Award-Winning Magazine of the Michigan State Medical Society September/October 2012 • Volume 111 • No. 5 msms.orgWWW MichiganMedicine

Is the Sun Setting on Tort Reform Laws? Not if Michigan Physicians… Doc the ote

Also In This Issue • The Effect of Payment Reform on Physician Practices – Part 1 • Why the Supreme Court Race is Important • Recommendations for the Management of HBV-Infected Health Care Providers II MICHIGAN MEDICINE September/October 2012 Volume 111 • Number 5 MICHIGAN MEDICINE 1 Executive Director Julie L. Novak Committee on Publications LYNN S. GRAY, MD, MPH, Chair, Berrien Springs MichiganMedicine MICHAEL J. EHLERT, MD, Livonia September/October 2012 • Volume 111 • Number 5 THEODORE B. JONES, MD, Detroit BASSAM NASR, MD, MBA, Port Huron Cover Story STEVEN E. NEWMAN, MD, Southfield PEGGYANN NOWAK, MD, West Bloomfield 9 Philosophy Matters By Stacy Sellek Director of Communications During this election cycle, it’s crucial for physicians to become as informed and engaged as & Media Relations possible in the Michigan Supreme Court race. MDPAC-endorsed candidates Justice Stephen Jessy J. Sielski Markman, Justice Brian Zahra, and Judge Colleen O’Brien tell MSMS’s Stacy Sellek why. Email: [email protected]

Publication Office FEATURES Michigan State Medical Society 14 The Effect of Payment Reform on Physician Practices – Part 1 PO Box 950, East Lansing, MI 48826-0950 Contributors: Stacey Hettiger, Joe Neller and Paul Natinsky 517-337-1351 In part one of this three-part series, our contributors describe the trends in physician www.msms.org reimbursement, particularly the shift from fee-for-service to outcomes-based. All communications on articles, news, exchanges In upcoming issues, we’ll examine the role physician organizations and incentive and classified advertising should be sent to the above programs will play in how physicians choose to practice medicine. address, attn: Jessy Sielski.

Display Advertising Columns GRETCHEN CHRISTENSEN 4 Ask Our Lawyer By Daniel J. Schulte, JD 2779 Aero Park Drive, Traverse City, MI 49686 Why the Supreme Court Race is Important 888-822-3102, Fax: 989-892-3525 6 Opinion By Michael J. Ehlert, MD Email: [email protected] The Uncertain Future of Graduate Medical Education Design 7 Professional Liability Update Contributed by The Doctors Company Joseph McGurn, Village Press, Inc. Are Your Prescribing Practices Secure? Printing 18 HIT Corner Village Press, Inc., Traverse City, MI Don’t Get Too Comfortable, Stage 2 Meaningful Use Requirements Have Arrived

Postmaster: Address Changes 20 MDCH Update From the Michigan Department of Community Health Michigan Medicine Recommendations for the Management of HBV-Infected Health Care Providers Hannah Dingwell 25 Medical Family Matters By Kathy Adams PO Box 950, East Lansing, MI 48826-0950 Alliance Members Rally for Tort Reform

Michigan Medicine, the official magazine of the Michigan 32 President’s Perspective By John G. Bizon, MD Come Election Day, Don’t Forget the Supreme Court State Medical Society, is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, Departments with special emphasis on socio-economics, legislation 22 New MSMS Members and news about medicine in Michigan. 22 Obituaries The Michigan State Medical Society Committee on Publications is the editorial board of Michigan Medicine 23 Disciplinary Actions and advises the editors in the conduct and policy of the 26 MSMS Foundation Conferences magazine, subject to the policies of the MSMS Board 27 The Marketplace of Directors. Neither the editor nor the state medical society will Michigan Supreme Court Building Cover Photo Credit: Jeffness 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 2012 it is published in January/February, March/April, May/June, July/August, September/October and November/December. Second class postage paid at East Lansing, Michigan and The mission of the Michigan State Medical Society is to promote at additional mailing offices. Yearly subscription rate, $110. a health care environment which supports physicians in caring Single copies, $10. Printed in USA. for and enhancing the health of Michigan citizens through science, quality, and ethics in the practice of medicine. © 2012 Michigan State Medical Society 2 MICHIGAN MEDICINE September/October 2012 Michigan State Medical Society the Voice of More Than 16,000 Michigan Physicians

Officers Directors District 8 President District 1 Waheed Akbar, MD, Saginaw JOHN G. BIZON, MD, Battle Creek Mohammed A. Arsiwala, MD, Livonia Debasish Mridha, MD, Saginaw President-Elect T. Jann Caison-Sorey, MD, Detroit District 9 Kenneth Elmassian, DO, Lansing Cheryl Gibson Fountain, MD, Grosse Pointe Park Richard C. Schultz, MD, Traverse City Edward G. Jankowski, MD, Grosse Pointe Woods District 10 Secretary Theodore B. Jones, MD, Detroit Carol L. Van Der Harst, MD, Bay City MICHAEL W. SMITH, MD, Chelsea George H. Shade Jr., MD, Detroit Treasurer Narinder K. Sherma, MD, Detroit District 11 Venkat K. Rao, MD, Flint James H. Sondheimer, MD, Detroit James J. Rice, MD, Muskegon Speaker J. Mark Tuthill, MD, Bloomfield Hills District 12 Rose M. Ramirez, MD, Belmont District 2 Craig T. Coccia, MD, Marquette Vice Speaker Amit Ghose, MD, Lansing District 13 Pino D. Colone, MD, West Bloomfield James E. Richard, DO, Lansing Jeffrey E. Jacobs, MD, Calumet Immediate Past President District 3 District 14 STEVEN E. NEWMAN, MD, Southfield John J.H. Schwarz, MD, Battle Creek John E. Billi, MD, Ann Arbor District 4 JAMES C. MITCHINER, MD, MPH, Ann Arbor Board Michael D. Chafty, MD, JD, Portage David A. Share, MD, MPH, Ypsilanti of Directors Lynn S. Gray, MD, MPH, Berrien Springs District 15 Chair District 5 Betty S. Chu, MD, Clarkston James D. Grant, MD, Royal Oak Anita R. Avery, MD, Grand Rapids Richard S. Frank, MD, MHSA, Flint Scot F. Goldberg, MD, MBA, Warren Vice Chair David M. Krhovsky, MD, Grand Rapids James D. Grant, MD, Royal Oak David A. Share, MD, MPH, Ypsilanti Todd K. VanHeest, MD, Zeeland PEGGYANN NOWAK, MD, West Bloomfield District 6 SRINIVAS “BOBBY” MUKKAMALA, MD, Flint Young Physician John A. Waters, MD, Flint Paul D. Bozyk, MD, Canton District 7 Resident Bassam Nasr, MD, MBA, Port Huron Michael J. Ehlert, MD, Livonia Student Haritha G. Reddy, Ann Arbor

Volume 111 • Number 5 MICHIGAN MEDICINE 3 Ask Our Lawyer Why the Supreme Court Race is Important By Daniel J. Schulte, JD

Question: whether the expert who signed an would have denied the defendant’s We were told at our recent Affidavit of Merit meets the statutory appeal and allowed the case to go qualification requirements can be (and forward. Fortunately, there are four county society meeting that frequently are) the subject of litigation. Justices on the Supreme Court who the courts do not always It should, however, be beyond question disagreed and routinely strictly apply enforce tort reforms. How that an Affidavit of Merit must be filed statutes as written (Robert Young, can this be? Shouldn’t courts with the complaint. Stephen Markman, Mary Beth Kelly In Hannah v Merlos it was undisputed and Brian Zahra). These four Justices always follow the law that no Affidavit was filed with the form a majority that is the last line exactly as written? Complaint. This was brought to the of defense for those who favor strict attention of the plaintiff prior to the construction and enforcement of our Answer: expiration of the statute of limitations medical malpractice tort reforms. Of It is true that judges do not always applicable to the plaintiff’s claim. the four, two (Stephen Markman and strictly apply the law as worded in a Instead of filing an amended complaint Brian Zahra) are up for reelection in statute. We have seen several examples with an affidavit of merit attached, the November of this year. The Hannah v of this over the years in medical mal- plaintiff insisted that the affidavit of Merlos case is the best and most recent practice cases. Many times, the case merit was filed with the court along example of why the Supreme Court race involves a failure to comply with the with the complaint and that the court is so important. notice of intent, affidavit of merit, misplaced it (which the court clerk Every Michigan physician should expert witness qualification or other denied). The defendant filed a motion support the reelection of Justices requirement and dismissal of the case to dismiss the case. The trial court Markman and Zahra. MM or some other consequence adverse to denied the motion. When the defendant the plaintiff is warranted. In these situ- filed a motion for reconsideration, the ations we have seen judges be reluctant plaintiff, for the first time, produced Daniel J. Schulte, JD, MSMS Legal Counsel, or even refuse to enforce the statutory an affidavit of merit as an exhibit is a member of requirement. This may be due to the to the response to the motion for Kerr, Russell and judge’s feeling that the plaintiff’s lawyer reconsideration. The trial court allowed Weber, PLC. alone is responsible for the failure and is the case to go forward despite the fact therefore unwilling for the plaintiff to that no affidavit of merit was filed with suffer the consequence. A judge’s sym- the complaint. pathy for the plaintiff may also be factor The Court of Appeals affirmed the causing him or her to look the other trial court’s decision to ignore the way or misconstrue a requirement. The affidavit of merit requirement, finding exact reasons for noncompliance are that the plaintiff had “serendipitously” known only to the judges. filed the affidavit of merit by attaching Editor’s Note: A recent example is Hannah v Merlos. it as an exhibit to his response to the If you have legal questions you would This case involved a dentist defendant, motion for reconsideration. Despite like answered by MSMS legal counsel but the issue involved would have applied the fact that it is undisputed that the in this column, send them to: equally to an MD, DO, or other health affidavit of merit requirement had not Jessy Sielski, Michigan Medicine, care professional to which the medical been complied with, the trial court MSMS, 120 West Saginaw Street, malpractice tort reforms apply. judge and three judges on the Court East Lansing, MI 48823, We all know that a plaintiff is of Appeals were willing to allow the or at [email protected]. required to file an Affidavit of Merit case to proceed. This is what would along with the Complaint (the have happened were it not for the defendant physician has a similar Supreme Court. obligation to file an Affidavit of By Order dated April 13, 2012, the Meritorious Defense with the Answer Supreme Court reversed the judgment to the Complaint). The affidavit of the Court of Appeals and sent the must contain detailed information case back to the trial court directing listed in the statute and be signed by it to dismiss the case. Incredibly, even someone meeting the expert witness in a case like this, where the failure qualification requirements. Whether to comply with the law is so obvious the detailed information required and undisputed, three Justices of the by the statute has been sufficiently Supreme Court (Michael Cavanagh, included in an Affidavit of Merit and Marilyn Kelly and Diane Hathaway)

