Licensing Boards Focus On Boundary Issues

Wachler & Associates, P.C

In the past few years there has been growing public concern about professional boundary issues in healthcare with the increase in reported cases of providers interacting inappropriately with patients. As a result, state licensing boards have become increasingly proactive in investigating such allegations. In fact, the Ohio Medical Board recently announced plans to review and potentially reopen nearly 2,000 closed cases of alleged sexual misconduct or impropriety by physicians in Ohio over the past 25 years to determine whether any credible evidence of criminal or otherwise inappropriate behavior had been previously overlooked.

The Ohio Medical Board’s review of cases that were previously closed without disciplinary action includes not only sexual assault investigations, but also allegations of improper, non-physical interactions. The relationship between a healthcare provider and a patient is a professional relationship based on trust. When a provider behaves in such a way that oversteps his or her professional role with the patient to create a personal relationship, a professional boundary has been crossed. When a provider inappropriately uses words or actions of a sexual nature with a patient, a sexual boundary has been violated. Violations of boundaries between a provider and his or her patient can include […]

GCMS Executive Director Peter Levine Announces Retirement

After 33 years of service as Executive Director of the Genesee County Medical Society, Pete Levine announced his retirement as of July 1, 2019. Levine said, “It has been an honor to serve as Executive Director of GCMS and work with such exceptional physicians and practice managers to improve healthcare in our community.”

During his retirement, Levine said he will enjoy more time with family, pursuing his personal interests, providing selected consultations, as well as continuing to represent GCMS at the Greater Flint Health Coalition.
Pete will also voice his insights and perspectives in these pages and continue as an editorial advisor to Healthcare Michigan.

“We are grateful for Pete’s many years of service to GCMS,” Edward Christy, MD, President of GCMS said. “We appreciate his dedication to patient and physician advocacy. His leadership was invaluable to our organization, and we wish him all the best for his retirement.”

Complete Eye Care Administrator Traci Kim said, “The significance of Pete’s role as a facilitator for the GCMS practice managers’ meetings cannot be overstated. He has been instrumental in bringing insurers to the table to address numerous complex reimbursement issues. We would not have this type of access to decision-makers without his advocacy. We are grateful for his leadership and […]

Inclusion And The Community Of Caregivers

The circle of care is wide – and getting wider. With all the national conversation around diversity and inclusion, I think the healthcare field can give itself a pat on the back, at least on the inclusion side. I refer to a different kind of inclusion here – and that’s the inclusion of a broad spectrum of caregivers as an extension of the care team – and ultimately into the world of reimbursement.

For too long, the focus was chiefly on the physician when it came to care and reimbursement, but the value of the care team has grown too strong (based on supporting data and anecdotal evidence) to look back. With patient outcomes improving as the availability of care teams increases, especially interdisciplinary teams comprised of nurses, dieticians, behavioral health specialists, exercise specialists, pharmacists and care managers, the care experience continues to evolve in a positive direction.

In 2006, our organization assembled one of the state’s first care team efforts. We called it the Chronic Care Travel Team (CCTT) and launched the program with the aim of focusing on patients with co-morbidities including diabetes, hypertension and obesity, as part of their care team in the primary care physician’s office. The name ultimately morphed into […]

New Proposed Updates to Substance Use Disorder Privacy Rule

Benkoff Health Law, PLLC
On August 22, 2019, the Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) announced proposed changes to the Confidentiality of Substance Abuse Disorder Patient Records regulations, set forth in 42 CFR Part 2 (Part 2). Part 2 protects and prevents access to patient records created by federally assisted substance abuse disorder (SUD) treatment programs. SUD is a defined term, and includes cognitive, behavioral, and physiological symptoms indicating that an individual continues using a substance despite significant substance-related problems such as impaired control, social impairment, risky use, and pharmacological tolerance and withdrawal, but does not include tobacco or caffeine use.(1)

Part 2 was initially designed to protect SUD patient records so that patients seeking SUD treatment would not be deterred from doing so. For that reason, Part 2 contains more restrictions on the disclosure of patient records than HIPAA. However, the outdated regulations have created clinical and safety barriers for providers seeking to treat such patients amid the opioid crisis, even despite recent updates to Part 2 in 2017. Thus, the proposed rule seeks to balance the need to both coordinate care among providers that treat SUD and maintain privacy […]


House Votes To Put Warnings On Pot For Mothers, Breastfeeders
The House voted overwhelmingly Sep. 10 to put warning labels on recreational and medical marijuana products, to tell pregnant women and breastfeeding mothers that smoking pot can have harmful effects on their infants.

