Wayne County Medical Society of Southeast Michigan

December 14, 2009

Editor's Column: We Do Not Swerve Who Stand And Wait
In My Opinion: Health Care And The 'Mad Hatter'
Michigan Passes Smoking Ban, Joins 37 Other States
H1N1 Heats Up, New Clinic Dates Added
Dr. Smitherman Honored For Community Service
Honors Presented At 'Ensure The Dream' Scholarship Launch
Health Plan Hot Topics From MSMS
2009 Annual Holiday Party Contributors

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Editor's Column: We Do Not Swerve Who Stand And Wait

By JOSEPH WEISS, MD
On Nov. 18 at the Wayne County Medical Society General Membership meeting the physician audience heard a presentation by Dr. Jim Rowsey describing Oklahoma Sen. Tom Coburn’s health plan, S. 1099. Senator Coburn is a Republican, a physician, and a gynecologist, who still practices his specialty.

Dr. Rowsey presented the Coburn plan in a straightforward manner, with emphasis on:

-Tax credits to individuals and family

-Portability from job to job

-Health care exchanges

-Supplemental assistance for low income individuals and families

-Bonus payments to physicians for high quality care

-Assistance to physicians introducing and upgrading formation technology

- And a number of other changes designed to improve patient health

Dr. Rowsey then entertained questions from the audience. Those queries revealed the interest of physicians in health care reform and their skepticism on the implications of Coburn’s proposals.

At the end of his presentation Dr. Rowsey asked for our support. There were few takers. Why? It was not just skepticism or disapproval of the Coburn plan, or preference for another plan. Rather, physicians feel a lack of connection between the health reform bills in Congress, and what we can sense as the way the proposals will change in our practice

For now, we depend on our leadership to guide our interventions on Capitol Hill. We look to our specialty societies to look after our interests. We will call or write Congress using the phrases our state and national societies say our advocacy appeals should include.

Only in issues such as opposing the Sustainable Growth Rate (SGR) or the state’s proposal of the Doctor’s Tax, can we go forward vigorously to defend principle made clear by personal experience.

We await the implementation of the health reform legislation. Then, by working in the milieu of change we can learn reform’s fine points and flaws. At that point, we will be able to speak with conviction on what aspects of health reform deserve support, need modification or require opposition.

Our time to serve will come, though it appears that for now we merely stand and wait.

Dr. Victor Bloom’s Response
The Coburn Plan looked good to me, as it was laid out here. I don't know what the skepticism or objections were about, but my feeling is that most doctors are fearful of and resistant to change. Doctors as a whole are not tuned in to national politics and find it hard to think of the common good. They are as susceptible to the media as anyone, therefore, and so are swept this way and that by the liberals and conservatives, the polemics on both sides. I think most doctors would approve of these measures in the Coburn Plan if it were not in this highly inflamed context. Most doctors want to do good for their patients and for all patients as a whole, but I think the alarms about 'socialized medicine' have most doctors standing and waiting. I went to a meeting in Ann Arbor of 'Doctors for America,' and was disillusioned to see it was only attended by eleven freshman medical students. I thought the house would be packed with senior practitioners and faculty members. Very sad. Doctors are susceptible to fear tactics by insurance companies and drug companies, unfortunately, and are set in their ways.

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In My Opinion: Health Care And The 'Mad Hatter'

By ALLAN DOBZYNIAK, MD
I was listening to a news anchor and a US senator discussing an issue this morning. Both appeared confident and seemed quite satisfied with their ability to talk about any and all aspects of the subject. Neither the senator, who is a lawyer, nor the news anchor had any actual experience with the issue they were eruditely analyzing. The senator was reiterating talking points which I have listened to repeatedly and ad nauseam. The anchor was functioning on perceptions. What struck me as ludicrous was they were actually drawing conclusions. Conclusions they actually thought were plausible. So what was rendered as realistic analysis of a complex topic was arrived at “authoritatively” by two individuals based on erroneous perceptions and political talking points. Knowing something about the topic, I reasoned that for these highly educated, confident but ill-informed people to solve complex problems all that was necessary were misconceptions and political double-speak.

