pandemic hit and we were able to connect with our patients online, our scores increased to something between 97 percent and 99 percent satisfaction, which is amazing.” Doctor Martin views telemedicine, which his practice had not previously offered, as an extraordinary opportunity. “Patients felt like we were still caring for them, even in the middle of the pandemic,” he says. “Our care managers, our social workers and our behavioral health specialists were all using it to treat the multiple issues people were having, and it worked. All they had to do was click a button and they could see their doctor.”
This strategy was particularly important for Doctor Martin’s elderly patients. Indeed, it played such a huge role that his office purchased a number of smart tablets to be hand-delivered and set up by office staff when in-home resources were unavailable. And it worked. “A lot of older patients who didn’t have family members nearby started feeling withdrawn and alone and very afraid, and this gave them a connection,” he says. “Our team members have so many stories over the last three, four months of talking with patients for 20 or 30 minutes, just listening. Our senior patients appreciated that so much because they were getting the human connection they’d been missing during the pandemic.” But for the Moores, it’s the quality of care that drives their appreciation for telehealth. “Telemedicine has gotten a bad name because it started out as this ‘doc in a box,’” Doctor Scott Moore says. “But for us, we’re here. If things aren’t proceeding as we’ve discussed, I know the patient will be in my office the next day. They know, ‘That’s what Doctor Moore said, and I know I can call tomorrow and get in there.’ Telemedicine does not work unless it’s in the context of a true medical home.”
“Telemedicine has gotten a bad name because it started out as this ‘doc in a box.’ But for us, we’re here. If things aren’t proceeding as we’ve discussed, I know the patient will be in my office the next day.” SCOTT MOORE, MD
Moving Beyond COVID-19 Many Michigan physicians, quick to realize the benefits of using telemedicine, now are considering how they can incorporate the technology over the long term. One such physician is Debra Graetz, MD, a family practitioner in Traverse City who, prior to COVID-19, was already using telemedicine on a limited basis and believes strongly in its potential. But Doctor Graetz has already begun expressing what many physicians fear: a post-pandemic return to the former legal, regulatory and financial structure that discouraged providers from using telemedicine. “If we go back to the old framework, telehealth will rapidly die off, which will be a huge loss,” she says. “Right now, I’m helping patients avoid unnecessary infection during influenza season. I’m helping family members that often take time off of work to manage appointments for loved ones—I’m helping them remain at work. And I’m able to be on call not only for my own practice, but for other local practices with which I partner.” For Doctor Martin, it’s an essential issue for primary physicians. He’s already begun working to encourage Blue Cross Blue Shield to keep the option open. “To me, there’s really no reason why, if one of my patients is feeling ill at 10:00 in the evening, why they can’t just contact me or one of my partners and see us via a video visit, rather than using a doctor they’ve never seen before,” he says. Doctor Misha Moore raises important patient care concerns that will continue to plague Michigan physicians if telehealth visits are eliminated.
“To me, there’s really no reason why, if one of my patients is feeling ill at 10:00 in the evening, why they can’t just contact me or one of my partners and see us via a video visit, rather than using a doctor they’ve never seen before.” JAMES MARTIN, DO
“We have very strong reservations about our patients seeing a stranger, who doesn't have access to their charts, who isn’t ever going to see them again,” she says. “And our reservations come from all the Monday morning quarterbacking we have to do to fix all the things that happened when a parent calls and says, ‘Yeah, we went to urgent care and we don't really trust what they said. So can you tell us? Here's what we told them. Here's what they did. Can you tell us if it's okay?’” According to Doctor Moore, this type of follow-up reduces continuity of care and costs the practice financially. “The urgent care got the reimbursement for the visit, and we got the headache and heartache of having to speak to this parent over the phone and correct, oftentimes, what was done somewhere else.” In the current environment, the Moores anticipate continuing and expanding their patient education about the value of telehealth options. At this writing, approximately 30–40 percent of their patient visits are occurring with the support of telemedicine—up from just one percent before. (CONTINUED ON PAGE 18)
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“It's an absolute game-changer for patients and physicians to be able to benefit from telehealth. However, I think insurance companies are guarded because they don’t want doctors who function entirely on telehealth.” DEBRA GRAETZ, MD
In northern Michigan, approximately 15 percent of Doctor Graetz’ work is being conducted with the support of telehealth tools. If payers and regulators go back to pre-COVID structures, however, she estimates this percentage will drop to the very low single digits. “It’s an absolute game-changer for patients and physicians to be able to benefit from telehealth,” Doctor Graetz says. “However, I think insurance companies are guarded because they don’t want doctors who function entirely on telehealth. And I think the rug is going to be pulled out from under us.” Dr. Scott Moore agrees. “It’s already started to waver a bit, in the sense that our biggest payer, Blue Cross Blue Shield, has ended the waiving of the cost sharing,” he says. “Most of the other payers are still waiving it, but once people start looking around the room, there’s a risk there. And it’s too bad.” What stops the change? According to Doctor Graetz, patient and physician demand will be key. “A critical mass of physicians and a critical mass of patients can move this needle,” she says. “We’ve already seen mul-
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tiple examples this year, as most of the insurers had set their end date as July 1st and then had to reopen that. And in fact, when they reopened it, they actually wiped out copays and some other features to try and encourage people to lessen the number of patients that are moving through waiting rooms and the doctor's office and encountering unnecessary illness. So there’s opportunity there for all of us, if we speak up.”
