December 7, 2009

IN THIS ISSUE

24th Children's Holiday Party Spreads Smiles, Cheers
Dr. Sawhney Honored For Founding Role In Holiday Party
AMA Weighs In On New Senate Health Care Reform Bill
MSMS Update On PHP Purchase, CHAMPS Social Security Number Issue
Two DMC Hospitals Ranked Among Nation's Safest
Oakwood Celebrates Award To Midwest Health Plan
Researchers Examine Spice's Impact On Cancer
Children's Holiday Party Contributors 2009

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24th Children's Holiday Party Spreads Smiles, Cheers

By PAUL NATINSKY
The 24^th Annual WCMS Foundation Children’s Holiday Party on Dec. 5 was, once again, a resounding success, with more than 170 children gifted with a winter coat, board game, toy, toothbrush and other items as well as lunch and a laptop visit with a candy cane-bearing Santa (Dr. Marty Barbour).

This year, the entire event took place inside the Detroit Science Center. The kids’ day started with a movie in the Science Center’s IMAX theater and ended with the audience with Santa. In between there was singing of holiday favorites Jingle Bells and Rudolph the Red Nosed Reindeer, led by MSMS President Richard Smith and a warm welcome from WCMSSM President George Shade Jr., MD. Dr. Cheryl Gibson Fountain, the WCMSSM President Elect worked with staffers Katina Hughley and Joel Hetzner and more than two dozen WSU medical students and Henry Ford Health System resident physicians worked tirelessly as Santa’s helpers to distribute the gifts.

The generosity of more than 150 contributors helped provide lunch and gifts and gave Santa’s workshop a jumpstart for the Holiday Party’s silver anniversary in 2010.

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Dr. Sawhney Honored For Founding Role In Holiday Party

By PAUL NATINSKY
Twenty-four years ago, Dr. Krishna Sawhney had an idea that he was surprised to have been able to sell to the Wayne County Medical Society Board – a holiday party to benefit children.

The Board supported the idea as it seemed noble and unobjectionable. Then they told Dr. Sawhney he would have to come up with the money to make it happen.

Those are the unlikely events that lead to a string of WCMS fundraising fashion shows. But the money was raised and the first 100 children got gifts and a lot more.

The event used to be held at the old WCMS headquarters on Antietam in Detroit. The old building had a large reception and dining hall along with a kitchen. Medical students and residents performed skits at those early shows, providing entertainment for everyone there.

Over the years, the number of children helped has increased and is now close to 200 annually. Other things have changed as well. There are no more skits, but Dr. Marty Barbour is an awfully jolly and convincing Santa. The party faced a crisis a few years ago when WCMSSM decided to sell the old headquarters. Dr. Lourdes Andaya saved the day when she proposed holding the event at the Detroit Science Center.

This year, as the WCMS Foundation’s Children’s Holiday Party continued it’s proud tradition, a select group of physicians, family and staff took a little time after the party to honor it’s founder, Dr. Sawhney, who was presented with decorative, rotating globe and lauded by his peers.

Dr. Sawhney seemed touched by the gesture and shared some of his fond memories about the origin and evolution of the idea he hatched almost a quarter of a century ago.

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AMA Weighs In On New Senate Health Care Reform Bill

Editor’s Note: The following is a Dec. 1 letter from the AMA to Senate Majority Leader Harry Reid. It is the AMA’s analysis of the latest Senate health care reform proposal.

The American Medical Association (AMA) remains committed to achieving enactment of comprehensive health system reform legislation that improves access to affordable, high-quality care and reduces unnecessary costs. We do not believe that maintaining the status quo is an acceptable option for physicians or the patients we serve.