4 MICHIGAN MEDICINE September/October 2012 Volume 111 • Number 5 MICHIGAN MEDICINE 5 Opinion

The Uncertain Future of Graduate Medical Education By Michael J. Ehlert, MD

ith an estimated 50 million support, this will lead to a shortage of stayed flat. This does not bode well for Americans uninsured and hop- positions as soon as 2015, and without a our future colleagues. Wing to benefit from the current residency, you cannot practice medicine. MSMS continues to pursue innovative reform laws, there are many looming ques- Complicating the picture, Congress is solutions through its state GME coali- tions in health care: who will be their considering removing one-third of GME tion, advocating for state funding, and doctor, how will we train these physicians, funding because they claim residents are assuring support of students and residents and who will pay for it? not being trained in essential aspects who stay in Michigan (66 percent). Our The majority of graduate medical edu- of health care: teamwork, systems of AMA continues to prioritize medical cation (GME) is supported by Medicare care, or quality and safety. For its part, education. Bills have been proposed to payments to training hospitals, but the the ACGME has beefed up review for increase residency spots. Meanwhile, the number of residency slots was capped in resident performance in these areas. future of GME is uncertain and those 1997. Since then, hospitals have added As long as the payment and delivery looming questions remain…. MM positions “over cap” without federal systems reward procedures and test- funds to cover them, and states – includ- ing, however, no amount of resident ing Michigan – have decreased GME education will bend the precious cost The author is the Resident Representative funding. Physician shortages are ex- curve the Washington bureaucrats are on the MSMS Board pected to spike med school enrollment chasing. Discussion of increasing pri- of Directors. by 2016. As Michigan keeps adding mary care slots will not change specialty medical schools, what remains is the choice until reward matches sacrifice. bottle-neck of residency programs that Tuition and debt have increased every are not expanding. Without increasing year, and physician salary has fallen or

6 MICHIGAN MEDICINE September/October 2012 Professional Liability Update

Are Your Prescribing Practices Secure? Contributed by The Doctors Company

rescription theft and abuse is a real • Note actual amounts prescribed, reporting requirements and further safe- and growing problem, making it and give matching numerals to guards for preventing diversion. imperative for physicians to protect discourage prescription alterations P Court Rules themselves and their practices. In (e.g., thirty/#30). Physicians Liable addition, a recent court ruling spotlights for Patient’s Actions potential obligations to third parties when prescribing medications to patients. If prescription In February, the Utah Supreme Court ruled that third parties may sue doctors Together, these developments signal the fraud occurs, need for vigilance and security in your for injuries caused by a patient whose prescribing practices. actions are associated with alleged physicians should medication mismanagement. The Prescription Regulatory investigate and notify The ruling allowed relatives to sue Environment a physician and his staff after a patient The Drug Enforcement Administration local law enforcement, killed his wife. According to the American (DEA) has developed federal and state Medical Association, “The court ruled regulations to safeguard prescribing the local DEA office, that when potential risks might outweigh practices. The Centers for Medicare potential benefits for a given activity, and Medicaid Services (CMS) also and the necessary state doctors must consider the potential effects requires that prescription pads have licensing and medical their actions could have on third parties.” security features to prevent copying, While state laws differ, courts in modifying, and counterfeiting. Cur- boards, as well as their several other states have issued similar rently, 49 states have passed legislation rulings. As a result, health professionals to implement operational Prescription malpractice insurer. in Utah and other jurisdictions may be Monitoring Programs (PMPs), which found to have a legal responsibility to seek to curtail prescription drug abuse third parties when prescribing medicine and diversion through highly effective Physicians may also consider termi- to patients – which will likely impact the tools and strategies developed for use nating the physician/patient relation- way medicine is practiced. MM by government officials. ship with a patient who is involved in prescription abuse, theft, or diversion. For more safety articles, practice tips, Tips to Avoid Prescription If prescription fraud occurs, physicians and interactive guides/site surveys, Fraud and Abuse should investigate and notify local law visit www.thedoctors.com/patientsafety. Physicians can incorporate electronic enforcement, the local DEA office, and prescribing, or e-prescriptions, into their the necessary state licensing and medical The Doctors Company is the exclusively practice to protect themselves against boards. Physicians should also contact endorsed medical liability carrier of the diversion. Electronic prescribing promotes their malpractice insurer to discuss other Michigan State Medical Society (MSMS). efficiency and reduces medical liability – two objectives of the HITECH Act. It The Doctors Company Announces eliminates the time-intensive process in- volved with tracking paper prescriptions, Five-Year Anniversary of the Tribute Plan voids opportunity for alterations, and pro- Career Award Represents Tangible Proof of Membership vides a direct connection to pharmacists to ensure accurate prescriptions. for Nearly 4,000 Doctors in Michigan Physicians who continue to use paper One of the many advantages of coverage with The Doctors Company is the prescriptions should implement protocols Tribute® Plan, a significant financial benefit that rewards doctors for their with local pharmacies to manage pre- loyalty to The Doctors Company and for their dedication to outstanding scription theft, forgery, and alteration. patient care. This year marks the Tribute Plan’s fifth anniversary. Consider these risk management tips: “The Tribute Plan is recognition of a career spent practicing good medicine,” said • Request notifications from local Richard E. Anderson, MD, FACP, chair and CEO of The Doctors Company. “In the pharmacies before prescriptions for last five years, more than 1,300 Tribute awards have been distributed, and over controlled substances are dispensed. 22,700 members of The Doctors Company have qualified for awards when they • Use the control batch number retire from the practice of medicine. These members have an average Tribute on each script to track the order balance of $11,500, and the highest distribution to date is $88,708.” of prescriptions. A special Tribute Plan five-year anniversary video – featuring details about • Require patients to visit the office Tribute, perspectives from members of The Doctors Company, and commentary to obtain prescriptions for from Doctor Anderson – can be viewed at www.thedoctors.com/tribute. controlled medications.

Volume 111 • Number 5 MICHIGAN MEDICINE 7 8 MICHIGAN MEDICINE September/October 2012 PHILOSOPHY MATTERS Electing the Right Supreme Court Justices Not Only Affects Access, But Also the Future of Medicine in Michigan

By Stacy Sellek

Justice Stephen Markman Justice Brian Zahra Judge Colleen O’Brien

During this election cycle, it’s crucial for “It’s not ‘pro’ or ‘anti’ any organization because that’s not what the court is about,” explains Michigan Supreme Court physicians to become as informed and Justice Stephen Markman, who was first appointed by Gov. John Engler in 1999, and is running for re-election to the engaged as possible in the Michigan bench this fall. But for the sake of preserving tort reform laws, physicians Supreme Court race. MDPAC-endorsed can – and MUST – support the “rule of law” candidates for the Michigan Supreme Court who avoid “putting their fingers candidates Justice Stephen Markman, on the scales of justice,” in Justice Markman’s words. In addi- tion to incumbent Justice Markman, those candidates include Justice Brian Zahra, and Judge Colleen incumbent Justice Brian Zahra and Oakland County Circuit Court Judge Colleen O’Brien, who seeks to fill the seat vacated O’Brien tell MSMS’s Stacy Sellek why. by retiring Justice Marilyn Kelly. “It’s important that the people of Michigan, including the et’s be clear: judges and justices are not your “friends.” medical community, look very closely at this race and the They cannot put your issues ahead of others when [Supreme Court] records of Justice Zahra and myself,” said writing their opinions or push your agenda during a Justice Markman. public hearing. You cannot claim to support a “pro- Why? medicine” court majority or judicial candidates who “Judicial philosophy matters. It all comes down to the proper are “on your side.” role of the court,” says Justice Zahra, who was appointed by

LVolume 111 • Number 5 MICHIGAN MEDICINE 9 “Those who sue you for a living already understand the stakes [of this race] very well.”

