Iowa Medicine Summer 2017

Summer 2017 Vol. 107/3

Celebrating Physician Advocacy ALSO INSIDE: AMA Delegation Report Spotlight: Tiffin Family Care IMS Task Force Tackles Physician Burnout

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IOWA

EDICINE Journal of the Iowa Medical Society

Summer 2017

Vol. 107/3

CONTENTS IN THIS ISSUE

CONTACT US Iowa Medicine 515 East Locust Street, Suite 400 Des Moines, IA 50309 Phone: (515) 223-1401 or (800) 747-3070 IMS President Joyce Vista-Wayne, MD, DFAPA Executive Editor Michael P. Flesher Managing Editor Bobbie Russie To Advertise Contact Michelle Dekker Phone: (515) 421-4778 Email: mdekker@iowamedical.org Subscriptions Annual Subscription $45 Iowa Medicine, Journal of the Iowa Medical Society (ISSN 0746-8709), is published quarterly by the Iowa Medical Society, 515 East Locust Street, Suite 400, Des Moines, IA 50309.

Periodicals postage paid at Des Moines, Iowa and at additional mailing offices.

Postmaster: Send address changes to Iowa Medicine, Attention: Crystal Swanson, 515 East Locust Street, Suite 400, Des Moines, IA 50309.

Editorial content: The Society is unable to assume responsibility for the accuracy of submitted material.

Editorial inquiries should be directed to the Editor, Iowa Medicine, 515 East Locust Street, Suite 400, Des Moines, IA 50309.

Copyright 2017 Iowa Medical Society. Opinions expressed by authors do not necessarily represent the official policy of the Iowa Medical Society. Iowa Medicine does not assume responsibility for those opinions. Products and services advertised in Iowa Medicine are neither endorsed nor guaranteed by the Iowa Medical Society unless specifically noted.

Get Connected Stay up-to-date with IMS on Facebook, Twitter, LinkedIn, and YouTube.

ON THE COVER

16 CELEBRATING PHYSICIAN ADVOCACY

The third annual Doc ‘n’ Pops celebration took place on July 3. View the pictures from this event and learn about the special Presidential Citation Award presented on page 16.

HOW DOES IMPAC STACK UP?

IMPAC, the Iowa Medical Society’s Political Action Committee, is the political voice of Iowa physicians. The chart below compares candidate contributions of IMPAC and other Iowa medicine-related PACs. Bold number indicates the rank in contributions of all Iowa PACs.

7 10

12

20

23

26

27

Lumbar Spine, Sacrum & Coccyx (2015) by artist Monica Zwiefelhofer, Bloomer, Wisconsin (monica.zwiefelhofer@ bloomer.k12.wi.us). This piece was a gift to Angie Overman, TFC Chiropractor, and is on display at the Tiffin Family Clinic.

Read about this special clinic on page 10.

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IMS CORE PURPOSE To assure the highest quality health care in Iowa through our role as physician and patient advocate.

Number indicates rank in spending among all PACs in Iowa

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Iowa Medicine Summer 2017

Upcoming Events AUGUST August 24 IMS CME Provider Quarterly Call Webinar SEPTEMBER September 21 IMS Board Meeting and Policy Forum, Iowa City September 22 IMS Candor Conference NOVEMBER November 30 IMS CME Provider Quarterly Call

10 SPOTLIGHT: TIFFIN FAMILY CARE

A recent visit to the Tiffin Family Care – Total Care Clinic revealed innovative ways one independent practice is serving their community needs on page 10.

ALSO INSIDE President’s Corner.................................................................. 4 From the CEO........................................................................ 6 AMA Delegation Report......................................................... 8 Legislative Update................................................................ 12 Legalese............................................................................. 14 Members News................................................................... 20 DMU Update....................................................................... 26

FEBRUARY 2018 FEBRUARY 28 Physician Day on the Hill (PDOTH) APRIL 2018 APRIL 27-28 IMS Annual Conference

MARK YOUR CALENDARS! The IMS CANDOR CONFERENCE will be held on September 22. Plan to attend this informative conference concerning Iowa’s early disclosure Candor law, to be held at the Kelley Conference Center at Iowa Methodist Medical Center in Des Moines.

See page 18.

Iowa Medicine Summer 2017

3

PRESIDENT’SCORNER

IMS URGES THE U.S. SENATE TO SLOW DOWN ON HEALTH REFORM

By Joyce Vista-Wayne, MD, DFAPA

JOYCE VISTA-WAYNE, MD, DFAPA Dr. Vista-Wayne is a child and adolescent psychiatrist practicing in Des Moines.

She is the president of IMS.

Joyce Vista-Wayne, MD, has been working hard, since taking the reins of IMS President at the end of April, to advocate for Iowa health care. She recently wrote Senators Charles Grassley and Joni Ernst on behalf of IMS members expressing concerns about the Better Care Reconciliation Act and how it could negatively affect the citizens of Iowa.

The leadership of the Iowa Medical Society strives to meet its core purpose “To assure the highest quality health care in Iowa through our role as physician and patient advocate.” As the current President of IMS ­— I can assure you we are doing that and more.

During the recent heated debate in Washington about the future of health care — I, on behalf of the IMS membership, sent letters to Senator Chuck Grassley and Senator Joni Ernst regarding the Better Care Reconciliation Act of 2017 (BCRA).

Although the U.S. Senate’s health reform alternative represented a slight improvement over the U.S. House’s American Health Care Act (AHCA), it still had the potential to place tens of thousands of Iowans at risk of once more becoming uninsured. IMS opposed both bills and was pleased to see the Senate’s rejection of the BCRA shortly before Iowa Medicine went to press.

The Affordable Care Act (ACA) is far from perfect, however, under the ACA more than 210,000 Iowans

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Iowa Medicine Summer 2017

currently have coverage through the Iowa Health and Wellness Plan or the Health Insurance Marketplace.

The vast majority of these individuals did not previously have any health insurance and would only seek care in emergencies.

Many of these individuals now have established care relationships with a local physician and have begun managing their long-term chronic conditions. The BCRA and the AHCA threatened to undo this progress. IMS opposed these pieces of legislation, however, we recognize the need for reform to create a more stable system long-term.

Iowa’s individual health insurance market is currently on the verge of collapse. The Insurance Commissioner’s Proposed Stopgap Measure offers a short-term solution to ensure the 70,000-plus patients with coverage via the marketplace continue to have insurance options next year. We support this short-term solution and encouraged our U.S. Senators to continue their efforts in urging federal officials to approve Iowa’s waiver application.

The provisions of the BCRA expanding federal waiver authority under Section 1332 of the ACA hold the potential for providing a long-term solution to stabilize Iowa’s imperiled individual health insurance market. However, we continue to have concerns over the many other significant reforms contained in the BCRA including the ability for states to waive the Essential Health Benefits (EHBs) requirement for health insurance plans.

The EHB requirement of the ACA has resulted in expanded access to critical medical care, including substance abuse and mental health treatment.

Iowa officials recognized the importance of EHB coverage when they sought to maintain this requirement as part of the Proposed Stopgap Measure.

We similarly see the value in these benefits and oppose allowing states the ability to weaken coverage by waiving the EHB requirement.

We also expressed concerns regarding the speed at which the U.S. Senate was pushing to vote on the BCRA ahead of arbitrary, leadership-imposed deadlines. We asked Iowa’s Senators to not repeat the mistakes of the past and rush passage of health reform legislation.

Iowa’s Medicaid program has seen tremendous change in the last year and a half as a result of transitioning to managed care and we reminded Senators Grassley and Ernst that IMS did not oppose this transition.

Recognizing that the program’s spending trends are unsustainable

and that programmatic change is not necessarily a bad thing, we opted instead to work to ensure that Iowa practices have the resources necessary to continue to provide high-quality care under the new system.

Similarly, we are not opposed to testing new models for the Medicaid program as part of federal health reform, however, wholesale transition to block grants or per capita caps are not the optimal models for change. This approach is merely setting the Medicaid program up for underfunding and failure.

We encouraged Grassley and Ernst to work with Senate leadership and policy experts to explore alternative payment and delivery models. We also recommended that any changes to the Medicaid program first be tested on a small scale to ensure new models are not adversely affecting Medicaid patients or providers.