Overview of Provisions that AMA Supports
H.R. 3590, the “Patient Protection and Affordable Care Act,” includes a number of provisions that are consistent with the AMA’s reform priorities. In general, we support the provisions in the bill that: reform the health insurance market to provide more choice and access to affordable coverage for individuals and small businesses, including provisions relating to guaranteed issue, guaranteed renewability, modified community rating, pre-existing condition limitations, nondiscrimination based on health status, adequacy of provider networks, and transparency. We also support: tax credits that are inversely related to income, refundable, and payable in advance to low-income individuals who need financial assistance to purchase private health insurance; establishing health insurance exchanges that offer more affordable choices; reducing overpayments to Medicare Advantage plans; enhancing Medicaid coverage as a safety net; coverage for prevention and wellness initiatives without co-payments or deductibles; and the creation of an independent comparative effectiveness research entity that will develop information to enhance patient-physician decision making about treatment options.

Improved Provisions
The AMA also appreciates that several physician-related provisions in the bill represent improvements over earlier proposals, including the elimination of a five percent Medicare payment cut for “outlier” physicians, changes to the Medicare quality reporting provisions, and reductions in proposed Medicare enrollment fees. Nonetheless, we continue to have serious concerns about certain provisions in the bill, and we look forward to working with you and your Senate colleagues to secure additional changes to promote stable and sound health system reforms.

The following are comments and recommendations on policy issues that the AMA believes the Senate must address during the floor debate before voting on a final bill.

Medicare Physician Payment Formula
While the AMA appreciates that H.R. 3590 would avoid a 21 percent cut in Medicare physician payments in January, a permanent repeal of the sustainable growth rate (SGR) is critical to the goal of ensuring security, stability, and access for seniors, and to provide the essential foundation for the development of new payment models and delivery reforms. The SGR must be replaced this year with a system that keeps pace with the cost of running a practice and is backed by a fair, stable funding formula. We oppose further temporary patches to the payment formula that serve to increase both the severity of future cuts and the cost of a permanent solution.

Independent Medicare Advisory Board
AMA policy specifically opposes any provision that would empower an independent commission to mandate payment cuts for physicians, who are already subject to an expenditure target and other potential payment reductions under the Medicare physician payment system. Therefore, we oppose the Independent Medicare Advisory Board as currently designed in H.R. 3590, and we look forward to working with you on significant changes to the proposal. Further, the provision does not apply equally to all health care stakeholders, and for the first four years significant portions of the Medicare program would be walled off from savings. This presents a serious inequity if spending reductions are to be obtained from only a fraction of the program. In addition, Medicare spending targets must reflect appropriate increases in volume that may be a result of policy changes, innovations that improve care, greater longevity, and unanticipated spending for such things as influenza pandemics. These are critical issues with the potential for significant adverse consequences for the program, which must be properly addressed through a transparent process that allows for notice and comment. Congress should also retain the ability to achieve a different level of savings than proposed by the Medicare Board to adjust for new developments that warrant spending increases, and maintain its ultimate accountability for the sustainability and stability of the Medicare program.

Value Based Payment Modifier
While the AMA strongly supports efforts to develop quality improvement programs and to appropriately address geographic variation, we oppose redistributing Medicare payments among providers based on outcomes, quality, and risk adjustment measurements that are not scientifically valid, verifiable, and accurate. Section 3007 of the bill requires the development and application of a cost/quality index modifier, and presumes the availability of policy tools and a level of precision that do not currently exist. Core components needed to develop the cost/quality index are in their infancy, and the Centers for Medicare and Medicaid Services (CMS) lacks the resources to develop and implement them. In addition, there are fundamental, technical problems with the basic concept of adjusting payments at the individual physician level, as well as with adjusting payments based on outcomes for the previous year’s patient case mix.

Necessary processes must occur for appropriate implementation and use of quality measures under the cost/quality index, including appropriate development, testing, and endorsement of measures. For example, cost-of-care measures require adequate risk adjustment methodologies and agreed upon methods for determining attribution of the care provided. Yet, to date, risk adjustment and attribution models are woefully inadequate. We recommend further study of geographic variation as well as funding for the transparent development and testing of measures that recognize necessary components of agreed upon risk adjustment and attribution models that would be most useful for addressing geographic and quality of care variations.

Primary Care and General Surgery Bonus
The AMA supports primary care and general surgery bonus payments treated as a funded workforce investment that is not offset through a reduction in payments to other physicians.

