mafp direct - winter 2013-14

MAFP DirectA publication of Michigan Academy of Family Physicians winter 2013-2014

in this issueAAFP Congress of Delegates and

Scientific Assembly Page 8

The Affordable Care Act:What Lies Ahead

0

Navigating the Sunshine ActPage 14

MAFP Direct | www.mafp.com 3

4 President’s Message

6 CeO insight

7 Lou’s Views

8 AAFP Congress of Delegates and Scientific Assembly

10 the Affordable Care Act: what Lies Ahead

12 Members in the news

13 Consultants Directory

14 navigating the Sunshine Act

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ContentsMAFP Board of DirectorsPresident: Fred J. Van Alstine, MD, MBAPresident-elect: Tina L. Tanner, MDImmediate Past President: E. Christopher Bush, MD, FAAFPVice President: Kim K. Yu, MD, FAAFPTreasurer: William P. Gifford, MDVice Treasurer: David T. Walsworth, MD, FAAFPSpeaker: William R. Webb, MD, FAAFPVice Speaker: Robert J. Jackson, MD, MMM

AAFP DelegatesDanny D. Greig, MD, FAAFPRobert E. Reneker Jr., MD, FAAFP

AAFP Alternate DelegatesAngelo N. Patsalis, MD, FAAFPJennifer R. Aloff, MD, FAAFP

Members at LargeJames A. Applegate, MD, FAAFPMargit C. Chadwell, MD, FAAFPPeter T. Graham, MDLynn S. Gray, MD, MPH, FAAFPMustafa Mark Hamed, MD, MBAEdward A. Jackson, MD, FAAFPKeerthy Krishnamani, MDLoretta M. Leja, MDKaren B. Mitchell, MD, FAAFPPierre A. Morris, MDBarbara L. Saul, DO, FAAFPEkram Smith, MDTimothy J. Tobolic, MDMichael G. Workings, MD, FAAFP

Resident ChairsLeanne Swiderski, MDCheryl L. Smith, MD

Student ChairNelli Thomas

MAFP Direct EditorLouis L. Constan, MD, FAAFP

Chief Executive OfficerDebra N. McGuire, MBA, IOM, CAE

Managing EditorAnnie McIntosh, CMP

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thank You to Our AdvertisersBronson ..................................................................... 15Emergency Care Specialists ...................................... 13Hospital Network Healthcare Services ..................... 15Practice Transformation Institute ............................. 15United Dairy Industry of Michigan ............................ 2

MAFP Direct

MAFP Office HoursMAFP Headquarters is open Monday through Friday, 8:30 a.m.-5:00 p.m. Please call 517.347.0098 to reach an MAFP staff member during these hours, or refer to the “Contact Us” page at www.mafp.com for direct phone numbers and email addresses.

www.mafp.com | MAFP Direct4

I think of MAFP as family and home. For me, it is a place that I find a welcoming group of friends and colleagues that share my ideals of ensuring access to health care for all of our citizens. Together, we lead by example to promote and encourage students to become Family Physicians. We advocate for pay-ment reform and loan-repayment programs that make it possible for our profession to thrive for future generations. We promote

public health. We provide education and fellowship to our “family” members. We debate, and occasionally disagree on, strat-egy; yet we remain united in our mission to ensure high-quality, cost-effective health care for patients of all ages. As an organiza-tion, MAFP is making great strides, and we are increasingly being recognized as a group that advocates as much for the health of the public as the welfare of our members.

When I first made the decision to become more actively involved in the Academy, I volunteered as a member of a committee focused on “practice environment” issues. As a rural, solo practitioner, I had found myself feeling pretty isolated at times; however, my sense of isolation disappeared with the small commitment of time I made to engage in MAFP.

President’s Message

Fred J. Van Alstine, MD, MBA

Having Your Cake and Eating It Too!

Call for Nominations: MAFP and AAFP AwardsDeadline: February 1, 2014 (to MAFP Headquarters)Each year, MAFP honors extraordinary in-dividuals through its Family Physician of the Year; Family Medicine Educator of the Year; The Archie Award of Excellence; and, new in 2014, Outstanding Family Medicine Resident of the Year awards. AAFP also recognizes individuals for achievements in a variety of catego-ries. Learn more and make a nomination at: www.mafp.com/awards.

Annual Michigan Family Medicine Advocacy DayFebruary 25, 2014 (at Karoub Associates in Downtown Lansing)The Annual Michigan Family Medicine Ad-vocacy Day provides a valuable opportunity for Family Physicians, Family Medicine resi-dents and medical students to visit one on one with state legislators to discuss the essential role Family Physicians play in driving mean-ingful improvements to our health care sys-

tem. To advocate for your specialty, register online at www.mafp.com/events (there is no cost to attend).