Members voted 105-4 on HB 4126 and HB 4127, sponsored by Rep. Thomas Albert (R-Lowell) and Rep. Daire Rendon (R-Lake City), to require labels in the same way tobacco and alcohol products carry warning labels now.

“There’s been some pretty alarming studies showing that in an unfortunate trend, a lot of women are continuing to use marijuana while they are pregnant,” Albert said. “It is pretty shocking that someone would make that choice and we want to make sure that they have the right information.”

Doctors believe that there could be some long-term developmental issues and it can cause low birth weight, he contended.

The warning would read: “Use by pregnant or breastfeeding women, or by women planning to become pregnant, may result in fetal injury, preterm birth, low birth weight, or developmental problems for the child.”

Rep. Beau LaFave (R-Iron Mountain) is not a fan of the idea.

“If we were to put a warning label on everything that is potentially dangerous, everything including Tim Skubick would have […]

‘Mediare For All,’ Economics And Philosophy

It is notable how the concept of “Medicare for all” has presently provoked such vigorous support by the Democrat leadership. With Obamacare moving the balance so close to single-payer via political muscle, to have a reversal of this embedded ideological goal is intolerable to the left. The thought of placing any entitlement back on the bargaining table and above politics, healthcare in particular, continues to be outside of mainstream Democratic mainstream ideological thinking. There is no guarantee an expanding welfare state can continue, despite emotional pandering that eclipses this reality. The weaponization of emotional issues to manipulate people, such as “virtue signaling,” is a despicable tactic. To create a public perception of, “I get mine no matter what the state of the country is when I get it,” is a formula for insolvency as the government goes broke. Look at Europe.

Free markets drive value to the goods and services we consume. In contrast, centrally planned government-run healthcare must rely on coercion. Of interest here is that this concept above all is the Achilles’s heel of Obamacare. It is obvious that millions of the young and healthy are forced into the exchanges and there exploited. The presidential rhetoric declaring you can keep your plan […]

Doctors Can Change Opioid Prescribing Habits In Small Doses

When they started practicing medicine, most surgeons say, there was little or no information about just how many pain pills patients needed after specific procedures.

As a result, patients often were sent home with the equivalent of handfuls of powerful and addictive medications. Then the opioid crisis hit, along with studies showing one possible side effect of surgery is long-term dependence on pain pills. These findings prompted some medical centers and groups of physicians to establish surgery-specific guidelines.

But questions remained: Would anyone pay attention to the guidelines and would smaller amounts be sufficient to control patients’ pain?

Yes, appears to be the answer to both — in some measure — according to a study that encompassed nearly 12,000 patients in 43 hospitals across Michigan. The researchers published details of their work in a letter Wednesday in the New England Journal of Medicine.

Seven months after specific guidelines for certain operations were issued in October 2017, surgeons reduced by nearly one-third the number of pills they prescribed patients, with no reported drop in patient satisfaction or increase in reported pain, according to the research.

“We’re not trying to deny patients narcotics,” said Dr. Joceline Vu, one of the paper’s authors and a general surgery resident […]

Nearly Two-Thirds Of Doctors ‘Not Interested’ In Opioid Treatment Training

While most doctors in Michigan believe the state’s new rules for prescribing opioids will help to address the overuse epidemic, only 20 percent have been trained in Medication-Assisted Treatment and nearly two-thirds said they aren’t interested in getting trained.

