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Fall 2017 Vol. 107/4

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IOWA

EDICINE Journal of the Iowa Medical Society

Fall 2017

Vol. 107/4

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.

6 CANDOR CONFERENCE

Read about IMS’ Candor Conference beginning on page 6.

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.

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

ON THE COVER The first Candor Conference was held in September. This issue of Iowa Medicine focuses on the event. IMS CORE PURPOSE To assure the highest quality health care in Iowa through our role as physician and patient advocate.

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Iowa Medicine Fall 2017

19 MEDICAL STUDENTS SERVE IN INDIA

FRANK JARECZEK, PHD CANDIDATE

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

Seven University of Iowa Carver College of Medicine M4 students traveled in August to serve as clinicians in a remote area of India on page 19.


Upcoming Events NOVEMBER November 30 IMS CME Provider Quarterly Call DECEMBER December 14 IMS Board of Directors Meeting

32 SPOTLIGHT: BLANK CHILDREN’S HOSPITAL FOSTER CARE CLINIC

Blank Hospital’s Foster Care Clinic serves a unique population with special healthcare needs on page 32.

FEBRUARY 2018 February 8 Physician Burnout and Professional Resiliency Conference February 28 IMS Physician Day on the Hill (PDOTH) APRIL 2018 April 27–28 IMS Annual Conference

ALSO INSIDE From the CEO........................................................................ 4 President’s Corner.................................................................. 6 Candor Conference................................................................ 8 Legalese............................................................................. 10 Iowa’s Candor Law.............................................................. 12 Legislative Update................................................................ 14 Policy Forum Results.............................................................. 16 IMS Foundation Sends Students to India.................................. 19 UI Health Care Leading Change............................................ 24 Members News................................................................... 26 Spotlight: Blank Hospital’s Foster Care Clinic........................... 32

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.

UI Update........................................................................... 35

Iowa Medicine Fall 2017

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FROMTHECEO

WE’RE ALL IN THIS TOGETHER

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

As we enter into the holiday season with traditions of giving thanks, sharing time with family and friends, and counting our many blessings, I want to personally welcome you to this fall edition of Iowa Medicine. The end of the year is a time of reflection on what we’ve accomplished throughout the year, both personally and professionally at Iowa Medical Society (IMS). Since joining the organization, I have enjoyed meeting with IMS members and working closely with our Board of Directors, Executive Committee, committee members, and staff in charting the course for IMS to achieve new levels of success. IMS staff and I have spent the past few months traveling across the state meeting with members, potential members, county medical society leaders and staff, executives of health systems, insurance companies, corporate partners, state officials, and clinic and practice administrators. We’ve gained tremendous feedback on the key issues impacting physicians and clinic administrators on a day-today basis and the challenges you face delivering and improving health care in Iowa. And we’re just getting started! I’m inspired by your universal commitment to providing quality health care, access to affordable care, and the importance you place on the

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Iowa Medicine Fall 2017

patient-physician relationship. We’re All in This Together is the theme of our annual membership drive. In order to elevate your voice at the State Capitol and the U.S. Capitol, we’ll need to work together and leverage our collective ranks regardless of specialty, practice, or county affiliation. You can read more about our cross-state travels on page 34.

On the IMS Front As many of you know, IMS succeeded this year in getting the most sweeping tort reform legislation passed in a generation. One of the key elements of this was expanding the IMS 2015 Candor law. The first Candor conference was held in September in Des Moines. This issue of Iowa Medicine focuses largely on Candor, Iowa’s early disclosure and resolution law. IMS President, Joyce Vista-Wayne, MD, weighs in on how this law is changing how healthcare practices handle adverse outcomes on page 6. A general overview of what transpired at the Candor Conference is featured on page 8, with more in-depth articles following. IMS

General Council, Kate Strickler, JD, LLM, who was a vital proponent of the law and helped coordinate the conference, explains the basics about the Candor law on page 10. Experts from COPIC, whose foundation grant made the conference possible, dive deeper into what communication and resolution programs involve on page 12. Dennis Tibben, with the IMS Center for Physician Advocacy, explains how Candor came about and how IMS led the way to establish the law on page 14. Concerning IMS business, our September board meeting held the Policy Forum 17-2. Results of issues discussed at the meeting appear on page 16.

New Partnerships In recent weeks, IMS has launched two innovative and exciting Business Affiliate Strategic Partnerships. Over the past year, IMS has partnered with COPIC on a number of patient safety (Candor-type) programs. We’ve recently expanded our relationship with COPIC, and they are now our endorsed provider of professional liability insurance for IMS members. Effective January 1, 2018, physicians, physicians’ families, and employees will have a new option when they need any type of insurance coverage. IMS has partnered with the Harry A. Koch Co. to create a new agency: The Iowa Medical Society Insurance Group (IMSIG). The new company will offer unique insurance products, including property and casualty, employee benefits, personal lines, and financial services that will be competitively priced statewide.


IMS Foundation In the spirit of giving, and in giving back, read about the seven medical students from the University of Iowa’s Carver College of Medicine, who traveled to remote areas of the Indo-Tibetan borderlands to treat isolated villagers. Their stories are incredibly inspiring and begin on page 19. This expedition was supported in part by the IMS Foundation, just one of the many ways the foundation fulfills its mission: To inspire, facilitate, and expand the philanthropic endeavors of the Iowa Medical Society. This year, the IMS Foundation is participating in #GivingTuesday on November 28. Following Black Friday, Small Business Saturday, and Cyber Monday, this “Day of Giving” was established to focus on supporting nonprofit groups during the holiday season. We hope you will consider

making a (tax-deductible) donation to the IMS Foundation – which is here to support physicians, future physicians, and key public health initiatives in Iowa.

News from the U of I Two additional articles in this issue come directly from the Carver College of Medicine. First, learn how UI Health Care is adopting and adapting new technologies to support healthcare professionals in their practice of medicine on page 24. And on page 35, Jean Robillard, MD, writes his final column for Iowa Medicine as Dean of Carver College. You will be inspired by the many accomplishments of UI Health Care during his tenure. We thank Dr. Robillard for his unwavering support over the years and wish him the best in his future endeavors. We also welcome J. Brooks Jackson, MD, MBA, who

has succeeded Dr. Robillard, as the Vice President of Medical Affairs and Dean of the Carver College of Medicine. We look forward to working with Dr. Jackson in the months and years ahead. This year IMS has accomplished much, yet we know we have more to do. Stay tuned; there are big plans in the works for 2018. And of course we want to continue to hear from you. Your comments and feedback are always welcome. Watch the website, e-newsletters, and social media for future updates. On a personal note, I would like to thank everyone for the warm welcome to IMS and Des Moines. My family is getting settled, and we’re enjoying our time in this great state. Best wishes for a safe, happy, and healthy holiday season!

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PRESIDENT’SCORNER

A CHANGING CULTURE FOLLOWING UNANTICIPATED OUTCOMES 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.

First do no harm. These words are more than just an oath learned by every medical student. They’re an innate piece of our professional identities as physicians. Like many of you, I entered my medical practice excited to care for patients and optimistic that I could make a real difference in others’ lives. What I didn’t fully understand at the time was the sheer number of external factors that distract and disrupt a physician’s ability to provide care. This includes medical malpractice lawsuits. A recent study in the policy journal Health Affairs found that the average physician spends more than 10 percent of his or her entire career with an ongoing malpractice suit. This means time spent meeting with risk managers and attorneys that could otherwise be spent doing what we love — caring for our patients. Like many of you, I have been counseled many times over the years by legal staff at my facility and medical liability insurers that if a patient experiences an unanticipated outcome during the course of treatment, you speak to your risk manager, your Chief Medical Officer, and your attorney before you share anything with the patient. As the thinking goes, if you deny anything went wrong, you’re better prepared to defend yourself later in court. This “deny and defend” approach isn’t without cause. Studies have shown that the

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majority of medical liability suits — 65 percent — are dropped, dismissed, or withdrawn before ever going to trial. Of those few that do go to trial, 91 percent are ultimately decided in favor of the physician. While this approach to an unanticipated outcome makes sense from a risk management perspective, it seems diametrically opposed to our core ethos as a physician to first do no harm. I’m proud to report that over the past decade, the Iowa Medical Society has been working to help change this culture. In 2006, IMS championed passage of Iowa’s Apology Protection Statute, which allowed physicians for the first time ever to offer a simple apology or expression of empathy to a patient who had experienced an adverse outcome without those words being able to later be used against the physician in court. This simple but significant protection started Iowa physicians on a long, and at times difficult, path of culture change that is still unfolding today. I was relatively new to the IMS Board of Directors in 2013 when we came painfully close to passing a package of traditional tort reform measures, only to see legislative leadership negotiate them away in the final days of session. On the

heels of this defeat, we recognized that we needed a new approach. To help identify that approach, we appointed an ad hoc Tort Reform Task Force, led by Michael McCoy, MD, from West Burlington. This Task Force was charged with completing a comprehensive review of legislative and policy options for IMS as we looked to renew our commitment to both short-term and long-term success on liability reform. What this group identified was a bold new approach to medical liability reform, which went against everything we had previously been told by our attorneys and liability insurers — engage patients in an early, open disclosure of the facts as they are known following an unanticipated outcome and you will be less likely to face a lawsuit. When the task force recommendations contained in the McCoy Report were presented to the board that September, there were a number of skeptics, and I will admit I was one of them. How was having the very sorts of conversations our legal staff had told us for years to avoid not just giving the patient a road map to later file suit against us? After extensive deliberations, the board decided we weren’t ready to move forward with the McCoy Report’s recommendations. We wanted more time to contemplate this early disclosure concept, to research, and to consult our peers. When we reconvened in December of 2013, Dr. McCoy was joined by Timothy McDonald, MD, a physician


who has pioneered this concept through his Seven Pillars Program at the University of Illinois at Chicago. Dr. McDonald was able to share with us the exciting results they were seeing in Chicago, including the significant number of process improvements they were able to identify and implement as a result of their early disclosure program. As the conversation progressed, we became convinced that this approach was right for Iowa. Early disclosure, which we were now referring to as Communication and Optimal Resolution or Candor, was the next big leap from Iowa’s 2006 apology statute to allow for a protected, comprehensive dialogue with the patient, and just as important, care for the caregiver navigating the stressful time following an adverse outcome. The board unanimously approved the McCoy Report and directed the staff to get to work developing a legislative strategy to put in place the statutory

protections necessary to make Candor successful here in Iowa. Since that meeting in Iowa City in December of 2013, IMS has passed the initial Candor statute, established a pilot site under the tireless leadership of Dr. McCoy at the Great River Medical Center (GRMC) in West Burlington, expanded the Candor statute to allow for greater utilization of the protections by all members of the care team, and developed countless resources and educational programming. I’m proud that so many physicians across the state of Iowa, myself included, have taken the time to learn more about the Candor concept. And I’m just as proud that Iowa has become a national leader in changing our culture around unanticipated patient outcomes. This edition of Iowa Medicine is focused on the recent statewide Candor conference that IMS was able to host

with the generous support of the COPIC Foundation, the Iowa Medical Society Foundation, and UnityPoint Health. I was pleased to see so many physicians, risk managers, and legal staff from across the state in attendance at this event. I was equally pleased to help welcome Dr. McDonald, the man with the answers, back to Iowa to share his passion and his experiences with more of my peers. The most encouraging and reaffirming experience I had that day, however, was watching the final panel, which featured Dr. McCoy with a GRMC patient who had experienced an adverse outcome and his sister who had gone through the Candor process with him. As they shared their experiences and how Candor allowed them to achieve closure while maintaining a relationship with their local physician, I knew that we had made the right decision on that cold day in December of 2013.

