Gov Encourages Fist Bumps, ‘Smart’ Hygiene As MI Preps For Coronavirus

If you see Gov. Gretchen Whitmer giving people fist bumps instead of handshakes, here’s why.

Replacing handshakes with fist bumps or “elbow bumps” were among the suggestions made by Whitmer as she and state officials outlined what they are doing to prepare for any potential coronavirus outbreak in Michigan and how the general public can prevent against it.

There are still no active cases in Michigan. No one is currently under investigation for coronavirus. And the five people in Michigan who were tested for it previously all came up negative.

The governor Feb. 28 announced the activation of the State Emergency Operations Center to begin coordinating state, local and federal agencies on preventing any spread of the disease.

The SEOC is typically activated during state emergencies, such as during the extreme cold temperatures from early 2019. The Governor said today that by activating the SEOC, “we’re ensuring that every branch of state government is on alert, and actively coordinating to prevent the spread of Coronavirus if it comes to Michigan. We are taking this step out of an abundance of caution.”

The actual SEOC itself is a large room within the Michigan State Police headquarters where representatives from state agencies—including spots for the Michigan Civil Service Commission and the Michigan Supreme Court, among others—gathers to report on what their agencies are doing to prepare and respond.

In addition to the SEOC, Dr. Joneigh Khaldun, the state’s chief medical executive, said the state has “funneled the information” on more than 350 travelers who have come through Metro Airport from China to those travelers’ respective local health departments so they can monitor the travelers for coronavirus-like symptoms.

Khaldun added that none of those travelers has developed the symptoms.

She said in a press release that while the “current risk to the general public” of getting coronavirus is low, “we need to use all of our public health tools to make sure we are prepared. Michiganders can be assured that we are taking this seriously and we will continue to make preparations to limit the spread and impact of” the virus.

Asked about the timing of the SEOC activation, Whitmer mentioned the recent spread of the virus as well as the first case reported in the United States. that wasn’t tied back to the origin of the virus in China.

As of late February, there have been more than 81,000 cases of coronavirus reported globally, with more than 78,000 of those in China, including over 2,600 deaths in China, according to the governor’s office. The outbreak is believed to have begun in Wuhan City in China.

Whitmer also said today that Michigan now has the resources to test for the virus here rather than sending off samples elsewhere.

In addition to fist bumps and elbow bumps, the governor said people need to wash their hands with soap and water for at least 20 seconds, and to try touching their faces less throughout the day.

“We encourage you to take care of one another, talk to one another, educate one another, and encourage smart personal hygiene,” she said.

After addressing reporters today, Whitmer spoke to the officials gathered in the SEOC, and was seen fist-bumping people on her way out, explaining that they needed to practice.

In other coronavirus-related news, Oakland County Executive Dave Coulter asked former U.S. Rep. Sandy Levin to lead the county’s internal and external coronavirus readiness efforts.

“I want to supplement our strong internal efforts with an independent advisor who can assist our staff and collaborate with community partners,” Coulter said in a statement. “Sandy Levin is uniquely qualified with his expertise on health care issues from his work on the Ways and Means committee, international relations, and his deep roots in Oakland County.”

Sen. Stephanie Chang (D-Detroit) and Rep. Padma Kuppa (D-Troy) issued a statement condemning the “rise of racist sentiments” related to coronavirus, citing a CNN article on the issue.

“(P)recautions and public health efforts do not ever mean that attacks in public spaces, bias incidents, xenophobic rhetoric, and refusing people business due to East Asian appearance are appropriate. A public health concern should not become a xenophobia concern. The attacks on Asian-Americans that have been happening around the country are wrong and need to stop,” they said.

State Wants Expedited Decision On Healthy Michigan Work Requirements

Democratic Gov. Gretchen Whitmer’s administration Feb. 25 asked a District of Columbia federal court for an “expedited decision” on whether the state’s Medicaid work requirements—imposed by Republican legislative leaders—is lawful.

The administration, through the Michigan Department of Health and Human Services, claims a U.S. Court of Appeals panel’s unanimous ruling in an Arizona case, Gresham v. Azar, Case No. 19-5094, “leaves little doubt that Michigan’s Medicaid work requirements are also unlawful.”

