Legalized Pot Shops Bills Signed Into Law

For the first time since voters said “yes” to medical marijuana in 2008, the state will be legalized freestanding shops where the product can be sold, under legislation Gov. Rick SNYDER signed into law Sept. 21.

A five-tier regulatory structure will now co-exist with the current distribution model, in which a caregiver can grow plants for him or herself and five others.

The bills, HB 4209, HB 4210 and HB 4827, create a license structure for the growing, testing, processing and transporting of medical marijuana, as well as legalize medical marijuana in non-smokable forms.

Those with any of the five state licenses, however, will not be allowed to a license for any of the other four tiers. A grower can’t sell the marijuana to a customer, just as a transporter can’t test or process the product.

“This new law will help Michiganders of all ages and with varying medical conditions access safe products to relieve their suffering,” Snyder said in a statement. “We can finally implement a solid framework that gives patients a safe source from which to purchase and utilize medical marijuana.”

The bills, sponsored by Rep. Mike CALLTON (R-Nashville), Rep. Lisa LYONS (R-Alto) and Rep. Klint KESTO (R-Commerce Twp.), also allow “medibles,” oils, chocolates and other products that contain the active ingredients for marijuana for those who don’t want to or can’t smoke it.

The most common example of a beneficiary of this product is a child who suffers chronic epileptic seizures.

“We’ve spent over five long years advocating for safe access to all forms of medical cannabis and are overwhelmed with gratitude today,” said Robin Schneider, the legislative policy director and patient advocate for the National Patients Rights Association. “We’ve overcome so much adversity, found middle ground with law enforcement and finally settled on common sense reforms.”

Willie ROCHON, vice president and spokesperson for the Michigan Cannabis Development Association, called the bills’ signage a “watershed moment in the years-long endeavor to create a framework to license and regulate the medical marijuana industry in the state and expand access to non-smokable forms of medical marijuana for patients.”

This story presented as part of a partnership between Healthcare Michigan and MIRS, a Lansing-based news and information service.

U-M Health System, Meijer Pharmacies Partner On Hypertension Care

The University of Michigan Health System has established a new partnership with Meijer pharmacies to provide hypertension management services for adult patients.

U-M patients will be able to visit participating Meijer pharmacy locations to receive a blood pressure check and assessment. If the patient’s blood pressure is elevated, the clinically trained Meijer pharmacist will communicate directly with the patient’s U-M Health System provider. The patient will also receive appropriate follow-up and education about disease, clinical goals, medications and lifestyle.

In addition, documentation of the patient’s visit to their Meijer pharmacy will be recorded in their electronic medical record so the patient can easily discuss the reading and assessment with their U-M Health System provider at their next medical visit.

“This partnership is allowing us to provide our patients with clinical pharmacist services in the community,” says Hae Mi Choe, director and associate dean of pharmacy innovations and partnerships at U-M. “Our patients will have more access to an effective and safe hypertension treatment and monitoring program right in their neighborhood.”

The partnership is available at two participating Meijer locations in Ann Arbor: Meijer at 3825 Carpenter Road and Meijer at 3145 Ann Arbor-Saline Road.

Nearly 90 percent of Americans live within five miles of a pharmacy and a community pharmacist is one of the most accessible health care professionals in the U.S., according to the National Association of Chain Drug Stores.

“Improving blood pressure control is one of the U-M Health System’s goals,” Choe says. “We’re hoping this partnership will allow patients another convenient access point to high-quality care and improved management of their condition.”

Each participating Meijer location has purchased an automatic blood pressure monitor to provide more accurate readings to patients. The device takes six consecutive blood pressure readings and provides an average of the readings. The devices were purchased based on a recommendation from the U-M Health System Hypertension Quality Improvement Committee. U-M cardiology and chronic kidney disease clinics currently use these machines to ensure accurate blood pressure readings for patients.

U-M Health System patients with elevated blood pressure will be identified at clinic visits and given the option to visit the Meijer pharmacy for their follow-up care. There will also be outreach to patients with elevated blood pressure who live in close proximity to the participating Meijer locations inviting them to visit their local Meijer pharmacy, or return to their physician’s office, for their follow-up care.

“This affiliation presents us with a unique opportunity to collaborate with Meijer pharmacists and enhance our system of care for our patients to better meet their needs,” says David Spahlinger, M.D., executive vice dean for clinical affairs and president of U-M Health System.