We oppose budget neutrality offsets and therefore strongly encourage the identification of other financing mechanisms to avoid across-the-board payment cuts for other physician services.

Tax on Cosmetic Surgical and Medical Procedures
The bill imposes a five percent excise tax on elective cosmetic surgical and medical procedures performed by a licensed medical professional collected at the point of service. The AMA strongly opposes taxes on physician services to fund health care programs or to accomplish health system reform. We believe that additional revenues generated to help finance health system reform should come from broad-based taxes.

Procedures that are excluded from the tax are “elective cosmetic surgical and medical procedures that are necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.” While the exception is broad, it nonetheless remains ambiguous as to the full scope of its application. The last phrase “disfiguring disease” limits the reach of the exception and potentially excludes disfiguring conditions. Also, it is not clear how “disfiguring” would be defined, which in any given case is subjective. Further, taxing medical services at the federal level is a major policy change. We have serious concerns that this revenue stream would be expanded in the future to encompass a broad array of other health care items and services that may not be considered “medically necessary or covered services.”

Physician Quality Reporting Initiative
We appreciate the proposed improvements to the Physician Quality Reporting Initiative (PQRI) to require timely feedback and establish an appeals process, as well as extending the period of bonus payments to allow for further program improvements and broader physician participation. However, the AMA opposes mandatory PQRI participation or the imposition of penalties on physicians who do not successfully participate. Based on physicians’ experience with the PQRI to date, this program is fraught with administrative problems that have made it extremely difficult to assess whether a physician has successfully participated. Further, not all physicians are currently eligible to participate in the PQRI with endorsed measures that are relevant to their service mix.

Physician-Owned Hospitals
While the AMA supports the disclosure of physician hospital ownership and investment information, we oppose the proposal to eliminate the whole hospital exception to the Stark self-referral law. Physician-owned hospitals have achieved the highest quality scores in some markets and have been shown to provide more net community benefits through uncompensated care and taxes than not-for-profit competitors as a share of total revenues. In addition, a recent study by the Center for Studying Health System Change found that physician-owned hospitals do not adversely affect general hospitals’ ability to care for patients. Limiting the viability of physician-owned hospitals will reduce access to high-quality health care and have a destructive effect on the economy in communities these hospitals serve. Proposed limits on existing physician-owned hospitals would put them at a competitive disadvantage, making it difficult for them to respond to the health care needs of their local communities. The provisions would also effectively shut down many physician-owned hospitals currently under development. We urge that this provision be removed from H.R. 3590.

Provider Enrollment Fees
The AMA opposes the imposition of Medicare provider enrollment fees on physicians. Given the multiple screening procedures that already apply to physicians in various licensing and credentialing processes, we believe this is an unnecessary duplication of review processes and another administrative burden with the potential of further discouraging physicians from participating in the Medicare and Medicaid programs. We urge that physicians not be subject to the proposed Medicare enrollment fee.

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MSMS Update On PHP Purchase, CHAMPS Social Security Number Issue

As sent to the MSMS Board Dec. 4, here are two updates on payer issues provided by the MSMS Health Care Delivery Department:

BCN Purchase of PHP
As has been reported, Blue Care Network (BCN) is seeking to purchase Physician Health Plan (PHP) for $45 million. This includes their commercial and Medicaid products, physician network and membership.

Based on the acquisition of M-CARE by BCN and CareChoices by Priority in 2006, MSMS has policy (HOD 89-07A) to closely monitor such acquisitions and a history of opposing such mergers. 

According to the American Medical Association "Competition in Health Insurance - 2009 Update," PHP currently accounts for 52 percent of the HMO market in the Lansing area, BCBSM has 47 percent. BCBSM's post-merger share would be 99 percent. The Herfindahl-Hirschman Index (HHI) of competition (a mathematical measure used by the Department of Justice (DOJ) to assess the overall competitiveness of a market) indicates the post-merger market share would be "highly concentrated" meaning DOJ would have "significant competitive concerns." 

