Infant Mortality Disparity Resource Released for Public Health Professionals

LANSING, Mich. – The Michigan Department of Health and Human Services (MDHHS) has released the Practices to Reduce Infant Mortality through Equity (PRIME): Guide for Public Health Professionals.  This is an informational resource for transforming public health through equity education and action.

“Achieving health equity for all residents is a goal of public health work within Michigan and across the country,” said Sue Moran, deputy director for the Public Health Administration at MDHHS. “This guide provides valuable strategies for developing a training model and resources that promote the understanding of the root causes of health inequities, as well as methods for creating changes in policy going forward.”

Health disparities are the metric used to measure progress toward ensuring that all residents have a fair opportunity to reach their potential. In Michigan, black and white infants died at a rate of 13.1 and 5.7 respectively in 2013, and these gaps in infant mortality rates between whites and blacks and whites and American Indians have persisted for decades.

The PRIME guide includes methods used by the department since 2010 to create a public health training model. These methods include consideration of the overall goals and design of the training components used, a description of specific content and concepts covered, the processes used, a description of the evaluation tools, lessons learned, and copies of existing tools and resources about health equity.

Additionally, the primary focus of PRIME has been to assist practitioners in the maternal child health arena, however, this guide will be a valuable resource for state and local public health systems interested in addressing racial and ethnic inequities related to other health outcomes.

The PRIME initiative is led by the Bureau of Maternal and Child Health within the department and a steering team that includes internal partners from the Health Disparities Reduction and Minority Health Section and the Lifecourse Epidemiology and Genomics Division of MDHHS.  External partners that assisted with the development of this guide include the University of Michigan School of Public Health, Vanderbilt University, Michigan Public Health Institute, Inter-Tribal Council of Michigan, Ingham County Health Department, and Wayne County Department of Public Health.

To view the full report and accompanying documents, visit   The PRIME initiative and publications were supported through a grant from the W.K. Kellogg Foundation.

Deadline Today for 2016 Medicare EHR Hardship Exemption

Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.

To file a hardship exception, you must:

  • Show proof of a circumstance beyond your control.
  • Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use. Supporting documentation must also be provided for certain hardship exception categories. CMS will review applications to determine whether or not a hardship exception should be granted.

You do not need to submit a hardship application if you:

  • are a newly practicing eligible professional
  • are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22; or
  • Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)
    CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception.

Apply by July 1

As a reminder, the application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered.

If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year.

In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include:

  • Medicaid only
  • No claims to Medicare
  • Hospital-based

Want more information about the EHR Incentive Programs?

Visit the EHR Incentive Programs website for the latest news and updates on the programs.

3 Things the Supreme Court’s ACA Ruling Means for Physicians

The Supreme Court of the United States delivered an historic decision Thursday morning, June 25, in King v. Burwell.

In a 6-3 decision, the justices ruled that subsidies should remain available for lower-income people who purchase their health insurance through the Affordable Care Act (ACA) marketplaces, regardless of whether their marketplace is maintained by the federal or state government.

This ruling affects physicians in three ways I’d like to highlight:

1. The decision supports our chief goal of helping patients stay healthy.

The Supreme Court’s ruling means that about 6.4 million people in the 34 states that did not create their own marketplaces will retain their ability to purchase coverage going forward. This is particularly important for low-income patients in states that did not expand their Medicaid programs. Without the subsidies, many of them could never afford health insurance.

As an emergency physician, I regularly see how important insurance coverage is to facilitate patients getting the medical care they need to recover from unexpected injury or illness. It also enables them to lead healthier, happier lives through better care of chronic diseases that can be devastating for them and their families.

The decision also means that insurance premiums will remain more affordable for most patients than would have otherwise been the case. A recent RAND study estimated that eliminating subsidies for patients who purchase their insurance through the federally run marketplace would result in a 47 percent increase in premiums. In such a scenario, a 40-year-old nonsmoker who purchased an unsubsidized silver-level plan would have needed to pay $1,610 more next year.

