Summer 2017 (July-September)

MISSOURI Official Publication of the Missouri Academy of Family Physicians

Family Physician July-September 2017 Volume 36, Issue 3

Pictured: Bruce Preston, MD, FAAFP, 2017 Family Physician of the Year

MISSOURI CELEBRATES

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70 Years of Strong Medicine

MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

Iowa, MIssourI & Nebraska acadeMy of faMIly PhysIcIaNs

2018 alaskaN cMe cruIse aboard the celebrIty solstIce

July 13-20, 2018

shIP deParts froM seattle, washINgtoN

2018

THE ALASKAN CME CRUISE We are pleased to announce

that the Iowa, Missouri & Nebraska Chapters have joined together to offer you a breathtaking, unique, and memorable vacation cruise to Alaska! Join us as we depart from Seattle and explore various ports in Alaska and Canada aboard the beautiful Celebrity Solstice for a week full of relaxation, fun, and CME. Ship Departs from Seattle, Washington with stops at ports in: 1 KetchiKan 2 tracy arm FjorD 3 juneau 4 inSiDe paSSage/ SKagWay 5 Victoria, BritiSh columBia

each cabin oceanview category and above will have the choice of 1 complimentary perk for 1st and 2nd guest only: o $150 per person onboard credit o Prepaid gratuities o Classic beverage package (includes alcoholic beverages up to $9, and soda package) o Unlimited internet Please note: 3rd & 4th guests will automatically receive the classic soda package and 40 internet minutes

ADDITIoNAL INFoRMATIoN:

delivered by your colleagues. CME will be scheduled for the mornings we are at sea. Details and programming will be updated on the website as we finalize topics/speakers

• Gratuities are $94.50 per person for all categories except suites which are $98 per person.

• Travel Protection is available through Celebrity for $159 per person payable with final payment.

CRUISE REgISTRATIoN: (all fees are per person)

CRUISE DEpoSIT/ pAyMENT SCHEDULE:

CME: You will have the opportunity to participate in 12 to 15 credits of CME

There are limited cabins available in the categories below.

rates are cruiSe only 1st & 2nd guest. 3rd & 4th guest current rate at time of booking per celebrity tBD. airfare is not incluDeD.

o A1-Aqua Class $2711.30 o C2-Concierge Class $2561.30 o 1C- Deluxe Oceanview w/Verandah $2361.30 o 2A- Deluxe Oceanview w/Verandah $2341.30 o 2B- Deluxe Oceanview w/Verandah $2301.30 o S2- Sky Suite $3811.30 o 9- Inside Stateroom $1581.30

• Deposit is $500 per cabin and $1000 per suite due upon registration.

• Final Payment is due by April 13, 2018

CRUISE CANCELLATIoN/ATTRITIoN:

• From 89-57 days prior to sailing the cancellation penalty is $250.00 per person.

• From 56-29 days prior to sailing the cancellation penalty is 50% per person.

• From 28-15 days prior to sailing the cancellation penalty is 75% per person.

• From 14-0 days prior to sailing there is no refund.

To RESERVE A CABIN:

please visit our website at

www.iaafp.org/alaska

You must register for the CME portion of the cruise separately this can be done by going to www.iaafp.org/alaska under the education tab.

executive commission Board Chair - Kathleen Eubanks-Meng, DO (Blue Springs) President - Mark Schabbing, MD (Perryville) President-Elect - Sarah Cole, DO, FAAFP (St. Louis) Vice President - Jamie Ulbrich, MD, FAAFP (Marshall) Secretary/Treasurer - James Stevermer, MD, FAAFP (Fulton) board of directors District 1

