FP SUMMER 2020
MISSOURI FAMILY PHYSICIAN VOLUME 39, ISSUE 3
The
Business of
Medicine
2
MISSOURI FAMILY PHYSICIAN July - September 2020
FP MISSOURI FAMILY PHYSICIAN
EXECUTIVE COMMISSION BOARD CHAIR Jamie Ulbrich, MD, FAAFP (Marshall) PRESIDENT John Paulson, DO, PhD, FAAFP (Joplin) PRESIDENT-ELECT John Burroughs, MD (Liberty) VICE PRESIDENT Kara Mayes, MD (St. Louis) SECRETARY/TREASURER Lisa Mayes, DO (Macon)
BOARD OF DIRECTORS DISTRICT 1 DIRECTOR Arihant Jain, MD (Cameron) ALTERNATE Jared Dirks, MD (Kansas City) DISTRICT 2 DIRECTOR Brooks Beal, DO (Kirksville) ALTERNATE Vacant DISTRICT 3 DIRECTOR Emily Doucette, MD, FAAFP (St. Louis) DIRECTOR Vacant ALTERNATE Dawn Davis, MD (St. Louis) DISTRICT 4 DIRECTOR Jennifer Scheer, MD, FAAFP (Gerald) ALTERNATE Jennifer Allen, MD (Herman) DISTRICT 5 DIRECTOR Natalie Long, MD (Columbia) ALTERNATE Amanda Shipp, MD (Versailles) DISTRICT 6 DIRECTOR David Pulliam, DO, FAAFP (Higginsville) ALTERNATE Carrie Peecher, DO (Marshall) DISTRICT 7 DIRECTOR Wael Mourad, MD, FAAFP (Kansas City) DIRECTOR Afsheen Patel, MD (Kansas City) ALTERNATE Beth Rosemergey, DO, FAAFP (Kansas City) DISTRICT 8 DIRECTOR Andi Selby, DO (Joplin) ALTERNATE Kurt Bravata, MD (Buffalo) DISTRICT 9 DIRECTOR Patricia Benoist, MD, FAAFP (Houston) ALTERNATE Vacant DISTRICT 10 DIRECTOR Vicki Roberts, MD, FAAFP (Cape Girardeau) ALTERNATE Gordon Jones, MD (Sikeston) DIRECTOR AT LARGE Jacob Shepherd, MD (Lees Summit)
RESIDENT DIRECTORS
Misty Todd, MD, UMC John Heafner, MD, SLU (Alternate)
STUDENT DIRECTORS Morgan Dresvyannikov, UMKC Noah Brown, UMKC (Alternate)
AAFP DELEGATES Todd Shaffer, MD, MBA, FAAFP, Delegate Keith Ratcliff, MD, FAAFP, Delegate Kate Lichtenberg, DO, MPH, FAAFP, Alternate Delegate Peter Koopman, MD, FAAFP, Alternate Delegate
MAFP STAFF EXECUTIVE DIRECTOR Kathy Pabst, MBA, CAE ASSISTANT EXECUTIVE DIRECTOR Bill Plank MEMBER COMMUNICATIONS AND ENGAGEMENT Brittany Bussey The information contained in Missouri Family Physician is for informational purposes only. The Missouri Academy of Family Physicians assumes no liability or responsibility for any inaccurate, delayed, or incomplete information, nor for any actions taken in reliance thereon. The information contained has been provided by the individual/organization stated. The opinions expressed in each article are the opinions of its author(s) and do not necessarily reflect the opinion of MAFP. Therefore, Missouri Family Physician carries no respsonsibility for the opinion expressed thereon. Missouri Academy of Family Physicians, 722 West High Street Jefferson City, MO 65101 • p. 573.635.0830 • f. 573.635.0148 Website: mo-afp.org • Email: office@mo-afp.org
CONTENTS 4 A Letter from the Chair 5 MAFP 2019-2020 Annual Reports 10 2019-2020 A Year in Review 14 Business of Medicine During the COVID-19 Pandemic: A Perspective
18 Supporting the Real Business of Family Medicine 19 Is Rural Solo Family Practice Medicine Still an Option for You?
21 Cautious Congratulations on the Job Offer 23 DPC as a Viable Business Model for Practicing Primary Care
26 Practice Preparedness for Times of Disaster 28 Is the Juice Worth the Squeeze? Innovation,
Technology and the Business of Family Medicine
30 The Joys and Perks of Being a Preceptor 32 American Board of Family Medicine Announces Recipients of the 2020 AAFP Chapter Pilots
34 Membership Anniversaries 36 Members in the News
MARK YOUR CALENDAR Oct.
4
2020 Oct.
14-18 2020 Nov.
12-14 2020
March
1-2 2021
KSA on Hypertension (Virtual) October 4, 2020 AAFP Family Medicine Experience (FMX) (Virtual) October 14-18, 2020 MAFP 28th Annual Fall Conference November 12-14, 2020 Big Cedar Lodge - Ridgedale, MO MAFP Advocacy Day March 1-2, 2021 Capitol Plaza Hotel Jefferson City MO-AFP.ORG 3
WELCOME!
I Jamie Ulbrich, MD, FAAFP Board Chair
am excited and enthusiastic to be your MAFP Board Chairman. My time so far with MAFP has been an absolute thrill. As I reflect on our many accomplishments (which you will read about in this magazine), I’m humbled to follow the wonderful leadership that has preceded me. As family medicine physicians, we have a very broad and deep knowledge base. Most of us pride ourselves on being able to provide the best care to the entire family. We may deliver a baby, counsel a teenager, diagnose dermatologic conditions, adjust hypertensive and diabetes medications, and provide hospice care – all in the same day! This was acquired through years of undergraduate, medical school, residency, and for some fellowship training. We have such a unique training experience that cannot be duplicated or replicated in any other specialty or training experience. With all the medical training, many of us never thought we would be confronted with the complex business decisions we have every day. The Business of Medicine is a complex and dynamic reality for our practices. Considering pandemics, healthcare
“
Mission Statement:
reimbursement, innovative practice business models, contract negotiation, and so much more, it deserves significant focus to continue to provide our patients the highest quality care. This magazine is dedicated to the management and financial aspects of our practices and how it
As family medicine physicians, we have a very broad and deep knowledge base.
”
integrates into providing the highest level of care we can for our patients. While we may not always have the answers, I’m confident our relentless search for education will enable us to handle whatever comes our way. My prayer for our MAFP is that we continue to grow strong through this very challenging time of a pandemic and that we continue to support each other in any way possible.
The Missouri Academy of Family Physicians is dedicated to optimizing the health of the patients, families and communities of Missouri by supporting family physicians in providing patient care, advocacy, education and research.
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MISSOURI FAMILY PHYSICIAN July - September 2020
2019-20 Annual Reports Sarah Cole, DO, FAAFP Board Chair
As my tenure as a MAFP Board officer closes, I reflect on the ways the world has unexpectedly changed in the past four years and how MAFP has adapted in response. I am proud to see MAFP recognized not only as a strong voice for its members but also as a leader among various physician organizations. Our programs and services for members have become more nimble to hear and meet the evolving needs of family physicians in this fast-paced health care environment – especially as the COVID-19 pandemic touched all of our lives, practices and patients. Through my journey, I have been inspired by your passion to become the family physician your patients need. Because of your passion, family medicine continues to be the foundation for better, lower costs, and improved outcomes – the triple aim – though we must continually remind ourselves and others that the fourth aim -- physician satisfaction -- is as vital to the equation as we optimize quality care for our patients. 2020 has thus far been a year of vulnerability for our state and our nation as we respond to COVID-19 and, more recently, the passing of George Floyd. Both events have focused attention on health and social disparities, justice and equity, all of which are the daily work of a family physician. In the past year, MAFP received three grants to educate and improve our efforts to serve those most vulnerable. AAFP offered a health equity grant to support MAFP initiatives that will be reported in a future issue of the magazine. Additionally, MAFP just received another AAFP grant to identify and assess implicit bias. Finally, the Missouri and Illinois state chapters are teaming to facilitate a rural health equity conference later this year. Look for more on this in the upcoming year. While I am proud of what MAFP and its members do, it is only by working together that we will continue forward momentum on these and other relevant issues. MAFP continues to work with other professional medical societies and associations to advocate on shared goals that protect our patients and our practices. We look to bolster the future primary care workforce by “filling the pipeline” as MAFP recently received a grant from the American Board of Family Medicine to help recruit medical students to the specialty of Family Medicine. Finally, I thank you for allowing me to serve you over the past several years. I am grateful for my journey last year across the state as I learned more about the diversity, joys and opportunities experienced by Missouri family physicians. I look forward to another year of strong medicine for Missouri under the leadership of incoming Board Chair Dr. Jamie Ulbrich!
Jamie Ulbrich, MD, FAAFP President
As president of the Missouri Academy of Family Physicians this past year, I have seen our organization move toward our strategic plan initiatives, as well as being nimble enough to adapt to the COVID-19 pandemic. We are in the middle of our 20192021 Strategic Plan and are making some progress toward the goals impacting advocacy, public awareness, and workforce/pipeline. This plan provides the direction and focus we need, especially to guide the organization in time of uncertainty. The board discusses our strategic initiatives at each board meeting and how we should proceed in accomplishing these goals. As in past years, I attended this year’s Advocacy Day at the Capitol in February and we had over 45 physicians, residents and students attend. We included a few extra virtual opportunities for members who were unable to attend. During the Monday evening detailed legislative briefing, we had members participate via Zoom. Little did we know then, but we would all become very familiar with Zoom or other web conference platform after this meeting. In addition, we had three opportunities for members to “Speak Out” on Medicaid expansion, assistant physician licensure, the MAFP preceptor tax credit bill. We had an excellent opportunity during this event to meet with the preceptor tax credit bill sponsor, Representative Jon Patterson, MD. The Missouri Healthcare Workforce Coalition was an excellent partner to work with on this bill. Immediately following our Advocacy Day, a hearing was scheduled on our bill. We had an excellent line up of supporters present testimony at the Preceptor Tax Credit hearing: Ed Kraemer, MD, University of Missouri Kansas City (UMKC) School of Medicine, Dr. Kathleen Quinn, and a medical student from the University of Missouri Columbia, Caroline Chang, Saint Louis University Physician Assistant (SLU PA) Program, Rachel Vogel, a recent graduate of the SLU PA program, and Kathie Ervie, UMKC Physician Assistant Program. Other groups that supported the bill included the Missouri State Medical Association, Missouri Association of Osteopathic Physicians and Surgeons, Missouri Hospital Association, Missouri Academy of Physician Assistants, and the Missouri Primary Care Association. There was no opposition testimony presented. Again, we will begin the year culminating my service on the board with our Show Me Family Medicine Virtual Conference. It looks to be a great conference with many educational opportunities. We are keeping an eye on the COVID-19 situation and will keep you apprised of any programmatic changes.
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MAFP 2019-20 Annual Reports In reviewing my goals for last year, we made progress toward them and I would like to continue this vision for the MAFP for the upcoming year. 1. Implement the strategic plan approved by the board of directors. Great effort and ideas went into crafting this document to guide our organization for three years. We will continue to use this to influence our decisions during the next 12 months. 2. Try to continue to strengthen our Board by improving our efficiency to allow us to be more forward-thinking. 3. COVID-19 is allowing me to modify how I meet with physician members. Although in person meetings are preferred, there are many avenues that I can meet with you during my service as board chair. What can MAFP do for you? 4. Rural family physicians have been challenged more than ever during these past several months. The AAFP goal is to recruit 25% by 2030. Going forward, I am still very interested to see if a simple “small business” design plan in practice formation may be a feasible way to draw physicians to small towns in Missouri. I am honored and humbled to represent you during the next year. We have challenges ahead of us, but this is not new. We will work together to promote the family medicine specialty and advocate for a better regulatory environment for our practices, quality care for our patients, and a pipeline of future family medicine students.
John Paulson, DO, PhD, FAAFP President-Elect
The MAFP Board continues to focus our efforts based on the strategic plan that was developed in the Summer of 2018 which focuses on Advocacy, Public Awareness, and the Pipeline for Family Medicine. Part of my job as I move into the presidency is strategic planning. Organizational success in times of crisis not only relies on good strategy, but on tactical ability to adapt fluidly to the changing environment. Change sometimes occurs suddenly and unexpectedly like it has with COVID-19. It is important that the MAFP not only gets through this crisis but more importantly, grows through this crisis. We are not going set the bar the same as it was set pre-COVID-19. We are going to stretch ourselves to be bigger and better than we were before. Our team is going to use the information that we have learned in regards to online vs. in-person meeting opportunities, synchronous vs asynchronous learning and information delivery, and we are going to look at leveraging technology to focus on meeting our strategic plan in a way that we were not thinking about in 2018. If we are going to be successful with advocacy, awareness, and feeding the pipeline, we are going to have to adapt to the virtual new world where the younger MAFP members and the future members of MAFP and family medicine 6
MISSOURI FAMILY PHYSICIAN July - September 2020
thrive. We are going to have to become more visible and social virtually and more technologically advanced if we want to grow. We are going to have to skate to where the puck is going to be and not where it is now like NHL Hall-of-Famer Wayne Gretzky noted. We have started with restructuring the MAFP office and staffing. This new structure with Kathy continuing as the executive director (ED), and the addition of Bill Plank as the full-time assistant-ED is working well. We have hired a Member Communications and Engagement Coordinator (see page 36). This individual would support all communications and membership activities Kathy and Bill are currently handling. I attended the Multi-State Forum meeting in Dallas in February 2020 which was one of the last large meetings I was able to attend before the shutdown. The AAFP Annual Chapter Leadership Forum was cancelled but I still plan to attend the AAFP-Congress of Delegates in October to participate in the policy making portion of our national organization. The MAFP strives to represent its members at the state and national level in all aspects of family medicine. We continue polling our members to make sure the issues we are advocating for align with our membership’s beliefs. Please continue to respond to the members’ survey that we send out which determines the MAFP’s position and advocacy efforts based on member response. I am especially interested in hearing from members with skills in social networking or interest with innovation and creativity that we may utilize to grow and strengthen our organization. As you may know, 2020 was the first year of the combined MD and DO match and it occurred during the national COVID-19 shutdown. It will be interesting to see the summary of results as they are released. How will the MDs, DOs, foreign and domestic graduates fair in this event? Time will tell. As always, I am more than happy to discuss member thoughts, suggestions, or concerns in regards to any MAFP or policy issues.