MSMS met with the Ingham County Medical Society (ICMS) to present market share data and confer on possible effects this merger may have on the community.  The ICMS Board of Trustees voted to support MSMS in opposing the acquisition for the following reasons:

• Substantially lessen the competition in the area for all commercial products
• Not in public's interest due to BCBSM having ability to further control health plan pricing and physician fees

In addition to working with the ICMS, MSMS has been in regular contact with the American Medical Association (AMA). The AMA has provided extensive market research and has shared their experiences with similar insurance purchases in other states.  Most recently, they worked with the Tennessee Medical Association to successfully block a BCBS merger in that state. 

MSMS is working with all pertinent regulatory agencies to share data and represent physician interests in this matter. MSMS attended and monitored the Office of the Financial and Insurance Regulation (OFIR) hearing. MSMS, ICMS and the AMA submitted opposition letters to OFIR by the Insurance Commission's deadline in late November. And, at their request, MSMS and ICMS participated in a conference call with the DOJ and the Office of the Michigan Attorney General (AG). 

We thank Doctor Richard and Doctor Elmassian, MSMS Board members from Ingham County on their assistance with this issue. 

Medicaid CHAMPS
MSMS has received numerous complaints regarding the CHAMPS Provider Enrollment Unit requiring office managers to provide them with their social security numbers. The Enrollment Unit is advising that due to the Centers for Medicare & Medicaid Services (CMS) Auditing regulations, all physicians/providers are now required to supply the office manager's name and social security number, to make sure that the office manager is not sanctioned or suspended with the Office of the Inspector General (OIG). Physician offices are being told the information must be received within 7 days or the physician/provider's National Provider Identifier (NPI) will be closed out, resulting in non-payments. MSMS legal counsel has reviewed this issue resulting in a difference of opinion in interpretation of the regulations. MSMS has communicated this to Medicaid and they have committed to reviewing our request with the Department's counsel. MSMS anticipates further discussions with attorneys from both organizations next week.  We will continue to keep the Board and membership informed on our progress. 

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Two DMC Hospitals Ranked Among Nation's Safest

For the third consecutive year, two Detroit Medical Center (DMC) hospitals met the stringent standards of the Leapfrog Group and have received honors as top hospitals in the nation for patient quality and safety, according to DMC officials. Detroit Receiving Hospital and Harper University Hospital the only hospitals in Michigan and are among only 45 hospitals (34 urban, 3 rural and 8 pediatric) nationally to receive the recognition for 2009.

The Leapfrog Group is the nation’s premier quality ranking agency, acting on behalf of many of the nation's Fortune 500 companies with the goal of coming together to improve overall hospital quality.

The Leapfrog group identified hospitals achieving the highest levels for quality and safety practices, being named 2009 “Leapfrog Top Hospitals”. The Leapfrog Group rankings are based on a survey conducted at 1206 hospitals across the country and is considered the most comprehensive and current assessment of hospital quality and safety available.

To make Leapfrog's list, a hospital must have a top efficiency of care score for at least three of four procedures and conditions. The Leapfrog survey collects data from hospitals on their progress and commitment toward implementing practices in the areas of: Computerized Physician Order Entry: Do physicians enter patient prescriptions and other orders into computers linked to error prevention software; ICU Physician Staffing: Are intensive care units staffed by trained ICU specialists (intensivists); Evidenced-Based Hospital Referral: How well do hospitals perform seven high-risk procedures and Leapfrog Safe Practices Score: How well are hospitals progressing in 13 National Quality Forum-endorsed Safe Practices.  

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Oakwood Celebrates Award To Midwest Health Plan

Oakwood Healthcare Inc. (OHI) is proud to announce that its business partner, Dr. Mark Saffer and the Midwest Health Plan were recently recognized nationally and regionally for three programs focused on improving member satisfaction. Midwest’s award winning programs Green Light Go, Caring for Culture – Caring for Women and Get Physical. Get Fit. Get Active!  were launched to eliminate referral requirements for routine services, to address low rates in a number of female health measures and to promote health and physical activity and health services.

