Iowa Medicine Winter 2018 by Bobbie Russie

Winter 2018 Vol. 108/1

Legislative Preview Issue ALSO INSIDE: Support IMPAC! Social Determinants of Health 2018 Strategic Partners

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IOWA

EDICINE Journal of the Iowa Medical Society

Winter 2018

Vol. 108/1

CONTENTS IN THIS ISSUE

CONTACT US Iowa Medicine 515 East Locust Street, Suite 400 Des Moines, IA 50309 Phone: (515) 223-1401 or (800) 747-3070 IMS President Joyce Vista-Wayne, MD, DFAPA Executive Editor Michael P. Flesher Managing Editor Bobbie Russie To Advertise Contact Michelle Dekker Phone: (515) 421-4778 Email: mdekker@iowamedical.org Subscriptions Annual Subscription $45 Iowa Medicine, Journal of the Iowa Medical Society (ISSN 0746-8709), is published quarterly by the Iowa Medical Society, 515 East Locust Street, Suite 400, Des Moines, IA 50309. Periodicals postage paid at Des Moines, Iowa and at additional mailing offices. Postmaster: Send address changes to Iowa Medicine, Attention: Crystal Swanson, 515 East Locust Street, Suite 400, Des Moines, IA 50309. Editorial content: The Society is unable to assume responsibility for the accuracy of submitted material. Editorial inquiries should be directed to the Editor, Iowa Medicine, 515 East Locust Street, Suite 400, Des Moines, IA 50309.

12 SOCIAL DETERMINANTS OF HEALTH

Read about the adverse factors affecting health on page 12.

Copyright 2018 Iowa Medical Society. Opinions expressed by authors do not necessarily represent the official policy of the Iowa Medical Society. Iowa Medicine does not assume responsibility for those opinions. Products and services advertised in Iowa Medicine are neither endorsed nor guaranteed by the Iowa Medical Society unless specifically noted. Get Connected Stay up-to-date with IMS on Facebook, Twitter, Instagram, Snapchat, LinkedIn, and YouTube.

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

Iowa Medicine Winter 2018

14 2018 IMS LEGISLATIVE AGENDA

Learn which policy issues IMS will advocate for during the second session of the 87th General Assembly on page 14.

Upcoming Events

22 HEALTHY CHOICES COUNT: THE NEW 5-2-1-0 CAMPAIGN

Learn about the new educational campaign to promote healthy eating and help combat childhood obesity on page 22.

ALSO INSIDE

FEBRUARY 2018 February 8 Physician Burnout and Professional Resiliency Conference February 28 IMS Physician Day on the Hill (PDOTH) APRIL 2018 April 13 Women’s Wellness Event, Carroll April 27–28 IMS Annual Conference

From the CEO........................................................................ 4 President’s Corner.................................................................. 6 Why Should You Care About IMPAC?...................................... 8 AMA 2017 Interim Meeting Report......................................... 10 Social Determinants of Health................................................ 12 Legislative Update................................................................ 14 Legalease........................................................................... 16 Policy Forum 17-3 Results....................................................... 18 IMS Strategic Partnerships in 2018......................................... 20 IMS 2018 Annual Conference................................................ 21 5-2-1-0 Healthy Choices Count Campaign............................... 22 Members News................................................................... 24 DMU Update....................................................................... 26

Membership Renewal Time! Membership renewal notices have been mailed. The IMS Board of Directors and staff appreciate the opportunity to serve you. Your membership allows us to fulfill our strategic plan, which is built upon the fundamental principle of professionalism, placing the physician and your patients at the center of our efforts. All IMS strategies support the IMS Core Purpose: To assure the highest quality health care in Iowa through our role as physician and patient advocate.

Iowa Medicine Winter 2018

FROMTHECEO

WE’RE ALL IN THIS TOGETHER

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

Welcome to 2018! The Iowa Medical Society (IMS) has big plans for 2018 to strengthen our House of Medicine in Iowa and continue to bring value to our members.

While we certainly achieved many legislative and policy successes last year, our 2018 advocacy efforts will focus on strengthening the Iowa behavioral health system, combating opioid abuse and protecting the Medicaid program, just to name a few of our priorities, read more on page 14. Our goal remains assuring the highest quality health care in Iowa through our role as physician and patient advocates. This edition of Iowa Medicine is designed to give you a glimpse of what to expect from IMS in 2018. Within this edition, IMS President, Joyce Vista Wayne, MD, recaps our accomplishments in 2017 and outlines how we will leverage that momentum to expand physician-friendly policies in 2018. She also encourages you to become a member of IMPAC, the largest statewide PAC supporting the interests of physicians, in order to support these efforts (page 6). Kenneth Wayne, MD, IMPAC Chair, addresses the need for physicians to support the Iowa Political Action Committee (IMPAC) and it’s work on behalf of the practice of medicine in Iowa (page 8). We encourage you

Iowa Medicine Winter 2018

Dennis Tibben, with the IMS Center for Physician Advocacy, presents our ambitious legislative agenda for 2018 (page 14). Identifying cases that do and do not fall under the Emergency Medical Treatment and Active Labor Act (EMTALA) can be tricky to say the least. In this issue’s Legalease article, IMS General Counsel, Kate Strickler, JD, LLM, answers common EMTALA questions to help protect you.

to find ways to get involved and help support the cause, like attending Physician Day on the Hill (PDOTH) on February 28. Join fellow IMS members from across Iowa for a day of grassroots advocacy. Educate lawmakers on the issue most important to you, your patients, and practice, while having a voice in the legislative process. Register for this free event by choosing it from the Event tab drop-down menu at www.iowamedical.org.

Congratulations to Des Moines University for being named the number one producer of Family Physicians in the U.S.! The University’s new Dean of the College of Osteopathic Medicine, Bret Rippley, DO, Family Medicine, illustrates how the DMU curriculum focuses on the whole patient, their social network, and the community.

In IMS governance news, Michael Kitchell, MD, AMA delegate, provides a report from the AMA Interim Meeting held in November, including the challenges of decreasing caucus membership numbers (page 10). The results of Policy Forum 17-3 are shared on page 18, along with news about our newest Strategic Partners and benefits to IMS members from these affiliations on page 20.

Mark your calendars and plan to attend upcoming IMS events: Provider Burnout and Professional Resiliency conference on February 8, at the West Des Moines Marriott. This free conference is open to all members of healthcare team. You needn’t be an IMS member to attend this event! Physician Day on the Hill is on February 28, and the IMS Annual Conference, Taking Charge of Change in Medicine — It’s Your Business, will be held on April 27–28, 2018, in Des Moines.

Population health is an area of concern for many physicians and practices. Read the guest column on page 12 from Primary Health Care, Inc., on social determinants of health. Jennifer Groos, MD, Pediatrics, Des Moines, discusses the recently launched 5-2-1-0 statewide initiative on page 22.

As CEO of IMS, I encourage you to support the efforts of your medical society, get involved in the issues you are passionate about, and attend these upcoming events. Thank you for your continued support of IMS and for your membership!

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PRESIDENT’SCORNER

IMS SUCCESSES IN 2017 AND THE PROMISES OF A NEW YEAR By Joyce Vista-Wayne, MD, DFAPA

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

Happy New Year! On behalf of the Iowa Medical Society, I want to thank you for your continued commitment to organized medicine and ensuring that Iowa physicians, residents, and medical students have a strong, unified voice as we head into 2018. The New Year holiday presents an annual opportunity to look back on our accomplishments of the past year and look forward to what is coming in the year ahead. IMS has had much to be proud of in the past year. 2017 represented one of the most successful legislative advocacy years in the 167-year history of the Society, highlighted by the enactment of comprehensive medical liability reform, including a cap on noneconomic damages. For more than 40 years, Iowa physicians have pushed for these reforms, which will lower medical liability premiums, reduce meritless lawsuits, expedite resolution for legitimate cases, and make Iowa more attractive for recruiting the next generation of physicians. The House of Medicine came together as we built the case for these reforms, countered

Iowa Medicine Winter 2018

misinformation from trial attorneys, and celebrated when the governor signed these reforms into law in May. In July, the IMS Board of Directors took another bold step forward in the fight against physician burnout with adoption of the Steenblock Report. This report represents a roadmap for IMS in the years to come as we work to ensure Iowa physicians have access to actionable tools and resources to combat burnout and reclaim joy in practice. The first major event resulting from the Steenblock Report recommendations, a joint physician wellness event with the Quad Cities Medical Society in November, drew more than 100 physicians and spouses and received high marks from many in attendance. I am pleased to see IMS leading in this endeavor as we

look to 2018 with a statewide, multidisciplinary conference scheduled for February 8 in West Des Moines and another regional event tailored to meet the unique needs of women providers scheduled for April 13 in Carroll. Plans are in the works for additional regional events, as well as tools and resources, in the coming months. Physician wellness and professional resiliency will be a focus area during the IMS Annual Conference on April 27–28 in Des Moines. National speakers will provide tools that you can implement immediately within your practice. In September, IMS brought together state and national early disclosure experts for a one-day Communication and Optimal Resolution (Candor) Conference. As reported in our last edition of Iowa Medicine, this conference included representatives from Iowa’s Candor pilot site at Great River Medical Center in West Burlington who shared the on-the-ground perspective of