Call for Nominations: MAFP Board of Directors and MAFP Foundation Board of TrusteesDeadline: March 1, 2014 (to MAFP Headquarters)Nominees for the MAFP Board of Directors and the MAFP Foundation Board of Trust-ees will be required to submit a letter of in-terest with a curriculum vitae and complete a short questionnaire. More information can be found online at: www.mafp.com/about-us/mafp-board-of-directors.

2014-15 Committee Sign-UpDeadline: March 1, 2014 (to MAFP Headquarters)As a member, the opportunity to volunteer on a committee provides you an inside connection and an important role in shaping the activities, direction and strategic work of both the MAFP and the MAFP Foundation. If you are inter-

ested in serving, please review the committees available for appointment, and complete the Committee Sign-Up Form available online at: www.mafp.com/about-us/mafp-committees.

Call for Resolutions to the Annual Meeting of MembersDeadline: June 1, 2014 (to MAFP Headquarters)All members are invited to write and submit resolutions for consideration at the MAFP Annual Meeting of Members (July 18, 2014, in Lansing). Submitting resolutions is an ex-cellent opportunity to influence MAFP pol-icy and address areas of interest or concern to Family Physicians in Michigan. Members may also offer resolutions of condolence to honor the memory of dedicated Family Physi-cians who have passed as well as resolutions that recognize certain individuals who have exemplified outstanding achievement and leadership. More information, including a “Resolution Writing 101,” can be found on-line at: www.mafp.com/amom.

Getting involved with Your Academy

Not long after my work on the committee, I was approached to apply to the MAFP Board of Directors. I never anticipated that I would be nominated for an officer position a few years later and then ultimately elected to serve as your president. Frankly, I never thought that I possessed the temperament or the skill set to take on these positions; fortunately, my colleagues saw my potential and encouraged my development as a leader. Through these experiences at MAFP, I have made lifelong friends, and I have been empowered to influ-ence positive change.

I have had the chance to share my experi-ences as a Family Physician with governors, senators and representatives through testi-mony at legislative hearings and one-on-one meetings. I have participated on a task force to reform mental-health services. I have en-gaged with representatives from other orga-nizations on issues such as end-of-life care and honoring patients’ wishes. Through all of these encounters, I convey MAFP’s message to policymakers on the changes necessary to encourage access to care and identify what barriers exist that inhibit access. I have trav-

eled to several states, as well as Washington, D.C., to learn and to advocate on your behalf. When I joined the Committee on Econom-ics and Practice Environments more than 15 years ago, I never visualized myself doing any of these things. Reflecting now, I feel like I have my cake, and I’m eating it, too.

I have come to find that the presidential year does require an exceptional amount of time — likely in the range of 10 hours per week plus multiple travel days throughout the year. While volunteers cannot be compensated for their time, I feel that it is a privilege to serve my colleagues, and I am honored to represent our Academy. As MAFP expands its reach and influence, there will continue to be a demand for individuals to be involved, and we need your help to maintain momentum.

A variety of opportunities are available for you to become actively engaged in the Academy, whether it be applying for a director position on the MAFP Board or a trustee position on the MAFP Foundation Board; completing a sign-up form to join a committee; nominating a colleague for one

of the MAFP’s or AAFP’s prestigious awards; submitting a resolution to the Annual Meet-ing of Members; or volunteering your time to advocate for Family Medicine during the Annual Michigan Family Medicine Advo-cacy Day. There is something for everyone to match your interests and availability. To learn more about these opportunities, see page 4 for deadlines and further information, or call MAFP Headquarters at 517.347.0098 to inquire.

We live in a time of fundamental change. There is no better organization than MAFP to make sure that the change preserves the pivotal role of primary care in our health care system. And there is no better advocate than oneself. Please accept my challenge to step up and become more involved. Exactly where that first small step will lead, I do not know, but I can assure you the rate of return is exceptional.

Fred J. Van Alstine, MD, MBA, is the 2013-14 president of

the Michigan Academy of Family Physicians. He is a Family

Physician in solo practice in the rural community of Owosso.

... SO MUCH MORE.

IT’S MORE THAN A NAME CHANGE ...JULY 17-19, 2014 | LANSINGM I C H I G A N

A N N U A LCONFERENCE

July 17-19, 2014 | Lansing, Michigan | www.mafp.com/annualconferenceMAFP ANNUAL CONFERENCE

More CME More chances

to fulfill Maintenance of Certification More time

to share with your colleagues More ideas More activities to

engage with your family More solutions


CeO insight

Shaping Our Future

If you’re feeling a bit overwhelmed lately and unable to grasp where things are headed on a variety of social, economic, political and personal fronts, you are not alone. According to research completed in July 2013 by the American Psychological Association, 48 percent of Americans feel that their stress levels have increased during the past five years, and 77 percent of Americans report that they regularly experience physical symptoms caused by stress.

