MI MEDICINE | NOV-DEC 2019

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 118 / NO. 6

November / December 2019

LARGE MICHIGAN EMPLOYERS

Pioneering Changes in Health Care Delivery

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FEATURES & CONTENTS November / December 2019

08

Exempt (Salaried) Earning Thresholds Set to Increase JODI SCHAFER, SPHR, SHRM-SCP

10

Preventing Influenza During the 2019-2020 Flu Season MICHELLE DOEBLER, MPH, INFLUENZA EPIDEMIOLOGIST, MDHHS

12

Health Care Delivery News Briefs STACIE SAYLOR, CPC, CPB

24

Terminating Patient Relationships JULIE BRIGHTWELL, JD, RN

COLUMNS 04 President's Perspective

MOHAMMED A. ARSIWALA, MD

06 Ask Our Lawyer

FEATURE

16

DANIEL J. SCHULTE, MSMS LEGAL COUNSEL

DEPARTMENTS 14 In Memoriam 23 Welcome New Members 28 MSMS Educational Courses

Large Michigan Employers Pioneering Changes in Health Care Delivery

BY NICK DELEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY

STAY CONNECTED!

Employers are taking creative measures to attract knowledgeable, experienced workers, and it’s impacting both the practice of medicine and the state’s health care economy. Story on page 16.

NOVEMBER / DECEMBER 2019 |

michigan MEDICINE® 3

MICHIGAN MEDICINE® VOL. 118 / NO. 6 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 2019 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. ©2019 Michigan State Medical Society

michiganMEDICINE® 4 michigan MEDICINE®

| NOVEMBER / DECEMBER 2019

perspective

By Mohammed A. Arsiwala, MD, MSMS President

Dear Colleagues, Michigan’s economy is booming, and employers are looking for newer, better, and more effective ways to recruit and retain talent.

What they’ve learned is that providing newer, better, and more effective health care benefits can make all the difference.

In this edition of Michigan Medicine, you’ll hear about Michigan businesses and the Michigan physicians who are helping them revolutionize the benefits they offer MOHAMMED A. ARSIWALA, MD MSMS PRESIDENT

employees and their families.

From on-site and walk-up primary care options at Dow in Midland to direct contracting for salaried employees at General Motors, and many more in between, new approaches to health care access and delivery are changing the way patients seek treatment and the way some of the state’s biggest employers source their care.

You’ll also read about broader national trends in health care benefits, and ways some employers are getting third-party payers out of the health care equation altogether.

The way Michigan seeks and pays for health care is changing, and Michigan physicians are leading the charge.

Sincerely,

Mohammed A. Arsiwala, MD MSMS President

NOVEMBER / DECEMBER 2019 |

michigan MEDICINE® 5

ASK OUR LAWYER

Disputing A Health Plan's Audit Findings

By Daniel J. Schulte, JD, MSMS Legal Counsel

Q:

A health plan that I participate with sent me a letter indicating that it was going to audit my practice. I sent copies of the medical records it requested.

Without speaking to me first, the health plan has concluded that many previously paid claims were improper and that I owe them a large refund. The refund is based, in my view, on incorrect conclusions and statistical extrapolation. The notice states that if I do not send the health plan a check it will withhold the amount of the refund from its future payments for my services. Is this proper? How can I dispute this?

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The situation you describe is common.

Physicians are frequently being audited by both governmental and private health plans with refunds claimed based on alleged failures to comply with coding, billing and documentation requirements.

Pursuant to common terms in participation agreements, a payer has the right to audit claims and may deny payment or seek a refund based on lack of documentation, incorrect coding, the payer’s belief that medical necessity for a procedure is lacking, etc.

Statistical extrapolation can greatly increase the amount of the requested refund.

The refund amount resulting from the claims the health plan has audited is extrapolated to all similar claims paid over an entire audit period. Using such a method, what may be a minor refund on actual audited claims can escalate to a refund demand of a much larger amount.

In order to dispute the audit findings, you first need to consult with an attorney experienced in these matters who will carefully review the terms of your participation agreement with the health plan and any policies and procedures of the health plan that have been incorporated into the contract by reference. The following information must be obtained and evaluated: Can you dispute the health plan’s right to conduct an audit? Does the contract, directly or indirectly, specifically allow the health plan to conduct an audit? If so, how often and under what terms and conditions, if

any? Is there a limit on how far back claims may be audited and/or refunds sought?

Do the issues raised by the health plan require you to retain your own coding, documentation or other consultants/experts?

The health plan should be required to disclose the complete audit results including an itemized list of the claims audited and the findings and the basis for the findings on a per claim basis.

Is the use of statistical extrapolation specifically authorized by the contract or the law? If so, the health plan should disclose the details of the method used so that its validity can be assessed.

If findings are based on medical necessity or other diagnosis or treatment issues, were they made by a physician in active practice with the same training, qualifications and experience as you or by a layman in the claims or underwriting department?

Does the contract, policies or procedures provide for mediation or managerial-level conference or other dispute resolution process prior to you seeking a legal remedy or pursing your rights with Michigan’s Department of Insurance and Financial Services or pursuant to the Patient Right to Independent Review Act or other law?

The starting point is always understanding what your contract and the applicable policies and procedures provide. This is should be followed by obtaining the documentation/information from the health plan so that you can fully understand the audit process and findings. This is a process that requires a health care attorney experienced in these matters.

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

Qualified Peer Reviewers Needed MPRO (Michigan Peer Review Organization) is looking for physicians, in primary care and other specialties, to do quality-of-care medical peer review on a contingent basis.

Reviews can be done off-site electronically, and do not involve medical liability evaluations. Compensation as an independent contractor is competitive.

If you are interested, and you maintain at least 20 hours per week of direct patient care, please contact James Mitchiner, M.D., MPH, at jmitchin@mpro.org or (248) 465-7313.