rolling out a Candor program in their community. IMS has fielded a number of inquiries about the Candor concept since that conference from clinics that are considering development of their own programs. In 2018, we plan to build upon this momentum, taking Candor educational programming and technical assistance on the road to educate more physicians and clinic administrators about the benefits of the concept, as well as the legal protections IMS championed in 2015 and expanded as part of the medical liability reform package in 2017. 2018 promises to be another transformative year for medicine in Iowa and across the country. The Centers for Medicare & Medicaid Services (CMS) is continuing to move forward with implementation of the Quality Payment Program (QPP), Iowa’s Medicaid program is moving forward with great utilization of value-based payment arrangements, and the State is preparing a long-term strategy to sustain ongoing practice transformation efforts after Iowa’s four-year State Innovation Model (SIM) grant expires at the end of 2018. In the face of all this change, IMS will continue to partner with subject-matter experts, as well as state and national leaders, to ensure Iowa physicians have access to

timely, relevant information and resources to navigate the changing healthcare landscape. The Iowa General Assembly convened for what many are expecting to be a short legislative session on January 8 in Des Moines. In this edition of Iowa Medicine, IMS Director of Government Affairs, Dennis Tibben outlines the exciting 2018 IMS Legislative Agenda that was approved by your IMS Board of Directors in December. As a practicing child and adolescent psychiatrist, I’m especially excited to see IMS partnering with the Iowa Hospital Association to lead a large coalition of patient and provider groups, as well as law enforcement, in strengthening our state’s behavioral health system. The proposals put forward by this coalition complement the recommendations of the State’s Complex Service Needs Workgroup and represent a real opportunity to move the needle in our pursuit to ensure Iowans in need have access to the appropriate level of behavioral health services in a timely fashion. This edition of Iowa Medicine also includes a column from the Iowa Medical Political Action Committee (IMPAC) Chair, Ken Wayne, MD. IMPAC serves as the largest statewide political action committee (PAC) representing the interests of the physician community. Despite our significant legislative achievements in 2017, last year saw a dramatic decline in

contributions to IMPAC. As we look to defend our hard-fought victory on medical liability reform, many legislative and gubernatorial candidates have already articulated their goal to repeal these reforms. IMPAC must have the financial resources necessary to defend tort reform and support our legislative champions while also helping to elect even more promedicine candidates to office. If you have not done so already, I urge you to join me in becoming a 2018 IMPAC member today. There is no shortage of activities and opportunities to get involved in 2018. IMS is expanding its federal advocacy in the coming year, restructuring the legislative review process to increase member input, and working to grow the political influence of IMPAC. If you are interested in getting more involved in IMS and helping to make 2018 more successful than 2017, I encourage you to reach out to the IMS staff. They are eager to work with you to find an opportunity that fits your schedule and your area of interest. Together, we will continue to move medicine in Iowa forward in 2018.

Iowa Medicine Winter 2018

IMPACBENEFITS

WHY SHOULD YOU CARE ABOUT IMPAC? By Kenneth S. Wayne, MD, FACP, FCCP

KENNETH S. WAYNE, MD, FACP, FCCP Dr. Wayne serves as chair of the IMPAC Board of Directors.

Physicians in Iowa are at a competitive disadvantage at the capitol. While there are nurses, pharmacists, and other health professionals serving in the Iowa House and Iowa Senate, currently there are no physicians in the Iowa legislature.

We must have champions to fight for issues that are important to the Iowa House of Medicine — issues that relate directly to quality, safety, as well as access of patients to care; issues that directly impact physician compensation, medical liability exposure, and scope of practice. The Iowa Medical Political Action Committee (IMPAC) does this and more. The purpose of IMPAC is to support the election of candidates to the Iowa General Assembly and the Governor’s Office who are committed to public policy that supports Iowa physicians and a strong healthcare delivery system. IMPAC supports promedicine candidates with campaign contributions. Whether you are an employed physician, a member of a medical group, or an independent practitioner, it is in your interest

Iowa Medicine Winter 2018

to follow the work of and provide support to IMPAC. IMS wrote the Candor Statute in 2015 and authored the successful and ground-breaking comprehensive medical liability reform package of 2017. These extraordinary gains that directly benefit you were accomplished through the tireless efforts of IMS professional staff, legislative pressure and activism by members of your IMPAC Board, testimony at innumerable hearings, and direct one-onone lobbying. All that has been accomplished is, however, not vouchsafe. You and I must be ever watchful of the legislative mood and direction. I have oft declared that when the legislature is in session, “physicians must be at the table, or surely we will be on the menu.” We must safeguard

our gains, guard against the everpresent threat of new incursions against medicine, and defend the interests of the patients we serve. What does all this have to do with you? The members of the IMPAC Board are all practicing physicians. We have two unfilled openings on the Board and would invite communication from any who wish to serve. Generally there are one to two meetings per year. Meetings generally last two to three hours and focus on candidate interviews for Iowa state and federal office, guide staff recommendations for legislative contributions, and review financial reports and IMPAC membership. We need your help and engagement. The lobbying organizations for the trial lawyers, the hospitals, and the insurers dwarf our organization in membership and financial support, and frequently are in direct conflict with your and my professional interests. IMS represents some 6,500 Iowa physicians, residents, and medical students. IMPAC, along with our expert team, is the fulcrum upon which rests your profession’s access to legislative activism and advocacy in our state.

Given this relevance and our legacy of organizational success, it is mystifying to me that Iowa physician support of its professional representative body is dwindling both in membership and contributions. In 2017, IMPAC had 68 members (only 0.01 percent of our constituency) and 94 total contributors. Our Candidate Support Fund ended 2017 with $24,698 to roll over to the 2018 election year. This contribution base is dwarfed by organizations in direct opposition to our interests. Please, each and every one of you, look into your conscience; whether independent, academic, partnership, or employed practitioner, and think about the integrity and autonomy of the profession you represent. If we are not going to stand and fight for our noble profession, can we really expect someone else to do it? In May, then-governor Terry Branstad signed the IMS-crafted comprehensive tort reform legislative package into law.

THANK YOU TO OUR 2018 IMPAC MEMBERS (Current as of January 22, 2018)

Platinum Members

(Donors contributing $500 to $749.99) Gene R. Lariviere, MD Tiffani Milless, MD

Douglas W. Martin, MD Mariannette J. Miller-Meeks, MD Stacey K. Neu, MD Noreen E. O'Shea, DO Jennifer L. Palmer, MD Robert R. Shreck, MD Kenneth S. Wayne, MD

Sustaining Members

Friend of Iowa Medicine

(Donors contributing $250 to $499.99) Timothy Daley, MD Thomas C. Evans, MD Steven F. Gordon, MD Jeydith Gutierrez-Perez, MD Shannon Lee Schauer Leveridge, MD

(Donors contributing $100 to $249.99) Cynthia Hoque, DO Erin Casey, MD

(Donors contributing $750.00 or more) Michael A. Romano, MD

Gold Members

General Contributors Lynn Rankin, MD

Iowa Medicine Winter 2018

AMAREPORT

AMA 2017 INTERIM MEETING REPORT A Report from the IMS Delegation By Michael Kitchell, MD

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

The AMA Interim Meeting was held in Honolulu, Hawaii, November 10â&#x20AC;&#x201C;14, and our three delegates, Rob Lee, MD, Vickie Sharp, MD, and Mike Kitchell, MD, were joined by Joyce Vista-Wayne, MD, IMS President, and staff Mike Flesher, Kate Strickler, and Dennis Tibben for a number of meetings and educational sessions.

Iowa, which has three AMA delegates, has been part of the North Central Medical Caucus (NCMC) for many years. The NCMC is made up of the state societies of Iowa, Nebraska (two delegates), South Dakota

(one delegate), North Dakota (one delegate), and Minnesota (five delegates). Wisconsin (five delegates), pulled out of the NCMC last summer because of severe budgetary problems.

The NCMC leaders have had some meetings before and during the Interim Meeting to determine our future goals and course of actions, which have been impacted by the loss of Wisconsin and from our own budgetary concerns. The discussion also involved assessing our ability as a small caucus to influence policy and promote candidates for AMA leadership, compared to some of the larger caucuses such as the Pacific West, which includes all the state societies in the western half of the U.S. One of the possibilities is for NCMC to join a larger caucus such as the PacWest, which has a governance structure that includes four regions â&#x20AC;&#x201D; and NCMC could be a fifth one if we choose to join them. Wisconsin has also been invited to join the PacWest, which it is considering. Some of the administrative costs and personnel of the PacWest are funded by the California Medical Association.

IMS delegates and IMS president attended the AMA Interim Meeting (L to R): Rob Lee, MD, Joyce Vista-Wayne, MD, Vickie Sharp, MD, and Mike Kitchell, MD.

Iowa Medicine Winter 2018

The many aspects of whether to join PacWest or another caucus have been reviewed, and the NCMC leaders are assessing the

advantages and disadvantages of this option versus staying as we are, with or without Wisconsin. We have asked the PacWest for more information, and we will have further discussion at the AMA Annual Meeting in Chicago in June. A final decision will not be made until later with the IMS Board’s oversight. As we do every AMA meeting, reference committees are held to review the numerous policy proposals brought before the AMA House of Delegates (HOD). The five committees heard about 3–5 hours of testimony on numerous resolutions that could establish, change, or reaffirm AMA policy. Our delegates all participated in the reference committee hearings. The results of each committee’s deliberations were then presented to the HOD. At this meeting there was much less controversy than usual,

and the House of Delegates strongly affirmed that we are opposed to any Medicaid caps or block grants, or any work requirements for Medicaid eligibility. The HOD decided to have the AMA seek to ban prescription drug price gouging and let pharmacists tell patients when their co-pay exceeds the drug’s cash price. The AMA will also ask that the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey account for social risk factors. Though there were resolutions to have the AMA advocate for certain changes in policy, such as a single payer system or a public option, the HOD reaffirmed the present policy of advocating for a pluralistic payment system that would give options for both patients and providers.

medicine, the opioid crisis, and current AMA priorities and successes in advocacy. At the Rural Caucus, I gave a presentation on how the Geographic Practice Cost Indexes (GPCIs) have negatively impacted rural health providers and led to a shortage of physicians in rural America. The temporary 1.0 Physician Work (PW) GPCI floor was not renewed prior to its January 1, 2018, expiration. This has resulted in Iowa and many other low GPCI regions taking another Medicare payment cut of up to 2.5 percent. These cuts make it even more difficult for Iowa and other rural states to recruit and retain physicians. Congress continues to work on another temporary two-year 1.0 PW GPCI floor as part of the Medicare extenders package that also includes reauthorization of CHIP funding.