Beyond the Visit: Other Expanding Health Care Technologies Of course, the physician consultation is only one piece of what today’s health care system must accomplish. “The physician visit—whether it’s virtual or face-to-face—is the tip of a large iceberg,” says Doctor Misha Moore. “There are other pieces, like checking the medication lists, the problems, and getting a full picture of what’s happening. Then you have the visit, after which you have to get the correct labs and the right medication. And then if there's any follow up here, you're getting a test, then interpreting results and getting them back to the patient and making sure that the plan that you created at the time of the visit is still the right plan. That's all still part of the visit, and all of that work is still happening even if the patient isn't coming into the office.”
Between visits, physicians work to keep healthy patients connected and monitor the wellbeing of the chronically ill. And when it comes to the new technologies available to leverage these efforts, the sky’s the limit. And Dara Barrera has her finger on the pulse of much of it. In addition to her work with MSMS, she also is president of the Michigan chapter of the global Healthcare Information and Management Systems Society (HIMSS), which works to leverage medical technologies worldwide. “It’s amazing what’s out there in terms of technology and data,” Barrera says. “From office administration to diagnostic tools, everything needs to ‘talk’ to something. And the technologies that enable that to happen have taken off like wildfire.” Barrera goes on to describe a level of automation and data management that is truly extraordinary—and still growing. “Diagnostic data needs to be available to so many users for so many different reasons,” she says. “The electronic health record becomes a central component that is used by physicians, hospitals, insurers, you name it. The data itself means different things to different organizations, but the systems need to speak clearly and effectively to one another.” In relative terms, the development of fully interactive medical technologies has advanced rather quickly. “When we were establishing our practice in 2004, someone advised me to ‘do electronic medical records right now,’” says
“It's amazing what's out there, in terms of technology and data. From office administration to diagnostic toos, everything needs to ’talk’ to something. And the technologies that enable that to happen have taken off like wildfire.”
michigan MEDICINE® | SEPTEMBER / OCTOBER 2020
Doctor Scott Moore. “At that time, just 15 or so years ago, I’m going to guess only 15 percent of practices were doing that work. Within six months, we had a system in place. It was a great piece of technology but, by 2011, that piece of technology worked really well at 13699 Old U.S. 12, but it didn’t reach into the world, didn’t integrate. So we’ve grown into a system that now integrates well, offers a patient portal and touchless check-in process with the forms and everything, and is very user-friendly with just a smartphone.” The next high-tech opportunities available to physicians will be perhaps every bit as game-changing as telehealth, at least when it comes to building up robust patient electronic health records. The “Internet of Things” (IoT) is coming to medicine and it promises to help expand physician/patient partnerships in new and exciting ways. “We have smart blood pressure cuffs and smart scales and smart watches and other devices that interface via Bluetooth with iPhones and Android devices, and they have the potential to offer a lot of support in terms of patient care,” says Doctor Martin. “We can gather and track and review patient data over time, and possibly be alerted when something’s of concern. So we can say, ‘Okay, well, Mrs. Jones had an episode of atrial fibrillation for two minutes at 1:23 in the morning. Is there a reason for this?’”