22670 Haggerty Road, Suite 100 Farmington Hills, Michigan 48335 www.mpro.org

HELP PROTECT THE INTEGRITY OF YOUR SPECIALTY! NOVEMBER / DECEMBER 2019 |

michigan MEDICINE® 7

ASK HUMAN RESOURCES

Exempt (Salaried) Earning Thresholds Set to Increase

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

On September 24th of this year the Department of Labor (DOL) announced a long-awaited update to the federal wage and hour law that establishes minimum wage, compensable hours and overtime provisions. By raising the salary threshold under which white-collar salaried workers qualify for overtime pay from $23,660 to $ 35,568 per year, more than 1.3 million workers will get overtime protections or see a rise in their salary above that threshold.

T

his isn’t the first time the DOL has attempted to update the Fair Labor Standards Act (FLSA) in recent years. Back in 2016, the Obama Administration also saw the need to raise the minimum earning threshold for exempt (salaried) employees – something that hasn’t been adjusted in more than a decade. What was startling to employers at the time was that the DOL wanted to more than double the earning amount! However, the DOL never got the chance.

A federal court in Texas issued an injunction at the 11th hour, just before the changes were set to go into effect, putting everything on hold. And there it sat… until now.

Effective January 1, 2020, the new FLSA rule will:

Raise the “standard salary level” from the currently enforced level of $455 per week to $684 per week (equivalent to $35,568 per year for a full-year worker) – a more reasonable increase than the 2016 proposal; Raise the total annual compensation requirement for “highly compensated employees” from the currently enforced level of $100,000 per year to $107,432 per year; Allow employers to use nondiscretionary bonuses and incentive payments (including commissions) paid at least annually to satisfy up to 10% of the standard salary level, in recognition of evolving pay practices; and Revise the special salary levels for workers in U.S. Territories and the motion picture industry.

UPDATES TO THE FLSA WILL TAKE EFFECT JANUARY 1, 2020

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To gauge the potential financial impact of these FLSA updates on your bottom line begin by identifying all current exempt employees making less than $35,568/year.

You can choose to: A.) increase their salary to meet this new threshold by January 1st, or B.) reclassify them as nonexempt.

For those employees making close to this new dollar amount, an increase could be the easiest route to go.

However, raising the pay of this subset of your workforce for reasons not associated with merit or tenure may cause a ripple effect with the rest of your staff. Be prepared for a few “that’s not fair” and “what about me” discussions.

If the pay increase would be cost prohibitive or would cause too much internal strife, you will be forced to reclassify these employees as nonexempt and they will become eligible for overtime compensation. If you are unsure of how much overtime your at-risk exempt employees are currently working, you should take these next few months to run a few time studies to help gauge the impact to your bottom line.

If the amount of overtime worked is fairly minimal, you may decide to: Convert their current salary to an hourly equivalent and pay time and a half for any hours worked over 40, or Continue to pay your employees their current salary (base pay) rate, but require them to submit an exemption report for any hours worked above and beyond 40 so that time a half can be paid for those hours.

If the amount of overtime worked is significant, you may decide to: Limit their work hours and potentially hire part-time and/or temporary staff to fill in as needed, or Reduce other benefits being offered to offset the anticipated increase in payroll expenses, or Reduce base rates of pay so that when you account for the overtime costs (1.5 x the base rate), the net impact is budget neutral; assuming the reduced base rate doesn’t drop employee pay below minimum wage.

The last two options, while potentially budget neutral, are not great options for employee morale and retention which means that budgeting for the extra costs associated with increasing salaries, rising overtime costs or the addition of part-time staff needs to start now.

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MDHHS UPDATE

Preventing Influenza During the 2019-2020 Flu Season

By Michelle Doebler, MPH, Influenza Epidemiologist, Michigan Department of Health and Human Services, Division of Immunization

Each year, influenza infections are estimated to cause millions of illnesses and thousands of hospitalizations and deaths nationally.

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The 2018-2019 flu season The 2018-2019 flu season (September 30, 2018 – May 18, 2019) was moderately severe with two distinct waves of influenza activity corresponding to two different influenza A viruses circulating throughout the season. Influenza-like illness (ILI) activity began increasing in November 2018, peaked during mid-February 2019, and returned to

| NOVEMBER / DECEMBER 2019

below national baselines in mid-April 2019. Nationwide, the 2018-2019 flu season saw 21 weeks of elevated flu activity, making it the longest flu season in a decade.1 Flu activity in Michigan reflected the patterns of activity seen on a national level.

Preliminary estimates indicate that influenza burden from the 2018-2019 flu season was significant. Influenza infec-

tions caused approximately 42 million illnesses, up to 647,000 hospitalizations, and up to 61,000 deaths.2 Nationally, as of September 27, 2019, 135 influenza-associated pediatric deaths have been confirmed for the 2018-2019 flu season, and 3 of these deaths were from Michigan.3

The most effective way to prevent flu is with an annual influenza vaccination.

data every year to make recommendations on the composition of the influenza vaccine.5 The Northern Hemisphere’s 2019-2020 flu vaccine composition includes an A/Brisbane/02/2018 (H1N1) pdm09–like virus, an A/Kansas/14/2017 (H3N2)–like virus, and a B/Colorado/06/2017–like virus (Victoria lineage).

Quadrivalent vaccines include these three strains plus a B/Phuket/3073/2013–like virus (Yamagata lineage) virus.6

30.4% Michigan's flu vaccination coverage for everyone aged 6 months and older for the 2018-19 season, according to MCIR data.

The Advisory Committee on Immunization Practices recommends that all persons aged 6 months and older, withoutcontraindications, receive an influenza vaccination every year. However, influenza vaccine coverage across the country is below the Healthy People 2020 goal of 70 percent. According to data from the Centers for Disease Control and Prevention (CDC), nationally only 49.2% of all persons aged 6 months and older received an influenza vaccination for the 20182019 flu season.4 The influenza vaccine coverage estimate in Michigan, utilizing data from the Michigan Care Improvement Registry (MCIR), for everyone aged 6 months and older was 30.4% for the 2018-19 season.

contagious respiratory illness that can lead to extreme sickness and even death.