Those were the results of a recent survey of some 600 primary care providers by the Center for Health and Research Transformation (CHRT) at the University of Michigan to gauge sentiment of the state’s 2017 efforts to deter over prescribing, including mandatory use of the Michigan Automated Prescription System (MAPS).

“CHRT’s physician survey shows that Michigan’s new requirements for MAPS reporting are generally supported by primary care physicians in Michigan. However, physician interest in Medication-Assisted Treatment is low, and more will need to be done in order for MAT to be a viable treatment option for the many Michiganders in need of help,” the report concludes.

“Between 1999 and 2016, the number of overdose deaths in Michigan increased 17 fold — from 99 to 1,699. In 2017, more deaths were due to overdose than car accidents,” the report states.

In 2017, state lawmakers passed several bills aimed at curbing the epidemic, notably limiting opioid prescriptions to seven days and requiring physicians to look up their patients’ prescription history on the […]

What To Do With Incarcerated Physicians?

One of the most interesting aspects of writing a healthcare column is that the topics can be wide-ranging because the issues surrounding physical and behavioral health and the community of care providers are so vast and far reaching. That being said, I believe I am introducing a topic today that is rarely discussed: What are we to do with incarcerated physicians who happen to be qualified clinicians? For physicians who have not committed capital crimes or crimes related to physical, sexual and emotional abuse, should we be considering the establishment of guidelines and programs for acceptable use of their medical skills behind bars?

Over the course of my career in the physician organization field, I have personally known about five physicians who have been imprisoned – all for crimes related to wrongful prescribing/overprescribing prescription drugs in the pre-opioid focused era or billing/coding abuse. Illegal activity? Character flaw? Abhorrent behavior? Yes, on all three counts; but does that mean their actual clinical skills as a physician, which in all cases were not in question, must be wasted as they serve their time?

Michigan’s prison system shortage of healthcare providers in nearly all categories is well-documented; are we overlooking a potential solution to mitigate the physician shortage […]


Allen Park Retirees Get 2nd Chance At Lawsuit Over Healthcare Benefit Changes

The Allen Park Retirees Association will get a second chance at pursuing its lawsuit against the city alleging retirees’ healthcare was improperly changed.
The Michigan Court of Appeals held it “makes little sense” to consider if the trial court erred when it dismissed APRA’s suit since a recent Michigan Supreme Court decision altered its argument, according to an opinion published Aug. 13 from Judges David H. Sawyer and Mark J. Cavanagh. Judge Deborah A. Servitto concurred in the result only.

“We prefer to have the trial court analyze the issue in the first instance,” the court’s opinion noted. “Accordingly, the better route is to reverse the trial court’s decision granting summary disposition to the city and remand the matter for reconsideration in light of the Supreme Court’s decision” in Kendzierski v. Macomb County.

The trial court also erred in relying on res judicata and collateral estoppel—which essentially prevents re-litigation of an issue—in dismissing the case, and on remand is to reconsider APRA’s motion to amend their complaint.
And, the trial court is not to consider former emergency manager Joyce Parker’s 2013 order that altered retirees’ healthcare because it is no longer in effect, the appeals court said.

The APRA […]

COMPLIANCE CORNER: State Enforcement Of HIPAA Violations

The Health Information Technology for Economic and Clinical Health Act (the HITECH Act) enacted as part of the American Recovery and Reinvestment Act of 2009 contains several provisions intended to strengthen Privacy and Security Rules in the Health Insurance and Portability Accountability Act of 1996 (HIPAA). One of these provisions gives state attorneys general (SAG) the authority to bring civil actions on behalf of state residents for violations of the HIPAA Privacy and Security Rules.

