Winter 2017 Vol. 107/1
A Prescription for Professional Burnout Candor Pilot Site a Success Renewing Passion and Purpose in Practice 2017 IMS Legislative Agenda
We invite you to grow with us. We are University of Iowa Physicians, the state’s largest multi-specialty medical and surgical group, with 800 physicians representing 200 subspecialties. Currently we are actively recruiting physicians who have a strong commitment to primary care, in the fields of Family Medicine, Internal Medicine, and Pediatrics, as well as many other specialties. Visit medicine.uiowa.edu/uiphysicians to learn more about our excellent benefits and exceptional support.
THANK YOU!
A SPECIAL THANK YOU TO OUR MEMBERS WHO ARE “ALL IN” IN 2017 100 percent of physicians in the following groups have joined the Iowa Medical Society in 2017. We appreciate your support and commitment! LARGE GROUPS McFarland Clinic Associated Anesthesiologists, PC Medical Associates of Clinton Blank Children’s Hospital Medical Center Anesthesiologists, PC Covenant Clinic Radiology Consultants of Iowa Grand River Medical Group The Iowa Clinic Iowa Heart Center University of Iowa Physicians SMALL GROUPS Amana Family Practice Clinic Avera Medical Group – Spirit Lake Medical Center Burgess Family Clinic – Mapleton Burlington ENT Clinic, West Burlington Burlington Pediatric Association, PC, West Burlington Cedar Valley Medical Specialists, PC – Eye Care, Waterloo Charles City Family Health Center Cherokee Regional Clinics Cresco Medical Clinic Dermatology & Dermatologic Surgery Center, PC, Clive Des Moines Eye Surgeons, West Des Moines Doran Clinic for Women, Ames Dubuque Anesthesia Services, PC Dubuque Obstetrics & Gynecology, PC Dubuque Surgery, PC ENT Medical Services, PC, Iowa City Family Health Care of Siouxland – Indian Hills Clinic, Sioux City Family Health Care of Siouxland – Morningside Clinic, Sioux City Family Health Care of Siouxland – South Sioux Clinic, Sioux City Family Medicine LLP, Grinnell Fox Eye Laser & Cosmetic Institute, PC, Cedar Rapids Franklin Medical Center, Hampton Fuerste Eye Clinic, Dubuque Genesis Pulmonary Associates, Davenport Great River Urology, West Burlington Guthrie Family Medicine Center, Guthrie Center Iowa Cancer Specialists, PC, Davenport Iowa City Dermatology Iowa Eye Center, Cedar Rapids Iowa Retina Consultants, West Des Moines Jones Eye Clinic, Sioux City Kossuth Regional Health Center Clinic, Algona Medical Clinic, PC, Hamburg Medix Occupational Health Services, Ankeny Mercy Clinics North Iowa Administration, Mason City Mercy Diabetes Center – North Iowa, Mason City Mercy East Pediatric Clinic – Pleasant Hill Mercy Family Clinic – Regency, Mason City Mercy Family Clinic – Forest City Mercy Family Clinic – Forest Park Mercy Family Clinic – Rockford Mercy Family Medicine Residency Faculty – North Iowa
Mercy Kidney Center, Mason City Mercy Medical Clinic – Centerville Mercy Pediatric & Adolescent Clinic – Clear Lake Mercy Pediatric & Adolescent Clinic – North Iowa, Mason City Mercy Pediatric Clinic, Cedar Rapids Mercy Urbandale Aurora Medical Clinic Mercy Urgent Care, Mason City Mercy Women’s Health Center – North Iowa, Mason City MercyCare Center Point Mid Iowa Fertility, PC, Clive Midwest Radiology & Imaging, Spencer Mitchell County Regional Health Center – Osage Clinic, Osage Myrtue Medical Center – Harlan Clinic, Harlan NE Iowa Family Practice Center, Waterloo Neurosurgery of North Iowa, PC, Mason City NW Iowa Bone Joint & Sports Surgeons, Spencer NW Surgery, Orange City OB/GYN Associates, PC, Cedar Rapids Ottumwa OB/GYN Physicians, LLC Ottumwa Regional Primary Care Pathology Associates, Dubuque Pediatric Associates Ottumwa Pediatric Cardiology, PC, Des Moines Physicians Lab of Northwest Iowa, Spencer Prairie Pediatrics & Adolescent Clinic, PC, Sioux City Radiologic Medical Services, PC, Coralville Red Oak Internal Medicine Siouxland Medical Education Foundation Faculty, Sioux City Siouxland OB/GYN, PC, Sioux City Siouxland Urology Associates, PC, Dakota Dunes Siouxland Women’s Health Care, Sioux City St Anthony Regional Hospital, Carroll Steindler Orthopedic Clinic, PLC, Iowa City The Group – OB/GYN Specialists, PC, Davenport UnityPoint Clinic Family Medicine – Huxley UnityPoint Clinic Family Medicine – Ingersoll, Des Moines UnityPoint Clinic Family Medicine – Mulberry, Muscatine UnityPoint Clinic Family Medicine – Northwest, Windsor Heights UnityPoint Clinic Family Medicine – Physical Therapy, Altoona UnityPoint Clinic Physical Medicine & Rehabilitation – Methodist Plaza, DM UnityPoint Clinic Surgery – Bettendorf Waterford Family Medicine, Davenport
IOWA MEDICAL SOCIETY Large Groups consist of 20 or more physicians, Small Groups consist of 2-19 physicians. Current as of January 15, 2017
IOWA
EDICINE Journal of the Iowa Medical Society
Winter 2017
Vol. 107/1
CONTENTS IN THIS ISSUE
CONTACT US Iowa Medicine 515 East Locust Street, Suite 400 Des Moines, IA 50309 Phone: (515) 223-1401 or (800) 747-3070 IMS President Paul Mulhausen, MD, MHS, FACP, AGSF Executive Editor Clare M. Kelly Managing Editor Bobbie Russie To Advertise Contact Michelle Dekker Phone: (515) 421-4778 Email: mdekker@iowamedical.org Subscriptions Annual Subscription $45 Iowa Medicine, Journal of the Iowa Medical Society (ISSN 0746-8709), is published quarterly by the Iowa Medical Society, 515 East Locust Street, Suite 400, Des Moines, IA 50309. Periodicals postage paid at Des Moines, Iowa and at additional mailing offices. Postmaster: Send address changes to Iowa Medicine, Attention: Crystal Swanson, 515 East Locust Street, Suite 400, Des Moines, IA 50309. Editorial content: The Society is unable to assume responsibility for the accuracy of submitted material. Editorial inquiries should be directed to the Editor, Iowa Medicine, 515 East Locust Street, Suite 400, Des Moines, IA 50309. Copyright 2017 Iowa Medical Society. Opinions expressed by authors do not necessarily represent the official policy of the Iowa Medical Society. Iowa Medicine does not assume responsibility for those opinions. Products and services advertised in Iowa Medicine are neither endorsed nor guaranteed by the Iowa Medical Society unless specifically noted. Get Connected Stay up-to-date with IMS on Facebook, Twitter, LinkedIn, and YouTube.
18 2017 IMS LEGISLATIVE AGENDA The November elections resulted in some of the most significant changes in Iowa politics in a generation. Transitions in control of the legislature and leadership of the executive branch will greatly impact a number of policy measures of interest to the house of medicine. In this edition of Iowa Medicine, we look at the IMS Legislative Agenda for the 2017 Legislative Session on page 18.
MARK YOUR CALENDARS! PHYSICIAN DAY ON THE HILL is March 15, 2017. Wear your
white coat and join your colleagues to discuss important health policy issues face-to-face with lawmakers in Des Moines.
IMS CORE PURPOSE To assure the highest quality health care in Iowa through our role as physician and patient advocate.
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The 2017 IMS ANNUAL CONFERENCE will take place April 28-29, 2017, at the Des Moines Marriott Downtown. Make plans for this two-day educational conference, with the goal of Renewing Passion and Purpose in Practice.
Upcoming Events FEBRUARY February 16 at Noon IMS Board of Directors meeting, video conference
6 A PRESCRIPTION FOR PROFESSIONAL BURNOUT Paul Mulhausen, MD, MHS, FACP, AGSF, president of IMS, addresses this growing problem and shares IMS’ plan to provide members with peer support, education, and ways to renew passion for practicing medicine on page 6.