I recently participated in a smallgroup discussion regarding federal health reform and the individual insurance market for a program on the CBS Affiliate in Des Moines, called Close Up. Our conversation included a discussion of the Affordable Care Act ­— what is working and what is not. I focused on the following points:

Working in Iowa

Expanded Coverage Approximately 210,000 Iowa patients have gained coverage from either the Health Insurance Marketplace or the Iowa Health and Wellness Plan.

Comprehensive Coverage The Essential Health Benefits (EHB) requirements have resulted in insurance plans that cover a broader range of services, including mental health and substance use disorder treatment.

Protections for Young Adults and High-Need Patients The ACA built upon a reform Iowa enacted on a state level in 2008 to allow children to stay on their parents’ health insurance until age 26. The federal law also removed lifetime caps on coverage and prohibited insurers from denying coverage due to a preexisting condition. These reforms resulted in more young adults with health insurance and continued coverage for patients with significant health care need.

Not Working in Iowa:

Individual Health Insurance Marketplace Iowa’s individual insurance market is on the verge of collapse. Policy decisions made by state and federal officials have allowed thousands of healthier Iowa consumers to retain a less expensive, grandfathered health plan and resulted in a sicker, more expensive pool of individuals covered by the Marketplace. This has caused costs to skyrocket and led multiple insurers to exit the market.

Medicaid Spending Medicaid costs consume an evergrowing portion of the state and federal budgets. We recognize these cost trends are unsustainable and believe the issue merits further study. IMS does not, however, support the AHCA and BCRA proposals to replace the current Medicaid funding mechanism with a per capita cap or block grant system.

As president of IMS, I will continue to work diligently on these and other issues of importance to Iowa physicians and the patients we serve.

I urge each of you to renew your membership and get involved in the advocacy role IMS plays in major health policy discussions.

SAVE THE DATE IMS Annual Conference | April 27-28, 2018

Iowa IowaMedicine Medicine Summer 2017

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FROMTHECEO

THE IMPORTANCE OF ORGANIZED MEDICINE MEMBERSHIP The Iowa Medical Society Needs Your Continued Support!

MICHAEL FLESHER Mr. Flesher is executive vice president and CEO of IMS.

Decisions are being made every day that impact the health of your patients and the ways you practice medicine at local, state, and federal levels.

As well as the alphabet soup of governmental agencies, and independent agencies: HHS (Health and Human Services), FDA (Food and Drug Administration), CMS (Centers for Medicare & Medicaid Services), AHRQ (Agency for Healthcare Research and Quality), ACGME (Accreditation Council for Graduate Medical Education), RRC (Residency Review Committees), FSMB (Federation of State Medical Boards), ABMS (American Board of Medical Specialties), JCAHO (actually now renamed “The Joint Commission”), IOM (Institute of Medicine), by insurance companies, and by hospitals just to name a few.

Yet, as physicians, you are the ones who have devoted most of your lives to studying medicine. The ones who spend your days practicing medicine within the ever-changing healthcare system. And the ones who have a front row view of how each decision affects actual patients.

Supporting organized medicine is critically important. As the new EVP/ CEO of IMS, it is my honor to join this dedicated team of staff professionals and physician leaders who work on behalf of you and the patients you serve every day.

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Iowa Medicine Spring 2017

Why Pursue Organized Medicine?

There are innumerable national, state, and specialty medical societies all with slightly different focuses and emphases — but all with a similar overall goal — to improve the profession of medicine, the healthcare system in which you practice, and the health of your patients.

There is only one Iowa Medical Society representing more than 6,000 physicians (MDs and DOs), residents, and medical students, regardless of geography or specialty.

IMS shares a common overall goal across the state. To improve the profession of medicine, protect the healthcare system in which you practice, and improve the health of your patients.

Despite how complex and daunting this may seem, getting involved in IMS is actually simple. We welcome your involvement and very much

appreciate your time and resources. If you have an idea, I encourage you to share it. Your voice can help change laws and health policies at the local, state, or national levels.

How Can You Benefit from Your Involvement in Organized Medicine?

Involvement in organized medicine provides countless unique opportunities that physicians generally do not have in their everyday lives. First, at the most basic level of membership and involvement, organized medicine affords an incredible opportunity to stay current on the issues that are critical to your patients, practice, or specialty — on everything from bills in Congress or the state legislature, to highlights of published journal articles, to tips on maintaining certification or dealing with insurers.

IMS provides members and their practices with information through three weekly e-newsletters, Practice Manager, a mid-week publication for clinic administrators; Weekly Debrief, the Saturday publication designed for physicians; and the Advocate, published on Fridays during the Iowa legislative session.

These publications, as well as the information under the Resources tab of the IMS website, www .iowamedical.org, are there to assist physicians and their practices.

Your voice can help change laws and health policies at the local, state, or national levels.

This level of involvement is important for every physician and given a busy practice, is all that most desire.

By being involved at this level, you ensure that your positions are being represented as IMS lobbies on your behalf to ensure those laws and regulations are in you and your patients’ best interest.

How Can Membership in Organized Medicine Benefit Your Patients?

The advocacy detailed above is not limited to just physicians. You entered this profession to make sick people well and to give comfort when your healing efforts fail. IMS’ core purpose is, “To assure the highest quality health care in Iowa through our role as physicians and patient advocates.”

Care of patients is the foundation of your profession and the physicianpatient partnership is unique and

Get involved.

Involvement does not have to be time consuming.

essential for high-quality care.

Freedom to practice the art and science of medicine professionally is essential. IMS is here to support you, your practice, and your patients in meeting this core value.

Who is IMS?

IMS is YOU. Physicians are the leaders of the healthcare team, and your voice matters when it comes to patient safety, access to care, and other issues that affect you and your patients.

My request of you: 1) Continue to BE IMS, renew your membership.

2) Share what it means to you to be IMS with your peers. More IMS members strengthens the

physician voice on key issues at the state and federal levels.

3) Get involved. Involvement does not have to be time consuming.

Respond to the emails requesting you to contact your legislators, share your and patients’ stories with local and state leaders. Review and comment on policy request statements. Attend an IMS event, either within your area or at the IMS Annual Conference.

Our healthcare system and Iowans are far better off today thanks to the advocacy of these organizations and physicians like you. With your financial support and volunteer time, collectively we can continue to improve health care for all Iowans.

S AV E T H E DAT E !

#PDOTH

Physician Day on the Hill – February 28, 2018 Iowa IowaMedicine Medicine Spring 2017

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ANNUAL AMA MEETING IN CHICAGO AMAREPORT

A Report from the IMS Delegation

By Michael Kitchell, MD

MICHAEL KITCHELL, MD Dr. Kitchell is a neurologist practicing in Ames and IMS AMA Delegation Designate.

The IMS delegation to the American Medical Association (AMA) met in Chicago with more than 500 other AMA delegates to review and generate new policy, attend educational presentations, witness the inauguration of new AMA President David Barbe, and participate in the election which resulted in Barbara McAneny, MD, a University of Iowa Carver College of Medicine gradate and former UI resident, becoming President-elect.

I, with fellow IMS AMA Delegates Robert Lee, MD, Family Medicine, Johnston; Vickie Sharp, MD, Family Medicine/Urology, Iowa City; and alternate delegate Jeff Anderson, MD, Anesthesiology, West Des Moines; and IMS President Joyce VistaWayne, MD, attended the House of Delegates sessions over three days, after participating in four reference committee discussions regarding various AMA reports and resolutions

submitted by other state and specialty societies. Mike Flesher, IMS EVP/ CEO, joined the delegation in Chicago and also attended the North Central Conference meetings with Nebraska, Minnesota, North Dakota, and South Dakota colleagues.

One of the biggest issues discussed was federal healthcare reform, and the AMA’s nine objectives for reform were reiterated. These include avoiding loss

of coverage for those currently insured, keeping coverage for anyone with preexisting conditions, parental coverage for young adults, keeping adequate funding for Medicaid, and helping low-income individuals to secure affordable, meaningful coverage.

The House of Delegates (HOD) voted to emphasize that the AMA would not accept any cuts or caps for Medicaid funding, and the HOD also voted to advocate offering a public option as part of a pluralistic health insurance system. The AMA wants to have the private individual insurance market stabilized, to avoid potentially disastrous consequences like the tenuous situation the individual health insurance market Iowa is facing.