There was also a new AMA policy that would advocate for legislation to provide additional funding to support medical school infrastructure and faculty, increase the capacity for expansion, and provide more clinical clerkships and other education. The House also modified current AMA policy that would advocate for elimination of “cumbersome, confusing, and burdensome requirements” relating to e-pre-scribing of controlled substances.

IMS President Joyce Vista-Wayne, MD, takes notes during a session.

There were a number of educational programs too, for example, physician wellness (burnout), reclaiming joy in

Former IMS Board of Directors Student Member, Anne Langguth, MD, who is now completing her residency in Chicago, stopped to visit the Iowa delegation. Iowa Medicine Winter 2018

POPULATIONHEALTH

SOCIAL DETERMINANTS OF HEALTH By Bery Engebretsen, MD, Chief Medical Officer, and Chris Espersen, MSTH, Independent Contractor, Primary Health Care, Inc.

BERY ENGEBRETSEN, MD

CHRIS ESPERSEN, MSTH

Current Healthcare Landscape and Attention to SDOH Social Determinants of Health (SDOH), often also referred to as the “upstream” causes of poor health, are being increasingly recognized as major contributors to poor health. These are generally poverty-driven factors and include poor nutrition, lack of exercise, unhealthy stress, poor housing, lack of education, discrimination, etc. SDOH has become a popular topic among safety-net providers such as Federally Qualified Health Centers (FQHC), Public Health programs, academia, and even in more traditional and mainstream healthcare organizations, Accountable Care Organizations (ACOs) and Managed Care Organizations (MCOs). Though the name is new, the concept has been around for many decades, its reemergence coinciding with the growing awareness of America’s mushrooming economic inequality, thoroughly detailed in Nobel Laureate Joseph Stiglitz’s 2012 book, The Price of Inequality.

Iowa Medicine Winter 2018

“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.” — Hippocratic Oath

You see a patient, a middleaged woman, MJO, for the third time. She is not doing well with her diabetes; the A1c is going up instead of down, despite increases in her metformin and the addition of other diabetic medications. She says she is following her diet and taking her meds. You think it may be time to start insulin, but she says she will try harder with her diet, just give her more time.

Role of Health Care in SDOH Addressing social determinants can be very challenging and even overwhelming to healthcare providers. What happens if I open that “can of worms”? But even if it is merely for enlightened self-interest, we have a stake and responsibility to identify social determinants. Our role as healthcare providers is not necessarily to resolve these issues, but to make the connections — to connect the health issues to the adverse determinants, and also to establish connections between our healthcare organizations and the proper external agencies that can

provide our patients with needed resources to address SDOH.

Reasons for Integrating If we need reasons to integrate SDOH into our busy healthcare settings, we need look no further than our own sustainability. Many payer programs — Medicare, Medicaid, MCOs, ACOs — are now reimbursing for quality outcomes instead of just quantity of care provided. Accomplishing better outcomes is inherently linked to addressing SDOH. Achieving favorable gains in clinical measures and decreasing cost of care is difficult until these more critical issues that complicate our patients’ health are addressed. We cannot fix nor pay for these problems out of our limited finances. But when we systematically identify the barriers, we are better able to recognize and advocate for the resources. This advocacy is critical for our patients to not only achieve improved health but to achieve improved quality of life, hold a job, and to participate meaningfully in our communities.

It also means fulfilling the oath we took long ago to adequately (and holistically) take care of the sick — before the problems of electronic health records and healthcare transformation were as pressing and maddening.

at staff’s fingertips can save a lot of time. Some insurers/MCOs have care managers that can help manage multiple issues for the patient, especially if they are high utilizers of health services and costing them money.

Integrating SDOH Questions into the Clinical Setting

And high utilizers almost always have adverse SDOH in their lives. First Five in Iowa can do the legwork on sorting out many problems where children are involved. Iowa Legal Aid has programs to help where there are legal ramifications, such as unfair housing or disability. Many patients have the wherewithal to navigate these resources on their own, once they know where to start.

As our patient outcomes and payment structures become increasingly tied to the identification and resolution of SDOH, there are some defined steps providers can take. Talk to the resources who are already doing this work. A number of groups across the country have years of experience in integrating SDOH questions into the clinical settings and have rich resources and toolkits available online. There are also experts here in Iowa. The Iowa Healthcare Collaborative recently conducted a survey of providers and found that a majority of providers believe their patients have social needs related to their health, and a third of providers who answered have experience in this type of work. Even small communities have resources available for many situations.

Conclusion MJO returns for her fourth visit. You recently started having your nurse ask the simple twoquestion screen for depression, the PHQ-2. She answers with a response suggesting depression, your nurse asks if anything is troubling her, and MJO, normally cheerful and upbeat, bursts into tears.

She says she has been living in her car for several months, her husband has kicked her out, she can’t sleep because she is afraid, and the only medications she can afford the copay for are the sleeping pills that allow her to sleep at night. She has known you and your staff for many years, respects you, and has been too embarrassed to tell you what has happened to her. But since her last visit, you have also established a relationship with the local DHS agency. They have resources for temporary housing assistance, and the nurse refers her to them. She also puts a note on the chart suggesting the Iowa Prescription Drug Corporation can get the metformin for her for free. These things take time, it is true, but not necessarily a doctor’s time. And, of course, office staff are already overwhelmed with insurance issues, phone calls, etc. But having the list of resources

Addressing social determinants is challenging. But the first step is easy and as simple as increasing our awareness of these issues (a depression screen is an easy start), followed by learning where the resources lie in our communities. There is also a larger issue behind the scenes. We all know that the U.S. spends far more on health care than any other country. But few know if you add social service spending to healthcare spending, the U.S. falls back to the middle of the pack. Broader awareness of this can lead to creative, efficient ways of addressing the upstream causes of the SDOH. For example, Polk County now has a single number that anyone can call, agency or individual, to access resources for homelessness. Called Centralized Intake, the number is (515) 2481850 (after hours call 211).

Iowa Medicine Winter 2018

LEGISLATIVEUPDATE

LEGISLATIVE UPDATE: 2018 IMS LEGISLATIVE AGENDA By Dennis Tibben

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

At their December 14, 2017, meeting, the IMS Board of Directors voted to accept the recommended 2018 Legislative Agenda put forward by the IMS Committee on Legislation. This legislative session, IMS will pursue:

Strengthening the Behavioral Health System IMS will work with a coalition of provider, patient, and law enforcement organizations to enact reforms to Iowa’s behavioral health system, including Support the recommendations of the State Complex Service Needs Workgroup, including increased bed capacity for patients with complex needs. Pilot sub-acute regional access centers to divert patients in need of behavioral health services and stabilization from the Emergency Room. Reform Iowa’s involuntary commitment process to expedite patient placement at the appropriate level of care and expand physician authority for patient intake and discharge. Establish sustainable funding mechanisms to expand behavioral health services, including blended funding models and commercial insurance telehealth payment parity. These policy priorities were developed with input from the IMS Committee on Law and Ethics; the American College of Emergency

Iowa Medicine Winter 2018

Physicians, Iowa Chapter; and the Iowa Psychiatric Society.

Opioid Abuse In recent years, Iowa physicians have made significant progress in reducing the volume of opioids prescribed in our state and expanding access to the opioid antagonist naloxone, which has resulted in a reduction in the number of prescription opioid overdose deaths in Iowa. Despite this progress, greater efforts are necessary to stem the growing number of illicit opioid overdose deaths and increase access to treatment for Iowans with substance abuse problems.

This year, IMS will support legislation focused on informed prescribing, harm reduction, and reduced barriers to care. This includes improving the accuracy of the records in Iowa’s Prescription Monitoring Program (PMP) by expediting dispensed medication reporting and increasing provider awareness of the new, more functional PMP scheduled to go live in April by giving all prescribers a PMP account at the time of their CSA registration renewal. IMS will support harm-reduction coalition efforts to legalize syringe exchange programs in Iowa, and reduce barriers to contacting authorities in overdose situations by enacting Good Samaritan protections for individuals who call for help, remain on the scene, and fully cooperate with officials.

Protecting the Medicaid Program Iowa’s Medicaid program is in the midst of an unprecedented level of turmoil as managed care organizations exit the program and halt new member enrollment while practices work to correct longstanding credentialing and payment issues. These issues are compounded by the legislature’s decision in 2017 to enact more than $54 million in provider payment cuts in an effort to balance the state budget. As the state again faces budget shortfalls in 2018, IMS will work to ensure that legislators understand the importance of prioritizing Medicaid funding to ensure the long-term sustainability of the program. IMS will fight to protect against further cuts to the program and build the foundation to restore adequate

This includes commercial insurance telehealth payment parity, which will help improve access to care for not only behavioral health services but a full spectrum of physician services in rural communities. IMS will work with provider and patient advocacy organizations to protect against insurer-imposed nonmedical medication switching and to safeguard against arbitrary insurer-imposed caps on opioid prescriptions.