John Burroughs, MD Vice President
As I complete my first year on the MAFP Executive Commission, I have been impressed with the commitment of the board and our members. The MAFP Strategic Plan is guiding our organization through 2021. It will begin new opportunities for continuing medical education, promote the family medicine specialty, and advocate for important issues to improve patient care. As a family physician at Cobblestone Family Clinic, Liberty, I believe in the partnership between the physician and patient. This same concept can be applied to MAFP – a partnership between the members and the Academy. We work together to achieve a better practice environment for family physicians and our patients.
I attended the 2020 Multi-State Forum held in Dallas last RESIDENT BOARD REPORT February. This was my first meeting with other board members and staff from 13 chapters. Gary LeRoy, MD, AAFP President, shared an update on AAFP and their membership efforts. Shawn Martin, incoming EVP for AAFP, presented the status of healthcare in the US, the most recent political issues, and the 2020 general election. Our executive director, Kathy Pabst, participated in a panel discussion on the primary care payment initiatives. The most informative discussions were best practices among the chapters attending and their ongoing legislative agendas. The Executive Commission holds monthly conference calls to “take care of business” between board meetings. These John Heafner, MD, meetings are very informative as I participate in decisions that Misty Todd, MD, Resident Director Alternate Resident Director are made impacting the organization as whole. We discuss items at the organizational, state, and national levels, and make decisions that represent the majority of our membership. We 2020 Family Medicine Residency Graduates are pleased that the MAFP has applied for several grants during COX FAMILY MEDICINE the past 12 months have been successful in receiving four: Program Director— Kyle Griffin health equity, rural health equity, implicit bias, and recruitment/ Per Class: Nine (9), 27 total retention of family medicine residents and students. The work Chief Residents: Caleb Tague and Karissa Merritt Chiefs starting begins as we implement these innovative programs. Contact July 2020. Kathy if you’d like to volunteer for any of these initiatives. Lauren Branham, DO, MBA – Outpatient, Cox Medical Mile I look forward to serving the next year as your PresidentClinic, Springfield, MO Elect. We will partner together to make MAFP the top specialty Evan Branscum, MD – Outpatient and Inpatient, Coxhealth – organization in Missouri. Harrison,AR Trevor Conner, DO - Sports Medicine Fellowship, University of Lisa Mayes, DO Kansas Primary Care, Kansas City, KS Joshua Gaede – MD, Ouotpatient, Inpatient, ER OB, Norton Secretary/Treasurer County Hospital, Norton, KS The Missouri Academy of Family Kyle Gillett, MD – Outpatient, Inpatient, OB, Prenatal, College Physicians continues their financial Park Family Care Center, Overland Park, KS stability, even amidst the market Brian Kennedy, MD – Hospitalist, Conway Regional Health fluctuations over the last 6 months. System, Conway, AR Reserves for the organization are Kelsey Keoppel, DO – Outpatient, INTEGRIS Family Care Edmond enough to sustain the group through East, Edmond, OK these challenging times. Although Kayla Matzek-Kittle, MD – Outpatient, OB, Bolivar Family Care our investments have lost some over Center, Bolivar, MO the last few months, our total assets Cody Rogers, MD – International Medicine, Ascension Via are slightly higher than this time last year. This is a reflection Christi Clinic Family Medicine, Wichita, KS that our investments are diversified to withstand some of these fluctuations in the market. The 2019-2021 Strategic Plan continues to drive the annual STILL OPTI-NORTHEAST REGIONAL MEDICAL budget and direction of the MAFP. In light of the COVID-19 CENTER FAMILY MEDICINE RESIDENCY pandemic, we are expecting some impact on the MAFP finances Program Director: Kyle Griffin as membership dues collection is down 5% from this same Per Class: Nine (9), 27 total time last year. Conference attendance is uncertain as we make Chief Residents: Eric Loesch, DO adjustments to reflect the needs of our members, and within Social Presence: www.atsuresidency.com the limitations they are currently under. Updates: Matched 4 interns through SOAP, which means they There is uncertainty looking ahead in 2020, but the MAFP will have filled all 12 ACGME slots this coming year! Elizabeth Board of Directors will make sound financial decisions based on Silvey, DO – is the graduating resident this year. She is moving to the best information available at the time. MAFP will continue to the Ozarks of Southwest Missouri to practice full-scope family move forward with our strategic initiatives to further strengthen medicine. She is going to be doing outpatient and inpatient the organization. medicine as well as obstetrical care and some pain management procedures. MO-AFP.ORG 7
MAFP 2019-20 Annual Reports MERCY FAMILY MEDICINE
Program Director: Sarah Cole, DO Per Class: Six (6), 18 total Chief Residents: Whitney Knapp, DO & Ryan Menchaca, MD outgoing chiefs Robyn Brownell, MD – Private practice with SSM Health Dean Medical Group Madison East Clinic, Madison, WI Dallas Chase, MD –Urgent Care Physician, San Diego, CA Kyle Johnson, DO – Private practice with Mercy Family Medicine Clayton-Clarkson, Ballwin, MO Whitney Knapp, DO – Private practice with Mercy Primary Care, Maryland Heights, MO Kim McClure, MD – Inpatient with Missouri Baptist Hospital, St. Louis, MO Ryan Menchaca, MD -- Family & Community Physician, Dallas, TX
RESEARCH FAMILY MEDICINE
Program Director—Jennifer Tieman, MD Per Class: Twelve (12) residents, total of 36 Chief Residents: Outgoing chiefs-- Christine Kong, MD, Kayte McDaniel, MD, Sean Rutschke, DO Social Presence: http://researchresidency.com/ Rachel Allen – Full scope family medicine including OB, Sabetha, KS Daniel Haire – Indian Health Service, Jicarilla Apache Service Unit, Dulce, NM Emily Hansen – Palliate Care Fellowship, University of Kansas, KS Christine Khong – Outpatient Family Medicine, Prairie Village, KS Kayt McDaniel – Outpatient Family Medicine, Overland Park, KS Rachel McDonald – Hospitalist, Centerpoint Medical Center, Independence, MO Sean Rutschke – Outpatient Family Medicine, plus newborn nursery, Nampa, ID Sabrina Sahadevan – Hospitalist, Centerpoint Medical Center, Independence, MO Joseph Sayegh – Hospitalist, Centerpoint Medical Center, Independence, MO Ben Saylor – Hospitalist, North Kansas City, MO Rhiannon Talbot – Palliate Care Fellowship, University of Wisconsin, Madison, WI Chelsea Willis – Outpatient Family Medicine, Tonganoxie, KS
SAINT LOUIS UNIVERSITY FAMILY MEDICINE RESIDENCY
Program Director -- Jay A. Brieler, MD, FAAFP Per Class: Six (6) residents, total of 18 Chief Residents: Outgoing Chiefs: Randy Jackson, MD & Daniel Stevens, DO Updates: Graduates and plans listed below: Kelly Dye, MD -- Private Practice with Scott & White in Killeen, Texas Bob Heiger, MD -- Private Practice with Mercy Medical Group in St. Louis Peter Ireland, MD -- Private Practice with Central Vermont Medical Center in Waterbury, Vermont Randy Jackson, MD - Faculty Position with University of California San Francisco Nesa Mohebpour, MD - Private Practice in Texas Daniel Stevens, DO -- Private Practice in Denver, CO
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MISSOURI FAMILY PHYSICIAN July - September 2020
ST. LUKE’S DES PERES FAMILY MEDICINE RESIDENCY
Program Director: Dr. Joseph Eickmeyer Per class: Six (6) PGY1, Two (2) PGY2, Four (4) PGY3; Chief Residents: Dr. Brittany Herrin Social Presence: https://www.stlukes-stl.com/DesPeres/ health-professionals/medical-residency.html Brittany Herrin, DO - Cedar Hill Primary Care, Cedar Hill, MO Bryan Duepner, DO - Westglen Family Physicians, Ellisville, MO Rebecca Michels, DO - Primary Care of Eureka, MO Jolene Kim, DO - University of Kansas, KU Med West Family Practice, Shawnee, KS
UNIVERSITY OF MISSOURI FAMILY MEDICINECOLUMBIA
Program Director--Erika Ringdahl, MD Per Class: Twelve (12) residents in R3, 15 in R2, & matched 14 new interns this spring. Chief Residents: Incoming July 2020 Miles Crowley, MD; Alyssa Emery, MD; Ethan Jaeger, DO; and Colin McDonald, MD Updates: Graduates and plans listed below: Joshua Bacon, MD - Outpatient Lake Charles Memorial Hospital in Lake Charles, Louisiana Gabe Eljdid, DO - Inpatient Medicine @ Unity Point—Allen Hospital in Waterloo, Iowa Justing Chang, MD - Inpatient Medicine @ Unity Point—Allen Hospital in Waterloo, Iowa Stephanie Espinoza, MD - OB Fellowship in Tennessee Tyler Gouge, MD - Sports Medicine Fellowship at University of Missouri-Columbia Johnathan Hoskins, MD - Outpt/Inpt/ED at Clinton County Rural Health Physicians in Breeze, IL Eric Kadlec MD-Palliative Care Fellowship in University of Arizona/Banner Health in Tucson, AZ Mary Murphy, MD- Addition Medicine and Outpatient at First Choice Community Health in Albuquerque, NM Misty Todd, MD – ER Moonlighting with Docs Who Care Carl Tunink, MD - Academic & Palliative Care Fellowship at University of Missouri Columbia Social Presence: Instagram: @Mizzoufamilymed Facebook: University of Missouri Family Medicine Residency. Website: https://medicine.missouri.edu/departments/family-andcommunity-medicine/residency
UMKC FAMILY MEDICINE
Program Director: Beth Rosemergey, DO Per class: Twelve (12) per class, 36 total Chief Residents: Outgoing Chiefs: Chris Koehn and Holly Perkins, MD Social Presence: https://med.umkc.edu/fm/ and https://www. facebook.com/UMKCFM/ Andrew Kwan, MD, MBA – Stormont Vail group, Topeka, KS Steven Taki, MD – Stormont Vail group, Topeka, KS Bhavishya Narotam, DO – Stormont Vail Group, Topeka, KS Jessica Braure, MD, PhD – Sunflower Medical Group, Mission, KS
Matthew Hendrix, MD – St. Luke’s Health System, Chillicothe, MO Hong Nguyen, MD – Salina Regional Health Center, Salina, KS Holly Perkins, MD – US Navy Active Duty, Coronado/San Diego, CA Joshua Williams, MD – Cox Health/Barton County Hospital, Lamar, MO Christopher Koehn, DO, MBA – Western Missouri Medical Center, Higginsville, MO Brandon Abbott, DO – Western Missouri Medical Center, Warrensburg, MO Li Yin Lan, DO, MBA – Olathe Health, Olathe, KS Nicole Lee, MD – To Be Determined
btesher@kcumb.edu, Secretary- Olivia Jang – Ojang@kcumb. edu, Treasurer- Tina Langley – tlangley@kcumb.edu, FMIG Representative – Devon Wright dwright@kcumb.edu Faculty Advisor: John Paulson, DO, PhD jpaulson@kcumb.edu
ST. LOUIS UNIVERSITY SCHOOL OF MEDICINE
• • • •
STUDENT BOARD REPORT
173 Graduates # of Students Who Matched into Family Medicine: 18 # of Students Who Matched into Missouri Family Medicine: 2 FMIG members: 84 Co-presidents: Amanda Springer (amanda.springer@health. slu.edu),Nour Khatib (nour.khatib@health.slu.edu) Other Board members: Kristen Woody (kristen.woody@ health.slu.edu), Kanav Gupta (kanav.gupta@health.slu.edu), Daphne Cheng (daphne.cheng@health.slu.edu), Daniel Sprehe (daniel.sprehe@health.slu.edu) Faculty Advisor: Matthew Breeden, MD (matthew.breeden@ health.slu.edu)
UNIVERSITY OF MISSOURI-COLUMBIA SCHOOL OF MEDICINE
Morgan Dresvyannikov, Student Director, UMKC
Noah Brown, Alternate Student Director, UMKC
• • • •
A. T. STILL UNIVERSITY OF HEALTH SCIENCES: OSTEOPATHIC MEDICAL SCHOOL
• • • •
162 Graduates # of Students Who Matched into Family Medicine: 43 # of Students Who Matched into Missouri Family Medicine: 15 FMIG Members: 177 President: Kade Kinney, VP: Lei Alena Dagat, Secretary: Mallory Dameron, Treasurer: Karina Timmerman Faculty Advisors: Dr. Margaret Wilson and Dr. Joseph Novinger
KANSAS CITY UNIVERSITY OF MEDICINE AND BIOSCIENCES – KANSAS CITY CAMPUS
• • • •
• •
UNIVERSITY OF MISSOURI-KANSAS CITY SCHOOL OF MEDICINE
• • • •
267 Graduates # of Students Who Matched into Family Medicine: 42 # of Students Who Matched into Missouri Family Medicine: 6 FMIG members: 137 President – Joe Li, joeli@kcumb.edu, VP – Mitchel Lau, mnlau@kcumb.edu, Secretary – Karen Lai, klai@kcumb.edu, Treasurer– Jonathan Hendrzak, jehendrzak@kcumb.edu
KANSAS CITY UNIVERSITY OF MEDICINE AND BIOSCIENCES – JOPLIN CAMPUS
The first graduating class will be in 2021. FMIG members: 147 Primary Care Officers (Includes Family Medicine): PresidentCharles Foust – cfoust@kcumb.edu,VP- Bridget Tesher –
106 Graduates # of Students Who Matched into Family Medicine: 13 # of Students Who Matched into Missouri Family Medicine: 6 FMIG members: 45 active members Kane Laks: kmlfdc@health.missouri.edu, Lindsay Koerperich: lmkmt9@health.missouri.edu, Liga Blyholder: labgf8@ health.missouri.edu, Tori Dahmer: dahmert@health. missouri.edu Advisor: Amelia Frank, MD: frankae@health.missouri.edu
119 Graduates # of Students Who Matched into Family Medicine: 9 # of Students Who Matched into Missouri Family Medicine: 7 FMIG Members: 115 President: Kyla Mahone (km824@umsystem.edu) Co-Vice Presidents: Andrea Pelate (aepcp2@umsystem.edu), Claire Wolber (cewgg7@umsystem.edu) Other Board members: Secretary: Sunita Kolareth (sk3v3@umsystem.edu), Treasurer: Noah Brown (npbdw7@umsystem.edu), PR Chair: Allison Green (aeghyv@umsystem.edu), Community Service Chair: Emma Connelly (emcmv4@umsystem.edu), Year 1 & 2 Rep: Mira Malavia (mcmkp8@umsystem.edu) Advisor: Dr. Aniesa Slack aniesa.slack@tmcmed.org
WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
• • •
120 Graduates # of Students Who Matched into Family Medicine: 3 # of Students Who Matched into Missouri Family Medicine: 1 FMIG Leadership: Madeline Danforth (mdanforth@wustl. edu) and Austin Hannemann (austinh@wustl.edu) Advisor: Dr. Phillip Asaro (asarop@wustl.edu) MO-AFP.ORG 9
2019-20 – A Year in Review
Y