“Dr. Saffer and Midwest Health have been consistently delivering quality care and meeting the healthcare needs of the southeast Michigan community for more than 30 years,” said Brian Connolly, president and CEO, Oakwood Healthcare, Inc. “Oakwood is honored and privileged to partner with such a fine organization and we look forward to continuing to provide quality healthcare for our friends and neighbors in this region.”

The Michigan Association of Health Plans designated Midwest as one of the best health care improvement practices in Michigan by awarding the organization with two Pinnacle awards recognizing the elimination of referral requirements and the youth health and fitness program created to promote health and physical activity among Detroit school aged youth with free and low-cost health services through community and school based centers.

For this program, Midwest partnered with the Detroit Wayne County Health Authority and the Detroit Department of Health and Wellness Prevention to offer physicals, sports physicals, nutrition counseling, asthma control, vision and hearing screening to students and athletes.

The National Committee of Quality Assurance (NCQA) award acknowledged Midwest for innovation in multicultural healthcare through its outreach efforts to educate women. With a culturally diverse membership, Midwest sought to educate members on the importance of preventive healthcare for women and increase the number of women obtaining preventive screenings. Community organizations such as the Arab Community Center for Economic and Social Services joined Midwest to promote community health education.

In January of this year, OHS acquired all five Midwest Health Center locations from Dr. Mark Saffer and his partners, including offices in Dearborn, Detroit, Livonia, Romulus and Taylor. In conjunction with Midwest Health Center, Oakwood is working on the Dearborn Town Center development project – a mixed use development that will offer multi-specialty medical care, retail, office space and an assisted living facility for seniors located on the corner of Michigan Avenue and Schaefer in the heart of downtown east Dearborn. The Dearborn Town Center will serve as the new home of the Dearborn Midwest Health Center, which has been serving the community for more than 30 years.

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Researchers Examine Spice's Impact On Cancer

Researchers at the Wayne State University School of Medicine and the Barbara Ann Karmanos Cancer Institute are taking a more holistic view of treatment for colorectal cancer, exploring the beneficial properties of curcumin, the major active ingredient in the spice turmeric.

Besides being a natural compound used in Southeast Asian dishes, turmeric has been used for centuries as an anti-inflammatory agent. School of Medicine and Karmanos researchers have been exploring the mechanical and therapeutic functions of curcumin for about seven years and have published a recent research paper titled “Elimination of Colon Cancer Stem-like Cells by the Combination of Curcumin and FOLFOX” in the December issue of scientific journal Translational Oncology. The paper highlights the scientists’ findings that using curcumin alone or paired with FOLFOX (a standard chemotherapy agent) in treating chemotherapy-resistant colon cancer cells resulted in a marked reduction in cancer stem-like cells.

“What we are interested in doing is utilizing natural agents to supplement or enhance the effectiveness of chemotherapeutic drugs,” said Adhip Majumdar, PhD, professor of Internal Medicine at the School of Medicine and the Karmanos Cancer Institute, and senior research career scientist at the Veterans Administration Medical Center. Dr. Majumdar is the corresponding author of the paper and the study’s principal investigator.

“I think this is very pioneering work because it further explores what we feel is an effective partnership between natural agents and traditional chemotherapy methods,” he said. “It’s a very hot area of work. We wanted to get the research out as fast as possible so that more in-depth research can continue.”

Cancer stem-like cells are resistant to conventional chemotherapy and can renew themselves. They can also develop into any cell in the overall tumor population and drive continued expansion of malignant cells, allowing them to invade and metastasize. Scientists believe failure to eliminate cancer stem-like cells is one of the underlying causes for continued malignancy. Once colorectal cancer returns, it is even harder to treat.

“Surgery is probably the best treatment that we have in fighting colorectal cancer,” said study co-author Bhaumik B. Patel, MD, assistant professor of Internal Medicine and Oncology at the School of Medicine and the Karmanos Cancer Institute, and staff oncologist at the Veterans Administration Medical Center. “If cancer stem cells haven’t gone into the blood stream and we can remove the entire tumor, then we can remove the stem cells.

“We now need to address that population of colorectal cancer patients whose stem cells have gone into the blood with better treatments that are less toxic.”