“Virtual examinations are not out of the question and, used properly, these tools can be powerful. They free up a physician’s schedule to be able to really treat those that
Doctor Martin believes these types of diagnostic and support resources are coming sooner rather than later. “Within the next five years, we might see technologies that act as stethoscope or otoscope, so we could do a fuller examination from a remote location,” he says. “Virtual examinations are not out of the question and, used properly, these tools can be powerful. They free up a physician’s schedule to be able to really treat those that need be in the office most.” While there is still a long way to go to get full interactivity among electronic health records, Barrera sees a highly compelling reason to keep moving in that direction. “We have all this growing wealth of data, and we want to get to a place where we can begin using it in ways that are predictive,” she says. “Can we use data to help look at the social determinants of health, to find pockets of disparities and use our knowledge to address them? That’s very big right now.” But while all these advanced resources and digital capacities are being built, even the most eager of early adopters recognizes that, in medicine, technology will always have a place that’s secondary to the physician’s own knowledge and relationship. “My primary concern as physician is missing something,” Doctor Martin says. “When I can't see somebody in person or listen to their lungs or heart, there's always the potential that I may miss something. And there's something to be said for having that human interaction, that human touch. When I see a patient, I tend to put my hand on their shoulders. I let them know that I'm there for them. And I'm their doctor. I'm going to be with them. I'm going to help treat them. And that matters a lot, for both of us. No computer can ever replace it.”
need be in the office most.” JAMES MARTIN, DO
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Wearables Offer Wealth of Data during COVID-19, but Liability Risks Remain John P. Erwin, III, MD, FACC, and Debra Davidson, MJ, ARM, CPHRM
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michigan MEDICINE® | SEPTEMBER / OCTOBER 2020
Contributed by The Doctors Company
thedoctors.com
The pressure that COVID-19 has placed on physicians, practices, and hospital systems to ramp up remote monitoring will no doubt accelerate the adoption of wearables into healthcare after this crisis passes. But at the same time, using data from wearables, especially those designed for consumer use rather than formal clinical monitoring, may bring liability risks.
B
efore the COVID-19 pandemic, an estimated 40 million people in the U.S. were using some type of smart watch or fitness tracker to monitor their health, a number that has more than doubled since 2013, according to the Deloitte 2018 Health Care Consumer Survey. Now with this public health emergency, these wearables are presenting benefits to individual and population health on two major fronts: by identifying those who are about to get sick—even before they feel unwell, and by preserving limited hospital resources for the sickest patients by monitoring some patients while they remain at home.
Potential to Predict COVID-19 Cases Researchers at the University of California, San Francisco, are investigating whether Oura smart rings can help identify healthcare workers who may
have been infected with COVID-19. An algorithm flags small upticks in temperature and heart rate, which can indicate immune response before people feel ill. To be effective, researchers will need to distinguish heart rate and temperature elevations indicating immune response from those due to other causes, and they’ll need to distinguish immune responses to COVID-19 from immune responses due to other germs—a tall order. But the ability to predict who will get sick would enable healthcare workers, who are among the most exposed, to seek care sooner, and would help prevent the virus’ spread. Meanwhile, scientists at Stanford University and Scripps Research Translational Institute are recruiting users of many kinds of wearables in an attempt to predict regional outbreak clusters by tracking data on heart rate and temperature, plus activity levels vs. sleep levels. They hope to recruit at least a million participants.
Monitoring COVID-19 Patients to Preserve Hospital Resources Hospital systems like the Mayo Clinic are talking with makers of existing remote monitoring tools about how clinical-grade wearables can be adapted to monitor confirmed COVID-19 patients while they are in isolation, whether at home or in a hospital. For instance, a wearable developed for opioid overdose patients is being retooled for use with COVID-19: It continuously monitors a patient’s pulse, breathing, and blood oxygen levels. If it detects shallow breathing or an unusually slow or accelerated pulse, it alerts caregivers and hospital staff. Such measures help preserve limited hospital resources for the sickest patients. These innovative remote monitoring strategies may also benefit patients with chronic conditions, such as heart failure, who require careful management while minimizing infection exposure.
Preparing for Wider Adoption Looking beyond the current pandemic, some new devices look promising, such as the AliveCor, which uses Bluetooth technology to send a single lead rhythm monitor to a smartphone or watch. Continuous glucose monitoring is another area in which wearables continue to make headway. Undoubtedly, this technology is going to continue advancing, and the medical community will find ways to apply it in the most effective way for patients. (CONTINUED ON PAGE 22)
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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 healthcare 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).