Supreme Court Justice Stephen Markman, speaking to Ingham County Medical Society members in September

Gov. Rick Snyder to replace retiring Justice Maura Corrigan of engaging on a different kind of court. He also has enjoyed in 2011. coaching his two sons’ Little League and basketball teams All three rule of law candidates, who are endorsed by the over the years in the Mason area, where he and his family live. Michigan Doctors’ Political Action Committee (MDPAC), Justice Markman’s eldest son may look back someday with believe their role is to interpret the existing laws on the books, particular interest on his father’s opinions regarding tort not rewrite them. reforms: his experience serving in Iraq as an Army medic “We believe the intent of the law is best derived by studying influenced his decision to attend medical school. the words legislators gave us,” says Justice Zahra. Justice Zahra became interested in the law during high “The consistent application of our laws affects the stability school, but recalls a guidance counselor steering him in a dif- of our state’s economy and ensures fairness to all who enter ferent direction. “I’m sure she didn’t say it the way I heard it, the courtroom,” adds Judge O’Brien. “This can be especially but I came out of that meeting concluding that I’m particularly important for physicians in ‘bad strong at math, and I should outcome’ cases where the emo- probably pursue computer sci- tional response might be to hold Doctor: ences or the math field. And someone accountable regardless Complete This Checklist I’m probably not cut out to be of the law.” to Elect Our Candidates! a lawyer because ‘it’s not about On the other side of the coin, going to court; it’s really about they explain that “activist” ju- □ Join MDPAC a lot of reading and writing, and rists typically look at the spirit that doesn’t seem to be my par- □ Write a check to their campaigns of the law, making decisions ticular strength.’” based on their empathies, as □ Connect to them through social media Even at the University of opposed to what the law says. □ Be persistent in spreading the word and urging Detroit Law School, where he Therefore, activist jurists tend support from colleagues, staff, family, friends graduated with honors, Justice to fill in the gaps to reach a pre- Zahra remembers having the determined outcome. □ Pledge to vote for them on Tuesday, Nov. 6 intent of earning a law degree Get started NOW at www.msms.org/supremecourt to possibly run for congress Meet the ‘Rule of Law 3’ or www.mdpac.org/supremecourt. someday, but not necessarily to If Justice Markman were to have become a lawyer. “But after the followed his early dream of play- first semester, I just loved it, and ing right field for the Detroit Tigers, who knows what the fate I knew that I would be in the legal profession for the rest of of tort reforms would be today. As it turned out, his passion my life,” he said. for the law led him down a different path. Prior to his Supreme Court appointment, Justice Zahra After receiving his law degree from the University of Cin- served on the Michigan Court of Appeals for 12 years and the cinnati in 1974, Justice Markman worked in Washington, DC, Wayne County Circuit Court. (Interesting fact: he is the only for many years, serving as Chief Counsel of the United States Supreme Court candidate this year who has Circuit, Appeals, Senate Subcommittee on the Constitution, and as Deputy and Supreme Court experience.) Chief Counsel of the US Senate Judiciary Committee. He then Justice Zahra, who received his undergraduate degree from was appointed by Pres. Ronald Reagan to the post of Assistant Wayne State University, is also something of an entrepreneur. Attorney General of the US, and served as a US Attorney in He operated a small health and personal care retail store (and Michigan after being appointed by Pres. George H.W. Bush. later a grocery store) in Detroit to finance his education. He has taught constitutional law at Hillsdale College since A longtime hockey player who lives with his family in North- 1993, and has spoken at every law school in the state, as well ville Township, Justice Zahra takes to the ice in his spare time, as other college and universities. lacing up for a local hockey league in Farmington. He jokes, An avid sports fan, Justice Markman says he finds time to “I’m so old that I say I’m proud to be in the over-40 league.” play basketball on occasion, and smiles as he notes the irony Judge O’Brien, a 1981 graduate of the Detroit College of

“When the Supreme Court does not speak with clarity, frivolous lawsuits increase, and justice under the law is not served.”

Oakland County Judge Colleen O’Brien, candidate for Supreme Court

10 MICHIGAN MEDICINE September/October 2012 Justice Zahra leads an elementary school group on a tour of the chamber, explaining how the court works.

“This election is extremely pivotal. For 26 years, the court didn’t have an incumbent lose until 2008. This has happened two election cycles in a row. There needs to be education of physicians about the importance of this race and of their participation.”

Supreme Court Justice Brian Zahra, addressing MSMS Board members in March

Law, knew she wanted to pursue law since her early teens. cases, and have presided over hundreds of criminal and civil However, “it was only after appearing in courtrooms across trials,” she noted. “This breadth of experience is unmatched our state that I thought of becoming a judge.” by those against whom I am running. It has allowed me to “During this time, I often appeared before judges who see firsthand the importance of consistency in the law, and applied their ‘personal’ views of the law rather than the how it affects our citizens and our state.” plain meaning of laws before them,” she explained. “This An occasional golfer, Judge O’Brien lives in Rochester Hills was not only frustrating, but was often unfair to my clients, with her husband, who also is an attorney, and their three and led to confusion among attorneys and litigants, alike. I children. She also has a passion for teaching law, and currently pledged that should I have the honor of serving as a Michigan serves as an adjunct professor at Cooley Law School in Lansing. judge, I would not allow my personal beliefs and views to “I have had the good fortune of teaching a number of interfere with an evenhanded law-related classes, and application of the law.” have found it invigorating,” In addition to 17 years as a Flip Over Your Ballot! said Judge O’Brien. practicing attorney handling both civil and criminal matters, Reminder: When you head to the polls on Stakes Have Increased Judge O’Brien has spent nearly November 6, be sure to examine all sections The make-up of the high court 14 years on the Oakland County of your ballot and turn it over, if necessary, can, has, and will continue to Circuit Court. And she under- to find the “non-partisan” section. This is greatly impact Michigan’s tort stands exactly how she stacks up where you will find Justice Markman, reform laws. against her opponents this fall. Justice Zahra, and Judge O’Brien. Since our model tort reform “I have disposed thousands of laws passed in 1993, almost

Volume 111 • Number 5 MICHIGAN MEDICINE 11 every aspect of the laws has been challenged – Notice of “One perspective I have is having been in the minority Intent, Affidavit of Merit, Loss of Opportunity Doctrine and on the Supreme Court. I guess it builds character,” Justice Expert Witness Qualification, to name a few. And almost Markman dryly quipped. all of the Supreme Court challenges have come down to a Justice Zahra interjected, “Or some would say perhaps it 4-3 rule of law majority vote in favor of upholding them. As reveals character.” a result of this climate, medical malpractice lawsuits in the “During that time, the kinds of cases in which we had state have been reduced substantially. been upholding medical malpractice reform and had been Contrast this with 2010, when Michigan got a taste of respecting the role of the doctor in the practice of medicine, what happens when the court’s majority shifts. Justice Betty I think, were largely reflected in dissents,” Justice Markman Weaver retired and Gov. Jennifer Granholm appointed an continued. “Many precedents of the court that had been activist judge, Alton Thomas Davis, to replace her. Shortly established were reversed in that period, and the court was thereafter, the activist majority loosened its interpretation going in a very different direction. Given a little more time, of the Loss of Opportunity Doctrine. tort reforms enacted by the legislature would have largely been nullified. So it did offer, I think, a study in contrast, a case study of what’s at issue today.” It took a rule of law majority in the Supreme Court to overturn Court of Appeals decisions that blocked doc- tors from objecting to plaintiffs’ faulty Notices of Intent (Roberts v. Mecosta County Hospital) and attempted to overturn Expert Witness requirements (McDougall v. Elivk). In 2009, MSMS fought legislative attempts to gut key provisions of the 1994 reforms, including Expert Witness Qualifications, Notices of Intent, Affidavits of Merit, and statutes of limitations. In 2010, additional legislation sought to make it easier for trial lawyers to win huge settlements from physicians who made legal medical record alterations, something rarely covered by liability insurance policies, leaving defendants on the hook to satisfy legal judgments. If these measures demonstrate nothing else, they show that tort reform laws are vulnerable to continuous attacks on several fronts. Despite the fact that physicians, through MDPAC, succeeded two years ago in shifting the majority back to rule of law, the medical community can’t afford to rest on its laurels and roll back the clock on tort reform. After all, if the medical community sits idly on the sidelines and lets the court majority shift back, we only have ourselves to blame when tort reform court challenges start going the other way…. MM

The author is MSMS Senior Manager, Communications & Public Relations.

12 MICHIGAN MEDICINE September/October 2012 Volume 111 • Number 5 MICHIGAN MEDICINE 13 The Effect of Payment Reform on Physician Practices Part 1 The Shift from Fee-for-Service to Outcomes-Based Reimbursement Contributors: Stacey Hettiger, Paul Natinsky and Joe Neller In part one of this three-part series, our contributors describe the trends in physician reimbursement, particularly the shift from fee-for-service to outcomes-based. In upcoming issues, we’ll examine the role physician organizations and incentive programs will play in how physicians choose to practice medicine.

hether the Patient Protection and Affordable Fall Series Will Help You Care Act (typically referred to as ACA) goes Lead Your Practice in Changing into effect with all of its provisions intact, is scrapped and reworked by Congress, or Health Care Environment altered by future court challenges, one thing is clear: it has confirmed that ongoing and “As insurance companies and others dictate more of physi- future efforts to evolve the structural landscape for practice and cian reimbursement and practice patterns, it is important W payment of medicine cannot be ignored. There is no turning for physicians and those at their negotiating tables to back, and those who fail to engage will find it difficult to survive. understand the business aspect of medicine.” So noted Our current health care system consumes $2.6 trillion per year Sara Liter-Kuester, DO, Chief Medical Information Officer at and 18 percent of the gross domestic product, but still leaves Port Huron Hospital, after completing the inaugural MSMS almost 50 million people uninsured nationally and almost 2 Physician Executive Development Program this spring. million people in Michigan dependent upon Medicaid. It misses This is truer than ever in the changing health care the mark on quality, as well, with the US achieving an overall environment of new care models, electronic records, and score of 65 out of a possible 100 across 37 performance indicators. The status quo has become unacceptable to all stakeholders. physician leadership challenges and opportunities. The Concerns about the sustainability of a fragmented health Physician Executive Development Program offers enrollees care system that is wrought with escalating costs, uneven the comprehensive curriculum based on the management access, and variable quality has triggered a chain reaction in competencies and behavioral attributes identified by which major payers – public and private – have already begun the American College of Physician Executives, practical to change the way they pay physicians. The changes are likely information, and tools necessary to meet today’s (and to be permanent. tomorrow’s) challenges and demands in health care. Soon to be gone are payments based on the volume of ser- The program is comprised of a series that includes two vices provided – patient visits, procedures and tests. In their all-day conferences – about six weeks apart – plus two place will be value- and outcome-based reimbursements that webinars in between. The next series will cover the same are conditional upon population health status and outcomes. topics as the spring 2012 series. In other words, the reimbursement system of the near future will reward physicians for statistically improving patient health Dates: and providing more bang for the buck. Wednesday, November 8 in Lansing (all-day conference) As Harold D. Miller, president and CEO of the Network for Wednesday, November 19 (webinar) Regional Healthcare Improvement and executive director of Wednesday, December 3 (webinar) the Center for Healthcare Quality & Payment Reform, told Wednesday, December 13 in Lansing (all-day conference) the MSMS Board of Directors in July, “The problem is that nobody gets paid when the patient stays well.” The Physician Executive Development Program also As payers respond to purchaser demands for more flexible incorporates the MSMS Future of Medicine strategic and affordable health care benefits, across-the-board fee updates priorities related to Primary Care, Quality & Safety, and and fee-for-service payments are being replaced by pay-for- Health Care Resources Stewardship. performance incentives and shared savings opportunities. New delivery and payment models will require physicians to practice For more information, contact Caryl Markzon at in a way that provides for an increasing amount of clinical inte- MSMS at 517-336-7575 or [email protected]. gration and care coordination. Physicians will be incentivized to better manage population health, as they will be measured