District 2

District 3

District 4

District 5

District 6

District 7

District 8

District 9

District 10

Director: John Burroughs, MD (Kansas City) Alternate: Jared Dirks, MD (Kansas City) Director: Lisa Mayes, DO (Macon) Alternate: Vacant Director: Emily Doucette, MD (St. Louis) Director: Kara Mayes, MD (St. Louis) Alternate: Dawn Davis, MD (St. Louis) Director: Jennifer Scheer, MD, FAAFP (Gerald) Alternate: Kristin Weidle, MD (Washington) Director: Vacant Alternate: Vacant Director: David Pulliam, DO, FAAFP (Higginsville) Alternate: Carrie Peecher, DO (Marshall) Director: Wael Mourad, MD, FAAFP (Kansas City) Director: Afsheen Patel, MD (Kansas City) Alternate: Kelsey Ryan, MD (Kansas City) Director: Mark Woods, MD (Ozark) Alternate: Charlie Rasmussen, DO, FAAFP (Branson) Director: Patricia Benoist, MD, FAAFP (Houston) Alternate: Vacant Director: Deanne Siemer, MD (Jackson) Alternate: Vicki Roberts, MD, FAAFP (Cape Girardeau)

resident directors Kanika Turner, MD (SLU) Alicia Brooks, MD (Alternate) (SLU) student directors Emily Gray (UMKC) John Heafner, MSPH (Alternate) (SLU) aafp delegates Todd Shaffer, MD, MBA, FAAFP, Delegate Keith Ratcliff, MD, FAAFP, Alternate Delegate Kate Lichtenberg, DO, MPH, FAAFP, Alternate Delegate Peter Koopman, MD, FAAFP, Alternate Delegate mafp staff Executive Director - Kathy Pabst, MBA, CAE Communications and Education Manager - Sarah Mengwasser Membership and Programs Coordinator - Becki Hughes Missouri Academy of Family Physicians 722 West High Street Jefferson City, MO 65101 p. 573.635.0830 f. 573.635.0148 www.mo-afp.org office@mo-afp.org The information contained in Missouri Family Physician is for information purposes only. The Missouri Academy of Family Physicians assumes no liability or responsibility for any inaccurate, delayed or incomplete information, nor for any actions taken in reliance thereon. The information contained has been provided by the individual/organization stated. The opinion expressed in each article(s) is the opinion of its author(s) and does not necessarily reflect the opinion of MAFP. Therefore, Missouri Family Physician carries no responsibility for the opinion expressed thereon.

MARK YOUR CALENDAR AAFP National Conference of Family Medicine Residents & Students (NCFMRS) July 27-29, 2017 Kansas City Convention Center, Kansas City, MO AAFP Congress of Delegates September 11-13, 2017 Grand Hyatt, San Antonio, TX AAFP Family Medicine Experience (FMX) September 12-16, 2017 Grand Hyatt, San Antonio, TX MAFP 25th Annual Fall Conference & KSA Working Group November 10-11, 2017 Big Cedar Lodge, Ridgedale, MO

MAFP Advocacy Day February 19-20, 2018 Capitol Plaza Hotel, Jefferson City, MO AAPF Annual Chapter Leadership Forum/National Conference of Constituency Leaders April 26-28, 2018 Sheraton at Crown Center, Kansas City, MO MAFP Annual Scientific Assembly June 8-9, 2018 The Lodge at Old Kinderhook, Camdenton, MO National CME Live Activity February 7-10, 2018 Board Review Express Hyatt Regency at the Arch St. Louis, MO

INSIDE THIS ISSUE Pg. 2 4 6 8 9 10 12 14 20 22 24 28 29 30 31 32 38 39

2018 Alaskan CME Cruise Outgoing Board Chair Report Outgoing President Report President's Report Secretary/Treasurer Report/MAFP Student Director Reports FPIN: Help Desk Answers Resident Board Report 2017 ASA Recap 2017 Family Physician of the Year Members in the News Meet the New MAFP President New Transition to Practice Conference AAFP Family Medicine Advocacy Summit and ACLF/NCCL Recaps Are You MACRA Ready?

Preceptorship End of Session Report Save the Dates for AFC and ASA White Coat Night

Advertisements Pg. 5 NORCAL 7 MHPPS 13 MPM-PPIA 23 Children's Mercy Kansas City 26 Core Review 27 Cox Health 37 Health is Primary

GET MACRA READY AT FMX

Listen, Learn, Lead Your Academy

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Peter Koopman, MD, FAAFP Outgoing Board Chair

s Board Chair of the academy this year, I have continued to promote the importance and centrality of family medicine for our state and for our country’s health care.