2. The decision lets us move forward.

With this case behind us, we as a profession and as a nation now must focus on the issue at the heart of health care reform: Ensuring every American has access to high-quality, affordable health care.

Regardless of differing opinions, access to high-quality, affordable health care is an issue we can all support. And by continuing to work together toward this end—whether through refining individual elements of the ACA, such as repealing the Independent Payment Advisory Board, or making changes to the current health care system—we can improve the health of all Americans.

3. The decision means we can turn our attention to improving the practice environment.

In moving forward, we must also devote our attention to transforming the practice environment so that both patients and physicians are healthier and more satisfied.

At the AMA, we’re working to enhance professional satisfaction and practice sustainability by pressing for relief from the tsunami of regulatory burdens that gets in the way of providing the highest-quality care for our patients. Among those burdens are the electronic health record meaningful use program, implementation of ICD-10 and the value-based payment modifier. Lawmakers, too, are now able to turn their attention to these pressing topics.

We’re also providing the tools physicians need to minimize professional stress and overcome barriers to providing the best possible care. Our newly launched STEPS Forward website offers a free online series of proven solutions that are developed by physicians to make practices thrive. We’ll be adding more modules over the coming months, so be sure to explore the website often.

Also, on the STEPS Forward website, we invite you to submit your own innovative solutions to clinical challenges to win $10,000 and help us create more modules to help physicians.

Even in these early years of health care reform, implementation of the ACA has affected much of the health care system. To examine this issue further, I encourage you to check out the July issue of the AMA Journal of Ethics, which takes a look at how patient care has changed in the era of health care reform.

Childhood Obesity in Washtenaw County

Local reports highlight positive trends and areas of concern
YPSILANTI, Mich., June 29, 2015 – Washtenaw County Public Health is pleased to announce the publication of new childhood obesity reports for Washtenaw County. They include an overall Washtenaw County report and community reports for Ann Arbor, Ypsilanti, Saline, Dexter, Chelsea, Whitmore Lake and Manchester.
Being overweight or obese in childhood increases the risk of obesity and other chronic diseases in adulthood. The reports show trends and identify factors that put local children at risk of being overweight or obese. They also provide a way to measure local progress.
“We want these reports to be as useful as possible for all of our partners working in the community to make a difference in children’s health,” says Laura Bauman, RN, MPH, epidemiology program manager with Washtenaw County Public Health. The reports are available at http://publichealth.ewashtenaw.orgThe Washtenaw childhood obesity surveillance project began in 2013. Through the Health Improvement Plan (HIP) collaborative, Washtenaw County Public Health worked with Saint Joseph Mercy Health System and the University of Michigan Health System to create the first Washtenaw Child Body Mass Index (BMI) Dataset.
Washtenaw County Public Health compiled and analyzed records for over 18,000 children, ages 2-17 years old, to create the local reports. Future waves of data will allow us to track progress of initiatives aimed at moving all children to a healthier weight.
Good News
Washtenaw County children as a whole have a lower rate of overweight and obesity than their counterparts nationally.
Local children of African American descent, however, surpass national rates. Children of African American descent as well as Hispanic and Latino children have the highest risk of being overweight or obese. This is a national trend that is reflected locally.
Analysis of the Washtenaw County data focused on factors known to affect the risk of childhood obesity, including poverty, race and ethnicity and age. Differences also exist depending on where children live within the county. 
Medicaid coverage is an indication of poverty. The risk of overweight and obesity was higher for children with Medicaid across all age groups and compared to children covered by commercial insurance.
There is some good news for local children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Rates of overweight and obesity in low-income WIC children declined between 2010 and 2014 (from 28% to 24% of WIC children age 2-4 years). The addition of peer educators to support local WIC moms in breastfeeding and changes in the WIC food package may have supported this trend.
Washtenaw County Public Health and the HIP partnership hope these reports will assist community leaders, clinicians, schools and others working to improve the health of children. With a greater understanding of which children in our community are most at risk of being overweight or obese, decision makers can direct local interventions and support where needed most. 