our MAFP leadership has been very active in 2019 and it is reflected in their annual reports that are included in this issue of the Missouri Family Physician magazine. Your Academy continues to advocate for family physicians and their patients at the local, state, and national levels. We serve medical students, family medicine residents, and family physicians in a variety of practice or academic settings. Match day in 2020 was a huge success for family physicians. With a total of 82 PGY-1 residency slots available, 73 were filled. The MAFP works with nine residencies (six allopathic and three osteopathic) in Missouri. The six medical schools with family medicine programs do not include campus expansions by Kansas City University of Medicine and Biosciences campus in Joplin, and the University of Missouri Columbia campus in Springfield. The MAFP staff met with five residencies and two medical schools to discuss organized medicine, 10
MISSOURI FAMILY PHYSICIAN July - September 2020
advocacy training, priority legislative issues, and the benefits of membership in the MAFP. With the COVID-19 pandemic in 2020, we are continuing this work, but in a different manner than face to face. The MAFP mission statement specifically calls for Advocacy. We represent our members on a wide array of policy issues and legislation. From medical malpractice to scope of practice issues, your voice is heard in the policy-making and legislative affairs. There were 40 attendees at the Advocacy Day which includes a detailed legislative briefing, legislator meetings, and advocacy training on current bills and family medicine priorities. In addition, a legislative briefing was live-streamed with six participants. Three Speak Out opportunities were available for those who were unable to attend: 21 messages were sent on Medicaid Expansion, nine messages on the preceptor tax credit Continued on page 12
MO-AFP.ORG 11
Continued from page 10 legislation, and ten messages opposing the expansion of the assistant physician pathway to licensure. The MAFP Advocacy Commission, staff and governmental affairs consultants, R.J. Scherr and Associates, lead these efforts with strategically sound decision-making. As a bi-partisan organization, we work to maintain solid relationships with lawmakers at all levels in both parties. We have supported your stance on scope of practice issues, medical malpractice, preceptor tax credit, access to quality health care, Medicaid Expansion, effective opioid prescribing, and many other bills. This year’s legislative session was cut short due to the COVID-19 pandemic. MAFP rallied the troops to present hearing testimony on the preceptor tax credit bill, and the measure that would create a pathway to licensure for assistant physicians during the brief session. We held an informational meeting with legislators in the Kansas City area to discuss GME and workforce issues. We hope to hold similar meetings with other residency programs in the state. We continue our work with the Missouri Healthcare Workforce Coalition in an effort to fill the pipeline of future family physicians through preceptor tax credits, precepting resources, data collection, GME, and loan repayment. Kathy Pabst, MAFP Executive Director, leads the preceptor tax credit working group. In addition, Sarah Cole, DO and Ed Kraemer, MD represent family physicians on this coalition. Another coalition where the MAFP is well represented is the Missouri Immunization Coalition. The MAFP received a grant from the Family Medicine Philanthropic Consortium to develop a website for this organization. MAFP Board Member Kate Lichtenberg, DO serves as the Secretary and MAFP Executive Director Kathy Pabst serves as the Treasurer. This duo will represent family physicians well as we work to increase immunizations across the lifespan. MAFP Alternate Board Member Kurt Bravata, MD also represents the MAFP on the Missouri Opioid Policy Advisory Council. COVID-19 has shined the light on racial disparities in primary care and the management of chronic diseases. The MAFP was the recipient of an AAFP Foundation grant that identified resources and champions to improve the social determinants of health. COVID-19 is also the perfect example for the need for immunizations. The MAFP, along with the Missouri Chapter of the American Academy of Pediatrics and Pfizer, joined forces to start the Missouri Immunization Coalition. Other advocacy initiatives include: • Submitted a letter to the Missouri Health Insurance Innovation Task Force asking for improved access to affordable insurance options and access to health care services within the state, especially rural areas, while reducing the state’s uninsured rates. • Supported legislation that would increase the tobacco cessation state budget from $50,000 to $300,000 – which is still underfunded. • Signed onto an AAFP letter supporting teaching health centers. Missouri has one center in Joplin (psychiatry). • Amended the bylaws to allow for virtual annual meetings. 12
MISSOURI FAMILY PHYSICIAN July - September 2020
Every Missourian has been impacted by COVID-19 and your Academy is no different. Our focus is to help you serve your patients during this pandemic and we achieve this through: • Sending a letter to Governor Parson explaining why midlevel provider scope of practice expansions as a result of COVID-19 does not need to be extended or made permanent and that any changes should be through the legislative process • Obtaining a small amount of PPE and distributing it to members in need • Holding a webinar on CARES funding • Providing resources on the MAFP website • Sending weekly e-newsletters with the most current information available at that time MAFP introduced two resolutions at the 2019 Congress of Delegates: Resolution 505 – Eliminating Barriers in Rural Communities for Cardiac Rehabilitation (Passed); and Resolution 201 – Survey AAFP Members on Legislative and Regulatory Issues (Failed). Your delegates at this meeting were Keith Ratcliff, MD and Todd Shaffer, MD (Dr. Shaffer served as chair of the Health of the Public and Science Reference Committee). Alternate Delegates were Peter Koopman, MD and Kate Lichtenberg, DO (Dr. Lichtenberg served as the observer for the Practice Enhancement Reference Committee). Lastly, the Missouri Chapter was recognized by AAFP and received the State Government in Advocacy Award for our efforts on the assistant physician regulatory process and legislative efforts. MAFP Political Action Committee (PAC) President of the MAFP-PAC, Mark Schabbing, MD, FAAFP spearheaded an initiative to raise funds for the MAFP-PAC. With the 2020 elections right around the corner, this initiative is critical to support legislators who are champions for family medicine under the dome. MAFP-PAC donations increased 7.5% as a result of this campaign – it is never too late to make a donation! Education The MAFP Education Commission and team works to deliver CME you need to be better physicians and improve patient and practice results. The Show Me Family Medicine Conference attracted 70 attendees with 11 speakers and 13.5 CME hours offered. The Annual Fall Conference drew 171 attendees with nine speakers and 11.75 CME hours. In addition, a Knowledge Self-Assessment was offered on The Well Child to help with your American Board of Family Medicine Certification. Residents and students are introduced to the MAFP by attending these conferences complimentary. Your donations to the Family Health Foundation of Missouri provides the funding source for our efforts to recruit the next generation of family physicians. Membership Your Member Services Commission and state chapter is on the move with continued increases in membership. We have shown strong and consistent growth over the last 15 years.
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In addition, new awards were initiated this year to recognize the efforts of Missouri family physicians and residents: Distinguished Service Award, Exemplary Teaching Award, Outstanding Resident, and a stipend for contract review or financial planning for a 3rd year resident. Students and residents are the key to our future workforce and the Academy supported medical students interested in family medicine from two medical schools to attend the 2020 Society of Student Run Free Clinics conference. In addition, the MAFP obtained a grant from the American Board of Family Medicine to enhance our recruitment of family medicine residents and students. Member communications includes a quarterly magazine, Missouri Family Physician; a monthly e-newsletter, Show Me State Update; and a monthly blog, Insights. Financial Review The MAFP Board of Directors approved the annual budget based on the strategic plan. These initiatives are important to carry out the vision of the membership to ensure the growth and relevance of the academy. Lisa Mayes, DO, MAFP Secretary/ Treasurer, provides oversight of the financial transaction of the
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Academy. She ensures the integrity of the fiscal affairs of the Academy, including overseeing the budget development and regular financial reporting. An annual audit is completed every four years and the next audit will be completed on the 2020 transactions. The MAFP earns its revenue from membership dues, conference registration fees, grants, and advertising. Based on the 2020 budget, membership dues comprise 67% while education is 23% of the total budgeted income. Budgeted expenses include administration (58%), governance (11%), advocacy (9%), member services (3%), education (14%), and communications/publications (5%). Family Health Foundation of Missouri Foundation fundraising events included a silent auction, raffle, and wine pull. A total of $4,115 was raised through these activities. These funds were used to support the summer externship program, leadership opportunities, and conference attendance. The Foundation also received a matching grant from the AAFP Foundation to fund the four summer externship experiences.
YOUR MAFP TEAM IS HERE TO HELP! Telephone: (573) 635-0830 | Fax: (573) 635-0148
Kathy Pabst, MBA, CAE Executive Director kpabst@mo-afp.org
Bill Plank
Assistant Executive Director bplank@mo-afp.org
Brittany Bussey
Member Communications and Engagement Coordinator bbussey@mo-afp.org MO-AFP.ORG 13
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MISSOURI FAMILY PHYSICIAN July - September 2020
Wael S. Mourad, MD, MHCM, FAAFP Chief Health Officer | Health Partnership Clinic Clinical Professor | UMKC School of Medicine, Dept. of Community and Family Medicine Medical Director | The Medina Clinic
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The COVID-19 pandemic was an inevitable yet unexpected calamity that traversed the globe with breathtaking speed. It was a true public health emergency that tested and continues to test the capabilities and expertise of our national medical and public health infrastructure. In addition, it has been a stress test on the capacity for leadership through crisis that health care organizations must exercise as they navigate through current and future waves of a pandemic with the highest mortality rate to strike the United States in a century.
FINANCIAL IMPACT
The macroeconomical impact of the pandemic has been well documented. In a depression, rising total debt that eventually reaches a tipping point is usually the underlying instigator of a domino effect that imparts a downward pressure on spending that negatively impacts the GDP. Normally, it takes all the tools in the fiscal and monetary toolboxes of the federal government and federal reserve, respectively, to reverse the trend. And those tools are appropriate for addressing the underlying problem of escalating total debt. The interesting feature in the current financial crisis is that the underlying instigator of the financial downturn is a medical and public health cause not easily under the control of these governmental agencies, and the normal tools leveraged to address the financial downturn will not solve the underlying problem. Because spending is equivalent to income in an economy, a downward trending GDP results in drastically reduced income for companies as well as people, leading to cost cutting, salary reductions, and ultimately higher unemployment and furloughs. While times of medical crisis may present themselves as business opportunities for health care organizations, the nature of the pandemic has been the opposite, as patient volumes and health care transactions have been depressed by approximately 50% -- a seismic shock to statements of operations across the country. In this fashion, the pandemic has demonstrated in a painful way that fee for service still rules the day.
CRISIS LEADERSHIP AMIDST THE FALLOUT
A crisis goes to the heart of what leadership is. Leadership is setting a vision and direction for where the team, company, or organization needs to go. It includes explaining why this direction is important, and what steps can be taken to get
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there. It also includes soliciting help and securing buy in from the team. Traversing this often treacherous and uncertain path requires fortitude, confidence, and creativity. These characteristics can inspire confidence and creativity amongst the team, as great ideas and momentum cannot come from one person alone. While leadership can come from any level in a company, it is a requirement for optimal outcomes that great leadership is demonstrated at the top. At our organization during the first blows of a crisis, our communications during our morning huddles routinely included answers to these four questions answered: • • • •
What is going on? What are we doing about it now? How do we get out of it? What is the ask from the team?
available technologies of telemedicine, to familiarize themselves with the already published guidelines on coding for these visits, and to consider vendors who will interface with their electronic health records to improve communication with patients in forms such as texting, as well as to better monitor and improve quality measures. Companies that take advantage of these times to improve their infrastructure for quality and population health may emerge from this existential crisis better primed and positioned than their peers for value based reimbursements in the future. And like in other industries suffering financial hardship, such as auto industry after the 2008 financial crisis, health care organizations will likely become leaner companies.