Young children can be especially susceptible to severe complications from the flu. Children aged 6 months through 8 years may require two doses of influenza vaccine to be fully protected for a season. Last season according to MCIR data, Michigan’s flu vaccination coverage for children recommended to receive two doses was only 12.5%. Children that do not receive their second dose may still be at risk from developing illness from influenza infection. Providers are encouraged to communicate the importance of the second dose of influenza vaccine to parents. We need to do better in Michigan to protect our most vulnerable children.

Influenza is not the “stomach flu” and not just a “bad cold” but rather is a highly

Annually, CDC and the Michigan Department of Health and Human Services encourages providers to utilize the plethora of resources available to educate patients and increase influenza vaccine coverage rates. Many of these resources provide sample messaging to address the misconceptions preventing people from choosing to get an influenza vaccine. Educational materials are available at www. cdc.gov/flu and www.michigan.gov/flu.

12.5% Michigan’s flu vaccination coverage for children recommended to receive two doses last year, according to MCIR data.

To address vaccine effectiveness concerns, the World Health Organization reviews surveillance, laboratory, and clinical study

While influenza viruses are detected yearround in the United States, typically influenza infections are most common in the fall and winter months, with activity peaking between December and February.6 National Influenza Vaccination Week (December 2-8, 2019) highlights the importance of continuing flu vaccination through the holiday season and beyond. Providers are encouraged to assess their patients through the winter for flu vaccination status and continue to offer flu vaccine for the entire season!

REFERENCES 1 Xu X, Blanton L, Elal AI, et al. (2019). Update: Influenza Activity in the United States During the 2018–19 Season and Composition of the 2019–20 Influenza Vaccine. MMWR Morb Mortal Wkly Rep 2019;68:544–551. DOI: http://dx.doi.org/10.15585/ mmwr.mm6824a3 2 Centers for Disease Control and Prevention (CDC).

(2019). 2018-2019 U.S. Flu Season: Preliminary Burden Estimates. Retrieved from https://www.cdc. gov/flu/about/burden/preliminary-in-season-estimates.htm 3 CDC. (2019). Weekly U.S Influenza Surveillance Report. Retrieved from https://www.cdc.gov/flu/ weekly/index.htm#ILIMap 4 CDC. (2019). FluVaxView, 2018-2019 Flu Season.

Retrieved from https://www.cdc.gov/flu/fluvaxview/1819season.htm 5 CDC. (2018). Selecting Viruses for the Seasonal Influenza Vaccine. Retrieved from https://www.cdc. gov/flu/prevent/vaccine-selection.htm 6 CDC. (2018). The Flu Season. Retrieved from https:// www.cdc.gov/flu/about/season/flu-season.htm

NOVEMBER / DECEMBER 2019 |

michigan MEDICINE® 11

HEALTH CARE DELIVERY

Health Care Delivery News Briefs

By Stacie Saylor, CPC, CPB, Manager, Reimbursement Advocacy, The Michigan State Medical Society

Carrier Advisor Committee

Health Plan Report Card

Wisconsin Physician Services (WPS), the Medicare Advisory Contractor for Michigan, is looking for physicians to serve on their Carrier Advisory Committee (CAC).

Help MSMS, help you! Tell us about your experience with Michigan Health Plans.

The purpose of the CAC is to provide: A formal mechanism for physicians in the State to be informed of and participate in the development of local coverage determinations (LCD) in an advisory capacity; A mechanism to discuss and improve administrative policies that are within carrier discretion; and A forum for information exchange between carriers and physicians.

In addition to at-large positions, WPS has the following several specialty slots available: Allergy/Immunology, Anesthesia, Gastroenterology, General Surgery, Gerontology, Internal Medicine, Interventional Pain Medicine, Medical Oncology, Neurosurgery, Orthopedics, Pediatrics, Peripheral Vascular Surgery, Plastic and Reconstructive Surgery, Psychiatry, Pulmonary Medicine, Radiology, and Urology.

Please contact Stacie Saylor at ssaylor@msms.org if you know a physician who may be interested in serving on the CAC.

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The payer advocacy work MSMS does is driven by issues that our members are experiencing in their practices. While we gather that information through phone calls and emails, we have created an online survey that is designed to gather additional information on Michigan health plans. This information will help in our advocacy efforts, as well as become a guide for members to use when considering contracting with health plans. Questions include: 1. How long does a clean, electronic claim take to get paid or denied?

2. How long does it take to get a response on an appealed claim?

3. How long does it take for a health plan representative to return a call or an email?

4. What is the percentage of claims that are accurately adjudicated upon initial submission?

5. When you submit medical documentation to support a claim submission or claim appeal, how many times do you have to submit the documentation before claim resolution is determined?

6. For claims that require prior authorization, what is the percentage of claims paid upon initial submission?

7. How long does it take to complete the prior authorization request for a medical service? For pharmacy?

8. How long does it take before you get an approval or denial of authorization for a medical service? For pharmacy?

9. How long does it take to complete the enrollment/re-enrollment application?

10. How long does it take to get a response on a provider enrollment/ re-enrollment application?

Please take a few minutes to complete this important survey: http://msms.org/HPReportCard

Request for Prior Authorization Data As a part of our work with the Health Can’t Wait Coalition on Prior Authorization Reform, MSMS is collecting additional data on prior authorizations.

MSMS is requesting information on tests, procedures or prescriptions that have a high approval rating. Meaning if your practice submits a request, the prior authorization is approved 90 percent of the time or more. MSMS is also interested in tests, procedures or prescriptions that are low in cost. For example, the administrative cost of completing the request is more than the reimbursement.

Please send any pertinent info to Rebecca Blake at rblake@msms.org.

Health Can’t Wait is a coalition of patients, physicians, health care providers, and patient-supported groups working to put Michigan patients first.

We aim to end dangerous delays in patients’ access to health care caused by insurance company bureaucracy, including prior authorization and step therapy requirements.

Share your Health Can’t Wait story at www.healthcantwait.org

NOVEMBER / DECEMBER 2019 |

michigan MEDICINE® 13

MEMBERS OF THE MICHIGAN STATE MEDICAL SOCIETY REMEMBER THEIR COLLEAGUES WHO HAVE DIED.