The Health and Human Services Office of Civil Rights, which has oversight of HIPAA violations at the federal level, is also involved in actions brought by SAGs. The Office of Civil Rights provides a training module to assist SAGs in investigating and seeking damages for HIPAA violations on behalf of state residents. SAGs contemplating filing a civil action for HIPAA violations are encouraged but not required to contact the regional office of the Office of Civil Rights to discuss potential actions. SAGs are also required to notify and serve Health and Human Services with a copy of the complaint they intend on filing at least 48 hours prior to filing an action, unless notice is not feasible. While Health and Human Services is required to investigate any […]

American Medical Students Less Likely To Choose To Become Primary Care Doctors

Despite hospital systems and health officials calling out the need for more primary care doctors, graduates of U.S. medical schools are becoming less likely to choose to specialize in one of those fields.

A record-high number of primary care positions was offered in the 2019 National Resident Matching Program — known to doctors as “the Match.” It determines where a medical student will study in their chosen specialty after graduation. But this year, the percentage of primary care positions filled by fourth-year medical students was the lowest on record.

“I think part of it has to do with income,” said Mona Signer, the CEO of the Match. “Primary care specialties are not the highest paying.” She suggested that where a student gets a degree also influences the choice. “Many medical schools are part of academic medical centers where research and specialization is a priority,” she said.

The three key primary care fields are internal medicine, family medicine and pediatrics. According to the 2019 Match report, 8,116 internal medicine positions were offered, the highest number on record and the most positions offered within any specialty, but only 41.5% were filled by seniors pursuing their M.D.s from U.S. medical schools. Similar trends were seen this year in family […]

CMHs: State’s Move Means ‘Overnight’ Privatization Of Mental Health

The state wants to end an agreement with the local public entity responsible for administering mental health services in West Michigan and instead go directly through a private health provider, sparking concern of the “privatization overnight” of mental health care.

The Michigan Department of Health and Human Services announced June 28 it plans to end its contract with Lakeshore Regional Entity, the pre-paid inpatient plan (PIHP) covering the region containing Allegan, Ottawa, Kent, Muskegon, Oceana, Mason and Lake counties.

In mental health service delivery, the state contracts with regional, locally controlled public entities known as PIHPs to administer behavioral health care services. The PIHPs in turn contract with the local community mental health agencies to deliver those services.

In this instance, DHHS wants to contract directly with Beacon Health Options—a private provider LRE already works with—and essentially make it the PIHP for the western Michigan region until the state can establish a new PIHP.

But this would mark the first time DHHS would depart from the usual mental health service delivery model and go directly through a private provider. DHHS spokesperson Lynn Sutfin said the state intends to strike a deal in such a way to make Beacon like a PIHP for the region under federal regulations.

But Robert Sheehan, […]

ON POINT WITH POs: New Learning Collaborative

Collaboration is a favorite topic of mine, but one offshoot of collaboration I haven’t touched on much is learning collaboratives. A learning collaborative takes collaboration into a more formal, but still relaxed, learning environment, bringing together practice teams to share ideas and find solutions to existing challenges.

Some may recall the Mackinac Learning Collaborative (MLC), which was launched in Detroit in 2009-2010 with the goal of transforming primary care physicians’ offices into patient-centric practices. While our Patient Care Organization championed and led the effort, its success was due to the commitment of primary care practices and family residency training programs throughout SE Michigan who not only participated but did their homework between sessions and established collegial relationships with other MLC participants. The fact that many of these relationships are still thriving today remains among one of the most satisfying outcomes of the MLC.

The MLC was further buoyed by its guest speakers—thought leaders contributing big picture trends and insights on state and national initiatives. They weren’t paid speakers—and some sought out the MLC because they wanted to be part of an audience of 100-plus physicians, behavioral health specialists, nurses, medical assistants, office administrators and healthcare executives that were changing healthcare in the trenches.

I hope at […]

Pelosi Aims For Feds To Negotiate Drug Prices

A draft plan spearheaded by House Speaker Nancy Pelosi would allow the federal government for the first time to negotiate prices for 250 drugs for Medicare and apply those prices to all payers, including employers and insurers.

As House Democrats hash out a proposal empowering the federal government’s top health official to negotiate lower drug prices, House Speaker Nancy Pelosi is taking it a step further and pushing a plan that could benefit even those Americans with private health insurance.