ALSO INSIDE From The CEO....................................................................... 4 President’s Corner: A Prescription for Professional Burnout........... 6 Legalese: Candor Pilot Site a Success....................................... 8 Renewing Passion and Purpose in Practice............................... 12 IMS Members in the News.................................................... 14 New IMS Members.............................................................. 16 2017 IMS Legislative Agenda................................................ 18 DMU Update: A National Upset............................................ 22 Your Practice: Content Marketing........................................... 24 Your Money: Make Your Goals Systematic in 2017.................. 26 Flashback to 1992............................................................... 28
MARCH March 10–23 IMS Policy Forum: Call for Action Phase March 15 at 11:30 a.m. Physician Day on the Hill, Des Moines March 17 National Resident Match Day March 24–April 6 IMS Policy Forum: Testimony Forum Phase March 30 National Doctors’ Day APRIL April 28 IMS Policy Forum, Des Moines April 28 IMS Executive Committee meeting, Des Moines April 28 IMS Board of Directors meeting, Des Moines April 28 IMS Health Care Executive Section meeting, Des Moines April 28–29 IMS Annual Conference, Renewing Passion and Purpose in Practice, Des Moines MAY May 12 University of Iowa Carver College of Medicine Commencement, Iowa City May 26 Des Moines University College of Osteopathic Medicine Commencement, Des Moines JULY July 1 IMPAC’S Docs ‘n’ Pops, Des Moines
Iowa Iowa Medicine Medicine Winter Winter 2017 2015
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FROMTHECEO
TO MAKE AN END IS TO MAKE A BEGINNING By Clare M. Kelly, Executive Vice President & CEO
CLARE M. KELLY Ms. Kelly is executive vice president and CEO of IMS.
At the turn of the New Year, I sat down with my 2017 calendar to begin planning for the year. I filled the empty white squares with work trips and projects, workouts (schedule it or you won’t go!), volunteer activities, my dog’s vet appointment, dental and physician appointments, family birthdays, etc., and soon the calendar was filled with activities and obligations. One year: 12 months; 52 weeks; 365 days; 8,760 hours; 525,600 minutes. The year is a blank canvas of time and opportunity. What will you do this year to fill your empty white squares? Perhaps you will take time to explore your passions and what drives you. Exploring career, passion and purpose is exactly what we’ll do at the 2017 IMS Annual Conference, to be held April 28-29 at the Des Moines Marriott Downtown. The IMS Program Committee selected Renewing Passion and Purpose in Practice as the theme for this year’s conference, and I think it’s a winner. Brian Privett, MD, IMS Program Committee chair, provides a great overview of the education tracks planned for the conference on page 12. State and national experts will highlight education in four areas: leadership development, physician wellness, chronic pain management
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and practice transformation. Learn, socialize, network, earn CME hours — renew your passion for medicine! Don’t miss out! IMS President Paul Mulhausen, MD, has his finger on the pulse of the profession with his column on page 6, A Prescription for Professional Burnout. He quotes a recent article in the New England Journal of Medicine in which the authors proffer a solution for improving professional satisfaction: “Perhaps the greatest opportunity for improving our professional satisfaction in the short term lies in restoring our connections with one another. . . .” (Psssst, see above). Dr. Mulhausen reflects on the challenges of being a physician today, and the unanticipated factor that “brought the greatest value to his professional development and satisfaction.” In his first column for Iowa Medicine, Greg Christiansen, DO, MEd, FACOEP-D, the new Dean of the Des Moines University College of Osteopathic Medicine, proposes two factors that have influenced the current state of physician leadership: 1. The role of social media on the collective consciousness of the next generation of physicians; and 2. Reconciling what it means to be a physician in our communities. This thoughtful piece urges physicians to embrace the role of mentor.
“Simply, students want to learn from our wisdom and, like our patients, are yearning to see that wisdom communicated into action. Consider the impact of your leadership, mentorship, and stewardship. Your legacy can shape the future.” When I depart IMS in May to pursue new personal adventures and professional opportunities, I will do so with the confidence that this organization — this strong, traditionrich professional association — will continue to build upon its legacy of serving Iowa’s physicians with dedication, passion, and purpose. It has been an honor to serve as your CEO for these last nearly five years. Serving the profession my dad practiced for 40 years has been professionally gratifying and personally very meaningful. I extend my warm appreciation to the many physicians, clinic administrators and colleagues who make IMS such a special place to work, and who inspired me to give my best each day. Giving our best each day is what we do at IMS, and we do it for you. When our team completes a big project or tackles a difficult situation, I urge them to the next challenge with a single word, onward, because we must keep moving forward. In his poem Little Gidding, T.S. Eliot wrote, “For last year’s words belong to last year’s language. And next year’s words await another voice. And to make an end is to make a beginning.” Here’s to 2017, making time to explore your passions and purpose, and beginnings. Onward. •
#PDOTH
PHYSICIAN DAY HILL MARCH 15, 2017 ON THE
JOIN YOUR FELLOW PHYSICIANS, RESIDENTS & MEDICAL STUDENTS
Decisions made by Iowa’s General Assembly have an impact every day on physicians, patients, and the practice of medicine in our state. To educate lawmakers and ensure physicians have a voice in the legislative process, we invite you to join your colleagues from across Iowa for this vital day of grassroots advocacy.
WEAR YOUR
WHITE COAT & STAND OUT
IN THE CROWD
PRESIDENT’SCORNER
A PRESCRIPTION FOR PROFESSIONAL BURNOUT By Paul Mulhausen, MD, MHS, FACP, AGSF
PAUL MULHAUSEN, MD, MHS, FACP, AGSF Dr. Mulhausen is board certified in Internal Medicine and Geriatrics and serves as the chief medical officer of Telligen in West Des Moines. He is the president of IMS.
In the closing months of 2016, my work with the Iowa Medical Society gave me the privilege of visiting with many fellow physicians across our wonderful state. It is a deep honor to meet with colleagues who are so committed to the well-being of their patients, their communities, and our profession. Simultaneously, I am concerned to hear the all-too-common tales of exhaustion, stress, and frustration at work — classic signs of professional burnout.
The stressors of rapid change, such as payment reform, knowledge growth, technology advancements, and cultural roles, have caused many of our colleagues to question the meaning of our work and to lose the inspiration that brought them to our profession. According to a 2015 IMS survey, half of Iowa physicians are experiencing moderate to significant professional burnout, while about 31% selfreport as somewhat burned out. Tragically, 6% of our Iowa physicians report complete exhaustion of motivation due to prolonged stress or frustration at work. Think about that at your next medical staff meeting; one quarter of your colleagues are burning out and someone in the room may already be burned out. The rising rate of physician burnout suggests to me that too many of us are losing our connection to the deeper meaning of our work. Too many of us in the medical profession are
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losing our connections with each other. In a recent thought piece published in the New England Journal of Medicinei, David Rosenthal, MD, and Abraham Verghese, MD, reflect on the changing nature of medical work and the impact of these changes. They diagnose a profession in which much of the work now distracts us from the “lives, bodies, and souls of the people entrusted to our care. . . .” Doctors Rosenthal and Verghese also reflect on the changing “fraternal order” of medicine and diagnose an ever-declining collegiality. What’s the remedy? They propose a multimodal treatment plan, but it is the following fix I found most inspirational: “Perhaps the greatest opportunity for improving our professional satisfaction in the short term lies in restoring our connections with one another. . . .” — physicians with patients, physicians with our care team, and physicians with physicians.
Our Iowa Medical Society recently convened a Physician Burnout Task Force, led by Marshalltown’s Douglas Steenblock, MD, to determine how to best support Iowa physicians at risk of or currently experiencing professional burnout. Comprised of practicing physicians, physicians in residency, and medical students, the Task Force recommended IMS identify ways to reduce many of the administrative burdens that contribute significantly to work dissatisfaction and foster an environment that helps us successfully combat professional burnout. The Board of Directors has embraced this recommendation and is now working with staff to address the unique circumstances that contribute to burnout at different stages in a physician’s medical career: medical student, resident, early-, mid-, and late-career. We will create opportunities to provide in-person and virtual education to aid our colleagues who are at risk for, or already suffering from professional burnout. We will develop and strengthen the society’s long commitment to professional and personal collaboratives. We will develop and act on strategies to advocate in the public sphere for relief from excessive administrative burden. More than ever, we need the Iowa Medical Society. We need this most valuable professional space. It’s a space to meet and become acquainted with our colleagues from different specialties, areas of the state, and systems of care.
Since its earliest history, the Iowa Medical Society has been dedicated to collegiality, communication, and deliberation. In his 1868 address to our Iowa Medical Society, Dr. William Watson praised this unique value of the society during a period of national crisis, noting, “Our Society has done much good by promoting acquaintance and awakening cordial friendship among professional men residing in distant sections of the state, an acquaintance that was of great importance in organizing to perform the part assigned to the profession in the stirring events of the past six years.” ii In my 20 years of engagement with the Iowa Medical Society, it is these qualities of shared connection, communication, and reflection that I have found of greatest value to my professional development and satisfaction.
We meet to share, deliberate, and act — the key word being “meet.” We meet to build our connections to one another. We meet to understand each other’s stories. We meet to find shared purpose and to create common cause within the profession. We meet to nurture community forged in our common oath to serve as healers through medicine. We meet at the Iowa Medical Society to rejuvenate and sustain the original purpose of our work — “to witness others’ suffering and provide comfort and care,” says Rosenthal. To witness the suffering of others has emotional costs. To provide comfort and care, we must create the environments — physical, administrative, and human — that support our connectedness, rejuvenate our spirits, and foster both healing and prevention for our patients and ourselves.