Advocacy efforts of your academy carry on regularly in Jefferson City, and through events such as our local Advocacy Day and the newly named Family Medicine Advocacy Summit (FMAS) in Washington, D.C., I attended both events. The local Advocacy Day is a well-attended event by practicing physicians, residents and students. Based on feedback received from staff and from the legislators themselves, our legislators continue to take notice when so many physicians are at the Capitol. This event, along with the continuing hard work of our Advocacy Commission and its members, continues to promote the value and importance of the comprehensive patient-centered care delivered across the state by our members. We do continue to support and promote legislation to create a functional Prescription Drug Monitoring Program in Missouri; and although this state-wide effort

"

I am excited to see those who are coming into leadership positions make us [the academy] even better."

has failed this year, we do have a county-wide PDMP in Kansas City, Columbia, Jefferson City, Springfield and St. Louis that is working and I have used and found helpful at www.stlouisco. com/HealthandWellness/PDMP. It is easy to sign up and use. The academy will continue to advocate for a similar state-wide program.

My time spent at FMAS in Washington, D.C., was a little different than the last few years. We

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MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

continue to advocate for access to healthcare for all and the importance of primary care to our health system, but recent proposed federal legislation is seen by most as a step back for access for all. As of yet, it has not been brought forward as law. Even some we spoke to on the Republican side of the aisle see this as a step back, but they feel they are working to improve costs overall to our healthcare system. Our active AAFP D.C. group is monitoring and advocating all the time for our specialty and our patients.

I urge you to also reach out to our state and federal legislators. We all need to be vocal now to maintain as much access for as many of our state’s citizen’s as we are able. Speak up please.

I attended the AAFP Leadership Conference again in Kansas City and continued to learn more about leadership for myself, but mostly supported newer leaders who attended. Our special constituency’s representation was full and active. I see good things ahead for your Missouri academy in its current staff, Executive Director, Kathy Pabst, and the upcoming executive board leadership. I feel I complete my four years with the academy in great hands.

As I end my four years of leadership to the academy, I believe I leave it stronger and growing.

We have excellent publications and people in place to continue to improve our magazine and publications. We have expanded our educational offerings to include a resident conference which was a success and promoted the academy’s value to more than 20 third-year residents.

We have a vocal and strong advocacy group working locally and nationally to promote family medicine’s interests, patient-centered care, and our patients. I am excited to see those who are coming into leadership positions make us even better.

I will remain active as an alternate delegate for the AAFP Congress of Delegates. It has been a great honor to serve as an advocate and leader of this academy for four years. Thank you all for your participation and support.

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MO-AFP.ORG 5

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Always Be Yourself, Unless...

Kathleen Eubanks-Meng, DO Outgoing President

onder Woman, I am not. If you attended last year’s installation, you may remember my true admiration of the tenacity of this superhero.

While I am not a superhero, I am amazed by the everyday heroes I have been surrounded by as your President this past year. I hope you had the opportunity to join us at the Annual Scientific Assembly to meet some of our heroes including our Physician of the Year, Dr. Bruce Preston. I am thankful for the opportunity to have served with and beside some of the best and brightest physicians advocating for our profession and our patients.

Advocacy continued to be a priority for our academy this year. Despite another year without a prescription drug monitoring program (PDMP), we continue to increase our presence in Jefferson City. I was fortunate to be able to attend my sixth Advocacy Day in Jefferson City in March. This Advocacy Day was the most attended in its history. I had the pleasure to advocate with family medicine residents to our local legislators. I assure you our future is in

"

Always be yourself, unless you can be Wonder Woman, then always be Wonder Woman."

good hands. We will continue to offer this type of advocacy opportunity to assist with training for any member who is willing to participate. Our advocacy priorities this year continued to consist of passing a PDMP, scope of practice, suicide awareness and prevention, and preventing opiate abuse. Although in the final days of this year’s legislative session, the PDMP failed to pass, we were closer this year to agreement then we have ever been previously. Please continue to foster a relationship with your state representatives and senators. Our legislators truly want to hear from you as you are the physicians in the trenches. The AAFP continues to have a presence in Washington, D.C., and several of our

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MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

executive commission, members of our advocacy commission, and our Executive Director, Kathy Pabst, attended the Family Medicine Advocacy Summit in Washington, D.C. They continue to nurture the established relationship with our national legislators and strive to make a difference at the national level.