A draft plan spearheaded, but not yet released, by Pelosi and other House Democratic leaders would ensure that prices negotiated on the most expensive drugs would apply not only to the government but to all payers, including employers and insurers, a Democratic aide said.

But first, Democrats must agree on how best to muscle drug companies to the negotiating table, as well as how to prevent Americans from paying more or even losing access to the other drugs they take. Pelosi has faced pressure from progressive House Democrats, who have pushed for a more aggressive approach, including opening up all drugs to negotiations.

However bold a plan Democrats produce, any proposal to invite the federal government into price negotiations looks doomed in the Republican-controlled Senate, where GOP […]


Budget Office Projecting $45M Shortfall In DHHS’ IT Spending
The Michigan Department of Health and Human Services (DHHS) could be as much as $45 million in the hole by the end of the fiscal year if “major adjustments” are not made to address the agency’s IT budget shortfall, according to the State Budget Office.

On May 31, the SBO informed the legislative appropriations chairs that DHHS is the only agency at risk of spending more than it’s allotted to spend this fiscal year, which ends Sept. 30.

While no appropriations have been overspent, according to Budget Director Chris Kolb in the letter, the shortfall could result in overspending by the end of Fiscal Year 2019. The $45 million figure was given as the “high-end” estimate.

There’s been prior documented IT project spending overages associated with the DHHS—the department was dragged before a committee hearing earlier this year to explain itself.

The FY 2019 budget included a $4.1 million General Fund appropriation to address an ongoing funding shortfall, after DHHS told the Legislature in May 2018 there was a $15 million shortfall in GF in its FY 2018 budget, according to a report by the House Fiscal Agency. The agency halted all new IT projects deemed as non-essential at that […]

No-Fault Deal Perpetuates Health Coverage Shell Game

A famous catcher and left fielder once reportedly said: “It’s like déjà vu all over again.” This is precisely the case with medical coverage under Michigan’s new no-fault auto insurance law.

The new law ends the unlimited medical benefits provision contained in the original 1973 no-fault law and replaces it with tiered premium discounts that allow drivers to pay less for less medical coverage. The law guarantees no premium increases for eight years on the medical portion of insurance premiums and imposes a fee schedule for healthcare providers that begins at about double what Medicare pays.

Michigan’s auto insurance premiums are the highest in the country, with Detroiters often paying $5,000 or more annually. The law precludes insurers from using ZIP codes and credit scores to set rates, numbers that fall disproportionately hard on Detroiters. However, there are loopholes that allow insurers to use “territories,” which can be based on census data and credit reports that track late payment histories.

The Detroit Free Press reported that the Michigan Catastrophic claims Association fee, which covers lifetime medical benefits would dip from $192 per car to $43 per car. There is a likelihood that drivers opting for unlimited coverage would pay substantially more than the current $192 because […]

Who Doesn’t Like The Auto No-Fault Deal?

Calling the bill “destructive,” “a sell-out of Michigan citizens” and “a total gift to the insurance industry,” the Coalition Protecting Auto No-Fault (CPAN) was among several groups that didn’t hold back opposition to the auto insurance bill approved by the Legislature and signed by Gov. Gretchen Whitmer.

CPAN, the Michigan Brain Injury Provider Council (MBIPC), the Michigan Association of Justice (MAJ), Michigan Health & Hospital Association (MHA) and the Insurance Alliance of Michigan (IAM) all criticized SB 0001.

About the only outside entity that shared in the Legislature’s enthusiasm was Detroit developer Dan Gilbert, whose promise of a citizens’ initiative absent legislative action helped push the issue for a pre-Memorial Day deal.

“Today is a monumental day in Michigan,” Gilbert wrote in a statement. “The unscrupulous actors have finally been defeated . . . Both Democrats and Republicans became wise to the predatory nature and strategies of those who rationalize their fleecing of the system with twisted arguments and fear tactics while using the complexity of the issue as a shield against real change. That dark era ends today.”