Medicaid funding as the budget stabilizes in future years.

Expanding Physician Workforce Iowa currently ranks 43rd in the nation for the number of physicians per capita. In 14 of the 25 most common medical specialties, we rank 40th or below. As we work to expand the state’s current healthcare system capacity through strategies like increased utilization of telehealth services, IMS will also push for state support to train and recruit more physicians. This includes a continued partnership with the Iowa Academy of Family Physicians to pursue state funding for the Rural Primary Care Loan Repayment Program. Over the past five years, these joint efforts have been successful in securing more than $8 million in state matching funds for this public-private endeavor to recruit primary care physicians to practice in rural Iowa. IMS will support restored funding for the state’s medical residency grant program and expanded flexibility to allow more communities to take advantage of additional loan repayment programs to recruit psychiatrists and other in-demand physician specialties.

Protecting the Practice of Medicine Each year, proposals are put forward to allow non-physicians to expand into the practice of medicine with little or no additional training. In recent years, IMS has seen a number of legislative and regulatory victories in the effort to curb scope expansions that threaten patient safety, including halting efforts to remove statutory restrictions on optometrists’ injections and surgical procedures, freezing the Iowa Board of Physician Assistants’ administrative rules on supervision, and enacting new Iowa Board of Medicine rules to ensure appropriate minimum standards for PA supervision.

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In 2018, IMS expects to see proposals to undo this progress and grant authority for non-physicians to perform services that have traditionally been performed by a physician. IMS will critically examine each proposal to protect patient safety and work to educate policy makers about the implications of these proposals.

Strengthening Public Health IMS will continue to partner with patient and provider organizations to support evidence-based public health initiatives in our state. In recent years, IMS has worked closely with the organizations like the American Cancer Society, the Iowa Dermatological Society, and the American Academy of Pediatrics, Iowa Chapter to educate legislators about the importance of public health imitative, including A $1.50 cigarette tax increase An underage indoor tanning ban Increased access to pediatric obesity resources Raising Iowa’s tobacco use age to 21

On January 1, IMS transitioned to its new legislative review structure, which includes a reformatted Committee on Legislation, designed to expand member input and increase the frequency with which physicians have direct involvement with our legislative advocacy. This new model also includes a designated IMS Policy Liaison at every 100-percent membership clinic in the state to provide rapid, direct input on emerging health policy issues throughout the year. For more information on this new structure or any of the 2018 IMS Legislative Priorities, please contact me at dtibben@iowamedical.org.

Reducing Administrative Burden Burdensome insurer requirements not only restrict access to care, they are also a leading contributor to physician burnout. This year, IMS will continue to push for policy changes to reduce administrative barriers to timely and appropriate care.

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LEGALEASE

GUIDELINES FOR TRANSFERRING PATIENTS UNDER THE EMTALA LAW By Kate Strickler, JD, LLM

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

A federal law dictates when and how a patient may be refused treatment or transferred to another facility.

The law, called the Emergency Medical Treatment and Active Labor Act (EMTALA), was passed in 1986 to protect patients seeking emergency care who might otherwise go without treatment and be left without a remedy. Its focus is on preventing disparate treatment of patients who cannot afford treatment, but it applies to all patients, regardless of whether the patient is eligible for Medicare benefits.

What Does EMTALA Require? EMTALA has three main requirements: 1. A ny person who requests examination or treatment of a medical condition must receive an examination to determine whether an emergency medical condition exists. Emergency departments must post signs to notify patients and

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visitors of their rights to a screening examination and stabilizing treatment. 2. If an emergency medical condition exists, treatment must be provided until the issue is resolved or the patient is stabilized. If the hospital lacks the capacity to stabilize the condition, the hospital must arrange an “appropriate transfer.”

3. Hospitals with specialized capabilities must accept transfers from hospitals lacking that capability.

What Constitutes “Emergency Medical Condition” Under This Law? The law outlines what constitutes an “emergency medical condition.” However, the definition is not especially clear; ultimately, the determination is medical, not legal. The statute says that an “emergency medical condition” is “A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in — placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part; or with respect to a pregnant woman who is having contractions — that there is adequate time

to effect a safe transfer to another hospital before delivery, or that the transfer may pose a threat to the health or safety of the woman or her unborn child.

When Can I Transfer a Patient? Many questions arise regarding when it is appropriate to transfer a patient to another facility. If the patient is stable with no emergency medical conditions, the statute imposes no restrictions on that transfer. However, if the patient is not stable, then he may only be transferred if the transfer is “appropriate.” The statute has six requirements for an “appropriate transfer,” and all six must be met: 1. The patient has been treated at the transferring hospital and is stabilized as far as possible within the limits of its capabilities; 2. The patient needs treatment at the receiving facility and the risks of transferring him are outweighed by the medical benefits; 3. The balance test that determined benefits outweigh the risk as outlined in number two, above, is certified in writing by a physician. However, if a physician is not physically present in the emergency room, the certification can be made by a qualified medical person in consultation with the physician if the physician agrees with the certification and subsequently countersigns it; 4. The receiving hospital has been contacted and has agreed to

accept the transfer, and has the ability to provide the necessary treatment to the patient; 5. The patient is accompanied by copies of his medical records from the transferring hospital; 6. The transfer is made with qualified personnel and transportation equipment as required by the circumstances, including the use of necessary and medically appropriate life support measures during the transfer. In addition to these six requirements, the written certification must also contain an express summary of the risks and benefits upon which it is based, and that the transferring hospital will forward copies of test results that become available after the transfer is made. If the physician who signed the certification in support of an appropriate transfer knew or should have known that the certification was false, then he is personally liable. Finally, the law requires a physician to respond to an emergency situation when he is assigned as the on-call physician. If a physician has violated this provision, the information conveyed by the transferring hospital to the receiving hospital must include the physician’s name and address.

Whom Does EMTALA Apply To? EMTALA applies to hospitals. A hospital that has violated EMTALA can be sued, fined, and have its Medicare provider

agreement revoked by CMS. Penalties may include hospital fines up to $50,000 per violation, physician fines up to $50,000 per violation, and hospitals may be sued for personal injury.

Can I Ask About the Patient’s Ability to Pay? Yes. However, investigating whether a patient can pay must not delay examination or treatment. Additionally, any pre-authorization requirements imposed by an insurer or a managed care organization may not be allowed to prevent or delay the examination or treatment. The physician must not allow issues of payment or authorization for payment to affect his decision regarding whether an emergency medical condition exists or the nature or timing of the treatment needed.

What Are the Requirements for the Hospital Receiving Patient Transferred Under EMTALA? Most of EMTALA’s obligations affect the transferring hospital, but some exist for the receiving hospital as well. The law specifically provides that any hospital with “specialized capabilities or facilities,” such as a burn unit or neonatal intensive care unit, or any hospital that is a “regional referral center” in a rural area may not refuse to accept a patient transfer. If you have questions regarding EMTALA, contact Kate Strickler, IMS General Counsel, at kstrickler@iowamedical.org.

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POLICY FORUM 17-3 RESULTS PHASES

CALL FOR ACTION The official Call for Action period begins seven weeks prior to each scheduled Policy Forum and lasts for two weeks. During this time, members are invited to submit Policy Request Statements (PRSs): brief descriptions of an issue or concern that you are experiencing in your medical practice and request that IMS take some action to help resolve the issue. PRSs may request IMS establish or amend policy, take an official position, seek legislative remedy, or work within respective organizations to bring relief. Members submit a PRS and staff assist with formatting the desired action plan to be considered by the Policy Forum. Members may submit PRSs to forum@ iowamedical.org or by mail to Iowa Medical Society, 515 E. Locust Street, Suite 400, Des Moines, IA 50309, Attn: Policy Request. PRSs can be submitted at any time during the year; however, they will only be discussed at a Policy Forum.

TESTIMONY FORUM

The second phase is the Testimony Forum. PRSs received during the Call for Action period are published online, signaling the opening of the Testimony Forum. Members have two weeks from the opening of the Testimony Forum phase to contribute testimony via members-only discussions on the IMS website or submit feedback privately to forum@iowamedical.org.

POLICY FORUM

The final phase is the Policy Forum meeting. At the meeting, all PRSs and accompanying Testimony Forum comments are addressed by the Policy

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Forum and either accepted, amended, rejected, tabled, or sent to an ad hoc committee for further discussion. All members are invited to attend the Policy Forum to engage in discussion and offer their testimony in support of or in opposition to PRSs under consideration. While Policy Forums must be held at least once a year, they are regularly scheduled to be held once in the spring in concert with the IMS Annual Conference and again in the fall. In addition, special sessions of the Policy Forum may be called as needed.

POLICY FORUM 17-3 RESULTS

PF 17-3 was held at following the IMS Board meeting on December 14 in Des Moines. The following represents the Policy Request Statements considered and the actions taken with regard to each.

PRS 17-3-01 Speaker of the Policy Forum

Submitted by the IMS Board of Directors POLICY REQUEST

An amendment to the IMS bylaws is requested to change the position of Speaker of the Policy Forum from an elected to an appointed position. When the bylaws were amended in 2014 and the House of Delegates was closed, the ex-officio board seat of Speaker of the House of Delegates was changed to Speaker of the Policy Forum.

ACTION TAKEN Adopted PRS

PRS 17-3-02 Filling the At-Large Vacancy Created by Selection of the President-Elect Submitted by the IMS Board of Directors

POLICY REQUEST

Amend the IMS bylaws to specify that only individuals who have been vetted by the Nominating Committee are eligible for appointment to serve out the duration of the at-large term vacated when the President-Elect begins his or her term of office.