I had the opportunity to attend the Congress of Delegates in Orlando, FL, in September along with our Executive Director, Kathy Pabst, and our delegates. The AAFP board election process brings out the best and the brightest. I was also able to see the announcement of our own Dr. Todd Shaffer’s AAFP Board of Directors candidacy for this upcoming year. We look forward to supporting Dr. Shaffer as he campaigns in San Antonio, TX, this September. I had the opportunity to share in meaningful discussions with our AAFP president elect, who is from Kansas and the AMA president elect, who is from Missouri.

These hometown leaders challenged me to think outside the box and bring a vigor back to our state. They encouraged me to continue to strive for excellence and improve on our ability to serve our members. Continued collaboration with our national family physician leaders and other state leaders will allow us to forge ahead into a changing unknown future of family medicine.

As current co-chair of the Membership Services Commission, I am excited to be celebrating our 70th anniversary. We continue to increase our membership and maintain our current active members. The MAFP magazine and website are available to support you as we continue to make modifications to streamline communication and make it more functional. We have also increased our Twitter and Facebook presence, and are always looking for members who are interested in helping us improve communication and social media.

As Board Chair in the coming year, I plan to continue to promote family medicine and advocate for our specialty. I look forward to working with our membership, advocacy and education commissions to facilitate continued learning and collaboration. In my final words, always be yourself, unless you can be Wonder Woman, then always be Wonder Woman.

We are dedicated to rural and underserved areas of our great state! MHPPS partners with safety-net providers and health care systems throughout Missouri to help health care professionals, like yourself, find a community that best fits your personal and professional needs. Whether it’s a scenic rural se�ng, dynamic urban loca�on, or somewhere in between, we are commi�ed to focusing on your interests and careers that count!

Find Out More: Contact Us Today!

Joni Adamson Manager of Recruitment 573.636.4222 jadamson@mo-pca.org www.3rnet.org/missouri

Opportuni�es t�roug�out our Rura� � Ur�an Areas:  �oan Repayment Op�ons  Compe���e �a�ary � Compre�ensi�e �ene�ts  Team �ased Mode�s of Care / Care Coordina�on  �i��e or no Ca�� / Mo�ing A��owance / �igning �onus

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MHPPS is non-profit and located within the MO Primary Care Associa�on MO-AFP.ORG 7

The Times They Are A-Changin'

T Mark Schabbing, MD President

his year has gone by very quickly as have many before. It has been busy with new, and some would say very interesting, changes in the world of politics. Our board has been very busy with advocacy and this has been led by our co-chairs, Keith Ratcliff, MD, FAAFP, and Emily Doucette, MD. Pat Strader continues to be an integral part as our state lobbyist.

In October, 2016, Dr. Ratcliff and myself attended the Board of Healing Arts Liaison Meeting. Dr. Ratcliff reported that we would be supporting a Preceptor Tax Initiative Working group. This would give a state tax exemption for physicians who are supportive in teaching students and residents out in the community.

"

I believe it will truly be an interesting time in medicine the next couple of years."

In February, we hosted our annual Advocacy Day in Jefferson City. We met the night before to discuss topics that were pertinent to our cause, and the following day we met with our respective legislators. We let our legislators know that we were in support of an effective PDMP and collaborative practice with our APRN colleagues.

We let them know that we believe all patients deserve access to quality health care, and we're supportive of bills that are protective to patients -like the bill of texting while driving and prohibiting younger drivers from using any electronic wireless devices - hands free or not, while operating a vehicle. We were also given the chance to support or oppose other legislation pertinent to us.

I have also been honored to represent our chapter this year at a couple of leadership meetings. In January, I participated in the MultiState Forum in Dallas, TX. Here, multiple states from the Midwest meet to discuss issues that are pertinent to our respective chapters. The meeting focuses on advocacy and education.

The purpose is to discuss things that are working

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MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

in our states, some of our struggles, and to come up with strategies that help all in our common causes. We received an update from our national leadership about the possible upcoming changes in healthcare. It is promising to hear from our leadership that primary care is being heard from and has a seat at the table of many of these discussions.