DANIEL PONTIUS, DO 8/26/19

JAMES REIFF, DO 9/10/19

SOSALE BERKUCHEL, MD 8/27/19

HOWARD OTTO, MD 9/11/19

MICHAEL FARMER, DO 8/28/19

NORMAN ARENDS, MD 9/12/19

JOHN PENNER, MD 8/29/19

JACK PRICE, MD 9/13/19

ALMON SCHUT, MD 8/30/19

SEYMOUR GORDON, MD 9/14/19

NORMAN THOMPSON, MD 8/31/19

THOMAS WRIGHT, MD 9/15/19

SUMAIYA ANSARI, MD 9/1/19

WILLIAM S. F. VIPOND, MD 9/16/19

DOUGLAS FOSTER, MD 9/2/19

ALBERT NAULT, MD 9/17/19

ROBERT GILLIES, MD 9/3/19

ALBERTO COHEN, MD 9/18/19

ALLAN CLAGUE, MD 9/4/19

MICHAEL HUGHES, MD 9/19/19

HERBERT CAMP, MD 9/5/19

BARRY SALTMAN, MD 9/20/19

CHARLES ARTINIAN, MD 9/6/19

DAVID JONNALAGADDA, MD 9/21/19

MARC HAIDLE, MD 9/7/19

FAZLOLAH NICKHAH, MD 9/22/19

JAMES JOHNSON, MD 9/8/19

ZEIA CASAB-RUEDA, MD 9/23/19

LAURENCE BURNS, DO 9/9/19

HARVEY KRIEGER, MD 9/24/19

TO MAKE A GIFT OR BEQUEST: CONTACT REBECCA BLAKE, DIRECTOR, MSMS FOUNDATION CALL 517-336-5729 OR EMAIL RBLAKE@MSMS.ORG

14 michigan MEDICINE®

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michigan MEDICINE® 15

LARGE MICHIGAN EMPLOYERS

Pioneering Changes in Health Care Delivery Our state and nation are in the midst of one of the strongest, most durable economic booms in modern American history.

Continued on page 18

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NOVEMBER NOVEMBER // DECEMBER DECEMBER 2019 2019 ||

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The United States continues to add about 173,000 new jobs per month, roughly ten times higher than modeled projections, while experts in Michigan clamor for new programs to fill a huge high-skill worker shortage. With statewide unemployment of just 4.3 percent, the competition for talent is demanding.

Employers are taking creative measures to attract knowledgeable, experienced workers, and it’s impacting both the practice of medicine and the state’s health care economy.

An Emerging Trend Today’s employers report that run-of-the-mill health care coverage is often no longer good enough to land—or keep—the talent they need. When workers are empowered with more choices where to punch the clock, they’re able to shop around for the best fit, pay, and benefit packages. In a changing health care landscape, that benefit package is taking on increasing importance as an essential piece of the “fit.”

That’s led large employers across the state to explore value-based medicine, dynamic health care delivery models, and opportunities to increase the quality of care while decreasing health care expenditures.

Willis Towers Watson is a leading global advisory, broking and solutions company that helps employers manage risk and support the well-being of their employees and dependents. Its on-the-ground experiences have shown that large employers are looking to improve the health of their workers and optimize the employee experience.

“Employers are looking to deliver the right health care at the right time to help employees manage their health conditions through a variety of methods,” said Beth Lieberman, FSA, MHSA, the Michigan Office Line of Business Leader, for Health and Group Benefits at Willis Towers Watson.

Lieberman says that approach leads to a wide variety of outcomes and approaches specifically tailored to specific workforces.

“Employers are looking to deliver the right health care at the right time to help employees manage their health conditions through a variety of methods.”

BETH LIEBERMAN, FSA, MHSA

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Telemedicine. Directing members to high quality providers. Onsite clinics. The creation and deployment of new technologies, so workers and their families can access care in a way that works best for them.

“The conditions most important to many of our clients are behavioral health and metabolic syndrome,” said Lieberman. “Managing the cost of specialty pharmacy [also] is still a concern, to ensure members can access [the] important, life-saving prescriptions [they need].”

In other words, employers are driving rapid change in the health care benefits world. But it’s Michigan physicians who are helping them be smart about revolutionizing it.

Some of those changes are more sweeping than others.

Sheila Savageau is the U.S. Health Care Leader with General Motors, and the woman credited by some in the press with putting “health care middlemen on notice.”

General Motors This year, General Motors began offering its 24,000 salaried employees and their families in Michigan a plan that works directly with the Henry Ford Health System, negotiating coverage terms directly with the provider and cutting third-party payers out of the equation.

“Ultimately, what I want to achieve for GM employees and their families is better health,” said Savageau. “It’s about the quality of care they are receiving and the better life they’re living, as well as a reasonable, reduced cost.”

GM’s move to get insurers (and their mark-up) out of workers’ way began in 2015 while Savageau served as the company’s global benefits director. She and her team redeveloped the company’s strategy, philosophy and principles from a broad benefits perspective.

She’d been paying close attention to activities and approaches at the Centers for Medicare and Medicaid (CMS) Innovation.

CMS had already begun deploying value-based models, and

“Let’s see how (CMS) correlates back to our employee population to see if we can move away from fee-for-service models into a true payment model that pays based on quality and value.”

SHEILA SAVAGEAU, U.S. HEALTH CARE LEADER, GENERAL MOTORS

Savageau realized that whenever CMS made a move to lower their costs, “a balloon pops on the employer side.”

“I said, let’s take a look, let’s research what CMS is doing, and let’s see how it correlates back to our employee population to see if we can move away from fee-for-service models into a true payment model that pays based on quality and value,” said Savageau.

She and GM developed a model, examined their job markets, dug in deep to learn regional carrier models and then in Michigan—where the bulk of the company’s salaried employees work—put out an RFP looking for the right provider relationship. It was a process that led to a framework built around what Savageau calls the 3 Es—experience, engagement, and efficiency—and it led GM to the Henry Ford Health System.

The Triple Aim Bruce K. Muma, MD, FACP, is the President and CEO of the Henry Ford Physician Network and Medical Director of population health for the Henry Ford Health Systems.