Tips for Mitigating Potential Liability As often is the case, these technological advances come with questions about potential liability. Many of the questions concern what a physician should do with the available data when a patient sends the physician data remotely or comes in and says, "Take a look at my watch. Here’s information about my health.” How much can you trust that information? At what level is it actionable? What do you need to document? Making meaningful use of information from wearables means addressing a variety of concerns: Data quality: Researchers have determined that wearables can detect atrial fibrillation, but only at a fairly low incidence in the almost 500,000 people who were studied in an Apple Watch study. A high rate of false positives also brings into question the usefulness of those results. How can physicians determine when data from wearables is reliable? Data saturation: Wearables provide so much information that the physician may become overwhelmed and miss important information, compromising patient safety and possibly leading to malpractice liability. Interoperability: Patients are already texting, faxing, and emailing information from their wearables to their physicians, and it may soon be common for the devices to transmit data directly to the physician. But when wearables are not interoperable with electronic health records (EHRs), it is difficult or impossible for the physician to securely acquire the
22
data. This leads to many questions about the physician’s obligations to protect and store that data. In addition, lack of interoperability may make finding relevant data a needle-in-the-haystack experience. Regulatory concerns: Even though HIPAA applies to patient data collected by healthcare providers, differing state laws mean that their specific responsibilities for monitoring and protecting patient data vary by location. Lack of legal clarity: Theoretical malpractice risks are abundant with wearables, but so far there is little guidance in case law. It is unclear, for instance, if and when the monitoring of a wearable medical device creates a physician-patient relationship that brings a duty of care. Does it matter if the physician provided the device, recommended it, or was merely made aware of the data by the patient? Once a wearable device is known to the physician, when and how often must the data be reviewed? When does a physician’s knowledge of data from a wearable device obligate the inclusion of that information in treatment decisions—and when does the failure to obtain or use data from a wearable constitute a breach of the duty of care? Once a wearable device is known to the physician, when and how often must the data be reviewed? Security: The security of wearable devices and apps cannot be controlled by the physician, and there is ample reason to question whether the data is safe. An app called MyFitnessPal suffered a breach in 2018 that affected 150 million people. If a physician has any hand in providing or managing wearables for patients, the practice could be held responsible for notifying consumers of a breach or a recall.
michigan MEDICINE® | SEPTEMBER / OCTOBER 2020
Navigating the Data Maze— Now and After COVID-19 The healthcare community will continue clarifying the role of wearable devices in improving patient health, as well as the responsibility of the healthcare provider in incorporating that data into treatment plans—particularly after COVID-19 applications show the value of data collected from wearables. As practices move forward in incorporating wearables into patient care—or as patients send practices unsolicited data from their devices— practices should develop written policies that state how the practice intends to use wearables and sets limitations on what data will be accepted. Wearable devices are part of the data maze that healthcare professionals continue to struggle through. The potential for improvement in patient health makes it worthwhile to determine how we can best incorporate this technology in our practices—during this pandemic and beyond— without undue risk.
JOHN P. ERWIN, III, IS A CARDIOLOGIST AT NORTHSHORE UNIVERSITY HEALTHSYSTEM IN CHICAGO, ILLINOIS, AND A MEMBER OF THE AMERICAN COLLEGE OF CARDIOLOGY AND PROFESSIONAL LIABILITY COMMITTEE (ACC PLC). DEBRA DAVIDSON IS A SENIOR PATIENT SAFETY RISK MANAGER WITH THE DOCTORS COMPANY IN EAST LANSING, MICHIGAN.
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TheHLP.com [284.996.8510] SEPTEMBER / OCTOBER 2020 |
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MSMS Board of Directors Disclosures House of Delegates Resolution 25-13 states that “MSMS annually provide Michigan physicians with a list of all officers, officials, candidates and staff who receive money as salary or non-patient care compensation from Blue Cross Blue Shield of Michigan (BCBSM) or any other insurer, medical product company or its affiliates annually in Michigan Medicine.” Following are the disclosures of the MSMS Board of Directors, officers and staff.
