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December 7, 2009 |
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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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Click Here To Contact Us
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24th Children's Holiday Party Spreads
Smiles, Cheers
By PAUL NATINSKY
The 24th 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 24th
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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