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CANDOR

CANDOR CONFERENCE A SUCCESS The Candor Conference, held on September 22 at Iowa Methodist Medical Center in Des Moines, was the first of its kind in the state and a continuation of IMS’ ongoing efforts to educate physicians, patient advocates, and attorneys about this relatively new law as we look to expand utilization of the Candor statutory protections throughout the state. Sessions included a Candor 101 presentation from international early disclosure experts Tim McDonald, MD, JD, director for the Center for Open and Honest Communication at the MedStar Institute for Quality and Safety; and Bruce Lambert, PhD, professor in the Department of Communication Studies and director of the Center for Communication and Health at Northwestern, where he is also a professor in the Department of Medical Social Sciences. This informational, and at times humorous, session served as an introduction for many attendees to Iowa’s Candor law.

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IMS board member Michael McCoy, MD, FACOG, delivered opening remarks.

Bruce L. Lambert, PhD, discussed the importance of empathy in effective communication in successful early disclosure programs.

Timothy McDonald, MD, JD, introduced the Candor concept during the conference’s opening session.

The Great River Health Systems’ risk management team discussed their experiences in establishing Iowa’s first Candor pilot site.

Iowa Medicine Fall 2017


Morning breakout sessions were presented by the Great River Health Systems’ risk management team and a medical liability insurer panel. The first session covered Great River Health Systems’ (GRHS) experience in establishing Iowa’s first Candor pilot site and advice for other facilities considering implementing Candor. The second panel presented viewpoints of the law from a handful of leading medical liability insurance companies. At noon, national academic expert Michelle Mello, JD, PhD, presented data on early resolution programs across the country, including the experiences of facilities in Michigan, Illinois, California, and Massachusetts. This data reinforced previous studies, which found that well-structured early disclosure programs lead to significant declines in medical liability costs, numerous patient safety improvements, and faster resolution for those patients who were harmed by a system or provider error. Mello is a professor of law at Stanford Law School and a professor of health research and policy at Stanford University School of Medicine. She conducts empirical research into issues at the intersection of law, ethics, and health policy.

Michelle Mello, JD, PhD, discussed her research into the results of early disclosure programs around the country.

The first afternoon session included a panel of Iowa defense and plaintiff attorneys sharing their perspectives on the Candor statute, as well as their experiences working with administrators, physicians, and patients navigating GRHS’ Candor pilot program. This lively discussion looked at how Iowa’s Candor statute is changing the culture of the legal system’s response to an unanticipated patient outcome. The conference’s final session, Candor Benefits Real People, was moderated by Michael McCoy, MD, FACOG, Chief Medical Officer for GRHS and current IMS Board member, who chaired the 2013 IMS task force that first identified the Candor concept. Dr. McCoy was joined by a GRHS patient who had experienced an adverse outcome and his sister, who successfully went through a Candor discussion and were able to reach a resolution with the facility. The patient and his sister shared their experiences with this new approach and discussed why the Candor program made them comfortable continuing their care relationship with GRHS to this day. This emotional session helped to highlight the confusion and anxiety experienced by many patients who experience an unanticipated outcome and emphasized the benefits of Candor programs for both patients and providers.

The Attorney Panel, moderated by Dr. McDonald, shared defense and plaintiff views on the Candor statute.

If you missed the Candor Conference or would like more information on Candor, visit the IMS website’s Candor Resource page or contact Kate Strickler, JD, LLM, IMS General Counsel, (kstrickler@iowamedical.org). Look for future Candor events to be held across the state in 2018. The Candor Conference was made possible by generous grants from the COPIC Foundation and the IMS Foundation. Gerry Lewis-Jenkins, COO of COPIC, shared her personal experiences with early disclosure programs.

Iowa Medicine Fall 2017

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LEGALEASE

THE IOWA Candor LAW FAQS 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.

Candor is the Iowa law, spearheaded by IMS in 2015 and expanded in 2017, that provides physicians and patients an opportunity for early disclosure and resolution after an adverse outcome. An expectant mother arrived at the emergency department complaining of an issue initially thought to be unrelated to the pregnancy. By the time an obstetrician was called, the patient needed an emergency cesarean section. The procedure was performed, but the infant did not survive. There was concern that the patient should have been seen by an obstetrician earlier in her treatment. Such is the worst nightmare for any physician, and it is the situation that occurred at a Candor pilot site in Iowa. Because of the Candor program, representatives from the clinic, including one of the physicians involved in the case, were able to meet with the patient before she filed a lawsuit to answer her questions and address her concerns and to reach a settlement agreement — all within months of the event. Additionally, the clinic took steps to ensure that a similar patient would not have a similar outcome in the future: The clinic developed an electronic health record alert for high-risk OB patients, implemented the ability to monitor fetal heart rate in the ED and be monitored by

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the OB department, and established a protocol that any OB patient in the ED requiring antihypertensive treatment be sent to labor and delivery immediately. The pilot clinic was able to respond in this manner thanks to a law championed by IMS in 2015. But what does this law mean for physicians, and how does it work? Here is a brief rundown of the concept.

What is Candor?

Candor is an open, honest, and confidential discussion between a patient and a physician following an adverse outcome. The discussion occurs shortly after the incident, and none of the discussion is admissible in court. (The discussion is more likely to be successful the earlier it occurs; under the law, it must happen within 180 days of the incident.)

Why is this good for patients? Patients receive honest and frank answers about the circumstances surrounding the adverse healthcare outcome and have the opportunity to assist the facility in implementing procedures to prevent similar incidents from repeating. The process

is also much faster than traditional law suits, so patients with a legitimate claim receive a faster resolution.

Why is this good for physicians? The process is faster, so physicians can spend more time in the exam room and less time in the courtroom. In addition, the statute is structured to mitigate the likelihood of National Practitioner Data Bank reportability.

Has this been successful elsewhere? Yes. The University of Illinois Medical Center at Chicago (UIMCC) saw an 80 percent drop in the time it took to settle cases where harm occurred, and the University of Michigan Health System (UMHS) saw a 55 percent decline in the number of new claims filed. Malpractice premiums also declined — they dropped by $22 million at UIMCC-affiliated facilities that were not self-insured.

How does a Candor conversation start? The conversation must be initiated by a physician or a physician jointly with his/her facility. The patient is invited to participate and is reminded in writing that all discussions are confidential. The conversations remain oral. In the event that a discussion leads to an offer of compensation, that offer must be in writing.

What if I don’t want to participate in a Candor discussion?

The discussions are completely voluntary for both the physician and


the patient. Only the physician can initiate the discussion, but no one is required to participate.

Can a patient still sue after a Candor discussion?

What if I want my practice to be a pilot site or I have further questions about Candor?

Please contact Kate Strickler at (515) 421-4783 or at kstrickler@iowamedical.org for more information.

A Candor discussion does not limit a patient’s ability to access the legal system. However, if a physician makes an offer of compensation, that offer can include a requirement that the patient not seek additional legal remedy.

How do I initiate a Candor discussion?

IMS is in the process of developing toolkits to assist practices and facilities in setting up Candor programs and in identifying pilot sites to test the concept. In the meantime, look to IMS publications for more information as the toolkit develops.

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Iowa Medicine Fall 2017

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CANDOR

IOWA’S CANDOR LAW: WHAT CLINICIANS NEED TO KNOW By Alan Lembitz, MD, Chief Medical Officer, COPIC & Mark A. Fogg, JD, General Counsel, COPIC

Alan Lembitz, MD

Mark A. Fogg, JD

Since the Iowa law was implemented in 2015, organizations have been working at educating providers and making themselves Candor ready at varying degrees of urgency. This article will briefly summarize the history of communication and resolution programs (CRPs); their major elements; how they can benefit patients, their families, clinicians, and healthcare systems; the important factors to consider in the process of a communication and resolution case; and the unique benefits that the Iowa Candor law provides.

History Communication and resolution programs have been in place for nearly two decades at some institutions. A January 2014 Health Affairs article1 summarizes some of this history and the early pioneers in the field. The recent Candor Conference held in September had leaders from several of the major pioneering programs, as well as a luncheon “state of the art” summary presentation by the article’s chief author, Michelle Mellow, JD, PhD. Originating from the “apology” programs, CRPs then evolved into “disclosure and resolution” programs, then “communication and resolutions” programs, and finally a federal grant made the primary elements of what was named Candor, communication and optimal resolution, available to

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the public without a fee (CANDOR Toolkit from the Agency for Healthcare Research and Quality2). CRPs exist now across the U.S. whether or not enabling legislation has been passed. Iowa has the advantage of the supportive Candor legislation, which helps remove some of the barriers to effective CRP implementation and outlines specific benefits and requirements.

Key elements The optimal CRP approach is built on a research project called The ‘Seven Pillars’ Response to Patient Safety Incidents3. The following are the major elements: EARLY REPORTING: Perhaps the most underestimated element in terms of its importance is the value of early identification of an adverse medical outcome. The definition of adverse medical outcomes could be the subject of an entire article. The simplest definition is when physical harm occurs to a patient, regardless of a determination of fault, to any degree from acts of omission or commission by clinicians or the healthcare system that could have been different, from the perspective of the patient, family, clinicians, or the healthcare system. Reporting triggers the Candor-ready resources and starts the entire process. COMMUNICATION: It is no mistake that the first letter in Candor and the first word in CRP is “communication.” Malpractice claims almost always have at their root a breakdown in the communication process for the patient/family. Ironically, the traditional liability

claims process doesn’t fix that. Open and honest communication in the setting of a medical liability claim is generally discouraged by both the plaintiff and defense attorney as they prepare their cases for argument in front of a jury. Communication is not an equally shared skill; there are good communicators and there are good systems to enhance the coaching of communication. Finally, communication should not be delayed, but be appropriate to what is known when it is known. It is said that following medical harm, every hour that goes by without effective answers, or a trusting relationship that answers will be given to the extent they are known, is yet another harm. CARE FOR THE CAREGIVER: Harm to patients arising from medical care also has a direct effect on the caregivers. Feelings from blame and shame, to embarrassment, to worry about one’s effectiveness, career choice, and an overwhelming sense of guilt can all become evident following harm to a patient in which one’s professional omissions, commission, or misjudgment played a role. The CANDOR Toolkit has resources from many institutions that have established programs to help clinicians and the members of healthcare systems get back as close as possible (or in some cases, better than before, having learned and grown from the process) to the effective, caring state that they had prior to the adverse event. INVESTIGATION: Determination of the causes of an adverse medical


outcome requires experience, resources, and time. It is important to understand that a patient’s and their loved ones’ need to know can be acute. Developing the skill to understand the etiology of the outcome and being able to communicate the results of those findings at the appropriate time as they become known are critical elements of the investigation. DATA AND SYSTEM IMPROVEMENT: Being able to learn from similar mistakes or inherent system issues can prevent those same adverse outcomes from occurring and harming the next patient. The basis of what is called a high reliability organization is the ability to learn from adverse events. An open reporting culture feeds the important data to the learning system so that improvements can be made. EDUCATION BASED ON LEARNING: All too often, we only learn about previous causes of medical harms after they have happened. Building a robust education platform based on those adverse events will protect the next patient from harm. The education should be case-based, interactive, and involve all members of the healthcare team. Debriefing following near misses is also an example of case-based education that protects the next patient. FINANCIAL RESOLUTION: Not all cases require financial resolution. All the elements listed above, if done well, may reduce the need for a financial resolution and allow all parties to heal from the event. When financial resolution is indicated, early involvement of the medical professional liability carriers that will ultimately pay the final settlement is critical. Early reporting allows them to stay on board throughout the process, and some may have

resources to assist clinicians and healthcare systems to navigate the elements of a CRP. The Iowa Candor law provides specific privilege protections from discovery that could prove harmful if a case ends up being litigated, and following the Candor law can also mean that the reporting requirements to the National Practitioner Data Bank (NPDB) and licensing boards may not apply based solely upon financial compensation.