USPS Statement of Ownership Statement of Ownership, Management, and Circulation (All Periodicals Publications Except Requester Publications)
1. Publication Title
2. Publication Number
Michigan Medicine
0
Bi-monthly
Six (6)
4. Issue Frequency
0
2
_
6
3. Filing Date
2
Telephone (Include area code)
8. Complete Mailing Address of Headquarters or General Business Office of Publisher (Not printer)
120 West Saginaw Street, East Lansing, MI 48823
Editor (Name and complete mailing address)
Pino D. Colone, MD – None
Contact Person
517-336-5745
Anita R. Avery, MD – Priority Health: Grievance and Appeals Committee, Outside Physician Member
Adrian J. Christie, MD –
8/03/2020
6. Annual Subscription Price
$110.00
Kevin McFatridge
120 West Saginaw Street, East Lansing, MI 48823
9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor (Do not leave blank) Publisher (Name and complete mailing address)
T. Jann Caison-Sorey, MD, MSA, MBA –
3
7. Complete Mailing Address of Known Office of Publication (Not printer) (Street, city, county, state, and ZIP+4 ®)
Mohammed A. Arsiwala, MD – None
Paul D. Bozyk, MD – None
9
2
5. Number of Issues Published Annually
Kevin M. McFatridge, 120 West Saginaw Street, East Lansing, MI 48823 Kevin M. McFatridge, 120 West Saginaw Street, East Lansing, MI 48823 Managing Editor (Name and complete mailing address)
10. Owner (Do not leave blank. If the publication is owned by a corporation, give the name and address of the corporation immediately followed by the names and addresses of all stockholders owning or holding 1 percent or more of the total amount of stock. If not owned by a corporation, give the names and addresses of the individual owners. If owned by a partnership or other unincorporated firm, give its name and address as well as those of each individual owner. If the publication is published by a nonprofit organization, give its name and address.) Full Name Complete Mailing Address
Michigan State Medical Society
120 West Saginaw Street, East Lansing, MI 48823
Donald P. Condit, MD, MBA – None Jayne E. Courts, MD – Affinia Health Clinically Integrated Network: 0.2 FTE Contracted to AH (within the Mercy Health Contract Integrated CIN).
11. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or More of Total Amount of Bonds, Mortgages, or None Other Securities. If none, check box Full Name
Complete Mailing Address
Talat Danish, MD, MPH, FAAP – Robert M. Doane, MD – None Robert F. Flora, MD, MBA Thomas M. George, MD – None Amit Ghose, MD –
12. Tax Status (For completion by nonprofit organizations authorized to mail at nonprofit rates) (Check one) The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes: Has Not Changed During Preceding 12 Months Has Changed During Preceding 12 Months (Publisher must submit explanation of change with this statement) 13. Form Publication PS 3526, Title July 2014 [Page 1 of 4 (see instructions page 4)] PSN: 7530-01-000-9931
Michigan Medicine
14. IssueSee Date forprivacy Circulation Below PRIVACY NOTICE: our policyData on www.usps.com.
15. Extent and Nature of Circulation
Average No. Copies No. Copies of Single Each Issue During Issue Published Preceding 12 Months Nearest to Filing Date
Theodore B. Jones, MD – None Paul S. Harkaway, MD – Priority Health: Consulting Work Larry R. Junck, MD – Mark C. Komorowski, MD – None Nita M. Kulkarni, MD – P. Dileep Kumar, MD – Gunjan B. Malhotra, MD – None Mark E. Meyer, MD – None Christopher J. Milback, MD, MBA – None
8828
a. Total Number of Copies (Net press run) (1) Mailed Outside-County Paid Subscriptions Stated on PS Form 3541 (Include paid distribution above nominal rate, advertiser’s proof copies, and exchange copies) b. Paid Circulation (By Mail and Outside the Mail)
(2)
Mailed In-County Paid Subscriptions Stated on PS Form 3541 (Include paid distribution above nominal rate, advertiser’s proof copies, and exchange copies)
(3)
Paid Distribution Outside the Mails Including Sales Through Dealers and Carriers, Street Vendors, Counter Sales, and Other Paid Distribution Outside USPS®
(4)
Paid Distribution by Other Classes of Mail Through the USPS (e.g., First-Class Mail®)
S. Bobby Mukkamala, MD – None
F. Remington Sprague, MD – Vice Chair, Board of Directors, Blue Cross Blue Shield of Michigan Brian R. Stork, MD – None Bradley J. Uren, MD Thomas J. Veverka, MD – None John A. Waters, MD – Phillip G. Wise, MD –
614
0
0
0
h. Total (Sum of 15f and g) i. Percent Paid (15c divided by 15f times 100)
0
8657
0
0
0
0
0
0
0
0
0
Free or Nominal Rate Distribution Outside the Mail (Carriers or other means)
f. Total Distribution (Sum of 15c and 15e)
Herbert C. Smitherman, Jr., MD, MPH –
640
e. Total Free or Nominal Rate Distribution (Sum of 15d (1), (2), (3) and (4))
g. Copies not Distributed (See Instructions to Publishers #4 (page #3))
Richard C. Schultz, MD – None
8043
8659
c. Total Paid Distribution [Sum of 15b (1), (2), (3), and (4)]
(4)
8700
8019
d. Free or (1) Free or Nominal Rate Outside-County Copies included on PS Form 3541 Nominal Rate Distribution (2) Free or Nominal Rate In-County Copies Included on PS Form 3541 (By Mail and Free or Nominal Rate Copies Mailed at Other Classes Through the USPS Outside (3) (e.g., First-Class Mail) the Mail)
Tabitha E. Moses – None Michael J. Redinger, MD – None
July/August 2020
0
8659
8657
8828
8700
169
43
Statement of Ownership, Management, 100% and Circulation 100% (All Periodicals Publications Except Requester Publications)
* If you are claiming electronic copies, go to line 16 on page 3. If you are not claiming electronic copies, skip to line 17 on page 3. 16. Electronic Copy Circulation
Average No. Copies Each Issue During Preceding 12 Months
No. Copies of Single Issue Published Nearest to Filing Date
a. Paid Electronic Copies b. Total Paid Print Copies (Line 15c) + Paid Electronic Copies (Line 16a) c. Total Print Distribution (Line 15f) + Paid Electronic Copies (Line 16a) d. Percent Paid (Both Print & Electronic Copies) (16b divided by 16c Í 100)
I certify that 50% of all my distributed copies (electronic and print) are paid above a nominal price. 17. Publication of Statement of Ownership PS Form 3526, July 2014 (Page 2 of 4) If the publication is a general publication, publication of this statement is required. Will be printed
Publication not required.