Colorectal cancer is the third most common cancer in men and women, constituting 10 percent of new cancer cases in men and 11 percent in women each year. The American Cancer Society estimates that almost 78,000 men and almost 75,000 women will be diagnosed with colorectal cancer this year. Even though surgery can be effective in treating isolated cancer cases when paired with chemotherapy, nearly 50 percent of patients with colorectal cancer redevelop the disease.

Curcumin, unlike standard chemotherapy agents, has no toxicity for the patient.

The researchers are attempting to improve how curcumin can be absorbed into the blood and other tissue and can reach cancer cells to kill them. Curcumin has good absorption rates in the gastrointestinal tract but very low absorption rates in the blood, where it could serve to help eradicate cancer stem cells if the cancer has metastasized.

“Despite its low absorption, it accumulates in the intestinal mucosa,” said Fazlul Sarkar, PhD, professor of Pathology for the School of Medicine and the Karmanos Cancer Institute. Dr. Sarkar is co-author of the study. “It also goes into the circulation quickly. Within half an hour to an hour, it peaks in the blood and then it disappears. To have a biological effect other than in the colon, one needs to improve the bio-availability of curcumin.”

This type of research is continuing in Dr. Sarkar’s laboratory, as documented by his publications that describe the increased synthesis of the new curcumin compound the researchers have created, compared to curcumin in its natural state. Dr. Sarkar believes that utilizing natural agents and perhaps their corresponding synthetic compounds should be paired with other methods of killing cancer cells.

“You need to take a holistic approach toward medicine. Food is the only way to make people healthy,” he said. “Using a natural agent like curcumin, it will inhibit all the inflammation that goes on in your entire system as you age. It synergizes drug-resistant cancer cells to the conventional drug, allowing the drug to work effectively in killing those cells.”

Fellow study authors include Yingjie Yu, MD, assistant research professor of medicine at the School of Medicine; Shailender S. Kanwar, Ph.D., of the Department of Internal Medicine at the School of Medicine; and Jyoti Nautiyal, Ph.D., of the departments of Internal Medicine and Pathology at the School of Medicine and the Karmanos Cancer Institute.

The scientists said they hope their work, which was performed on human cancer cells in the laboratory, inspires continued research into how natural compounds can help the cancer treatment process overall, whether it is for colon cancer or breast, pancreas, prostate, and head and neck cancers. The results with curcumin specifically have been so promising in the laboratory, researchers have already tested it in Phase I and Phase II trials.

“Research has to move on from here,” Dr. Sarkar said. “Researchers are trying to make improvements on the curcumin molecule so that we have different synthetic compounds, which would be useful for killing most cancer cells, especially cancer stem-like cells.”

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Children's Holiday Party Contributors 2009

The following is a list of contributors to the WCMS Foundation’s 24^th Annual Holiday Party for underprivileged children. This year’s event is Dec. 5 at the New Detroit Science Center. For more information, or to contribute, call (313) 874-1360 or visit www.wcmssm.org

Dr. Adnan Munkarah

Paul & Debbie Natinsky

Dr. & Mrs. Mark Tuthill

Dr. Orlando S. Sison

Guat and Dionisia Sy, MD's

Giovanni A. Morreale, MD and Lisa J. Morreale

Dr. & Mrs. Theodore B. Jones

Dragos M. Galusca, MD

Robert G. Borchak, MD

Dr. & Mrs. William J. Cosgrove, Jr.