Creating a crisis out of an issue, overlaying it with perceptions and misconceptions and then locking in a cadre of political points is an interesting exercise. Unfortunately, there is a disregard for reality. It seemed to me that the lunacy represented by the interaction of these two people about a subject of consequence to every single citizen in the United States of America—both presently and into the future—was analogous to the Mad Hatter’s tea party in Alice in Wonderland.

Several of the conclusions with which they felt most satisfied were astounding in their simplistic inability to see through to consequences. One conclusion was to arbitrarily reduce reimbursement to those needed to provide the most important services basic to the topic in question. Another was that we should have a system that delivered consistent care, but often less than desired, at decreased cost to more people without rationing and allow those who desired more to buy it on their own without having a multi-tiered system. If there is any logic here, please educate me. It sounds like more nonsense from the Mad Hatter. Lastly, a point with scientific validity was characterized as not being politically palatable and hence abandoned. But this was acceptable because it was said to be by a hand picked political appointee, a top echelon bureaucrat. So what we have established is that crucial decisions could be made on a political basis by bureaucrats without considering scientific validity.

You have probably guessed the subject was health care. If this is the process of consequential and positive health care reform, I guess the nonsense presented in the allegorical, political critique presented in Alice in wonderland sadly remains.

Dr. Victor Bloom’s Response
The discussion of two people is cherry picking. Not only that, the details of this “debate” were lacking. We have to take the author's word that the discussants were in la-la land. Why doesn't the author write about discussants who are truly scientific and objective? The author tries to give the impression that he is truly scientific and objective, but his credentials are lacking. However, he is entitled to his opinion and in this country there is freedom of speech. Everybody is entitled to his say.

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Michigan Passes Smoking Ban, Joins 37 Other States

By PAUL NATINSKY
The Michigan Legislature finally passed a bill banning smoking in workplaces last week, making Michigan the 38^th state curb smoking in restaurants, bars and other public places.

Somewhere, the late Ron Davis, MD, is smiling about House Bill 4377. The law will go into effect in May and will be named after Dr. Davis, who is a former Michigan Public Health Director, AMA President and international anti-tobacco activist.

HB 4377 includes all worksites, except casino gaming floors, existing cigar bars (no new ones are permitted by the law), and tobacco shops. The casino exemption was a concession to the House in the negotiating process and is intended to help keep the Detroit casinos competitive with Native American-owned casinos, which are exempt from the law.

“This is one of the most important and significant public health bills that the Michigan Legislature has ever passed,” said MSMS president Richard Smith, MD, a former WCMSSM President. “This legislation provides immediate protection to everyday citizens who otherwise would be vulnerable to the more than 4,000 toxins and 50 known carcinogens that are found in secondhand smoke.

“Unfortunately, Michigan funding for tobacco education remains near the bottom among all states,” Doctor Smith said. “Now it’s time for Michigan to re-engage in the overall battle against tobacco use.”

MSMS was part of the Campaign for Smokefree Air, a coalition with more than 270 members, including leadership from the American Cancer Society, American Heart Association, American Lung Association of Michigan, Michigan Health & Hospital Association, and Michigan State Medical Society, as well as other statewide groups that are committed to passing a smokefree workplace law.

“Legislators have given Michigan workers the greatest gift of all - the ability to breathe smoke-free air in the workplace,” said Susan Schechter, CSA spokesperson and director of advocacy at the American Lung Association of Michigan. “We have spent more than a decade fighting for the health of Michigan workers and our efforts have finally prevailed.”

Laws in other states and localities have been effective in reducing smoking adult smoking rates and, contrary to the worries of many bar and restaurant owners (their membership association in Michigan opposed the ban), smoking bans do not necessarily harm the hospitality industry.

