By SUSAN ADELMAN, MD
What is a profession? The on-line Oxford Dictionary defines a profession as “a paid occupation, especially one that involves prolonged training and a formal qualification.” What is a guild? The same dictionary defines a guild as “a medieval association of craftsmen or merchants, often having considerable power…[or] an association of people for mutual aid or the pursuit of a common goal.” What are proletariat? This dictionary defines proletariat as “workers or working-class people, regarded collectively. (often used with reference to Marxism)” also, “the lowest class of citizens in ancient Rome.”

What attributes characterize a profession? According to the Association of Accredited Public Policy Advocates to the European Union, these are “great responsibility, accountability, based on specialized, theoretical knowledge, institutional preparation, autonomy, clients rather than customers, direct working relationships, ethical constraints, merit-based, and morality.” Further, “A profession makes deliberate choices where others have choices made for them or they simply react to what comes their way.”

Remember, Karl Marx defined the proletariat as “the social class having no significant ownership of the means of production (factories, machines, land, mines, buildings, vehicles) and whose only means of subsistence is to sell their labor power for a wage or salary.”

Which one sounds more like medicine today? When I entered the medical [Read More]

Certainly, this is not a formal survey, but those physicians that I have recently interacted with have been sadly and regrettably consistent. The new mantra seems; “I will put in the next four or five years and get out of the agony as soon as I can.” This defines a profession that has lost. Without the visibility or even the hope of any significant action steps, surrender becomes the final chapter. All of the professional organizations, the AMA and reinvented and reinvigorated state and local medical societies must acknowledge reality and get proverbially “their heads out of the sand.”

Medical students must be prepared for the realities of practicing medicine in an environment where their burnout is to be anticipated. Optimally, they would be equipped with the understanding and tools needed to rescue this great profession from the politicos, bureaucrats, insurance companies and myriad corporate entities that have attached themselves to the financial opportunity represented by this huge one fifth of GDP.

But medical educators are failing our future doctors. All of these including the inappropriate mandate of expensive useless technology poison the physician-to-patient relationship which is foundational to the enjoyment of practicing medicine and the survival of the profession. A model of subservience to the paymasters [Read More]

Terminally ill patients in Michigan, determined to have up to six months left to live, could request life-ending medication under bills the Legislature could likely take up next year.

“We wanted to make sure to introduce it before this holiday season in order to continue to work with stakeholders, for (it), against (it)…or even people that might have questions,” said Sen. Mary CAVANAGH (D-Redford Twp.), the lead sponsor behind this term’s “Death with Dignity” bill package, to MIRS. “But, it is not my intent to shove anything down that we haven’t had full vetting and full conversations of what is the best thing for Michigan, and who might be utilizing some of these new access points in end-of-life care.”

On the last day of regular session activities for 2023, Cavanagh and Sens. Kevin Hertel (D-St. Clair Shores), Veronica Klinefelt (D-Eastpointe) and Sam Singh (D-East Lansing) introduced SB 678 , SB 679 , SB 680 and SB 681 . In order to access the end-of-life care established through the legislation, a patient must be specifically diagnosed as terminally ill and cannot have more than six months remaining to live, based on medical judgements.

Life-ending medication must be prescribed by an attending physician and a consulting physician under the bills, and the patient must be evaluated to ensure they’re capable of decision making and rational [Read More]

Gov. Gretchen Whitmer signed a bipartisan legislative package at Sparrow Hospital last month that would increase the punishment leveled against people, excluding patients, that assault health care workers.

As she signed HB 4520 and HB 4521 , sponsored by Reps. Mike Mueller (R-Linden) and Kelly Breen (D-Novi), Whitmer was surrounded by nurses and doctors, who she said were facing an increase of violence, even as they faced a shortage of workers. Her response was signing this legislation into law, which could help stem the tide.

“We owe a debt of gratitude to the doctors, nurses, and health care workers who routinely step up to protect our communities and save lives,” Whitmer said. “Unfortunately, health care workers face rising rates of bullying, viciousness, and violence.”