PULLING IT ALL TOGETHER: PRIVATE PARTNERSHIPS
PUBLIC AND
My organization is one of over 1300 federally qualified health centers in the United States. As such we are a captive audience for the federal government as it communicates its priorities during this pandemic and provides funding. Opportunities exist to continue to improve the alignment of the public health goals of our nation and the population health incentives of health care organizations. While the federal government has capabilities to address rising debt and its consequences it is less equipped to directly mitigate EXPLOIT AND EXPLORE the spread of a pandemic with our public health infrastructure’s Exploitation refers to using the resources, capabilities, and current state. This infrastructure needs to be as robust as our current market conditions to maximize value to the organization. financial crisis management infrastructure in terms of responding Exploring refers to the innovative and creative aspect of an to crises. Just like there is coordination between the governmental organization that considers new services and new markets that are agencies and banks, there needs to be the same degree of intimate keys to a company evolving. Kodak is a good example of a company coordination and alignment of incentives and goals between public that exploited, but did not adequately explore. Companies health agencies and health care organizations. This coordination that have not struck the proper balance between exploiting and can only come from leaders, who can project a vision for population exploring are vulnerable to disruptive innovations, which are often health outcomes, adoption of new technologies, reducing racial fueled by new technologies as well as creative processes. Despite inequities, and enhancement of public health preparedness. This this prospect and because of a lack of incentives, the balance is direction to guide how federal funding and stimulus programs are often shifted in favor of exploiting during normal times. implemented is needed to ensure that funding is directed towards The COVID-19 pandemic however has provided powerful activities that bring the most value to our patients and communities. incentives for health care organizations to leverage the long These questions will effectively fill in the gaps in the minds of the team, and thereby minimize the anxiety so that we can all move on together. People management is already complex and a challenge during the best of times, much less during a crisis. To move on is critical for the functions of adaptation, innovation, and taking advantage of opportunities for potential growth.
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Supporting the Real Business of Family Medicine
T
R. Shawn Martin AAFP Chief Executive Officer
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he business of family medicine, at its core, is helping patients prevent disease, maintain their health and live fulfilling lives. To accomplish this, family physicians engage in a variety of activities that range from caring for and treating patients when they are sick, partnering with patients to achieve their health goals and working closely with families and caregivers to ensure that everyone is supporting the health outcomes of the patient. The value of family medicine has been articulated by researchers, but true first contact, comprehensive, continuous and coordinated primary care is without peer when it comes to driving health outcomes and the efficient use of resources. Family physicians must rely on a payment system that supports their pursuit of these core functions. “No margin, no mission,” as we say in the non-profit sector, also applies to the practice of family medicine. Without appropriate payment structures, the health care mission of family physicians becomes more difficult to achieve. The American Academy of Family Physicians (AAFP) understands how important payment is to the business of family medicine. In fact, one of our strategic objectives is to support and sustain comprehensive family medicine practices by advocating for models of payment reform that result in greater investment in family medicine. We do that by achieving enhanced payment of primary care services in today’s fee-forservice (FFS) world while laying the groundwork for better models of primary care payment in the future. For most family physicians, payment remains an FFS proposition, with office visits being the service they provide most often. Medicare’s payment allowances and the relative value units underlying them drive the fees paid for family physicians’ services. Recognizing that, in 2019, the AAFP participated in a survey of the physician work and practice expenses typically associated with office visits. As a result of that effort, the Centers for Medicare & Medicaid Services (CMS) plans to increase the relative value of office visits in 2021. Consequently, CMS estimates that family physicians will experience a 12% increase in their Medicare allowed charges in 2021. To the extent commercial health insurers and other public payers use the Medicare rates and relative values to set their own fees, we expect family physicians will see an increase in payment for office visits from multiple payers in 2021, which will support and sustain family medicine practices.
MISSOURI FAMILY PHYSICIAN July - September 2020
While we work to strengthen FFS payments in the short run, we recognize FFS is incapable of supporting the primary care system that our health care system needs and that patients deserve in the long run. Primary care is comprehensive, continuous, holistic, portable, and patient-centered. FFS is, by design, the complete opposite. It is focused on units of care, units of time, and sites of service. Family medicine has politely whispered for years that FFS was an illogical payment construct for primary care, and the COVID-19 pandemic has put a giant spotlight on this issue. Prospective payment changes that. Individuals within the commercial health insurance sector have told us that capitated primary care practices have coped better and more effectively with the pandemic. Imagine if every family physician had had an attributed panel of patients and an associated prospective payment for each when the crisis hit. Transformation from office-based to virtual workflows would have been easier and quicker. When units of care and units of time no longer get measured, providing care to patients becomes the focal point. And, when providing care to patients is the focal point, family medicine wins. The concept of prospective payments is not new. The AAFP has advocated adopting this type of payment model for years and, in 2018, we developed the Advanced Primary Care Alternative Payment Model. Our model is the foundation of the Primary Care First model that CMS will implement in 2021. We also have advocated for other global/ prospective value-based payment models, such as direct contracting, physician-led accountable care organizations, and direct primary care arrangements. And, we’re not stopping there. The AAFP is working on a payment strategy, “Vision 2025,” to support continuous, comprehensive, and coordinated primary care into the future. To achieve the vision of sustainable, comprehensive family medicine practices, we must fundamentally change the way in which our health care system pays for primary care. While increased FFS resources help ensure family medicine’s survival in the short term, financing must shift away from the FFS system designed for last century’s care to a flexible, prospective, value-based model for the 21st century. When that happens, the AAFP will be a long way toward achieving one of its strategic objectives, and family medicine practices will be in a better position to do the real business of family medicine.
Is Rural Solo Family Practice Medicine Still an Option for You?
“D
octor, have you ever considered opening your own practice?” is a question I’ve heard several times over the years. It came from well-meaning patients who sometimes felt the burden of trying to navigate an automated phone system, having to talk to the on-call doctor who may not know them like I did, or trying to get triaged by a nurse who may not really understand their problem. Last year, I attended a leadership conference in Kansas City held by the AAFP. One discussion with National Leadership, State Presidents, and President-Elects involved dialogue on physician workforce shortages, especially in rural and inner-city areas of the country. Most suggested that these shortages were related to reimbursement issues, and proposed increasing taxes to help fund these shortage areas. During these discussions, I was struck by the fact that I didn’t move to rural Missouri for the money. I moved there to practice full-scope family medicine, and because I was born and raised in rural Missouri and didn’t really like living in the “big city.” My wife was also from rural Missouri, and enjoyed being a part of and raising our children in a small community. I also enjoyed talking and relating to people that were like me. Farmers are really cool to talk to because they are nearly as compulsive and superstitious as we doctors are about practicing our trade. They are “real” in that they will tell you exactly what they think about the subject at hand, whether you like it or not. People in rural communities also seem to have a similar approach to life as myself. Their belief systems, desire to be independent and hard-working attitudes are just a few examples of why I feel so comfortable here. Another factor in the workforce shortage became apparent after asking a few people in the discussion room how often directors of residency programs had
solo-practice physicians or members of small towns come to their program to try to recruit residents and explain to them the benefits of practicing in a small town. Most directors told me that metro-based recruiting firms had reached out to them, or that large hospital systems most heavily recruited their residents. So, one can conclude that most residents do not have rural solo family medicine on their radar as an employment option when they finish their training. I suspect that most residents, having loans to repay along with very little training in the business of medicine, would feel intimidated even considering this possibility when most employment opportunities sound much more secure and attractive; they present the notion that “someone else” will take care of the business aspect of your practice and all you have to do is “practice medicine.” Sound familiar? What would happen if residents were exposed to the idea that rural solo family practice is a viable option? I believe it would present a feasible opportunity for family medicine doctors to move to rural Missouri to practice, especially if they knew that it could be done with little more than understanding a few business principles and working through a couple of pages of technical “to-dos”. One advantage to working as a physician/small business owner is that you really own your own business, and as such, you can eliminate committees! You get to make all the decisions, right or wrong, and live with the consequences. Fortunately for me, my office staff enjoys pointing out when I have clearly blundered on something like running out of a particular immunization that I told them I had already ordered. Setting up efficient reminder systems in the office has helped to eliminate these sorts of issues and delegation of certain responsibilities has become a learned art form. There are no hour-long meetings
Jamie Ulbrich, MD, FAAFP
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to decide what services you will offer, phone system you will use, lab services to contract with or insurances you will participate with. You can treat your patients as you really feel called to. There are no nurse managers telling you that you have to see so many patients a day or that your salary is based on your RVU’s. You can choose the pace at which you see patients. Your clinic staff and patients will ultimately become like family to you. You will feel the desire to take as good of care of the people you work with as the care you give your patients. When you live in a small community, your patients and staff go to church with you, participate in sport activities, help each other get to work during snow storms or car troubles, and help solve familial problems. Everyone helps raise and support each other through all life events whether physical, emotional, relational or spiritual. You really get the womb-to-tomb experience with your family of patients and staff. A disadvantage of being a solo family practice physician is the feeling of isolation. When you are dealing with a complicated patient, “curbside” consultations are somewhat more difficult than if you worked in a large practice. You usually have to pick up a phone instead of walking down the hall. Another thing to consider is how cellular coverage in your area will affect the practice of telemedicine and working remotely. With the technology available today, I go everywhere with my computer and can set up a mobile hotspot just about everywhere (minus the Grand Canyon a few years ago); I can usually care for my patients remotely. Being able to take a mental holiday is somewhat more challenging. I have found over the years, however, that most of my patients have really learned to respect my time and feel very apologetic for “bothering” me at night and on the weekends. Most of them will usually wait to call me during clinic hours because they know I am doing this on my own. This attitude was probably one of the most humbling and cool things I did not expect when starting my own practice. Most of the phone calls I used to get when I was in a large practice came from some of my partners ordering protime/inr’s on Friday nights and getting culture results called to me, or some patients phoning in the early morning hours complaining of not being able to sleep. Yes, really. Financial risk is another consideration. When you are on your own, one must watch great in- and out-fluxes of money in your operating and payroll accounts every 2 weeks. At first, it can be alarming, but after a few months, you realize that the bottom line is about the same. Certainly, the financial rewards have been greater over the last 5 years than in previous years when I belonged to a large group practice, simply because I can control costs and keep my overhead much more manageable. One of the earliest principles I learned in owning my own business was that you have to operate within your means. The sky is not the limit; rather, your budget is your limit. The last limitation to being in rural solo practice is knowing what you can and cannot realistically do on your own. As I had mentioned earlier, when moving to a small town in Missouri, my dream was to practice full-scope family medicine. In my early years, this meant delivering babies, and performing caesarian sections, post-partum and elective laparoscopic tubal ligations, breast biopsies, vasectomies, upper and lower scopes, colposcopes, leeps, circs and critical care medicine. As the years have gone by, my family dynamics changed, and I wanted to prioritize attending some of my kids’ sporting and other school events. In doing so, it became less important to do all the things I had been trained to do. It was also more difficult to continue to receive continual training in all the above procedures as the number of procedures were harder to attain in a small town than it would have 20
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been in an academic training center. As a result, it became possible to transition to a solo practice where my duties centered around fulltime clinic practice, leaving the hospital work to the hired hospitalist and procedures to the specialist. I certainly miss that aspect of family medicine, but also find great joy in being a small business owner. I do not think it would be realistic to be doing everything I did in my early years while simultaneously trying to be the successful business owner of a solo practice. Previously, I mentioned some technical “to-dos” for starting a solo practice. I am indebted to one of my previous partners for sharing this laundry list of essential tasks. These range from items like retaining an attorney for purposes of establishing an LLC to obtaining a Medicare number and Tax Identification number. Credentialing with your local hospital, along with NPI numbers, Missouri Licensing, DEA, BNDD are other considerations. Supplies such as office furniture, an autoclave, and an EKG machine are other items that are easier to come by. If interested in pursuing this type of practice, know that I would be willing to share my “cheat sheets” with anyone who desires to follow me in this pursuit. Maybe you’re already in practice and starting a solo practice sounds like a really good idea that you have been praying about for a long time,
“
You need to negotiate your current and future employment contracts to include a clause that would exempt you from a no-compete clause.
”
as I did prior to stepping out in faith to do this. Perhaps you are just finishing residency and are not sure this is for you, but somewhere down the road you might like to have this option available. To ensure this, you need to negotiate your current and future employment contracts to include a clause that would exempt you from a no-compete clause for the purposes of establishing a solo practice in your present place of residence. Most hospitals are interested in you remaining in their town and supporting them. Based on my experience, they would not want you to compete against them, but likely would accept you practicing family medicine and continuing to refer patients for admission and diagnostic testing. Remember everything in your contract is negotiable, and that both parties just need to agree in principle about what they want; you do not need to burn any bridges. When you move your family to a small town, you’re investing as much as the employer has invested in bringing you there. In conclusion, I can find no greater joy in the practice of family medicine right now than being in a rural solo practice. It has been so much fun over the last 5 years getting to care for the patients I have seen for so many years now. I consistently receive positive feedback from patients: “You all seem to get along and have so much fun together!” I can say that this pandemic has tried to get us down, but we have resolved to continue to provide great care for our patients, validate their concerns and continue to thrive through it all. Great staff and working within our means have kept us going. If anyone would be interested in discussing this as a grand round at a residency program, or is looking at making the transition to a solo practice, I and the MAFP would be more than happy to help anyway we can.