As Family Physicians, these findings are probably not surprising to you, since you see firsthand the effects of worry and anxiety. However, who is looking out for YOUR well-being, helping to reduce your stress levels and navigate a future with your best interests in mind?

Your state professional society can provide to you a collegial atmosphere and offer support through the collective efforts of more than 3,500 physicians, residents and students who specialize in Family Medicine. Because you share a common bond — a passion for caring for people of all ages in all walks of life — the Michigan Academy of Family Physicians is a lifeline where you can share experiences, rally for causes you believe in and work together to influence the future, which ultimately impacts the lives of millions of people.

America is experiencing unprecedented changes that not only exacerbate anxiety but also add to a sense of powerlessness and lack of control relative to having input as to how the changes are evolving and playing out. Rather than sitting back and watching the future unfold, why not have a say in what that future looks like? You can — and in ways that will make your own life, and that of others, much more meaningful.

Remember … there is strength in numbers. By sharing your viewpoints, thoughts and ideas with MAFP, you have a voice in the future of Family Medicine. This winter, your state Academy is conducting its most comprehensive survey ever among physicians, residents and students who share a passion to practice Family Medicine. While we certainly would like to know how you value our current services, even more important is for us to discover “what is keeping you awake at night” and what could help you be more successful — and satisfied — in your work. Although we cannot promise to find you more time in the day (we could all use that!), if you do invest a modest amount of time and effort conveying your dreams, fears and overall perspectives with us, we will create a professional society that not only meets, but strives to exceed, your expectations.

New laws and regulations have changed the way medicine is being practiced. MAFP is working diligently to have a greater voice on the legislative front where many of these decisions are being made. We cannot afford to be left behind, nor can the patients whom you serve. Family Physicians always have been, and will continue to be, the primary care team leaders — but it will not be easy. It’s no longer “business as usual,” and MAFP must reinvent itself to remain relevant given the changing needs of our members and society as a whole.

Therefore, we ask not only for your support in renewing your membership in 2014 but also to join with us as we create an association “makeover,” designed with you in mind. We need information from you to make data-driven decisions to maximize your dues dollars and get you the “biggest bang for your buck.” When you see the Member Needs Assessment arrive in your email inbox or mailbox, please take the time to thoughtfully weigh in and shape the future of MAFP and Family Medicine in Michigan!

Yours in improved health and quality of life,

Debra N. McGuire, MBA, IOM, CAEChief Executive Officer

Debra N. McGuire, MBA, IOM, CAE

MAFP Chief Executive Officer Debra N. McGuire made a stop at the California Academy of Family Physicians (CAFP) Headquarters in San Francisco following the conclusion of the AAFP Congress of Delegates, which was held in San Diego September 23-25. During her visit, Ms. McGuire spent time with CAFP staff members, shared best practices, and discovered some new ideas and innovations to enhance offerings in Michigan for MAFP members.


Louis L. Constan, MD, FAAFP

Lou’s Views

Courageous Care

As a Family Physician, have you ever experienced one of these real-life scenarios?

• A surgeon swears at you, a “mere” GP, when you ask him to recheck your patient for a post-op complication that he missed. You tell him that, if he doesn’t take care of the prob-lem, you’ll find someone who will.

• A hospital administrator tells you that you have to change your practice patterns because you are an “outlier” and are costing them money. You refuse.

• In your first year of practice — while still worried about making payroll — a patient tells you that she will switch doctors if you don’t give her an antibiotic. You respectfully refuse to do so.

• Your hospital-employer tells you to refer to its doctor even though you know she is substandard. You must refuse.

• Just after being served with a lawsuit by a patient who didn’t get what he wanted, another patient asks for an unnecessary test. Once again, you refuse.

Telling someone “No,” whether you’re saying it to a patient, a colleague or your boss, requires a measure of courage. Those “No”s can hurt you professionally, financially and personally.

Though you may never have thought about your routine activities precisely in this way, it should be evident to you that being a good doctor does require courage. In order to ensure what’s best for the patient, a good Family Physician will disagree with, push back and sometimes even offend those who pay the bills and make the rules.

Because you may not always feel like Medal-of-Honor material, you may find yourself wondering how you can be sure that you possess sufficient quantities of the elusive quality I speak of. Not to worry. Most people who are generally recognized as courageous individuals — such as the firemen who rushed into the World Trade Center on September 11, 2001 — do not know their own courage. Most will declare that they were “simply doing their job.” The same is probably true for you.