14 MICHIGAN MEDICINE September/October 2012 on their population-level performance. Physicians will need to hit quality targets as compensation increasingly becomes tied to outcomes rather than quantity of services performed. In an October 2011 survey of 182 health care organizations, 66 percent indicated that they incorporated quality measures into incentive programs for physicians (Hay Group Survey-Oct. 17, 2011). Another study released in January 2012, found that 72 percent of 424 health care organizations surveyed linked a portion of pay to quality (Sullivan, Cotter and Associates- Jan. 10, 2012). Various Medicare incentive programs are structured to provide “carrots and sticks,” with participation being voluntary, but negative payment adjustments imposed for non-participation after a set date. Additionally, beginning in 2013, the ACA calls for the public reporting of physician performance information. Value-Based Payment Models Several programs resulting from provisions in the ACA are designed to test and evaluate new payment models, such as the National Bundling Pilot Program and the Medicare Shared Sav- ings Program. Under the ACA, the Centers for Medicare and Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMI) is charged with developing innovative health care and delivery models that slow cost growth and improve quality. Additionally, CMS will be launching a new Value- Based Purchasing initiative in 2015 that will impact physicians. However, the evolution to practice and payment models based on outcomes and value rather than volume or procedures had a foothold well before the passage of the ACA. In Michigan, several payers continue to embark on value-based incentive programs they designed years ago. One of the largest is Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program (PGIP), which began in 2005 and utilizes a wide vari- ety of initiatives designed to incentivize practice improvement through rewards to physician organizations/physician-hospital organizations (POs) and physicians for the value of health care delivered. Priority Health’s practice transformation initiatives have been evolving over the past several years. Their Partners in Performance (PIP) Program was recently expanded and cur- rently focuses on four key elements: attributed relationships; measured outcomes for usage, quality, costs, and member sat- isfaction; collaboration; and rewards for prevention, improved clinical outcomes and cost-effective care. These payers are not alone in offering performance and quality incentives. While Be in the Know program specifics may vary, some of the common measures look about Legal at preventive screenings; medication management; technology Aspects of ACOs capabilities including registry use and electronic prescribing; disease management; care coordination; and patient-centered Physicians need to become medical home capabilities. familiar with a variety of issues These new models of care and reimbursement, as well as in- relative to accountable care creased regulatory demands, are forcing physicians to consider organizations (ACOs) under new practice strategies. Partnership and collaboration with other the Medicare Shared Savings colleagues, whether through employment arrangements, affiliation Program so they can make informed decisions about with POs or other organized systems or care, or other alignment whether to participate, opportunities are fast becoming the norm. Hospitals, too, are or wait and see if these more likely to seek hospital-physician alignment opportunities organizations take root. MSMS has as they recognize the need to partner with physicians in order created a new Legal Alert exclusively for members to meet quality expectations and avoid payment reductions for called “What Physicians Need to Know about Accountable poor outcomes (i.e., avoidable hospital readmissions). Care Organizations under the Medicare Shared Savings “The growing emphasis on population health management Program.” Download at www.msms.org/hcd. will drive the need for closer collaboration among physicians,”

Volume 111 • Number 5 MICHIGAN MEDICINE 15 says F. Remington Sprague, MD, Vice President & Chief Medical Employment by a hospital or health system can provide in- Officer of Mercy Health Partners. “Connectivity with enhanced creased stability for physicians by offering better financial security information technology can support this, but fundamentally and a lower burden of day-to-day practice management than the culture of medical care must evolve. Broader application physicians have in independent practice. Under most employment of algorithms based on accepted evidence of best care, mutual agreements, a physician’s salary is at least partially guaranteed accountability among primary care and specialty physicians, ap- and less dependent on the finances of their practice. Data show propriate delegation of responsibilities to other care givers, and over the last decade that practice overhead continues to rise shared decision-making models with patients will all be necessary. while reimbursements have remained relatively flat. The recent This is not to diminish the critical role of physicians, but we will economic downturn has only exacerbated the problem as many need to learn new skills and approaches to achieve the aims of patients have lost their coverage or rely on lower paying programs enhanced quality, greater patient engagement and lower cost.” like Medicaid. The failure of physician payment rates to keep pace with practice costs coupled with the need to invest in necessary Trends to Employment and required infrastructure, such as electronic medical records The administrative burden of running a practice has always (EMR) or other health information technology (HIT) have made been fairly high, but as payers demand more accountability for employment an attractive option for many physicians. The cost their health care dollar, physicians are under more pressure than burdens of technology requirements alone have proven to be out normal. As a result, many physicians are choosing to become of reach for many independent practices. employed by hospitals or health systems to reduce their level of involvement in the “business end” of running a practice. Ac- How to Survive While Remaining Independent cording to the New England Journal of Medicine (N Engl J Med While the advantages of employment by a hospital or health 2011; 364:1790-1793; May 12, 2011), nearly half of all primary system may be attractive to some, many physicians are resistant care physicians in the United States are now employed. In our to the trend because they must surrender some of the control state, the Michigan Department of Community Health 2011 they previously enjoyed running their own practices. For Physicain Survey reports only 36 percent of physicians are not instance, under an employment arrangement, physicians have a salaried employee of any organization. These trends reflect a less say about their work schedule, call coverage, record keeping stark departure from a decade ago when the vast majority of requirements and other general business or administrative physicians were independent. The shift is a direct result of the operations, as these are typically dictated by the physician’s greater demands on physicians to focus on cost containment employer. For those physicians who enjoy their current autonomy through improvements in population health. and independence, hospital or health system employment is

16 MICHIGAN MEDICINE September/October 2012 not an attractive arrangement. However, physicians who desire continued independence must also understand that some level of clinical integration will be required to survive in the future practice of medicine. Physician Organizations, especially in Michigan, will be critical to the way health care is delivered in the future. Phy- sician Organizations (POs), Physician Hospital Organizations (PHOs), and Independent Physician Associations (IPAs) can provide doctors with the ability to link their practices into a health care delivery network without the rigidity or potential loss of independence presented by an employment arrangement. Affiliation with a PO can provide physicians with the adminis- trative support offered by employment, such as assistance with HIT infrastructure and billing or reporting functions, without strict control over the physician’s behavior. In Michigan, af- filiation with a PO is important as it is required to participate in BCBSM’s PGIP. Additionally, it can be helpful coordinat- ing the requirements of multiple private insurance incentive programs and capturing the respective enhanced payments for quality outcomes. So, Where Do Things Stand? Regardless of the level of physician affiliation, one thing is cer- tain about the future of health care in America, “the practice of medicine as a cottage industry is over,” as stated by Doctor Mark Kelley in an April presentation to physicians on the impact of health care reform. Doctor Kelley is Executive Vice President and Chief Medical Officer at Henry Ford Health System, Detroit. He is also Chief Executive Officer of the Henry Ford Medical Group,

Volume 111 • Number 5 MICHIGAN MEDICINE 17 HIT Corner a large, multi-specialty group practicing in metropolitan Detroit. The demands of private and public payers to contain costs Don’t Get Too Comfortable, by improving the health of the population will require greater clinical integration, collaboration, and system sophistication Stage 2 Meaningful Use through the adoption of new practice technologies. It will also require tremendous physician leadership to guide the American Requirements Have Arrived health care system as it transitions into a new era. Will physicians embrace, accept and try to influence new prac- ust when everyone was starting to grasp the Stage 1 tice and payment models, hold out until forced to participate, or Meaningful Use (MU) requirements under the Medicare wait it out? How will physicians survive under these new delivery Jand Medicaid Electronic Health Record (EHR) Incentive and payment models? Doing business the old way will be harder Programs, the final Stage 2 requirements are released. As you and likely not feasible. The system will no longer support or pay might recall, when the EHR Incentive Programs were being for physicians who operate in silos, unconnected to other physi- developed, it was determined that in order for them to be cians and integrated patient care plans. However, this doesn’t successful, an incremental approach was needed. This was mean physicians can’t seek solutions and partnerships that en- due to the varying readiness among eligible professionals, able independent practice working toward improved population eligible facilities, and EHR vendors to meet the proposed health within a clinically integrated system. There are a variety criteria. Therefore, it was decided that the MU criteria would of alignment opportunities to explore such as networking, part- be rolled out in three stages. nering and working collaboratively. As Doctor Jackson points out, “If our health care system is going to thrive, physicians must take the lead.” In the next issue of Michigan Medicine, we will take a closer look at the incentive programs available to Michigan physicians, and the infrastructure they’ll need to take advantage of them. MM

Stacey Hettiger is Manager of Health Care Delivery at MSMS. Paul Natinsky is Managing Partner of Creatavision Partners, LLC, a Royal Oak, MI-based marketing, communications and digital media firm. Joe Neller is Manager, Physician Organization Liaison at MSMS. As expected, the Stage 2 requirements build upon the Stage 1 criteria. Many of the Stage 1 menu set objectives (optional) are now core measures (required) and many of the thresholds in the Stage 1 objectives have been increased. There have also been some “groupings” of various objectives where it made sense and some modifications to Stage 1 requirements. Just like in Stage 1, eligible professionals (EPs) will have to demonstrate 20 meaningful use objectives. However, 17 of these will now be core and three of six will be from the menu set. In regard to the reporting of clinical quality measures (CQMs), there will be more than 100 CQMs to select from under Stage 2 as compared to the current 44 CQMs. To view the complete list, visit http://go.cms.gov/TrCcod. Under Stage 1, EPs must report a total of six CQMs while Stage 2 requires EPs to report on a total of nine CQMs. The Centers for Medicare and Medicaid Services is also looking at electronic reporting options at the aggregate-level from groups and through the Physician Quality Reporting System.