“Since it’s inevitable that the courts will also find Michigan’s work requirements unlawful, we should not move forward with implementation,” Whitmer said in a statement. “Doing so would waste millions of taxpayer dollars and cause senseless confusion for tens of thousands of families.”

Whitmer also made a second call on the Legislature to immediately pass legislation suspending the work requirements.

In December, Senate Majority Leader Mike Shirkey (R-Clarklake) told reporters his response to the governor’s request: “Nope, not necessary.”

Shirkey spokesperson Amber McCann reiterated that stance Feb. 25, noting: “Sen. Shirkey is passionate about the work engagement policy. He believes fostering a path of independence and supporting an individual in pursuit of his or her highest level of personal productivity is essential to the health and productivity of our entire population.

“The Majority Leader’s support for the policy has not waivered and the Senate does not intend to revise the law based on the Governor’s request,” McCann added.

Gideon D’Assandro, spokesperson for House Speaker Lee Chatfield (R-Levering), echoed those sentiments, adding: “Able-bodied adults who want cash assistance and subsidized health care coverage should obviously be expected to either work part-time or at least prepare for a career in exchange for welfare benefits. That is simply common sense, and it is something taxpayers who foot the bill for these programs should expect. Out of respect for those taxpayers, we are not willing to accept a pause in our state’s new welfare work requirements.”

Without a court order or legislative action, DHHS will send letters beginning March 10 to an estimated 80,000 people who did not comply with the work requirements in January and as a result, who could be at risk of losing their Medicaid coverage, according to the state’s court filing.

HMP participants must fail to meet the requirements for three months before losing coverage, according to the plan.

In Gresham, the federal appeals court said Medicaid’s “principal objective” was “providing health care coverage” and that work requirements lacked legal authorization.

The state’s request comes as an intervenor in the Young v. Azar case, No. 19-03526. Filed by the National Health Law Program, Center for Civil Justice and the Michigan Poverty Law Program on behalf of four Michigan residents, it seeks a declaration that the state’s Medicaid expansion program–Healthy Michigan Plan—work requirements are unconstitutional and that it rewrites the Medicaid Act.

Then-Gov. Rick Snyder signed Medicaid expansion legislation in September 2013 that extended coverage to residents with income at or below 133 percent of the federal poverty level—or $16,000 for a single person or $33,000 for a family of four.

The work requirements were added in June 2018. Those requirements, with exemptions for disabled residents and pregnant women among others, included able-bodied, adult HMP recipients working 80 hours a month or be in job training program after Jan. 1, 2020.

Bills Would Allow Do-Not-Resuscitate Orders For Terminally Ill Minors

When the parents of William (Willy) Pickett—who suffered from lissencephaly, a rare disorder in which the brain does not form correctly during gestation—decided to place a “do-not-resuscitate” order in his file at school, the Washtenaw Intermediate School District declined to do it.

His mother, Dawn Krause, initially took the district to court in an attempt to overturn the policy, but Willy died in 2015 at age 11 before the suit could be settled.

Krause was set to testify late last month in the House Judiciary Committee on HB 5417, HB 5418 and HB 5419, which would allow for do-not-resuscitate orders for minors with advanced illnesses and require that schools follow those orders.

“It is a very small population of students that this topic affects, but for that small population it is literally life and death. Keep in mind it is a very small population and thank God if you are not involved in it, but for those who are involved in this, it’s literally life and death,” Krause told MIRS.

“You don’t expect to be talking about death and education in the same context . . . But medical technology is exponentially, almost daily, growing, but education has almost remained flat. So, you can keep a child alive. They are terminally ill, but they are not actively dying for a long time and what do you do with them in the meantime? That’s where education has to rise up to meet with the technology.”

There has to be a continuity between the medical professionals, the educational professionals, and the families, keeping that continuity intact wherever the child happens to be, she said.

“All three of those factions have to be on the same page,” Krause said.

The bills are sponsored by Rep. Daire Rendon (R-Lake City) and Rep. Rebekah Warren (D-Ann Arbor) and count as a reintroduction of bills proposed in 2018 and passed by the Senate unanimously. The package stalled in the House in lame duck.