According to a 2008 University of Kentucky study that compared post-ban smoking rates in Fayette County Kentucky and 30 other Kentucky counties that without bans that served as “control” counties, smoking decreased 31.9 percent in Fayette County 20 months after the ban as opposed to a 2.8 percent decrease in the control group counties. The study’s authors concluded that “there was a significant effect of smoke-free legislation on adult smoking rates.”

Kentucky’s smoking rate was the highest in the United States in 2006, with 28.5 percent of the population lighting up, according to a 2006 CDC Behavioral Risk Factor Survey. Michigan’s smoking rate was 12^th in the nation at 22.4 percent, exceeding the national average of 20.1 percent.

New York City’s bars and restaurants have been smoke-free since 2003, and its hospitality industry has prospered. A March 29, 2004 New York Times article detailed the business impact of the city’s smoking ban.

“Data from the city’s Department of Finance shows that the money spent in New York bars and restaurants has increased, the report states: from April 2003 to January (2004), the city collected about $17.3 million in tax payments from bars and restaurants, a rise of about $1.4 million over the same period a year earlier.”

Employment and liquor licenses were also up. “An average of 164,000 people were employed in restaurants and bars in 2003, the highest number in at least a decade. Since the smoking ban took effect last March 30, employment in bars and restaurants has risen by 10,600 jobs, taking into account seasonal fluctuations, according to the report.

“The number of the city's bars and restaurants -- roughly 20,000 -- remained about the same in the third quarter of 2002 as in the third quarter of 2003. Last year, the New York State Liquor Authority issued 1,416 new liquor licenses to New York City businesses, compared with 1,361 the previous year, the study reports.”

New York State’s smoking rate was 18.2 percent in 2006, 37^th in the country.

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H1N1 Heats Up, New Clinic Dates Added

(Editor’s Note: The following comments, statistics and link to new flu-shot clinics were provided by Talat Danish, MD, MPH, the medical director for the Wayne County Department of Public Health. The numbers are for all influenzas, but Dr. Danish pointed out that 90 percent of “circulating viruses” are H1N1, “so these numbers are a good reflection of H1N1 known morbidity and mortality.)

The state reset the Flu season to begin Sept. 1 for this years Flu season so the numbers reflect the current flu season and not the outbreak in April. These are accurate as of Dec. 8.

Number of deaths in Michigan since Sept. 1: 66
Number of hospitalizations in Michigan since Sept. 1: 1,830
# of deaths in Wayne County Department of Public Health (WCDPH) jurisdiction since September 1st--6
There were NO pediatric deaths in the WCDPH jurisdiction
# of H1N1 vaccine doses allocated to Michigan to date-approximately 2 million
# of doses distributed to providers/health systems/other partners by Wayne County thus far-over 160,000
# of individuals vaccinated by WCDPH approximately 25,000

I Just want to add that the H1N1 vaccine will be opened to the general public by all health departments by Dec. 14. WCDPH plans to open it to the general public starting Dec. 12 with their scheduled mass flu clinic on that date.

For the dates and times of the H1N1 clinic dates please follow the link below.

http://waynecounty.com/mygovt/hhs/publichealth/ph_h1n1.aspx

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Dr. Smitherman Honored For Community Service

Herbert Smitherman Jr., MD, MPH, assistant dean of Community and Urban Health and assistant professor of the Department of Internal Medicine for the Wayne State University School of Medicine, was recognized this last by the Michigan State Medical Society for his efforts to battle health care disparities.

Dr. Smitherman received the society’s Community Service Award on Dec. 9. He was recognized for his work with Health Centers Detroit Foundation Inc. He serves as chief executive officer of the foundation, which operates three community-based health centers in Detroit.

"We are very proud to recognize of our physician members in this way,” said MSMS President Richard Smith, MD. “They have taken time out of their busy lives to give back to their communities and they have truly made a difference in the lives of others.”

Society officials noted that Dr. Smitherman has worked for more than 20 years to improve access to health care and reduce health care disparities for people in Detroit.

“I’m very honored and humbled to receive such an award,” Dr. Smitherman said. “Hopefully this recognition will bring additional attention to the plight of those we serve who need greater access to primary health care.