Let the U.S. Air Force remind you why you became a physician in the first place. Go to the places you’re most needed and help those who have the least. As a physician in the Air Force, you will truly change lives – starting with your own. AIRFORCE.COM

TSgt Jill Cardoza / 313-600-1202 / [email protected] 1-800-423-USAF / www.airforce.com/healthcare

18 MICHIGAN MEDICINE September/October 2012 It’s safe to say that patient engagement and the electronic to their health information, and electronic transmission of exchange of information are key focuses of Stage 2. The summary of care documents. MU criteria include measures that require sending secure The table below provides a summary of the MU requirements messages between patients and EPs, patient online access for EPs in Stage 2:

Core Objective Stage 2 Measure 1. CPOE Use CPOE for more than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology 2. eRx eRx for more than 50 percent 3. Demographics Record demographics for more than 80 percent 4. Vital Signs Record vital signs for more than 80 percent 5. Smoking Status Record smoking status for more than 80 percent 6. Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy 7. Labs Incorporate lab results for more than 55 percent 8. Patient List Generate at least one patient list by specific condition 9. Preventive Reminders Use EHR to identify and provide reminders for preventive/follow-up care for more than 10 percent of patients with two or more office visits in the last 2 years 10. Online Patient Access Provide online access to health information for more than 50 percent with more than 5 percent actually accessing 11. Clinical Summaries Provide clinical summaries within one business day for more than 50 percent of office visits 12. Education Resources Use EHR to identify and provide education resources more than 10 percent 13. Secure Messages More than 5 percent of patients send secure messages to their EP 14. Rx Reconciliation Medication reconciliation at more than 50 percent of transitions of care 15. Summary of Care Provide summary of care document for more than 50 percent of transitions of care and referrals with 10 percent sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR 16. Immunizations Successful ongoing transmission of immunization data 17. Security Analysis Conduct or review security analysis and incorporate in risk management process Menu Objective Stage 2 Measure 1. Syndromic Surveillance Successful ongoing transmission of syndromic surveillance data 2. Imaging Results More than 10 percent of imaging results are accessible through Certified EHR Technology 3. Family Health History Record family health history for more than 20 percent 4. Cancer Registry Successful ongoing transmission of cancer case information 5. Specialized Registry Successful ongoing transmission of data to a specialized registry 6. Progress Notes Enter an electronic progress note for more than 30 percent of unique patients

Stage 2 requirements will take effect in 2014. Most EPs will To read the rule in its entirety, visit http://1.usa.gov/OXEzYi. progress to Stage 2 MU criteria after two program years under MSMS offers a variety of tools to assist physicians in under- the Stage 1 criteria. However, those EPs who first met MU in standing and successfully participating in the Medicare and 2011 will operate under Stage 1 for three years. The Stage 2 final Medicaid EHR Incentive Programs. See the MSMS Health rule finalized the process in which Medicare payment adjust- Information Technology (HIT) Webpage at www.msms.org/ ments beginning in 2015 will be determined for those EPs who HIT for HIT Alerts and Checklists, as well as links to helpful are not meaningful users under the EHR incentive programs. sites. MSMS also launched its own Meaningful Use Consulta- The final rule also identified four categories of exceptions for tion Service that is available to physicians and their office staff EPs based on barriers including infrastructure, newly practic- at a very competitive rate. For details, contact Dara Barrera at ing, unforeseen circumstances, and specialist/provider type. MSMS at [email protected] or (517) 336-5770. MM

Volume 111 • Number 5 MICHIGAN MEDICINE 19 MDCH Update

Recommendations for the Management of HBV-Infected Health Care Providers An Update from the Michigan Department of Community Health

n July 6, 2012, the Centers for Dis- the CDC Classification of Exposure- students who are discovered to have chron- ease Control and Prevention (CDC) Prone Patient Care Procedures, which ic HBV infection. For most chronically Opublished a report to update the 1991 accompanies this article.) HBV-infected providers and students who recommendations for the management of The previous recommendations have conform to current standards for infection hepatitis B virus (HBV)-infected health been updated to include the follow- control, HBV infection status alone does care providers and students to reduce risk ing changes: not require any curtailing of their prac- for transmitting HBV to patients during the • No pre-notification of patients tices or supervised learning experiences. conduct of exposure-prone invasive proce- of a health care provider’s or These updated recommendations outline dures. The full report is published online at student’s HBV status the criteria for safe clinical practice of HBV- www.cdc.gov/mmwr/pdf/rr/rr6103.pdf. infected providers and students that can • Use of HBV DNA serum levels The primary goal of this report is to be used by the appropriate occupational rather than hepatitis B e-antigen promote patient safety while providing or student health authorities to develop status to monitor infectivity risk management and practice guidance their own institutional policies. The recom- to HBV-infected health care providers and • For those health-care professionals mendations can be used by an institutional students, particularly those performing requiring oversight, specific expert panel that monitors providers who exposure-prone procedures such as suggestions for composition of perform exposure-prone procedures. certain types of surgery. These updated expert review panels and threshold In addition to these recommendations, recommendations reaffirm the 1991 CDC value of serum HBV DNA please refer to Immunization of Health-Care recommendation that HBV infection alone considered “safe” for practice Personnel: Recommendations of the Ad- should not disqualify infected persons from (less than 1,000 IU/ml) visory Committee on Immunization Prac- the practice or study of surgery, dentistry, These recommendations also explicitly tices (ACIP), posted at www.cdc.gov/mmwr/ medicine, or allied health fields. (See address the issue of medical and dental preview/mmwrhtml/rr6007a1.htm. MM

20 MICHIGAN MEDICINE September/October 2012 CDC Classification Category II of Exposure-Prone Patient Care All other invasive and noninvasive procedures These and similar procedures are not included in Category I as they Procedures pose low or no risk for percutaneous injury to a health-care provider or, if a percutaneous injury occurs, it usually happens outside a Category I patient’s body and generally does not pose a risk for provider-to- patient blood exposure. These include: Procedures known or likely to pose an increased risk of percutaneous injury to a health care provider • Surgical and obstetrical/gynecologic procedures that do not that have resulted in provider-to-patient involve the techniques listed for Category I transmission of HBV • Use of needles or other sharp devices when health care provider’s hands are outside a body cavity (e.g., phlebotomy, These procedures are limited to major abdominal, cardiothoracic, placing and maintaining peripheral and central intravascular and orthopedic surgery, repair of major traumatic injuries, abdominal lines, administering medication by injection, performing needle and vaginal hysterectomy, caesarean section, vaginal deliveries, biopsies, or lumbar puncture) and major oral or maxillofacial surgery (e.g., fracture reductions). • Dental procedures other than major oral or maxillofacial surgery Techniques that have been demonstrated to increase the risk for health care provider percutaneous injury and provider-to-patient • Insertion of tubes (e.g., nasogastric, endotracheal, rectal, or blood exposure include: urinary catheters) • Digital palpation of a needle tip in a body cavity, and/or • Endoscopic or bronchoscopic procedures • Simultaneous presence of a health care provider’s fingers and • Internal examination with a gloved hand that does not a needle or other sharp instrument or object (e.g., bone spicule) involve the use of sharp devices (e.g., vaginal, oral, and rectal in a poorly visualized or highly confined anatomic site. examination) Category I procedures, especially those that have been implicated in • Procedures that involve external physical touch (e.g., general HBV transmission, are not ordinarily performed by students fulfilling physical or eye examinations or blood pressure checks). the essential functions of a medical or dental school education. Source: http://www.cdc.gov/mmwr/pdf/rr/rr6103.pdf