For CPAN President John Cornack, he said it would result in the loss of “current lifetime medical expense coverage because they are simply no longer able to pay the unconscionable […]

New CMS Payment Models Put Patients Above Paperwork

While my recent columns have put me on the defensive regarding primary care trends, I’m thrilled to see CMS not only acknowledge but reinforce the important role of primary care in achieving optimal overall health and well-being through the recent introduction of its Primary Care Initiative Medicare payment models. At the heart of the introduction is a threefold goal: reduce administrative burdens, empower PCPs to spend more quality time with patients, and reduce overall healthcare costs. I’m not the only one applauding. The Patient Centered Primary Care Collaborative (PCPCC) cites the CMS move as reinforcement of the role primary care plays not only in health, but healthcare value.

There are five models falling under one of two categories, Primary Care First (for individual practices) and Direct Contracting (for large organizations like ACOs, Medicare Advantage Plans and MCOs); all models are geared to patients with chronic conditions and serious illnesses:

1. Primary Care First (PCF)
2. Primary Care First – High Need Populations
3. Direct Contracting – Global
4. Direct Contracting – Professional
5. Direct Contracting – Geographic

Primary Care First (PCF) is the model Medical Network One will enthusiastically recommend to high performing providers/practices. There is up to a 50 percent gain in reimbursement and only a 10 percent downside […]

Compliance Corner: The Data Bank Provides Guidance on the Use of Proctorships

Wachler & Associates, P.C

The National Practitioner Data Bank (Data Bank) published an article in the May 2019 issue of NPDB Insights that provides significant guidance regarding when proctoring is reportable. Proctoring can come in many different forms and has several different names depending on the hospital, such as monitoring, mentoring, or preceptoring. Regardless of the name, hospital-assigned proctorship agreements can be a useful tool to help evaluate a practitioner when a hospital has concerns about clinical competence. This is especially true because certain proctorships can be structured to avoid a report to the Data Bank. When that is accomplished, hospitals are able strike a rare balance between adequately addressing competency concerns and not tarnishing a practitioner’s reputation and career.

According to the Data Bank, when a hospital is deciding whether it should report the assignment of a proctor, it should consider the role of the proctor and whether that role limits the practitioner’s privileges. A hospital should report proctoring if: (1) it is a result of a professional review action related to professional competence or conduct, (2) it is a limitation on the practitioner’s privileges, and (3) it is in effect for more than 30 days. As such, if as […]

Legal Cannabis, Michigan And Public Health

Last Nov. 6, in lieu of a legislative decision that never took place, the Michigan voters approved the legalization of marijuana for recreational use by adults. That made our state the first in the Midwest to have such policy, complementing the previous implementation of the medical marijuana use. The statute included the proviso that recreational marijuana was to be allowed on persons of 21 years old and above, and that certain rules and regulations were to be developed via legislation to organize the cultivation, process, distribution and sales of the approved substance by a state certified system.

As of May 6, six months after the approval, a rather confusing environment is in front of us. And we have only six more months to be up and running. First, if medical marijuana is a substance that treats certain medical conditions, we must know that indeed the results of its use shows an improvement on those conditions as part of the public health effort to improve population health and practice evidence-based medical care.

The Michigan public, the state Department of Health and the practicing physicians are entitled to see those results to justify supporting the medical use of cannabis in the improvement of the debilitating conditions […]

Lansing Lines

State Medicaid Official Placed On Leave Following Negligence Accusation

Michigan’s chief medical director for Medicaid was placed on administrative leave May 9 after accusations of negligence and deficiencies in patient care.

Dr. David Neff, who had been recognized for helping combat the state’s opioid crisis, is accused of failing to meet minimal standards and violating his general duty as a health care provider, according to an administrative complaint filed by the Michigan Department of Licensing and Regulatory Affairs (LARA) that MIRS received via a Freedom of Information Act request May 31.

LARA spokesperson David Harns said the department is not commenting outside the administrative complaint.

Lynn Suftin, spokesperson with the Michigan Department of Health and Human Services, confirmed Neff’s leave from his $191,184 a year position began May 9. She also said the department is not offering further comments.