Doctor Muma cites the Affordable Care Act in 2009 as the beginning of the value-based care movement. Health care purchasers are finding opportunities to change payment and contracting mechanisms so health care providers are held accountability for the quality, experience and cost of health care.

“Providers are held accountable for the value of health care and their payment mechanisms reflect [that] value,” said Doctor Muma. “We’ve been on that journey for 10 years now. The value-based care model continues picking up momentum.”

The direct relationship between employer and health care provider also makes the benefit more nimble. The Henry Ford Health System goes out of its way to The higher address issues, make contract fixes, and meet GM’s the quality or needs in real time, without going through a big insurance company’s cumbersome and onerous negoservice level, tiation processes. or the lower the

cost, the more value you have.

Direct-to-employer contracting between Henry Ford and General Motors now ensures that where value in health care increases, it is GM employees who reap the benefits, not third-party payers.

Savageau and her team negotiated with Henry Ford 19 quality measures, each with metrics tied to national quality standards. Every measure revolves around those 3 Es. If the national quality standard for C-section rates is at the 85th percentile, then Henry Ford will have to achieve or outperform the national standard. Outcomes are continually measured and monitored, including overall costs.

Henry Ford is expected to achieve total cost of care financial targets each year.

“It is truly designed to deliver quality, better health outcomes for our members, and at the same time bringing that total cost of care down to where it should be,” said Savageau.

It’s an approach that shares both risks and benefits. At the end of each year, a healthier GM workforce—one that’s been well engaged and treated efficiently—creates bonus payments for physician providers. When contractual standards around quality and cost of care aren’t met, penalties result in payments back to General Motors.

While GM focuses on the 3 Es, physicians like Doctor Muma take what they call the “triple aim.”

Industry leaders describe value as an equation, with a numerator defined as the quality of the care/service/product, plus the experience or service level rendered, divided by the cost. The higher the quality or service level—or the lower the cost—the more value you have.

“That three-part equation – the triple aim - is how we define value in health care,” said Doctor Muma.

“In the same way that CMS and commercial payers like Blue Cross, Aetna, and Humana are pushing the envelope of value-based care and contracting, large employers are saying, ‘we want more value for what we pay for health care,’” explained Doctor Muma. “The big employers who have the capability to do this—[as well as] the volume—they are beginning to say, ‘we’re going to start to take control of health care contracting so we can ensure more value. We can generate direct contracts with the providers that will create more value.’”

GM is a trailblazer, but they’re not the only big Michigan employer redefining the employee health care delivery landscape.

Continued on page 20

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michigan MEDICINE® 19

The Dow Model Gregg Stefanek, DO, is a family physician employed by QuadMed, a national firm providing innovative, high-value health care solutions to companies designed to improve employees’ health and well-being.

Through QuadMed, he serves as the Client Medical Director to Dow, a Midland based company with 37,000 employees globally, including 5,300 in Michigan and thousands more in Texas and Pennsylvania.

Roughly four years ago, the company contracted with QuadMed to provide dedicated, on-site primary care and other health care services for employees at its Midland headquarters.

“We’re charged with supplying Dow with great primary care,” said Doctor Stefanek. “We’re right on Dow’s campus and anyone who has Dow’s insurance can use us.”

That includes each of the company’s Michigan employees and their eligible family members—roughly 14,000 men, women and children in total.

It’s a trailblazing arrangement for a Michigan firm that takes primary care and ease-of-use to entirely new levels for Dow employees.

It’s also a big win for the employer, which is cognizant of their own company-wide health care expenditures.

According to Stefanek, available, quality, and appropriate primary care improves health and lowers health care costs. It keeps patients healthier, cuts down on the need for more expensive interventions like trips to the emergency room, and reduces the amount of time off needed to shuttle around town or juggle appointments.

Doctor Stefanek calls the arrangement “a win-win.” Employees get the benefits they desire. They stay healthier. The employer has healthier, happier workers and family members that require fewer costly interventions.

“Available, quality, and appropriate primary care improves health and lowers health care costs.

It keeps patients healthier and cuts down on the need for more expensive interventions.”

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The convenience and cost savings that can be achieved through onsite clinics like the one opened this year at Dow are hard to overstate.

“We recently saw a patient who came in with pneumonia,” said Doctor Stefanek. “We were able to do a chest x-ray right here. We have x-ray facilities, and laboratory facilities. We were able to do bloodwork, diagnose the pneumonia, give him a bag of IV fluids, give him intramuscular antibiotics, follow up with him the next day and he got charged $10 for that whole visit.

Innovative and patient-minded approaches give employers who deploy them and advantage on the competition for talent.

Data even shows that adults who have a primary care physician accumulate 33 percent lower health care-related costs.

GREGG STEFANEK, DO

A recent survey by the Harvard Business Review found that 88 percent of respondents identified better health, dental and vision insurance options as key drivers in their decisions whether or not to accept a job—even a job with lower pay.

“If he’d gone to urgent care or the emergency room, where most practices in the community would have sent him, the cost would have been in the thousands.”

Direct-to-employer contracting has many faces.

There’s the global value-based contract like what Henry Ford provides GM, on-site primary care like Doctor Stefanek and his team provide Dow, and there’s much more.

Employers are looking down additional pathways to create more value in contracting directly with providers to deliver additional on-site medical care and, wellness programs – programs around disease management, diabetes, musculoskeletal conditions – where providers then come in and do programs or provide other types of wellness based services either onsite or offsite.

Other employers are looking at centers of excellence contracts, where they contract with a center of excellence to provide workers with additional health options in the event additional consultation is needed (e.g., cardiac patients could consult with the Cleveland Clinic, or arthritis patients could seek specialized joint care at Johns Hopkins).

Innovative and patient-minded approaches like these give the employers who deploy them an advantage on the competition for talent.

A recent survey by the Harvard Business Review found that 88 percent of respondents identified better health, dental and vision insurance options as key drivers in their decisions whether or not to accept a job—even a job with lower pay. That number was higher than those who were looking for flexible hours, the ability to work from home, tuition assistance, and even unlimited vacation time.