Sept/Oct 2020 in the ________________________ issue of this publication. 18. Signature and Title of Editor, Publisher, Business Manager, or Owner
Kevin M. McFatridge
Digitally signed by Kevin M. McFatridge DN: cn=Kevin M. McFatridge, o=Michigan State Medical Society, ou=Marketing, Communications and Public Relations, email=kmcfatridge@msms.org, c=US Date: 2015.09.11 09:09:44 -04'00'
Date
8/7/2020
I certify that all information furnished on this form is true and complete. I understand that anyone who furnishes false or misleading information on this form or who omits material or information requested on the form may be subject to criminal sanctions (including fines and imprisonment) and/or civil sanctions (including civil penalties).
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michigan MEDICINE® | SEPTEMBER / OCTOBER 2020
Convenient access to specialists at
MICHIGAN’S ONLY HONOR ROLL HOSPITAL
• Make appointments • Transfer patients • Consult with physicians
M-LINE:
800-962-3555
24 hour s a day, 7 days a w eek
• Get patient information
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Educational Offerings
MSMS On-Demand Webinars Coding and Billing Webinars: Access to Medicare Changes to E&M Codes for 2019 and other Coding Updates Billing 101 Claim Appeals Credentialing Medical Necessity Tips on Documentation to Prove it Reading Remittance Advice Tips and Tricks on Working Rejections
Webinars at No Cost to Members:
NEW, FREE ON-DEMAND WEBINAR! Integrating Pharmacists into Practice: The Missing Link for Comprehensive Medication Therapy Management
Webinars that meet Board of Medicine Requirements:
Human Trafficking Medical Ethics – Conscientious Objection among Physicians Medical Ethics – Decision Making Capability Medical Ethics – Just Caring: Physicians and Non-Adherent Patients Pain and Symptom Management Series Balancing Pain Treatment and Legal Responsibilities MAPS Update and Opportunities Michigan Automated Prescription System Update Opioid Town Hall Pain and Opioid Management 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 (Fulfills the 1-time training on opioids and other controlled substances awareness)
michiganMEDICINE® 26 26 michigan MEDICINE® || SEPTEMBER SEPTEMBER // OCTOBER OCTOBER 2020 2020
Balancing Pain Treatment and Legal Responsibilities CARES Act Impact 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 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 MAPS Update and Opportunities Medical Necessity Tips on Documentation to Prove it Michigan Automated Prescription System Update Opioid Town Hall Prescribing Legislation Section 1557: Anti-Discrimination Obligations Sexual Misconduct – Prevention and Reporting Telemedicine and Other Technology Codes in a COVID-19 Environment 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 What Physicians Need to Know as Employers During the COVID-19 Pandemic
Other Webinars: Michigan Medical Marihuana Law Non-Pharmacologic Management of Musculoskeletal Pain Syndromes
Visit msms.org/OnDemandWebinars for complete listing of On-Demand Webinars. Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.