ACTION TAKEN Adopted PRS

PRS 17-3-03 IMS Membership for Administrative License Physicians

Submitted by the IMS Board of Directors POLICY REQUEST

Amend the IMS bylaws to allow physicians who have an active administrative medical license to become an active IMS member.

ACTION TAKEN Adopted PRS

PRS 17-3-04 IMS Administrative Membership

Submitted by the IMS Board of Directors POLICY REQUEST

Amend the IMS bylaws to create a new IMS membership category for physicians who are eligible to receive an administrative medical license but have not done so.

ACTION TAKEN Adopted PRS

NEXT POLICY FORUM PF 18-1 CALL FOR ACTION

March 16â&#x20AC;&#x201C;March 23 TESTIMONY FORUM

March 30â&#x20AC;&#x201C;April 13 POLICY FORUM 18-1

April 27 at the IMS Annual Conference, Des Moines

VECTORS & VIEWPOINTS

® IMS EDITION

VECTOR: SMALL CHANGES MAKE A BIG DIFFERENCE

NEW YEARS RESOLUTIONS ROSS POLKING, CFP®, AIF®,MBA® Lead Advisor YOU CAN’T AVOID IT; IT’S COMING, AND THERE’S NOTHING YOU CAN DO ABOUT IT. No, not the fiscal cliff; rather, the annual ritual of making New Year’s resolutions! Our good intentions to make changes that will improve health, relationships, eating habits, etc. often flounder. 80% of all such resolutions, on average, fail by January 20! For those resolving to improve their financial standing in the coming year, we offer the following simple “resolution checklist” for your consideration: RESOLUTION #1: Make sure your investments (including your overall stock/ bond exposure) align with your financial plan. If you don’t have a financial plan, make that resolution #1. RESOLUTION #2: Understand what you own in your investment accounts. Don’t simply assume your advisor is “taking care of things” for you. RESOLUTION #3: Diversify your investments. This doesn’t mean holding a handful of different stock in your portfolio. It means having exposure to multiple asset classes around the world that behave differently from one another.

RESOLUTION #4: Keep costs down. It’s one of the very few things in investing that you can really control. Not sure what, if anything, your investments cost you? Don’t think for one second any of them are free; look at commissions, transaction fees, and expense ratios. Those tend to be common expenses borne by all investors, and often not welldisclosed. RESOLUTION #5: Tune out the noise. “Advice” from television talking heads is not specific to your situation and may have little or no relevance. Screaming newspaper headlines striking fear or advertisements promoting once-in-a-lifetime opportunities are also generally not helpful. Emotions always have a way of clouding our decision-making ability. RESOLUTION #6: Stay the course and resist the urge to “tweak” your current allocation in response to (or in anticipation of) market, economic or political events. Markets factor all this information into prices very rapidly, so there’s a good chance the risk is already priced in by the time you take action. Remember, you’re not the only one out there who’s thinking about these things. Of course,

if your own financial circumstances change, it may be valid to consider changing your allocation in response. RESOLUTION #7: Rebalance your portfolio periodically. This keeps you somewhat close to your intended risk target on a consistent basis. Be conscious of not making insignificant rebalancing changes. Make changes only when you’re meaningfully out of balance so transaction costs don’t eat up return. Following these suggestions will help hold you accountable to yourself. It will also make your likelihood of investment success greater than your likelihood of keeping off those ten pesky pounds you want to lose this holiday season! As we enter another year that promises uncertainty, complexity, challenges and changes in the world of medical professionals, we extend our best wishes for a happy holiday season to you and your family. If a no-obligation second opinion from us would help ensure your success in achieving these financial resolutions, please let us know. We are absolutely committed to the well-being of IMS and its members, and are humbled by the privilege to serve you all.

IT’S NOT LIKE WE ACTUALLY TUCK OUR CLIENTS IN AT NIGHT. But you might feel that way. At Foster Group, it’s our fiduciary responsibility that lets you know you’re truly cared for. As an independent, fee-only firm with an integrated approach to financial planning and investment management, we work hard so you can rest easy. For a complimentary, no-obligation financial Second Opinion, please call 844-437-1103

6601 Westown Parkway, Suite 100 | West Des Moines, Iowa | fostergrp.com/IMS PLEASE NOTE LIMITATIONS: Please see Important Advertising Disclosure Information and the limitations of any ranking/recognitions, at www.fostergrp.com/disclosures. A copy of our current written disclosure statement as set forth on Part 2A of Form ADV is available at www.adviserinfo.sec.gov.

IMS STRATEGIC PARTNERSHIPS IN 2018 By Michelle Dekker, CMP

MICHELLE DEKKER, CMP

members and will serve as an IMS Strategic Partner.

Ms. Dekker is the director of society relations and events for IMS, and serves as the lead for the IMS Program Committee.

IowaMed Insurance is a new agency option in the insurance marketplace for physicians, their families, and employees. This joint venture between the Iowa Medical Society and First Insurance Group, via the Harry A. Koch Company,

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•

In late 2017, the Iowa Medical Society was pleased to announce two new IMS Strategic Partners: the IowaMed Insurance and COPIC. These two new Strategic Partners offer exciting resources for our members.

These expanded areas now include Preferred Partners and Strategic Partners, in addition to IMS Business Affiliates. For a listing of all our Business Affiliates, be sure to visit the Iowa Medical Society website.

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The Iowa Medical Society Business Affiliate Program features a key number of partner organizations for IMS and its membership. The Iowa Medical Society expanded its Business Affiliate Program in late 2017 to recognize organizations and partnerships that provide significant support of the Iowa Medical Society. These organizations and their support create opportunities for continued impact on IMS initiatives and organizational goals.

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will represent nearly 150 carriers providing first-in-class products and services. Iowa physicians are currently accessing these resources but now can purchase them from a partnership that will in turn continue to support physician and patient advocacy, physician wellness, medical education, and public health services. “The Iowa Medical Society Board of Directors felt the timing was ideal to launch such a venture. This opportunity is a way to bring new, customized, and competitive options to our members,” said Michael Flesher, IMS Executive Vice President and CEO. IowaMed Insurance will sell all lines of insurance products, including professional liability insurance, business insurance, employee benefits, health, retirement plans, homeowners and private auto insurance. In addition, the Iowa Medical Society is also pleased to welcome COPIC as the preferred medical professional liability insurance provider for its

During the last year, IMS has worked closely with COPIC on several initiatives, which led to discussions about a potential partnership. In September 2017, the IMS executive committee and board of directors met and unanimously decided to endorse COPIC. “COPIC is nationally recognized for its expertise in patient safety and risk management and has demonstrated a strong commitment to health care in Iowa,” said Joyce Vista-Wayne, MD, DFAPA, President of the Iowa Medical Society. “We are always looking for ways to improve how we support our members, and working with a trusted, proven partner like COPIC is essential to this.” In particular, COPIC has been instrumental in helping IMS work with medical professionals to better understand and utilize Iowa’s Candor law. Candor offers a “communications and optimal resolution” approach to deal with unexpected outcomes that addresses patients’ needs, and COPIC’s experience has offered expert guidance in this area. For more information on the Iowa Medical Society Strategic Partners, or interest in joining the Business Affiliate Program, please contact Michelle Dekker at mdekker@ iowamedical.org or 515-421-4778.

TAKING CHARGE OF CHANGE IN MEDICINE: IT’S YOUR BUSINESS

The 2018 IMS Annual Conference will be held April 27–28 at the Des Moines Marriott Downtown. This year’s conference will strive to empower physicians to be successful, impactful, and an agent of change in Iowa medicine by providing skills necessary to make a change in practice and in the state. The 2018 Annual Conference will provide key takeaways for

physicians and will focus on key initiatives, including wellness, advocacy, leadership, and networking. What to expect at the 2018 IMS Annual Conference: • FREE! Registration for the 2018 IMS Annual Conference will be FREE to all IMS members.

• Sessions will be scheduled in the following topics: end-oflife care, physician wellness, business, and advocacy at the state level. • The IMS Policy Forum will be a featured component of Friday’s agenda. Be sure to check out how to implement change within IMS. • The IMS Annual Conference will have an increased focus on advocacy in Iowa. • Last, but certainly not least, be sure to join us for an evening of celebration on April 27, 2018, at the IMS President’s Reception. Mark your calendars and make plans to attend today! Registration opening soon!

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5-2-1-0 HEALTHY CHOICES COUNT: FIGHTING CHILDHOOD OBESITY By Jennifer Ann Groos, MD, FAAP

JENNIFER ANN GROOS, MD, FAAP Dr. Groos is the IMS Physician Champion for the 5-2-1-0 Healthy Choices Count Campaign. She is a pediatrician who practices in Des Moines.

5-2-1-0! These are numbers you will be seeing more of in the near future. In October, Governor Kim Reynolds announced the 5-2-1-0 Healthy Choices Count campaign.

This is an educational campaign to promote healthy eating and active living for children and families in our state. The campaign promotes the daily recommendations of FIVE servings of fruits and vegetables, TWO hours or less of recreational screen time, ONE hour of physical activity, and ZERO sugary drinks and more water. The campaign is supported by the Iowa Department of Public Health and the Healthiest State Initiative. It is widley known that children with healthy habits learn better, feel better, and have a decreased risk for chronic medical conditions (such as obesity, diabetes, liver disease, and cardiovascular disease). 5-2‑10 is endorsed by the American Academy of Pediatrics and National Head Start Association.