Top 5 Tips to Survive Severe Storms

University of Michigan Hospital emergency room physician Dr. Brad Uren, and Washtenaw County Medical Society President-Elect, has seen the aftermaths of severe storms and shared his top 5 tips to avoid becoming one of his patients in the ER.

1. Shelter

Like Bob Dylan, your first concern should be for shelter from the storm.

The safest rooms are located in basements, but those without should look for a closet, bathroom or other rooms with no windows on the ground floor.

Those living in mobile homes are particularly at-risk in severe weather events with strong wind. Uren said people in those communities should have a plan to reach more stable and secure structures quickly if a tornado is on the way.

Make sure everyone in your family knows where to go in case of a severe weather warning. If you have small children, it’s a good idea to have run family “drills” so everyone is prepared when the time comes to take cover.

2. Food and Water

Uren recommends having three days of food and one gallon of water per family member per day, including the family’s furrier members.

“People often don’t think about their pets when they’re planning for disasters,” he said. “If you don’t, then you’ll end up sharing your water and food and everyone comes up short.”

A first aid kit, a sharp tool to open cans and a hand crank radio also are on Uren’s list of things to have stocked in a safe room on the interior of the lowest available floor of your home.

3. Did you forget…

The tornado siren sounds in the middle of the night and you run downstairs to a room in your basement.

You’ve prepared for this, and the room is stocked with everything you might need. You have a first aid kit, plenty of food and enough water for you and your family.

But you can’t see any of it.

Uren said many people don’t remember to bring their glasses when they seek shelter.

“If you need those to function, you should make sure to have an old pair with all the rest of your emergency supplies,” he said.

While most people are aware of the necessary steps to take when severe weather strikes, Uren said they are often not fully prepared to deal with the aftermath of a very severe thunderstorm or tornado.

“One thing a lot of people don’t think about is their medications,” he said. “If there are meds you need, you have to make sure you have a few days supply with you. It can take up to 72 hours after a major disaster for help to arrive and refill those.”

It’s also important to remember basic necessities such as diapers if there are infants or toddlers in the home.

4. Cars are not (usually) the answer

Uren said the most dangerous urban legends about severe weather safety mostly have to do with cars.

“People think that if you’re in a car, the rubber tires will keep you safe from any lightning danger,” he said. “That’s just not the case.”

If you’re in contact with the metal frame of a car, you’re liable to receive any electrical shock that would come through the frame from a lightning strike. The strong burst of energy also can damage the car or even set parts of it on fire.

Cars are not fast enough to outrun tornadoes, and pulling over to the side of the road in a storm is only a good idea if you’re dealing with straight-line winds. One common misconception is that an overpass is a safe place to wait out a strong storm.

“Someone once got a video when they were able to pull over and stop under an overpass and they survived a tornado by getting up in between the steel girders,” Uren said.

“These days, most overpasses have concrete girders or you can’t even access them, and without that, an overpass is an incredibly dangerous place because of how the wind can get concentrated there.”

Of course, being in a car is still preferable to being out in the open and completely unprotected during a storm. The best thing to do is know when storms are coming so you can avoid being stranded.

5. Be serious and have a lot of back-ups

Do you have a flashlight? Stock up with extra batteries.

Is your cellphone fully charged? An external charging source is probably also a good idea.

Uren’s biggest message is that things can always go wrong, and even as we hope for the best, we should always prepare for the worst.

“These things can be very real,” he said. “Everyone near Ann Arbor will remember the Dexter tornado we had. We were very fortunate there were no fatalities and not a lot of serious injuries related to that.”

Don’t take severe weather warnings lightly, Uren said. Make sure to pay attention to local news and reports from the National Weather Service. Knowing when a storm is coming can give you enough time to take the proper precautions necessary to keep yourself and loved ones out of harm’s way.

MI Food Allergy Conference August 29 at the Kensington Court Ann Arbor Hotel

From our community partners at the Food Allergy & Anaphylaxis Michigan Association:

Physicians and other health care professionals are encouraged to attend this free 1/2 day conference on food allergy.  This program applies to the MI Board of Nursing rule 2(l) and reflects 4 hours of continuing education credit for RN’s.