The new law increases assault and battery to a 93-day misdemeanor and $1,000 fine, aggravated assault to a one-year misdemeanor and $2,000 fine, and felonious assault to a four-year felony and a $5,000 fine.

An exemption for patients was carved out in the legislation.

Jessica Lannon, a nurse at Sparrow, told stories before the bill signing about assaults on colleagues and her own experience with a man who pulled a large plumber’s wrench and threatened all the workers, saying  if his baby “did not come out perfect, we would all pay.”

“Too many workers are forced [Read More]

By EWA MATUSZEWSKI
Healthcare is not for the faint of heart. I’m not speaking of exposure to blood, trauma, distress, violence, and death – but there’s that, too.  Rather, I’m playing my violin for the healthcare warriors who are dealing with a new era of healthcare in a post-pandemic world. These are frontline nurses, physicians, phlebotomists, clerks, medical assistants, x-ray, ultrasound and med techs, midwives, social workers and behavioral health specialists. But they are also administrators, hiring managers and recruiters, payors, financial personnel and office managers.

This is not an exhaustive list; the healthcare world is simply too massive to capture every role in this column. The overarching commonality, though, is that healthcare professionals are facing a crisis of societal despair that is exhibited in increasing mental health problems in doctor’s offices, hospitals, community agencies, and school and university health clinics.

In speaking with a colleague recently, I opened up about some troubling statistics from our PO’s patient population regarding Emergency Department (ED) visits from January 2023 through September 2023. Out of 1,208 ED visits, 469 were due to substance use disorder and depression: alcohol (329), opioids (28), cocaine (29), general substance misuse (96) and depression (107). These numbers, significantly higher in most categories than pre-pandemic numbers, represent [Read More]

By KAITLYN DELBENE
Wachler & Associates, PC
The Michigan State Medical Society and various specialty organizations are urging the Michigan Attorney General to investigate the role of private equity in healthcare and to enforce Michigan’s corporate practice of medicine (CPOM) doctrine against apparent violations. In an October 23, 2023 letter, MSMS expressed concern that “a series of deceptive legal loopholes and shell corporations” has allowed private equity groups to effectively circumvent Michigan’s CPOM laws. While physician practice management companies and medical staffing companies are common in the healthcare industry, physician groups and management companies must be aware of the legal and regulatory challenges presented by these arrangements.

CPOM Primer: Michigan’s CPOM laws restrict who can own and control certain healthcare entities and employ certain healthcare providers. Specifically, Michigan law requires entities that provide professional medical services to be organized as professional corporations (PCs) or professional limited liability companies (PLLCs). Michigan PCs and PLLCs engaged in the practice of medicine may only be owned by individuals licensed to provide the professional medical services rendered by the entity, or by entities directly or indirectly solely owned by such licensed individuals. All officers of PCs and managers of PLLCs must be licensed to provide the professional medical services rendered [Read More]

By RALPH Z. LEVY & BRIAN S. FLEETHAM

Successful negotiation of physician employment agreements requires a careful balance of the objectives of the prospective employer with those of the prospective employee while ensuring that the negotiated agreement complies with the federal and state laws that apply to agreements of this type.  The prospective employer wants to make certain it has enough professionals to handle the needs of its patients, and the prospective employee wants to be paid adequately and fairly for services provided while preserving a work-personal life balance.  If the agreement “blows up,” the prospective employer wants protection against the physician “stealing” its patients, and the prospective employee wants to practice medicine without relocating.

Impact of Federal and State Laws That Apply to Physician Employment Agreements

Written physician employment agreements should comply with the regulatory safe harbors for agreements of this type under federal and state anti-kickback statutes (“AKS”) and the exceptions to the laws that restrict referrals by physicians to entities in which the physician has a financial interest for certain types of ancillary services under applicable state and federal laws, such as the Stark Law.  In addition, federal and state laws require preservation of the privacy of patient records (such as HIPAA and [Read More]

Michigan’s Unique Drug Immunity Statute Is No More

(FLINT) A Gov. John Engler-era law that shields drug manufacturers from liability if their medicine received U.S. Food and Drug Administration approval was flushed down the toilet late last month.