The AMA Senior Vice-President for Advocacy, Rich Deem, outlined why the AMA has opposed the American Health Care Act (AHCA): The AHCA would increase the uninsured by 23 million, cut Medicaid funding by $830 billion, reduce tax credits and subsidies for low and middle income Americans, eliminate some of the funding that helps support the CDC and Prevention programs, and ban Planned Parenthood funding — which violates patient freedom of choice and physician freedom of practice principles.

Some of the many other topics discussed and voted on by the House of Delegates included skyrocketing drug costs, where a number of resolutions were passed to increase transparency of drug prices and to force drug companies to give public notice justification if any yearly price increase was over 10 percent.

New policies included allowing the Centers for Medicare & Medicaid Services to negotiate drug prices.

IMS delegates to the AMA, L to R: Dr. Kitchell, Dr. Sharp, and Dr. Vista-Wayne.

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Iowa Medicine Spring 2017

David Barbe, MD, a family physician from rural Missouri, the new AMA President, emphasized three major leadership roles for physicians: 1) Advocating for health reform in today’s political environment, 2) Describing and shaping the future of health care, and 3) Mentoring those who will follow us in our profession.

IMS delegates pose with AMA President-elect Barbara McAneny, MD, a former medical student graduate and resident at the University of Iowa (third from left).

Additional resolutions addressed the opioid epidemic and promotion of multidisciplinary pain care.

The AMA will convene a task force to 1) Discuss medicine’s response to the public health crisis of undertreated and mistreated pain, 2) Make

recommendations for augmenting medical education to help patients by using evidence-based treatment options, 3) Discuss strategies to prevent or mitigate acute pain, educate physicians about these strategies, and suggest research to study strategies that would prevent development of chronic pain.

Dr. Barbe called for integrity and respectful collaboration, in contrast to the extreme partisanship in politics these days, and more action to improve healthcare access, availability, and affordability. He stressed that it takes leadership to get things done, and that good leadership is constructive, consensus-building, and principled.

This was the most solidarity displayed at an AMA meeting in my 12 years of attendance. The AMA leadership and delegates are very much in consensus with our AMA policies and advocacy.

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Extraordinary Care, Every Day Iowa IowaMedicine Medicine Summer 2017

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SPOTLIGHT: TIFFIN FAMILY CARE TIFFIN FAMILY CARE Opened in Summer of 2016

Located 1110 Tall Grass Avenue Tiffin, Iowa Physicians: • Ronald Dose, MD • Chris Dunn, MD • Tim Momany, MD Non-Physician Providers: • Sara Schneiders, PA-C • Rebecca Kuehn, PA-C • Heidi Waters, PA-C Number of patients seen annually: Approximately 6,000 The natural light flooding the waiting area welcomes patients.

In April, Kara Bylund, IMS Director of Membership & CME, had the opportunity to meet with physicians and leadership staff of the Amana Family Practice Clinic and Tiffin Family Care, and was amazed by the patientcentered approach to the Tiffin Family Care design and services. In speaking to the physicians and their staff, it was easy to see their commitment to their

patients and the love for what they do.

Chris Dunn, MD, openly admitted, “I love coming to work every day!”

Practice History In the early 1990’s Timothy Momany, MD, purchased the Amana Family Practice Clinic, about a decade later Chris Dunn, MD, joined the practice, and more than five years ago Ronald Dose, MD, joined the group. The Amana Family Practice Clinic, an independent practice, has been growing and thriving for more than 20 years, to the point that they had outgrown the space in the Amana Family Practice Clinic. In the summer of 2016 the Tiffin Family Care clinic was opened in Tiffin to meet patient needs.

Facebook: @tiffinfamilycare Each patient room within the clinic has a separate examination and consultation area. When asked what the goals were in designing the clinic in this manner, Betsy Momany, clinic administrator, responded, “to provide a no- or low-wait clinic with integrated services to meet the following patient issues: Avoid identifying the type of

Patient-Centered Environment

The pediatric table has a scale built in to help exams go smoothly.

10 Iowa Medicine Summer 2017

When one enters the patient rooms there are two things that stand out.

First off, the scale is in the room for patient privacy. For those patients with balance or other conditions that make stepping onto a regular scale difficult, the clinic has a bariatric bed with a scale built into it. The pediatrics table has a scale built in as well, to make visits go smoothly.

In-room scales and separate consultation areas help to foster the physician-patient relationship.

Future Plans

service you are receiving by the room you enter.

Stop the waiting room experience where everyone can hear your information and where you are exposed to additional illness.

Create an environment where patients feel they are honored and respected, listened to, and can listen.”

From an outsiders perspective these initiatives were impressive, but what do patients think when they first walk into the room? “They love it!” says Momany, “Our providers were stunned at the amount of time they spent sitting at the table taking to patients. Some days over 50 percent of their time is spent at the ‘kitchen’ table and not at the exam table. This enhances the experience of our patients, who have expressed how happy they are that the provider talks to them. Sometimes the exam table isn’t even necessary.”

The clinic has cut wait times by leaving space on the physicians’ and non-physician providers’ schedules to allow for walk-ins and emergencies. To meet the needs of the community, the clinic has extended hours, and makes house calls for those patients who are unable to come to the clinic.

Collaborative Care Collaboration among different specialties and disciplines is commonplace in today’s healthcare environment. The Tiffin Family Care design embraces this. In addition to the primary care providers, the clinic is home to a behavioral health counselor and a chiropractor. Having these services has benefited the physicians, non-physician providers, and most of all the patients.

“The ability to incorporate the notes from multiple types of care into one note allows our providers to render the most complete and informed care to our patients.” Says Betsy Momany, “We felt we needed to meet the growing need for behavioral care among all ages, knowing that the most effective

The physicians and staff of the Amana Family Practice Clinic and Tiffin Family Care clinic are patient-focused and always looking for ways to better serve the members of their community.

This one-stop clinic includes a full lab and x-ray services. treatment strategies for mental health challenges combine medication management and counseling.”

“Putting the three [disciplines] together also positions us to care for patients with pain syndromes in the most effective manner. We are able to utilize all three treatment paradigms to obtain optimal results in one place.”

Keeping with that “all in one place” theme, the clinic has an in-house lab and x-ray services, and there is a door leading to the Tiffin Pharmacy from the waiting room.

When asked about the future for the clinic, Momany responded, “We would like to partner with our local high school and middle school, United Action for Youth, and Abbe Community Mental Health to provide behavioral and medical interventions for those with access issues during the school day.” In addition, they are looking at telehealth options for their patients in the over-the-road trucking industry, and are considering expanding the practice to include specialists.

The IMS Board of Directors continues to emphasize the importance of IMS being an outward facing organization.

In the coming months, leadership and staff will be visiting more clinic leaders and physicians throughout the state, to learn about your practices, hear your stories, and discuss ways that IMS may be able to assist with any issues you are encountering. This column will be a new feature in Iowa Medicine. If you are interested in meeting with IMS, please contact Kara Bylund (kbylund@iowamedical.org) at (515) 421-4776.

The behavioral health office is design to make patients comfortable during their sessions.

Iowa Medicine Summer 2017

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LEGISLATIVEUPDATE

IMS TASK FORCE TACKLES PHYSICIAN BURNOUT

By Dennis Tibben

DENNIS TIBBEN Mr. Tibben is the director of government affairs for IMS. He serves as the staff liaison to IMPAC, as well as the Committees on Legislation, Medical Services, and Law and Ethics.

Regular readers of Iowa Medicine may recall our fall 2015 edition, which reported some disturbing results from the then-recently completed survey of all Iowalicensed physicians. 79.3 percent of respondents reported some level of professional burnout, with 48.2 percent of these individuals reporting moderate to total burnout. These results, while in line with national statistics, were quite sobering. Recently, the online publication Medscape released its rankings of the best cities in the country to avoid professional burnout when practicing medicine. They ranked Des Moines the fourth best city in the country, yet nearly 80 percent of Iowa physicians are reporting burnout symptoms. This very clearly is a profession in crisis.