My experience as chief of staff at a 350-bed hospital convinced me that Family Physicians — in contrast to many other specialties — possess courage in abundance and use it quite frequently during their day-to-day practices. In all probability, you are already a brave and courageous person.

If I haven’t convinced you that you possess this quality, then I encourage you to go ahead and act as though you are brave anyway — the feeling often follows the action. And you may still not, even then, recognize that you are a courageous person, but others will, and it will be part of what makes you an excellent Family Physician.

With that in mind, we may add this to our well-known motto: “We are Family Doctors: delivering continuous, comprehensive, compassionate … and courageous care.”

This column is the personal perspective and opinion of MAFP Direct Editor Louis Constan, MD, FAAFP, and does not necessarily reflect the overall views of the Michigan Academy of Family Physicians.

AAFP Congress of Delegates and Scientific AssemblyA Photo Recap from Our Members

Hundreds of Family Physicians from Michigan headed to sunny San Diego September 23-28 to participate in the AAFP Congress of Delegates and the Scientific

Assembly. While there, many of you shared your photos with those of us “back home.” Here’s a recap of the two events from the eyes of our valued membership!

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Left: Several members from Grand Blanc, along with their significant others, joined for a photo during the AAFP Celebration at Petco Park. Pictured from left: Dr. Prabhat Pokhrel, Ms. Anita Pokhrel, Dr. Kevin Youngs, Dr. Joseph Shull, Dr. Heidi Lakes (Dr. Lakes graduated from Genesys Regional Medical Center in Grand Blanc; however, she is now practicing in Tennessee) and Ms. Yasmin Youngs. (Photo Credit: Prabhat Pokhrel, MD, PhD, FAAFP.) Middle: AAFP Delegates Robert E. Reneker Jr., MD, FAAFP, of Wyoming, and Danny D. Greig, MD, FAAFP, of Midland, represented Michigan during the Congress of Delegates. (Photo Credit: Christin O’Brien.) Right: President-elect Tina Tanner, MD, of Shelby, and MAFP Director of Government Affairs Christin O’Brien enjoyed a short break between Congress sessions. (Photo Credit: AAFP.)

Left: Kim Yu, MD, FAAFP, of Novi, addressed the Congress as the 2013 National Conference of Special Constituencies (NCSC) convener. (Photo Credit: Jennifer Aloff, MD, FAAFP.) Middle: Cindy Hung, MD, FAAFP, of West Bloomfield, stopped to pose with the “unofficial” mascot of the San Diego Padres. The AAFP Celebration held at Petco Park was a fun event for attendees to relax and recharge. (Photo Credit: Cindy Hung, MD, FAAFP.) Right: AAFP Delegate Robert E. Reneker Jr., MD, FAAFP, of Wyoming, participated in discussion on the resolution that the AAFP request a policy change by the American Board of Family Medicine to allow for voluntary participation in its demographic survey, which was originally offered by Michigan. The resolution was adopted. (Photo Credit: AAFP.)

Left: Glynda Moorer, MD, FAAFP, of East Lansing (pictured right), met keynote speaker Glenna Salsbury, author of The Art of the Fresh Start: How to Make and Keep Your New Year’s Resolutions for a Lifetime at her book signing in the expo hall. (Photo Credit: Glynda Moorer, MD, FAAFP.) Middle: In preparation for the Congress of Delegates, AAFP delegates and alternate delegates met with MAFP staff members to review the resolutions and determine Michigan’s position on each upon arrival in San Diego. (Photo Credit: Kim Yu, MD, FAAFP.) Right: Ronald J. Coriasso, DO, FAAFP (pictured at left), and Prabhat Pokhrel, MD, PhD, FAAFP (pictured right), both of Grand Blanc, participated in the Fellowship Convocation Ceremony and received their certificates as Fellows of the AAFP from AAFP President Reid B. Blackwelder, MD, FAAFP. (Photo Credit: Prabhat Pokhrel, MD, PhD, FAAFP.)

Left: Sheala Jafry, MD, MS, of Saint Clair Shores (pictured center), had an opportunity to meet with her past colleagues (both members of the Hawaii Academy of Family Physicians) from Kaiser during a break between Scientific Assembly sessions. (Photo Credit: Sheala Jafry, MD, MS.) Middle: Attendees enjoyed an opportunity for “real talk” during the Scientific Assembly with a video booth. Family Physicians have powerful stories to tell, and this was an opportunity to do so. MAFP looks forward to hearing your voices at our Annual Conference in July 2014! (Photo Credit: Sohaib Khalid, MD.) Right: Friends and colleagues from southeast Detroit reunited in San Diego. Pictured from left to right: Dr. Siri Gopi; Dr. Nikhil Parekh; Dr. Christina Kimbrough; Dr. Shaela Jafry; Dr. Cecilly Pratt; and Dr. Pratt’s significant other. (Photo Credit: Sheala Jafry, MD, MS.)