Evidence for Multi-setting Approach The Institute of Medicine has

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identified the importance of using a multi-setting approach to prevent and address the chronic medical condition of obesity. Iowa’s 5-2-1-0 Healthy Choices Count Campaign is modeled after the 5210 Let’s Go! program, developed by and used in Maine for the last 10 years. Maine’s program has resulted in improved healthy behaviors in Maine’s pediatric population and stabilized increasing rates of obesity. Closer to home, the Northeast Iowa Food and Fitness Initiative has been engaged in communities in multi-setting efforts and utilized 5-2-1-0 messaging. Its recently published work has demonstrated significant improvement in student growth parameters in northeast Iowa communities. The United Way of Central Iowa brought the campaign to central Iowa in 2015. After the majority of Iowa counties identified nutrition and physical activity as a major public health

issue in their communities, the Iowa Department of Public Health (IDPH) identified and began promotion of the 5-2-1-0 campaign statewide.

5-2-1-0 Health Care Healthcare providers have an important role to play both inside and beyond clinic walls. 5-2‑1-0 Health Care is a program to provide tools to healthcare providers and their clinic staff in contributing to statewide 5-2-1-0 Healthy Choices Count efforts. These programs are offered at no cost to clinics. Clinics must accomplish all three of the following goals: 1) Connecting with the community by displaying posters in their waiting rooms and exam rooms 2) Accurately weighing and measuring and recording BMIs on patients 3) Having respectful conversations about health behaviors utilizing the Healthy Habits questionnaire at all well-child checks for children ages 2 to 18. If successful in accomplishing all three goals, the clinics are recognized as a 5-2-1-0 Health Care Sites of Distinction. The posters and stickers to endorse the

message are provided to clinics, and an annual survey is required.

in their communities are provided if desired.

Individualized technical support and additional optional trainings on a variety of topics are available through the program. These include topics such as Best Practices for Accurately Weighing and Measuring Pediatric Patients. Behavior change is not easy and addressing topics like BMI and its connection to chronic health conditions can be sensitive and difficult to discuss with patients. To help, additional trainings were developed: Addressing Weight Stigma to Reduce its Impact on Patient Care and Motivational Interviewing and Brief Action Planning to Efficiently and Effectively Engage Patients in Behavior Change.

IMS Leading the Way in Childhood Obesity Prevention and Treatment Efforts in Iowa

Furthermore, note templates and dot phrases to facilitate documentation in the electronic medical records, tools to effectively connect families to community resources, and individualized support to providers who wish to advocate

In 2017, the Iowa Medical Society with support from State Innovation Models Initiative has developed tools for healthcare providers wishing to provide evidence-based care to their pediatric patients with obesity. Last spring the Iowa Clinician’s Guide to Prevention, Assessment, and Treatment of Childhood Obesity was developed by the IAAP Committee on Obesity, pediatric subspecialists in central Iowa and at the University of Iowa, and the Iowa Medical Society, and was endorsed by the Iowa Department of Public health and the Iowa Academy of Family Physicians. Downloadable versions of the guide are available on the IMS Childhood Obesity Resource Page (www .iowamedical.org). As mentioned above, Iowa Medical Society is supporting a

statewide pilot of 5-2-1-0 Health care. In the next six months, the program will be offered to the four IDPH-funded sites as well as a few other communities. Sites will be offered program materials and in-person and virtual technical support. If your clinic is interested in becoming a 5-2-1‑0 Health registered site, please contact Becca Kritenbrink (bkritenbrink@iowamedical.org) at IMS.

5-2-1-0 Health Care Fills Needs Identified by Iowa Providers If you would like more information about how you can be a part of 5-2-1-0 efforts or would like other resources to support care for pediatric patients with obesity, please contact Dr. Jennifer Groos at Jennifer.groos@unitypoint.org.

Mark your calendars and join us for the following resiliency events: February 8: Provider Burnout and Professional Resiliency Conference, West Des Moines April 13: Women’s Wellness Event, Carroll April 27–28: IMS Annual Conference, Des Moines Stay tuned for more wellness outreach events in 2018 coming to a city near you!

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WELCOME NEW IMS MEMBERS

(October 1 to December 31, 2017)

Isabella Ahanogbe, MD, Family Medicine, Manning Regional Healthcare Clinic, Manning

Lovkesh Arora, MD, Anesthesiology, UIHC – Anesthesia, Iowa City

Steven Baskerville, MD, Family Medicine, Avera Medical Group – Lakes Family Practice, Spirit Lake

Vijay Aluri,* MD, Rheumatology, Physicians’ Clinic of Iowa – Rheumatology, Cedar Rapids

Mahi Ashwath, MD, Cardiovascular Disease, UIHC – Internal Medicine – Cardiology, Iowa City

Chandramohan Batra, MD, Family Medicine, Primary Health Care at Mercy, Des Moines

Paulino Alvarez, MD, Cardiovascular Disease, UIHC – Internal Medicine – Cardiology, Iowa City

Thomas Baer, MD, Family Medicine, Methodist Physicians Clinic – Glenwood, Glenwood

Adam Bell, MD, Pathology, Pathology Associates of Central Iowa – Mercy, Des Moines

Allan Andersen, MD, Psychiatry, UIHC – Psychiatry, Iowa City,

Lisa Banitt, MD, OB/GYN, Planned Parenthood of the Heartland Inc, Ames

Michael Berry, MD, Orthopedic Surgery, ORA Orthopedics, Bettendorf

LoriAnne Andersen, MD, Family Medicine, Sioux Center Health – Medical Clinic Avera, Sioux Center

Bradley Beer, MD, Family Medicine, MercyCare Blairs Ferry, Hiawatha

Matthew Andres, DO, Pathology, Pathology Associates of Central Iowa, Des Moines

Nicole Barbee, MD, Family Medicine, Gundersen Waukon Clinic, Waukon

Brittany Bettendorf, MD, Rheumatology, UIHC – Internal Medicine – Arthritis and Rheumatology, Iowa City

Sarah Arnone, DO, Family Medicine, Grand River Medical Group – Family Practice, Dubuque

Barbara Barnell, DO, Family Medicine, Genesis Health Group – Davenport Clinic, Davenport

Sharathkumar Bhagavathi, MD, Pathology, UIHC – Pathology, Iowa City

Sharon Bertroche, MD, Family Medicine, Primary Health Care at Mercy, Des Moines

Frank Bittner, DO, Neurology, UIHC – Neurology, Iowa City Shira Black, DO, Anesthesiology, Anesthesia & Analgesia PC, Davenport

MEMBERS IN THE NEWS MEMBERS IN THE NEWS (October 2017 to December 2017) Adam Roise, MD, MPH, FAAPH, Family Medicine, Waterloo, has achieved the distinction of Fellow with the AAFP. Andrew Pieper, MD, PhD, Psychiatry, Iowa City, featured in an article on Alzheimer’s disease study. Bhata Kumar, MD, Internal Medicine, Iowa City, featured in Medscape article regarding rheumatoid arthritis study. Bret Ripley, DO, Family Medicine, Des Moines, received the Iowa Osteopathtic Medical Association Physician of the Year. Chad McCambridge, MD, Family Medicine, Mason City, named Medical Educator of the Year.

Timothy Brown, MD, Orthopaedic Surgery, UIHC – Orthopaedic Surgery, Iowa City Alan Braun, MD, Rhematology, Iowa Arthritis & Osteoporosis Center, Urbandale Erin Casey, MD, Internal Medicine, UnityPoint Clinic Hospitalists – Cedar Rapids, Cedar Rapids Roberto Castro, MD, Internal Medicine, Keokuk County Medical Clinic, Sigourney

Nandakumar Narayanan, MD, Neurology, Iowa City, discusses Parkinson’s disease study in Medical Press article.

William Ching, MD, PhD, FAAP, Pediatrics, Ching Pediatrics, Ltd, Coralville

Stephen Russell, MD, Ophthalmology, Iowa City, presented research on Gene Therapy Improved Visions for Patients with Leber Congenital Amaurosis at the AAO Meeting.

Robert Clemens, MD, Family Medicine, Sioux Center Health – Medical Clinic Avera, Sioux Center

IN MEMORIAM

Melisa Coaker, MD, Internal Medicine, CIC Associates Mercy Sleep Center, Clive

Jay Moeller, MD, OB/GYN, 91, of Peosta passed away on October 10, 2017.