Candor requirements

In order to achieve these protections, the following is required. Please note that the following is abridged so that all can understand the requirements and the benefits of the Candor law. Healthcare providers and facilities should consider assistance from qualified persons experienced in such matters before proceeding on their own. QUALIFYING EVENT: An adverse healthcare incident is an objective and definable outcome arising from or related to patient care that results in death or physical injury of the patient. NOTICE: The open-discussion communications and possible offers of compensation do not constitute an admission of liability, are privileged and confidential, and cannot be discovered or disclosed in subsequent judicial, administrative, or arbitration proceedings. Notice must be given to the patient within 180 days from when the healthcare facility or provider knew or should have known of the adverse healthcare incident. The notice must be given in writing, and the patient (or legal representative in the event of death) must agree in writing to engage in open discussions. The notice must include ▪ A desire to engage in open discussions. ▪ Specific statutory language related to the statute of limitations. ▪ The right to the medical records upon an appropriate authorization

for release. ▪ The conditions of confidentiality. ▪ The right to legal representation. NO WRITTEN DEMANDS: The Candor process must be clinician initiated. The patient and/or their legal representative should understand that making formal written demands can exclude their case from the protections of the Candor law and certain reporting requirements. If financial compensation is determined to be indicated, the healthcare provider or facility can put that in writing with notice of the patient’s right to legal representation.

Some final considerations Ask if your system is Candor ready. If not, why not, and is it working on any of the elements of a CRP listed previously? The financial resolution piece is an important piece of CRPs, but just one of many important elements. Ask if your medical professional liability carrier is Candor ready and has the resources and experience to support you through the process. Remember that delay reduces the likelihood of success in the Candor process, and delay and poor communication, for whatever the reason, is viewed as yet another harm to the medically injured patient and their loved ones, and that there are specific requirements of the law in order to achieve the benefits. Report early. Do you know whom to call in order to trigger the Candorready resources? Candor is not a one-size-fits-all panacea for medical harm and the trauma that follows for patients, families, clinicians, and systems, but it can be a very effective tool if used correctly in a system that understands it.

1. Health Affairs, January 2014 vol. 33; no. 1; 20-29 2. www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/candor/introduction.html 3. Health Services Research Journal, December 2016; vol. 51; Issue Suppl 3: 2491-2515

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LEGISLATIVEUPDATE

TIMING & TENACITY YIELD SIGNIFICANT WINS ON LIABILITY REFORM 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.

The recent Candor Conference marked the culmination of more than five years of work by IMS physician leaders and staff, which can trace its roots to a significant legislative setback and the Iowa Medical Society proving once again that it will not accept defeat in the pursuit of meaningful medical liability reforms. During the 2013 Legislative Session, IMS worked closely with legislative leadership to craft a package of liability reforms, including measures such as Certificate of Merit and strengthened expert witness standards. This legislation proved to have greater political momentum than any other tort reform proposal in recent years and looked likely to become law. Unfortunately, in the final days of session, legislative leadership negotiated the measure away in endof-session discussions that ultimately yielded the Iowa Health and Wellness Plan. In light of this legislative defeat, the IMS Board of Directors felt it was time to take a step back.

in Iowa, reviewed more than two decades of IMS advocacy on medical liability reform, and completed a national assessment of reform measures enacted in other states. Through the course of this work, the group identified an emerging concept known first as Disclose, Apologize & Offer; then Early Disclosure & Resolution; and finally Communication and Optimal Resolution or Candor.

Regardless of the name, the concept was the same — engage the patient as soon as possible following an unanticipated outcome, share the facts of the situation as best they are known at the time, and continue to engage the patient throughout the investigation of their case until a resolution can be reached. This concept, which represents a significant culture change and flies in the face of traditional advice from defense attorneys and liability carriers, has been validated by a growing body of research that shows benefits for patients and providers, as well as system improvements, which lead to improved quality of care and a decrease in the likelihood that another patient will experience the same adverse outcome. When the task force submitted its report, known as the McCoy Report, to the IMS Board of Directors that September, it reiterated support

At its May 2013 meeting, the IMS Board of Directors approved the formation of an ad hoc Tort Reform Task Force to complete a comprehensive review of legislative and policy options as IMS renewed its commitment to both short-term and long-term success on liability reform. Over the summer and fall of that year, the task force, led by Michael McCoy, MD, surveyed the political landscape Results of the ad hoc Tort Reform Task Force were published in the McCoy Report in 2013. 14

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for traditional reforms while also recommending that IMS pursue establishment of a Candor model for Iowa. As IMS President Joyce VistaWayne, MD, discusses in her column in this edition of Iowa Medicine, the board wanted more time to consider and research this significant departure from traditional reform models before it voted unanimously in December to support moving forward with Candor implementation. In 2014, IMS secured a commitment from the Iowa Association for Justice (IAJ), the membership organization for trial attorneys, to jointly craft legislation with the intention of introducing a bill in the 2015 Legislative Session. After so many years of pointed opposition to medical liability reform, the agreement to even discuss legislation marked a turning point in the relationship of our two organizations. Throughout the summer and fall of 2014, then-IMS President Jeff Maire, DO, and IMS Committee on Legislation Chair Kevin Cunningham, MD, worked with staff and IAJ representatives to craft what would eventually become the Candor statute. After some last-minute refinements during session, the Candor legislation unanimously passed both chambers of the legislature and was signed into law on April 14, 2015. Enactment of the Candor statute represented the first reforms to Iowa’s medical liability system in nearly a decade and came less than two years after IMS’ previous reform proposals had been flatly rejected by the legislature. The speed with which this transition from defeat to victory occurred and the unanimous nature of the legislation’s passage was truly a testament to the tenacity of IMS’ physician leaders and the willingness of the IMS Board of Directors to think creatively about how best to serve the physicians and patients of our state. When Iowa enacted its early disclosure statute, we became

Governor Terry Branstad signs the 2017 expanded Tort Reform legislation surrounded by IMS members and others. just the third state in the nation after Massachusetts and Oregon to enact such legislation. In the two and a half years since passage of the original Candor statute, IMS has been working hard to help Iowa practices put the protections of the law to work and to help lead the national discussion about this emerging area of patient safety. Since 2016, Great River Medical Center (GRMC) in West Burlington has piloted Iowa’s first full-fledged Candor program under the leadership of Dr. McCoy. As attendees of the recent Candor Conference learned, GRMC has handled several cases through its Candor program, the vast majority of which have resulted in mutually acceptable resolutions for providers and patients, expedited resolution of cases, and a diversion of multiple cases that would have otherwise resulted in a lawsuit. Thanks to the lessons learned through the GRMC Candor pilot program, IMS returned to the legislature this session to successfully push for expansions to Iowa’s Candor statute, which lowered the threshold for cases that qualify for the statute’s legal protections and expanded the law to allow all members of the care team to make use of the

voluntary Candor statute’s protections. These expansions were signed into law May 5, 2017, along with a package of traditional reforms, including those that came painfully close to passage in 2013. For the second time in two years, IMS had achieved enactment of meaningful medical liability reforms, with this second legislative package encompassing some of the most sweeping reforms to Iowa’s liability system in more than 40 years, including a $250,000 cap on noneconomic damages. Now just five years removed from the defeat of 2013, Iowa is positioned to enjoy the benefits of tradition reforms that have been in place across the country for decades and is leading the country in implementation of Candor programs to provide an alternative to litigation. This progress could not have been possible without the tireless work and leadership of Dr. McCoy, Dr. Maire, Dr. Cunningham, the IMS Board of Directors, and the advocacy and support of countless IMS members. For more information on past IMS advocacy efforts in support of meaningful medical liability reform and future IMS initiatives, please contact me at dtibben@iowamedical.org.

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POLICY FORUM 17-2 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

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and accompanying Testimony Forum comments are addressed by the Policy 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 17-2 RESULTS

PF 17-2 was held at 2:30 p.m. on September 22 in Iowa City. The following represents the Policy Request Statements considered and the actions taken with regard to each.

PRS 17-2-01 Insurance Coverage for Tests or Treatments Identified as a Practice Standard Submitted by: Ronald Sims, MD, Dubuque POLICY REQUEST

IMS adopt the following policy: The Iowa Medical Society supports autonomous clinical decision-making, utilizing evidence-based practice guideline, and opposes efforts by health insurers to deny authorization for diagnostic tests or treatments that are in line with these guidelines. We further believe: Health insurance plans in Iowa must conform to published, current

practice guidelines in making authorization determinations for ordered tests or treatments. Submission by the treating physician of a practice guideline that supports the test or treatment must be accepted by the insurance plan as sufficient documentation of medical necessity, without requiring additional authorization forms or telephone peerto-peer conferences.

ACTION TAKEN

Not approved; AMA policy H-320.939, AMA policy H-450.935, and the AMA Health Insurer Code of Conduct Principles were reaffirmed.

PRS 17-2-02 Medical Staff Autonomy & Legal Counsel Submitted by: Craig Clark, MS, MD, JD, FCLM, Cedar Rapids POLICY REQUEST

IMS should amend PF 225.004 to read as follows: PF-225.004: Hospitals: Medical Staff, Self-Governance and Autonomy The Iowa Medical Society supports the principle that the organized medical staff of a hospital is an autonomous, self-governing legal entity with the authority to sue on its behalf and on behalf of its individual members in order to enforce medical staff bylaws. The Iowa Medical Society further supports the principle that an autonomous, self-governing medical staff should obtain independent, outside legal counsel for any proposed material changes in medical staff bylaws, rules, or regulations. And, The Iowa Medical Society should submit a resolution to the American Medical Association House of Delegates urging it to formally adopt as policy the same principles.


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ACTION TAKEN

Not approved; IMS Policy PF-225.004, AMA Policy H-225.957, and AMA H-235.994 were reaffirmed.