Right to Life of Michigan is neutral on the bills, according to legislative director Genevieve Marnon.

“This would be a very small subset of medically fragile children whose parents, along with the doctor, have determined that in the event of a heart attack or a cessation of breathing, in these particular instances, that letting them go is probably the best option for them,” Marnon said.

She contended that current law is that only adults can opt for a DNR and special education in Michigan goes up to age 26, so some may have DNRs now.

“Right now, the schools are actually obligated under law to provide some form of CPR and, of course, paramedics are required, as well, in the face of no do-not-resuscitate order,” Marnon explained “You are required to attempt resuscitation, call 911. You have to do something; you can’t just leave them sit there. That is actually the law unless you have a do-not-resuscitate order.”

Rendon said the school balked at the DNR out of fear of lawsuits.

“Even my little school district has been rocked by lawsuits from time to time, and it is an expense we can’t afford,” Rendon said. “So, I understand. This was a big school district. That doesn’t mean they had more money than anyone else. I guess everybody has a different philosophy as to what we need to do to protect ourselves and limit the exposure we would have to lawsuits.”

Krause has told her story about Willy on her blog site, A Very Post-Modern Family.

She has also written an article for the February edition of the Pediatric e-Journal, Pediatric Palliative and Hospice Care.

Willy was born in March 2004 and the pregnancy seemed normal, Krause stated. Four months later, he suffered a grand mal seizure and was diagnosed with lissencephaly, which literally means smooth brain. Willy’s brain had no gyri or ridges, which is what gives people motor skills.

At diagnosis, Krause was told most children with the condition live about two years. Willy reached age 11 before passing, Krause said.

“We enrolled him in the Early On program and the therapists and teachers there taught us how to take care of him and give him quality of life. They opened up a new world for us. A world where special education meant a life for Willy. A life of his own where he still had goals. They had equipment at school that we could have never afforded to have at home. They had specialists there who had studied how to educate and work with this very special population of students. He couldn’t walk or talk. But they focused on what he could do, not what he couldn’t do,” Krause stated.

Lissencephaly is a regressive disorder, so Willy’s performance peaked at a very young age and started to decline slowly, but it’s a slow regression.

“Every time he had some sort of hospitalization, he would come back a little less than his former self. And that is where quality of life and medical technology kind of butt up against each other,” Krause said.

Eventually, her family had to consider the DNR.

But they also wanted him in Washtenaw Intermediate School District, which had more services and equipment, including a therapy pool.

“We decided to still send Willy even though we knew they would not honor his DNR. We knew the pros outweighed the cons. Willy loved school. He loved the pool. He needed the therapy and the stimulation they offered there,” Krause said.

Willy died at home in 2015, and the lawsuit ended because he was the plaintiff in the case, Krause explained. She decided to try to address the issue legislatively.

“Willy was in school five days before he passed. He was doing great. On Oct. 31, he was in school and he had started to catch a little bit of a cold, which happens. Neurotypical kids catch colds. He passed Nov. 5 of double lung pneumonia. That just shows you how quickly it can go downhill, but in the meantime, these kids deserve an education. It’s federally mandated,” Krause explained.

Gov Creates Prescription Drug Task Force

A new task force has until Aug. 15 to come up with ways state government or the Legislature can help lower the cost of prescription drugs or at least shine a light on how the prices are established, under action Gov. Gretchen Whitmer took Feb. 21.

Whitmer signed her first executive order of 2020 to follow up her pledge to create a prescription drug task force in her State of the State address. The panel will identify strategies and recommend legislative and administrative actions that can be taken to increase transparency in the pricing of prescription drugs and to lower costs for Michigan families.

It’ll be made up of leaders from the Michigan Departments of Health and Human Services, Insurance and Financial Services and Licensing and Regulatory Affairs, as well as from the Legislature, including Sens. Winnie Brinks (D-Grand Rapids) and Curt VanderWall (R-Ludington) and Reps. Padma Kuppa (D-Troy) and Hank Vaupel (R-Fowlerville).

VanderWall is the chair of the Senate Health Policy Committee and Vaupel the chair of the House Health Policy Committee.