Nathan Blair, MD, Anesthesiology, UIHC – Anesthesia, Iowa City

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NEW MEMBERS CONT. Dennis Colby, DO, Family Medicine, Iowa Specialty Hospital – Belmond Clinic, Belmond

Scott Geisler, MD, Neurology, Physicians’ Clinic of Iowa – Neurology, Cedar Rapids

Shiny Kunjummen, MD, Pediatrics, Grand River Medical Group – Pediatrics, Dubuque

Regan Cone, DO*, Family Medicine, Genesis Health Group – Davenport Clinic, Davenport,

Becki Goldberg-Kahn, MD, Pathology, Methodist Jennie Edmundson Hospital, Council Bluffs

Cassandra Lange, MD, FAAOS, Orthopedic Surgery, Physicians’ Clinic of Iowa – Orthopaedics, Cedar Rapids,

Edward Connolly, MD, Orthopedic Surgery, ORA Orthopedics, Bettendorf

Tara Graff, DO, Internal Medicine, Medical Oncology & Hematology Associates – Mercy, Des Moines

Chong Lee, MD, Thoracic Surgery, Mercy Cardiothoracic & Vascular Clinic, Cedar Rapids

Suleman Hussain, MD, Orthopedic Surgery, ORA Orthopedics, Bettendorf

Hasmig Link, DO, Family Medicine, Broadlawns, Des Moines

Waqas Hussain, MD, Orthopedic Surgery, ORA Orthopedics, Bettendorf

Myles Luszczyk, DO, Orthopedic Surgery, ORA Orthopedics, Bettendorf

Ryan Coppola, DO, Family Medicine, Iowa Specialty Hospital – Belmond Clinic, Belmond

John Hoyt, DO, Family Medicine, Greater Regional Medical Clinics, Creston

Laurie McCormick, MD, Iowa City

Claudia Corwin, MD, Pulmonology, UIHC – Pulmonary & Critical Care, University of Iowa Hospitals and Clinics, Iowa City

Daniel Irwin, MD, Family Medicine, Family Medicine Center – Sioux City, Sioux City

Teresa Coon, MD, Family Medicine, Grinnell Family Care PC, Grinnell Chance Coppola, DO, Family Medicine, Iowa Specialty Hospital – Belmond Clinic, Belmond

Clinton Crowder, MD, Pathology, Pathology Associates of Central Iowa, Des Moines Clinton Cummings, DO, Family Medicine, Regional Family Health, Manchester Renee Diamond, MD, Family Medicine, Clarion Clinic, Clarion Sunnah Doesken, MD, Family Medicine, Family Medicine Center – Sioux City, Sioux City Ryan Dowden, MD, Emergency Medicine, East Central Iowa Acute Care, Cedar Rapids

Susan Jacobi, MD, Rhematology, Iowa Arthritis & Osteoporosis Center, Urbandale Gregory Janda, MD, Urology, Physicians’ Clinic of Iowa – Urology, Cedar Rapids Bharat Jenigiri, MD, Oncology/ Hematology, Physicians’ Clinic of Iowa – Oncology/Hematology, Cedar Rapids Michael Kalkhoff, MD**, Family Medicine, Avera Medical Group – Lakes Family Practice, Spirit Lake Swetha Kandula, MD, Pediatrics, Community Health Care, Davenport

Cara Drew, MD, Family Medicine, Family Medicine Center – Sioux City, Sioux City

Dennis Klein, MD, Pathology, Iowa Office of the State Medical Examiner, Ankeny

Joseph Eaton, DO, Pathology, Pathology Associates of Central Iowa, Des Moines

Jason Koelewyn, MD, Family Medicine, Sioux Center Health – Medical Clinic Avera, Sioux Center

Scott Ekroth, MD, Orthopedic Surgery, Physicians’ Clinic of Iowa – Orthopaedics, Cedar Rapids

Avina Kolareth, MD, Pathology, Pathology Associates of Central Iowa, Des Moines

Jose Figueroa, DO, Physical Medicine and Rehabilitation, Des Moines University Clinic, Des Moines

Bethel Kopp, MD, Internal Medicine, CHI Health Clinic Family Medicine/Internal Medicine – Corning, Corning

Garrett Fleming, DO, General Surgery, Medical Associates Clinic – Surgery, Dubuque

Michael McKenna, MD, Family Medicine, Tri-State Family Practice, Dubuque Jill Meadows, MD, OB/GYN, Planned Parenthood of the Heartland Inc, Des Moines Holly Melahoures, DO, Internal Medicine, CareMore Care Center, Des Moines Joseph Mitros, MD, Pathology, Pathology Associates of Central Iowa – Mercy, Des Moines Roscoe Morton, MD, FACP, Oncology, Medical Oncology & Hematology Associates – Mercy, Des Moines Santiago Moscoso Martinez, MD, Oncology/Hematology, June E. Nylen Cancer Center, Sioux City, Eden Murad, DO, Family Medicine, Primary Health Care at Mercy, Des Moines Ronald Oberfoell, DO, Anesthesiology, Dubuque Anesthesia Services PC, Dubuque Carolyn Pease, MD, Pathology, Pathology Associates of Central Iowa, Des Moines Travis Petree, MD, Diagnosist Radiology, Radiologists of North Iowa PC, Mason City Andrew Pick, DO, Orthopedic Surgery, NW Iowa Bone Joint & Sports Surgeons, Spencer

Iowa Medicine Winter 2018

NEW MEMBERS CONT. Kunatum Prasidthrathsint, MD, Infectious Diseases, UIHC – Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City Cheryl Quinn, DO, Family Medicine, Keokuk County Medical Clinic, Sigourney Vijay Rajendran, MD, Cardiovascular Disease, Cardiovascular Medicine PC, Davenport

Tori Smith, DO, FAAP, Pediatrics, Mercy Pediatric Clinic, Coralville Jefrey Start, DO, Family Medicine, CIC Associates Mercy Sleep Center, Clive Julie Stecher, MD, FAAP, Pediatrics, Genesis Health Group – Bettendorf Pediatrics, Bettendorf

Yvonne Rayborn, MD, Family Medicine, Sioux Center Health – Medical Clinic Avera, Sioux Center

Mark Stelzer, MD, General Surgery, Floyd Valley Hospital – Gen Surgery & Orthopedics, Le Mars

Michael Reed, MD, Otolaryngology, ENT Medical Services PC, Iowa City

Jay Strittholt, MD, Orthopedic Surgery, Floyd Valley Hospital – Gen Surgery & Orthopedics, Le Mars

Scott Rens, MD, Family Medicine, Hull Medical Clinic, Hull

Matthew Smith, MD, Family Medicine, Matthew Smith MD, Waterloo

Bret Ripley, DO, Des Moines, Family Medicine, Des Moines University Clinic

Joshua Stubblefield, DO, Family Medicine, UnityPoint Health – Marengo Memorial Hospital – Emergency, Marengo

Ryan Romano, DO, Pathology, Pathology Associates of Central Iowa, Des Moines

Gary Swenson, MD, Diagnostic Radiology, Radiologists of North Iowa PC, Mason City

Jeffrey Roske, DO, Family Medicine, CIC Associates Mercy Sleep Center, Clive

Maureen Tacke, DO, Family Medicine, Primary Health Care at Mercy, Carlisle

Michael Roxas, MD, Internal Medicine, Red Oak Internal Medicine, Red Oak

Joseph Tansey, MD, Orthopedic Surgery, Physicians & Clinics of HCHC, Mount Pleasant

Amy Schantzen, DO**, Family Medicine, Kossuth Regional Health Center Clinic, Algona

Michelle Tansey, MD, General Surgery, Physicians & Clinics of HCHC, Mount Pleasant

John Schantzen, DO**, Family Medicine, Kossuth Regional Health Center Clinic, Algona

Ryan Taylor, DO, Physical Medicine and Rehabilitation, Genesis Pain & Spine Center – Bettendorf, Bettendorf

Christian Schultheis, MD, FACP, Hematology, Medical Oncology & Hematology Associates – Mercy, Des Moines

Michael Telisak, MD, Otolaryngology, Physicians’ Clinic of Iowa – ENT, Cedar Rapids

Bradley Scott, DO, Orthopedic Surgery, Haas Medical Office Plaza, Ottumwa

Jon Thomas, MD, Family Medicine, CHI Health Clinic Family Medicine/ Pediatrics – West Broadway, Council Bluffs

Jay Seligman, DO, General Surgery, Boone County Hospital – General Surgery, Boone

Craig Thompson, DO, Family Medicine, Regional Family Health, Manchester

Todd Shover, DO, Family Medicine, Waverly Health Center – Emergency, Waverly

Jean Thomsen, MD, Pathology, Methodist Jennie Edmundson Hospital – Pathology, Council Bluffs

Iowa Medicine Winter 2018

Tri Tran, MD, Anesthesiology, Bluffs Pain Management, Council Bluffs Richard Unger, DO, General Surgery, Regional Family Health, Manchester Jamie Vitamvas, MD, Family Medicine, Hull Medical Clinic, Hull Thomas VonGillern, MD, Orthopedic Surgery, ORA Orthopedics, Bettendorf Ahmad Wehbe, MD, Oncology, Medical Oncology & Hematology Associates – Mercy, Des Moines Lucas Wendel, MD, Opthalmology, Eye Physicians & Surgeons LLP, Iowa City Amanda Wendel, MD, Dermatology, Iowa City Dermatology, Iowa City Justin Wikle, MD, Iowa City, Anesthesiology, UIHC – Anesthesia Amy Wingert, MD, Family Medicine, Sanford Clinic, Sheldon James Wyatt, MD, OB/GYN, Obstetrical Gynecological Specialists PC, Red Oak Shawn Wynn, MD, Orthopedic Surgery, ORA Orthopedics, Bettendorf * Former Resident Member **Former Student Members

HAVE NEWS TO SHARE? IMS welcomes news related to our members. Please send information to Kara Bylund kbylund@ iowamedical.org

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THANK YOU! A SPECIAL THANK YOU TO OUR MEMBERS WHO ARE “ALL IN” IN 2018 100 percent of physicians in the following groups have joined the Iowa Medical Society in 2018. We appreciate your support and commitment!