PRS 17-2-03 Medicaid Cancellation Fees Submitted by: Chad Carlson, MD, West Des Moines POLICY REQUEST

IMS shall pursue legislation to allow practices to impose a reasonable fee for patient appointments that are canceled within 12 hours of the appointment time or for which a patient fails to show up for a secured appointment time.

ACTION TAKEN

Not approved; IMS Policy H-290.010 was reaffirmed.

PRS 17-2-04 Telehealth Payment Parity Submitted by: Patrick Brophy, MD, Iowa City; Andrea Greiner, MD, Iowa City; Emily Boevers, M4, UI CCOM POLICY REQUEST

IMS adopt the following policy: The Iowa Medical Society believes parity in payment between in-person and telehealth services is vital to helping spur expansion of telehealth services in our state. IMS supports efforts to ensure payment parity among commercial payors, as well as the Medicaid and Medicare programs. And, The Iowa Medical Society pursue legislation to enact commercial telehealth payment parity in Iowa.

ACTION TAKEN Adopted

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SCHEDULE FOR NEXT FORUM CALL FOR ACTION

March 9–23, 2018 • PRSs must be received by March 23 to be considered during PF 18-1. • PRSs received after March 23 will be considered during PF 18-2. TESTIMONY FORUM

April 13–27, 2018 • PRSs under consideration during 18-1 will be posted online and members will be encouraged to offer virtual testimony during this time. POLICY FORUM 18-1

April 27, 2018 • PF 18-1 is scheduled to be held on Friday, April 27, at the IMS Annual Conference at the Marriott Downtown Des Moines.


In August, seven University of Iowa Carver College of Medicine medical students took part in an expedition to rural areas of the Indo-Tibetan borderlands. There they served villagers and monks without access to regular health care. Students received funding from the Iowa Medical Society Foundation to make this trip possible. The students took part in the Kargiakh expedition with the Himalayan Health Exchange (HHE) program in India. Robin Paetzold, Director, Global Programs at The University of Iowa Carver College of Medicine, coordinated with HHE’s Director, Ravi Singh, to arrange the students’ overseas clinical experience. HHE’s expeditions combine service, education, and adventure to provide care to the underserved populations in remote areas of Indo-Tibetan borderlands. Each trip combines service and adventure, with team members providing care while also experiencing the land, its natural environment, people, and culture. These teams travel on foot and by road to remote settlements and villages to provide free medical care to a mix of Tibetan refugees, Northern Indians, and Gaddis, a sheepherding tribe of the Himalayas. The following are photos and excerpts from the students’ experiences. Read their full stories on the IMS website, www.iowamedical.org. The group lived in shared tents during their journey. Sherpa guides led the way, traveling with 47 mules loaded with medical and personal supplies and food.

AARON LACY, M4

IMSFOUNDATION

IOWA MEDICAL STUDENTS SERVE REMOTE VILLAGERS IN LADAKH, INDIA The team hiked between villages at high altitude. Physical conditions were as challenging as the clinical work.

KATHRYN SONGER, M4

My first impression was amazement that people could live in such a harsh environment. This is a place that gets 6–8 feet of snow in the winter, but very little water during the summer. The growing season is limited to five months, and seven months of the year the valley is isolated due to snowfall. Yet these people have learned to grow and thrive in this environment. The people have a fascinating relationship with the mountains and water. They will redirect entire mountain streams laterally along the mountain base and then divert small rivulets of water that are used to water their fields and supply water to their homes. Everything in the valley is built using human effort. There are miles and miles of stone walls snaking through the valley used to pen yaks and mark territory. The amount of effort it took to construct all the structures in the valley is just staggering. – Adam Verhoef, M4 At the Phugtal Monastery, which is built into the side of the cliff, students enjoyed a tour and tea with monks before beginning their clinic.

AARON LACY, M4

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Portable white tents became the clinic facilities as the team traveled from village to village. KATHRYN SONGER, M4

KATHRYN SONGER, M4

By invitation from the local government, a team from HHE visits Zanskar every summer to provide free care and medicine to the underserved inhabitants of the valley. The medical team flew into New Delhi, then to Leh in the region of Ladakh. From Leh, we trekked to and set up eight mobile, walk-in-style clinics throughout the Zanskar Valley of Ladakh. The villages where the clinics were located were in areas of rough terrain between 12,000–14,700 feet. This high elevation and the environment in which they live leads to many unique health challenges for the people who inhabit those areas. The patient population we saw included indigenous Tibetans, nomads, children in monastic schools, and Buddhist monks. The primary health challenges in this population, which are often related to its isolated and underserved status, include malnutrition, tuberculosis infection, limited resources for handicapped children, and environmental ophthalmologic and musculoskeletal conditions. On this expedition, we provided care for approximately 500 patients over the course of the month, working with local healthcare providers and utilizing local interpreters. – Kathryn Songer, M4 BRANDON BOLDT, M4

The expedition combines service with adventure, so there was time built in to enjoy the natural beauty of the surroundings, here at elevation of 18,200 feet.

We had been trekking for about four days before entering the valley where many of the villagers we served resided. I remember coming down the gorge and being taken aback by the beauty and peacefulness of the valley. When we reached our first village, Tangste, we were welcomed by the villagers and were allowed to camp and set up clinic in the fields surrounding their homes. When traveling from village to village throughout the trek, it was this welcoming demeanor and kindness that was very special to me and is a testimony to the Buddhist culture within the region. – Chloe Gumpert, M4

KELSEY HART, M4

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What is IMSF? FRANK JARECZEK, PHD CANDIDATE

Clinic days began with early-morning tea and a later breakfast, with clinic start time around 9:00 or 10:00 a.m. The first clinic was held in Sarchu. After several days of trekking and crossing the Phirste La pass, the team reached the otherwise inaccessible Zanskar Valley, where six further clinics were held at Tangste Village, Phuktar Monastery, and the villages of Khangsar, Testa, Kyng, and Kargiakh. The last clinic site, Chika, was visited after we exited the valley. During each clinic, we were split up into teams of three or four students supervised by a resident or staff physician. Another group of students triaged patients, recording vitals before bringing each patient to a provider team. Patient evaluations were a group effort, with one or two students taking the history and performing the physical while another student scribed a note documenting the encounter. The students then presented their patient and their plan to their supervising physician, received feedback before sharing the assessment and plan with the patient, and subsequently brought the patient to the student-staffed pharmacy for administration of medications when appropriate. – Frank Jareczek, PhD Candidate

The Iowa Medical Society Foundation (IMSF) is the giving arm of IMS, the largest physician membership organization in Iowa representing more than 6,100 medical students, residents, and physicians. IMSF is a voluntary organization that uses personal donations from physicians and friends of medicine to inspire, facilitate, and expand the educational and philanthropic endeavors of the Iowa Medical Society.

Why contribute? IMSF supports physician initiatives promoting professionalism and leadership, including the development of medical students in Iowa. IMSF also supports public health initiatives and the philanthropic efforts of Iowa physicians and IMS.

Donate today! In 2017, IMSF provided scholarships to Iowan students attending medical school at Des Moines University College of Osteopathic Medicine and the University of Iowa Carver College of Medicine. The Foundation purchases the white coats worn by these students and helps fund Global Health Studies Clinic Experiences. In efforts to provide professional development to Iowa physicians and patients, IMSF helped in sponsoring the IMS Candor conference in September and will be funding state-wide physician burnout and professional resiliency activities in 2018, as well as educational sessions during the IMS Annual Conference. Your contributions are needed to continue to make a lasting impact in Iowa and globally. This year, IMSF is participating in #Giving Tuesday, on November 28, as part of a year-end fund drive. Give to IMSF and help its continued support of physicians, residents, and medical students in Iowa. Visit the IMSF (www. iowamedical.org/iowa/ imsf) website to make a tax-deductible donation.

A Buddhist monk turns the tables on Kat Songer, taking her blood pressure, making for a light-hearted moment.

For more information regarding IMSF, contact James Hart (jhart@ iowamedical.org) at (515) 421-4773. KELSEY HART, M4

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Students were taught how to play cricket by UK medical students and played with some of the Sherpa guides and a local boy in Tangste village. BRANDON BOLDT, M4

Unfortunately we had no employed translator for the local language, Ladakhi. The valley was so isolated that the language is mostly unknown, and we relied on local villagers to translate for us. Each village only housed 80– 100 people, so having a community member translate was difficult due both to breaches in privacy as well as having no knowledge of medical terminology. The Ladakhi translators would have to translate from Ladakhi to Hindi, and then a Hindi translator would have to translate from Hindi to English, making for a challenging game of two-way telephone. Additionally, we only had supplies that we carried in on the mules and our backs. It was frustrating to diagnose someone with a medical condition and not have the proper treatment for it. We had to be very creative with our distribution and selection of medications, which was a valuable learning experience. Often we were using second- or third-line treatment for medical conditions, which forced me to expand my practice knowledge from beyond what we have in the States.

The easiest part of the trip to adapt to was the group dynamics. We had a fantastic group of medical students, physicians, and undergraduate students. We had lots of fun every night learning new card games and telling stories from our college days. The greatest bonds I made were with the fellow medical students. We had six students from the U.K., three from Canada, and 11 from the U.S. There is something special about spending one month together in the wilderness. By the end of trip, it was sad to see everyone go back to their respective schools. I think most of us will stay in touch long into the future. We are even planning a reunion trip to Iceland after medical school graduation! – Brandon Boldt, M4

The Kargiakh Expedition with the Himalayan Health Exchange program was a once-in-a-lifetime experience, and I made many great memories and met incredible people along the way. I would recommend this experience if you are interested in global health, enjoy trekking and backpacking, physically fit, and okay with living without usual hygiene practices for one month. . . . I am happy that I had this opportunity as a medical student. It was incredibly humbling, making our living conditions, medical technology, and access at home feel like such incredible luxuries. – Kelsey Hart, M4

Many of our patients had chronic medical conditions that were not appropriate to treat. Osteoarthritis was one of the most common adult patient diagnoses due to the difficult farming lifestyle. Prescribing medications without any follow up to look for adverse effects would be irresponsible, so unfortunately many patients walked away without symptomatic relief. However, we were able to treat many infections as well as provide reassurance that symptoms were not part of a more sinister pathologic process. – Aaron Lacy, M4

BRANDON BOLDT, M4

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Survey Is it important to you that the Iowa Medical Society Foundation (IMSF): Support professional leadership development of IMS members? Provide educational conferences, seminars, and meetings on subjects such as the Candor law and avoiding professional burnout? Support public health initiatives? Provide white coats to all Iowa medical students? Assist medical students with medical school scholarships? Pay travel expenses for medical students to attend the AMA Conference? Assist in covering expenses for medical students participating in Overseas Clinical Practice?

If you answered “yes� to any of these questions

Support the IMS Foundation This year, the IMSF is participating in the Day of Giving on November 28. If you support the work of IMSF, please consider a contribution on this or any other day. Make a tax-deductible donation with our easy online donation page! www.iowamedical.org/iowa/imsf/giving

#GivetoIMSF


UIHEALTHCARE

LEADING CHANGE IN SUPPORT OF IOWA’S PHYSICIANS For more than 100 years University of Iowa Hospitals and Clinics and the UI Roy J. and Lucille A. Carver College of Medicine have been partners with physicians and other healthcare professionals around the state to provide health care to the people of Iowa, educate future and current providers, and develop new knowledge through research. management software program for accessing continuing medical education. Telemedicine and telehealth services continue to expand for the benefit of patients and providers.