SAVE THE DATE for 2020! FREE! COVID-19 On-Demand Webinars COVID-19: AMA Advocacy and Physician Resources CME Credits: .75
COVID-19: Best Practices for Implementing Telemedicine CME Credits: .75
COVID-19: CARES Act Impact CME Credits: 0.50
COVID-19: CARES Act Impact: Q&A with CPAs CME Credits: .75
COVID-19: CARES Act Impact: Q&A with CPAs 2.0
Virtutal Conference –
7.5
Fall 2020 Symposium on COVID-19
Date: September 16, 7 - 11 am and September 17, 7:30 - 11:30 am This two-day virtual conference with the option to attend one or both days is designed to provide up to date information on the COVID-19 pandemic in Michigan while providing a safe way for physicians to learn and earn CME Credit. Member cost: $100 a day; $150 for both days Non-member cost: $150 a day; $200 for both days Contact: Beth Elliott at 517/336-5789 or belliott@msms.org
CME Credits: .75
COVID-19: New Employment Policies for Practices CME Credits: .50
COVID-19: New Waivers and Billing Changes for Telemedicine CME Credits: 1.0
COVID-19: Race Inequalities and COVID-19: Contagion, Severity, and Social Systems CME Credits: .75
COVID-19: Safe and Innovative Office Procedures for Seeing Patients CME Credits: .75
COVID-19: Telemedicine and Other Technology Codes in a COVID-19 Environment
5
AMA/PRA CATEGORY 1 CREDIT(S) TM
Virtutal Conference –
Board of Medicine Renewal Requirements
Date: October 20, 9 am - 3:30 pm This one-day virtual conference will cover the following: • Controlled substance license requirements • Pain and Symptom Management • Medical Ethics • Human Trafficking Member cost: $150 Non-member cost: $200 Contact: Beth Elliott at 517/336-5789 or belliott@msms.org
CME Credits: 0.75
COVID-19: Testing, Tracing and Tracking CME Credits: .75
COVID-What Physicians Need to Know as Employers During the COVID-19 Pandemic CME Credits: 1.0 AMA Credit Designation The Michigan State Medical Society designates this enduring material for a maximum of .50 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity. AMA Credit Designation The Michigan State Medical Society designates this enduring material for a maximum of .75 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity. AMA Credit Designation The Michigan State Medical Society designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity.
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michigan MEDICINE® | SEPTEMBER / OCTOBER 2020
Virtutal Conference –
155th MSMS Foundation Annual Scientific Meeting Date: October 21 - 23, 2020 and October 28 - 30, 2020 Save the date for the first-ever virtual Annual Scientific Meeting. Join your colleagues and experts from around the state virtually as we address local, state and national practice gaps and needs. The full program will be announced within the coming weeks. Contact: Beth Elliott at 517/336-5789 or belliott@msms.org
24th Annual Conference on Bioethics Date: Saturday, November 14 Tentative Location: DoubleTree by Hilton, Ann Arbor Intended for: Physicians and all other health care professionals. Contact: Beth Elliott at 517/336-5789 or belliott@msms.org
SEPTEMBER / OCTOBER 2020 |
michigan MEDICINE®
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URGENT: Oppose Surprise, Out-of-Network Billing Consider a comprehensive, balanced solution to House Bills 4459, 4460, 4990, and 4991
A
t a time when physicians are busy adjusting to the new world of COVID-19, the Michigan Legislature has re-started the conversation about price fixing for out-of-network physicians. Surprise, out-of-network billing legislation has been a topic of conversation in Lansing for years. Unfortunately, the sponsors of legislation introduced in Michigan – HB 4459 & 4460 and
HB 4990 and HB 4991 – believe there is a simplistic answer, namely implementing a fee schedule that constitutes a pay cut for physicians, with very limited recourse for physicians to dispute that payment. MSMS supports holding patients harmless from unanticipated, out-of-network medical bills and believes the most effective approach – that has been successful in other states – allows the insurers and providers to negotiate in good faith with a truly independent dispute resolution process, when no other agreement can be reached. The independent dispute resolution proposed by HB 4459 requires physicians to prove network inadequacy and only applies in narrowly defined special circumstances. Michigan physicians understand that every discussion about health care and health policy should start and end with what is best for Michigan patients. The proposed “solution” could create more problems for patients than it solves. This bill package is now in the Senate Committee on Health Policy and Human Services.
ENGAGE – msms.org/engageOON:
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michigan MEDICINE® | SEPTEMBER / OCTOBER 2020
Fix Prior Authorization Because Health Can’t Wait
Activate your political voice!
Support Senate Bill 612
Get started at mdpac.org
Prior authorization and step therapy/fail first requirements hamstring treatment, drive up nonadherence to medication and lead to diminished health. It’s onerous and needless insurance company bureaucracy, and it’s negatively affecting patients, physicians, providers and their practices.