With Gov. Gretchen Whitmer’s signature, Sen. Jeff Irwin (D-Ann Arbor)’s SB 410 ends the 1995 Michigan Product Liability Act, a statute House Democrats and Democrats et al. used with some success on the campaign trail about 15 years ago.

The bill, which received bipartisan support in both the House and Senate, will end Michigan’s status as the only state with what Whitmer called an “immunity shield in place.”

Joined by bill sponsor Irwin, who Whitmer said has been working to overturn immunity for two decades, and Attorney General Dana Nessel, Whitmer told the story of Leslie Richter, whose husband lost his life after taking a prescription drug.

Richter became the public face of the statewide attempt to repeal the 1995 law after her husband, Richard Richter, died from a stroke, allegedly from taking the pain medication Vioxx for his arthritis

Richter’s name appeared on a New Jersey court’s case list as having filed a claim there against the company that manufactured Vioxx, Merck, which would have made her potentially eligible to receive a portion of a $4.85 billion settlement.

“Had they lived in [Read More]

By BRAM SABLE-SMITH

UNIVERSITY CITY, Mo. — As activists parse the results of a Nov. 8 vote to protect abortion rights in Ohio, Jamie Corley is already well on her way to putting a similar measure in front of Missouri voters next year.

Corley, a former Republican congressional staffer, filed not one, but six potential ballot measures in August to roll back her state’s near-total ban on abortion, triggered by the U.S. Supreme Court’s June 2022 decision to end federal protections for terminating pregnancies.

“I can’t emphasize enough how dangerous it is to be pregnant in Missouri right now,” Corley said at a restaurant near her home in this St. Louis suburb. “There is a real urgency to pass something to change the abortion law.”

Missouri is one of at least 11 states considering abortion-related ballot measures for next year, part of the wave of such actions since the Supreme Court’s decision on Dobbs v. Jackson Women’s Health Organization. And while November 2024 is still a year away, the groundwork for those campaigns has been in motion for months, sometimes years.

In Iowa, for example, efforts to pass a state constitutional amendment declaring no right to abortion began in 2021, although the legislature has yet to finish the process. In Colorado, competing [Read More]

By SUSAN ADELMAN, MD
When lawyers and legislators talk about abortion, they often struggle to define viability, but the matter is much more complicated than most of them acknowledge. The classic Supreme Court case Roe versus Wade claims that viability starts at the third trimester, which they interpret as meaning 28 weeks gestation. British law has settled on 24 weeks. American state laws vary from 20 to 25 weeks.  The problem is that whether or not a fetus would be viable outside of the womb depends on many factors.

The American College of Obstetrics and Gynecology explains that “many other factors…influence viability, such as sex, genetics, weight, circumstances around delivery, and availability of a neonatal intensivist health care professional.”  But that just scratches the surface, since some babies could never be viable, such as ectopic pregnancies. Other babies would be viable if born in a major medical center with a superb neonatal unit, but not so much in a small town with no such facility.

Moreover, the goal posts keep moving.  Babies who correctly would have been judged nonviable years ago have a far better prognosis today because of the many advances in neonatology. A literature search shows how much things have changed since I began my career as [Read More]

By EWA MATUSZEWSKI
I wrote last month about my admiration for The Salvation Army’s outreach efforts to combat the social determinants of health through its services to the hungry, the homeless, and those with substance use disorder or other difficult life challenges. This month, I want to extend my admiration to the payors and partners who joined The Salvation Army and MedNetOne in a new program aimed at ramping up numbers for Medicaid Renewal.