You often hear our physician leaders and staff quote the IMS core purpose: “To assure the highest quality health care in Iowa through our role as physician and patient advocate.” As a mission-driven organization, IMS has a duty to intervene when challenges such as professional burnout threaten physicians’ ability to continue delivering high-quality care.

The IMS Board of Directors recognized this when they voted in early 2016 to form an ad hoc Physician Burnout Task Force to determine how IMS might best support Iowa physicians at risk of or currently experiencing professional burnout.

Over the past year and a half, this Task Force has reviewed numerous burnout resources, completed an environmental assessment to determine what burnout and professional resiliency efforts are already underway, and spoken

12 Iowa Medicine Summer 2017

with state and national experts to determine how best to position IMS as a resource for all Iowa physicians, residents, and medical students.

The Physician Burnout Task Force submitted their final report, known

as the Steenblock Report, to the IMS Board at its July 14, 2017, meeting.

This report outlines a series of recommended strategies and tactics to support those currently suffering from burnout and, arguably more importantly, to prevent others from becoming burned out in the first place.

Early in the Task Force process, it became apparent that any successful effort to combat burnout would require IMS to develop tailored resources, opportunities, and approaches based upon the differing needs of physicians, residents, and medical students at different stages of their professional careers.

Task Force members grappled with problems such as reaching those disengaged physicians who either do not want to publicly seek out

Rate yourself relative to the statement: “I am experiencing professional burnout” 5.7%

Total 20.6%

17.7%

Significant Moderate

31.1%

24.8%

Somewhat Not At All

Source: 2015 Iowa Physician Survey

resources and support or who don’t even recognize they are exhibiting burnout symptoms.

Throughout the report, they sought to highlight options for addressing these challenges, while providing concrete tactics so that IMS could immediately begin implementing their recommendations.

Task Force Recommendations

1) Make available a series of inperson educational programs and collaboration opportunities focusing on burnout and professional resiliency.

Continue to feature burnout

and professional resiliency programming, as well as collaboration opportunities at the IMS Annual Conference, April 27-28, 2018.

Develop regional programming, starting with pilots in 2017 and moving statewide in 2018, to make resources and education available in a local setting throughout the year.

Consider hosting a statewide

multi-disciplinary conference to provide all members of the care team with professional burnout and resiliency resources.

Convene leadership from Iowa’s

two medical schools to share best practices and build upon current efforts already underway.

2) Make available a series of virtual educational programs and collaboration opportunities focusing on burnout and professional resiliency.

Work with state and national partners to develop a series of live and on-demand webinars to increase access to education and resources.

Utilize virtual programming and resources to augment inperson programming.

3) Develop an online resource page to connect Iowa physicians with resources and support.

Utilize existing, trusted national burnout and professional resiliency resources to help Iowa physicians, residents, and medical students.

Partner with other state-level organizations to make available Iowa-specific resources.

Make available resources to combat the factors that lead to professional burnout, including the challenges associated with practice transformation.

4) Be mindful of the burnout implications of all policy proposals that IMS reviews on the state and national level.

Identify the burnout implications of policy under consideration.

Identify policy changes that IMS might pursue to help reduce professional burnout.

To view the full Steenblock Report, please visit the IMS website, www.iowamedical.org.

What Comes Next Staff have begun developing plans to implement the recommendations of the Physician Burnout Task Force.

IMS is partnering with the Quad Cities Medical Society to host the first regional burnout and physician well being pilot program on Tuesday, November 14, 2017.

The Physician Burnout and Professional Well Being Resource page of our website is under development and will be going live in the coming weeks. Watch upcoming IMS publications for additional announcements as more programs and resources become available.

The Iowa Medical Society is committed to ensuring that every physician, resident, and medical student in our state has access to the resources, education, collaboration, and support necessary to stem the tide on professional burnout. For more information on the Steenblock Report and IMS efforts, please contact me at dtibben@iowamedical.org.

Iowa Medicine Summer 2017

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LEGALEASE

NEW RULES ON SUPERVISION OF PHYSICIAN ASSISTANTS

By Kate Strickler, JD, LLM

KATE STRICKLER, JD, LLM Ms. Strickler is the general counsel for IMS, and serves as the lead at IMS for the Candor program.

In recent years, the Iowa Board of Medicine (IBM) has fielded an increasing number of complaints regarding inappropriate or questionable arrangements for the supervision of physician assistants (PAs).

IMS has similarly seen an increase in member inquiries and has become aware of some alarming employment trends including IBM complaint investigations that have uncovered instances where physicians had been designated a PA’s supervising physician without the physician’s knowledge.

Over the past several years, the IBM and the Iowa Board of Physician Assistants (IBPA) have been working to amend the rules governing PA supervision. Joint rules were drafted by the IBM and the IBPA and adopted by the IBM; those rules were nullified by the 2017 Legislature and are no longer in effect. The IBM has proposed a new set of rules, which are expected to go into effect in September.

Prior to the 2015 Legislative Session, the IBPA proposed eliminating its rule requirement that supervising physicians and PAs who practice at a remote site meet in-person at the remote site at least once every two weeks. Physician organizations, including IMS, objected to the elimination.

IMS successfully sought a session delay from the legislative Administrative Rules Review

14 Iowa Medicine Summer 2017

Committee (ARRC) to prevent this rule change from going into effect and the IBPA ultimately relented on its proposal to eliminate the two-week remote practice visit requirement.

This proposed rule change underscored that the existing rules for physicians supervising PAs were vague and provided little guidance to either health professional.

Physicians continue to be subject to IBM discipline for improper supervision, but there were no clear rules delineating what constitutes proper minimum supervision standards. Further complicating the problem, Iowa is the only state in the nation where the IBM does not have clear authority to regulate physician supervision of PAs. In response, the Legislature enacted a bill that year requiring the IBM and the IBPA to work together to promulgate joint rules. A subcommittee consisting of members from both boards met several times over the course of more than a year; received extensive input from stakeholder organizations, including IMS; and twice agreed on a set of rules to take back to their full boards for adoption.

The rules included guidance for physicians supervising PAs, such as PA chart review standards and that the PA’s scope of practice should be within the same area of practice as his or her supervising physician. Also included in the rules was a requirement that all PAs meet with their supervising physician at least two times a year.

If the PA works primarily at a remote practice location, both meetings were to have been there and, regardless of practice location, that these meetings be documented. This rule was intended to replace the IBPA requirement that supervising physicians visit PAs in remote-site clinics, in person, at least every two weeks.

After the rules were approved by the subcommittee, both full boards then needed to vote to adopt the rules. The IBPA refused to do so with the first jointly crafted rules, so in April of 2016, the two subcommittees once again came together and developed a second, looser set of rules.

The IBM subsequently adopted these rules, which took effect in June of 2016. The IBPA, after significant debate, opted to once more reject the jointly-crafted rules and begin unilateral development of a third, even more lax rules draft, which it was still unable to adopt.

With the IBPA gridlocked and the IBM rules now in effect, there was considerable confusion in the summer and fall of 2016 as to what standards a supervising physician must adhere to. The IBPA rules still required that a supervising physician visit

remote-practice PAs at least once every two weeks, while the IBM rules now required supervising physicians to meet with all PAs under their supervision at least twice a year.

Further complicating matters was the revelation that the IBPA had been regularly issuing blanket waivers to their remote-practice site visit requirement and not enforcing other supervision standards that predated this latest rule fight, leading many PAs and their supervising physicians to not even know their existing legal obligations.

The legislature was forced to again take action on this matter during the 2017 Legislative Session. House File 591 nullified both boards’ versions of the joint rules and required the IBPA to begin sharing disciplinary records with the IBM when inappropriate supervision was alleged. The statute, which was signed into law in April, further prohibited the IBPA from amending any of its existing supervision rules without the consent of the IBM. Nullifying the joint rules addressed the conflicting status of the two boards’ rules and implemented necessary process improvements to ensure the IBPA was communicating with the IBM about supervision complaints.

However, it did not address the underlying issue that physicians still lack clear guidance on what constitutes appropriate supervision.

The IBM has adopted new rules regarding physician supervision of PAs, ARC 3069C. Unlike the previous set of supervision rules, the IBPA does not need to also enact them. The rules largely codify existing requirements, some of which are not currently being enforced by the IBPA. New to Iowa, the rules seek to adopt a model currently in place in 41 states and the District of Columbia — prior to entering into a practice arrangement, PAs and their supervising physicians must complete a written supervisory agreement to clearly articulate their responsibilities and details of their practice arrangement.