Efforts to reach Neff were not successful. A response to LARA’s complaint was filed May 31, but that report wasn’t immediately available for release.

The May 1 complaint filed with the Michigan Board of Osteopathic Medicine and Surgery alleges Neff overprescribed controlled substances to some patients in his part-time medical practice.

Specifically, the complaint alleges Neff didn’t request MAPS reports prior to prescribing controlled substances medication to patients between June 1 and September […]

House Passes Insurance Reform With Mandated Rate Rollbacks

House Republicans stuck together and, with the support of three Democrats, pushed through sweeping reforms to the state’s 40-year-old auto insurance.
Michigan’s auto insurance customers would see guaranteed rate rollbacks, choice in personal injury coverage and a fee schedule for medical providers under a plan that moved 61-49 at 2 a.m. Thursday morning, 18 hours after the Senate passed similar changes.

Unlike the Senate version, HB 4397 will give the Department of Insurance and Financial Services (DIFS) the power to prevent non-driving factors from affecting rates. It also mandates that between 10 and 100 percent of previous personal injury protection (PIP) costs, meaning some ratepayers can opt out of the Michigan Catastrophic Claims Association’s (MCCA) unlimited, lifetime coverage.

Despite the concessions made on the two issues that Democrats and Gov. Gretchen Whitmer cited as reasons for their opposition on May 7, most Dems were a no vote. Instead, Democrats pivoted to talking about the people who will choose to take lesser coverage and “be left in the cold” if they get in a catastrophic car accident.

The governor joined Democrats in the caucus room for about 10 minutes May 8, but left the chamber without commenting to the media to give a reaction to the plan.

Democrats who voted in […]

Even Doctors Can’t Navigate Our ‘Broken Health Care System’

Dr. Hasan Shanawani was overcome by frustration. So, he picked up his cellphone and began sharing on Twitter his family’s enraging experiences with the U.S. health care system.
It was an act of defiance — and desperation. Like millions of people who are sick or old and the families who care for them, this physician was disheartened by the health care system’s complexity and its all-too-frequent absence of caring and compassion.

Shanawani, a high-ranking physician at the Department of Veterans Affairs, had learned the day before that his 83-year-old father, also a physician, was hospitalized in New Jersey with a spinal fracture. But instead of being admitted as an inpatient, his dad was classified as an “observation care” patient — an outpatient status that Shanawani knew could have unfavorable consequences, both medically and financially.

On the phone with a hospital care coordinator, Shanawani pressed for an explanation. Why was his dad, who had metastatic stage 4 prostate cancer and an unstable spine, not considered eligible for a hospital admission? Why had an emergency room doctor told the family the night before that his father met admission criteria?

Sidestepping Shanawani’s questions, the care coordinator didn’t provide answers. Later, another senior nurse in the hospital unit didn’t respond when […]

Watch Your Step, PCPs—Mission Creep Is Tripping Up Primary Care

As any regular reader of this column knows, I’m a big booster of the pharmacy profession and have been committed to maximizing the skill level and reach of pharmacists when it comes to primary care. That’s why our organization was among the first Patient Care Organizations (formerly PO’s) in Michigan to actively recruit pharmacists into care management training programs and to seek out pharmacists to serve as care managers at large primary care practices within our network. It’s been gratifying to see other Patient Care Organizations follow suit.

Still, I was taken aback when I read a recent Detroit Free Press article with the headline, “Flocking to pharmacies instead of the family doctor.” Yes, it’s fitting and overdue to see pharmacists getting the recognition they deserve for the invaluable role they play in the health care continuum. With newer pharmacy service offerings like vaccines and treatment for relatively simple ailments via the Minute Clinic type model, much needed access to care has been enhanced because of pharmacists and the large consumer-driven entities that support them. That’s to be applauded.

Yet, pharmacists and pharmacies are not equipped to offer integrated care that treats both behavioral and physical health; they are not set up to coordinate care […]