LARGE GROUPS Associated Anesthesiologists, PC

Iowa Heart Center

Blank Children’s Hospital

McFarland Clinic

Covenant Clinic

Medical Associates of Clinton

Family Health Care of Siouxland

Medical Center Anesthesiologists, PC

Grand River Medical Group

Radiology Consultants of Iowa

The Iowa Clinic

University of Iowa Physicians

SMALL GROUPS Amana Family Practice Clinic Avera Medical Group - Spirit Lake Medical Center Black Hawk Grundy Mental Health Center Boone County Hospital - General Surgery Burlington Area Family Practice Center Burlington ENT Clinic Burlington Pediatric Association PC CareMore Care Center Charles City Family Health Center Cherokee Regional Clinics ChildServe CIC Associates Mercy Sleep Center Clarion Clinic Community Memorial Hospital Clinic Cornerstone Family Practice Cresco Medical Clinic

Cross Medical Laboratories LLP Davenport Surgical Group PC Dermatology & Dermatologic Surgery Center PC Des Moines Eye Surgeons Doran Clinic for Women Dubuque ENT Head & Neck Surgery PC Dubuque Obstetrics & Gynecology PC Dubuque Surgery PC ENT Medical Services PC Family Medicine Center - Sioux City Family Medicine, LLP Family Practice Clinic - Emmetsburg Floyd Valley Hospital - Gen Surgery & Orthopedics Fox Eye Laser & Cosmetic Institute PC Franklin Medical Center Fuerste Eye Clinic

Genesis Health Group - Bettendorf Pediatrics Genesis Pulmonary Associates Genesis Quad Cities Family Medicine Residency Faculty Great River Urology Great River Women’s Health Grinnell Family Care PC The Group - OB/GYN Specialists PC Gundersen Palmer Lutheran Hospital and Clinic West Union Guthrie Family Medicine Center Haas Medical Office Plaza Hall Radiation Center Heartland Dermatology Heartland Oncology Hematology Hull Medical Clinic Iowa Cancer Specialists PC Iowa City Dermatology Iowa Eye Center Iowa Retina Consultants Iowa Specialty Hospital - Belmond Clinic Jones Eye Clinic June E Nylen Cancer Center Kossuth Regional Health Center Clinic Mahaska Health Partnership - General Surgery Manning Regional Healthcare Clinic Mason City Clinic - Plastics & Reconstructive Surgery Medical Clinic PC Medical Oncology & Hematology Associates-Mercy Medical Oncology & Hematology Associates-Stoddard Medix Occupational Health Services Mercy Children’s Hospital & Clinics - Hospitalists Mercy Clinics Internal Medicine West Mercy Ear, Nose and Throat Clinic - Clive Mercy East Pediatric Clinic - Pleasant Hill Mercy Johnston Medical Clinic Mercy Medical Services - Breast Care Mercy Neurosurgery Mercy North Pediatric Clinic - Ankeny Mercy Plastic Surgery Mercy Prairie Trail Family Medicine Mercy Ruan Neurology Clinic Mercy Surgical Affiliates Mercy Transplant Center Mercy Trauma Services Mercy Urbandale Aurora Medical Clinic Mercy West Pediatric Clinic Methodist Jennie Edmundson Hospital - Pathology

Methodist Physicians Clinic - Glenwood Mid Iowa Fertility PC Midwest Radiology and Imaging Mitchell County Regional Health Center - Osage Clinic Mount Ayr Medical Clinic Myrtue Medical Center - Harlan Clinic NE Iowa Family Practice Center North Iowa Eye Clinic PC NW Iowa Bone Joint & Sports Surgeons NW Iowa Bone Joint & Sports Surgeons NW Surgery OB/GYN Associates PC Oncology Associates at Hall-Perrine Cancer Center Orthopaedic Specialists PC Orthopaedics PC Ottumwa Anesthesiologists PC Pathology Associates Pathology Associates of Central Iowa PathSource Diagnostics LLC Pediatric & Adult Allergy PC Pediatric Associates Ottumwa Physicians & Clinics of HCHC Physicians’ Clinic of Iowa - Oncology/ Hematology Physicians’ Clinic of Iowa - Rheumatology Prairie Pediatrics & Adolescent Clinic PC - Morningside on Glenn Prairie Pediatrics & Adolescent Clinic PC - Northside on Pierce Radiologic Medical Services PC Red Oak Internal Medicine Regional Family Health Rheumatology Associates PC River Hills Pediatric Clinic Sioux Center Health - Medical Clinic Avera Siouxland Medical Education Foundation Faculty Siouxland Urology Associates PC Story Medical Clinic - Nevada UnityPoint Clinic Family Medicine - Ankeny at Prairie Trail UnityPoint Clinic Family Medicine - Huxley UnityPoint Clinic Family Medicine - Physical Therapy UnityPoint Clinic Family Medicine - Sergeant Bluff UnityPoint Clinic Internal Medicine - Ankeny at Prairie Trail UnityPoint Clinic OB/GYN - Utica Ridge Road UnityPoint Clinic Surgery - Bettendorf UnityPoint Health Finley Hospital Wound Healing & Hyperbaric Center Waterford Family Medicine Waverly Health Center - Shell Rock Clinic

IOWA MEDICAL SOCIETY Large Groups consist of 20 or more physicians, Small Groups consist of 2-19 physicians. Current as of January 23, 2018

DMUUPDATE

DMU AND OUR MISSION By Bret D. Ripley, DO

appropriate board tests for a DO in all 50 states in the U.S. DMU-COM has maintained a pass rate above the national average for the last five years (see figures below).

BRET D. RIPLEY, DO Bret D. Ripley, DO, is the Dean of the College of Osteopathic Medicine at Des Moines University.

The last 10 years have been a time of change in the world and in health care. New ideas are taking hold, and old ideas are being replaced. The Des Moines University College of Osteopathic Medicine (DMUCOM) has worked to adapt to the rapid pace of change and has been successful in continuing to produce the osteopathic physicians that the world needs to help improve our well-being in the changing healthcare landscape. To quote Andrew Taylor Still, MD, DO, in Philosophy of Osteopathy, “[Finding] health should be the object of the doctor. Anyone can find disease.” Before I launch into finding health, however, I would like to provide evidence for my assertion that we have been successful in continuing to produce the osteopathic physicians that the world needs. One measure of the physicians the world needs is the primary

Year of Graduation COMLEX Level 1 first-time pass rate / (National Average)

Iowa Medicine Winter 2018

care to specialty care ratio. While I will not be able to define an exact number, the experts agree that somewhere between 40 percent and 75 percent of physicians should care for the whole person and pay attention to their social network. DMU-COM’s success in this area recently become a national news item when the American Academy of Family Medicine Journal (American Family Physician) recognized DMU-COM as the number one producer of Family Physicians in the United States. Another measure of physician quality is the national medical board test series. Osteopathic physicians are certified by the COMLEX series of board tests, which are recognized as the

Looking at only Level 1 of the boards could be taken out of context; so I want to assure you that our pass rates are excellent and above the national average across the four tests that comprise COMLEX and lead to DO certification in the United States. Please do check out our outcomes web page if you need more clarification. (www .dmu.edu/com/outcomes/) So I can produce tangible national evidence for producing a high proportion of family physicians and for the quality of the education of our students. To me, the final piece of producing the osteopathic physicians that the world needs to help improve our well-being in the changing healthcare landscape relates to community and compassion. It is the sense of community in our students and faculty, and our students’ and faculty’s true caring for one another, that moves DMU-COM from one of the best

2014

2015

2016

2017

2018

2019

93.4/ (90.6)

95.3/ (92.0)

97.6/ (93.9)

97.7/ (92.3)

95.7/ (92.7)

99.6/ (97.1)

osteopathic schools in the country to the best osteopathic school in the country. Of course, sense of community and compassion are harder to define and measure than National Board scores. As evidence of our caring and community, I want to give a pair of concrete examples. I think everyone who has trained as a physician has heard the apocryphal story about a dean’s introductory words to his incoming class of students, “Look to your right, look to your left; one of you won’t be here by the end of the year.” This is not the way we see our students here at Des Moines University, College of Osteopathic Medicine. We graduate greater than 95 percent of our students, based on the first-day-of-class student enrollment. We maintain an extensive network of student support services to help in our mission of graduating the students

who join us in our class each year. In a very real sense, these students are part of our extended DMUCOM family. And their success in becoming the graduates, that I am so proud of, is mine and every faculty and staff member’s true measure of our success as well. One example of our student support is our new Foundations of Physicianship Course. Foundations of Physicianship is designed around a longitudinal small group model that builds resilience and community among our students while it introduces them to the key elements of caring and professionalism that are the foundation of a successful physician’s career. Students enter medical school to become practicing physicians. But to practice they must have at least one year of postgraduate education. Starting with J.D. Polk, DO, and continuing to be developed and improved since Dr. Polk left,

the administrative branch of DMU-COM has instituted a host of measures to help our students successfully match to a residency of their choice. Our effort starts with information in the first year as to what qualifications each type of residency is looking for and culminates with the whole senior staff devoting the week of Spring Break to helping our last few unmatched students match and successfully find residencies. There are countless other instances in our educational process where we mirror community and caring to and for our students. From an opendoor policy for our professors to reducing the stigma of seeing our counselors to ongoing advisor education, we strive to develop true community and demonstrate true caring for our faculty and for our students. It is the caring and community that sets Des Moines University apart from all other top-notch osteopathic medical schools. It is the caring, community, and osteopathic distinctiveness that prepares our students to find health in their patients instead of focusing on disease. As the new Dean, I plan to continue to build on DMU-COM’s strong foundations of caring and excellent teaching to continue to prepare our students to find and encourage health in their patients and their community.

Tom Benzoni, DO, Emergency Medicine, instructs students on the use of an ultrasound system.

Iowa Medicine Winter 2018

PHYSICIAN DAY HILL ON THE

February 28, 2018

#PDOTH

WEAR YOUR

WHITE COAT & STAND OUT

IN THE CROWD

Decisions made by Iowaâ&#x20AC;&#x2122;s General Assembly have an impact every day on physicians, patients, and the practice of medicine in our state. To educate lawmakers and ensure physicians have a voice in the legislative process, we invite you to join your colleagues from across Iowa for this vital day of grassroots advocacy.

JOIN YOUR FELLOW PHYSICIANS, RESIDENTS & MEDICAL STUDENTS

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