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.
It’s time we cut out the red tape, because at the end of the day, health can’t wait. And now we can do just that. State lawmakers recently introduced SB 612, a bill that reforms the prior authorization and step therapy/fail first process by introducing new transparency, fairness and clinical validity requirements, ensuring our patients receive timely coverage decisions, and ultimately, the care and treatment they need.
Physician engagement is essential to the success of a pro-medicine legislature. Current and potential lawmakers want and need to hear from professionals in the field of medicine. Through MDPAC, you will activate your voice on the things most important to Michigan physicians.
Join MDPAC today!
This is the kind of reform our patients deserve—it’s time to put them first.
Five Reasons t
BACK the
Please contact your lawmakers today and urge them to support SB 612.
The Michigan Doctor Action Committee (M and maintains strong with lawmakers, as w dates running for po
As the face of physic
MSMS Engage – https://MSMS.org/engage
Activate your political voice!
Connecting constituents and lawmakers is a critical and central function of grassroots advocacy. MSMS’ Engage gives users access to an editable, The Michigan Doctors’ Political Action Committee (MDPAC) is prefilled web-form letter sending system, which has become the easiest and most effective way fortheconstituents to contact theirSociety. lawmakers. political arm of the Michigan State Medical It is a bipartisan political action committee made up of Communicate, educate, engage, and activate on the things that are most important to Michigan physicians. With Engage, YOU become a “virtual physicians, their families, residents, medical students and others interested in making a positive contribution to the medical lobbyist,” so please familiarize yourself with Engage and take action now! profession through the political process. MDPAC supports pro-medicine candidates running for political office in Michigan. Physician engagement is essential to the success of a pro-medicine legislature. Current and potential lawmakers want and need to hear from professionals in the field of medicine. Through MDPAC, you will activate your voice on the things most important to Michigan physicians.
SEPTEMBER / OCTOBER 2020 |
michigan MEDICINE®
bring medical know discussions with p decision makers.
For more than thre MDPAC has mount successful lobbyin behalf of physician
For example... MDPA strengthens tort refo the physician’s tax,
helped to stop the e non-physician’s sco
MDPAC has power, respect! If you wake giant, MDPAC could m positive change for p patients. It could eas pressures with the cu authorization proces
and time on your M Certification, and ad health issues.
Trial lawyers, insuran and other political op massive sums of mon
Medicine’s friends MDPAC, must dig de equivalent or greate of funds to advance M
29 physician’s agenda. The current political
Welcome New Members www.msms.org/Membership
Branch County
Marquette/Alger County
Charles Whitaker, MD
Viktoria Koskenoja, MD Spring Madosh, MD
Genesee County Mohamad Loay Alasbahi, MD
Oakland County
Raafay Sophie, MD
Jared Goldberg, MD Varsha Karamchandani, MD
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Eboni Martin, MD Remilekun Soile, MD
Jacquelyn Charbel, DO, FACOS, FACS
Bradford Walters, MD
Ingham County Oussama Al-Sawas, MD
Out-of-state
Radoslav Coleski, MD
Jonathan Decker, DO
Dorian Jones, MD Lucas Julien, MD
Saginaw County
Cristin Opreanu, MD
Karensa Franklin, MD
Scott Plaehn, DO, FACOI Robert Rose, DO, FACOI
Shiawassee County
Dana Stewart, DO
Joseph Bustamante, DO
John Walling, DO, FACOI
Washtenaw County
Kent County
Juan Luis Marquez, MD, MPH
John Campbell, MD Lakshmi Kocharla, MD
Wayne County
Livingston County
Teronto Robinson, MD
Brooke Buckley, MD
Jean Nelson, DO
Macomb County Matthew Edwards, DO Mouhammed Joumaa, MD Sherezade Khambatta, DO Sheel Tolia, DO Mark Zainea, MD
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michigan MEDICINE® | SEPTEMBER / OCTOBER 2020
( ) | @
SEPTEMBER / OCTOBER 2020 |
michigan MEDICINE®
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Connecting practices to
EMERGING TRENDS. We’re taking the mal out of malpractice insurance. In an ever-evolving healthcare environment, we stay on top of the latest risks, regulations, and advancements. From digital health innovations to new models of care and everything in between, we keep you covered. And it’s more than a trend. It’s our vision for delivering malpractice insurance without the mal. Join us at thedoctors.com
Endorsed by
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1/22/19 4:22 PM