Doctors Rosenthal and Verghese call on our profession to “. . .promote the sorts of human connections that sustain us. . . .” I encourage you to start with us, the Iowa Medical Society. Come Meet! Come Share! Come Deliberate! Come Act! Let our collective work, as the physicians of Iowa, be a part of the rejuvenating force that sustains our joy, happiness, and success as healers during these times of great stress and uncertainty. •
i Rosenthal DI, Verghese A. Meaning and the Nature of Physicians’ Work. N Engl J Med 2016; 375:1813-1815. ii Fairchild DS. History of Medicine in Iowa, reprinted from the Journal of the Iowa State Medical Society, 1927, The Iowa History Project. iagenweb.org/ history/Medicine/
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Extraordinary Care, Every Day Iowa Medicine Winter 2017
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CANDOR PILOT SITE A SUCCESS LEGALEASE
IMS receives grant to further Candor education By Kate Strickler, JD, LLM
KATE STRICKLER, JD, LLM Ms. Strickler is the general counsel for IMS, and serves as the lead at IMS for the Candor program.
A pregnant patient arrived at the emergency department. She waited in the ED for a period of time before being sent to obstetrics. By the time she reached obstetrics, she needed an emergency cesarean section — which ultimately resulted in a stillborn infant. There was concern that the patient was in the ED for too long without proper monitoring or aggressive enough medical treatment. Such is the worst nightmare scenario for any physician, and it is the situation that occurred at a Candor (Communication and Optimal Resolution) pilot site in southeast Iowa this past year. 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
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fetal heart rate in the ED by the OB department, and established a protocol that any OB patient in the ED requiring antihypertensive treatment be sent to labor and delivery immediately. Through the Candor process, the patient-physician relationship was maintained and systemwide clinic changes were implemented to avoid a similar outcome in the future. Years of costly litigation were avoided. Both the physician and the patient avoided the stress and anxiety surrounding litigation.
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. Using Candor gives patients honest and frank answers about the circumstances surrounding the adverse outcome, and gives them the ability to participate in implementing procedures to prevent similar outcomes. The process is also much faster than traditional lawsuits, so patients with legitimate claims receive faster resolutions. Candor also allows physicians to spend more time in the exam room and less time in the courtroom, and is less likely to
result in reports to the National Practitioner Data Bank. The law making the Candor discussion confidential went into effect July 1, 2015. Since that time, the Iowa Medical Society has worked with the southeast Iowa pilot site to establish a program. In less than a year, two adverse outcomes have been addressed through Candor, and both reached a successful resolution, maintaining the patientphysician relationship. More discussions are ongoing. The experience of the clinic in southeast Iowa was beneficial for the patients and for the physicians, but other parties were also involved. The medical malpractice insurance carrier for the clinic had representatives
involved in the discussions about the event as well as settlement discussions, and was supportive of the process. In addition, each of the patients had legal counsel present through all stages, and counsel was encouraging of the Candor program. While the plaintiff’s attorneys ultimately received less compensation representing a patient through Candor rather than through a traditional lawsuit, attorneys have recognized that this process is better for patients and requires a significantly smaller time commitment. IMS applied for and received a grant through the COPIC Foundation to further its work in promoting and educating Iowa’s physicians and healthcare leaders about Candor.
With the dedicated funding, IMS is in the process of identifying and securing an additional pilot site and developing new educational resources. In addition, recognizing the need to train all parties to a potential lawsuit, IMS is planning a Candor conference designed not only for physicians, but also for risk managers, hospital and clinic leaders, and attorneys. Look to the IMS Weekly Debrief for more information about the conference, planned for September 2017. For more information about Candor, or to be considered for a pilot site, please contact Kate Strickler at kstrickler@ iowamedical.org. •
submit requests to the IMS policy forum All IMS members are encouraged to participate in the official policy setting process. Submit your Policy Request Statement to imspolicy@iowamedical.org for consideration at Policy Forum 17-1 on April 28. Submissions are due by March 23rd.
this is YOUR society, we welcome (and need) your input IOWA MEDICAL SOCIETY
Iowa Medicine Winter 2017
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REGISTER TODAY! IOWA MEDICAL SOCIETY
IMS ANNUAL CONFERENCE Interested in Sponsoring or Exhibiting at the Conference?
April 28-29, 2017 Des Moines Marriott Downtown Des Moines, Iowa
Contact Michelle Dekker (515) 421-4778 mdekker@iowamedical.org www.iowamedical.org
ED U C AT I O N
REGISTER ONLINE
w w w.iowamedical.org Click the Logo on the home page
N E T WO RK I N G
I N SPI R AT I O N
PASSION & IN PRACTICE PURPOSE
RENEWING
This two-day conference has exciting programming in store to maximize educational and networking opportunities.
FR I DAY, A PR I L 28
• A full day of education sessions geared to clinic administrators, staff and physicians • Networking Lunch • President’s Reception featuring the installation of the 168th and fourth female IMS President, Joyce Vista-Wayne, MD
SAT U R DAY, A PR I L 29
• Opening Session with Keynote Speaker Brad Nieder, MD, CSP, “The Healthy Humorist”® • Networking Lunch • Four Tracks Of Physician-Focused Education: Leadership Development, Practice Transformation, Physician Wellness, and Chronic Pain Management
“Working hard for something we don’t care about is called stress. Working hard for something we love is called passion.” – Simon Sinek
• Closing Session with Keynote Speaker Matt Jones “Life is a Marathon”
L E A D ERS H I P
W EL L N ES S
I N N OVAT I O N
ANNUALCONFERENCE
RENEWING PASSION AND PURPOSE IN PRACTICE By Brian Privett, MD
BRIAN PRIVETT, MD Dr. Privett is board certified in Ophthalmology and practices with Iowa Eye Center in Cedar Rapids. He serves IMS as chair of the Program Committee and as an at-large director on the Board of Directors.
“Working hard for something we don’t care about is called stress. Working hard for something we love is called passion.” – Simon Sinek
The IMS Annual Conference will be held April 28-29, 2017, at the Des Moines Marriott Downtown. The Program Committee, comprised of IMS member physicians, residents and medical students, selected this year’s theme to be Renewing Passion and Purpose in Practice. The two-day educational conference has exciting programming in store to maximize educational and networking opportunities. Friday will feature a full day of education geared to clinic administrators, staff and physicians. On Friday evening, Joyce VistaWayne, MD, Child and Adolescent Psychiatry, Clive, will be installed as the 168th and fourth female IMS President. Stay for the postinauguration reception featuring fantastic food, delicious beverages, fun entertainment and socializing with colleagues from across the state. With a general session, networking lunch and four tracks of physicianfocused education, Saturday will be a day not to miss. This year, IMS is pleased to offer four education tracks: Leadership Development Practice Transformation
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Physician Wellness Chronic Pain Management
Leadership Development Track For the 2017 IMS Annual Conference, the Iowa Medical Society has partnered with the University of Iowa’s Office of Healthcare Leadership Education to create a three-hour physician leadership development track. With an ever-changing healthcare delivery system, this track will help physicians learn key and practical business solutions in leadership, teamwork, change management, and financial management. The need for physician leaders in our state will only increase in the coming years. This track addresses the nuances impacting daily practice and provides practical business solutions. The first two-hour session, Developing and Leading HighFunctioning Healthcare Teams, will be led by Brady Firth, PhD. Through evidence-based content and open discussion, this session will examine how the ‘command and control’ approach to team management is counterproductive and introduce practical alternatives for leading high-functioning teams. The second one-hour session, Effective Healthcare Change Management, will be led by Alan Reed, MD, MBA, FACS, and Ian Montgomery, MA, CMPE. This session will focus on organizational
change and give physicians the tools needed to understand and effectively lead through a transformation. Open discussion and examples will provide valuable resources and information to implement into practice.
Physician Wellness The IMS Burnout Task Force and the Program Committee have partnered to develop the Physician Wellness Track. Physician well-being has a direct impact on patient care, safety, and general happiness in practice. The IMS Annual Conference will feature education sessions on Friday and Saturday for both physicians and clinic administrators to address this important topic.
Networking Opportunities Some of the most valuable takeaways from the annual conference are those conversations that happen outside of the classroom, between sessions and during coffee breaks. IMS is pleased to offer several opportunities at the 2017 IMS Annual Conference including two networking lunches and the President’s Reception. We know these opportunities will provide valuable time to connect with colleagues.
Opportunities for All to Learn No matter where you are in your career or what role you play in the healthcare team, the 2017 IMS Annual Conference will have valuable, practical and applicable information for you and your team. In an ever-changing industry, take this opportunity for you and your team to join us at the 2017 IMS Annual Conference: Renewing Passion and Purpose in Practice! •
ARE YOU A LEADER IN IOWA MEDICINE? IOWA MEDICAL SOCIETY
Learn more about leadership opportunities with the Iowa Medical Society. Submit an application to run for the IMS Board of Directors. Applications due by March 10. nominations@iowamedical.org
THIS SHOULD BE YOUR ADVERTISEMENT.