Web Portal The referring provider portal on the UI Hospitals and Clinics website (uihc.org/ referring-providers) was developed with input from referring physicians who identified the UI services for which they wanted quick, convenient access. This single website provides online, 24-hour, seven-day-a-week access to REQUEST A CONSULT

Via phone or the web link, on-call physicians are available for each clinical department. Staff members make every effort to connect providers with a physician as quickly as possible. REFER A PATIENT

And although the commitment to the partnership hasn’t changed, times have. UI Health Care is leading the way in using technology to improve communications and better serve Iowa’s healthcare providers. Recent advances in communications include a web portal for referring providers and secure access to patient record information through CareLink and Care Everywhere. Work is continuing on a smartphone application that will provide even more convenient, immediate connections to UI consulting physicians and a learning

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Via phone or web, refer a patient for evaluation in one of more than 200 specialty clinics.

downloadable listing of UI Physicians and phone numbers by department/ division/specialty), a listing of specialty outreach clinics in more than 40 Iowa communities, and more.

Electronic Access Electronic access to patient information is available to all referring providers in Iowa, through CARE EVERYWHERE

For referring providers who use the Epic electronic health record system, this connection allows access through Epic to patient information from UI Health Care, including clinical summaries, encounter summaries, lab results, and progress notes. UI CARELINK

For referring providers not on the Epic system, this connection allows 24hour secure, remote access to review medical records including procedure notes, surgery reports, clinic notes, medications, and lab results. A standard and consistent way to receive external records at time of scheduling outpatient appointments and inpatient transfers is also in development to ensure all materials are on hand when patients arrive for their appointments.

TRANSFER A PATIENT

The UI Admission and Transfer Center assists providers who need to transfer patients to UI Hospitals and Clinics through a direct phone line, (866) 890-5969. VIEW OR SEND MEDICAL RECORDS

Provides directions on the several methods of sending and retrieving medical records. Other informational links on the site include Find a Doctor (online directory), Quick Contact directory (a

Additional digital access for day-to-day operations and communications with referring providers is planned for launch in early 2018, including an application for smartphones that will offer streamlined secure communications directly with UI providers. From their mobile phones, providers will be able to access features on the referring provider web portal and more, including secure texting. In addition, developers are


Telemedicine and Telehealth UI Health Care’s 2017–2020 integrated strategic plan calls for expanding the use of technology to improve our service to providers and patients, especially through telemedicine and telehealth. Several programs are already in place. More will be added in the coming years, making medical specialists with UI Health Care available across the state in real time through secure telemedicine connections, including TELEPSYCHIATRY

UI Health Care has launched three new telepsychiatry services in local communities. As part of a grant, UI Hospitals and Clinics will offer geriatric telepsychiatry to 13 skillednursing facilities statewide. The Department of Psychiatry has also launched an Intellectual Disability Program at Hills and Dales Child Care Center and Preschool in Dubuque and telepsychiatry program at Grinnell College, which assists students with medication management. VIRTUAL HOSPITALIST SERVICE

Van Buren County Hospital was the first to partner with UI Hospitals and Clinics on this service launched in July 2017, which allows consultation and collaboration between the local care team and UI Hospitals and Clinics’ Hospitalists via daily virtual rounding and shared patient medical records. The program has allowed local Critical Access Hospitals to enhance patient care and keep patients in their home community. If transfer to UI Hospitals and Clinics becomes necessary, the patient experiences a more seamless transition. The University received a Distance Learning and Telemedicine Grant from the U.S. Department of Agriculture

to place telemedicine equipment in medically underserved locations (skilled-nursing facilities, family medicine sites, and Child Health Specialty Clinics) throughout Iowa. The objectives of the grant are to increase access to specialist care through telemedicine and medical education via weekly virtual Grand Rounds. In addition to these services, UI physicians are partnering with providers and patients, using secure video conferencing and other digital technology for maternal fetal medicine virtual visits; neonatal care consults; burn treatment consultations; and remote monitoring for diabetes in pregnancy. For more information about digital health initiatives at UI Health Care, please visit www.thesignalcenter.com.

Education and Development Services that support the continuing medical education, professional development, and practice management of healthcare providers in Iowa are available through the Carver College of Medicine.

The office annually publishes and provides online Iowa Medical Practice Opportunities Directories, which list open positions for nurse practitioners and physician assistants, as well as physicians specializing in family medicine, emergency medicine, pediatrics, obstetrics and gynecology, general surgery, psychiatry, and hospital medicine. The goal of these directories is to make all resident physicians in the state aware of opportunities to remain in Iowa for their practice as well as to provide a resource for physicians out of state interested in relocating to Iowa. From standard methods to new ventures, UI Health Care is committed to improving the services we provide Iowa’s referring providers, support of care for patients in Iowa and beyond, and providers themselves. For more information, to discuss additional ideas, or offer suggestions, please contact The Office of Physician Relations at (319) 384-6103 or physician-relations@uiowa.edu.

The Office of Continuing Medical Education assists providers in meeting their continuing medical education requirements by offering more than 100 directly and jointly sponsored programs annually. Online access to the courses, CME transcripts, certificates, a calendar of events, and other features are now available through a new learning management system called CloudCME. The Office of Statewide Clinical Education Programs offers many services that assist Iowa’s healthcare providers, group practices, hospitals, and communities, including Physician recruitment Practice coverage Data describing the existing healthcare workforce and trends in Iowa Confidential consultation for physicians seeking Iowa medical practice opportunities

PHOTOS COURTESY UI HEALTH CARE

exploring the potential for a secure, face-to-face video consultation application for smartphones. More information on these applications will be made available closer to their implementation.

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MEMBERS IN THE NEWS (July to September 2017) Michael Abramoff, MD, Ophthalmology, Iowa City, featured in IDx article entitled “IDx-DR to Complete Clinical Trial.” Allan Andersen, MD, Psychiatry, Iowa City, author of article entitled “Shared Genetic Factors Influence Comorbid Major Depression, Alcohol Dependence” in JAMA Psychiatry, published on August 16, 2017. Veerajalandhar Allareddy, MD, Pediatrics, Iowa City, presented on “Opioid Abuse and Dependency in Pediatrics” during the American Academy of Pediatrics Annual Meeting. Bryan Allen, MD, PhD, Radiation Oncology, Iowa City, interviewed by HemOnc Today on “Potential Benefits of Highdose Vitamin C Increased Efficacy of Cancer Therapies.” Saket Girotra, MD, Cardiovascular Disease, Iowa City, author of “Temporal Changes in the Racial Gap in Survival After In-Hospital Cardiac Arrest” study in JAMA Cardiology. Michikiko Goto, MD, Infectious Diseases, Iowa City, authored “Staphylococcus aureus bacteremia at Veterans Health Administration Hospitals” study published in JAMA Internal Medicine on September 5, 2017. Past President, K. John Hartman, MD, General Surgery, Davenport, featured in Quad-City Times article, “More Incidents, Injuries with Fireworks.” Charles Jennissen, MD, Emergency Medicine/ Pediatrics, Iowa City, featured in Medscape article, “Sliding with Kids on Lap Can Raise Fracture Risk.” Ursula Livermore, MD, Family Medicine, Cedar Rapids, comments in “New Iowa Law Regarding Vaccines Required for Older Students” on KCRG9 news, July 25, 2017. Chad McCance, MD, FACS, General Surgery, Atlantic, named 2017 Hospital Hero by the Iowa Hospital Association.

Lynn Rankin, MD, Neurology, Des Moines, provided medicine and non-medicine options for treating migraines for UnityPoint Health website article, “Living with Migraine Headaches.” Brian Swick, MD, FAAD, Dermatology, Iowa City, accepted promotion to Clinical Professor in the UIHC Department of Dermatology. Cheryl True, MD, Family Medicine, Davenport, elected to Board of the Quad City Health Initiative. George Weiner, MD, Hematology, Iowa City, featured in an online article for Business Wire, “UI Health Care’s Cancer-Prevention Strategies Earned Them CEO Cancer Gold Standard™ Accreditation.” Brian Wolf, MD, MS, Orthopedic Surgery, Iowa City, coauthored “Opioid Consumption After Rotator Cuff Repair” in the August 2017 edition of Arthroscopy. Marta Van Beek, MD, Dermatology, Iowa City, discusses the social and emotional burden of skin disease on patients in a Medscape article, “Vitiligo and Emerging Skin Repigmentation Options.”

Iowa Neurological Association Elects New Leaders

Congratulations to the IMS members who were elected to the Iowa Neurological Association Board; each will be serving a two-year term. President, David Moore, MD, Ames President-Elect, Edward Clemmons, DO, Ames Vice President, Connie Pieper, MD, Iowa City Secretary, Rodney Short, MD, Davenport Treasurer, Keith Kohout, DO, Des Moines Immediate Past President, Anil Dhuna, MD, West Burlington

Michael Ohl, MD, Infectious Diseases, Iowa City, authored article “Iowa Leads Nation in Rural HIV Prevention with Launch of TelePrEP Program” in The Loop. Eric Peterson, MD, Family Medicine, Boone, featured in Ames Tribune article “Health Care Repeal in Iowa: By the Number,” published on August 19, 2017.

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IN MEMORIAM Donald Bomkamp, MD, Family Medicine, Cedar Rapids, passed away on August 7.