This past April I traveled to Kansas City, MO for the Annual Chapter Leadership Conference. This meeting focuses on board governance, advocacy, and education that can be taken back to our boards. Forty-seven state chapters were present at this meeting. Again, our national leadership updated us on what was occurring in Washington, D.C. One of the statements was how amazing one man’s TWEETs effect so many people and drive that day’s news headlines. I believe it will truly be an interesting time in medicine the next couple of years.

Our board continues to be active in education.

We have continued with our semi-annual meetings and conferences - our Scientific Assembly in June at the Lake of the Ozarks, and our fall meeting at Big Cedar Lodge near Branson, MO. Our fall meeting continues to be the best received by attendees. Our board offered for the first time this year, a resident’s conference in May. This was held in Jefferson City, MO. The goal was to offer residents information that would prepare them for what to expect when entering the workforce. This was received very positively and was given high marks by the residents who participated in the event.

It has been a pleasure to serve the board this past year. I look forward to the upcoming year, and serving as your President.

Moving Our Mission Forward

T

he financial stability of the Missouri Academy of Family Physicians remains sound, and we appear to have more than adequate reserves to sustain the academy for the foreseeable future.

Our current assets are approaching three years of budgeted expenses. We anticipate receiving our official audit report (which we complete every five years) by the annual meeting, and it will be summarized for the board meeting.

Because of the cyclic and intermittent nature of our income and expenses, it’s a bit challenging to evaluate our actual flows against budget at this time of the year. However, our income and expenses remain consistent with past years. We have the resources to continue to invest in areas that will move our mission forward. Currently these include Dr. Shaffer’s campaign for an AAFP board seat and increased investment in educational conferences and advocacy efforts.

Jim Stevermer, MD, MSPH, FAAFP Secretary-Treasurer

MAFP Student Director Reports MAFP Medical Student Director: Emily Gray (ejgz93@mail.umkc.edu) MAFP Medical Student Alternate Director: John Heafner (jheafne1@slu.edu)

Kansas City University of Medicine and Biosciences

• Current student population: 1,210 students • Number of students involved in FMIG: All KCU students receive membership in our local ACOFP (American College of Osteopathic Family Physicians) student chapter.

• Mission/goals: To advance the standards of family practice in the field of Osteopathic Medicine and Surgery by encouraging and improving the educational opportunities for the training of family physicians in all branches of osteopathic medicine and surgery, and to establish and promote a general understanding of the scope of the services rendered by the family physician and his/her relationship to other specialty groups.

• Events held this school year: In the 2016-17 academic year, KCU’s ACOFP chapter assisted with sports physicals in partnership with Della Lamb Community Services, hosted a health tent at the Chalk Walk (a Northeast neighborhood arts festival), invited guest speakers to campus to speak on the topics of residency applications, family medicine, and hosted an EKG clinic, and more.

• Future plans/events for your organization: Our ACOFP student leadership is working to develop and finalize a programming plan for the 2017-2018 academic year.

• Number of Students who matched to family medicine at your school this year: 43 of our 2017 graduates matched to family medicine.

• Student contact: Jameson Bastow (jbastow@kcumb.edu) • Faculty advisor: Gautam Desai, DO (gdesai@kcumb.edu)

Emily Gray, Student Director

St. Louis University School of Medicine

• Current student population: 720 • Number of students involved in FMIG: Roughly 50-60 students attend each event. However, we do not have an exact number of students who are members of AAFP or FMIG. • Mission/goals: Increase awareness/interest in family medicine and primary care by serving the students, the institution, the community, and anyone in need.

• Events held this school year: 'What is Family Medicine?' Introduction Talk, Family Medicine Residency Fair, M1 Procedure Night, Primary Care Panel, M2 Procedure Night at Mercy, Medicaid Expansion Talk, Missouri Foundation for Health Talk, Undergrad Procedure Night, Family Medicine Match Panel.

• Future plans/events for your organization: Residency Fair (September 6, 2017), Belleville Procedure Night.

John Haefner, Student Alternate Director

continued on page 11...