"Over the past 10 years, through the Voices of Detroit Initiative, we have found access to a primary care physician for 71,578 people who were without health insurance in Detroit and Wayne County," he said. "It is extremely fulfilling to be able to assist people with access to basic health care. Helping fellow Americans is one of the founding principles of our country, and what separates us from many other societies. I was honored for my involvement in this work, and I thank the Michigan State Medical Society for this recognition”

Dr. Smitherman has spent the past 23 years working with diverse communities in Detroit to develop urban-based primary-care delivery systems that integrate the health and social goals and concerns of the community. He has succeeded in establishing and working with best-practice models that engage community participation and collaboration as the key element in creating sustainable primary care programs.

“Dr. Smitherman is the living, breathing and working embodiment of one of the School of Medicine’s core missions: to provide badly needed health care for the underserved segments of our population,” said Valerie Parisi, MD, MPH, MBA, interim dean of the School of Medicine. “The Michigan State Medical Society certainly selected a worthy recipient for this recognition.”

The society is a professional association of 15,000 medical doctors who work as patient advocates in areas of legislation, communication and education.

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Honors Presented At 'Ensure The Dream' Scholarship Launch

The Wayne State University School of Medicine honored Detroit area businessman Jim Hiller and Silas Norman Jr., MD, assistant dean for Admissions, when the school’s alumni association launched the Ensure the Dream, Secure the Future scholarship campaign Dec. 10.

Hiller, president and CEO of Hiller’s Markets, will receive the school’s Ambassador Award. The award is presented annually to individuals who epitomize the spirit of Wayne State University and the School of Medicine. Those honored represent world-class vision, leadership and progress demonstrated through outstanding service, commitment to the school’s teaching and research missions, and dedication to the city and the community.

Born in Detroit in 1948, Hiller attended public schools in the city and is a 1973 graduate of the University of Detroit Law School. In addition to his chain of seven grocery stores, Hiller formed and endowed the Program for Understanding Neurological Diseases at the University of Michigan School of Medicine. He founded the Hiller Amyotrophic Lateral Sclerosis Center at Wayne State University in 2007.

Dr. Norman, assistant dean for Admissions at the School of Medicine, will receive the Trailblazer Award, which honors outstanding alumni and faculty who have made substantial contributions and demonstrated courage, initiative, innovation, risk-taking and leadership.

An assistant professor in the Department of Internal Medicine, Dr. Norman also serves as director of Community Health Services. He has been involved in admissions for the School of Medicine for more than 25 years.

Dr. Norman received a bachelor’s degree in Natural Sciences from Paine College, Augusta, Ga., and is a 1976 graduate of the Wayne State University School of Medicine. He completed his internship and residency in Internal Medicine at Detroit General Hospital. Dr. Norman is active in church and civic affairs and organizations. He is board chairman of the Community Health Awareness Group Inc., and a member of the advisory board of the HIV and Prisons Project of the National Minority AIDS Council.

He received the 2000 Alumni Achievement Awards of both the United Negro College Fund Inc. and the Organization of Black Alumni of Wayne State University.

Dr. Norman is a member of county, state and national medical societies. He is a diplomat of the American Board of Internal Medicine and is certified as an Advanced Correctional Health professional. He was recently appointed president of the Paine College National Alumni Association.

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Health Plan Hot Topics From MSMS

MEDICAID – CHAMPS
MSMS has received numerous complaints regarding the Community Health Automated Medicaid Processing System (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 ensure 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 seven (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 are reviewing our request with the Department's counsel. MSMS anticipates further discussions with attorneys from both organizations after they have spoken about the issue. MSMS will continue to keep membership informed of our progress.