WELCOME NEW IMS MEMBERS

(July 1 to September 30, 2017)

Austin Bancroft, DO, Otolaryngology, McFarland Clinic PC – ENT and Audiology, Ames

Matthew Hill, DO, Oncology, Medical Oncology & Hematology Associates – Stoddard, Des Moines

Sarah Bancroft, DO, Family Practice, Sports Medicine, McFarland Clinic PC, Ames

Gregory Hoekstra, DO, Family Medicine, Waterloo

Amit Pathak, MD, Internal Medicine, UnityPoint Clinic, Cedar Rapids

Kathryn Kersenbrock, MD, Internal Medicine, Methodist Hospital, Omaha

Danielle Pellow, MD, Internal Medicine, McFarland Clinic PC – Adult Medicine, Ames,

Angela Kloepfer, MD, Internal Medicine, McFarland Clinic PC, Ames

Hugo Rivadeneyra, MD, Endocrinology, McFarland Clinic PC, Ames

Robert Behrens, MD, Hematology/ Oncology, Medical Oncology & Hematology Associates–Stoddard, Des Moines Alexandros Briasoulis, MD, PhD, Cardiovascular Disease, UIHC, Iowa City

Audrey Ko, MD, Ophthalmology, UIHC, Iowa City

Joseph Buckwalter, MD, PhD, Orthopaedic Surgery, UIHC, Iowa City

Hubert Labio, MD, Psychiatry, Great River Mental Health Care, West Burlington

Daniel Buroker, MD, Hematology/ Oncology, Medical Oncology & Hematology Associates–Stoddard, Des Moines

Sydney Leach, MD, Emergency Medicine, Des Moines River Physicians, Des Moines

Jenny Butler, MD, Family Medicine, UnityPoint Clinic – Clarke County, Osceola Hazem El-Arousy, MD, PhD, Vascular Surgery, The Iowa Clinic Cardiovascular Services, West Des Moines Jennifer Erbes, MD, Emergency Medicine, McFarland Clinic PC – Urgent Care North Ames, Ames Joel Geerling, MD, Neurology, UIHC – Iowa City Gena Ghearing, MD, Neurology, UIHC, Iowa City

Kaustubh Limaye, MD, Neurology, UIHC, Iowa City Tamim Mahayni, DO, Pulmonary Diseases, McFarland Clinic PC, Ames Akrivi Manola, MD, Cardiovascular Disease, Iowa Heart Center PC – Laurel, Des Moines Andrea McGuire, MD, Nuclear Medicine, Des Moines Benjamin Miller, DO, Family Medicine, Marengo Family Medical Clinic, Marengo Heather Mohr, DO, Internal Medicine, The Iowa Clinic, West Des Moines

Scott Owen, MD, Otolaryngology, UIHC, Iowa City

Mary Rysavy, MD, OB/GYN, UIHC, Iowa City Jennifer Schubert, DO, Internal Medicine, UnityPoint Clinic, Cedar Rapids Jennifer Schuchmann, MD, OB/ GYN, McFarland Clinic PC, Ames Marc Shulman, MD, Family Medicine, McFarland Clinic PC – Sports Medicine, Ames Nancy Sullivan, DO, Anesthesiology, Mississippi Valley, Dubuque Alia Thomas, DO, Pediatrics, McFarland Clinic PC, Ames Jarrett Walsh, MD, PhD, Otolaryngology, UIHC, Iowa City Mark Westberg, MD, Oncology, Medical Oncology & Hematology Associates – Stoddard, Des Moines Robert Westermann, MD, Orthopaedic Surgery, UIHC, Iowa City

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

Iowa Medicine Fall 2017

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WELCOME NEW IMS RESIDENT AND FELLOW MEMBERS Blank Children’s Hospital Pediatrics Kristen Anderson, DO Jordan Ferguson, DO Margaret Free, MD Jacquelyn Mauk, DO Matthew Naegle, DO Safia Nawaz, MD Erin Swieter, DO Broadlawns Medical Center Family Medicine Daniel Agraz, MD Christopher Eernisse, DO Jenna Eshcol, MD David Fahey, DO Magan Gross, DO Alexandrea Jacob, DO Lindsey Kurdi, DO Heather Leong Hulstein, DO Dylan Lowe, DO April Mangrich, DO Nathan Neuberger, DO Lesa Nord, DO Thanh Phung, DO Alyssa Plouzek, MD Michael Simons, DO Joshua States, MD Spencer Turner, DO Nickolas Williams, DO Matthew Yauch, DO Transitional Year Lainee Goettsche, MD Cedar Rapids Medical Education Foundation Family Medicine Derrick Alger, MD Asghar Ali, MD Atabak Asvadi Kermani, MD Jane Fischer, MD Martin Sahakyan, MD Mina Soleimani, MD Dylan Streb, DO Genesis Quad Cities Family Medicine Mitchell Binkley, MD Averill Fuhs, DO Ann Homan, DO Matthew Kraciun, DO Manisha Kumar, MD Olakunle Oguntodu, MD Michael Sinklier, DO Iowa Methodist Medical Center, Des Moines General Surgery Daniel Locker, MD Kevin McElroy, MD Ashlea Semmens, MD Christopher Welander, MD Alexander Wickenkamp, MD

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Iowa Medicine Fall 2017

Transitional Year Cameron Koch, MD James Erickson, MD Timothy Hurst, MD Iowa Lutheran Hospital Family Medicine Samantha Banser, DO Madeline Godar, MD Sabrina Martinez, MD Matthew Molin, DO Tyler Olson, MD Cameron Overcash, MD Valerie Willis, DO Mercy North Iowa Family Medicine Shapan Debnath, MD Justin Harrington, MD Brett Mulkey, DO Jed Padre, MD Jennifer Suen, MD Brittany Waletzko Bartz, DO Mercy Medical Center, Des Moines Family Medicine Abisoye Adebayo, MD Stephanie Anyikude, MD Meryem Chaudhry, MD Catherine Del Rosario, MD Mohamed Humad, MD Huda Jarmakani, DO Micah Price, MD Nicole Zabrinas, DO General Surgery Benjamin Ferrel, DO Marc Gorvet, DO Caitlin Lund, DO Devon Peightal, DO Internal Medicine Ruth Campbell, DO Gino Chesini, DO Austin Coder, DO Omar Jaradat, MD Shane McIntyre, DO Christopher Nguyen, DO Ashley Osenga, MD Stephanie Sam, DO Katelyn Splett, DO Jacob West, DO Muk Chun Yan, DO Northeast Iowa Family Medicine Mirela Bacevac, MD Rosalie Cassidy, MD Shamim Khan, MD Linus Leivon, MD Jeremy Moncrieff, MD Sameet Moor, DO Joseph Petersen, DO

Siouxland Medical Education Foundation Family Medicine Evan Davis, MD Katie Dunbar, DO Mallory Forsyth, MD Maria Johnson, MD Erin Kastl, DO Laramie Lunday, MD Destiny Miller, MD Alana Ryan, DO Kathleen Savio, DO Ashley Tiahrt, MD Tou Lee Xiong, MD University of Iowa, Des Moines Internal Medicine Audrey Baute, DO Kaitlin Branick, MD Skyler Dahlseng, DO Mohamed Elfeki, MD Greggory Flint, DO Matthew Gannon, MD Dana Lowry, DO Ryan Meyer, MD Nam Pham, DO Patrick Shaeffer, MD Katie Thompson, DO University of Iowa, Iowa City Anesthesiology Deepak Agarwal, MD Mina Alfi, MD Jarrod Bang, MD Zachary Dalhoff, DO Gareth Gardiner, MD Derek Gartner, MD Sarah Helwege, DO Chad Jensen, DO Ethan Lowman, DO Uche Maduka, MD Anna Moldysz, MD David Padilla, MD Philip Schulte, DO Alexander Woodrow, DO Christopher Yates, DO Dermatology Jessica Harms, MD Vinesh Melvani, MD Emergency Medicine Elizabeth Buchanan, MD Benjamin Christians, DO Alexander Colgan, MD Scott Meester, MD Kaila Pomeranz, DO Alex Tomesch, MD Jessica Woelfel, MD Jeff Zavala, MD

Family Medicine – Psychiatry Nader Shakir, DO Kumi Yuki, MD Family Medicine Brandon Bingham, MD Michael Jorgensen, MD Kelly Krei, DO Ji Eun Lee, MD Roshan Razavi, DO Kelsey True, MD Dalia Youssef, MD Internal Medicine Asma Al-Zougbi, MD Nicholas Arnold, MD Sirshendu Banerjee, MD Thorarinn Bjarnason, MD Jason Cascio, MD Mohsan Chaudhry, MD Devashree Dave, MD Austin Greco, MD Aziz Hammoud, MD Amanda Heuszel, MD Kevin Hoang, MD Iiro Honkanen, MD Christopher Iverson, MD Alissa Kauffman, MD Amy Keranen, MD Behnam Laderian, MD Wei Lu, MD Matthew McGee, MD Nagalakshmi Nagarajan, MD Don Nguyen, MD Lena Sabih, MD Kevin Sanchez, MD Matthew Smith, MD Matthew Soltys, MD Roger Struble, MD Luis Vargas Buonfiglio, MD Weidan Zhao, MD Internal Medicine – Psychiatry Hashim Chaudhry, MD Ogechukwu Obiano, MD Neurological Surgery Colin Gold, MD Brian Park, MD Neurology Lama Abdel Wahed, MD Jason Duchscherer, MD Jeff Karduck, MD Kevin Kay, MD Jason Maljaars, MD Adriana Rodriguez Leon, MD Stephen Rostad, MD Emily Tamadonfar, MD


OB/GYN Colette Gnade, MD Leigh Hess, MD Emily Jacobs, MD Keely Ulmer, MD Avery Whitis, MD Occupational Medicine Marisol Sepulveda, DO Ophthalmology Christopher Fortenbach, MD, PhD Lauren Hock, MD Tyler Quist, MD Alexis Warren, MD Caroline Wilson, MD Orthopaedic Surgery Christopher Carender, MD Christopher Cychosz, MD David DeMik, MD Kyle Kesler, MD Christopher Lindsay, MD Alan Shamrock, MD Otolaryngology Megan Foggia, MD Elyse Hanly, MD, PhD Amanda Ngouajio, MD Kristen Seligman, MD Ryan Smith, MD Pathology Ibrahim Abukhiran, MD Denise Jacob, MD Joseph Laakman, MD Mohammad Obeidat, MD Rachel Starks, MD, PhD Jadon Wiese, MD Pediatrics Kristin Avery, DO Melissa Baranay, MD Timothy Boly, DO Michael Cole, MD Haley Hogan, MD Alex Hoover, MD Matthew Maves, MD Tyler Murtaugh, MD Meaghan Reaney, DO Heather Reichert, MD James Reinecke, MD Rachel Segal, MD Kamel Shibbani, MD Ryan Town, MD Alexander Tuttle, MD Oriana Vanegas Calderon, MD Psychiatry Emira Deumic, MD Shannon Hammer, MD Shea Jorgensen, MD Warren Kane, MD Kyle McGinty, MD, MPH Anthony Purgianto, MD, PhD Corinne Webb, MD

Radiology – Diagnostic Nandita Agarwal, MD Robert Becker, MD James Campbell, MD Simmi Deo, MD Nicholas Fain, MD Renato Ferreira de Silva, MD Atsuhiko Handa, MD Taylor Harms, MD Jared Hodgson, MD Matthew Hustrulid, MD Bradley Kvamme, MD Mothana Saad Eldine, MD Jakub Siembida, MD Chris Welder, MD

Clinical Cardiac Electrophysiology

Ophthalmic Plastic, Orbital, and Reconstructive Surgery

Thein Aung, MD

Bryce Radmall, MD

Endocrinology, Diabetes, and Metabolism

Orthopaedic Surgery

Hematology and Medical Oncology

Tejashree Karnik, MD

Surgery Ahmad Alzubaidi, MD Amanda Benavides, MD, PhD Rory Carroll, MD Constance Chen, MD Catherine Coyne, MD Hannah Phillips, MD Dakota Thompson, MD Catherine Tran, MD Sarah Walker, MD Adnan Al Ayoubi, MD Pauline Go, MD

Isaac Chambers, MD Christopher Strouse, MD

Shahanawaz Jiwani, MD, PhD

Urology Mark Bevill, MD Justin Drobish, MD Charles Paul, MD Andrew Vitale, MD

Iliya Amaza, MD Elizabeth Batchelor, MD Oscar Llanos Ulloa, MD Scott Schecter, MD

Vascular Surgery Jeanette Man, MD University of Iowa Fellowship Programs Anesthesiology Pain Medicine