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2013

January 1, 2013

Medicaid Payments Increase for Primary Care PhysiciansAs part of the ACA, the federal government will fully finance the difference between the state Medicaid reimbursement rate and the current-year Medicare rate for the years 2013 and 2014 for eligible primary care physicians. Only certain evaluation and management (E&M) codes and vaccinations codes apply. While Michigan began paying enhanced rates for fee-for-service, there has been a delay in increasing payments for the managed-care population. However, all payments will be retroactive to January 1, 2013.

August 1, 2013

Pharmaceutical Manufacturing Companies and Distributors Required to Report Financial Transactions with Physicians under the Physician Payments Sunshine ActManufacturers and distributors of drug, medical devices, supplies and biologicals that supply at least one product covered under Medicaid, Medicare and/or the Children’s Health Insurance Program (CHIP) must report financial transactions that occur between the manufacturer and a physician to the Centers for Medicare and Medicaid Services (CMS). For more information on the Physicians Payments Sunshine Act, see page 14.

October 1, 2013

Health Insurance Exchanges Go LiveIndividuals and small businesses are able to shop for health insurance plans on either a federally run, a state-run or a partnership exchange, depending on which state they live in. [Recall that Michigan has a federal-facilitated exchange, so the federal government will retain much of the responsibilities of administering the functions of the marketplace, including approval, implementation and oversight of the health plans offered on the exchange, as well as setting parameters for cost-sharing requirements.] Thirteen health insurance companies have been certified to offer plans on the exchange.

Disproportionate-Share Hospital Payments to Treat Uninsured Individuals ReducedUnder Medicare, disproportionate-share hospital (DSH) payments will be initially reduced 75 percent with subsequent adjustments based on the percent of the uninsured population and the amount of uncompensated care that is provided. Medicaid DSH payments will also be reduced, and the reduction will be distributed under a methodology adopted by the secretary of the U.S. Department of Health and Human Services (HHS).

2014

January 1, 2014

Mandate for Individual Health Insurance Coverage Goes into EffectMost U.S. citizens and legal residents will be required to obtain health insurance coverage or pay a penalty, which will increase substantially between 2014 to 2016 — $95 or 1 percent of taxable income in 2014; $325 or 2 percent of taxable income in 2015; and $695 or 2.5 percent of taxable income in 2016. After 2016, dollar amounts will be indexed. Certain individuals would be exempt from the individual mandate and, thus, will not be subject to a penalty, including individuals who have certain qualifying religious reasons, those who do not meet the threshold for filing federal income taxes and those whose cost-sharing requirements would exceed 8 percent of their income.

Medicaid Eligibility ExpandedStates that have chosen to participate in Medicaid expansion will receive 100 percent federal funding for three years (through 2017). Coverage will be expanded to eligible adults with incomes at or below 133 percent of the federal poverty level (FPL). Although Michigan approved Medicaid expansion, the Legislature delayed implementation; therefore, it is likely that eligible Michiganders will not be able to receive benefits until the end of March 2014 at the earliest.

Health Insurance Exchange Plans Provide Coverage, Offer Tax CreditsIndividuals who enrolled in a plan offered on the exchange prior to December 15, 2013, should begin to see their benefits by January 1, 2014.

The Affordable Care Act: What Lies Aheadby Christin O’Brien, Director of Government Affairs

It goes without saying — piloting the Affordable Care Act (ACA) is challenging. To provide some direction, MAFP has compiled the following timeline and brief summary of some of the ACA’s main provisions that have gone into effect or are set to go into effect between 2013 and 2015. This timeline is subject to change. Should you have questions about any of the information below, please contact MAFP Director of Government Affairs Christin O’Brien at [email protected] or 517.664.9082.


Eligibility and enrollment will be coordinated across Medicaid, CHIP and the new marketplaces. Eligible individuals between 100 percent and 400 percent of the FPL will receive refundable, advanced tax credits and cost-sharing subsidies. Those under 250 percent of the FPL will be eligible for cost-sharing subsidies, while premium subsidies will be available for those between 133 percent and 400 percent of FPL.