Cautious Congratulations on the Job Offer
W
hat should you look out for in employment agreements? Whether you’re transitioning from resident to practitioner or you’re making the move to a new facility, there are many potential pitfalls and practical considerations when negotiating an employment agreement. If you’re just focusing on salary, you’re not seeing the whole picture. It’s important to review any employment agreement, preferably with a lawyer, for monetary and non-monetary provisions. From the money side, sure you get a salary, but what about cost of living adjustments or bonuses? How does that system work? How are you going to get taken advantage of, and is there a way to balance it more in your favor? Compensation bonuses can be structured based on revenue generated, patients seen, hours worked, or a combination of these and other factors. If any of those factors are negotiable, it’s important to negotiate those up front. You also need to know your benefits. Who is paying your malpractice insurance premium? What about continuing education expenses, lab bills, and costs of purchasing new equipment? How about 401k and profit-sharing programs? These should all be spelled out in your employment agreement. Don’t expect any benefit to be available to you that isn’t directly defined in your contract.
On the non-monetary side, there are several concerns such as length of the contract, time commitments to the job, annual paid time off restrictions, commitments on bringing new patients into the practice, or what constitutes a breach of the agreement –termination with or without cause. However, the biggest concern in any professional’s employment agreement is a non-competition covenant. Most folks just call it a “non-compete.” As a lawyer, my profession is not allowed to have noncompete agreements that restrict clients from their lawyers when they leave a law firm. Supposedly, this is because everyone should have their own choice of a lawyer. But why isn’t that the same for doctors? It seems much more important to have a physician you trust than a lawyer, and I’m supposed to be biased! Regardless, these are commonlyignored clauses in employment agreements that lay dormant until you decide it’s time to leave the practice. At that point, you’ll scramble to see what patients you can take with you, what other practices you can join, and whether or not you’re going to get sued when you leave. In Missouri, non-compete agreements are disfavored in the eyes of the law. But this does not mean they are unenforceable. When an employer takes the time to provide training and expertise to its employees, as well as expending resources to
Blake I. Markus, JD Managing Partner, Carson & Coil P.C.
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bring in customers, courts will try to enforce reasonable noncompete provisions. It should also be noted that courts have a unique ability to “blue pencil” these non-compete agreements. This means a judge can decide whether a non-compete provision is too strict, and if so, the judge has the power to rewrite the provision to make it more reasonable. No other area of contract enforcement allows this, only non-compete agreements. There are two main issues with non-competes that get looked at the most: geographic and temporal restrictions. In other words, where can I work when I quit and how long do the restrictions last? For geographic restrictions, Missouri courts will generally look to the market in which the employer operates. If you work for a local practice with patients in a 30-mile radius from the physical location, a reasonable geographic restriction might be 30-50 miles. It gets tougher when we consider larger systems that might operate in multiple states. No court would enforce a nationwide ban on employment, and most courts would never entertain a multi-state restriction. Even a state-wide restriction would be suspect for most physicians. Since you don’t want to fight this on your way out the door, you need to look at these provisions before you sign any employment contract and determine what you can live with. As for temporal restrictions, Missouri courts will almost always
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find that a one to two year non-compete is reasonable for any professional position or job requiring an advanced degree. There are even some cases where courts have upheld non-competes in excess of three years for executives or business owners who sell their businesses, but those are special circumstances. If a timeframe is unreasonable, a court could throw out the entire agreement, or blue-pencil that down to a one- or two-year restriction. There are certainly more considerations than just time and geography though. You will want to look at any non-solicitation clauses that prevent you from taking patients with you or contacting them once you’re gone. It needs to be limited to your current practice area, even if the facility has several practices. Many employers are willing to negotiate any and all of these terms, and the only way to do so effectively is to do it up front. For non-competes, you don’t want to be stuck trying to leave a job where you’re not a good fit and you are hamstrung from going where you will be happier. For the other provisions of your contract, unless you have a unique position of leverage in the practice, making any changes to your employment agreement will be awfully difficult once it’s signed. Review thoroughly, be skeptical, and give yourself the ability to escape unscathed if you find the facility isn’t a good fit from the start.
DPC as a Viable Business Model for Practicing Primary Care
D
r. Gruender is a board certified Family Medicine physician who owns Liberty Family Medicine, a Direct Primary Care clinic located in Columbia, Missouri. She opened her DPC clinic over 4 years ago and it was the first of its kind in the mid-Missouri area. She truly enjoys offering amazing, relationship-based care while supporting her community in the process.
phone, and videoconferencing visits in addition to providing traditional office visits. Physicians typically carry somewhere between 600 and 800 patients on their panel which is a stark contrast to the traditional model of practicing medicine where physicians have 2,500 to 3,000 patients on their panel; this allows physicians to spend more time with each individual patient when care is needed.
GIVE US A BRIEF OVERVIEW OF DPC FOR THOSE WHO ARE NOT FAMILIAR WITH IT.
WHAT ABOUT THE SERVICES NOT COVERED IN THE DPC CLINIC?
Bridget NT Gruender, MD, MS
DPC can provide about 90% of the healthcare services most patients need including general DPC, short for direct primary care, is a model primary care, procedures, laboratory services, and of practicing medicine where the patient pays an medications. However, for the larger medical needs affordable membership fee in exchange for primary like hospitalizations, surgeries, specialist visits, and care services. Typically, this is done without insurance imaging, additional coverage can be financially although patients can still have insurance they use helpful. It is recommended that anyone who is a outside of the clinic (and in some DPC clinics, even member of a DPC clinic that does not already have inside the clinic for certain services). Most DPC clinics additional insurance coverage should obtain some offer laboratory services, prescription dispensing form of additional coverage for unforeseeable services, procedures at minimal or no additional cost, and comprehensive primary care including expenses or services that are not provided in the care coordination with specialists or other facilities. clinic. Most clinics will recommend patients consider With their membership, patients do not pay a co-pay catastrophic plans with high deductibles or health for services and have unlimited visits available with sharing plans, which work well with the DPC model their physician; most clinics can provide care through of primary care. multiple forms of telemedicine including text, email, MO-AFP.ORG 23
IF PATIENTS HAVE INSURANCE, WHY WOULD THEY SIGN UP FOR A MEMBERSHIP PRACTICE?
DPC clinics are quite different in how they are set up from the traditional model of primary care and this is beneficial for both the patients and the physicians. Traditionally, family physicians will see anywhere between 20 or 30 patients per day in the clinic whereas in the DPC model, they will typically see 6 to 10 patients per day in the traditional office setting with additional care provided as needed via nontraditional methods for concerns not requiring hands-on care. This approach to care allows much more time per patient in the clinic and the ability for the patient and physician to communicate in nontraditional methods including text, email, phone and videoconferencing when appropriate. Even patients with insurance can appreciate the convenience and personalized care that is easy to attain in a DPC practice given the smaller patient panels and thus more time spent with each patient when a need arises; some insured patients will even find that they save quite a bit of money on prescription medications and laboratory services through their DPC membership as opposed to using their insurance.
ARE PHYSICIANS TYPICALLY TAUGHT ABOUT RUNNING BUSINESSES WHILE IN MEDICAL SCHOOL IN RESIDENCY?
Unfortunately, most physicians will receive little to no training in running a business as the majority of physicians will end up joining a larger system as an employee. For those physicians who are interested in independent practice as a DPC physician, there are many veteran physicians who are available to offer advice personally, at conferences, as well as through online groups. There have also
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been a few books written on the topic that are helpful resources including The Official Guide to Starting Your Own Direct Primary Care Practice by Doug Farrago. The local Chamber of Commerce is usually a good place to start to connect with other business owners as well as to integrate into the business community.
IN STARTING A DPC PRACTICE, HOW ARE THINGS FUNDED?
Starting a DPC practice is different than starting a regular business in that you can start quite affordably with minimal overhead and this is typically the suggested format. Most practices will start with just the physician, minimal office space (some even use their homes), and minimal equipment as a micro practice. As the patient panel grows, the physician will add additional staff, supplies, and space as needed. This way of starting a DPC practice allows physicians to open without taking out large loans and in some cases, no loans at all. This does not however, mean that DPC practices are without financial risks or hardships. Most physicians will end up moonlighting to cover expenses in the beginning as they typically will not pay themselves a salary (or only a very small one) while their panel is growing to keep overhead low.
IF YOU START WITH NO STAFF, HOW EXACTLY DOES THAT WORK AND WHEN IS A GOOD TIME TO ADD THEM?
Starting a business with you as the sole employee can seem scary, but as a physician, you have all of the skills necessary to successfully do so, especially if you are committed to the outcome. Practices who start with no additional employees will typically add
them when the panel reaches between 100 and 200 patients, as most physicians find that this is the time when they are unable to do everything completely by themselves. That being said, some practices will start with one additional part-time employee and other practices will wait longer to add an additional employee; this is solely based on the physician’s preference and financial situation in most cases.
ARE YOU OPEN MONDAY THROUGH FRIDAY, OR HOW DO YOU OPERATE?
patient and offer very personalized care that is not rushed. Patients are able to contact their physician conveniently via multiple avenues and most patients will save money on medications, laboratory services, and procedures through the DPC model of care. DPC physicians always search for the most affordable avenues to offer amazing care for their patients, which is a huge benefit for both the patient and the overall healthcare system as the DPC model of primary care decrease the overall cost of healthcare.
WHAT ARE SOME OF THE NEGATIVES IN THE DPC MODEL OF CARE?
Most DPC clinics are similar in their base structure of functioning; however, details like business hours can vary greatly depending on the physician. Some practices will function Monday through Friday during the daytime hours while others will offer some evening hours and even some weekends. Clinics that are just starting may offer only 2 or 3 days per week or possibly partial days while they are growing their panel and moonlighting at other locations. One of the great benefits of DPC clinics is amazing care can still occur even when the clinic is not open or the physician is not in office as the patient is able to reach the physician via nontraditional forms of communication like text and email. Most DPC physicians will offer their patients access after-hours for urgent matters. This means the physician is almost always on call; however, most physicians find that patients respect their time and do not contact them after hours unless absolutely needed.
Although there are not many negatives in DPC, one would be that this affordable and accessible option for primary care does attract some patients who have not received primary care in many years or maybe their entire adult life so the first time you see them you are correcting many issues at one time. The benefit of this however is that DPC can help them continually work on improving their health given the affordable and accessible access to not only primary care but also medications. Another negative would be that as an independent small business, you must attract potential patients, which leads to the need for marketing and networking as well as having a presence on social media as a business. If you are the first DPC practice in your area, you will also need to educate the community about the benefits of DPC as they very likely will only know about the traditional model of medicine utilizing insurance.
AS AN INDEPENDENT PRACTICE, HOW DO YOU GET NEW PATIENTS?
HOW CAN INTERESTED PHYSICIANS LEARN MORE ABOUT THE DPC MODEL OF PRACTICING MEDICINE?
In a traditional medical practice, patients are funneled to the clinics by the hospitals and other healthcare systems meaning there is usually never a shortage of patients. In a DPC practice however, patients must fully understand the benefits of the membership model in order to take the leap from the traditional way of receiving care to the DPC model of care. Unfortunately, because most people are accustomed to the traditional model of receiving medical care, when a practice opens in a community without a prior DPC clinic in the area, there is a large amount of education that needs to happen with the general public because they are uncertain of what DPC actually entails. When many people learn about DPC, they think the model is too good to be true and may doubt that physicians are able to deliver everything they promise. However, once patients sign up for a membership and try it for themselves, they absolutely love it. This lack of education about DPC can lead to slower initial growth for practices that are opening in an area without a current DPC clinic.
WHAT ARE SOME OF THE BENEFITS FOR PATIENTS AND PHYSICIANS IN THE DPC MODEL OF CARE?
Almost everything about DPC is positive for both the physicians and the patients. Physicians are able to spend more time with each
Each year, there are multiple conferences centered around the DPC model of care where both veteran DPC physicians along with those interested in DPC or just opening a practice can come together to expand and share their knowledge. The DPC community of physicians is one of the most accepting and open communities where physicians who are just starting out or considering taking the leap into DPC can reach out to veteran DPC physicians for advice on how to start and how to be successful; as this model of care is quite different from the traditional model, these communities are also where many DPC physicians go for support on other issues throughout their DPC career including growing their practice, dealing with business issues, and advice on medical concerns including diagnosis and treatment.
ANY CLOSING REMARKS?
Commitment to the end goal when starting a DPC practice is essential as it is a process and does take a substantial amount of time and effort to fully establish your practice and be financially successful. Many DPC physicians will agree that the DPC model of primary care has allowed them to fully express how passionate they are about caring for patients and their community and they are grateful that they are able to offer these services to them.