Volume 111 • Number 5 MICHIGAN MEDICINE 21 MSMS MeMbers

Welcome to These New MSMS Members Eric Daniel Achtyes, MD, Grand Rapids Scott K. Huffaker, DO, Marlette Bernardo A. Rojas, Jr, MD, Troy Bishr A. Al-Ujayli, MD, Rochester Hills Louis E. Jacobs, DO, Garden City Gary T. Roome, MD, Flint Shannon D. Armstrong, MD, Grand Rapids Yogesh Jagirdar, MD, Flint Ralph G. Ryan, III, MD, Muskegon Yasir O. Babiker, MD, Flint Leena Jindal, DO, Flint Peter M. Rydesky, MD, Flint James D. Balger, DO, Charlotte Leroy Johnson, MD, Flint Chadi Youssef Saad, MD, Troy Christopher R. Barnes, DO, Grand Rapids Madhuri V. Kakarala, MD, Grand Rapids Elna N. Saah, MD, Okemos Karen K. Berris, MD, West Bloomfield Manish Khare, MD, Rochester Hills James Eric Samuelson, MD, Wyoming Diane C. Bigham, DO, Grand Rapids Linda Lu Reese Kosal, DO, Clinton Township Richard Charles Sarle, MD, Dearborn David D. Bonnema, MD, Muskegon Alfonso G. Llanto, MD, Watervliet Anju Sawni, MD, Bloomfield Hills James R. Bullen, MD, Alpena Ryan Dean Madder, MD, Grand Rapids Daniel K. Shogren, DO, Port Huron Quinter M. Burnett, II, MD, Kalamazoo Miriva Magar, MD, Flint John F. Skallerup, MD, Muskegon Ann Y. Burton, MD, Grand Blanc M. Ashraf Mansour, MD, Grand Rapids Jason Daniel Slaikeu, MD, Grand Rapids Christopher M. Chambers, MD, Grand Rapids Bruce W. Martin, MD, Grand Haven William A. Sray, MD, Battle Creek Shivani Choudhary, MD, Flint J. David Maskill, MD, Grand Rapids Seema Srivastava, MD, Troy Su-Jin Chung, MD, Westland Terry Merrill Matthews, DO, Lansing Sharon A. Stoll, MD, Lake Linden Joseph V. Cotroneo, MD, Lansing Faisal M. Mawri, MD, Howell Richard James Strabbing, DO, Holland Casey J. Cress, MD, Spring Lake Michael McCann, DO, Swartz Creek Mohammad J. Tabbah, MD, Flushing Robert Francis Cuff, MD, FACS, Grand Rapids Kelly McClean, MD, Dexter Burhan M. Tajour, MD, Flint Hanady A. Daas, MD, Troy Mark E. Meengs, MD, Muskegon Michael W. Tawney, DO, Clinton Township Ryan Chandler Daily, MD, Saint Joseph Jeanette M. Meyer, MD, Kalamazoo Niti B. Thakur, MD, East Lansing Carly H. Davis, MD, Kalamazoo John R. Mogor, MD, Lowell Satya Srini Vasu Toram, MD, Ypsilanti Steven T. DeRoos, MD, Grand Rapids Osama Nicola Nunu, MD, Troy James Michael Tucci, MD, Grand Rapids Brian N. Dishinger, MD, Holland Shawn Harry Obi, DO, Jackson Christopher W. Uggen, MD, Kalamazoo Mark J. Dzwik, MD, Battle Creek Duane A. Oetman, MD, Byron Center Sarat K. Vaddineni, MD, Kalamazoo Muhammad Umar Farooq, MD, Grand Rapids Bryan J. Pack, MD, Grand Rapids Karthik Vijayaraghavan, MD, Kalamazoo Kevin Michael Feber, MD, Huntington Woods Tarulata P. Patel, MD, Grand Rapids Thomas J. Visser, MD, Holland Kari R. Formsma, MD, Battle Creek Bojan Pavlovic, MD, Portage Jack Blair Wagoner, MD, Ann Arbor Leopold M. Fregoli, MD, Port Huron Veera Pavuluri, MD, Alma Don J. Walbridge, DO, Kalamazoo Michelle Gianturco, DO, Allendale Sara Margaret W. Pendleton, MD, Grand Blanc Douglas C. Westveer, MD, Berkley James R. Grace, MD, Muskegon Nathan Edward Pomeroy, MD, Grand Rapids Christa B. Williams, MD, Ossineke Kathryn Grossman, MD, Vicksburg Daniel Carl Postellon, MD, Grand Rapids Peter Y. Wong, MD, Grand Rapids Sam Hamade, MD, Flint Carol Prince, MD, Southfield Frank J. Yono, MD, Troy Jamal Hammoud, MD, Flint Fengxia Qiao, MD, Flint Angela R. Yurk, MD, Clarkston Thomas J. Hill, MD, Muskegon Todd L. Ream, MD, Kalamazoo Louinda V. Zahdeh, MD, Flint Hem R. Regmi, MD, Mount Pleasant Obituaries The members of the Michigan State Medical Society remember with respect their colleagues who have died.

Norman Carter, MD, Grand Blanc Township, died July 12, 2012 at the age of 78. Earle James McGarvah, MD, Grand Blanc, died August 18, 2012 at the age of 75. John E. Finger, MD, Saginaw, died June 27, 2012 at the age of 83. Ramesh Naram, MD, Saginaw, died July 30, 2012 at the age of 62. W. Richard Harris, MD, Muskegon, died August 27, 2012 at the age of 76. Paul T. Niland, MD, Gainesville, FL, formerly of East Lansing, died June 1, 2012 Edward Patrick Juras, MD, Traverse City, formerly of Kewadin and at the age of 86. Bloomfield Hills, died June 29, 2012 at the age of 72. Richard John O’Malley, MD, Ionia, died July 5, 2012 at the age of 81. James B. Kilway, MD, Portage, died July 22, 2012 at the age of 78. Gregory A. Peters, MD, East Grand Rapids, died July 20, 2012 at the age of 71. Joseph Kopchick, MD, Savannah, GA, formerly of Muir died June 3, 2012 at the age of 91. Jacques M. Rosenfeld, MD, Bloomfield Hills, died June 25, 2012 at the age of 84. George H. Lewis, MD, Allegan, died July 26, 2012 at the age of 90. William D. Walters, MD, Battle Creek, died September 2, 2012 at the age of 92.

In Memory If you would like to recognize a colleague by making a gift or bequest in their memory to the MSMS Foundation, the physicians’ own charity, please contact Rebecca Blake, Director, MSMS Foundation, 120 W. Saginaw, East Lansing, MI 48823, call 517-336-5729 or send e-mail to [email protected].

22 MICHIGAN MEDICINE September/October 2012 Disciplinary Actions

The following actions of the Michigan Board of Medicine were taken following inves­tigative and appropriate actions and are reproduced verbatim from summaries prepared by the Michigan Department of Community Health Bureau of Health Professions.

Report Dated: Steven B. DeWilde, DO 43-01-061192 Criminal Conviction – Alcohol Related 6-11-2012 through 6-15-2012 Marine City, MI 07/13/2012 Sister State Disciplinary Action John Frederick Hildebrandt, MD 51-01-009688 Summary Suspension Report Dated: Ionia, MI 06/19/2012 Violation of General Duty/Negligence 7-23-2012 through 7-27-2012 Reinstatement Denied Substance Abuse 43-01-407296 R. Charles Medlar, MD Mental/Physical Inability to Practice 06/13/2012 Alisa Esther Goldstein, DO Jackson, MI Reclassified w/Full and Unlimited License Birmingham, MI Report Dated: 43-01-036871 Roberta G. Kurtz, MD 51-01-013607 7-16-2012 through 7-20-2012 07/24/2012 Traverse City, MI 07/19/2012 Edgar Alejandro Cardenas, MD Summary Suspension 43-01-038245 Suspended Irving, TX 07/27/2012 06/13/2012 Violation of General Duty/Negligence 43-01-097574 Summary Suspension Stayed Suspended, Lack of Good Moral Character Substance Abuse 08/17/2012 Sexual Misconduct Negligence – Incompetence Richard S. Neely, DO Fine Imposed, Reprimanded Mitchell Lawrence Parmet, DO Davison, MI Brian Francis Lane, MD Sister State Disciplinary Action Escanaba, MI 51-01-004783 Bowling Green, OH Failure to Report/Comply 51-01-014467 06/12/2012 43-01-076999 Eric L. Clark, MD 07/23/2012 Reinstated with Probation 07/13/2012 Imlay City, MI Reprimanded, Fine Imposed, Probation Probation, Fine Imposed Katherine Lily Richmond, DO 43-01-055207 Failure to Meet Cont. Ed. Requirements Failure to Report/Comply Garfield Heights, OH 07/18/2012 Report Dated: Sister State Disciplinary Action 51-01-010762 Probation 7-30-2012 through 8-3-2012 07/19/2012 Violation of General Duty/Negligence Edwin Carl Blumberg, DO, NHA Oscar Agustine Linares, MD Suspended Milagros Tagorda Ebreo, MD Farmington Hills, MI Plymouth, MI Sister State Disciplinary Action 43-01-045607 Port Sanilac, MI 51-01-004871 06/11/2012 Report Dated: 43-01-032508 48-01-000018 Summary Suspension Dissolved 6-25-2012 through 6-29-2012 08/17/2012 07/27/2012 Suspended – 60 days Suspended Michele Renee Ritter, MD Robert Love Baker, II, DO Upon Automatic Reinstatement, Violation of General Duty/Negligence Pontiac, MI Lima, OH Probation concurrent w/Limited License Drug Diversion, Failure to Report/Comply 43-01-070661 51-01-007874 Probation Violation Criminal Conviction – Alcohol Related 07/13/2012 06/21/2012 Lack of Good Moral Character Fine Imposed, Suspended Reprimanded, Probation Sheila Marie Gendich, MD Negligence – Incompetence Fine Imposed Dewitt, MI Marc Albert De Nuccio, DO Failure to Meet Cont. Ed. Requirements 43-01-058189 Novi, MI Veronica Lynn Vas, MD Paul Andrew Brown, DO 08/17/2012 51-01-010211 Niles, MI Grand Rapids, MI Fine Imposed, Reprimanded 08/02/2012 43-01-077420 51-01-015652 Unprofessional Conduct Fine Imposed, Probation 06/13/2012 06/26/2012 Hisham Abdel-Aziz Hashish, MD Violation of General Duty/Negligence Reinstated – w/Limited License Fine Imposed, Reprimanded, Probation Old Bridge, NJ Probation Dominic Anthony Garrisi, DO Failure to Meet Cont. Ed. Requirements 43-01-083360 Saint Clair Shores, MI Edwin Yen Wang, MD Jeffery Scott Morrill, DO 08/17/2012 51-01-007885 Wilsonville, OR Fort Dodge, IA Reprimanded 08/21/2012 43-01-071830 51-01-014880 Sister State Disciplinary Action Voluntarily Surrendered 07/13/2012 06/21/2012 Failure to Report/Comply Failure to Meet Cont. Ed. Requirements Fine Imposed, Reprimanded Probation, Fine Imposed, Reprimanded Joseph Edwin Oesterling, MD Timothy Lee Hayes, DO Sister State Disciplinary Action Failure to Meet Cont. Ed. Requirements Saginaw, MI Dafter, MI Failure to Report/Comply Alan Percy Peter, DO 43-01-063677 51-01-013323 Jo Ann Johnson, DO Macomb, MI 07/18/2012 08/02/2012 Linden, MI 51-01-014745 Fine Imposed Fine Imposed Drug Control License 06/26/2012 Limited/Restricted Probation Violation of General Duty/Negligence 51-01-010026 Summary Suspension Dissolved Negligence – Incompetence Kathleen Marie Kleinert, DO 06/13/2012 Patrick Randall Robinson, MD Roseburg, OR Voluntarily Surrendered Report Dated: 7-2-2012 through 7-6-2012 Ocala, FL 51-01-013318 Technical Violation of the Michigan, PHC 43-01-097407 08/02/2012 Stanley Halprin, DO 07/18/2012 Limited / Restricted Probation Report Dated: Clinton Township, MI 6-18-2012 through 6-22-2012 Probation, Reprimanded Negligence – Incompetence 51-01-005465 Limited/Restricted Louis Ward Brittingham, Jr., DO Alan Percy Peter, DO 06/29/2012 Negligence – Incompetence Lakebay, WA Macomb, MI Probation, Reprimanded, Fine Imposed Lack of Good Moral Character 51-01-006462 Failure to Meet Cont. Ed. Requirements 51-01-014745 07/19/2012 Gireesh Velugubanti, MD 08/02/2012 Report Dated: Suspended Detroit, MI Probation 7-9-2012 through 7-13-2012 Sister State Disciplinary Action 43-01-087670 Violation of General Duty/Negligence Failure to Report/Comply John Richard Wagner, Jr., MD 08/17/2012 Substance Abuse Warren, MI Probation Mental/Physical Inability to Practice