The new services will be rolled out one clinic at a time throughout the Health System, beginning with clinics that see a large population of patients that reside close to the participating Meijer locations.

“We are excited to partner with the highly regarded University of Michigan Health System,” says Karen Mankowski, vice president of pharmacy operations at Meijer. “This partnership shows the importance of the collaboration between community pharmacists and health care providers. We look forward to offering our clinical services to the residents of Ann Arbor and the surrounding areas through this opportunity.”

CMS Set To Reduce Flexibility On ICD-10 Oct. 1

ICD-10, which contains more than 70,000 diagnostic codes, replaced the ICD-9 code set, which relied on just 11,000 codes.

The grace period had only applied to claims submitted to Medicare and Medicaid, and while many commercial insurers offered similar flexibility, the majority did not, according to a report in Healthcare IT News.
The lead-up to the ICD-10 had many healthcare providers worried that the exponential increase in diagnostic codes would lead to more errors in medical claims, and ultimately denials, due to the new specificity required. But the years of lead-up to the launch due to a handful Congressional delays gave healthcare providers more time to prepare. The years of training, and the extra time to staff-up coding departments paid off. Most studies show the rate of denials had gone practically unchanged since the roll-out.

Though the grace period will end on Oct. 1, CMS said providers will still be allowed to use unspecified codes when they are warranted.

“While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter. You should code each healthcare encounter to the level of certainty known for that encounter.”

Mental Health Group Awards WSU $3.2 Million For Research

Researchers in the Wayne State University School of Medicine’s Department of Psychiatry and Behavioral Neurosciences will use a new five-year, $3.2 million grant from the National Institute of Mental Health to explore the underlying mechanisms of impaired learning and memory in schizophrenia from the perspective of brain plasticity, function and network dynamics.

The NIMH defines schizophrenia as a chronic and disabling mental disorder that affects how a person thinks, feels and behaves, including loss of reality due to hallucinations, delusions, unusual or dysfunctional ways of thinking, and agitated body movements. People with the condition also have difficulty beginning or sustaining activities, focusing or paying attention, or remembering information immediately after learning it. About 1 percent of the United States population, or 2.2 million people, have schizophrenia, but the neurobiology of the illness remains poorly understood.

Principal Investigator and Associate Professor Jeffrey Stanley, PhD, and Co-Principal Investigator and Professor Vaibhav Diwadkar, PhD, lead the study “Advancing innovative brain imaging to detect altered glutamate modulation and network dynamics in schizophrenia,” which was funded on its first submission. The study is the first to combine functional MRI, or fMRI and complex analyses of brain imaging data with innovative measurement of the brain’s functional neurochemistry using functional magnetic resonance spectroscopy, or fMRS.

“While fMRI data are somewhat ‘distant’ from fundamental neurobiological processes because the signal relies on blood flow that is correlated with – but distinct from – neurophysiological and neuro-chemical events, in developing fMRS we are able to measure and quantify changes in hippocampal glutamate in the brain. We have an imaging technique that may provide more direct information about functional changes in the brain,” Dr. Stanley said.

Biotech Industry Could Be ‘The Next $1 Trillion Industry’

If technology and data was the last $1 trillion industry, data-driven advancement in biotechnology will be the next and West Michigan is positioned to take advantage, said former Hillary CLINTON innovation aide Alex ROSS.

Ross was a keynote speaker at the Grand Rapids Economic Club luncheon and drew on his experience as former senior innovation aide to Clinton while she was Secretary of State. Ross said the data collected mapping the human genome over the last 15 years will likely be used next to conduct “liquid biopsies”—an early cancer detection test–and pharmaceutical therapies tailored to a patient’s specific genetic needs.

“In five years, 95 percent of the hands in this room will go up,” Ross said about liquid biopsies. Right now the procedure is too cost-prohibitive, but that cost is likely to plummet Ross said. Today, the procedure costs $3,000, but 13 months ago it cost $14,000 Ross said.

The way the pharmaceuticals will also change. Ross said he believes that doctors will begin to “develop therapies and treatments not generically designed to treat an illness, but designed around an individuals genetics.”

Ross said the barriers to new bio-science therapies is “principally regulatory” as it takes “billions in FDA

[Food and Drug Administrations] drug trials” to get a new drug to market. Ross encouraged business leaders to begin developing a research agenda at the state and local level to signal to investors that Michigan is friendly territory.