Putting It All Together It shouldn’t come as a surprise that Michiganders take their health—and that of their families— seriously. In a field as radically diverse as health care, it’s also not a surprise that large employers and providers take different approaches to meeting myriad health care goals.

The 2020 Large Employers’ Health Care Strategy and Plan Design Survey by the National Business Group on Health found that large employers’ top health care initiatives for next year include a broad array of tactics.

Fifty-one percent of respondents plan to implement more virtual care solutions, 39 percent are developing more focused strategies on high-cost claims, and 26 percent will look to expand centers of excellence to include additional conditions, like cancer or infertility.

In a field as radically diverse as health care... large employers and providers take different approaches to meeting myriad health care goals.

At GM, beyond the direct benefit provided to salaried employees, workers have access to Henry Ford Health System for care management and an improved health care experience, including concierge services.

Concierge health care services, point-of-sale rebates in pharmacy benefits, and targeted specialty pharmacy management make the list, too, alongside strategies like Dow’s, which will implement direct primary care solutions in select markets.

“It has to be more than reduced cost I’m going to give to my members,” said Savageau. “It’s a one-stop-shop. It’s one number, whether you need a physician, a same-day appointment, whether you need a next-day appointment, to get in to see a specialist, nurse case managers that are truly advocating for every single thing you need. It really takes the responsibility off of the employee and their family members and Henry Ford is coordinating all of that for us.”

Those are employee asks that more and more Michigan employers are delivering.

The goal of the approach is familiar to physicians across Michigan—to put patients first.

Health Can’t Wait is a coalition of patients, physicians, health care providers, and patient-supported groups working to put Michigan patients first. We aim to end dangerous delays in patients’ access to health care caused by insurance company bureaucracy, including prior authorization and step therapy requirements.

STAY CONNECTED!

Share your Health Can’t Wait story at healthcantwait.org We want to highlight the impact of insurance company red tape, so we can help fix it. Tell your story—or those of your patients—so we can begin making the changes Michigan needs.

Talk the issue up with your family, friends, and colleagues

MSMS.ORG

Use your own networks—and social media—to help build awareness of this problem, and consider reaching out to your lawmakers. The team at MSMS is standing by to help you craft and share your story.

We need your help! Visit HealthCantWait.org

NOVEMBER / DECEMBER 2019 |

michigan MEDICINE® 21

Welcome New Members www.msms.org/Membership

Genesee

Midland

Roger Jump, DO Kunal Singh, MD R C Ravikumar, MD

Jose Raygada, MD

Gratiot

Monroe Timothy VandenBoom, MD

Maria Klahre, MD

Muskegon

Hillsdale Timothy Murray, MD

Timothy Wang, MD Katherine Foster, DO Wylie de Vera, MD

Jackson

Northern Michigan

Amanda Brannick, MD Farhad Amani, DO Nitin Ambani, MD Anjum Handoo, MD Daniela Memoli, DO David Burks, MD Merritt Bern, MD Sylvester Paulasir, MD Alicja Wasilewski, MD Marla Hires, MD, PhD Rabeea Mirza, MD Sharon Rouse, DO

Kalamazoo Academy of Medicine Argelio Lopez-Roca, MD

Kent Joseph Boss, MD Liliya Sutherland, DO Nathan Pezda, MD Scott Westhouse, DO Kevin Gostenik, MD Gerald VanWieren, MD James LeBolt, DO Kendall Hamilton, MD Levi Hinkelman, MD Travis Menge, MD Tsz Kit Chan, MD, MSc, FRCSC Clayton Perry, MD Garett Pangrazzi, MD Amanda Meulenberg, MD Vinayak Manohar, MD

Livingston Bindesh Patel, MD

Marquett/Alger Brianna Cadigan, DO Natalie Madland, MD Maria Barreras, MD Michael Piggot, DO Christin Nguyen, MD Valerie Taglione, MD

Mecosta/Lake/Osceola Harold Moores, MD

Barbara Mathes, MD, FACP, FAAD

Oakland Heidi Jenney, DO Hamid Banooni, MD Peter Jajou, DO, FAOCD John Hart, MD Brian Sygiel, MD Nathan Cutler, MD Anca Andrei, MD Despina Walsworth, MD Elisheva Newman, MD

Saginaw Chris Liakonis, DO Elizabeth Marshall, MD

St. Clair Xinyue Pan, MD Anshum Bhalla, MD Zubin Bhesania, MD, FACS Cheryl Canto, MD, CMD Navkiranjot Brar, MD William Braaksma, MD Frederick Coop, MD Saurabh Gandhi, DO Yehia Elsafy, MD Emad Daher, MD Seema, Doshi, MD Steven Heithoff, DO Fahim Ibrahim, MD Kamal Fahim, MD Gerald Jerry, MD Scott Heithoff, DO Wasif Hussain, MD Gary James, DO Aaron Overly, DO Christie Laming, MD Dawn Morey, DO Edgar Pasia, DO Patrick Kut, MD Rafia Khalil, MD Scott McPhilimy, DO Seemab Khan, MD Sharon Mitchell, DO

Todd Murphy, MD Wayel Katrib, MD Christopher Provenzano, MD Matthew Sciotti, MD Neal Obermyer, MD Anmar Sheet, MD Ira Sabbagh, DO Mark Petrocelli, DO Brian Favero, MD Fasahat Hamzavi, MD Paul Somerville, DO Robert Sachs, MD Anthony Boutt, MD George Carley, DO Mohammad Chisti, MD, FACP Viswanadh Vegesna, MD Aaron Clark, MD Jukaku Tayeb, MD Kevin Johnson, MD Renee Susko, MD Dania Khoulani, MD John Mullally, MD Laura Zelenak, DO Scott Kowalski, DO Philip Matich, MD Shilpin Mehta, DO Anupama Devara, MD Marwan Shuayto, MD Reid Stromberg, MD Kamalakar Nerusu, MD Khurshaid Alam, MD Sabbir Ahmed, MD Syed Ali, MD Annette Barnes, MD Charbal Bazo, MD Scott Barton, DO

Van Buren Catherine Boomus, MD, MPH, FACO

Washtenaw Philip Zazove, MD

Wayne Peyman Kabolizadeh, MD, PhD Mahir Elder, MD Geoffrey Prysak, MD, MPH Stacie Clark, MD

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Terminating Patient Relationships

By Julie Brightwell, JD, RN, Director, Healthcare Systems Patient Safety, Department of Patient Safety and Risk Management, The Doctors Company, and Richard Cahill, JD, Vice President and Associate General Counsel, The Doctors Company

The Criteria The criteria for terminating a physicianpatient relationship are numerous and varied. Although the list is not exhaustive, it is appropriate and acceptable to terminate a relationship under the following circumstances:

Treatment nonadherence The patient does not or will not follow the treatment plan.