Notice of Intent to Deny – formal docu­ment that indicates Reprimand – the written statement of rebuke from the Board Explanation the Department intends to deny the issuance of a license that a specific activity of the licensee was a violation of the because of violations of the Public Health Code, past accepted standards of practice. of Disciplinary Terms or current. Revocation – a licensee can not practice for a minimum period Probation – a disciplinary action in which the licensee’s of three years; if the violation involved controlled substances, Board Order – the legal document that is issued by the practice is conditioned for a given period of time or until the licensee can not practice for a minimum of five years. Department, on behalf of the Board, which describes the specific requirements are met. Probation can include condi- Suspension – a licensee can not practice for a specified sections of the Public Health Code that have been violated tions such as: period of time. and the discipline that has been imposed for the violation(s). • participation in the Health Professional Recovery Program Summary Suspension – if the actions a licensee are con- Limitation – a restriction or condition imposed on a licensee • submission of regular reports from employer or other sidered a threat to the public’s health and safety, the right by the Board for a specified period of time such as: specified individual to practice can be withdrawn immediately. The Summary Suspension orders the licensee to stop practicing immedi­ately • confinement of practice to a location • completion of specific continuing education requirement upon receipt of the summary. The summary is hand-delivered • supervision of practice – either on-site or periodic review • no violations of the Public Health Code to the licensee. by Board or other Board approved licensee • other conditions deemed appropriate. Summary Suspension Dissolved – the sum­mary suspen- • restriction of practice to specific activities Reinstate – the granting of a license with or without re- sion has been removed after an administrative review and the • no access to controlled substances strictions or conditions to an individ­ual whose license was licensee is either allowed to practice or is subject to other • no ownership or financial interest other restrictions suspended or revoked. disci­plinary actions imposed by the Board. or conditions deemed appropriate.

Volume 111 • Number 5 MICHIGAN MEDICINE 23 24 MICHIGAN MEDICINE September/October 2012 Medical Family Matters

Alliance Members Rally for Tort Reform By Kathy Adams

onvening in Lansing early on reform was sad because those people’s whining. It sounded as if doctors were July 18, members of the MSMS lives were adversely affected by doctors saying, “I want what the lawyers have.” CAlliance arrived at Boji Tower to and their care. However, that does not At the end of the day, it left us attend the Senate Insurance Committee mean that all doctors should be tossed feeling frustrated and wondering what tort reform hearing. We were surprised will happen to these important bills. to find every seat and aisle filled with This is a crucial MSMS Alliance members believed people wearing white t-shirts reading, the issue was important enough to “Accountability, Not Immunity.” Since opportunity for all stand for three hours in support. But Cooley Law School is within one-half this lopsided hearing showed that block, it appeared to be easy for lawyers Michigan physicians to we desperately need to energize our and law students to show up en masse. community to show a larger force than Doctors, Alliance members, and other advance their profession we did on July 18. Ultimately, this is like-minded supporters were not as a crucial opportunity for all Michigan obvious, wearing our green “Put Patients and to improve physicians to advance their profession First!” buttons. and to improve patients’ lives. MM During testimony, those who opposed patients’ lives. the bills outnumbered those in support. It appeared that there was no difficulty into the same basket. Having “one size The author is President of the in finding people with stories of bad fits all” legal consequences is expensive MSMS Alliance, medical outcomes and purported poor and unfair. comprised of doctor care, but it was apparently I left thinking, “What just happened physicians’ spouses. impossible to find people to relate stories here?” The testimony by the doctors of good, thoughtful, successful medical in support of the tort reform bill was care. I was amazed by this. appropriate; however, it came across to The testimony in opposition to tort my ears – and possibly to others – like

Volume 111 • Number 5 MICHIGAN MEDICINE 25 MSMS Foundation Educational Conferences

Advanced Practice The Masters Series Note: Continental breakfast and lunch will be provided. Strategies for Date: Thursday, October 25, 2012 Intended for: Physicians, and the Patient Centered Time: Noon to 4:30 p.m. office administrators/managers. Location: Somerset Inn, Troy Medical Home Contact: Jody Roethele, (517) 336-5734 Date: Tuesday, October 23, 2012 or [email protected] MSMS Note: Lunch will be provided. Time: 9:00 a.m.to 3:45 p.m. Physician Executive Location: Somerset Inn, Troy Intended for: Physicians, executives, Contact: Caryl Markzon (517) 336-7575 office administrators/managers, Development Program or [email protected] and all other health care professionals. Date: Thursday, November 8, 2012 Note: Continental breakfast and Time: 9:00 a.m.to 4:00 p.m. (Conference) lunch will be provided. Date: Monday, November 19, 2012 Intended for: Physicians, practice Lean Physician Time: 7:00 to 8:00 p.m. (Webinar) managers/administrators, executives, Practice Innovation: Date: Monday, December 3, 2012 and all other health care professionals. Time: 7:00 to 8:00 p.m. (Webinar) Finding the Time to Deliver Date: Thursday, December 13, 2012 Great Health Care Time: 9:00 a.m.to 4:00 p.m. (Conference) Symposium Location: The Henry Center for Executive Introduction Webinar Development, Lansing, Michigan on Retirement Planning Date: Thursday, September 27, 2012 Contact: Caryl Markzon (517) 336-7575 Date: Wednesday, October 24, 2012 Time: 7:00 to 8:00 p.m. or [email protected] Time: 5:45 p.m. to 8:15 p.m. Session I Note: Continental breakfast and lunch Location: Somerset Inn, Troy Date: Friday, October 26, 2012 will be provided. Contact: Marianne Ben-Hamza 517-336- Time: 8:30 a.m. to 12:00 p.m. Intended for: Physicians. 7581 or [email protected] Location: Somerset Inn, Troy Note: Dinner will be provided. Session II Intended for: Retired physicians, Date: Wednesday, November 14, 2012 those planning for retirement, Time: 9:00 a.m. to 4:30 p.m. office managers, and spouses. Location: Eagle Crest, Ypsilanti Follow-up Webinar Date: Thursday, December 6, 2012 147th Annual Time: 7:00 to 8:00 p.m. To Register Online: Scientific Meeting Session III www.msms.org/eo Date: Wednesday, October 24 through Date: Wednesday, January 23, 2013 Saturday, October 27, 2012 Time: 9:00 a.m. to 4:30 p.m. Mail: MSMS Foundation Location: Somerset Inn, Troy Eagle Crest Resort, Ypsilanti PO Box 950 Contact: Marianne Ben-Hamza 517-336- Session IV East Lansing, MI 48826-0950 7581 or [email protected] Date: Wednesday, February 20, 2013 Note: Continental breakfast and Time: 9:00 a.m. to 4:30 p.m. Fax: lunch will be provided. Eagle Crest Resort, Ypsilanti 517-336-5797 Intended for: Physicians and all Contact: Jody Roethele, (517) 336-5734 Phone: other health care professionals. or [email protected] 517-336-5785

26 MICHIGAN MEDICINE September/October 2012 The Marketplace

Would You Like To Place A Classified Ad? The rate for classified adver­tising in Michigan Medicine, including both print and online versions, is $1.60 per word, with a minimum of $65.00. All ads must be prepaid. Text for classified advertisements­ and advertising fee should be received no later than the first of the month proceeding the month of publica­ ­tion. All submitted ads must be typed. No handwritten or dictated ads will be accepted.To place an ad call 1-888-822-3102 or fax to Michigan Medicine Classified 989-892-3525.