Insurance Market ReformsThe following insurance market reforms will be in effect on January 1, 2014:

• Plans must cover individuals regardless of health status – a requirement known as “guaranteed issue”

• Rating variation will be limited to age, geographic area, family and tobacco use for plans offered in the individual and the small-group markets on the health insurance exchanges

• Insurance plans can no longer impose annual dollar limits on beneficiaries

• Plans offered on the exchanges and in the individual and small-group markets must, at a minimum, offer a benefit package that includes “Essential Health Benefits” as defined by HHS, which can be found on www.HealthCare.gov

• Certain health insurance providers will be subject to annual fees

March 31, 2014

CMS Disseminates Data Under the Physician Payments Sunshine ActBeginning March 31, 2014, CMS will disseminate the data on financial transfers collected from pharmaceutical drug manufacturers, distributors and other mandated entities to affected parties. Physicians will have 45 days to dispute any reported information they find to be inaccurate, false or misleading.

April 30, 2014 (no later than)

First Independent Payment Advisory Board Recommendations DueThe Independent Payment Advisory Board (IPAB) — a 15-person board appointed by the president and confirmed by the Senate — will be tasked

with submitting recommendations on cost-containment measures to reduce Medicare spending if CMS actuaries determine spending exceeds certain targeted growth rates.

September 30, 2014

CMS Releases Data to Public Under the Physician Payments Sunshine ActAll financial transactions reported to CMS will be released to the public under the National Physicians Payment Transparency Program (NPPTP), allowing consumers direct access to all 2013 records. Subsequent records will be released on an annual basis.

2015

January 1, 2015

Mandate for Employer Health Insurance Coverage Goes into EffectEmployers with 50 or more employees will be assessed a fee of $2,000 per employee if they fail to provide health insurance coverage for their employees. This provision was originally set to go into effect January 1, 2014; however, it was delayed for one year.

October 1, 2015

Federal Matching Rate for the Children’s Health Insurance Program IncreasesFederal matching funds for the CHIP will increase 23 percent, up to a cap of 100 percent.

2015

Medicare Payments Under Physician Quality Reporting System ReducedThe Physician Quality Reporting System (PQRS) was implemented under the Tax Relief and Health Care Act of 2006 in an effort to reward quality improvement measures. Under the ACA, physicians who choose not to participate in PQRS or physicians who are found to be unsuccessful at the end of 2013 will be subject to a penalty of a 1.5 percent reduction in Medicare payments beginning in 2015 and 2 percent in subsequent years.

Physicians who do not participate in the Physician Quality Reporting System (PQRS) in 2013 will see a 1.5 percent penalty from the Centers for Medicare and Medicaid Services (CMS) in 2015. By the time you are penalized, it will be two years too late to do anything about it! The American Board of Family Medicine (ABFM) is an approved registry for PQRS, and diplomates are able to participate in the online registry at no cost from their Physician Portfolio. The deadline for data entry in the online activity is

January 10, 2014. Additional details about PQRS may be found in your Physician Portfolio at www.theabfm.org.

An alternative to the ABFM registry is offered to members through AAFP. Recently, AAFP partnered with CECity to offer members a discounted price for use of the Physician Quality Reporting Initiative (PQRI) Web-based registry and reporting tool, PQRIwizardSM, which CMS also designated as a qualified registry for

PQRS reporting. Through www.aafp.org, you can subscribe to the PQRIwizardSM for $219, which is an $80 saving for members. The tool allows you and your staff to enter data for one measures group into the registry program for the required Medicare patients and receive validation alerts to avoid submission errors. PQRIwizardSM monitors your progress; calculates your measures; and provides a printable, real-time report of your performance rates.

PQRS – Did You Know?


Lauren Hughes, MD, MPH, of Ann Arbor, was appointed to the AAFP Commission on Governmental Advocacy as a resident representative for a one-year term starting January 1, 2014, and ending December 31, 2014.

The Wayne State University School of Medicine Robert R. Frank Student Run

Free Clinic was a feature article in the October issue of HOUR Detroit magazine. This unique clinic is staffed entirely by Family Physicians — many of whom are MAFP members — in the Metro Detroit area and is built on a continuity-of-care model. To read the article, please visit www.hourdetroit.com/Hour-Detroit/October-2013/Clinical-Salvation.

Anne Kittendorf, MD, FAAFP, of Dexter, spoke on a panel on behalf of MAFP at the Michigan Purchasers Health Alliance Annual Fall Kickoff Conference at Washtenaw Community College on September 19. The title of this year’s conference was “Here Comes Healthcare Reform — Ready or Not.”

Fred J. Van Alstine, MD, MBA, of Owosso, offered a resolution — “Demographic Survey on the ABFM Board Exam” — to the MAFP Annual Meeting of Members in April 2013, which was then referred to the AAFP Congress of Delegates as Resolution No. 604 in September 2013. After much discussion, the resolution that the AAFP request a policy change by the American Board of Family Medicine to allow for voluntary participation in its demographic survey was adopted.