Modeled after the system that has been in place in Minnesota for more than 20 years, the short form must be completed and maintained at the practice location, rather than being submitted to the board for approval.

In vetting these latest rules, IMS reached out to the Minnesota Medical Association (MMA) to confirm that this model did not pose a significant

burden on practices or place PAs at a competitive disadvantage for employment. This feedback was included with the IMS written comments to the IBM. To view the IMS written comments, please visit our website, www.iowamedical.org.

The IBM’s new rules were adopted at its July 24 meeting. The earliest the rules could take effect is September 20, 2017, however, the ARRC must still review them a final time.

While the joint rules between the IBM and the IBPA are no longer in effect, the IBPA rules governing supervision, that predate the joint rule-making effort, remain in effect.

IMS will continue to monitor the proposed rules; look to the Weekly Debrief for updates. For questions regarding the current legal obligations of supervising physicians, please contact Kate Strickler, general counsel of the IMS Center for Physician Advocacy, at kstrickler@ iowamedical.org.

For questions about the new rules or to share your thoughts on them, please contact Dennis Tibben, director of government affairs at the IMS Center for Physician Advocacy, at dtibben@iowamedical.org.

THIS SHOULD BE YOUR ADVERTISEMENT. MAKE IT SO. CONTACT IMS. | MICHELLE DEKKER, MDEKKER@IOWAMEDICAL.ORG | 800-223-1401

Iowa Medicine Summer 2017

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CELEBRATING PHYSICIAN ADVOCACY The third annual IMPAC Independence Day Celebration, Docs ’n’ Pops, was held in conjunction with the worldclass Des Moines Symphony’s annual Yankee Doodle Pops concert. Guests enjoyed the concert from air-conditioned comfort, along with hors d’oeuvres and cold beverages. Following the concert, IMS opened its balconies to view the fireworks show.

Doc ’n’ Pops is an event to raise funds for IMPAC’s work on behalf of Iowa physicians. This year we celebrated passage of the most sweeping package of medical liability reforms in Iowa in more than a generation. At the event, IMS President Joyce VistaWayne, MD, presented a special Presidential Citation Award to Iowa Senate Majority Leader, Bill Dix. Ceremonies around the state are being planned to recognize this year’s other legislative champions (see side bar).

IMS President, Joyce Vista-Wayne, MD, presents a Presidential Citation Award to Senate Majority Leader, Bill Dix (R-Shell Rock) for his work on behalf of physicians in passing the new medical malpractice reform law.

L to R: Senator Bill Dix, Joyce Vista-Wayne, MD, Sandi Conlin, IMS Contract Lobbyist, IMS Secretary/Treasurer, Brian Privett, MD, Andy Conlin, Ken Wayne, MD, and Dennis Tibben, IMS Director of Government Affairs. Opthalmology, Cedar Rapids, enjoyed the evening with his family.

16 Iowa Medicine Summer 2017

The Awards This year IMS is awarding four Presidential Citation Awards to legislators who played a distinct and crucial role in the passage of the new medical liability reform law, effective July 1. The award recipients are: Senate Majority Leader Bill Dix (R-Shell Rock) who declared tort reform one of the top four priorities for the Iowa Senate in 2017. His insistence on passing the strongest bill possible out of the Senate built momentum and was a crucial component to this legislative victory.

Photos from top left: Red, white, and blue was the theme for the evening.

The event was a family affair and some guests came all decked out.

There was a nice mix of physicians, residents, medical students, and guests at the celebration.

Senator Dix shares stories with EVP/IMS CEO Mike Flesher, and Dennis Tibben.

Members and guests enjoyed the fireworks show from IMS headquarter’s balconies.

House Speaker Linda Upmeyer (R-Clear Lake) also played a critical role in this effort. Working tirelessly behind the scenes, she ensured that a cap on noneconomic damages stayed in the bill and that the reform package passed the House with a comfortable margin.

Senator Charles Schneider (R-West Des Moines) and Representative Ashley Hinson (R-Marion) floor-managed the bill in their respective chambers. Their extensive preparation and skilled navigation of the subcommittee, committee, and floor debate process ensured that proponents of the legislation were well-prepared to make the case for these reforms.

Working closely with IMS to craft the specific components of the legislation, these leaders fought off significant opposition from the trial attorneys and their legislative allies. Without the support of Majority Leader Dix, Speaker Upmeyer, Senator Schneider, and Representative Hinson, Iowa physicians could easily have seen another session pass without any meaningful action on medical liability reform.

Iowa Medicine Summer 2017

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Register Today

Candor COM MUNICATION AND OPTIM AL RESOLUTION

IOWA MEDICAL SOCIETY

CONFERENCE Friday, September 22, 2017

Kelley Conference Center at Iowa Methodist Medical Center 1200 Pleasant Street Des Moines, Iowa 9:00 a.m. to 3:30 p.m.

Free to IMS members, $25 for Non-members

REGISTER TODAY!

National medical and legal experts will discuss early disclosure programs across the country, and the successful Candor (Communication and Optimal Resolution) pilot program established in Iowa.

This day-long conference is tailored to physicians, risk managers, hospital and clinic leaders, and other members of healthcare teams involved in patient safety.

SESSIONS INCLUDE:

Candor 101 Large system and independent clinic breakouts Attorney Panel Physician, patient, and family session

Don’t miss this valuable educational opportunity!

IOWA MEDICAL SOCIETY

The Candor Conference is supported by grant funding from The COPIC Foundation.

One Number Accesses Our Pediatric Surgical Specialists, Any Problem, Anytime.

1.855.850.KIDS (5437) PHYSICIANS’ PRIORITY LINE

Your 24-hour link to pediatric specialists for physician-to-physician consults, referrals, admissions and transport service.

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MEMBERS IN THE NEWS (April to July 2017) Alexander Bassuk, MD, PhD, Child Neurology, Iowa City, co-authored new study on CRISPR gene editing published in Nature Methods.

Congratulations to Shira Simon, MD, NeuroOphthalomology Fellow, Iowa City, daughter of Dana Simon, MD, Anesthesiology, Des Moines on her recent marriage on May 28 to Oliver Bevan.

Terry Briggs, MD, OB/GYN (retired), and Joseph Pollpeter, MD, Family Medicine, both of Marshalltown, have been named to the UnityPoint Health Board of Trustees – Marshalltown.

Jolene Smith, DO, Anesthesiology/Pain Medicine, Des Moines, discussed how spinal cord stimulation is a nonmedication option for patients suffering from chronic pain.

The story was broadcast on WHOTV on May 1.

Alex Cohen, MD, PhD, Ophthalmology, Iowa City, describes the work that he is doing on behalf of the people of Swaziland in South Africa. Article was published in the Iowa City Press Citizen on June 16.

Stephen Stephenson, MD, Pediatric HematologyOncology, President/COO of Blank Children’s Hospital, authored a Des Moines Register article entitled “Medicaid Changes Could Risk Our Children’s Health,” published on June 21.

Josephine Dunn-Junius, MD, Family Medicine, Sheldon, has been called to active duty with the U.S. Naval Reserve Medical Corps. Her 9-month deployment will begin in September.

Alicia Gerke, MD, Pulmonary Diseases, Iowa City, was featured in a KCRG-TV9 news story regarding radon testing, broadcast on May 12.

Jennifer Groos, MD, FAAP, Pediatrics, Des Moines, received a Special Achievement Award from the American Academy of Pediatrics in June.

Alan Gunderson, MD, Gastroenterology, Iowa City, discussed the rise of hepatitis cases during KCRG- TV9 broadcast on May 15.

Ryan Hollenbeck, MD, FACC, Cardiovascular Disease, Cedar Rapids, led the first Iowa team to utilize a new FDA-approved stent system to treat patients with large coronary arteries.

Congratulations to the 2017 Kathie J. Lyman Scholarships Award Recipients, Allison Smith, DO’18, Des Moines and Tarek Karam, M2, Iowa City. Scholarships were awarded during the Polk County Medical Society Annual Meeting on April 19 at the Downtown Des Moines Embassy Club.