Interdisciplinary speakers will cover a variety of topics related to IgE mediated food allergy with risk for anaphylaxis.  Please note conference content will not include information on other forms of adverse reactions to food such as food intolerance.

For more information on speakers, topics, sponsors, exhibitors, lodging, registration and continuing education credit is available at:

The conference is produced and managed by Food Allergy & Anaphylaxis Michigan Association ( The conference is funded through a community grant from the nonprofit Food Allergy Research & Education (

Washtenaw County Amends Clean Indoor Air Regulation to Include E-Cigarettes: Changes Take Effect June 18

The use of electronic nicotine delivery systems, e-cigarettes or similar devices, will no longer be allowed in indoor public areas in Washtenaw County that are already smoke free. Changes to the Washtenaw County Clean Indoor Air Regulation were approved in March and take effect today, June 18, 2015.

New language in the regulation prohibits the use of electronic nicotine delivery systems in public and private worksites and other indoor areas open to the public, such as stores, public buildings, reception areas and public transportation. The 2015 amendment also extends the regulation to Washtenaw County Parks for the first time.

“The amended regulation treats electronic devices the same as traditional tobacco products in our shared, public spaces,” says Ellen Rabinowitz, MUP, health officer for Washtenaw County Public Health. “As the local public health authority, we are pleased with the changes. Relevant, up-to-date regulations that provide everyone with cleaner air to breathe are effective ways for us to protect and promote health in our community.”

Tobacco specialty shops and retailors specializing in e-cigarettes or other electronic smoking devices are exempt. Additionally, the county regulation does not address smoking or e-cigarette use in restaurants or bars, which are governed by Michigan’s Smoke-Free Air Law and have been smoke-free since 2010.

The current state law does not cover the use of e-cigarettes. Individual bars and restaurants, however, are free to set their own policies and can choose to ban e-cigarettes in the same way as traditional tobacco products.

“I’m delighted that the Washtenaw County Commissioners are in agreement with leading health authorities and have acted to include e-cigarettes and related devices in the Washtenaw County Clean Indoor Air Regulation,” says Jim Bergman, director of the Smoke-Free Environments Law Project, based in Ann Arbor.

According to Bergman, “The dangers of e-cigarette use and of secondhand e-cigarette aerosol in the air have been recognized by the American Medical Association, the American Heart Association, the World Health Organization, the National Institute for Occupational Safety & Health, the Centers for Disease Control & Prevention and many others. All of these health authorities have called for e-cigarettes to be treated in the same manner as traditional combustible cigarettes, including prohibiting their use where cigarette use is prohibited.”

Electronic Nicotine Delivery Systems

Electronic nicotine delivery systems are battery-powered devices that provide inhaled doses of nicotine or other substances by way of a vaporized solution. These devices are commonly called e-cigarettes, but also have other forms, such as e-cigars or e-hookahs. Most contain nicotine and resemble the act of smoking. Some varieties are flavored, which may increase their appeal to younger users.

E-cigarettes are currently not approved as smoking cessation aids and are not regulated. Exposure to the aerosol, chemicals and nicotine from these devices has not been proven safe for non-users to inhale. The amended regulation will protect county residents from involuntary exposure.

“E-cigarettes and similar devices are not regulated by the FDA,” says Alice Penrose, MD, MPH, medical director with Washtenaw County Public Health. “The amount of nicotine dispensed and the additives vary from brand to brand, and we do not have long-term data about the safety of these products for the people using them or those around them.”


Washtenaw County Public Health is responsible for enforcing the Washtenaw County Clean Indoor Air Regulation. Enforcement is driven by complaints. Residents who observe violations of the regulation may register a complaint by contacting DeBorah Borden, Tobacco Prevention Coordinator, at 734-544-6874 or

The text of the amended Washtenaw County Clean Indoor Air Regulation is available online.


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