Congratulations to the Michigan State University College of Human Medicine students who were selected to participate in the 2013-14 Integrated Medical School and Family Medicine Residency (TIP) Program. Four of the students selected are MAFP student members, including Jamie Kantola, of Okemos, entering the Sparrow/MSU program in Lansing; Mitch Sydloski, of Caledonia, and Jarrad Utter, of Grand Rapids, entering the Grand Rapids program; and Samantha Cummings, of Ossineke, entering the Marquette program.

Angelo Patsalis, MD, FAAFP, of Livonia, was recently named a 2013 Champion of Service Honoree by the Ebenezer AME Church Scholarship Commission for his contributions to the Metro Detroit community, including his mentorship of high school students and his influence

in producing a national toolkit to assist Latino and Hispanic individuals to understand and know how to use medications correctly and decrease adverse effects.

Ramona Kwapiszewski, DO, of Norton Shores, participated on the Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium (Q-METRIC) Panel in November consisting of primary care, specialists and parents. The goal of the panel was to establish feasible and realistic quality measures for asthma

in children. Dr. Kwapiszewski shared that it was an invaluable experience because it allowed primary care to be actively involved in the ever-changing health care environment and have a voice in the guidelines that were being set.

The Wayne State University School of Medicine has partnered with the Detroit Lions’ Living for the City philanthropic initiative that focuses on sustainable community health, wellness and development. In a partnership that’s the first of its kind between an NFL franchise and a university medical school, the Detroit Lions and WSU School of Medicine’s Department of Family Medicine and Public Health Sciences will work with Detroit residents, especially children, to teach methods to

Members in the news

Have an Item for Members in the News?MAFP Direct, as well as the Family Medicine Update e-newsletter, welcome your short announcements and photos. If you have received an honor or award, been nominated to a position, made a practice move or just have information to share, please let us know! Send submissions to:

Michigan Academy of Family PhysiciansAttn.: Annie McIntosh, Managing Editor2164 Commons ParkwayOkemos, MI 48864Email: [email protected]


improve health; conduct health fairs; and plan other programs, events and activities.

E. Christopher Bush, MD, FAAFP, of Grosse Ile, is currently participating in the Department of Com- munity Health’s Workgroup to create a standard prior-authorization form in Michigan.

During the Michigan State Medical Society Resident & Student Abstract Research Poster Symposium, three MAFP members took home top honors, including Tabitha Bedini, MD, of Henry Ford-Wayne State University School of Medicine Family Medicine Resi-dency Program, for Weight Status Trends of the Henry Ford Health System and Pediatric Population, Aged 6-19; Kevin Ginsburg, of Wayne State University School of Medicine, for Identifying Differences in Michigan Hospital Antibiogram Preva-lence Utilization and Perception of Antibiotic Resis-tance by Geographical Location and Hospital Size; and Sajiv Sethi, of Wayne State University School of Medicine, for Role of MiRNA in the Bone Tumor Metastasis of Prostate Cancer.

Tina Tanner, MD, of Shelby, participated in the White Coat Ceremony held at the Michigan State University College of Human Medicine in August (pictured below). Additionally, she was featured on WLNS-TV 6 News discussing the importance of stopping Senate Bill 2, which would allow nurse practitioners in Michigan to practice independent of physician supervision and delegation. The amended bill passed by a vote of 20 to 18 on November 13, and it has now been referred to the House Health Policy Committee.

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Section 6002 of the Affordable Care Act (ACA) requires manufacturers that produce at least one product that is covered by Medicare, Medicaid and/or the Children’s Health Insurance Program (CHIP) to disclose certain financial transfers that occur between the manufacturer and a physician. This section of the ACA, commonly referred to as the “Sunshine Act,” has direct implications for any licensed, practicing physician regardless of whether he or she accepts Medicare, Medicaid or CHIP patients. It is important that MAFP members are well-informed about the new policy, its implementation timeline and how it may impact physician practices.

The concept behind the Sunshine Act is not unique to the ACA; rather, it has evolved over the years, born out of growing public awareness and concern surrounding the relationships between physicians and pharmaceutical drug manufacturers. Several independent reports surfaced in the last decade highlighting the perceived vulnerability for abuse and influence on prescribing behavior. Calls for more transparency emerged from various patient and consumer organizations; many health care industry groups, including the American Academy of Family Physicians (AAFP), voluntarily adopted new internal policies and/or a code of ethics. While, in recent years, a handful of states have enacted their own sunshine laws, Michigan has not done so. In an effort to impose a national, consistent standard, Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wisconsin) advocated for the inclusion of Section 6002 during ACA negotiations.