Dr. and Mrs. Mark A. Kelley

Steven A. & Deborah L. Portney

Hassan Amirikia, MD

Sheryl Wissman, MD

Dr. & Mrs. Kost Elisevich

Terrence R. Lock, MD

Halim D. Haber, MD

Dr. & Mrs. James Fordyce

Thomas J. Ruane, MD

Clara and Federico Mariona

Dr. Richard & Gail Smith

Jeff & Wendy Page

Dr. & Mrs. Gilbert B. Bluhm

Robyn J. Arrington, Jr., MD

Irene and Oscar Signori

Gehring T. Sauter, MD

Dr. & Mrs. E. N. Obianwu

Dr. B.J. & Marcia Woodley

Dr. Estigarribia

George H. Shade Jr., MD

Karen Chapel, MD & Doug Arenberg, MD

Clarence H. Schultz, MD

Dr. Stephen Lemos

Fred R. Nelson, MD

Ronald E. Trunsky, M.D. & Judy Jenkins Trunsky

Michael R. Harbut, MD

Dorothy M. Kahkonen

Dr. and Mrs. H. Michael Marsh

Lisa T. Cooper, MD

Volna Clermont, MD

Robert Brent, MD

William Knapp, MD

Nancy Goll

Elizabeth Edmond, MD

Martin Daitch, MD

Benjamin Ramos, MD

Peter Cracchiolo

Robert Borchak, MD

Julian Alvarez, MD

Beth Ann Brooks, MD

Dr. & Mrs. Sajal Choudhury

William L. and Betty G. Knapp

Drs. Safwan Halabi & Razan Asbahi

Joe Weiss & Marilyn Shapiro

Dr. & Mrs. George C. Hill

Neela Sripathi

Homer M. Smathers, MD

Sidney Baskin, MD

John C. Somogyi, MD

Charla Blacker, MD

Todd R. Williams, MD

Iris and Fred Whitehouse

Joseph M. Beals, MD

Stephanie Flom, MD

Dr. & Mrs. Mark F. Pezda

Eudoro Coello, MD

Christopher W. Hughes, MD & Debra J. Hughes

Claus Petermann, MD

Richard D. Cieslak, MD

Daniel S. Moore

Drs. Peter & Alice Watson

Drs. Rachel and Brian Silver

Kathleen Yaremchuk, MD

Anne-Mare' Ice, MD

John M. Malone, MD

Anne Nachazel, MD

Eastside Surgical Specialists

Paul Mazzara, MD

Dr. Richard Pollard

Michael G. Taylor, MD, FACS

Drs. Kenneth & Deborah Granke

Aaron Lupovitch, MD

Keith P. Bartold, MD

Rev. William and Dr. Mary Logan

Scott Monson, MD

Arthur J. Frazier, MD

M. Natacha Umlauf, MD

Phyllis A. Vallee, MD

Michael Schaldenbrand, MD

Heidi R. Gunderson, DO

Paul J. Sullivan, MD

S.V. Mahadevan, MD

Indu & Bala Pai

Chris and Janet Bush

Eve M. VanEgmond, MD

Taufiek Alhadi, DO

Gwendolyn H. Parker, MD

Dr. Ray and Mrs. Marcia Littleton

Drs. Daniel & Margarita Morris

Dr. & Mrs. Laurence E. Stawick

Dr. & Mrs. John Calwell

S. Rao Talla, MD

Ghaus M. Malik, MD

Eastlake Pediatrics PC

Vernon F. Strand, MD and Jane P. Strand

Martin H. Daitch, MD

John Kurtz, MD

Dr. & Mrs. Dan Michael

Mohammed Arsiwala, MD

Livonia Urgent Care

Margaret Dowling, MD

Dr. S. Maitra

George Mogill, MD

Dr. MaryJean Schenk & David Fry

Dr. Grace Engler & Ms. Anna Fedor

Dr. & Mrs. Donald M. Ditmars Jr.

James A. Rowley, MD

Sion Soleymani, MD

Madjid Mesgarzadeh, MD

Dr. & Mrs. Allan Dobzyniak

Helene C. Dombrowski, MD

Drs. Lalitha and Babu R. Vemuri

Robert G. Borchak, M.D.

Patricia A. Kolowich, MD

Joan & Bob Allaben

Advanced Family Health Care

Marcie Treadwell & Gregory Goyert

Dr. Michael Sandler

Tom & Nancy Coles

William G. Nutting, MD

Dr. & Mrs. Edmund M. Barbour

Dr. Philip C. Hessburg

Ron & Diane Strickler

Joseph Mark Tuthill, MD

Deloris Ann Berrien-Jones, MD

Vincent C. Yu, M.D.

Andrew J. Mitchell, MD

Barbara & Adrian Sheremeta

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