Some background. As the federal government seeks to redetermine who is qualified for Medicaid following a pandemic-related executive order that extended Medicaid benefits without proof of continuing qualification, each state is required to champion redetermination and renewal efforts. The redetermination period runs through July 24, 2024, and those of us involved are racing to meet the deadline through a host of innovative programs that directly reach impacted residents.

To ensure that our state’s most vulnerable residents have access to Medicaid, we can’t expect them to come to us. The renewal process can be overwhelming to some – and for those without computer or smartphone access, it’s nearly impossible without hands-on assistance.

Enter Michigan’s healthcare community. At an October 24 gathering at The Salvation Amry Harbor Light’s facility on Rosa Parks Boulevard in Detroit, health insurers, [Read More]

By ROLF LOWE
On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) introduced new policies related to the Calendar Year 2024 Physician Fee Schedule intended to improve and promote access to mental health and substance use disorder services to meet the growing demand for these services. In its November 6, 2023, blog discussing the changes[1] CMS identified three areas the policies are intended to address which are expanding the behavioral health workforce, covering gaps in in access to behavioral health services and paying more accurately for behavioral health services.

The types of behavioral practitioners able to enroll in Medicare are being expanded to allow the enrollment of nearly 400,000 who were previously not eligible to bill the Medicare program for the services. CMS is allowing Marriage and Family Therapists and Mental Health Counselors to provide what they deem essential services, including individual and group psychotherapy. This includes all addiction counselors or alcohol and drug counselors who meet the Mental Health Counselor requirements. CMS has also instructed Medicare Advantage Plans (MAPs) to have an adequate number of outpatient behavioral health providers in their networks to help meet the identified demand for these services, as well as working on establishing payment for services [Read More]

By SUZANNE SUKKAR & KATHLEEN CAMPBELL WALKER

The nursing profession vital signs are unstable and require an intervention. The single largest occupation of health care workers is Registered Nurses (RN). It is also the fifth largest profession nationally.[1] Yet the nursing profession is facing extreme shortages as the need for health care workers grows. Specifically, according to data projections, the United States (US) will have a shortage of RNs resulting from an aging population and significant numbers of nurses nearing retirement age.[2] Compounding the situation is US nursing schools’ limited capacity to enroll nursing students into programs due to the lack of faculty, limited clinical placements for the nursing students, and a shortage of preceptors, who can supervise nursing students at health care providers.[3]

How can the US health system sustain itself in the short and/or long-term? As nurses prepare a plan of care for patients, health care providers need to prepare a plan of care for attracting and retaining nurses. Part of the assessment and diagnosis will depend in part on bringing foreign national health care workers into the US.  Certainly, Detroit based Henry Ford Health has focused significant efforts in recruiting up to 600 registered nurses from the [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Thompson Wants House Hearings Held About Hawthorn, Walter Reuther Hospital

In a letter to House Behavioral Health Subcommittee Chair Felicia Brabec (D-Ann Arbor), Rep. Jamie Thompson (R-Brownstown) requested the subcommittee hold a hearing to look at instances where the state juvenile mental health system has failed greater Detroit families.

She specifically referenced the Walter Reuther Psychiatric Hospital in Wayne County, which is temporarily housing children within an adult facility, and the Hawthorn Center in Novi, which lawmakers have previously requested an audit of.

In addition to the 17 patient escapes Thompson said have been reported since 2020, the center was recently subjected to lawsuits after holding an unannounced shooter drill.

Though the suit was not successful, Thompson said she’s spoken with families who have loved ones in both facilities and who have expressed “concern and outrage” about communication barriers, restrictions on weekends, health concerns, erratic education services and limited recreation and outdoor time.

“Standing up for families and making sure children in our region and throughout the state are safe are my top priorities in the Legislature,” Thompson said. “There have been several reports and accounts about troubling issues at these two facilities. Even as months go by, there has been no accountability [Read More]

Ahead of national physician assistant (PA) week, Oct. 6-12, several House members introduced a bipartisan, four-bill package including PA’s under the blanket of mental health professionals and changing their title to “physician associate.”