“Nobody should have to choose between refilling their prescription and paying rent, but that’s the current reality for too many Michigan families,” Whitmer said. “There are people who are already struggling to get by, who know that any day, they could get a diagnosis that would put them in severe medical debt. That has to change.”

Over the past six years, the average price of drugs prescribed to treat diabetes, heart disease, depression, and other common conditions has more than doubled, according to the governor’s office.

Brinks said it is estimated that nearly a quarter of every dollar spent on health care goes toward the cost of prescription drugs and the federal government isn’t acting quick enough to address it.

“Michigan can’t wait for action in Washington D.C. to bring relief to our residents,” she said. “I look forward to serving on this task force to explore ways we can do better for the people of Michigan.”

The Michigan Association of Health Plans said it “strongly supports Gov. Whitmer’s new task force seeking ways to reduce the cost of prescription drugs in Michigan.”

15 Michigan Counties Have Zero Psychiatrists

Six Upper Peninsula counties and nine Lower Peninsula counties have no psychiatrists, according to Altarum, a nonprofit health research organization in Ann Arbor. Three U.P. counties and seven Lower Peninsula counties have neither psychiatrists nor psychologists

An even greater shortage exists within specialty practices, like addiction and child psychiatrists, the study reads.

Most practitioners are in the southeast part of the state, creating a disparity in services in rural areas, according to Professor Rajiv Tandon, the chair of Western Michigan University’s Department of Psychiatry.

“Rural communities are underserved,” Tandon said. “This is a problem that has gone on for a long time. If anything, it’s getting worse.”

Even though the salaries are high and the field is popular, many hospitals and mental health service centers lack the funding to have a psychiatry department, according to the study.

Developing programs that entice psychiatrists to move to rural areas, use of Telehealth services and strengthening residency ties to rural areas could help reduce such shortages.

It’s not an uncommon problem across the country. About 111 million people live in “mental health professional shortage” areas, according to the U.S. Department of Health and Human Services.

A majority of the 3,135 counties in the United States have no psychiatrists, the U-M study found.

The salaries for psychiatrists have gone up in the past few years, leading to a scarcity of job openings due to slower turnover, according to Tandon. Rural communities have fewer job openings as a whole.

“Interest in psychiatry in medical students has gone up and down over the last several decades,” Tandon said. “Over the last several years, it’s gone up. For example, we had more applicants to our residency program this year than in previous years.

“All the positions in psychiatry in the country have been filled. It’s a consequence of Obamacare, where the coverage for psychiatric services has received a higher priority,” he said.

The shortage of psychiatrists has spread already-thin resources and require many mental health practitioners to seek outside help, according to Christine Gebhard, the North Country Community Mental Health Authority’s chief executive officer. The authority, based in Petoskey, covers six counties: Antrim, Charlevoix, Cheboygan, Emmet, Kalkaska and Otsego.

“The shortage is very real. It limits access for patients, and it can create some wait time to get in for services,” she said. “Many of us in this field use mid-levels, such as psychiatric nurse practitioners, who can do some of the same work of a psychiatrist,” Gebhard said. In addition, the authority uses primary care physicians to do some medication reviews and support work, but not necessarily do psychiatric evaluations.

Another resource is Telehealth, a service that connects patients and clinicians over long distances. It allows contact, care and monitoring without the patient traveling long distances to a medical office, she said.

There is a strong correlation between where psychiatrists practice and where they completed their residency.

More than half of those who completed residency training between 2007 and 2016 practice in the same state, according to the Association of American Medical Colleges.
Western Michigan University’s Tandon said affiliations with academic psychiatric programs could create an incentive to practice in rural communities.

“We need to provide better incentives to work in those areas,” Tandon said. “Providing the structure and the sense of belonging in a greater community of psychiatrists would be helpful,” he said.

(Contributed By Capital News Service correspondent Katrianna Ray).

Senate Health Hears A Defense Of Prior Authorization

Medical knowledge is growing so fast these days that no one can keep up, doctor and benefits manager Eric Gratias told the Senate Health Policy and Human Services Committee Feb.13 as he mounted a defense of the use of prior authorization by insurance companies.