Lawrence Liebscher, MD, FACR, Radiology, Waterloo, elected American College of Radiology Council Vice President during the College’s annual meeting in May. Ken McCann, DO, Pediatrics, Des Moines, showcased the STAR Center, a new clinic within Blank Children’s Hospital designed to promote the health of foster children. The story was broadcast on KCCI Des Moines on June 13.

Neil Mandsager, MD, OB/GYN, Des Moines, was featured in a story that received national attention regarding how the “Count the Kicks” app is helping to reduce stillbirth rates in Iowa.

Jennifer Robinson, MD, MPH, Cardiovascular Disease, Iowa City, featured in TCTMD online article regarding research outlining that women and physicians are not talking about the leading cause of death among this population, heart disease, published on June 28.

20 Iowa Medicine Summer 2017

IMS At-Large Board Member, Scott Truhlar, MD, FACR, Diagnostic Radiology, Coralville, was awarded the degree of Fellow of the American College of Radiology during the ACR Annual Meeting on May 21.

Iowa Academy of Otolaryngology President, Thomas “Fritz” Viner, MD, Iowa City, celebrated his latest milestone birthday with “FRITZBRAI,” a bike ride from Iowa City to the Park Rapids, Minnesota on May 20. About a dozen family and friends took part in the 530 mile ride.

Michael Welsh, MD, Internal Medicine/Pulmonary Diseases, Iowa City, led the research team study that may help explain mucus clearance problems for patients with cystic fibrosis. The study was published in Proceedings of the National Academy of Sciences (PNAS) Early Edition in June.

Patricia Winokur, MD, Infectious Diseases, Iowa City, discussed UI experimental Chikungunya vaccine trial during story broadcast on KWQCTV6 on June 5.

Polk County Medical Society Announces 2017-18 Executive Council Congratulations to the IMS members that have been elected to serve on the Polk County Medical Society Executive Council for 2017-18. These physicians include:

Officers: President – Matthew Rauen, MD, Ophthalmology, West Des Moines President- Elect – Kaaren Olesen, DO, OB/GYN, Urbandale Past President – Joel From, MD, Cardiovascular Disease, Des Moines

Councilors: Douglas Massop, MD, Vascular Surgery, West Des Moines Steve Cahalan, MD, General Surgery, West Des Moines William Wortman, MD, Internal Medicine, Ankeny Larry Severidt, MD, Family Medicine, Des Moines

WELCOME NEW IMS MEMBERS Ravi Ashwath, MD, Pediatric Cardiology, UIHC, Iowa City Derek Bitner, MD, Ophthalmology, Wolfe Eye Clinic, PC, West Des Moines Geoffrey Bowman, MD, OB/GYN, UnityPoint Clinic OB/GYN – Utica Ridge Road, Davenport

(April 1 to June 30, 2017)

Sandra Granger, MD, Pediatrics, Prairie Pediatrics & Adolescent Clinic, PC – Morningside on Glenn, Sioux City

David Kusner, MD, Internal Medicine, Infectious Disease Physician of Iowa City, LLC, Iowa City

Ann Stroh, DO, Oncology, Oncology Associates at Hall-Perrine Cancer Center, Cedar Rapids

Thomas Pietras, MD, Dermatology, Forefront Dermatology, Cedar Rapids

Theresa Clemmons, DO, Psychiatry, Fort Dodge Correctional Facility, Fort Dodge

Sarika Deshmukh, MD, Nephrology, UIHC, Iowa City Friederike Fischer, MD, Family Medicine, UIHC, Iowa City Jeremy Granger, MD, Pediatrics, Prairie Pediatrics & Adolescent Clinic, PC – Morningside on Glenn, Sioux City

Christopher Dupuis, MD, Orthopedic Surgery, Quincy Medical Group, Keokuk Stephen Fox, MD, Ophthalmology, Wolfe Eye Clinic, PC, Spencer

Karla Solheim, MD, OB/GYN, Partners in Obstetrics & Gynecology, PC, Waterloo John Trible, MD, Ophthalmology, Wolfe Eye Clinic, PC, West Des Moines

IN MEMORIAM Stanley Haugland, MD, 89, Family Medicine, Winterset, passed away on April 8.

MEMBERS ON THE MOVE • Mark Andrew, MD, FACS, General Surgery, has joined Iowa Weight Loss Specialists, and is seeing patients at the Iowa Specialty Hospital – Clarion, Iowa Specialty Hospital – Belmond, and the Hampton Clinic.

• Quentin Dickins, MD, and Michael Pogel, MD, joined Burlington Neurology & Sleep Clinic, PLC, on June 26. Drs. Dickins and Pogel continue to see patients in Fairfield, Ottumwa, and Albia.

• IMS At-Large Board Member, Cynthia Hoque, DO, Family Medicine, completed her residency training at Iowa Lutheran Hospital and joined Knoxville Hospital and Clinics.

• Jaclyn Haugsdal, MD, Ophthalmology, completed her residency training at the University of Iowa and has joined the Iowa Eye Center in Cedar Rapids.

• Michael Haugsdal, MD, OB/GYN, completed his residency training at the University of Iowa and has joined the UIHC-OB/GYN department.

CORRECTION: In the Spring 2017 edition of Iowa Medicine’s “Members in the News”: Chad Carlson, MD, West Des Moines and Mederic Hall, MD, Iowa City, elected to leadership roles with the American Medical Society for Sports Medicine and will assume their roles in May of 2017.

Mederic Hall, MD’s name was misspelled. IMS apologizes for the error.

HAVE NEWS TO SHARE? IMS welcomes news related to our members.

Please send information to Kara Bylund kbylund@iowamedical.org

Iowa Medicine Summer 2017

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THANK YOU! A SPECIAL THANK YOU TO OUR MEMBERS WHO ARE “ALL IN” IN 2017 100 percent of physicians in the following groups have joined the Iowa Medical Society in 2017.

We appreciate your support and commitment!

LARGE GROUPS Associated Anesthesiologists, PC McFarland Clinic Blank Children’s Hospital Medical Associates of Clinton Covenant Clinic Medical Center Anesthesiologists, PC Grand River Medical Group Radiology Consultants of Iowa Iowa Heart Center The Iowa Clinic University of Iowa Physicians

SMALL GROUPS Amana Family Practice Clinic Avera Medical Group – Spirit Lake Medical Center Burgess Family Clinic – Mapleton Burlington Area Family Practice Center, West Burlington Burlington ENT Clinic, West Burlington Burlington Pediatric Association, PC, West Burlington Cedar Valley Medical Specialists, PC – Eye Care, Waterloo Charles City Family Health Center Cherokee Regional Clinics ChildServe, Johnston Cornerstone Family Practice, Guttenberg Cresco Medical Clinic Dermatology & Dermatologic Surgery Center, PC, Clive Davenport Eye Group PC, Davenport Des Moines Eye Surgeons, West Des Moines Doran Clinic for Women, Ames Dubuque Anesthesia Services, PC Dubuque Obstetrics & Gynecology, PC Dubuque Surgery, PC ENT Medical Services, PC, Iowa City

Family Health Care of Siouxland – Indian Hills Clinic, Sioux City Family Health Care of Siouxland – Morningside Clinic, Sioux City Family Health Care of Siouxland – Northside Clinic, Sioux City Family Health Care of Siouxland – South Sioux Clinic, Sioux City Family Medicine, LLP, Grinnell Family Practice Clinic, Emmetsburg Fox Eye Laser & Cosmetic Institute, PC, Cedar Rapids Franklin Medical Center, Hampton Fuerste Eye Clinic, Dubuque Genesis Pulmonary Associates, Davenport Genesis Quad Cities Family Medicine Residency Faculty, Davenport Great River Family Practice Clinic, West Burlington Great River Urology, West Burlington Great River Women’s Health, West Burlington Gundersen Behavioral Health, Decorah Gundersen Palmer Lutheran Hospital and Clinic, West Union Guthrie Family Medicine Center, Guthrie Center Hall Radiation Center, Cedar Rapids Heartland Dermatology, Clive Heartland Oncology Hematology, Council Bluffs