MO-AFP.ORG 9

HDAs HelpDesk Answers

In Healthy Adults, Does Routine Vitamin Supplementation Reduce the Incidence of Respiratory Infections EVIDENCE-BASED ANSWER

Vitamin C does not reduce incidence of the common cold in the general population, but appears to have a protective effect in strenuous athletes (SOR: A, metaanalysis of RCTs). Daily dosing of vitamin D, but not bolus dosing, reduces respiratory tract infections (RTIs) in the general population (SOR: B, meta-analysis of heterogeneous RCTs). Neither multivitamin nor vitamin E supplementation reduces the incidence of RTI in healthy older adults (SOR: B, single RCT).

A

EVIDENCE SUMMARY

Bethany Crawford, MD University of Missouri Columbia

Andrew Patel, MD University of Missouri Columbia

Peter Koopman, MD University of Missouri Columbia

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2013 Cochrane review and meta-analysis of 29 RCTs (N=11,306) compared the incidence of the common cold, defined as any combination of upper respiratory symptoms with or without fever, in participants taking oral vitamin C supplementation (daily dose >0.2 g) or placebo.¹ A subset of 24 trials (n=10,708) included adults and children from the general community supplemented with 0.2 to 3 g vitamin C or placebo.

Vitamin C demonstrated no protective effect (relative risk [RR] 0.97; 95% CI, 0.94–1.0) compared with placebo. A subset of 5 RCTs (n=598) included participants exposed to strenuous exercise (marathon runners, competitive skiers, or soldiers) supplemented with 0.25 to 1.0 g/d vitamin C. Follow-up ranged from 2 weeks to 5 years. In this subgroup, vitamin C supplementation demonstrated a 50% decreased incidence of the common cold compared with placebo (RR 0.48; 95% CI, 0.35–0.64).¹ A 2013 meta-analysis of 11 RCTs compared the incidence of upper and lower RTI in 5,660 patients 0 to 97 years old (mean age 16 years) taking oral vitamin D3 with both daily and bolus dosing at intervals (average dose 1,600 IU/d cholecalciferol) or placebo.² Follow-up ranged from 7 weeks to 3 years.

Overall, vitamin D supplementation was associated with a reduced risk of RTI versus placebo (11 trials; N=5,660; odds ratio [OR] 0.64; 95% CI, 0.49–0.84).

Daily administration of vitamin D was also associated with a significant reduction in RTIs (7 trials, n=1,270; OR 0.51; 95% CI, 0.39–0.67) compared with placebo.

Vitamin D administered in bolus doses once per month or less frequently was not associated with a reduction of RTIs (3 trials, n=382; OR 0.86; 95% CI, 0.62–1.2).

The protective effect of vitamin D supplementation was not affected by health status, age, sex, trial duration, or baseline vitamin D levels. In order to account for heterogeneity, a random effects meta-analysis was used. The review was limited by significant heterogeneity among studies (I²=72%), a reliance on relative measures of effect, and publication bias.²

MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

A 2002 RCT (N=652) involving noninstitutionalized adults older than 60 years compared the incidence and severity of RTIs in patients orally supplemented with physiologic doses of multivitamins with minerals, 200 mg vitamin E, both, or placebo.³ Over a period of 15 months, patients reported symptoms of possible RTIs by telephone to a study nurse who determined whether they met the definition for RTI. Compared with placebo, there was no decrease in RTI incidence or severity for multivitamins (RR 0.95; 95% CI, 0.75–1.2) or vitamin E (RR 1.1; 95% CI, 0.88–1.3).³ 1. Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2013; (1):CD000980. [STEP 1] 2.

Bergman P, Lindh AU, Björkhem-Bergman L, et al. Vitamin D and respiratory tract infections: a systematic review and meta-analysis of randomized controlled trials. PLoS ONE. 2013; 8(6):e65835. [STEP 1] 3. Graat J, Schouten E, Kok F. Effect of daily vitamin E and multivitamin-mineral supplementation on acute respiratory tract infections in elderly persons: a randomized control trial. JAMA. 2002; 288(6):715–721. [STEP 2]

Interested in more HelpDesk Answers?

Get the answers to your clinical questions with a complementary 3 month electronic subscription to

Evidence-Based Practice!

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MAFP Student Director Reports, continued from page 9...