Follow-up nonadherence The patient repeatedly cancels follow-up visits or is a no-show.

Office policy nonadherence The patient fails to follow office policies, such as those for payment, prescription refills, or appointments. For example, the patient uses weekend on-call physicians or multiple healthcare practitioners to obtain refill prescriptions when office policy specifies how to obtain refills between visits.

Verbal abuse

J

ust as it is an acceptable and reasonable practice to screen incoming patients, it is acceptable and reasonable to know when to end patient relationships that are no longer therapeutic. It is critical, however, that the physician end the patient relationship in a manner that will not lead to claims of discrimination or abandonment.

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The patient or a family member is rude and uses improper language with office personnel or other patients, visitors, or vendors; exhibits violent behavior; makes threats of physical harm; or uses anger to jeopardize the safety and well-being of anyone present in the office.

Nonpayment The patient owes a backlog of bills and has declined to work with the office to establish a payment plan.

Contributed by The Doctors Company

thedoctors.com

Exceptions and Special Circumstances A few situations, however, may require additional steps or a delay or even prohibit patient dismissal. Examples of these circumstances include the following: • If the patient is in an acute phase of treatment, delay ending the relationship until the acute phase has passed. For example, if the patient is in the immediate postoperative stage or is in the process of a medical workup for a diagnosis, it is not advisable to end the relationship.

• If the practitioner is the only source of medical or dental care within a reasonable driving distance, he or she may need to continue care until other arrangements can be made.

• When the practitioner is the only source of specialized medical or dental care, he or she is obliged to continue care until the patient can be safely transferred to another practitioner who is able to provide treatment and follow-up.

• If the patient is a member of a prepaid health plan, the patient cannot be discharged until the practitioner has communicated with the third-party payer to request that the patient be transferred to another practitioner or otherwise complies with the terms of the payer-provider agreement.

• A patient may not be dismissed or discriminated against based on limited English proficiency or because he or she falls within a protected category under federal or state legislation. Examples of civil rights laws include the Americans with Disabilities Act (ADA), the Civil Rights Act, and the Emergency Medical Treatment and Labor Act (EMTALA).

“

The criteria for terminating a physician-patient relationship are numerous and varied.

• If a patient is pregnant, the physician can safely end the relationship during the first trimester if the pregnancy is uncomplicated and there is adequate time for the patient to find another practitioner. During the second trimester, a relationship should be ended only when it is an uncomplicated pregnancy and the patient is transferred to another obstetrical practitioner prior to the cessation of services. During the third trimester, a relationship should end only under extreme circumstances (such as illness of the practitioner, etc.).

• Physician or dental groups with more than one practitioner may want to consider dismissing a patient from the entire practice. This will avoid the possibility that the patient might be treated during an on-call situation by the practitioner who ended the relationship.

• The presence of a patient’s disability cannot be the reason(s) for terminating the relationship unless the patient requires care or treatment for the particular disability that is outside the expertise of the practitioner. Transferring care to a specialist who provides the particular care is a better approach.

Continued on page 26

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Terminating Patient Relationships – Continued from page 25

Steps for Withdrawing Care When the situation with the patient is such that terminating the relationship is appropriate and acceptable and none of the restrictions mentioned above are present, termination of the patient relationship should be completed formally. Put the patient on written notice that he or she must find another healthcare practitioner. The written notice should be mailed to the patient by both regular mail and certified mail with a return receipt requested. (Both types of mailing are required in some states.) Keep copies of all the materials in the patient’s medical record: the letter, the original certified mail receipt (showing the letter was sent), and the original certified mail return receipt (even if the patient refuses to sign for the certified letter).

Elements of the Written Notice The written notice terminating the relationship should include the following information:

Reason for termination Although a specific reason for termination is not required, it is acceptable to use the catchall phrase “inability to achieve or maintain rapport” or to state that “the therapeutic practitioner-patient relationship no longer exists.”

Effective date The effective date of termination should provide the patient with a reasonable amount of time to establish a relationship with another practitioner. Although 30 days from the date of the letter is usually considered adequate, follow your state regulations. The relationship may be terminated immediately under the following circumstances:

• The patient has terminated the relationship. (Acknowledge this in writing with a letter from the practice.)

• The patient or a family member has threatened the practitioner or staff with violence or has exhibited threatening behavior.

Interim care provisions Offer interim emergency care. Refer true emergency situations to an emergency department or instruct the patient to call 911 as necessary.

Continued care provisions Offer referral suggestions for continued care through medical or dental societies, nearby hospital medical staffs, or community resources. Do not recommend another healthcare practitioner by name.

Request for medical or dental record copies In your written notice, offer to provide a copy of the medical or dental record to the new practitioner by enclosing an authorization document (to be returned to the office with the patient’s signature). One exception is a psychiatric record, which may be offered as a summary in lieu of a full copy of the medical record.

Patient responsibility Include a reminder that the patient is responsible for all follow-up and continued medical or dental care.

Medication refills Explain that medications will be provided only up to the effective date of termination.

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thedoctors.com

Case Examples The following scenarios illustrate some of the issues that could be involved in terminating a patient relationship.