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Practice Preparedness for Times of Disaster
D Mariam Akhtar, MD
John Paulson, DO, PhD, FAAFP
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ue to COVID-19, life has been drastically altered in a way that is unexpected for many. Therefore, it appears that in the case of a disaster, whether a pandemic or a natural disaster, there is an urgent need for medical practices to not only adapt and change their existing disaster management plans, but also have certain response management implementations in place in order to handle the complexities that are brought on by these events. This article will serve to highlight the primary response management protocols that medical practices should plan for, in order to help assure a smooth transition if a disaster takes place, so that patient care is not compromised. These changes emphasize the efficient utilization of existing employees and supplies to continue patient care. All practices, prior to a disaster event, should ensure that a list of all employee contact information is compiled, up-to-date, and easily accessible. This information should include emails, phone numbers, home address, and have emergency contact information for family members. Additionally an adequate and well-connected phone tree should be made to include all employees. This will allow the practice to account for and communicate with all employees in a systematic fashion in times of distress. Staff should also be properly cross-trained as the workforce can potentially be drastically reduced during these disaster events due to various reasons (such as physical/mental impairment, financial constraints, caretaking, etc.). Proactively cross training prepares staff to take on different roles, or more efficiently multitask when other co-workers are not available. Management will also need to ensure that they appropriately assign their employees responsibilities that match their capability. Staff should not only be able to perform administrative work, but also help with minor patient care needs such as triaging and rooming (Sanchez, 2007) (Buck et al., 2020). Part of this training should include staff knowing how to perform proper hand hygiene with the use of soap and water, as well as being adequately able to perform regular disinfection of any patient care areas. This is vital during a pandemic event as this is one of the most effective means in reducing transmission and keeping patients and employees safe (Cole, 2007). Employees should also be encouraged to prepare their own individual plans, especially in the case of a pandemic. This will allow them to keep their families
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safe and/or reduce exposures to family members. Special care should also be taken to monitor stress levels in employees, and having flexible and generous sick leave would be useful in reducing uncertainty and anxiety levels within staff (Cole, 2007). COVID-19 has placed the availability and use of personal protective equipment (PPE) in center stage for the entire world. PPE is essential and especially important in the face of a pandemic or any natural disaster that impairs adequate ventilation, and helps reduce the spread of disease, especially amongst health workers. Thus, it is vital to ensure that gloves, gowns, eyewear, facial shields, and facial masks be available to all healthcare personnel, as well as any personnel coming into contact with hazardous materials within your practice (Sanchez, 2007). Availability of alcohol and alcohol-based sanitizers will be important in reducing both the current pandemic pathogen, as well other viruses and bacteria (such as MRSA especially). This is to protect staff and patients from further viral transmission or possible coinfection with another pathogen. Proper hygiene protocols will also need to be in place in order to give staff guidelines on how to properly utilize and disinfect PPE after patient care. During times of PPE shortages, guidance on how to preserve PPE supplies while simultaneously preventing the spread of any contaminant will be necessary as well (Buck et al., 2020). Many of these guidelines will be provided by national organizations such as the Center for Disease Control and Prevention, so physicians will not always have to create them during times of crisis. Employees will need to fully understand these standards and be provided regular updates on the disaster or disease in order to ensure that they follow through with these measures (Sanchez, 2007). Disaster preparedness also requires some stockpiling of certain supplies. These supplies include water, food, antibiotics, chemical antidotes, and other medications (Cascardo, 2015). Supply chains will face strain during these times, and thus, it may be helpful for practices to maintain their own personal stockpiles of possible antibacterial/antiviral drugs, as well as possible routine medications. This will ensure optimal patient care. Although there may be a national stockpile of supplies (NSS), it is important that practices already have these supplies secured and on hand, as obtaining these from the NSS may take time (Buck et al., 2020). As a disaster can be a life-altering event, it follows
that it will also alter the way a medical practice functions. Since staff may be limited due to safety of both the employees and the patients, unnecessary office visits should be limited. Well-visits or annual visits should be halted, and only essential care should be performed. In order to determine what is deemed essential, triaging protocols will need to be in place (Sanchez, 2007). For pandemics specifically, triaging potentially infectious patients versus those coming in for other complaints will need to be considered carefully. Practices may need to have staff who are devoted just to those suffering from the pandemic-pathogen or suspected pandemic patients. Moreover, patient scheduling should also be taken into account, and staggering of patient arrivals to ensure social distancing protocols are maintained may be required. The clinic layout and operational logistics will need to be reviewed, and a plan will need to be implemented to reduce any unnecessary exposure to either patients or employees (Cole, 2007). Additionally, it is important that entrances be staffed with employees who perform screenings of staff and patients according to the appropriate pandemic diagnostic criteria. Staff will need to be trained in establishing a reporting system to notify necessary health authorities and inform contact-tracing programs if needed. Coordination with testing sites should also be performed to identify and reduce viral spread. While performing all of these duties, employees in a practice must ensure that they maintain Health Insurance Portability and Accountability Act (HIPPA) compliances in all that they do. Informational Technology (IT) staff will be key in maintaining HIPPA, and will help ensure that patient data does not become lost or vulnerable to exposure in these times (Cascardo, 2015). Logistics will need to be changed during this time. Staff that can work remotely should be allowed to do so immediately. The first to consider are employees responsible for billing, transcription, scheduling, IT support, and administrative support staff (Cole, 2007). Other forms of remote work, such as telemedicine, should also be implemented. This can be in the form of a phone call or live video conferences. Since the main method of preventing spread is through social distancing, telemedicine has become vital to pandemic disaster management. Telemedicine has been employed internationally during other disasters such as during the Severe Acute Respiratory Syndrome (SARS) in the early 2000s, or most recently during the droughts in Australia (Smith, et al., 2020). Effectiveness of telemedicine is dependent upon a clinician’s acceptance of this new and emerging method, as well as obtaining accreditation and being able to receive appropriate reimbursements for service (Smith, et al., 2020). If implemented correctly, telemedicine can be an incredibly useful form of medical care, especially for underserved populations who may have difficulties in obtaining care otherwise. Disaster preparedness discussion would not be complete without some discussion about insurance. Based on data from statefarm.com there are a variety of medical office coverage options available. Not having the appropriate credentials to provide insurance advice, this article mainly focuses on identifying several areas for physicians to be aware of when they have more specific conversations with their respective agents. Readers are likely familiar with property, liability, equipment breakdown, employee
dishonesty, and backup of sewer and drain. However, we currently see the need to be properly insured for loss of income. Interestingly enough, most loss of income policies exclude pandemics. Basically, insurance policies do not apply when the government is going to indemnify losses even if the reimbursement is significantly less than your actual loss. Make sure and question this when reviewing your policies as it applies to pandemics, weather, etc. During weather related disasters like floods, tornados, or hurricanes, it is more important to have policies that cover utility interruption, spoilage, computer property, sign damage, and loss due to damage or loss of accounts receivable records. One challenge that may present is the ability to obtain this type of small business/medical office coverage if you are employed by a hospital. Please consider this as part of your discussion with your respective insurance representative as you navigate risk management thru your insurance provider. Disaster management planning is vital for a medical practice in
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Telemedicine can be an incredibly useful form of medical care, especially underserved populations who may have difficulties in obtaining care otherwise.
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order to ensure the health and safety of its patients and employees. Proactively addressing the above topics will allow staff in a medical practice to mobilize quickly and establish stability in uncertain times. This will allow physicians to practice in a systematically effective manner as well as help them adapt to various complications that can arise in the event of a disaster. It is important to note that medical practices are a part of the large healthcare ecosystem within the United States and should not be isolated to one’s own medical practice. It is recommended that physicians and practices consistently use guidance from trusted sources to shape protocols both prior to and during disaster occurrence.
References
Buck, B. H., Cowan, L., Smith, L., Duncan, E., Bazemore, J., & Schwind, J. (2020, April). Effective Practices and Recommendations for Drive-Through Clinic Points of Dispensing: A Systematic Review. Cambridge University Press. doi: DOI: https://doi.org/10.1017/ dmp.2020.15 Cascardo, D. (2015, February). Keeping Your Practice Healthy in the Aftermath of a Disaster: Are you prepared for the unexpected?. The Journal of Medical Practice Management, 243-246. Cole, R.L. (2007, August). Note Just for Birds: Assessing your medical practice for pandemic readiness. MGMA Connexion, 36-41 Sanchez, M.-K. (2007). Pandemic Planning in office-based practices. Texas Medicine, 45–47.
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Is the Juice Worth the Squeeze? Innovation, Technology and the Business of Family Medicine
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J. Paul Dow, MSHI, eHealth Innovation Strategist, AAFP
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echnology has advanced the ability of clinicians to treat patients since the beginning of medicine. In the past, many of these tools were developed over long periods of time and at great cost. This limited their implementation and benefits to large academic facilities. For example, Magnetic Resonance Imaging (MRI) systems provide valuable diagnostic insights to physicians; however, the revenue required to install and maintain that level of technology can be cost prohibitive. These innovations are becoming cost effective for a range of family practices as technology becomes more reasonably priced and cloud-based. The challenge is to find the right tools that add value to your patient care continuum without burdensome disruptions to your workflow.
MISSOURI FAMILY PHYSICIAN July - September 2020
The American Academy of Family Physicians has funded a three-year project to discover, test, and recommend various classes of technology to help a broad range of physicians simplify the administrative aspects of healthcare. Care providers are spending too much time creating documents to support billing activities rather than providing care. Ultimately, the decision to implement a solution rests on each practice evaluating the unique challenges that are presented. COVID-19 has changed the way a physician practices and the frequency with which a patient utilizes clinical resources in America for the foreseeable future. The almost instantaneous transition to telehealth has proved to be complex. Some practices were not ready for the sudden shift
and are still playing catch up. Decreasing revenue only adds more pressure to selecting technology partners. Selecting the right solution should add to your overall efficiency as well as the bottom line. Choose wrong and you may destroy a delicate work/life balance and put your financial viability at risk. How can you decide which tool is the best choice for you and your patients’ benefits? This article will provide four questions each physician/owner must ask themselves before considering a purchase.
for the visit. Patients are also experiencing this new reality. It may require a few visits for them to understand the new processes. You also may need some time to adjust how you interact with and interview the patient. The same questions will exist: should I look at the patient or the computer screen? Will they be able to pick up on my non-verbal cues to keep the conversation moving? Will they ask “one more thing” right before you end the encounter?
WHAT PROBLEM ARE YOU TRYING TO SOLVE?
Numerous companies are offering telehealth services and solutions at a low price, or even for free, some for up to a year. After the initial period the pricing structure varies. Some use a per encounter pricing model, others have a flat fee per provider, per month. Still others provide freemium pricing, allowing users basic functionality and only charge for more advanced technology, such as to integrate with other practice management systems. Other fees and overages may be applied to your contract, as well as penalties if you decide the product is not right for you or your patients. If it is the product you want, and it seems like a fit for your practice, you may consider connecting it to your EHR. One additional aspect to explore is that the solution may work, but may have additional high cost items ($10,000 - $20,000 or more) for interfaces that may need to be upgraded annually for another tidy sum. In this case it might be worth looking at a consumer grade tool such as Google Meet which is free to implement and works on a wide range of devices. It might not integrate with your documentation tools but you may be able to use your personal devices relatively easily.
COVID-19 has suddenly added numerous layers of complexity to your delivery of care. Social distancing has made the standard clinic arrangement problematic and requires a rapid implementation of telehealth. Clearly defining the problems that exist in your workflow will make sorting the solutions easier. Do you need to find a way to interact with patients remotely? Some electronic health records (EHRs) have built-in telehealth solutions. If yours does not, there are many vendors willing to share one with you. Additionally, many have COVID-19 specific technology such as symptom checking. This may prove useful in the short term. However, it most likely requires another separate log-in and might not share information with your EHR if the tool is webbased. This increases the administrative requirements and might even require double documentation. Are you trying to use your practice management software but it does not have the flexibility to allow patients to self-schedule visits? This may be a function of telehealth software that has more functionality which usually means a slightly higher cost. There are no perfect technology solutions and many of the items involved with telehealth are out of your control: the network reliability, the patients’ ability to have a suitable device, updated to recommended software levels, with access wi-fi are some of the most critical to consider. Sometimes a simple phone call may be all that’s possible when there are so many variables.
HOW COMPLEX IS THE IMPLEMENTATION?
If you attend any health technology meeting literally every vendor declares that their product is one of the few that works with every EHR in existence. The number of EHRs that are easily compatible with most products is usually much smaller. If your practice is large enough to have technical support staff there still might be substantial effort required from your practice, the solution vendor, and the EHR vendor in concert to implement a solution. Additionally, there is the need to update your clinical workflows to accommodate this new tool. New technology may require your practice to adjust how its day-to-day operations flow. Physical distancing guidelines mean fewer patients entering your clinic. Office staff may need to complete a virtual technology assessment of the patient prior to the scheduled telemedicine visit. This would look like a staff member contacting a patient twenty to thirty minutes prior to the appointment to confirm the ability to connect remotely as well as to discuss the symptoms and treatment goals
HOW MUCH ARE YOU WILLING TO SPEND?
HOW LONG TO DEMONSTRATE VALUE?
COVID-19 has put a tremendous strain on primary care. Decreasing patient volumes even with the transition to telehealth may not be enough to maintain practice viability. In these cases, technology is not a get-rich-quick scheme. Considering the complexity of a new tool, plus the time to develop new workflows, as well as finding time to train staff and acclimatize patients, it may take a month or two, sometimes longer, to realize the positive revenue flow from the technology. Technology advancements, including telehealth, has proved to be a benefit to clinicians but adding it to day-to-day operations can be difficult. The public health emergency that is COVID-19 has had a huge impact on many family practices. Transitioning to telemedicine so quickly and so completely has proved to be a challenge for even the best prepared practice. As we begin to assess how to face the new future of medicine, answering a few questions can help with technology planning and finding the right tool at the right price for your practice. If you have further questions or would like to learn more about the AAFP Innovation Lab please contact Paul Dow via e-mail at pdow@aafp.org.