Shruti Patil, MD Thomas White, MD

Muhammad Ansar, MD Rea Nagy, MD

Nicholas Beck, MD

Gastroenterology

Orthopaedic Foot and Ankle

Barakat Aburajab Altamimi, MD Sumant Arora, MD Munish Ashat, MD Fadi Niyazi, MD

Karthikeyan Chinnakkannu, MD

General Internal Medicine

Harry Porterfield, DO

Hospice and Palliative Medicine

Orthopaedic Sports Medicine

Andrew Freese, MD Pathology Cytopathology Molecular Genetic Surgical Pathology

Woodlyne Roquiz, DO

Amy Keranen, MD

Pediatrics

Infectious Disease

Neonatal-Perinatal Medicine

Hiroyuki Suzuki, MD

Julie Hanson, MD

Nephrology

Pediatric Cardiology

Mandeep Gill, MD Prerna Kumar, MD Agnes Ounda MD

Nikola Dragisic, MD Natasha Gonzalez Estevez, MD

Pulmonary Disease and Critical Care

Rheumatology

Priyanka Iyer, MD Aneet Kaur, MD Neurology Neuromuscular Medicine

Diana Mnatsakanova, MD Vascular Neurology Ali Sheharyar, MD Sami Al Kasab, MD

Pediatric Anesthesia

OB/GYN

Mohamad Jahangiri, MD

Female Pelvic Medicine and Reconstructive Surgery – OB/GYN

Regional Anesthesiology and Acute Pain Medicine

Hand Surgery

Pediatric Critical Care Medicine

Harsh Kothari, MD Mitchell Luangrath, MD Pediatric Gastroenterology

Asha Sukumaran Nair, MD Pediatric Hematology Oncology

Neeraja Swaminathan, MD Radiology Body Imaging

Ravishankar Pillenahalli Maheshwarappa, MD Endovascular Surgical Neuroradiology

Waldo Guerrero, MD Musculoskeletal Radiology

Richard Beutler, MD Stephane Desouches, DO Joel Pereira, MD Douglas Watt, MD Pediatric Radiology

Sarv Priya, MD

Konstantin Garibashvili, MD

Allen Mehr, DO

Dermatology

Yasmin Lyons, DO

Micrographic Surgery and Dermatologic Oncology

Ophthalmology

Lisa Chastant, MD

Cornea and External Disease

Tara McGehee, MD

Surgery

Family Medicine

Glaucoma

Plastic Surgery

Sports Medicine

Ze Zhang, MD

Christopher Madsen, MD

Ryan Kruse, MD

Medical Retina

Surgical Critical Care

Christy Cunningham, MD Surgical Retina Sam Abbassi, MD Daniel Feiler, MD

Irfan Qureshi, MD

Internal Medicine Allergy/Immunology

Javen Wunschel, DO Cardiovascular Disease

Pulkit Chaudhury, MD Faisal Matto, MD Akhil Parashar, MD Edward Powers, MD

Gynecologic Oncology

Neuro-Ophthalmology

Jane Bailey, MD

Neuroradiology

Neetu Soni, MD Vascular and Interventional Radiology

Peter Taylor, DO

Vascular Surgery

Samatha Alsop, MD, MPH Urology Katherine Cotter, MD

Ophthalmic Pathology

Francisca Zuazo Echenique, MD

Iowa Medicine Fall 2017

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MY WHITE COAT MEANS . . . That was the question posed to the 152 members of the University of Iowa Carver College of Medicine Class of 2021 prior to receiving their white coats on August 11. The responses included “Not only caring for, but caring about patients” “Mama, I made it!” “Putting others and my patients before myself “To give back to those who have helped me” “Serving my community” “The ability to heal” “I finally did it!”

Oh! The Places You Will Go!

The popular Dr. Seuss work was the basis of the ceremony’s keynote address by Steven Craig, MD, assistant dean, Des Moines branch campus. Dr. Craig shared lessons he had learned during his medical career, including Stay in touch with your family and friends. Take care of yourself. Pay attention to your physical and mental health.

Medicine is a team sport; you must learn to be a good team player. The biggest lessons have come from the mistakes made and vowing to never make them again. After imparting these lessons, he asked the students to look to their left and then right, stating, “You have an obligation to look out for and assist each other on this journey.” In closing, Dr. Craig recited a poem: “Congratulations! Today is your day. You’re off to great places! You’re off and away! You have brains in your head.

You have feet in your shoes. You can steer yourself any direction you choose. You’re on your own. And you know what you know. And you are the guy who’ll decide where to go.” Following the keynote address, the newest UI medical students and IMS members donned their white coats and received their IMS lapel pins from IMS President, Joyce VistaWayne, MD. The ceremony closed with the Class of 2021 reciting the Oath of Hippocrates. “Whether you make a difference one patient at a time or through research, remember that promise,” Patricia Winokur, MD, UI CCOM Executive Dean, told student after the reading of the Oath of Hippocrates. On behalf the IMS leadership, membership, and staff, we would like to welcome the classes of 2021 from the University of Iowa and Des Moines University. We look forward to celebrating with Des Moines University medical students during their white coat ceremony in the spring of 2018.

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Iowa Medicine Fall 2017


WELCOME NEW IMS STUDENT MEMBERS University of Iowa Carver College of Medicine

Austin DeLau Erika Dorff Sarah Dougherty Nicholas Evans Marisa Evers Megan Fellows Megan Ferguson Tyler Foley Benjamin Fick Julia Gales Margaret Gannon Waale Gbara Jenna Geick Brendan George Shadeh Ghaffari-Rafi Logan Goetzinger Kerri Golinghorst Pavane Gorrepati Brian Grieve Sarah Gross Destinee Gwee Malika Hale Hayley Hansen Cassandra Hardy Ali Hassan Michael Heffernan Erica Henderson Emma Henze Zoetta Hildreth Chloe Hlas Mitchell Hooyer Conor Houlihan Jessica Hui Ashlee Hulbert Destinee Irish Joshua James Nicholas Jensen

Patrick Rooney Jeremy Sanchez Raven Saunders-Duckett Luke Schiller Eric Schnieders Kiran Sharma Joanna Silverman Amrinder Singh Mary Skalitzky Michael Slattery Ryan Staudte Alaina Studt Sierra Stuerman Allison Thilges Robert Thinnes Hannah Thompson Cassandra Tomberlin Jonathan Trinh Victoria Troesch Richard Uhlenhopp Justin Valdez Sarah Van Dorin Brandon Vander Stoep Joseph Vecchi Joyce Wahba Mackenzie Walhof John Walsh Kyle Walsh Cheryl Wang David Wang Michael Warhank Sanjeeva Weerasinghe Benjamin Wilkinson Sophia Williams-Perez Betelehem Wole Nealy Wooldridge Kelly Yom Tong Yu Kasra Zarei

PHOTOS BY SUSAN MCCLELLEN / COURTESY UNIVERSITY OF IOWA CARVER COLLEGE OF MEDICINE

Roshan Abid Russ Adwan Heba Albazboz Soham Ali Christoffer Amdahl Julie Amendola Erik Anderson Steven Arce Mitchell Arends Nolan Asprey Olivia Atari Elijah Auch Sarah Bakir Kayla Bartos Nicholas Bartschat Theresa Benskin Shelby Bloomer Jayden Bowen Madeleine Brindle Nicholas Caldwell Jeffrey Carley Brian Casillas Claire Castaneda Grace Chabal Melissa Chan Samantha Cheng Kevin Cheung Joseph Chin Dabin Choi Michael Clapp Lauren Coffey Holly Conger Gabriel Conley David Crompton Andres Dajles Tucker Dangremond Lucas De Jong

Alyssa Johnson Brandon Johnson Nathaniel Johnson Andrew Kalenkiewicz Austin Kazarian Michael Klemme Erik Kneller Sarah Kottenstette Kevin Lawrence Steven Leary Kyle Leubka Weiren Liu William Lorentzen Katharine Marsden Timothy Maxwell Christine Mbakwe Anne Meis Arthur Mercado Katherine Merritt Rory Metcalf Drew Miller Vaelan Molian Marcus Munoz Anne Nora Michael Orness Daniel Pape Arham Pasha Madeline Peters Jared Peterson Vivian Pham Daisy Pilarczyk Andrew Poggemiller Hannah Pope Gregory Power Cindy Puga Deepika Raghavan Madalyn Rasor Anne Rempel Josiah Roller

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SPOTLIGHT: LETTING CHILDHOOD BEGIN Letting Childhood Begin is the theme of the Blank Children’s Support Teams for Achieving Resiliency (STAR) Center’s Foster Care Clinic. Walking into the clinic, it looks very much like other pediatric waiting rooms with an assortment of toys and underlying hum of childhood energy. However, this clinic is different in that it only serves foster children and their biological and foster parents.

The American Academy of Pediatrics classifies foster children as having special healthcare needs. Dr. McCann was seeing evidence of that during initial examinations, which could take up to two hours to complete. “Foster care can be a place to heal for children and their family. This is the approach that we take: Heal and move forward,” explained Dr. McCann.

From an Idea to Reality

The Foster Care Clinic is modeled similarly to the Rees-Jones Center for Foster Care Excellence in Dallas, Texas. Dr. McCann and his team were able to obtain grant funding to visit the clinic in Dallas and formulate the implementation plan to establish the Foster Care Clinic.

When the Blank Children’s Hospital STAR Center Medical Director, Ken McCann, MD, FAAP, was asked what led to the establishment of the clinic, he explained that during the health examination required by Iowa’s foster care program, children in the foster care system typically: Do not have an identified primary care physician Do not have a medical or dental home Have undiagnosed conditions (i.e., uncontrolled asthma, eczema, etc.) Many have behavioral health issues

The clinic opened in January of this year and operated one day a week through June. Currently, the clinic conducts primary care services three days and behavioral services four days a week. It is anticipated that the clinic will operate both medical and behavioral health services five days a week in 2018 and see 200– 300 patients. Serving a primarily Medicaid population, the clinic relies greatly on community funding to expand its services to meet the needs of this population.

Services Provided

Dr. McCann saw a need for a clinic that meets the special healthcare needs of foster children. 32

Iowa Medicine Fall 2017

The clinic offers services for children through the age of 18 and include Primary care medical services, well-child exams, and sick visits Mental health assessment, shortterm therapy, and ongoing therapy Comprehensive health assessment upon placement in the foster care system Developmental assessment Care coordination and information gathering

Care coordination includes interoffice coordination between primary care services and the behavioral health services, as well as specialists to meet patient needs. A typical appointment runs 30 to 90 minutes to allow adequate time to properly assess and treat medical and/ or behavioral healthcare needs. This method ensures that the child’s needs are always at the center of care. This is a pediatric practice; however, the counseling services provided are for the entire family. The behavioral health counselors regularly meet with both the biological and foster parents without the children needing to be present. The clinic staff strongly believes the parents involved want what is best for the children. If they are missing appointments or not complying with treatment plans, the staff wants to know what barriers are causing this behavior. “We want to knock down those barriers” said Dr. McCann. Children and families are referred to the clinic in a variety of ways: word of mouth, the Iowa Department of Human Services, healthcare providers, and past involvement.