MAKE IT SO. CONTACT IMS. | MICHELLE DEKKER, MDEKKER@IOWAMEDICAL.ORG | 800-223-1401
Iowa Iowa Medicine Medicine Winter Winter 2017 2015
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MEMBERS IN THE NEWS MEMBERS IN THE NEWS
IN MEMORIAM
Georgina Aldridge, MD, PhD, Chief Neurology Resident, Iowa City, was chosen to present From Synapses to Circuits: Investigating the Etiology of Prefrontal Cortex Dysfunction in Parkinson’s Disease Dementia and Related Synucleinopathies, during the INA/UI Invited Resident Lectureship portion of the Iowa Neurological Assocation Annual Meeting held on October 8, 2016.
Donald Wolters, MD, 92, Family Medicine, Esterville, passed away on December 2, 2016
Paul Barber, MD, Internal Medicine, Storm Lake, and Timothy Breon, MD, General Surgery, Oskaloosa, were each named a 2016 Hospital Hero by the Iowa Hospital Association. Patrick Brophy, MD, Pediatrics, Iowa City, was featured in the article Virtual Care Services Could Take Pressure Off ER Use, in the September 30, 2016, edition of the Business Record, Des Moines. Sherri Flugrad, DO, Emergency Medicine, Ames, received the 2016 Mary Greely Medical Center Innovation and Excellence Award for Medicial Practice. Keith Kohout, DO, MS, Chief Neurology Resident, Iowa City, was named to the Iowa Neurology Association Board of Directors. The resident position on the association’s board is new and was approved by the membership during the INA Annual Meeting on October 8, 2016. Dr. Kohout will serve a one-year term ending on June 30, 2017. Brian Privett, MD, Ophthalmology, Cedar Rapids, authored the oped piece Ophthalmologists Best Trained for Risky Eye Care Situations, that appeared in the October 14, 2016, edition of the Des Moines Register. Amir Shaban, MD, Neurology Resident, Iowa City, was chosen to present Basilar Artery Stenosis, during the INA/UI Invited Resident Lectureship portion of the Iowa Neurological Assocation Annual Meeting held on October 8, 2016. Christine Sinsky, MD, Internal Medicine, Dubuque, is one of the authors of Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialities, published in the September 6, 2016, edition of the Annals of Internal Medicine. Donald Skinner, MD, Family Medicine, Ames, was awarded the 2016 McFarland Clinic Founder’s Award. Chris VandeLune, DO, Family Medicine, Cherokee, named Iowa Family Physician of the Year by the Iowa Academy of Family Physicians.
IAFP NAMES 2016-2017 BOARD On November 5, 2016, the Iowa Academy of Family Physicians elected their 20162017 Board of Directors, among those elected were IMS members: PresidentElect – Scott Bohner, DO, Story City; Vice-President – James Bell, MD, Cedar Rapids; Secretary-Treasurer – Corrine Ganske, MD, Des Moines; Board Chair – Noreen O’Shea, DO, Des Moines; District 1 Alternate Director – Melissa Austreim, MD, South Sioux City, NE; District 2 Director – Chereen Stroup, MD, Mason City; District 3 Alternate Director – Laura Bowshier, MD, Waukee; District 6 Director – Jason Wilbur, MD, Iowa City; Residency Representative – Kate Thoma, MD, Iowa City; Resident Members – Amber Meyer, MD, Davenport and Benson Hargens, MD, Mason City; Student Members – Samantha Aust, Iowa City and Grace Lau, Iowa City; AAFP Delegates – Larry Beaty, MD, West Des Moines and Brian Mehlhaus, MD, Boone; Alternate Delegate – Douglas Martin, MD, Sioux City.
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George L. York, MD, 87, General Practice, Clinton, passed away on September 15, 2016.
HAVE NEWS TO SHARE? IMS welcomes news related to our members. Please send information to Kara Bylund (kbylund@ iowamedical.org) at IMS.
NEUROSURGEON WANTED Mercy Clinics is seeking Neurosurgeon to join thriving practice in Des Moines. Competitive compensation structure with paid malpractice, CME. Send resume to: Sarah Schreurs Mercy Medical Center 1111 6th Avenue Des Moines, IA 50314
MEMBERS ON THE MOVE Taylor Abel, MD, Neurology, completed residency training and joined the UIHC – Neurosurgy department Iram Ahmad, MD, Otolaryngology, completed residency training and joined the UIHC – Otolaryngology department Demma Alkapalan, MD, Pathology, completed residency training and was accepted into fellowship training in the UIHC – Pathology department Eman Al-Selmie, MD, Family Medicine, completed residency training and joined Covenant Clinic – Family Medicine in Cedar Falls Vijay Aluri, MD, Rheumatology, completed fellowship training and joined Physicians’ Clinic of Iowa in Cedar Rapids Evgeny Arshava, MD, General Surgery, completed fellowship training and joined UIHC – Cardiothoracic Surgery department Peter Coonrod, MD, Anesthesiology, completed residency training and joined Associated Anesthesiologists, PC, in West Des Moines Svjetlana Dolovcak, MD, Rheumatology, completed fellowship training and joined the UIHC – Internal Medicine – Arthritis and Rheumatology department Christian Grindberg, DO, Family Medicine, completed residency training and joined Kossuth Regional Health Center Clinic in Algona Mara Groom, DO, Family Medicine, completed residency training and joined Avera Medical Group – Spirit Lake Medical Center Lyndsay Harshman, MD, Pediatrics, completed fellowship training and joined the UIHC – Pediatrics department
Alexandra Hubbel, DO, Family Medicine, completed residency training and joined UnityPoint Clinic Family Medicine – East Des Moines, in Des Moines
Sneha Phadke, DO, Hematology/ Oncology, completed fellowship training and joined UIHC – Internal Medicine – Hematology/Oncology department
Robert Koller, DO, Family Medicine, completed residency training and joined Grinnell Regional – Family Practice in Grinnell
Steven Rippentrop, MD, Family Medicine, completed resident training in Internal Medicine/Preventative Medicine and joined UIHC – Internal Medicine department
Michelle Kurt-Mangold, MD, Pathology/Hematology, completed fellowship training and joined Pathology Associates, Dubuque
Bryce Robison, MD, Family Medicine, joined Family Health Care of Siouxland – Morningside Clinic, Sioux City
Devin Lindstrom, MD, Anesthesiology, completed residency training and joined Associated Anesthesiologists, PC, in West Des Moines
Takashi Sato, MD, Diagnostic Radiology, completed fellowship training in Neuroradiology and joined UIHC – Radiology department
Heather Longal, MD, Family Medicine, joined Family Health Care of Siouxland – Morningside Clinic in Sioux City Gagan Mathrur, MD, Pathology, completed residency training and joined the UIHC – Pathology department Ala Mohsen, MD, Internal Medicine, completed residency training and joined the UIHC – Internal Medicine department Varum Monga, MD, Hematology/ Oncology, completed fellowship training and joined UIHC – Internal Medicine – Hematology/Oncology department Waldemar Nowak, MD, Child Neurology, completed fellowship training and joined UIHC – Neurology department Gregory Olson, DO, Family Medicine, joined Mery Medical Center – Sioux City, as a hospitalist Emily Peterson, MD, Pediatrics, completed residency training and joined UIHC – Pediatrics department
Shobhana Talukdar, MD, OB/GYN, completed fellowship training and joined Genesis Health Group in Davenport Huy Tran, MD, PhD, FHRS, Gastroenterology, completed fellowship training and joined UIHC – Internal Medicine – Gastroenterology department Melissa Willis, MD, Dermatology, completed residency traing and joined the UIHC – Dermatology department
NEUROLOGY CONSULTANTS, PC OPENS NEW OFFICE Neurology Consultants, PC, opened their new clinic, located at 4700 E. 56th Street, Suite 100, in Davenport, in October 2016. This privately-owned clinic has served the Quad Cities area for more than 30 years. Irena Chaysz-Birski, MD; Rod Short, MD; John Wright, MD, and staff specialize in general neurology, neuropyshcological testing, dementia, adult geriatrics, neurodiagnositic testing, and sleep disorders. The new office location will accommodate expanded services to better meet patient needs.