Ross also said Michigan business leaders should be on the lookout for new opportunities in autonomous vehicle technology–dovetailing nicely with Michigan’s advanced manufacturing industry-and advancements in agriculture.

Aetna Pulls Back From Obamacare

The nation’s No. 3 insurer said this week it will reduce the number of states in which it sells policies on government exchanges from 15 to three or four.

Aetna, Inc, decided to pull out of the 11 states amid sizable losses on it’s individual policy business. The states remaining are Delaware, Iowa, Nebraska and Virginia.

“Following a thorough business review and in light of a second-quarter pretax loss of $200 million and total pretax losses of more than $430 million since January 2014 in our individual products, we have decided to reduce our individual public exchange presence in 2017, which will limit our financial exposure moving forward,”said Aetna Chairman and CEO Mark Bertolini Aug. 15. “More than 40 payers of various sizes have similarly chosen to stop selling plans in one or more rating areas in the individual public exchanges over the 2015 and 2016 plan years, collectively exiting hundreds of rating areas in more than 30 states. As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision.”

Aetna’s action follows on the heels of similar moves by major insurers UnitedHealth Group and Humana, which have also cited financial losses on the government exchange business.

Aetna is attempting to buy Humana and is the target of a Justice Department anti-trust lawsuit, fueling speculation that Aetna’s move is also swipe at the federal government.

The risk adjustment mix, the number of healthy versus sick people who sign up for exchange plans is unbalanced, several insurers contend. Major insurers are unlikely to come back, unlness changes and more healthy people sign up and pay premiums to offset payouts for the sick, according to several analyses.

Aetna’s pullback also poses a unique problem for the Obama administration as Arizona will be left without an exchange plan option for its residents.

In addition to Arizona, Aetna is pulling out of Florida, Georgia, Illinois, Kentucky, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina and Texas.

AG Received 14 Flint River Water Complaints In 2015

The Flint water flowing from her showerhead caused her hair to fall out, read a Jan. 29, 2015, complaint from one Flint resident to Attorney General Bill Schuette’s office.

A year later, the Attorney General opened his investigation into the city’s municipal water supply.

“My skin is disgusting and my dog was sick until we switched her to bottled water . . . We need help in Flint PLEASE,” the Tiffin Street resident wrote.

Today, Schuette is a central figure in the prosecution of nine government employees allegedly connected to the contamination of Flint’s municipal water.

He’s also spearheading civil action against a pair of engineering firms potentially responsible for mistreating Flint River water.

But before taking action this past January, Schuette received 14 complaints from Flint residents about the city’s poor water quality, according to documents MIRS received through the Freedom of Information Act from April 1, 2014—the same month Flint switched its supply to Flint River water—to Dec. 31, 2015.

Schuette started his investigation into the Flint water situation Jan. 15, 2016.

“I don’t know why he didn’t get in front of this quicker than he did,” said Laurie Barr, one of the 14 to write Schuette a letter. Her correspondence came in early November. “When the shit hit the fan, he was all about justice. I don’t know the details, but it just seems that until it became a bigger deal for everybody else, it became a big deal for him.”

Schuette’s office notes that the Consumer Protection Team received more than 9,000 written complaints in 2015 to which each received a reply.

“When enough information became available for the attorney general to open a criminal investigation, he did so,” said Schuette spokeswoman Andrea Bitely.

During a June reporter roundtable, Schuette was asked if he had any contact with anyone from his environmental division about what was going on in Flint through most of 2015. He said, “Not to my recollection.”

When a reporter asked if it was “negligence on somebody’s part that the top law enforcement” officer wasn’t given a head’s up, Schuette was quick with a response.

“Absolutely not . . . If anyone with direct authority when they saw that the water was brown, when it smelled and the people could taste it, that was red alert. That was DEFCON 1,” Schuette said June 22.

But one of four consumer complaints received by the Attorney General’s Consumer Protection division on Jan. 29, 2015, flagged that exact circumstance, starting with, “Water smells and is discolored.”

Schuette said his environmental division had contact with the Governor’s office and the Department of Environmental Quality in 2015, but couldn’t speak to the exact conversations.