The bills, sponsored by Reps. Carrie A. Rheingans (D-Ann Arbor), Donavan McKinney (D-Detroit), Reggie Miller (D-Belleville) and Curtis VanderWall (R-Ludington), create the “Patient-Led Care Bill Package,” which Rheingans said will improve patient access to care, “while also reducing some of the red tape that’s standing in the way of physician assistants.”

Rheingans’ bill, which she said was read in this afternoon, would address the 3.5 million Michiganders living in a health provider shortage area, including the 38% of Michiganders who experience a mental illness and have an unmet treatment need.

“Since we know patients deserve the highest quality of care from professionals who are trained to provide it, we’re here trying to address this gap,” she said. “Sometimes, outdated laws on the books get in the way of people’s ability to provide that care.”

Her bill would amend the mental health code to include PAs and nurse practitioners under the definition of mental health professionals, allowing an additional 7,400 practicing PAs to treat patients with mental health concerns, Rheingans said.

She said approximately one in five of them are in primary care [Read More]

By SUSAN ADELMAN, MD
The British have a one-payor public healthcare system, the National Health Service (NHS), which pays for most medical care in the UK. For the rest, many NHS doctors also see patients privately, and a number of others have strictly private practices. As our English cousins explained, the NHS has been breaking down and running short of money for years. Now, the aftermath of COVID and the onset of serious inflation have stimulated widespread strikes. And for the first time, both junior doctors and consultants are walking out together nation-wide for three to four days at a time. The issues are both financial and matters of patient care. Doctors complain of being forced to work long hours without a break, and junior doctors have suffered a pay cut of 26.1% since 2008.

The British Medical Association (BMA) represents 75,000 doctors. It has requested raises of 12% for consultants and 35% for juniors, just to match real salaries paid in 2008. Last year junior doctors were offered a 2% increase. More recently, the government offered raises of 6% to 8.8%. They say it is their last offer. So far, negotiations with both consultants and junior doctors have been stalled since May, and the BMA announced [Read More]

By EWA MATUSZEWSKI
When you hear the name, Salvation Army, you think Red Kettle, right? As you should; but don’t just think about bell ringing at the holidays. Salvation Army, a faith-based, nonprofit organization dedicated to serving people in need without discrimination, can be an excellent partner to physician organizations and other healthcare groups seeking sustainable change in the community through grass roots efforts.

While I’ve been on the Metro Detroit Advisory Board of the of the Salvation Army since 2021, I was not asked to write about the organization. I just can’t help myself. Our working relationship started in 2020, when MedNetOne Health Solutions collaborated with the Salvation Army to bring primary care services to its Macomb Harbor Light facility, a residential treatment program for those experiencing substance use disorder, and one of three operated by the Great Lakes Division.

Like many positive working partnerships, our collaboration grew – in large part due to the leadership of Capt. Jamie Winkler, executive director of the Eastern Michigan Harbor Light System. Most recently, Capt. Winkler decided to spearhead the Salvation Army’s efforts with the Michigan Medicaid redetermination program, which is part of a post-pandemic nationwide initiative to assist Medicaid beneficiaries verify the factors of eligibility to ensure continuation of [Read More]

By JENNIFER COLAGIOVANNI
Wachler & Associates, PC

In August 2023, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced its strategic plan for managed care oversight.  OIG’s plan involves rigorous oversight of managed care plans while also closely coordinating with the plans in the efforts to fight fraud, waste, and abuse. OIG’s plan will scrutinize Medicare and Medicaid managed care contracts from inception through enrollment, reimbursement, services, and renewal. In order to address fraud, waste, and abuse risks, the goal of OIG’s plan is to hold Medicare Advantage organizations (MAOs) and Medicaid managed care organizations (MCOs) accountable.