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WELCOME NEW IMS MEMBERS (September 1 – January 1, 2017) Mahmoud Abou Alaiwa, MD* Internal Medicine, UIHC – Internal Medicine, Iowa City
Nkanyezi Ferguson, MD* Dermatology, UIHC – Dermatology, Iowa City
Marwan Jarmakani, MD Diagnostic Radiology, Radiology Consultants of Iowa, PLC, Cedar Rapids
Nasser Abu-Erreish, MD Oncology, June E. Nylen Cancer Center, Sioux City
Shelia Foster, DO Radiology, Radiology Consultants of Iowa, PLC, Cedar Rapids
Paul Jensen, MD, PharmD Family Medicine, Cresco Medical Clinic, Cresco
Dan Allen, MD Internal Medicine, UnityPoint Clinic – Central Iowa Regional Office, Johnston
Emilie Fowlkes, MD* Emergency Medicine, UIHC – Emergency Medicine, Iowa City
Daniel Jones, MD Orthopedic Sports Medicine Surgery Steindler Orthopedic Clinic, Iowa City
Eman Al-Selmie, MD* Family Medicine, Covenant Clinic – Family Medicine, Cedar Falls
Shuchita Garg, MD* Anesthesiology, UIHC – Anesthesia, Iowa City
Thomas Kalkhoff, DO Family Medicine, Avera Medical Group Lakes Family Practice, Spirit Lake
Ryan Arnevik, DO Family Medicine, Mercy Medical Clinic, Centerville
Daniel Gillette, MD Psychiatry, UnityPoint Health St. Luke’s, Sioux City
John Kamholz, MD, PhD Neurology, UIHC – Neurology, Iowa City
Evgeny Arshava, MD* General Surgery, UIHC – Cardiothoracic Surgery, Iowa City
Winn Gregory, MD General Surgery, Pella
Aditya Badheka, MD* Pediatrics, UIHC – Pediatrics, Iowa City Ronald Brinck, MD Child and Adolescent Psychiatry, Sioux City Kyla Carney, DO Family Medicine, Primary Health Care, Des Moines Umesh Chakunta, MD Psychiatry, Medical Associates Clinic – Psychiatry Department, Dubuque Umar Chaudhry, MD* Radiology, Radiology Consultants of Iowa, PLC, Fort Dodge George Clavenna, DO Ophthalmology, Des Moines University Clinic, Des Moines Casey Clor, MD Family Medicine, Des Moines University Clinic, Des Moines Erica Collins, MD OB/GYN, Mercy Medical Clinic, Centerville Peter Coonrod, MD* Anesthesiology, Associated Anesthesiologists, PC, West Des Moines Shannon Crout, DO Osteopathic Manipulative Medicine, Des Moines University Clinic, Des Moines Svjetlana Dolovcak, MD* Rheumatology, UIHC – Internal Medicine – Arthritis and Rheumatology, Iowa City Roy Doorenbos, MD Family Medicine, Grinnell Family Practice, Grinnell Case Everett, MD Family Medicine, Mahaska Health Partnership Medical Group, Oskaloosa 16
Iowa Medicine Winter 2017
Anne Grieves, DO, FACOG OB/GYN, Great River Women’s Health, West Burlington Christian Grindberg, DO Family Medicine, Kossuth Regional Health Center, Algona Geoffery Hadlock, MD Family Medicine, Covenant Clinic – Kimball Ridge Center, Waterloo Deborah Haines, DO Family Medicine, UnityPoint Clinic Family Medicine, Altoona Nidal Harb, MD Cardiovascular Disease, Cardiovascular Medicine, PC, Davenport Lyndsay Harshman, MD* Pediatrics, UIHC – Pediatrics, Iowa City Jeff Hartung, DO Family Medicine, Pella Regional Health Center, Pella Sailesh Harwani, MD* Cardiovascular Disease, UIHC – Internal Medicine – Cardiology, Iowa City David Henry, MD Radiology, Radiology Consultants of Iowa, PLC, Cedar Rapids Ryan Holdsworth, MD Radiology, Radiology Consultants of Iowa, PLC, Cedar Rapids Brian Hopper, MD Radiology, Radiology Consultants of Iowa, PLC, Cedar Rapids Neil Horning, MD Pulmonology, Chest Infectious Diseases and Critical Care Associates, PC, Clive Erin Howe, MD* Pediatrics, UIHC – Pediatrics, Iowa City Sarah Jacobitz-Kizzier, MD* Family Medicine, Grand River Medical Group – Family Practice, Dubuque
Jon Kammerer, MD Family Medicine, Cresco Medical Clinic, Cresco Vidya Kollu, MBBS Internal Medicine, UIHC – Internal Medicine – Hematology/Oncology, Iowa City Abhishek Kumar, MD, MPH Pulmonary Disease, Mercy Pulmonary Clinic, Cedar Rapids Michelle Kurt-Mangold, MD* Pathology – Hematology Pathology Associates, Dubuque Drew Lewis, DO Physical Medicine and Rehabilitation Des Moines University Clinic, Des Moines Lawrence Leon, MD Radiology, Radiology Consultants of Iowa, PLC, Cedar Rapids Devin Lindstrom, MD* Anesthesiology, Associated Anesthesiologists, PC, West Des Moines Michael Mahoney, MD Internal Medicine, Red Oak Internal Medicine, Red Oak Gagan Mathur, MD* Pathology, UIHC – Pathology, Iowa City Satsuki Matsumoto, MD Child Neurology, UIHC – Pediatrics, Iowa City Steven Mickelsen, MD* Cardiovascular Disease, UIHC – Internal Medicine – Cardiology, Iowa City Timothy Miller, MD Anesthesiology/Pain Medicine, Iowa Illinois Pain Consultants, PC, Bettendorf Varum Monga, MD* Hematology/Oncology, UIHC – Internal Medicine – Hematology/ Oncology, Iowa City Naga Nadipuram, MD Internal Medicine, Covenant Clinic – Arrowhead, Cedar Falls
David Newton, MD Gastroenterology, Iowa Digestive Disease Center, Clive
Christopher Ronkar, MD Rheumatology, Iowa Arthritis & Osteoporosis Center, Urbandale
NOTE FROM THE EDITOR
Dean Moews, MD Family Medicine, Primary Health Care, Des Moines
Takashi Sato, MD* Diagnostic Radiology, UIHC – Radiology, Iowa City
Ala Mohsen, MD* Internal Medicine, UIHC – Internal Medicine, Iowa City
Cosette Scallon, MD Family Medicine, Iowa State University – Thielen Student Health Center, Ames
Varun Monga, MD* Hematology/Oncology, UIHC – Internal Medicine – Hematology/ Oncology, Iowa City
James Singer, DO Ophthalmology, Iowa Retina Consultants, West Des Moines
In the Fall edition of Iowa Medicine, it was inaccurately reported that the following residents were in the UIHC Department of Neurological Surgery. They are actually in the UIHC Department of Neurology. The editorial staff apologizes for the error, and would like to welcome the new resident members in the UIHC Department of Neurology: Salman Al Jerdi, MD Annaliese Bosco, MD Syed Hussain, MD Ann Jones, MD Eric Kimmel, MD Julie McDaniel, MD Aldo Mendez Ruiz, MD Patricia Richey, MD Amir Sabzpoushan, MD
Andrew Mueting, DO* Family Medicine, Avera Medical Group Lakes Family Practice, Spirit Lake Naga Nadipuram, MD Internal Medicine, Covenant Clinic – Arrowhead, Cedar Falls Waldemar Nowak, MD* Neurology, UIHC – Neurology, Iowa City Nina Nuangchamnong, MD* OB/GYN, UIHC – OB/GYN, Iowa City Wei Ouyang, MD Diagnostic Radiology, Radiology Consultants of Iowa, PLC, Cedar Rapids David Parsons, DO Family Medicine, Van Buren County Hospital, Keosauqua Emily Peterson, MD* Pediatrics, UIHC – Pediatrics, Iowa City Thomas Petrie, DO Ophthalmology, Cedar Valley Eye Care, Waterloo Sneha Phadke, DO* Hematology/Oncology, UIHC – Internal Medicine – Hematology/ Oncology, Iowa City Fabiana Policeni, MD* Radiology, UIHC – Breast Imaging, Iowa City Andrew Pugely, MD* Orthopedic Surgery, UIHC – Orthopedics and Rehabilitation, Iowa City Brigit Ray, MD* Family Medicine, UIHC – Family Medicine, Iowa City Amy Reppert, MD Anesthesiology, Covenant Clinic – Anesthesiology, Waterloo Steven Rippentrop, MD* Internal Medicine, UIHC– Internal Medicine, Iowa City Kelli Roenfanz, DO Family Medicine, Avera Medical Group Lakes Family Practice, Spirit Lake
Danny Smith, DO Family Medicine, Ankeny Loren Smith, MD Urology, Covenant Clinic – Urology, Waterloo Stephanie Stauffer, MD* Pathology UIHC – Pathology, Iowa City Tejinder Swaran Singh, MD* Anesthesiology, UIHC – Anesthesia, Iowa City Vesselin Tenev, MD* Psychiatry, UIHC – Psychiatry, Iowa City Allison Testroet, DO Family Medicine, UnityPoint Clinic Family Medicine, Huxley Kara Thompson, DO Family Medicine, Des Moines University Clinic, Des Moines Leah Thornaum, DO Neurology, Medical Associates Clinic, Dubuque Maggie Thornaum, DO OB/GYN, Medical Associates Clinic, Dubuque Huy Trans, MD, PhD, FHRS* Gastroenterology, UIHC – Internal Medicine – Gastroenterology, Iowa City Michael Willey, MD* Orthopedic Surgery, UIHC – Orthopedics and Rehabilitation, Iowa City Melissa Willis, MD* Dermatology, UIHC – Dermatology, Iowa City Eytan Young, MD Otolaryngology, Iowa ENT Center, PLLC, West Des Moines Joshua Zawacki, DO Diagnostic Radiology, Radiology Consultants of Iowa, PLC, Fort Dodge
HOSPITALIST WANTED Mercy Clinics is seeking Hospitalist physician to join thriving hospitalbased practice in Des Moines. Competitive compensation structure with paid malpractice, CME. Send resume to Melissa Delaney Mercy Medical Center 1111 6th Avenue Des Moines, IA 50314
*Former Resident Member.