Letting Children Tell Their Story Children that have experienced abuse and neglect must often tell their story to their healthcare provider, behavioral health provider, law enforcement, and others. The goal with the STAR Center is to have the child tell their story as few times as possible to avoid additional trauma. To achieve this goal, the interview rooms have been designed with two-way mirrors that allow for law enforcement and others to see the child


and hear the interview. The children are always made aware of who is on the other side of the mirror, and the sessions with the forensic interviewers are recorded. “Many times the child gets so involved with the interviewer that they forget about the mirror and who else is listening to their conversation,” said Dr. McCann.

Post-Foster Care Monitoring

Employee of the Month

Data and Benchmarking

As he walked past a picture of a smiling child holding on to a Golden Lab, Dr. McCann’s eyes lit up and he proclaimed, “That is our Employee of the Month every month!”

In the pay-for-performance environment of health care today, every practice is looking at the data collected and benchmarks to be achieved. Blank Children’s STAR Center’s Foster Care Clinic’s outcome goals are very different than other practices and align with the Department of Human Services. These include Reducing the number of homes a child is placed in or keeping them from “bouncing” from one home to another trying to find the right fit. Reducing the incidences of a child being repeatedly placed in foster care after being returned to their biological parents.

The dog in the picture, Lily, is a critical member of the care team. Dr. McCann explains that many children visiting the clinic have anxiety when they have to share their traumatic experiences. Lily will sit with children in the waiting room, walk them into the interview room, and patiently wait outside the door to walk them back to the waiting room. “It’s not uncommon to walk out to the waiting room and see a child lying on the floor with Lily,” shared Dr. McCann. Besides being a therapy dog, Lily is also a courthouse facility dog, so if a child needs to testify in court, Lily is allowed to be there for support.

The services provided by the clinic do not end when the child is reunited with their biological parents or adopted by foster parents. The staff continues to work with the family for six months to assist in finding a permanent medical/dental home and with the overall transition.

Message to the Iowa Healthcare Community At the conclusion of the interview with Dr. McCann and Renae Jones, mental health therapist, they were asked what they would like the Iowa healthcare

Exam rooms are decorated with words of encouragement and inspiration. community to know about the clinic and services? “To think of us as a resource,” said Dr. McCann. “Whether it is answering questions regarding possible options or providing a consultation, we are available to help.” What “red flags” should physicians and other healthcare providers be looking for with this population? “As soon as you pick up on stress within the family, you need to act. We have had some families who have been at their wits’ end before seeking help, and by that time the child needs to be placed in another home,” McCann responded. Currently the program is serving only the Des Moines metro area, but hopes are to establish similar clinics throughout the state in the future.

Goal of the Clinic “Once the abuse stops, letting childhood begin.”

A behavioral health professional talks with a teen.

For more information regarding the Blank Children’s Hospital STAR Center or the Foster Care Clinic, visit its website at www.blankchildrens.org/ STARCenter or call (515) 241-4311.

Iowa Medicine Fall 2017

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ON THE ROAD WITH IMS

7 Medical Center

Anesthesiologists, Des Moines

8 Mercy Medical Services,

5 9 11 12 2 4 8 13 14

Sioux City

9 North Iowa Anesthesia

Associates, Mason City

10 Physicians’ Clinic of Iowa,

1

Cedar Rapids

6

10

11 Pathology Associates of

Mason City, Mason City

12 Radiologists of North Iowa, 3

PC, Mason City

7 1516

13 Siouxland Cancer Center, Sioux City

14 Siouxland Medical

Education Foundation, Sioux City

15 UnityPoint Health Clinics, In July your IMS Board of Directors gave the directive that the staff is to go out and meet the membership. Staff members have embraced this and have been traveling across the state to meet with IMS members, practice and hospital administrators, county medical societies, and other healthcare organizations. Some of these travels have included social events such as the medical student and resident event held on August 10 in Iowa City. This event was held in conjunction with the University of Iowa Carver College of Medicine White Coat Ceremony. Read more about this monumental day for UI medical students on page 30. IMS Director of Government Affairs, Dennis Tibben, was invited to be a guest speaker for multiple groups and organizations, including UI CCOM AMA/IMS Chapter Meeting – August 14 in Iowa City DMU AMA/IMS Chapter Meeting – September 15 in Des Moines Cerro Gordo Medical Society Meeting – October 3 in Mason City

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Iowa Medicine Fall 2017

On the Map Mike Flesher, IMS Executive Vice President & CEO, and Kara Bylund, IMS Director of Membership & CME, have been visiting with physicians and clinic and hospital leaders to discuss their successes, challenges, new IMS initiatives and offerings, and ways IMS may be of assistance to physicians and practices. The IMS staff would like to thank the leaders from the following organizations for meeting with us in August, September, and October:

1 Cedar Valley Medical Specialists, Waterloo

2 Family Health Care of Siouxland

3 Iowa Heart Center, PC, West Des Moines

4 Jones Eye Clinic, Sioux City

5 Mason City Clinic, Mason City

6 McFarland Clinic, PC, Ames

Des Moines

16 UnityPoint Health – Des Moines

We Are All in This Together — the theme of the 2018 IMS Membership Campaign — recognizes that collaborating with other organizations is essential to assisting physicians in meeting their needs and those of their patients. Staff members have also had meetings with the following county and regional organizations to build and strengthen relationships to assist in meeting this goal: Linn County Medical Society Board Paramount Health Options Scott and Polk County Executive Directors Woodbury County Medical Society Board Staff members have visits, meetings, and guest speaking opportunities planned for Davenport, Dubuque, Marshalltown, Waterloo, and other locations in the coming months. For practices interested in meeting with IMS, contact Kara Bylund (kbylund@ iowamedical.org) at (515) 421-4776.


UIUPDATE

A LOOK BACK AND AHEAD By Jean Robillard, MD

BY JEAN ROBILLARD, MD Dr. Robillard is vice president for Medical Affairs and dean of the Roy J. and Lucille A. Carver College of Medicine at the University of Iowa.

As the University of Iowa prepares to welcome a new leader of University of Iowa Health Care and the Roy J. and Lucille A. Carver College of Medicine, this will be my last column for Iowa Medicine. Looking back, I can truly say that serving the people of Iowa has been the greatest privilege of my career. I didn’t know much about Iowa when I arrived in 1973 as a pediatric nephrologist researching the fetal kidney. But I learned that Iowa is a fabulous state — where the people are true, honest, and understand the value of quality education and health care. In Iowa I also found university colleagues as well as government and healthcare leaders with whom I could work collaboratively to serve the people of Iowa and beyond. Over time, as I became the dean of the Carver College of Medicine and then also vice president for Medical Affairs, it became clear that to continue to be successful in our tripartite mission of patient care, education, and research in the rapidly changing healthcare environment, we, too, would need to change.

And so, in 2007, under the leadership of interim UI President Gary Fethke, we formed UI Health Care to fully integrate the college, the hospitals and clinics, and the faculty practice plan into one unified academic medical center. In the past 10 years UI Health Care has been guided by a common mission and vision with shared values and an integrated strategic plan, which have helped achieve remarkable change and growth in all mission areas to better serve the people of Iowa and beyond. I encouraged the team to be bold and to embrace change. I am proud of the many achievements over the past decade made possible by UI Health Care’s hard-working faculty, staff, students, volunteers, and other partners working together to bring Iowa’s only academic medical center to new heights of excellence:

Served a record number of patients Opened multiple new patient care locations on our campus and around the state, including UI Health Care — Iowa River Landing and the University of Iowa Stead Family Children’s Hospital Increased research funding and philanthropic gifts Created a hub for biomedical research with the John and Mary Pappajohn Biomedical Discovery Building and several key research institutes, including the Iowa Neuroscience Institute, Fraternal Order of Eagles Diabetes Research Center, Steven A. Wynn Institute for Vision Research, and Iowa Institute for Biomedical Imaging Expanded educational opportunities and implemented new medical school curriculum Developed statewide healthcare partnerships, such as the University of Iowa Health Alliance Our 2017–2020 integrated strategic plan is the result of

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UI Health Care will soon move forward under new leadership, and I am confident it will continue to be a strong, successful enterprise. extensive planning sessions that explored how academic medicine might evolve and considered how economic growth, consumerism, personalized medicine, and the growth of “big data” and other technologies will permeate all aspects of what we do. It is clear that the pace of change in science and medicine will continue and require us to be more responsive and flexible than ever before. Like the recently adopted Iowa Medical Society strategic plan, UI Health Care’s strategic plan has five main goals and also sees strong partnerships as key to growth and service.

Our plan goals span each of the mission areas and provide for the best people; collaborative learning, research, and care models; nimble structure and accountable culture; diversified financial resources; and strong partnerships. Strong partnerships is also one of the goals in the IMS strategic plan. There is no doubt about the common ground for our partnership with the IMS. We value our relationship, and we will continue our collaborations as we both advance through new partnerships with communities, providers, and industry.

UI Health Care will soon move forward under new leadership, and I am confident it will continue to be a strong, successful enterprise. I also know the new leader will find, as I did when I first arrived in Iowa, a welcoming community, a collaborative environment, and many, many great educators, scientists, physicians, students, and staff who are committed to changing medicine and changing lives in Iowa and beyond. I will remain on the faculty in the Department of Pediatrics and look forward to being part of the great things in UI Health Care’s future.

Mark Your 2018 Calendars! FEBRUARY 2018 8 Physician Burnout and Professional Resiliency Conference 28 Physician Day on the Hill (#PDOTH) APRIL 2018 27–28 IMS Annual Conference (#IMSAC2018)

For more information visit www.iowamedical.org and click on the Events tab. 36

Iowa Medicine Fall 2017


VECTORS & VIEWPOINTS

® IMS EDITION

VECTOR: SMALL CHANGES MAKE A BIG DIFFERENCE

MILES ADD UP SHEA MEARS, CPA, CFP®, MBA Lead Advisor

We invite you to experience a complimentary, absolutely no-obligation review of your finances and a second opinion. Just like a patient receives second opinions, so should you! Give us a call at 1.844.437.1105 or visit www.fostergrp.com/IMS

Can your business miles reduce your tax liability? The short answer is yes. However, in order for the miles to be deductible, they cannot be incurred while commuting to your primary place of business. Mileage can be deducted if incurred while traveling either to a temporary work location or from your primary work location to a secondary work location. The first is straightforward. If you are covering someone’s practice short-term, keep track of the miles and they can be deducted at the end of the year. The second is a little more complex. The mileage to your primary work location is not deductible. If you have a second job, the mileage from your home to your second job is also not deductible. However, if you travel from your first job to your second job, those miles are deductible. With that said, the 2017 IRS rate is 53.5 cents per business mile. Total mileage needs to exceed 2% of your Adjusted Gross Income to be deductible, and you must itemize deductions to see any kind of tax benefit. It is possible to deduct mileage. It’s just a little challenging to incur qualified mileage in an amount that benefits your taxes.

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IOWA MEDICAL SOCIETY

Iowa Medicine Fall 2017  
Iowa Medicine Fall 2017  

The journal of the Iowa Medical Society

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