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The Joys and Perks of Being a Preceptor
Y
Ed Kraemer, MD, FAAFP University of MissouriKansas City
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ou love being a Family Physician! Why not share that heartfelt dedication with a future doctor by serving as a medical student preceptor? At the same time, you can showcase your patient centered practice and model what it really means to be a Family Physician! You are needed! A preceptorship in Family Medicine is required of all medical students in order to graduate. With some medical schools expanding in recent years, the number of medical students in Missouri has increased significantly. Other health profession student numbers requiring preceptors are also up while many long-time preceptors are nearing retirement. In other words, there is a perfect storm of increased demand for preceptors at the same time that supply is going down. What’s involved? Typically, your commitment would be to have a student in your practice between two and four weeks at a time, depending on the school’s needs. How often you do this is entirely up to you. You will, of course, want to provide the student with the best Family Medicine experience that you and your practice can offer. Preceptorship usually includes seeing some of your patients together initially as the student learns your practice flow and style and your expectations of them. Students typically progress quickly to seeing patients you select by themselves, performing the initial patient interview and focused physical exam, developing a differential diagnosis and diagnostic/ therapeutic plan…then presenting the patient to you for your guidance and clinical teaching and feedback. You typically conclude by seeing the patient briefly together. How this all looks and works will vary based on your preferences, time constraints, student abilities, etc. Students are also required to learn practical aspects of how a practice functions, including patient flow and scheduling, how patient messages are handled, the roles and training requirements of various office staff and non-physician professionals, Internation Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding for visits, and a feel for overall practice management. They are encouraged to spend time with others in your practice to learn some of these things firsthand. The student may also spend time seeing patients with your physician partners such as Physician Assistants or Nurse Practioners, as you may direct them, including days when you may be out of the office.
MISSOURI FAMILY PHYSICIAN July - September 2020
As it has with everything else, COVID-19 has impacted medical education in major ways. In March, medical schools paused student involvement in patient care, transferring all learning to online formats. Thankfully, students have since returned to on-site patient care, with reasonable precautions of course. COVID-19 procedures vary slightly from school to school so the student’s medical school will discuss this with you. Typically, students will not be involved in the care of COVID-19 patients. They will be prepared to abide by your office policy on masking, PPE use, etc. Students may also be able to participate in telemedicine visits if you have incorporated those into your practice.
WHAT’S IN IT FOR YOU?
• AAFP CME credits: You may receive up to 20 prescribed CME hours each year for teaching, including preceptorship activities, from the American Academy of Family Physicians. https://www.aafp.org /cme/about/types. html#prescribed-examples • ABFM Certification Credit: https://www. teachingphysician.org/become-a-preceptor/ incentives-for-precepting-2019 o CME: Up to 50% (maximum of 75 hours per certification cycle) of the CME required for certification by the American Board of Family Medicine can be earned by teaching medical students. o PI credit: Family physicians can earn ABFM performance improvement credit (MOC IV) by teaching medical students and/or residents and participating in a teaching performance improvement activity. • Many medical schools also offer for their preceptors: o Academic faculty appointments o Access to information and online library resources o Recognition events/programs o Access to continuing education • Students can help with patient encounter workups, medication reconciliation, note writing and other documentation. (Medicare now allows the preceptor to simply verify any student documentation of components of E/M services in the medical record, rather than re-documenting the work.) https://www.teachingphysician.org/ become-a-preceptor/How-Students-Can-AddValue-to-Your-Office
• Students help keep you on your toes, revitalized, and up to date! • Patients enjoy the students. They will also appreciate your commitment to medical student education and will be impressed by your affiliation with a medical school. • MAFP helped introduce a “Preceptor Tax Credit” bill to the Missouri legislature earlier this year. Due to the necessary attention to COVID-19, the legislature never voted on this bill. Be assured that we will be back in Jefferson City with a similar proposal early in the next session. • You will experience the great joy and satisfaction of training a future doctor, possibly even a future Family Physician, practice partner and community leader!
WHAT DO STUDENTS HAVE TO SAY?
“Students love FM Preceptorship: Working side-by side with a practicing FP! The pace! The variety! The Complexity! The patient relationships! The community involvement! Everyone was so nice to me!” “I wasn’t considering FM before, but now I am!”
WHERE CAN YOU FIND MORE INFORMATION?
From: https://www.teachingphysician.org/become-apreceptor/find-a-clerkship : Saint Louis University School of Medicine http://www.slu.edu/medicine/curricular-affairs/year-threeinformation-required-clerkships/family-medicine-clerkship 314-977-9870 A.T. Still University of Health Sciences - Kirksville College of Osteopathic Medicine (ATSU-KCOM) https://www.atsu.edu/ 660-626-2237 University of Missouri-Columbia School of Medicine http://medicine.missouri.edu/family-communitymedicine/medical-students/ 573-882-0974 University of Missouri-Kansas City School of Medicine http://med.umkc.edu/fm/docents-clerkships/ 816-235-1808 Kansas City University of Medicine and Biosciences College of Osteopathic Medicine (KCU-COM) - KC http://www.kcumb.edu/ 800-234-4847 Kansas City University of Medicine and Biosciences College of Osteopathic Medicine (KCU-COM) - Joplin http://www.kcumb.edu/ 800-234-4847
MAFP Racial Disparity Statement Dear MAFP Members:
The Missouri Academy of Family Physicians has always been inclusive and welcoming to people and perspectives from a variety of backgrounds and across the state in rural, urban, or suburban geographic locations. Regardless of our members’ and patients’ backgrounds, we are all equal and should be respectful of each person, period. The recent tragic events across our country are an opportunity to become more aware of the racial disparities that exist in our society. Expressions of these disparities have been peaceful, aggressive, and even illegal. As Missouri’s family physicians, we stand with our communities to institute change and dismantle structural racism and discriminatory practices. We all have different emotions related to these issues and the methods that are being utilized to initiate change. We all struggle to find peace and purpose in the wake of unspeakable tragedy and pain, but our commitment to all of our patients’ health and well-being continues to be the focal point of our efforts. The MAFP stands with AAFP’s strong statement opposing racism in any form. Racial injustice causes physical and emotional harm. As family physicians, we offer our medical skills and compassion to those in need. As an organization, we acknowledge we can improve and are working to identify our own implicit bias and to work with other health equity champions to move Missouri toward a just and equal state for all its citizens. We want to be a part of the solution. Yet, we know we need to do more through education and awareness. We are implementing regional CME opportunities, live streaming, and enduring CME that will focus on racial injustice and implicit bias. As leaders in your practice, these materials will be available for you to share with your team – one step at a time to have systemic change. As our strategic plan guides our efforts, we support the family medicine pipeline to become more diverse to care for all our communities. Change starts with each of us. Let’s get started…
Jamie Ulbrich, MD, FAAFP Board Chair MO-AFP.ORG 31
American Board of Family Medicine Announces Recipients of the 2020 AAFP Chapter Pilots
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he American Board of Family Medicine has been grateful for the opportunity to work with AAFP Chapters to mutually serve AAFP members who are ABFM Diplomates or candidates in support of their certification journey. In 2019 ABFM introduced an outreach initiative that gave us the opportunity to meet with AAFP Chapter Executives and their members in their “home” chapters, as well as to provide enhanced and personalized education about certification activities and requirements to these physicians. We have learned much from this process that has already made a positive difference in our communication strategies and our programmatic planning. Everyone benefits when we are working together on behalf of family medicine and family physicians! Earlier this year, our Board of Directors endorsed the addition of a State Chapter Pilot Project opportunity for 2020. Through this, ABFM sought to provide support to chapters seeking to create innovative ways to address member needs in ways that also would align with ABFM’s Strategic Plan: • Advancing the certification process • Supporting family physicians through the certification process • Promoting positive professionalism • Supporting medical education • Transforming healthcare at the state and local levels A subcommittee of ABFM staff and board members had the pleasure of reviewing submissions from chapters of all sizes and from each region of the country. Ten chapters were selected for support in 2020-2021, 32
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encompassing a variety of exciting initiatives. ABFM is excited to work with these Chapters, learning from these chapters and identifying ways that their efforts could be replicated by other chapters through the creation of materials and processes that result from these pilots.
MAFP IS THE RECIPIENT OF ONE OF THESE GRANTS.
The MAFP project is aimed at increasing student interest in Family Medicine by increasing the robustness and collaboration of FMIGs across the state with statewide residency programs. The MAFP will develop a unified tracking mechanism to monitor and evaluate FMIG interactions with pre-clinical medical students, setting a goal of 100 students per year. They will also facilitate four or more meetings per year with FMIGs across the state to learn from each other. A long-term goal is to build relationships between family medicine residents/programs across the state and the medical schools’ FMIGs. Other states that were awarded grants are: Alaska, California, Georgia, New Jersey, North Carolina, Ohio, Oklahoma, Oregon, and South Dakota. ABFM is proud to support each of these Chapters with their initiatives. The ongoing collaboration with ABFM diplomates’ “home” chapters will help us to continue to improve the value of certification. By better understanding the local environments and needs, we can better support physicians in their certification efforts. We look forward to supporting these types of initiatives and communicating on their progress throughout the coming year.
MAFP ENDORSES MEDICAID EXPANSION CAMPAIGN – AMENDMENT 2 The MAFP Board of Directors voted to support Amendment 2 which expands Medicaid in Missouri by a Constitutional Amendment. The timing of this issue of the magazine may overlap the August 4 election which is when Medicaid expansion will be on the ballot. We are so proud to support the Yes On 2 campaign to deliver life-saving care to nearly 230,000 Missourians, keep our rural hospitals open, protect frontline healthcare jobs, and bring billions of our tax dollars home from Washington. Nearly 350,000 Missourians supported the chance to vote for Amendment 2. Family physicians see more individuals and families who are underserved, poor, or come from a rural community than any other medical specialty. We have also seen the closure of 10 rural hospitals in Missouri since 2014. More than ever, Medicaid needs to expand in our state to provide Missourians access to healthcare. MAFP is one of 300 organizations to support this initiative along with the Missouri Hospital Association, Missouri State Medical Association, Missouri Nurses Association, and many other healthcare groups. Medicaid expansion in Missouri would help provide health coverage to more than 230,000 uninsured
adults in the state, the overwhelming majority of whom work at jobs that don’t provide health coverage, by extending eligibility to individuals earning less than $18,000 a year. That cohort includes 50,000 parents and 18,000 near retirees. It would bring more than $1 billion of our tax dollars home from Washington each year, create thousands of jobs and boost the state’s economy. Thirty-six states have already opted to expand Medicaid, including neighboring Arkansas, where officials reported using savings from expansion to cut state income taxes and reduce payments previously allocated to the uninsured. Bordering states of Illinois, Kentucky, Nebraska and Iowa have also opted for Medicaid expansion. Researchers at Washington University in St. Louis have found that expansion could save our state more than $1 billion by 2026 by reducing many of the healthcare costs the state now pays.
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MEMBERSHIP ANNIVERSARIES Thank you for your commitment to family medicine. Congratulations for your membership anniversary!