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LEGISLATIVEUPDATE
2017 IMS LEGISLATIVE AGENDA By Dennis Tibben
DENNIS TIBBEN Mr. Tibben is the director of state government affairs for IMS. He serves as the staff liaison for the Committee on Legislation and for the IMPAC Board of Directors.
The November 2016 election resulted in some of the most significant changes in Iowa politics in a generation. The 87th General Assembly convened in January with Republicans controlling both chambers of the legislature and the Governor’s office for the first time in 20 years. In addition, President Trump’s selection of Governor Terry Branstad to serve as U.S. Ambassador to China has set the stage for Lt. Governor Kim Reynolds to serve as Iowa’s first female governor. While Lt. Governor Reynolds is expected to govern in a manner consistent with the Branstad Administration, of which she has been a member for the past six years, this change in executive branch leadership will naturally alter the political dynamics this legislative session.
IMS enters the 2017 Legislative Session well-positioned to see meaningful action on a number of issues of critical interest to Iowa physicians. The IMS Committee on Legislation convened a few days after the November election and recommended a dynamic set of legislative priorities, which were approved by the IMS Board of Directors at its December meeting.
Tort Reform In 2004, IMS championed legislation to establish a cap on noneconomic damages, which was ultimately vetoed by the then-Democratic governor. Since that time, the political composition of the legislature has precluded IMS from passing any similar traditional tort reform measures. With Republicans now controlling both chambers of the legislature and the Governor’s office, enactment of comprehensive tort reform is within reach. IMS remains committed to statewide implementation of our 2015 Candor legislation, which has been successfully piloted at a healthcare
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facility in Eastern Iowa. This session, IMS will pursue a package of traditional reforms to further improve Iowa’s medical liability climate. IMS is working with leaders in both chambers to craft legislation that includes the following: A $250,000 cap on noneconomic damages Strengthened expert witness standards A certificate of merit requirement for medical liability suits An affirmative defense for the practice of evidence-based medicine Limits on plaintiff attorneys’ contingency fee arrangements
IMS has been actively involved in helping practices navigate the new system, and working with the state and managed care organizations (MCOs) to identify and address system failures. The policy measures enacted over the past two sessions represent an important first step in ensuring basic oversight of the MCOs. IMS supports efforts to strengthen MCO oversight and ensure greater transparency of MCO performance in areas such as network adequacy, timely access to care, initial claims rejections, and payment accuracy.
Protecting the Practice of Medicine Each year, legislative proposals are introduced to allow non-physician healthcare practitioners to expand into the practice of medicine with little or no additional training.
Medicaid Managed Care Oversight Practices throughout the state continue to be challenged with Iowa’s transition to Medicaid managed care.
Iowa must pursue a multi-faceted approach to preventing and combating opioid abuse. In addition to voluntary educational efforts, IMS supports: Expanding the functionality and connectivity of the state’s Prescription Monitoring Program (PMP) Creating a process for streamlined, automatic enrollment of all prescribers in the PMP at the time of their license renewal Allowing patients to request partial fills of opioid prescriptions Removing the statutory cap on the Board of Pharmacy’s ability to fullyfund controlled substance takeback programs throughout the state Reducing administrative barriers to ensure timely access to opioid addiction treatment
Protecting Public Health
Recent efforts such as licensing direct-entry lay midwives and removing statutory restrictions on optometrist injections are likely to return next session. IMS will closely monitor these and other similar measures to protect against dangerous expansions and oppose legislation that lacks sufficient protections against patient harm.
naloxone, in 2017, IMS will pursue proactive legislation focused on informed prescribing, supply reduction, harm reduction, and access to treatment.
IMS will continue to collaborate with stakeholders, including the Iowa Dermatological Society, the Iowa Chapter of the American Academy of Pediatrics, and the American Cancer Society to pursue legislation aimed at protecting the public health, especially Iowa youth.
Combating Opioid Abuse In the past ten years, opioid overdose deaths in our state have more than quadrupled. While Iowa continues to be better positioned than many states with comparatively low overdose rates, the issue of opioid diversion and abuse is a significant problem that has caught the attention of concerned policymakers. Building upon last year’s successful enactment of legislation to expand access to the opioid antagonist
This includes legislation to prohibit children under the age of 18 from using indoor tanning beds. IMS will also continue its push to modernize Iowa’s tobacco control statute, starting with raising the legal age for smoking to 21.
Trauma System Funding In 2016, IMS pursued dedicated state funding for Iowa’s Trauma System. Currently funded almost exclusively
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LEGISLATIVEUPDATE
out of federal block grants, the system is understaffed and unable to provide sufficient resources or technical assistance to local trauma coordinators, especially those at rural Level IV trauma centers. In 2017, IMS will build upon our work last session to secure a state appropriation to fund the existing 1.0 Trauma System FTE at the Iowa Department of Public Health (IDPH) and to double the number of the medical professionals on IDPH trauma survey teams that provide on-site technical assistance to centers. This will ensure sufficient capacity to provide on-site technical assistance visits to all 118 Trauma Care Facilities in the state.
Prior Authorization Reform In 2015, IMS commissioned a survey of all actively practicing physicians in Iowa to assess, among other things,
the most pressing issues impacting their practices. While responses differed by specialty or practice type, all respondents ranked burdensome insurance regulations at the second mostpressing concern. To help ease this burden, IMS has developed comprehensive legislation to reform Iowa’s prior authorization process. Modeled after successful reforms enacted in Ohio and Delaware, the bill would: Require increased transparency of authorization requirements, public reporting of insurers’ authorization approval and denial rates, and advanced, written notice of any changes to authorization policies; Enact prompt authorization determination standards that align with existing Medicare Part D and commercial prescription medication standards; Prohibit prior authorizations in emergency situations; Prohibit retrospective authorization denials after care is rendered; Create consistency in the issuance of authorizations and an expedited renewal process when the patient is medically stable; and Establish a fee schedule to reimburse clinical staff for the time spent dealing with insurance companies rather than caring for patients.
Rural Physician Loan Repayment Program IMS continues its commitment to improving Iowa’s physician workforce shortages by collaborating with the Iowa Academy of Family Physicians in pursuit of state funding for the Rural Physician Loan Repayment Program. Over the past four years, these joint efforts have been successful in securing
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approximately $7 million in state matching funds for this public-private endeavor to recruit primary care physicians to practice in rural Iowa.
Medicaid Payment Rates Last session, IMS successfully halted a proposal from Governor Branstad to cut Medicaid provider rates by nearly $30 million through the elimination of the enhanced primary care physician rates and capping Medicare crossover claims at Medicaid levels. As the state faces ongoing pressure to achieve the savings projected under managed care, rate cut proposals have resurfaced in 2017. IMS will seek legislative action to preserve current Medicaid physician payment rates. Practices are making a good-faith effort to navigate the new managed care system and ensure their Medicaid patients continue to have access to the care they need. The legislature and the governor must take action to protect physician practices from arbitrary and unnecessary rate cuts.
Want Updates During the Legislative Session? Political and policy discussions can shift rapidly during the legislative session. To help member physicians, residents, and medical students follow discussions in Des Moines, every Friday while the General Assembly is in session, we publish the IMS Advocate — an email newsletter that contains the latest on health policy under consideration at the Capitol. If you’re not already subscribed to receive this weekly publication, please contact Dennis Tibben, Director of Government Affairs within the IMS Center for Physician Advocacy (dtibben@iowamedical.org). •
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A NATIONAL UPSET DMU UPDATE
The Remedy Starts Here By Greg Christiansen, DO, MEd, FACOEP-D
GREG CHRISTIANSEN, DO, MEd, FACOEP-D Greg Christiansen, DO, MEd, FACOEP-D is the Dean of the College of Osteopathic Medicine at Des Moines University
When I penned this article in November, I was enamored by the improbable upset in the contest that stunned the pundits. Who would have believed Iowa could shock the heavily favored and 3rdranked Michigan Wolverines football team in a 14-to-13 win? It was another historic November to remember, and Iowa was at the heart of it all. After the fans stormed the field with celebratory fervor, it was time to get back to business and reflect on the past to plan a course for the future.