Currently, more than half of Medicare enrollees and more than 80% of Medicaid enrollees are covered by managed care programs. In order to oversee the almost $700 billion that the federal government spent on managed care programs in 2022, OIG has set out four stages of the managed care life cycle that it intends to investigate: (1) plan establishment and contracting, (2) enrollment, (3) payment, and (4) provision of services.

Plan Establishment and Contracting: OIG intends to review activities that occur when the Centers for Medicare & Medicaid Services (CMS) or states initially establish or renew managed care contracts. In this contract review phase, [Read More]

By ALLISON TUOHY & MARK E. WILSON
In an age of highly polarized opinions, there is a common consensus to address the rapidly rising health care costs in the United States. Research shows that the US average gross national product for health care costs is 17.1% while the rest of the world average is about 10.6%; the US missing that mark costs $1.7 trillion per year. There are numerous opinions and beliefs on how to achieve significant savings in health care without sacrificing quality of care.

Many believe that the current “fee-for-service” model simply incentivizes the health care system to treat “sick” patient symptoms rather than to practice preventative care. Attempts to control costs by reducing individual fee-for-service rates have not been successful. Over the past ten years, new concepts like ACOs, CINs and other similar operational vehicles initiated the shift from fee-for-service financing. The ultimate goal has been to move toward a true risk-and-reward model that incentivizes health care practitioners to delay or reduce unfavorable medical outcomes as long as possible.

Value-based care is a health care delivery model that aims to proactively adjust the quality and timing of patient care thus reducing overall costs. The model rewards providers based on influencing positive patient outcomes [Read More]

When I started out as a reporter, I got to know the major players in healthcare in Michigan. Most came from Metro Detroit or Lansing. A few came from West Michigan. But there was this one guy who worked for a county medical society in the middle of the state who seemed to be involved in all of the major health policy debates and a bunch of obscure ones.

He was a bear of a man, tall and broad in stature with a booming voice and loud laugh that had the playful ring of childhood on the edges. He brought passion and caring to every issue on his docket. And he was smart, no, more than that, he was wise.

Under his stewardship, the Genesee County Medical Society left a large footprint disproportionate to its size. Pete seemed to convince his members and the state medical society that GCMS doctors belonged in leadership positions. Once there, they advocated strongly for traditional physician interests such as reimbursement issues medical liability policy, but also environmental issues and single-payer universal healthcare.

After I made the move to Lansing to work for the state legislature on health policy, Pete and I kept in touch, his insightful perspectives and wry sense of humor [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Immigrant Children, Pregnant Women Wouldn’t Need To Wait For Medicaid Under Bill

The five-year waiting period for immigrant children and pregnant women to be able to use Medicaid services in Michigan would be waived under a bill taken up by a House committee early this month.

Rep. Alabas A. Farhat (D-Dearborn) told the House Insurance and Financial Services Committee that HB 4740 would help the lives of immigrants while addressing infant mortality and children’s health issues.

“It’s transformational for some lives and helps ensure that there are safe patches for that child,” Farhat said.

Sara Ismail of the Arab Community Center for Economic and Social Services (ACCESS) told a story about a family that had been living in the United States for nearly four years, but couldn’t get insurance.  She said they had to rely on free clinics and limit their visits to the emergency room.

Michigan Council for Maternal and Child Health Executive Director Amy Zaagman told a similar story and said many of those populations didn’t get the health care they needed because of it.

“They increase utilization of higher intensity services, like emergency rooms. They struggle to find providers that will even accept them. They miss out on critical preventative services, [Read More]

Six bills rolling back 30 years of abortion restrictions put on the books by Republican majorities moved through a House committee this morning, but their future in the full chamber is dubious after one Democrat came out against them and more may be on the way.

Rep. Karen Whitsett (D-Detroit) issued a press release two minutes before today’s House Health Policy Committee that she would not support the 11-bill Reproductive Health Act, which includes legalization of late-term elective abortions.

One piece of the package allows taxpayer money to fund elective abortions, which Whitsett said she could not support at a time when many seniors in her district live in poverty.