“One of the things that comes up a lot in debates about prior authorization is the concept that it is there because physicians can’t be trusted to do the right thing. And that couldn’t possibly be further from the truth,” Gratias said.

In 2010, the “cumulative body of medical knowledge doubled every three and a half years.” Today, the estimate is it is doubling every 73 days.

“So think about that, every 73 days the cumulative body of medical knowledge is turning over, so nobody can keep up and blind spots creep into your practice. Everybody’s blind spots are different. I had them myself,” he said.

Gratis is chief medical officer at eviCore, which he said was one of nation’s largest medical benefit management firms for insurance companies. He was previously a pediatric oncologist. He was testifying in the committee’s third hearing on Sen. Curt VanderWall’s (R-Ludington) SB 0612, which would require health insurers in Michigan to respond in 24 hours in urgent cases where a medical procedure or prescription needs prior authorization, and in 48 hours for non-urgent requests.

Currently, the only timelines in law are for prescriptions, and non-emergency cases have up to 15 days for prior authorization. For urgent cases, prior authorization can take up to 72 hours.

Gratias said he is not opposed to the legislation, but there are elements he would like to see improved.

“In those circumstance where physicians have a plan that isn’t quite aligned with the evidence, it’s not a big miss. A number of times we see people who are just totally off the reservation and doing something that has no basis in evidence, but that is tiny percentage,” Gratias explained. “The overwhelming majority are evidence adjacent. It is almost there, but it is not quite right and there is a better way to go. So we are a firm believer in our process of proactive outreach to get involved in that conversation with your physician.”

He said his company has a policy that if prior authorization is denied, it has to go to a physician for review. He contended the process becomes more of a collaboration where the insurance company offers authorization for a better alternative.

If the alternative is used, it has to be with the agreement of the treating physician, Gratias contended.

“Where you are getting at the rub is when the two physicians can’t come to agreement,” Gratias said. “And at the end of the day, the person performing the medical determination, if they can’t hear the reasons why this patient is an exception to the evidence, it’s their job to say no. They do affect the care of that patient, but I would argue that what they are doing, if all the information is correct there, is that the ordering physician had a blind spot and this patient didn’t need that thing the way that it was done. So the care is altered but in a positive way.”

That did not sit well with Sen. John Bizon (R-Battle Creek), also a doctor.

“I’m glad you have reviewers that have no blind spots, sir. I’m glad you have reviewers that have no similar blinds spots, it is only the providers,” Bizon said.

Bizon challenged him on several other points. Gratias had contended that when a doctor calls to talk about a denial, they are connected to another physician and that a first level reviewer would never be on the phone to a doctor.

“That’s different than my experience, if I may say,” Bizon responded. “Perhaps it has been a year since I have done that but, typically, I get people who have no idea even how to say the words much less have any knowledge of the base underneath it.”

“That did frustrate me when I encountered that in practice as well,” Gratias admitted. “I know that that is not how we approach things as a company, but I know that is a constant source of frustration.”

The committee also heard from John Roarty, Michigan Society of Eye Physicians, who told of instances in which he had to cancel surgery for a patient with eye cancer because the insurance would approve only a CT scan and not an MRI.

He said he does not have an issue with prior authorization and some companies do it well, but in other cases it is interfering with patient care and he encouraged the committee to move the bill.

Susan Pigg, a patient with stage 4 metastatic cancer, told the committee her treatments become ineffective every six to eight months and the doctor has to come up with a new plan.

“Every single time, the insurance company slams on the brakes and argues with the doctor,” Pigg said.

Julie Greene, CEO of Orthopaedic Associates of Muskegon, told of how a patient with a dislocated hip had to be sent home overnight because they couldn’t get prior authorization. They nearly had to send him home a second time without treatment over a weekend when prior authorization wasn’t coming for the needed surgery. She had to get on the phone with medical director of the health plan to resolve the roadblock.

VanderWall said his committee has received a lot of information over the past three hearings and he wants to take his time to review it before deciding what if any changes need to be made to the bill.

In particular, he said he wants to listen again to Gratias’ testimony because of the number of suggestions he made for improvements.