Front and center among the ‘things to come’ is the fate of the Affordable Care Act (ACA), commonly known as Obamacare. The issue was widely touted as a major factor influencing the election results as insurance premium increase notifications hit household budgets near Election Day. But even with the talk of repealing the ACA, the Medicare Access and CHIP Reauthorization Act (MACRA) — and its alphabet soup of acronyms — is expected to remain largely unchanged. The impact will be far-reaching and touch nearly every practice in one way or another. The bottom line: The U.S. still faces a crisis in healthcare financing and physicians need to be at the table to advocate for our profession, patients, and practices. Gene Uzwaw Dorio, MD, argues in a KevinMD.com piece that physicians have generally been marginalized in the process of developing and implementing health policy. We haven’t used our voices, experiences, 22
Iowa Medicine Winter 2017
and talents effectively to shape healthcare delivery, nor have we made time or expressed interest in engaging in the political process. To illustrate the issue, at a recent MACRA update in Des Moines, less than a dozen physicians from the region attended the seminar to learn from the experts on how the system would work. The research group Deloitte reported in their 2016 article, MACRA: Disrupting the Health Care System at Every Level, that only 50% of surveyed physicians had ever heard of MACRA, and only 32% recognized the term. Studies show 8 out of 10 currently-practicing physicians prefer the fee-for-service model. In their survey, more than 70% of doctors do not support performancereporting or quality-measure compensation models. Universally, physicians cite regulatory burdens as the obstacle. If you believe in polling data, then consider that almost 60 percent of practicing physicians would prefer to consolidate their practice with larger organizations in order to lessen financial risk. These perspectives suggest collectively we
are still struggling with the idea of a national health policy. However, the process of centralization as a result of health policy has already taken hold in many specialties. Upon reflection, two factors appear to have influenced the state of physician leadership today. The first factor is the role of social media on the collective consciousness of the next generation of physicians. They seem to seek wisdom from the social media space where few seasoned physician mentors exist. In a focus group of student leaders, one student confided he was surprised by his father’s vote in the presidential election. The messages he heard in his own echo chamber did not prepare him for alternate outcomes. He did not realize his father had delayed seeking care for himself because he had leveraged insurance costs against his family’s financial stability. His father reported paying about $15,000 per year in premiums with an additional $5,000 in copay expenditures before his insurance would cover his medical services. In a moment of metacognition, he admitted the complexity of the topic of health policy. Coupled with his relative inexperience, the student’s own confirmation bias blinded his awareness to the reality occurring within his own family. His substrate for decision-making was based on social media data sources, which ignored factors he would ultimately learn as the truth. This anecdote supports the findings of a survey I conducted with colleagues (and will present
at the University of California in April), namely, that half of the medical student population lacks any understanding of the health insurance market. They have little-to-no understanding of the complexity and frustration patients experience in attempting to obtain, navigate, and utilize health insurance. D.H. Lawrence said it well when he suggested, “The eyes cannot see what the mind does not know.” How can we possibly be listening to our patients when we aren’t even aware that we aren’t listening? Here lies the hidden danger. Eventually we lose our ability to innovate and our patients suffer because of our unwitting self-centeredness. We absolutely need diversity — diversity in thought in particular. Without the wisdom of mentors willing to step forward to support untested thought, the next generation will be blind to the diversity that examines our assumptions and makes us stronger for having a different vantage point. It’s a biblical concept that is as true today as it was thousands of years ago. It is integral to the privilege of being a physician and it is called empathy. The second factor has to do with reconciling what it means to be a physician in our communities. It requires us to be leaders and to put that empathy into action. Historically, physicians have been the ‘go-to’ leaders in the face of difficult struggles. Let me offer a case in point from the founders of our nation. The President of the Massachusetts Provincial Congress, Dr. Joseph Warren, had forgone the privileged rank of Major General and rallied the troops as a ‘private soldier’ at the battle of Bunker Hill. His bravery earned him a place in history as a hero of the Revolutionary War. His name was memorialized in Iowa in 1846, when Warren County was named in his honor. A second illustration from the same era, Dr. Samuel Prescott, a surgeon in the Continental Army, became engaged and projected political leadership in the face of adversity. During Paul Revere’s famous ride, the patriot was actually captured and never completed the run to
Concord, Massachusetts. In fact, it was Dr. Prescott who took the charge of alerting the countryside to the impending danger. Health policy is still evolving and access to health care is out of reach for too many. Using your wisdom to guide and direct a student on how to approach patient-centered care is invaluable. Based on the history of physician leadership in
times of adversity, I would expect our colleagues to step forward and establish the principles that made our healthcare system second to none. Simply, students want to learn from our wisdom and, like our patients, are yearning to see that wisdom communicated into action. Consider the impact of your leadership, mentorship, and stewardship. Your legacy can shape the future. •
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CONTENT MARKETING
YOURPRACTICE
How Your Medical Practice Can Benefit By Catherine M. Staub, Ed.D.
BY CATHERINE M. STAUB, ED.D. Catherine Staub is owner of Lexicon Content Marketing and associate professor and Fisher-Stelter Chair of Journalism and Mass Communication at Drake University.
Out of all the things on your to-do list each day, thinking about effectively marketing your practice likely sits somewhere near the bottom — if it makes the list at all. But a purposeful and consistent content marketing strategy can do the heavy lifting for you, strengthening your relationships with existing patients and bringing in new ones.
Content marketing — creating and distributing relevant information to target audiences on a regular basis — is a highly-effective strategy that’s a surprisingly good fit for most medical practices. Consider this: Content is a part of your patients’ everyday life. It’s in the magazines they receive in the mail, the informative ad they hear on radio or television, the videos they watch online, the blog posts they look forward to all week, and the testimonials they read.
For today’s consumers, good content cuts through the messaging clutter to become something they proactively seek out. Even better, the provider of the content earns their trust and loyalty — even before that first appointment.
Extend Patient Relationships Beyond the Office
Think about marketing as an extension of what you do in your medical practice. While you may only get a few minutes to have a dedicated one-on-one with your patients, a structured marketing strategy allows you to continue the conversation even after they’ve left your office. How?
74% of consumers prefer information about a service provider in a collection of articles, rather than an ad.
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Press releases and social media posts alert your patients to the newest technology you’re offering. A regular message from you offers tips about how to remain healthy. A satisfaction survey gives them an opportunity to share
their feedback. And adding a targeted message to an appointment reminder extends the value of an otherwise basic text message or email. Another benefit? The content you provide empowers patients to be more involved and make better decisions about their health care. By “meeting” patients where they are, offering information they can use, and staying in regular contact with them, you’ll foster more effective physicianpatient relationships.
Efficiently Draw in New Prospects
When patients are in the market for a new healthcare provider, most will start their search online. Even if they get a recommendation from a friend or family member, they’ll go online to learn more about your practice. Compelling content is key to getting their attention and drawing them in. For example, instead of offering a laundry list of services, you could include a link to a podcast about a particular service that you or your partner have narrated. This humanizes your services, initiating
a “conversation” with your prospective patient.
you may simply say, “I don’t have the time.”
Or, if the content on your site is all about you and your practice, step back and reframe it from the patients’ point of view. Rather than say you have eight specialists on your staff, tell patients why this matters to them: All that expertise under one roof saves them time because they can schedule multiple appointments within your office — with providers they know and trust.
That’s where a marketing partner can step in. Just as caring for your patients is your number one priority, effectively marketing and growing your practice is the priority of your marketing partner.
Maintaining an active online presence through your website, social platforms, or a blog not only gives your practice greater visibility, it communicates the personality of your practice and your staff — intangible qualities that make a difference when patients are choosing a new provider.
Save Time by Partnering with Experts
Despite the benefits that content marketing can bring to your practice,
76%
A marketing partner brings a thoughtful outside perspective to your program. Even though you know your practice inside and out, it may be difficult to step into your patients’ shoes. Your marketing partner bridges that gap, translating the features of your practice into benefits that resonate with your patients. And with a marketing partner, you don’t have to stress about the details. Marketing agencies specialize in project
of marketers are increasing their investment in content marketing. Curata
management, offering turnkey solutions for executing your program. Your content will be developed, promoted, and delivered on schedule — as promised. When it comes to their health care, your patients have a lot of choices today. An effective marketing program can help them find — and choose — your practice. •
reasons 5 YOU NEED CONTENT MARKETING
1. GET NOTICED. Prospective patients study multiple online sources before making a decision. Make a solid first impression with content. Know what questions your patients have, and answer them before they ask. (Did we mention that content is essential to SEO?)
2. CONNECT WITH PATIENTS. Solution-based content helps
boost respect, trust, and loyalty between your practice and your patients. Create an emotional connection by communicating your goals and mission through stories about your brand.
3. ESTABLISH EXPERTISE. Well-researched, well-written content can prove that you’re the best at what you do, putting your practice at the center of its focus area in a competitive environment.
4. DRIVE LONG-TERM RELATIONSHIPS. Engage patients with useful content throughout their relationship with
you; they’ll reward you with their loyalty. Make that relationship long-term by creating content that sustains that connection between visits.
5. STAY ON TREND. Content marketing is now an essential component of the marketing mix. A well-executed content
marketing plan will help you connect with your patients, deliver significant value to your practice, and set you apart from your competitors.
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YOURMONEY
MAKE YOUR GOALS SYSTEMATIC IN 2017 By Marcus Iwig, CPA, CFP
MARCUS IWIG, CPA, CFP Mr. Iwig is a lead advisor with Foster Group, a fee-only financial planning, investment advisory and life coaching firm located in West Des Moines.