BCBSM – Medicare Recoveries
Blue Cross Blue Shield of Michigan (BCBSM) will conduct a Medicare recovery on December 8 and 9, 2009. Affected physicians/providers were notified on November 2, 2009. For each claim being recovered, BCBSM has confirmed which plan is primary with the Centers for Medicare & Medicaid Services (CMS) coordination of benefits contractor; however, we understand that primary determinations are not completely static. Whether or not affected physicians/providers agree that CMS is primary to BCBSM, it is imperative they bill claims with dates of service prior to October 1, 2008 to CMS by December 31, 2009. Billing CMS allows affected physicians/providers to continue to work with CMS following the December 31, 2009 timely filing limit or to resubmit claims to BCBSM for special consideration. Special consideration will be provided by BCBSM only if CMS was billed by December 31, 2009.

MEDICARE – Consultations
In the CY 2010 Physician Fee Schedule (PFS) proposed rule (74 Federal Register 33551), it was proposed, beginning January 1, 2010, to eliminate the use of all consultation codes (inpatient and office/outpatient codes for various places of service except for telehealth consultation G-codes) by increasing the work Relative Value Units (RVUs) for new and established office visits, increasing the work RVUs for initial hospital and nursing facility visits, and incorporating the increased use of these visits into the Practice Expense (PE) and malpractice RVU calculations.

There is an open comment period that ends on December 29, 2009, at 5:00 p.m. We encourage members to comment on the elimination of reimbursement of the consultation codes. You may submit comments in the following ways:

Electronically – You may submit electronic comments to www.regulations.gov. Follow the instructions under the “More Search Options” tab
By regular mail – You may mail written comments to the following address ONLY:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1413-FC
P.O. Box 8013
Baltimore, MD 21244-8013

Please allow sufficient time for mailed comments to be received before the close of the comment period.

By express or overnight mail – You may send written comments to the following address ONLY:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1413-FC
Mail Stop C4-26-05
7500 Security Boulevard
Baltimore, MD 21244-1850

BCBSM posted this message on webDENIS regarding the consultation codes: Beginning January 1, 2010, CMS will eliminate the use of evaluation and management consultation CPT codes (99241—99255) and require physicians/providers to bill the most appropriate office visit or hospital inpatient CPT code (99201—99215, 99221—99239). However, BCBSM’s professional reimbursement policy will continue to recognize and reimburse all consultation codes after January 1, 2010. BCBSM does not anticipate changing the status of the codes until July 1, 2010, to coincide with the annual fee update and adoption of the 2010 Relative Value Units (RVU). Be sure to check with your Medicare carrier regarding billing guidelines in secondary payer situations.

PECOS
The Centers for Medicare & Medicaid Services (CMS) will delay until April 5, 2010, the implementation of Phase 2 of Change Request (CR) 6417 [Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)] and CR 6421 [Expansion of Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME) MACs)]. CR 6417 and CR 6421 are applicable to Part B claims only.

The delay in implementing Phase 2 of these CRs will give physicians and non-physician practitioners who order items or services for Medicare beneficiaries or who refer Medicare beneficiaries to other Medicare providers or suppliers sufficient time to enroll in Medicare or take the action necessary to establish a current enrollment record in Medicare prior to Phase 2 implementations.

Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and also contains the physician/non-physician practitioner’s National Provider Identifier (NPI). Under Phase 2 of the above referenced CRs, a physician or non-physician practitioner who orders or refers and who does not have a current enrollment record that contains the NPI will cause the claim submitted by the Part B provider/supplier who furnished the ordered or referred item or service to be rejected.

CMS continues to urge physicians and non-physician practitioners who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003 to update their enrollment record now. If these physicians and non-physician practitioners have no changes to their enrollment data, they need to submit an initial enrollment application, which will establish a current enrollment record in PECOS.

For more information about reimbursement issues, contact Stacie Saylor, CPC, at MSMS at (517) 336-5722 or ssaylor@msms.org. Get additional news and information from MSMS publications, such as Medigram, Michigan Medicine and the Monthly Top 10, online at www.msms.org .

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2009 Annual Holiday Party Contributors

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

Julius V. Combs, MD
Dr. and Mrs. Charles Barone
Melvin L. Hollowell, 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. 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
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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