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YEARS OF MEMBERSHIP
C W Chastain, III, MD, FAAFP, Appleton, WI George Groce, MD, Fulton, MO Charles Peterson, MD, FAAFP, Osage Beach, MO
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YEARS OF MEMBERSHIP Claude Smith, MD, West Plains, MO
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YEARS OF MEMBERSHIP
Donna Drees, MD, FAAFP, Dallas, TX Bartolome Kairuz, MD, FAAFP, Saint Louis, MO Melville Moore, MD, FAAFP, Sun Lakes, AZ Robert Pavlu, MD, FAAFP, Carrollton, MO
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YEARS OF MEMBERSHIP
Merlin Brown, MD, MBA, FAAFP, Saint Joseph, MO George Comfort, MD, Mexico, MO Kenneth Derrington, MD, FAAFP, Lenexa, KS Patrick Harr, MD, FAAFP, Shell Knob, MO Richard Kimball, MD, FAAFP, Stroud, OK Lawrence Shields, MD, FAAFP, Springfield, MO William Sill, DO, FAAFP, Saint Charles, MO Paul Spence, MD, Cape Girardeau, MO
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YEARS OF MEMBERSHIP
Carol Berner, MD, FAAFP, Springfield, MO Babu Dandamudi, MD, Saint Louis, MO Carl Davis, MD, FAAFP, Lees Summit, MO Arthur Freeland, MD, FAAFP, Independence, MO Roy Gillispie, MD, FAAFP, Branson, MO John Goff, MD, FAAFP, Stillwater, OK R Griffith, MD, FAAFP, Kansas City, MO
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MISSOURI FAMILY PHYSICIAN July - September 2020
Dale Henselmeier, MD, FAAFP, Bridgeton, MO James Hunter, MD, FAAFP, ROGERSVILLE, MO Mark Kasten, MD, FAAFP, Cape Girardeau, MO Daniel Lischwe, MD, FAAFP, Chesterfield, MO Mark Martin, MD, FAAFP, Lees Summit, MO Phillip Monroe, MD, Springfield, MO Chennaiah Nadindla, MD, FAAFP, Chesterfield, MO Natu Patel, MD, FAAFP, Wilmette, IL Bruce Preston, MD, FAAFP, West Plains, MO George Prica, MD, Columbia, MO William Rosen, MD, FAAFP, Springfield, MO Theodore Schuerman, MD, Chesterfield, MO Susan Singer, MD, MPH, FAAFP, Saint Louis, MO Paul Williams, MD, Saint Louis, MO Timothy Wilson, MD, FAAFP, Trimble, MO
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YEARS OF MEMBERSHIP
Donald Allcorn, MD, Lincoln, MO Jeffrey Atkins, MD, Fenton, MO Richard Bowles, MD, FAAFP, West Plains, MO David Cathcart, MD, FAAFP, Springfield, MO Charles Crist, MD, Ashland, MO Randall Cross, MD, FAAFP, Springfield, MO Stanley Crown, MD, High Ridge, MO Patrick Dawson, MD, Maryville, MO Stephen Dorsch, MD, Lees Summit, MO Romeo Eugenio, MD, Perryville, MO Robert Frederickson, MD, Sedalia, MO Bonnie Friehling, MD, Columbia, MO Filip Garrett, MD, Springfield, MO Louis Harris, MD, Bolivar, MO Stephen Hawkins, MD, Cabool, MO Karen Heath, MD, Saint Louis, MO Scott Henderson, MD, Columbia, MO Jesse Hoff, MD, Farmington, MO Brent Hoke, DO, Warrensburg, MO Craig Holzem, MD, FAAFP, Washington, MO Martin Kanne, MD, Kansas City, MO Kendel Klein, MD, Mount Vernon, MO Michael LeFevre, MD, Columbia, MO Donald Lippert, MD, Branson, MO Alexander Mammen, MD, Saint Louis, MO Gregory Markway, MD, Independence, MO
Nathaniel Murphey, MD, Columbia, MO Shari Ommen, MD, Kansas City, MO Howard Pickett, MD, FAAFP, Excelsior Springs, MO Jay Pickett, MD, FAAFP, Waterloo, IL Robert Power, MD, FAAFP, Jefferson City, MO Daniel Purdom, MD, FAAFP, Liberty, MO Thomas Robbins, MD, FAAFP, Jefferson City, MO Bryan Sitzmann, MD, FAAFP, Parkville, MO Walton Sumner, MD, Saint Louis, MO Robert Tague, MD, FAAFP, Sainte Genevieve, MO Vernon Tegtmeyer, MD, Lebanon, MO Gary Thompson, MD, FAAFP, Kansas City, MO Hope Tinker, MD, Fayette, MO Kerry Vance, MD, FAAFP, Branson, MO David Voran, MD, Leawood, KS Jack Wells, MD, FAAFP, Columbia, MO Christian Wessling, MD, Saint Louis, MO Jeffrey Wheeler, MD, FAAFP, Kansas City, MO Philip Wittmer, DO, FAAFP, Springfield, MO Steven Zweig, MD, Columbia, MO Debra Atkinson, MD, Jefferson City, MO Holly Benedict, MD, Nixa, MO
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YEARS OF MEMBERSHIP
Kirk Brockman, MD, Washington, MO Barbara Bumberry, MD, FAAFP, Springfield, MO George Carr, MD, FAAFP, Jefferson City, MO Kimberly Cater, MD, Smithville, MO Karen Doerry, MD, Warrensburg, MO Mark Ellis, MD, FAAFP, Springfield, MO Neal Erickson, MD, Kansas City, MO Susan Essman, MD, Springfield, MO Samuel Ferreri, MD, FAAFP, Cape Girardeau, MO Donna Harper, DO, Springfield, MO Curtis King, MD, Joplin, MO Peter Koopman, MD, FAAFP, Columbia, MO Byron Law, DO, Kansas City, MO Lisa Leonhart, MD, Saint Louis, MO Elizabeth Logan, DO, Clinton, MO LaVert Morrow, MD, FAAFP, Saint Louis, MO Robin Morse, DO, Chesterfield, MO John Mruzik, MD, Columbia, MO Solomon Noguera, MD, FAAFP, Saint Louis, MO Christopher Normile, MD, Saint Charles, MO Robert Pierce, MD, FAAFP, Fulton, MO Robert Pozzi, DO, FAAFP, Saint Louis, MO Yvonne Prince, MD, Salem, MO Caroline Rudnick, MD, Saint Louis, MO Kim Smith, MD, FAAFP, Kansas City, MO James Stevermer, MD, FAAFP, Fulton, MO Kenneth Taylor-Butler, MD, FAAFP, Kansas City, MO Thomas Thomas, MD, Liberty, MO Shari Thompson, MD, Marshall, MO
Gary Upton, DO, STURGEON, MO Susan Vega, DO, Country Club, MO
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YEARS OF MEMBERSHIP
Matthew Beckerdite, MD, O Fallon, MO Michael Bennett, MD, Greenfield, MO Mona Brownfield, MD, Boonville, MO Denise Buck, MD, Saint Louis, MO Julie Busch, MD, Saint Louis, MO Christopher Conger, DO, Rolla, MO Rick Daugherty, MD, Belle, MO Eric Davis, DO, Fredericktown, MO Steven Douglas, II, MD, East Prairie, MO Jeff Dyer, MD, FAAFP, KANSAS CITY, MO Bridget Early, MD, Columbia, MO J Feuerbacher, MD, FAAFP, Maryville, MO Todd Fox, MD, Kansas City, MO Jennifer Frost, MD, FAAFP, Kansas City, MO Bradley Garstang, MD, Kansas City, MO Pascal Gaudreault, MD, Arnold, MO Dolores Gunn, MD, Saint Louis, MO Anne Hibbard, MD, Saint Peters, MO Kimberly Johnson, MD, Rolla, MO Jennifer Kelley, MD, Kansas City, MO Rebecca Kelley, MD, Auxvasse, MO Thomas Kelley, MD, FAAFP, Kansas City, MO Deatrice Kellogg, MD, Springfield, MO Ronald Kempton, MD, Kansas City, MO David Keuhn, MD, Marshall, MO Darren Killen, MD, Kansas City, MO Jae Lee, MD, Columbia, MO Lori MacPherson, MD, Mountain Grove, MO Jerome Mank, MD, Centralia, MO Angelia Martin, MD, Stanberry, MO Rachel Mc Intosh-Holt, MD, Kansas City, MO Debra McCaul, MD, FAAFP, St Robert, MO Steve Nelson, MD, Kansas City, MO Samuel Newton, MD, Gainesville, MO Kenneth Ogawa, MD, Columbia, MO Patrick O'Neil, DO, FAAFP, Osage Beach, MO Craig Pendergrass, DO, FAAFP, Neosho, MO Katrina Powers, MD, Blue Springs, MO Michael Robbins, MD, Fredericktown, MO Philip Rumbaoa, MD, Boonville, MO Carolle Silney, MD, Columbia, MO Sean Tarsney, MD, Springfield, MO Damon Thomas, MD, Nixa, MO Michele Thomas, MD, FAAFP, Saint Louis, MO Gary Vickers, DO, Saint Louis, MO Stacey Vorhies, MD, Ozark, MO Gordon Wouters, DO, Preston, MO Volare Yantis, MD, Nixa, MO MO-AFP.ORG 35
MEMBERS IN THE NEWS
DO YOU HAVE NEWS TO SHARE?
Email it to office@mo-afp.org for review. We love to hear from our members!
MAFP Welcomes Brittany Bussey as Member Communications and Engagement Coordinator
AAFP Vaccine Science Fellow Shares Family Medicine’s Perspectives on Increasing Vaccines
The Missouri Academy of Family Physicians announced the addition of Brittany Bussey as Member Communications and Engagement Coordinator. Bussey will be instrumental in developing and implementing the MAFP’s communications strategy as part of the strategic plan, increasing member engagement through member services, and general office administration. Bussey has several years of experience in marketing and communications positions for nonprofit organizations. In roles prior to the Academy, she helped grow companies’ online and social media presence through branding and increased cohesiveness and continuity throughout internal and external marketing materials. Bussey has been involved in leadership roles and holds memberships in statewide professional organizations. Her communications background will be valuable in increasing member engagement for the Academy. Brittany holds a Bachelor of Science degree in Journalism, AOE: Strategic Communications/Public Relations from West Virginia University. You can contact Brittany Bussey at bbussey@mo-afp.org. Welcome Brittany!
On June 11, Laura Morris, MD, FAAFP, presented at a virtual congressional briefing sponsored by the Adult Vaccine Access Coalition, a multi-stakeholder group for which the AAFP serves on the steering committee. Dr. Morris is a 2018 AAFP Vaccine Science Fellow practicing in Fulton, MO. She commented on the importance of shared decision-making and providing strong vaccine recommendations. Dr. Morris also discussed the financial barriers and time constraints that may undermine vaccine administration. The event is part of the AAFP’s consistent advocacy for increasing vaccine access through monies to plan for the nation’s pandemic needs, legislation to reduce vaccine hesitancy, and support for the CDC’s Section 317 immunization access and surveillance program.
MAFP Member, Tommy McDonald, MD, was featured in Congresswoman Vicky Hartzler’s newsletter to constituents. As a World War II veteran, Dr. McDonald raised the flag at the new Webster County Justice Center.
Join the Effort to Improve Masking in Public To reduce the spread of COVID-19 and maintain the progress in reopening, a coalition of stakeholders are promoting “Mask Up Missouri.” The goal is to educate Missourians on the benefits of mask wearing to control the spread of COVID-19. To help get the message out, they released a printable poster that individuals, organizations and businesses can use to promote the wearing of masks in public. The Centers for Disease Control and Prevention, and state and local public health officials recommend cloth face coverings whenever in public to limit the spread of COVID-19. According to a recent study from global investment firm Goldman Sachs, mask wearing by every American could save the U.S. economy from a 5% drop in GDP, or approximately $1 trillion in reduced economic spending. Missouri’s stay-at-home order helped reduce transmission of the virus. However, with many regions of the state opening, Missouri’s transmission rates have been rising. Missourians can protect themselves, their families and members of the community by wearing a mask when in public and when in contact with at-risk individuals. 36
MISSOURI FAMILY PHYSICIAN July - September 2020
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In Memory: Patricia Strader September 21, 1949 – July 4, 2020
The Family Physician’s Role in Lung Cancer Care
atricia Strader, former MAFP governmental consultant, passed away July 4, 2020 after her battle with cancer. Pat was a lobbyist for 35 years at the Missouri State Capitol, including 16 years as MAFP’s governmental consultant. She began by lobbying for Ameren UE and AT&T before founding her own lobbying group, Strader and Associates, that she operated for the majority of her professional career. Pat loved that her career as a lobbyist allowed her to meet so many interesting people and foster lifelong friends. She enjoyed time at the Capitol until ill health forced her retirement in January, 2018. She was instrumental in the passage of the Missouri Direct Primary Care legislation and was a key player in advocating for family medicine. Pat is survived by her husband Dennis, son Shawn, and her beagle, Oscar. Memorial contributions are suggested to the Hope Lodge, 4215 Lindell Blvd, St. Louis, Mo. 63108. (Reference: Pat Strader Obituary)
Lung cancer is the leading cause of cancer deaths in Missouri – more than breast, prostate, and colorectal cancers combined. The good news is that annual lung cancer screening (LCS) with low-dose computed tomography (LDCT) allows for lung cancer to be diagnosed at earlier stages than in the past. Despite USPSTF recommendations for LCS with LDCT in high-risk individuals and CMS coverage since 2015, only 5.2% of those eligible have received screening with LDCT in Missouri (American Lung Association, 2019 State of Lung Cancer Report). Studies have shown that lung cancer patients receive treatments at lower rates than other cancer patients, regardless of stage of diagnosis. And despite decades of research into tobacco use treatment, many providers still lack the knowledge of best approaches to assist patients in their attempts to quit smoking. As a family physician, your involvement in risk reduction, screening, and treatment is critical for reducing the burden of lung cancer. Training, resources, and tools can help you address the needs of your patients who are at risk for or living with lung cancer. The LuCa National Training Network at the University of Louisville provides free lung cancer training and materials for family physicians and other healthcare professionals. LuCa’s online course, “Lung Cancer and the Primary Care Provider” is the first of its kind to educate providers on lung cancer care across the continuum, including lung cancer screening, tobacco cessation, shared decision making, treatment advances, patient follow-up, and survivorship care. The comprehensive and innovative online course is videobased, features animated demonstrations, includes three separate lessons, and offers participants up to 2.5 Prescribed continuing medical education credits by the American Academy of Family Physicians. The course was developed with input from family physicians across the United States, as well as lung cancer screening and treatment specialists to help you:
P
Pat’s impact on family medicine will be felt for many years to come. MAFP board members shared their thoughts about her service to the MAFP:
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Pat was a competent and genuine supporter of family medicine. She was a great advocate. She was the one who inspired me to join the Advocacy Commission. Always willing to help and provide extra information. She will always be an integral part of our Academy. I was always so impressed by Pat’s strong, calm dedication to knowing the issues at hand and how best we can use our voice. She was a wonderful lady and I always enjoyed spending time with her and working with her. She was an amazing advocate for Missouri family physicians. She will be missed.
”
She was awesome with her job. We were blessed for the many years of service she gave us. Rest in peace, Pat – you will be missed! 38
MISSOURI FAMILY PHYSICIAN July - September 2020
• Have more success with patients’ tobacco cessation in less time • Follow the latest recommendations for lung cancer screening • Receive appropriate reimbursement for shared decisionmaking discussions • Know how to follow-up on screening results • Be aware of treatment options to answer patients’ initial questions if diagnosed • Collaborate more effectively with treatment specialists • Provide optimal care to your patients during and following cancer treatment Enroll in the free online course today at www.lucatraining. org/course. For more information about LuCa’s course or other services, visit www.lucatraining.org, email lucatraining@louisville. edu, or call 1-844-LUCA-NTN.
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Missouri Academy of Family Physicians 722 West High Street Jefferson City, MO 65101