I don’t like New Year’s resolutions very much. The whole thing feels overwhelming, especially after just surviving the holidays. It also seems like a difficult time of year to make big, wholesale changes. For instance, deciding to start exercising when it’s ten below outside, the kids have multiple before- and after-school activities, and if you aren’t recovering from the flu or a cold, you are just about to catch something.
form a new habit.i The challenge of making a change to our daily routines is compounded by our busy, hectic, over-scheduled lives. And if you are like me, you may be unfamiliar with routine altogether.
It seems like June would be a better time to make exercise resolutions, as the weather gets better, school lets out and (hopefully for you) vacation is on the horizon.
The good news is you can leverage technology to help you make significant progress in your financial life in 2017.
That being said, now is a good time to make financial planning resolutions. The tax year is just beginning, raises and bonuses are handed out, and you recently spent time reviewing your benefit elections at work. All the standard financial resolutions are out there; save more, pay off debt, maintain budget, go out to lunch less (which might be both a financial and health resolution). Those are all good resolutions, but most of us know how difficult it is to accomplish any resolution. Some studies show it takes, on average, more than two months to
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This will make it easy to enter and monitor expenses on the fly. Once you know how much extra you can afford to devote to your loans each month, utilize bill pay at your bank and set up your monthly payment to include the extra amount. Maybe you just paid off your loans and you’re trying to decide what to do with your extra cash flow, or you might be well into your career and have extra cash on hand, but it’s ultimately spent instead of saved for retirement. One way to ensure that extra cash flow goes to work for you is to automatically transfer it each month. Many payroll departments allow you to have portions of your paycheck sent to two separate accounts; once you decide on a savings goal, consider having unneeded cash flow sent directly to an investment account. You’ll learn to live without it and it takes one conversation with your payroll department or bank, versus a conscious monthly effort to track cash flow and move money. There’s a side benefit in that you also become a systematic investor and don’t fall prey to trying to time the markets with large amounts of cash.
If you are in residency, or starting your first full-time position, and trying to determine how to manage or begin eliminating debt, start by setting and maintaining a budget using software that has an app for your phone.
The nice thing about financial planning resolutions in this day and age is once you make them, you can use technology to automate the process, giving you a higher probability of success by eliminating the daily conscious effort to create a new habit. •
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http://jamesclear.com/new-habit
VECTORS & VIEWPOINTS
® IMS EDITION
VECTOR: SMALL CHANGES MAKE A BIG DIFFERENCE
Why should I pay off my debts before investing if my interest rates are so low? ROSS POLKING, CFP®, AIF®,MBA® Lead Advisor
FOSTER GROUP® R E C O G N IT I O N S
ELIMINATING DEBT AND, THUS, THE INTEREST YOU PAY on those borrowed dollars, is essentially the best way to guarantee a return on your money. The added benefits of financial independence and emotional freedom of being beholden to your lender are equally important. Some will argue that they should keep their mortgage because of the tax deductibility of the interest. Trouble there is you are still paying someone a fee to use their money…money that you could use to invest and/or pursue other life goals and experiences. Others will argue that they can get a better return on their dollar than existing debt is costing them. That could prove true, but the only way to a guaranteed return is via the purchase of a product: annuity, permanent life insurance policy, CD, etc. Again, trouble there is you lose some access to those “invested” dollars, and are subject to penalties or fees if you try to pull out too much too soon. Tax ramifications can be quite unfriendly, as well, depending on product used. Very few sure things exist in life. One happens to be the guaranteed return on your dollar if you pay off debt as quickly as possible. Stay focused. Stay disciplined. Stay debt-free. Stay diversified.
S E RV I N G I N D I V I D UA L S , I N ST I T U T I O N S , A N D QUA L I F I E D P L A N S C o n t a c t u s t o d a y a t 8 4 4 - 4 3 7- 110 3 o r v i s i t fo s te rgr p. c o m / I M S
6601 Westown Parkway STE 100 West Des Moines IA 50266 PLEASE NOTE LIMITATIONS: Please see Important Advertising Disclosure Information and the limitations of any ranking/recognitions, at www.fostergrp.com/disclosures. A copy of our current written disclosure statement as set forth on Part 2A of Form ADV is available at www.adviserinfo.sec.gov. Foster Group and its employees are independent of and are not employees or agents of Charles Schwab & Co., Inc. (“Schwab”). Schwab does not prepare, verify or endorse information distributed by Foster Group. The Best-in-Business IMPACT Award™ 2012, part of Schwab’s IMPACT Awards® program, is not an endorsement, testimonial endorsement, recommendation or referral to Foster Group with respect to its investment advisory and other services.
FLASHBACK1992
Coping with stress physicians share their secrets Rowing and gardening are just two of the many activities these Iowa physi cians count on to help them relax and relieve the stress of practicing mod ern medicine.
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ulations, etc., but my way of handling it is to have a good office staff who can deal with it. I think there are other specialists such as family practice physicians who feel more stress than surgeons. I think it's important to relax, and I get away by myself whenever I can. Though I don't mean to be rude, I don't socialize with other physicians because you end up talking about medicine all the time."
XPERTS NOW BELIEVE STRESS is a major fac tor in both mental and physical illness. IOWA MEDICINE asked several Iowa physicians how they cope with stress and they offered some interesting theories about how it affects the lives of physicians.
Dr. John Gay, a pediatric cardiologist in Des Moines, says he and Dr. Marion Alberts, IOWA MEDICINE scientific editor, share the same secret to relaxation: "Dr. Alberts and I are soulmates with dirty fingernails-our secret to relieving stress is gardening. Maybe there's something in the personality structure of pediatricians that makes us want to get our hands dirty! I used to jog before I developed back problems, but that wasn't as fulfilling. There are times when I've been out gardening at 10 p.m. In the wintertime, I go through catalogues planning what I'll plant in the spring."
Dr. Paul Gordon, a Mason City family physician, says strenuous exercise is his choice: "When I feel stress, the thing that helps the most is exercise-outside. I ride a bicycle during the summer, sometimes even in the winter. I also love daytime or nighttime cross country skiing-it heightens my senses. T can also relax by just laying on a dock with the waves lapping around me. Getting rid of stress is very important-I believe it plays a bigger role in a physicia11's life than anyone realizes."
Dr. Warren Bower, a Grinnell surgeon, says stress felt by some physicians may not necessarily be occupational: "Certain people are more subject to stress and depression -no matter what their profession. I have felt some added stress because of third party reg-
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Dr. Patricia Connell, a Waterloo family practice physician, says exercise is an underrated stress reliever: "I participate in aerobics and definitely believe this exercise helps me relax. 1 have season tickets to the theater and the symphony. I'm a Hospice volunteer and I do volunteer work in my church and the school. Yearly, I take a one-week retreat to an island in Wisconsin-it's a wonderful getaway. I'm fortunate also because within my practice we have a behavioral science coordi nator who helps us with i.nterventional group therapy activities. I think there's more awareness of the role of stress in our lives which is part of the new emphasis on wellness, but I don't beHeve physicians in general are good at coping with stress."
Dr. Sherry Bulten, a Humboldt family physician, says stress plays an extremely important role in a pl1ysician's We, particularly in rural Jowa. ''Most of us are practicing in a shortage area, whether or not the govern ment has designated it. There's no full time emergency room coverage and you're always running back to the hospital. Also, the family organizational duties are my responsibility, though my husband is excellent about helping. I've learned to relax in our family hot tub. There's no television or no telephone and the whole family is in a small area so we have to talk. "Physicians don't do a good job of coping with stress. We're taught to be in control and not to deal with our own limitations. I'm still working on saying "no" without guilt-it's an important coping skill. I might add that the IMS Women in Medicine Committee is investigating an annual conference, and one of the program topics will be coping, re lieving stress and networking."
Dr. Dan Waters, a Mason City heart sur geon, says the sport of rowing provides a sorely-needed getaway: "Rowing is physically strenuous and is a big stress reliever. It's intense and it requires concentration and timing. I think it's important to have even just one thing that changes your focus-a mental vacation. It could even be something mindless like mowing the lawn. I don't think it's the work of practicing medicine that's the problem-I think most physicians realize they're choosing a stressful career. Where the stress comes in is the amount of your time the practice takes. I think family doctors probably have it worse than surgeons. I also think physicians who practice in a climate of medical politics are under more stress."
Dr. Patricia Harrison, a Cherokee family physician, believes her conscious effort to focus only on taking care of patients-not bureaucratic hassles-helps keep her stress level at a minimum: "It's very important to learn how to manage your practice and have a staff you trust so you can delegate and not have to wonder if it got done correctly. I relax on a stationary bicycle and I lift weights. Also, you must have close friends you can talk things over with. Other than that, I have a tendency to ignore any stress and keep doing what needs to be done."
BLAST FROM THE PAST This article is a reprint from the February 1992, issue of Iowa Medicine. Plan to Attend the IMS Annual Conference, April 28-29, and learn how to avoid professional burnout.
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