Supporters note that, at the time, Schuette’s team was reacting to the same information the DEQ and state department and local officials were giving Gov. Rick Snyder’s team. The governor and attorney general’s offices were told everything was fine. No reason to get involved. When it became clear those officials were not telling the whole story, Schuette launched an investigation and several of those state bureaucrats are now facing criminal charges.

“As more information came to me, it was time for me to do an investigation as Attorney General. I don’t run the departments,” Schuette said in June. “More information came in the press and the papers.”

Desiree Duell, an activist with Flint Rising, said the response by Snyder, Schuette and the whole Republican operation in Lansing has been “anemic and slow.” Residents had been speaking up about the quality of the city’s water since the beginning of 2015 and it was only until late 2015 and early 2016 when the national news became involved that a response came.

“It comes down to Flint being economically depressed,” Duell said. “The complaints coming from the residents were not of value to them. This is why we were gaslighted for so long and told the water was safe.”

Schuette had the complaints in his own Consumer Protection division for months before launching an investigation, action taken after Snyder acknowledged the problem Oct. 1.

As recently as late December, Schuette was praising then-DEQ Director Dan WYANT as a “terrific guy . . . that’s going to be involved with state government for a long time in high positions of responsibility” (See “Wyant Resigns As Task Force Slams MDEQ Over Flint Water Contamination,” 12/29/15). Snyder cut Wyant loose about a week later on Dec. 29.

In total, the Attorney General reported receiving 14 complaints on the quality of the city of Flint’s water supply from April 2014, when Flint switched its municipal water supply from the Detroit municipal supply to the Flint River. Six of those complaints came between Jan. 29, 2015 and April 9, 2015.

The names and full addresses of the individuals making the complaint were blacked out to protect their privacy, according to the AG’s FOIA office.

A Flint resident living on East Piper Avenue told Schuette’s office on Jan. 29 about the tooth decay he or she was experiencing because of the water supply. The resident’s pets wouldn’t drink it.

“I see why (General Motors) said they can’t use Flint water on there (sic) metal,” the person wrote. “My filling and teeth can’t use it either. I am asking you for myself and the many other Flint people to do something to correct this problem or refund my rates for this water that is undrinkable.”

Another Flint resident, a cancer survivor, living on Beta Lane wrote Schuette on the same day, telling him that he or she had been in remission for eight years and has “a severely compromised immune system.” After receiving a Jan. 3, 2015 notice of the contaminated water supply, this person wasn’t going to test his or her luck on the public water supply.

When this person called the city of Flint, the response allegedly given by Flint officials was they “don’t have to provide water for individual needs,” the letter reads.

Laurie Barr, of Saginaw, told MIRS she volunteered for Schuette’s first congressional campaign in 1984. Barr’s Nov. 5 letter alerted the Attorney General that Flint residents didn’t have the money to seek medical attention if they were being slowly poisoned by the water.

Residents couldn’t wash in hot water or else they’d risk the steam getting into their pores, she wrote.

“Once it gets to a point where they seek medical attention it will be the taxpayers responsibility because they will be going to the ER,” Barr wrote. “Everyone is talking and no one is doing. If you aren’t part of the solution then you are part of the problem. Flint is not a Third World country, it is Michigan!”

Barr praised Schuette’s response since Jan. 15, 2016 as being awesome.

“I see some bright light. I see some trust earned back. They’ve picked up the ball and running with it. They just shouldn’t have dropped it to begin with,” Barr said.

Rep. Sheldon Neeley (D-Flint) also was forgiving of Schuette not following through quicker on Neeley’s Sept. 29 written request to the AG for an investigation.

Neeley said he appreciates the Attorney General seriously looking into the heart of the conversion away from Detroit water to the temporary Flint River water while the 67-mile Karegnondi Water Authority pipe from Lake Huron to Flint was being built.

Was the mistreated Flint River water maleficence by bureaucrats? Was it driven by investors looking to profit from the project? Both? Neither?

“Yes, he was late to the game, but he’s on the battleground now,” said Neeley of Schuette. “Everyone was failed by the information that was being put out, including the public. When somebody makes a complaint, we have a duty to take the extra step to see what is happening. I think we all learned from that.”

This story presented as part of a cooperative arrangement between MIRS, a Lansing-based news and information service and Healthcare Michigan.

Mercy Health Opens $3.9 Million Medical Center In Ludington

Mercy Health has opened a $3.9 million medical center in Ludington in northwest Michigan.