Iowa Cancer Specialists, PC, Davenport Iowa City Dermatology Iowa Eye Center, Cedar Rapids Iowa Retina Consultants, West Des Moines James Trahan, MD, PLC, Ames Jones Eye Clinic, Sioux City June E. Nylen Cancer Center, Sioux City Katzmann Breast Center, Clive Kossuth Regional Health Center Clinic, Algona LifeServe Blood Center, Des Moines Mahaska Health Partnership – General Surgery, Oskaloosa Marshalltown OB/GYN, PC Mason City Clinic - Plastics & Reconstructive Surgery Medical Clinic, PC, Hamburg Medix Occupational Health Services, Ankeny Mercy Clinics Family Medicine, Johnston Mercy Clinics Family Medicine Prairie Trail, Ankeny Mercy Clinics Family Medicine, Urbandale Mercy Clinics North Iowa Administration, Mason City Mercy Diabetes Center – North Iowa, Mason City Mercy East Pediatric Clinic – Pleasant Hill Mercy Family Clinic - Clear Lake Mercy Family Clinic – Forest City Mercy Family Clinic – Forest Park Mercy Family Clinic – Regency, Mason City Mercy Family Clinic – Rockford Mercy Family Medicine Residency Faculty – North Iowa Mercy Johnston Medical Clinic Mercy Kidney Center, Mason City Mercy Medical Center - Cedar Rapids - Pulmonology Clinic Mercy Medical Clinic – Centerville Mercy Medical Services – Breast Care, Dakota Dunes, SD Mercy Obstetrics & Gynecology – North Iowa, Mason City Mercy Pediatric & Adolescent Clinic – Clear Lake Mercy Pediatric & Adolescent Clinic – North Iowa, Mason City Mercy Pediatric Clinic, Cedar Rapids Mercy Plastic Surgery, Des Moines Mercy Prairie Trail Family Medicine, Ankeny Mercy Radiation Oncology Clinic, Mason City Mercy Ruan Neurology Clinic, Des Moines Mercy Surgical Affiliates, Des Moines Mercy Transplant Center, Des Moines Mercy Urgent Care, Mason City Mercy Weight Loss & Nutrition Center, Clive Mercy Women’s Health Center – Mason City MercyCare Center Point Mid Iowa Fertility, PC, Clive Midwest Radiology & Imaging, Spencer Mitchell County Regional Health Center – Osage Clinic Myrtue Medical Center – Harlan Clinic Neurosurgery of North Iowa, PC, Mason City

Northeast Iowa Family Practice Center, Waterloo North Iowa Eye Clinic, PC, Mason City NW Iowa Bone Joint & Sports Surgeons, Storm Lake NW Iowa Ear Nose & Throat, Spencer NW Surgery, Orange City OB/GYN Associates, PC, Cedar Rapids Oncology Associates at Hall-Perrine Cancer Center, Cedar Rapids Orthopaedic Specialists, PC, Davenport Ottumwa OB/GYN Physicians, LLC Ottumwa Regional Primary Care Pathology Associates, Dubuque PathSource Diagnostics LLC, Davenport Pediatric & Adult Allergy PC, Des Moines Pediatric Associates Ottumwa Pediatric Cardiology, PC, Des Moines Physicians’ Clinic of Iowa – Oncology/Hematology, Cedar Rapids Physicians Lab of Northwest Iowa, Spencer Prairie Pediatrics & Adolescent Clinic, PC, Sioux City Radiologic Medical Services, PC, Coralville Rheumatology Associates, PC, Bettendorf River Hills Pediatric Clinic, Ottumwa SE Iowa Neurological Associates, PC, Fairfield Siouxland Medical Education Foundation Faculty, Sioux City Siouxland OB/GYN, PC, Sioux City Siouxland Urology Associates, PC, Dakota Dunes Siouxland Women’s Health Care, Sioux City Steindler Orthopedic Clinic, PLC, Iowa City The Group – OB/GYN Specialists, PC, Davenport UnityPoint Clinic - Family Health Center Storm Lake UnityPoint Clinic - Family Medicine Sac City UnityPoint Clinic Family Medicine – Huxley UnityPoint Clinic Family Medicine – Ingersoll, Des Moines UnityPoint Clinic Family Medicine – Mulberry, Muscatine UnityPoint Clinic Family Medicine – Northwest, Windsor Heights UnityPoint Clinic Family Medicine – Physical Therapy, Altoona UnityPoint Clinic Family Medicine – Sac City UnityPoint Clinic Family Medicine – Sergeant Bluff UnityPoint Clinic Internal Medicine – Prairie Trail, Ankeny UnityPoint Clinic OB/GYN - Utica Ridge Road, Bettendorf UnityPoint Clinic Surgery – Bettendorf UnityPoint Health Waterloo – Center for Urology, Waterloo Waterford Family Medicine, Davenport Wolfe Clinic, PC, Cedar Rapids Wolfe Eye Clinic PC, Marshalltown Wolfe Eye Clinic PC, Fort Dodge Wofe Eye Clinic PC, Cedar Falls Wolfe Eye Clinic PC, Ames Wolfe Eye Clinic PC, Spencer Wolfe Eye Clinic PC, Ottumwa Wolf Eye Clinic PC, Iowa City

IOWA MEDICAL SOCIETY Large Groups consist of 20 or more physicians, Small Groups consist of 2-19 physicians. Current as of July 31, 2017

ON THE ROAD WITH IMS

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45 6 8

7

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1216

Mike Flesher, IMS CEO, and Kara Bylund, IMS Director of Membership & CME, have been traveling throughout Iowa meeting with members and administrative staff.

These meetings have allowed our staff to see first-hand the issues that affect physicians and their practices, and the innovative ways that practices of all sizes are improving the health of their communities.

Beginning in this issue of Iowa Medicine, IMS will be featuring a physician practice that is making a difference in their community. Read how the Tiffin Family Care clinic is changing the patient experience and their physicians approach to patient encounters on page 10.

Coming visits to Ames, Cedar Rapids, Iowa Ctiy, Mason City, Soiux City and points in between are being planned.

If you are interested in meeting with IMS, contact Kara Bylund (kbylund@ iowamedical.org) at (515) 421-4776.

24 Iowa Medicine Summer 2017

Where on the Map? Thank you to the following practices and facilities that have welcomed IMS staff:

1 Steindler Orthopedic Clinic, Iowa City

2 North Liberty Family Health Center, PC, North Liberty

3 Mercy Physician Health

Organization, Iowa City

4 Radiology Consultants of Iowa, PLC, Cedar Rapids

5 Linn County Anesthesiologists, Cedar Rapids

6 Physicians’ Clinic of Iowa, PC, Cedar Rapids

7 Medical Associates of Clinton, PLC, Clinton

8 Tiffin Family Care, Tiffin

9 Dubuque Surgery, PC, Dubuque

10 Dubuque Obstetrics &

Gynecology, PC, Dubuque

11 Maquoketa Family Clinic, PC, Maquoketa

12 Burlington Area Family Practice/Great River Family Practice Clinic, West Burlington

13 Methodist Jennie Edmundson Hospital, Council Bluffs

14 The Iowa Clinic, Des Moines

15 UnityPoint Clinic Family Medicine, Humboldt

16 Great River Medical Center West Burlington

GET TO KNOW YOUR BOARD MEMBERS on the East coast, and was curious about the Midwest. When I moved to Iowa in 1998 from Connecticut, the friendliness of the people in the Midwest and the calm, quiet life of a rural town appealed to me. I got married two years after I moved to Iowa, and my husband, who is also from the East coast, felt that a rural town in the Midwest offered a safe and secure place to raise a family.

In April, the IMS membership elected three new At-Large Directors, the Resident Director and Medical Student Director to the IMS Board of Directors. Throughout the next year readers will be introduced to these new leaders. This issue features IMS At-Large Director, Sharmini Suriar, MD, Internal Medicine/Pediatrics, Humboldt.

What drew you to serve on the IMS Board of Directors?

After practicing medicine as a primary care provider for a few years, I realized the importance of being directly involved in the decision making that impacts the care we provide to our patients.

I decided to enhance my leadership skills and to be a voice of our patients and fellow physicians, so that our patients continue to receive excellent care and that physicians in Iowa are given an environment to serve their patients to the best of their ability, without unnecessary distractions. It is also important that the physicians did not feel helpless or overwhelmed by regulatory bodies, and feel that they have firm support from strong administrative groups, to perform their duties as best as they know how.