“Elderly citizens across our state are forced to make unthinkable trade-offs just to survive – deciding between food, shelter or the medication that literally keep them alive,” she said. “We have an unbreakable moral obligation to direct limited Medicaid resources first and foremost toward caring for these vulnerable grandparents who built the very fabric of our society.”

MIRS has learned Whitsett is not the only Democrat with concerns. Democrats representing strong communities of faith are fine returning Michigan to a Roe v. Wade environment, but they are not OK with dismantling the guardrails around the procedure.

Five of the 11 bills – two allowing for Medicaid-paid abortions [Read More]

By EWA MATUSZEWSKI

I’ve been hesitant to dip my toe into the artificial intelligence (AI) discussion in this forum because so much has been written about it in a short period of time. What can I add at this early juncture? I changed my mind after a healthcare tech colleague recently asked me to test out a platform using AI that helps clinicians access evidence-based guidelines or even determine if a patient needs to have a consult with a specialist. While I’m not a clinician, it’s not unusual for me to test products and services that may help our healthcare provider members in their quest to provide high quality care. Following and responding to the designated steps, the ‘Need a Consult?’ option popped up. Sure, I’ll bite! I clicked on the option and – lo and behold – a real-life specialist appeared on the screen! Wow – this could really be a neat tool. AI can be wonderful! And yet…

I couldn’t help but recall when the Michigan Quality Improvement Consortium (MQIC) offered simple guidelines to primary care physicians on topics like diabetes, pediatric obesity, hypertension, co-morbidities, and behavioral health. Updated every two years by healthcare professionals the guidelines had a Michigan-focused context and were an extremely [Read More]

By SUSAN ADELMAN, MD
As most might guess, marijuana is the commonest illegal drug in the United States. An estimated 48.2 million people used it at least once in 2019. The percentage of U.S. drivers with marijuana detected in their blood was 8.6% in 2007 and rose to 12.6% in 2013-14. Should marijuana be legalized nationally? For safety’s sake, are there legal blood limits for drivers?

Marijuana and hemp come from the Cannabis sativa plant.  Legally, hemp is defined as any part of the cannabis sativa plant that contains 0.3 percent or less of THC (tetrahydrocannabinol), while marijuana contains more than 0.3 percent THC. THC is the substance that causes a high. CBD (cannabidiol) does not. In some sources, cannabis is a Schedule 1 drug, as is heroin, but the Michigan Public Health Code says “Marihuana, including pharmaceutical-grade cannabis, is a schedule 2 controlled substance if it is manufactured, obtained, stored, dispensed, possessed, grown, or disposed of in compliance with this act and as authorized by federal authority.”

In 2018, the U.S. Congress passed the Agriculture Improvement Act, removing hemp from the federal Controlled Substances Act and effectively legalizing CBD if it comes from hemp. Confusingly, marijuana still may be illegal at the federal level, but 24 [Read More]

By DANIEL AYYASH

Overview

At its core, hospice provides palliative care and support for terminally ill individuals and their families. People who elect to receive hospice care generally receive this care in the home setting by a team of professionals and caregivers who are specially trained to address the sensitive needs of those nearing end of life. In addition to meeting patients’ physical needs, hospices provide care for the “whole person,” which includes care that meets their emotional, social, and spiritual needs. Being able to provide beneficial, high-quality care is critical to the successful efforts of hospice providers. Recently, the Centers for Medicare & Medicaid Services (CMS) indicated that they have noticed an increasing trend of hospice services fraud. In response to this perception, CMS is significantly increasing its attention and scrutiny on hospice providers.

CMS Observations

In recent statements, CMS claims to have identified instances of hospices certifying patients for hospice care when they were not actually terminally ill, as well as providing minimal or no services to patients. CMS also claims that some of the addresses listed for these allegedly fraudulent hospices appear to be tied to non-operational locations. Additionally, CMS highlighted a particular trend known as a “churn and burn” scheme, where a new hospice opens [Read More]