Mercy Health Ludington offers urgent care, primary care services, lab, imaging and specialty clinics, and continues services at neurosurgery and cardiology clinics. An occupational medicine clinic was slated to open Aug. 15 and behavioral health services are penciled in for the fall.

The 15,000-square-foot facility is less than a mile away from the Spectrum Health Ludington Hospital.

Mercy Health announced plans to build the center last May and broke ground in September.

A West Michigan multi-campus health care system, Mercy Health features five hospital campuses, more than 60 physician offices and more than 1,300 medical staff physicians.

WSU Neurology Chair Passes Away

Omar Khan, MD, chair of the Wayne State University Department of Neurology, died Aug. 13.

Dr. Khan joined the Department of Neurology in 1998, and was appointed chair in 2012.

“He was a strong leader of his department,” School of Medicine Dean Jack D. Sobel, MD, said. “This is a substantial loss to our School of Medicine and a tremendous loss for multiple sclerosis patients, for whom Dr. Khan was a staunch advocate.”

Dr. Khan also served as director of the Wayne State University Multiple Sclerosis Center and Magnetic Resonance Image Analysis Laboratory, neurologist-in-chief for the Detroit Medical Center and formerly as associate chief medical officer for the Wayne State University Physician Group.

He received his medical degree in 1987 from the Allama Iqbal Medical College, University of the Punjab in Lahore, Pakistan. He served on the University of Maryland faculty from 1996 to 1998, when he joined Wayne State University.

Dr. Khan secured more than $8 million in research funding. He served as principal investigator in more than 55 studies and at the time of his death was the principal investigator in more than 15 clinical trials and investigator-initiated studies.

The Wayne State University Multiple Sclerosis Center, which he directed, is one of the top five MS centers in the country, with a patient population exceeding 4,000. He established the largest African-American multiple sclerosis clinic in the United States and is a founding member of the African-American Initiative in Multiple Sclerosis, a Detroit community-based endeavor. Dr. Khan’s MRI Analysis Laboratory focused on mechanisms of tissue injury and repair in neurodegenerative disorders, including multiple sclerosis, amyotrophic lateral sclerosis, Parkinson’s disease and Alzheimer’s disease.

Funeral services for Dr. Khan were conducted Aug. 15 at the Islamic Association of Greater Detroit mosque in Rochester Hills, Mich. Interment took place the same day at White Chapel Cemetery in Troy, Mich.

ACS Outfits Clothing Codes For Surgeons

A combined concern based on professional image and safety drives the American College of
Surgeons new communique on clothing. No dangling surgical masks, loose jewelry, grungy scrubs or uncovered ponytails or mutton-chop sideburns allowed. And, much like pro athletes, ditch the uniform (scrubs) for a jacket and tie for “encounters outside the OR.”

“The whole idea is to support professionalism on behalf of patients,” ACS Executive Director David Hoyt, MD, said in a news story.

The guidelines, which the ACS says were developed based on “based on professionalism, common sense, decorum, and the available evidence,” were designed standardize dress codes, which vary in different organizations.

“There’s a lot of confusion as to what is out there and what is being assessed. We felt it was very important to create a document that tries to evaluate everything and put it into perspective,” Hoyt said in the story. “This is what the surgical community feels is appropriate and best practice.”

Such dress codes aim to ensure that physicians look professional, which research shows is important to patients: Data aggregated from 30 studies found that most patients prefer physicians in professional attire.

As defined within the study, professional attire is “a collared shirt, tie and slacks for male physicians and blouse (with or without a blazer), skirt, or suit pants for female physicians.”

Professional attire is linked with perceptions of trustworthiness and respect, as well as improved patient satisfaction.

In addition, the statement provides details on wearing the skullcap in a way that ensures patient safety, and puts forth respective cleaning or disposal recommendations for cloth and paper caps. To facilitate enforcement of the guideline on wearing scrubs only within the perimeter of the hospital, the ACS also suggests the adoption of distinctive, colored scrub suits for OR personnel.

“This statement reflects our strong commitment to surgical patient safety. It’s important to provide an optimal surgical care environment for our patients. These recommendations for a comprehensive dress policy for surgeons will help us to achieve that goal,” said Hoyt.

The College is collaborating with the Centers for Medicare & Medicaid Services and the Joint Commission to ensure that their policies and regulatory oversight activities are aligned with these ACS recommendations.