WhAt does the ACt Cover?Under the Sunshine Act, a reportable financial transaction includes any transfer of value, including cash, stock, gifts, food, travel, services, consulting fees, honoraria, charitable contributions, and current or prospective physician-held ownership and investments. Other reportable transactions include certain transfers related to education and research, speaker compensation for continuing medical education events, and grants. Although the Centers for Medicare and Medicaid Services (CMS) exempted educational materials that are defined as having a direct patient benefit, AAFP and other health care organizations have publicly voiced concerns with the impact the law will have on the distribution of educational materials, such as textbooks and reprints of peer-reviewed journals. Their concern is that these materials are written primarily for physicians and could be construed as having only an ancillary benefit to patients. Indeed, there are other exceptions, including product samples, products exchanged for charitable purposes, coupons and vouchers, short-term loans of a covered medical device, and payments to nonmedical professionals, among others (for the full list, visit www.mafp.com/membership/physician-resources/physician-payment/the-sunshine-act). Additionally, payment transfers under $10 are not reportable unless the aggregate amount exceeds $100 in one year.

WhAt is the timeline for imPlementAtion?Beginning August 1, 2013, manufacturing companies, group purchasing organizations

(GPOs) and physician-owned distributors are required to report information to CMS. Beginning March 31, 2014, CMS will disseminate the data collected during the five-month period (August to December) to affected parties. At that time, physicians will have a 45-day window to dispute reported transactions they find to be inaccurate, false or misleading. By September 30, 2014, information will be released to the public under the National Physician Payment Transparency Program (NPPTP), allowing consumers to have direct access to all 2013 records. Subsequent records will be released on an annual basis.

WhAt CAn mAfP members do noW?To help protect yourself from any inaccurate reporting, make sure your National Provider Identification (NPI) profile is up to date and accurately corresponds to your specialty. For more information on your NPI profile, please visit the U.S. Department of Health and Human Services website at www.hhs.gov.

Be confident in knowing that MAFP will continue to work in concert with AAFP to assess and provide member feedback on the new policy and to discuss how implementation is impacting our Family Physicians.

If you have additional questions about the Sunshine Act or any other elements of the ACA, please contact MAFP Director of Government Affairs Christin O’Brien at [email protected] or 517.664.9082.

NAvigAtiNg the SuNShiNe ACtby Christin O’Brien, Director of Government Affairs

The American Academy of Family Physicians supports full disclosure to physicians and patients of corporate ties and financial relationships between pharmaceutical manufacturers, mail-order pharmacies, pharmacy benefit-management (PBM) entities and pharmacists (adopted by the 1998 AAFP Congress of Delegates, reaffirmed in 2010).



OUTSTANDING FAMILY MEDICINEOPPORTUNITIES in Southwest Michigan

Bronson Medical Group has several employed BC/BE family medicine physician opportunities at established medical prac-tices, and at a new practice opening spring 2014. All practices have immediate access to laboratory & X-ray testing. We offer competitive salary, comprehensive benefits, relocation, potential sign-on bonus and residency stipends!

Bronson Healthcare Group in Kalamazoo, MI, is a not-for-profit, tertiary healthcare system serving SW Michigan and northern Indiana. With a workforce of more than 6,000, Bronson is one of the area’s largest employers with a proven track record of clinical and workplace excellence with many national achieve-ments (bronsonhealth.com). We offer a full range of services from primary care to advanced critical care. Kalamazoo, located midway between Detroit and Chicago, is a diverse university town with highly rated public schools and affordable real estate. The area offers galleries, symphony, theater, museums, year-round festivals and many activities for the entire family including numerous parks, lakes and fine dining. Lake Michigan is less than an hour away.

Don’t miss an exciting opportunity to work for an award-winning system that is customer service driven, prides itself on patient care/outcomes and a national leader in healthcare quality!

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1351-5.indd 1 11/19/13 9:30 AM

Make the voices of Michigan’s

Family Physicians heard loud and clear!

MICHIGAN FAMILY MEDICINE ADVOCACY DAY

Tuesday, February 25, 2014 | Downtown Lansing

Learn more and register at www.mafp.com/events or call 517.347.0098

Michigan Academy of Family Physicians2164 Commons ParkwayOkemos, MI 48864

PRSRT STDU.S. POSTAGE

PAIDchAmPAIGn, ILPERmIT nO. 100

February 2-7, 2014 | Boyne Highlands | Harbor SpringsRegister at www.mafp.com/midwinterupdate or call 517.347.0098

38th Annual MidWinter Family Medicine Update

Make Midwinter

Memories

Presented by:36 CLINICAL TOPICS

21.5 CME CREDITS

SUPER BOWL PARTY

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HOTEL & SKI PACKAGE DISCOUNTS

mafp direct - winter 2013-14

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