Case One A patient has been in your practice for about 10 years, has faithfully made regular visits, but has not been compliant with your medical regime for taking hypertension medications. You have repeatedly explained the risks of nonadherence, and you have rescued the patient on many occasions with emergent medications, usually in the local emergency department over a weekend. You are convinced that the patient understands but stubbornly refuses to comply.

Should This Patient Relationship Be Terminated?

With any nonadherent patient, it is essential to document your recommendations, the patient’s continued nonadherence, your efforts to help the patient understand the risks of nonadherence, and his or her failure to follow the treatment plan and advice. Terminate the relationship if the patient and physician agree that the patient would achieve better compliance with another practitioner. The written notice terminating this relationship should be explicit in stating the reason you are no longer willing to provide care—that the patient’s outcome is predestined to be unfavorable because of his or her nonadherence with recommended treatment plans. Suggest that the patient would benefit from a relationship with another physician, and state that continued medical care is an absolute requirement.

Case Two A new patient has made an appointment with your office for a full and complete physical examination. Before the appointment, the patient experienced an unusually long wait in your office as a result of your need to address an urgent situation with an infant. Your office personnel explained the delay to those in the waiting room, and this new patient reacted by becoming loud and abusive, insulting the registration person, and shouting that his time is as valuable as that of the doctor.

Options for the Practitioner In the privacy of an office or an examination area, address your concerns about his behavior by indicating that the practice maintains a zero-tolerance policy for loud, threatening, or abusive behavior, and state that this type of reaction will not be tolerated in the future.

After you have completed his physical examination, suggest that he seek medical care elsewhere if he is reluctant to observe office decorum. If the patient indicates a refusal to comply, consider preparing and sending a termination letter. If the patient fails to keep subsequent appointments or has notified your office that he will be seeking care with another physician, document the conversation and send the patient a letter reiterating his decision to seek care elsewhere.

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.

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michigan MEDICINE® 27

Educational Offerings MSMS On-Demand Webinars Webinars Offering CME: Balancing Pain Management and Prescription Medication Abuse: Chronic Pain and Addiction*

Webinars at No Cost to Members: Billing 101

CDL-Medical Examiner Course

Balancing Pain Management and Prescription Medication Abuse: Chronic Pain and Addiction*

Human Trafficking*

Claim Appeals

Medical Ethics – Conscientious Objection among Physicians*

Credentialing

Preparing for the Medicare Physician Value-Based Payment Modifier

Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities

Pain and Symptom Management Series*

HEDIS Best Practices

Opioid Town Hall (new in 2019) *

In Search of Joy in Practice: Innovations in Patient Centered Care

Pain and Opioid Management*

Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage

The CDC Guidelines* The Current Epidemic and Standards of Care* Treatment of Opioid Dependence* The Role of the Laboratory in Toxicology and Drug Testing*

Coding and Billing Webinars: Access to Medicare Changes to E&M Codes for 2019 and other Coding Updates

Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media MAPS Update and Opportunities* Michigan Automated Prescription System Update* Reading Remittance Advice Section 1557: Anti-Discrimination Obligations Sexual Misconduct – Prevention and Reporting (new in 2019) Update on Chronic Fatigue Syndrome Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS (new in 2019)

Billing 101 Claim Appeals Complete Coding Updates for 2018 Credentialing

Update on Chronic Fatigue Syndrome Part 2: Uniting Compassion, Attention and Innovation to treat ME/CFS (new in 2019)

Managing Accounts Receivable

Prescribing Legislation*

Reading Remittance Advice

Tips and Tricks on Working Rejections

Tips and Tricks on Working Rejections

*Fulfills Board of Medicine Requirement.

Visit msms.org/OnDemand for the complete listing of On-Demand Webinars.

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Visit msms.org/OnDemand for complete listing of On-Demand Webinars.

Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.

Upcoming Educational Conferences – REGISTER TODAY! A Day of Board of Medicine Renewal Requirements

5

AMA/PRA CATEGORY 1 CREDIT(S) TM

Let MSMS be your resource to earn the new mandated Michigan Board of Medicine CME – all in one day.

2020 Spring Scientific Meeting Morning, afternoon and evening clinical courses available Date: Thursday, May 14 and Friday, May 15

Date: Friday, November 22, 2019 9:00 AM - 2:45 PM

Location: DoubleTree Hotel, Dearborn

Location: BCBSM Lyon Meadows Conference Center, New Hudson, MI

Note: Continental breakfast and lunch will be provided

Cost: Members - $195; Nonmembers - $275; Retired - $105

Intended for: Physicians and all other health care professionals

Contact: Marianne Ben-Hamza 517/336-7581 or mbenhamza@msms.org

Contact: Marianne Ben-Hamza 517/336-7581 or mbenhamza@msms.org

Agenda: 9:00 am – 2:45 pm Presentations will address Pain and Symptom Management, Human Trafficking and Medical Ethics, fulfilling these additional requirements. It will also fulfill the new (effective January 4, 2019) one-time license requirement for opioid and other controlled substances awareness training standards for prescribers and dispensers of controlled substances.

24th Annual Conference on Bioethics Date: November 2020 Note: Continental breakfast and lunch will be provided Intended for: Physicians, bioethicists, residents, students, other health care professionals, and all individuals interested in bioethical issues.

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

9:00 - 11:00 am Pain & Symptom Management, including MAPS - Carl Christensen, MD 11:15 am - 12:00 pm Balancing Pain Treatment and Legal Responsibilities - Ronald W. Chapman, II, Esquire 12:45 - 1:45 pm Human Trafficking - Dena Nazer, MD, FAAP

Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.

1:45 - 2:45 pm Medical Ethic - Janice Firn, PhD, MSW Statement of Accreditation: The Michigan State Medical Society (MSMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA Credit Designation Statement: The MSMS designates this live activity for a maximum of 5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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michigan MEDICINE® 29

ADVOCACY

Five Reasons to

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

As the face of physicians, MDPAC bring medical knowledge into

Activate your political voice!

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

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

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

discussions with political decision makers.

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

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

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

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

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

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

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

physician’s agenda.

Get started today at MDPAC.org

The current political landscape is uncertain.

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

MDPAC is that voice.

Get your voice heard by contributing today at MDPAC.org

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