EMPLOYMENT $590,000 for everything. Physician and Cash Flow Medical building OPPORTUNITIES PA available to assure a smooth transition in far west Detroit. Rentals Mobile Doctors, a premier period for 6 months, 1 year or longer. bring in nearly twice the operating company specializing in home visits, Flexible terms. Call for details on income expenses on the 8700 sq.ft. brick seeks a full and a part-time physician and terms. For more details, contact medical building. Property taxes just to do House Calls. No evening work or our practice specialist Joseph at Union reduced $12,000 through an appeal. on call. MedMal insurance, MA and Realty, 248-919-0037 or 248-240-2141 6 suites rented out for years, great company car are provided. E-mail CV (cell) [email protected], www. potential, the same tenants will stay to Nick at [email protected] unionrealtypc.com. All inquiries strictly on for years more. Some room for a or fax to 312-284-4755. Call Nick at confidential. specialist or part time practice. Net 312-848-5319 for more information. cash flow is approximately $60k per Long established family year. Well built newer building, practice; Flint area. Annual good safety record, parking, visibility. gross income in excess of 1 million No major maintenance issues. dollars. Large portion of managed Asking $495,000. Recently appraised by care, 7 exam rooms, surgery suite, bank appraiser for much more. For more x-ray, huge parking lot, pharmacy details contact our practice specialist Primary care/Wound Care tenant with separate suite/entrance. Joseph at Union Realty, 248-919-0037 Physicians needed! Growing Most of the practice is electronic or 248-240-2141 (cell) joezrenchik@ company seeks part-time to full-time health records friendly. Great location yahoo.com, www.unionrealtypc.com. physicians to practice in-home care. Will – asking $420,000 for practice and All inquiries strictly confidential. see 30 -40 patients per week. Background $505,000 for the real estate. For more in wound care is a plus. Must be board details contact our practice specialist Busy Family Practice and/or certified. Help transform care to those Joseph at Union Realty, 248-919-0037 anchor building in Oakland that need it the most. Fax CV to 248- or 248-240-2141 (cell) joezrenchik@ County on main road. Please call 356-4505 or call 248-356-1111/Michael. yahoo.com, www.unionrealtypc.com. 248-224-1999 for more information. All inquiries strictly confidential. Classified Ads continued on page 28 Wanted: Full time Internist, Downriver area. Offering $150k plus, partnership and ownership options for the right candidate. Must be board certified or eligible. For more details, contact our practice specialist Joseph at Union Realty, 248-919-0037 or 248-240-2141 (cell) joezrenchik@ yahoo.com, www.unionrealtypc.com. All inquiries strictly confidential. PRACTICES FOR SALE Long established primary/ urgent care clinic, St. Joseph/Benton Harbor area, has triage room and equipment for most procedures, including surgery. High visibility and central location. Asking $100,000 for practice, real estate available. For more details, contact our practice specialist Joseph at Union Realty, 248-919-0037 or 248-240-2141 (cell) joezrenchik@ yahoo.com, www.unionrealtypc.com All inquiries strictly confidential.

Busy, long time established, highly grossing family practice near DMC, Harper hospitals. Modern facility, 3200 sq. ft., multiple exam rooms, plenty of fenced parking. The two rental incomes should offset © 2012 Johnny Hawkins cost of real estate and practice. Asking

Volume 111 • Number 5 MICHIGAN MEDICINE 27 Classified Ads continued from page 27 SPACE FOR LEASE MEDICAL SPACE FOR LEASE: TWO PRIME MEDICAL SUITES: Located on North Woodward just north of I-696. Suites are in a prime location of three story professional building. Newly refurbished common area. *1,000 square feet with three exam rooms. *2,500 square feet with six exam rooms and expandable to nine exam rooms. Existing tenant only uses space two days per week and would be interested in remaining and sharing the space. Rent includes janitorial and all common area maintenance expenses. Building Management and building maintenance man are located in the building. Covered drop off area. Easy patient access with lots of close parking! Present tenants include general practitioners, internists and other medical professionals. Will divide and finish to suit. AVA I LA BLE IMMEDIATELY Contact: (248)548- 0880 or [email protected]. REAL ESTATE Central UP. 115 wooded acres with 3/4 mile of blue-ribbon trout stream running through it with native brookies and brown trout. Land managed for grouse, turkey, and deer. Fully furnished well-kept lodge. Contact Brian Olson, Northern Michigan Land Brokers, Marquette MI 906-869-6446 [email protected]. MISC FOR SALE For Sale: Home Health Care License. CHAP accredited. Immediate ability to bill insurance carriers, no pending litigation, asking $349,000 which includes all physical assets leased or owned at present location. For more details, contact our practice specialist Joseph at Union Realty, 248-919-0037 or 248-240-2141 (cell) joezrenchik@ yahoo.com www.unionrealtypc.com. All inquiries strictly confidential. ON THE WEB Stay on top of breaking news you can use in your practice! Check out MSMS Hot Topics related to Health Information Technology, Pending Legislation, and Practice Management. Visit MSMS Hot Topics at:www.msms.org/hotttopics Or scan this QR code with your smartphone.

28 MICHIGAN MEDICINE September/October 2012 PRACTICE IN SW Lower Michigan Michigan State • General Surgeon Medical • Orthopedic Surgeon Society • Family Practice The Voice of • ENT • Dermatologist more than • Internal Medicine 16,000 • Fully Accredited 60-Bed Hospital Michigan • Rehab Unit Physicians • Regional Referral Availability • Employed Call Coverage The mission of the • Excellent Benefits Michigan State Physicians of all specialties Medical Society is interested in this area are to promote a health encouraged to forward CV. care environment Forward CV in confidence to: which supports Cindi Whitney – In-House Recruitment [email protected] physicians in (269) 506-4464 or mail to: caring for and Three Rivers Health enhancing the Cindi Whitney – Recruitment health of Michigan Administration Office citizens through 701 South science, quality, Health Parkway Three Rivers and ethics in MI 49093 the practice of medicine. Equal Opportunity Employer

Volume 111 • Number 5 MICHIGAN MEDICINE 29 30 MICHIGAN MEDICINE September/October 2012 A Behavioral Medicine Update for the Primary Care Physician Wednesday, October 24, 2012 • 7:30 a.m. – 1:30 p.m.

Course Director Patricia West, PhD, RN Assistant Program Director, Family Medicine Residency Program, St. John Hospital and Medical Center, Detroit, MI

Symposium Use of Anti-psychotics in Primary Care Abdallah Zamaria, MD Chief, Psychiatry, St. John Hospital & Medical Center, Detroit, MI The Addicted Patient and Use of Suboxone Bela Shah, MD Medical Director, Eastwood Clinics, Royal Oak, MI Behavioral Medicine Services in SJPHS: The Services Available to PCP Patients Debra Hollander, MD Medical Director, SJPHS Behavioral Medicine Services, St. John Providence Health System, Warren, MI Adult ADHD in Primary Care Steven Warnick, MD Family Physician, Advantage Health Centers, Detroit, MI Update on Alcohol Dependence and Treatments Jeffery Berger, MD Medical Director, Brighton Center for Recovery, Brighton, MI

ACCREDITATION St. John Hospital & Medical Center is accredited by the Michigan State Medical Society to provide continuing medical education for physicians. St. John Hospital designates this live activity for a maximum of 4.0 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This symposium will be held at the Grosse Pointe War Memorial, 32 Lakeshore Dr.,Grosse Pointe Farms, MI 48236

Continuing Medical Education: St. John Hospital & Medical Center Upcoming Programs 2012

December 5, 2012 Cardiology Update

For more information contact: 313-343-3877 as these may be subject to change.

Volume 111 • Number 5 MICHIGAN MEDICINE 31 President’s Perspective Come Election Day, Don’t Forget the Supreme Court by John G. Bizon, MD

residential election campaigns tend the Supreme Court elections, but also Court. Michigan’s trial lawyer groups to draw all public attention toward to be activists in their communities, have been strongly funding activist Pthe race for the White House, like and contributors to MDPAC. opponents to Markman and Zahra, a political black hole. Yet voting issues Perhaps you’re thinking that state and, after their success in turning that may have the greatest impact on our Supreme Court races are a bit “down- out incumbent judges in 2008, are lives, our professions, and our futures ballot” in a year of sharply-defined a powerful threat. This can’t be are often buried deeper in the ballot. presidential battles and contentious overstated: the stakes in this year’s Here in Michigan, a matter of great Michigan Supreme Court race are concern to the practice of medicine higher than ever for physicians. If we may not even be on the first page of This can’t be overstated: lose the current rule of law majority, it your typical ballot this November – could be another 20 years before we get you’ll have to flip to the back to find the stakes in this year’s it back. And these lawyer groups have the nonpartisan state Supreme Court also made clear their bitter opposition voting options. But it would be a serious Michigan Supreme Court to the “Patients First” package of reform mistake to overlook this duty, both as laws currently in the state Senate. a citizen, and as a physician practicing race are higher than These bills, especially SB 1116, would in our state. help undo some of the tort reform The Michigan Supreme Court races ever for physicians. damage done by the courts, and level in 2008 radically reshaped both the the liability playing field between Court and its judicial philosophy. We If we lose the current physicians and lawyers. If the “Patients saw a new, activist majority who believed First” package becomes law, and if the that laws were passed to be rewritten rule of law majority, trial bar succeeds in adding activist – and a prime target was the body of judges to the Supreme Court, guess tort reforms we’ve worked so hard to it could be what will happen to these reforms? protect since they were enacted in the Funding for health care already faces 1990s. As a result, Michigan physicians another 20 years looming dangers. Sustainable growth have been on the losing end of some rate formulas and the Accountable Care important decisions that weakened before we get it back Act could combine with 2013’s “fiscal liability protections. cliff” tax changes to bring devastating This election year, MSMS and our cuts to health care. Does Michigan Michigan Doctors’ Political Action really want our shrinking health Committee (MDPAC) are working state proposals, but look at how pivotal care dollars to be wasted on meritless hard to turn the judicial tide. We’re courts have become as “gatekeepers” of lawsuits? Contribute, call, and speak supporting the reelection of Supreme government. In August, Michigan held out in the run-up to Election Day – and Court justices who have proven records its collective breath as the state Supreme come November, be sure to flip your of respecting and upholding the rule Court decided which of the statewide ballot and vote. MM of law. Justices Stephen Markman and proposals would make it onto the ballot Brian Zahra have reputations as solid this November. While executive and Doctor Bizon, jurists who resist the temptation to legislative races grab the headlines, a Calhoun County legislate from the bench. MDPAC has decisions by both these branches of otolaryngologist, formally endorsed them for reelection government must still pass muster with is President of the in November (as well as new Supreme the third branch – the judiciary. Michigan State Court nominee Colleen O’Brien). I The forces who oppose tort Medical Society. urge MSMS members not only to “flip reform surely recognize the value of their ballots” and make sure to vote for who stays and goes on our Supreme

32 MICHIGAN MEDICINE September/October 2012

IV MICHIGAN MEDICINE September/October 2012