We have been blessed to be surrounded by folks with great community values, and have had access to excellent educational and recreational opportunities locally.

IMS has been a proven, effective body that has not only been a strong voice for our patients and physicians in Iowa, but also has been successful in safeguarding the wellbeing of our patients and has been playing a critical role in ensuring that legislators treat physicians fairly in Iowa. I am honored to be part of an organization that represents our values so well.

Why did you choose to practice in Iowa?

I am a primary care physician and I started my first job post-residency in Iowa. I had trained and lived

My patients are my extended family, and Iowa is a great state to practice medicine, especially in rural towns, where there is a critical shortage for primary care physicians.

What are your hobbies and interests outside of medicine?

I am a busy mom and a physician, and my free time is very precious. I love to spend time with my family, traveling to new places, and visiting family. I also enjoy volunteering, reading, and listening to music.

CELEBRATING 30 DAYS OF WOMEN PHYSICIAN LEADERS September is Women in Medicine month. Throughout the month, IMS will feature female leaders within medicine. Watch the IMS e-newsletters, Twitter, and Facebook for information on 30 Days of Women Physician Leaders, beginning September 1.

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DMU UPDATE

YOUR BACK-STAGE PASS TO MEDICINE

By Greg Christiansen, DO, MEd, FACOEP-D

GREG CHRISTIANSEN, DO, MEd, FACOEP-D Greg Christiansen, DO, MEd, FACOEP-D is the Dean of the College of Osteopathic Medicine at Des Moines University

There is a bit of romanticism watching your favorite concert from the privileged position of the back-stage. Back-stage passes let you see the production and logistics of the show.

If you transpose that imagery to your medical practice, would the romanticism of being a physician persist?

I am guessing the view from the other side would be quite different and the romanticism would fade for many. There has been a steady stream of evolutionary change for decades and the driver of that evolution is the cost of health care.

The blame for the increased healthcare expenditure in the perspective of many physicians is that physicians are bearing the burdon disproportionally. I won’t argue the merits of this point other than to say there is widespread angst in the physician community.

A Facebook post from a long-time colleague illustrates the ‘backstage view’ after re-entering practice after a long hiatus. As if he entered out of a time capsule, he valiantly tried to reduce the polypharmacy burden for his patients with multiple conditions.

In doing so, he unwittingly became entangled in the insurance prior authorization game.

He spent hours of his valuable time getting approvals for medications with four-dollar price tags.

Needless to say, these barriers have changed physician behavior but not necessarily for the benefit of the patient. The illustration demonstrates the bureaucratic creep that exists at all levels of medical practice.

26 Iowa Medicine Summer 2017

Administrative costs account for more than 25 percent of medical delivery bills, the highest rates in the world. The $200 billion-dollar price tag attributed to administrative practices is sure to increase for two reasons. The aging population requires more services, and the implementation of the Merit-based Incentive Payment System (MIPS) will add more parameters.

Keep in mind Iowa’s aging population makes up 15 percent of its roughly 3 million people. In 10 years, 19 percent of Iowans will be 65 years old or older.

Nationwide 13 percent of physicians declined to accept Medicare patients for financial reasons and that number has been increasing. This collision is quietly happening without much attention.

Physician-limited time to support the increasing needs of an aging population, while adjusting to yearly changes to quality- and costperformance measures, is consuming the very will to practice for many physicians. If you consider the secondary effects of these changing processes, then it becomes easier to see how all these changes are threatening the industry’s survival.

Practice patterns are reacting to workforce deficits in serviceable skills.

Physician development and training models have not matched pace with many new restrictive mandates. The lack of data on the front end of these policies has had an impact on the practice and training on the back end.

For example, after it was implemented, the 80-hour work rule was shown to have negative patient care effects in the training of surgeons, so only recently have the work rules been relaxed.

This was not surprising to many who practice surgery everyday yet the rule was broadly mandated. We still don’t know the effects these rules have had on physician placement in regards to the work force.

My anecdotal observation suggests these rules have negatively impacted physician placement in the areas of most need. Adding to the mix of the compounded effects of change are other major domains like technology.

The Electronic Medical Record (EMR) productivity effects were not predicted by the regulators. In addition, more hospital system complexities resulted in increased vulnerabilities to the very systems they now depend on to maintain the operation.

Performance metrics misalignment is another costly issue to physician societies and as we are now learning, costly to patients. Highlighting this untoward effect of performance metric ‘interpretation’ misalignment is a raging debate over who is responsible for opioid prescribing (5th vital sign) issues. These decisions and their effects illustrate the seriousness of the issues.

I present this overview demonstrating the effects of change to say, often

unsustainable. The current healthcare law is unsustainable. Without a more balanced approach to healthcare policy we are likely to remain frustrated.

There are many lessons and themes to extract from this process.

But the one salient and recurrent deficit displayed when we pull back the curtain to see how things really run, is the limited engagement of physicians with the policy makers to make the appropriate change. Our patients need your wisdom to do what we can afford and serve our patients.

We can’t expect perfection but we can expect to do a lot better.

our Gestalt is correct and predictive.

The wisdom of our physicians needs to be communicated more effectively and shared with the community in greater clarity.

It can be said we’ve had too much change without the desired results and we can anticipate a lot more change looking forward. The bottom line for health care is the costs are

The backstage view experienced by our patients and future physicians could be better if we each did our part while we are on the stage of life playing our roles. Get involved with the advocacy to support your patients and let’s avoid these bad decisions that have removed physicians from the stage.

Do Your Patients Know Their Status?

1.2 million people are living with HIV in the U.S. 45,000 people are newly infected annually 14% of Iowans infected with HIV have not been diagnosed

HIV Screening Is Standard Care.

Every Patient Should Be Tested.

The CDC & USPSTF recommend individuals get screened for HIV at least once in their lifetime

PREVENTI N

C RE Care IS Prevention

IS

ACT gainst

a

AIDS Iowa Medicine Summer 2017

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Inaction vs.

IN ACTION

The Litigation Center of the American Medical Association and the Iowa Medical Society are committed to protecting physicians and upholding access to quality care for their patients.

Must patient safety incident reports be disclosed during lawsuit discovery? That was the central point in a recent Iowa Supreme Court case in which the American Medical Association and Iowa Medical Society (IMS) worked together to support the argument that reports are protected under Iowa’s Morbidity and Mortality Law—and the court ultimately agreed. This ruling means that patient safety incident reports remain confidential, so hospital staff may feel self-assured in reporting all safety concerns—protecting both patients and physicians.

Learn more on how The Litigation Center can help you: ama-assn.org/litigation-center Membership in the American Medical Association and IMS makes the work of the Litigation Center possible.

Join or renew your memberships today.

IOWA MEDICAL SOCIETY

VECTORS & VIEWPOINTS

® IMS EDITION

VECTOR: SMALL CHANGES MAKE A BIG DIFFERENCE

Don’t JUST invest in what you know ROSS POLKING, CFP®, AIF®,MBA® Lead Advisor

We invite you to experience a complimentary, absolutely no-obligation review of your finances and a second opinion. Just like a patient receives second opinions, so should you!

Give us a call at 1.844.437.1105 or visit www.fostergrp.com/IMS

IS IT A GOOD IDEA TO “BUY WHAT YOU KNOW”?

This famous recommendation originated with an extremely successful investor, Peter Lynch. The idea is to invest your dollars in companies you either work for or are extremely familiar with, which seems to make sense. Trouble is, this loads up one basket with way too many eggs. Investing in assets that have a high correlation with someone’s human capital (aka paycheck) puts an individual’s livelihood and future at increased – and unnecessary – risk. Investing heavily in the stock of one’s employer or businesses you closely associate with likely lacks diversification. Employees of companies like Enron and WorldCom found out how costly a mistake that can be. No matter how well you feel you know your business, always be careful about allowing your confidence level to bleed into your investment strategy. All it takes is some bad news to weigh down an industry and its return…or one individual inside the walls of a particular company to do something irresponsible and create financial chaos. STAY DIVERSIFIED

FOSTER GROUP® RECOGNITIONS

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