• Number of students who matched into family medicine at your school this year: 28 • Executive board members: Co-Presidents: Melissa Chambers (chambersme@slu.edu) and Jared Schaefer (schaeferjd@slu.edu) • Financial officers: Eric Penton (epenton@slu.edu) and Emmy Mai (emai1@slu.edu) • Community service: Sara Ficenic (sficenic@slu.edu) and Andrew Ngo (ngoat@slu.edu) • Faculty advisor: Matthew Breeden, MD (breedenma@slu.edu)

University of Missouri - Columbia School of Medicine

• Current student population: 400 • Number of students involved in FMIG: 120 • Mission/goals: Top priority right now is engaging M1 students and finding ways to make them active in FMIG. • Events held this school year: Helpful hints for MS year at the Heidelberg; Welcome Back Fiesta; Ronald McDonald House Dinners; Grand Rounds Lunches; Fall Dinner Forum.

• Future plans/events for your organization: Residency Fair, Doctors Back to School, Tar Wars, Ready Set Fit, and Spring Dinner Forum.

• Number of students who matched into family medicine at your school this year: 5 solely, many are dual applying. No update for total family medicine match.

• Student contact: Co-Chairs: Ashley Albertson, M3 (ajawh8@health.missouri.edu), Elizabeth Worscowicz, M3 (ewdm2@health.missouri.edu), Kayla Matzek, M4 (kbmy83@health.missouri.edu), Misty Todd, M4 (mftrz4@health.missouri.edu) • Faculty advisor: Amanda Allmon, MD (allmona@health.missouri.edu)

University of Missouri - Kansas City School of Medicine

• Current student population: 600-650 (total 6 year BA/MD program) • Number of students involved in FMIG: 20 per meeting • Mission/goals: To introduce students to family medicine and the opportunities available within the field. To provide contacts and resources to those interested in family medicine. To educate students in the community about healthy living through sports physical events.

• Events held this school year: Casting workshop, suture workshop, clinical skills workshop, sports physicals events, RBI sports physicals event with the Boys and Girls Club, Strolling Through the Match Post Match Panel.

• Future plans/events for your organization: Sports Physicals Event for the community in July.

• Number of students who matched into family medicine at your school this year: 5 • Student contact: Emily Gray (ejgz93@mail.umkc.edu) and Seenu Abraham (savhd@mail.umkc.edu), Columbine Che (cncd49@mail.umkc.edu) and Nymisha Rao (nry74@mail.umkc.edu) • Faculty advisor: Dr. Miranda Huffman (huffmanmm@umkc.edu)

Washington University School of Medicine

• Current student population: 400 MD students plus 20-25 MTSP students.

• Number of students involved in FMIG: 150 students on listserv, 30 active members • Mission/goals: to increase exposure to primary care related fields at a center that is very tertiary/ quaternary care driven and to provide students interested in primary care fields or in family medicine with community mentors at nearby institutions like Mercy and SLU who have family medicine residencies. (Wash U does not have a family medicine program, so we rely a lot on the support of Mercy and SLU when helping our students match to family medicine).

• Events held this school year: This year, we have held an introductory lunch talk, a procedure night as a part of Primary Care Week (which is officially hosted by AMSA at our institution), a few networking dinners with local family medicine doctors, and an advising panel for third years looking to match into family medicine with the faculty and program directors from the SLU and Mercy family medicine programs.

• Future plans/events for your organization: Our last event will be a summer picnic that is hosted by some of the physicians in the area for anyone in town over the summer.

• Number of students who matched into family medicine at your school this year: 3 • Student contact: Samantha Greaney (sgreaney@wustl.edu) and Danielle Poivre (apoivre@wustl.edu) • Faculty advisor: Dr. Walton Sumner (wsumner@wustle.edu) A. T. Still University of Health Sciences: Osteopathic Medical School: • No report

MO-AFP.ORG 11

MAFP Resident Board Report Cox Family Medicine Residency, Springfield, MO 1.

2.

3.

4.

5.

6.

7.

8.

Kanika Turner, MD Resident Director

Meghan Blay, DO: Cox Medical Center Branson Hospitalists, Branson, MO (inpatient) Wes Campbell, DO: Springfield Inpatient Physicians, Springfield, MO (inpatient) Ian Cheyne, MD: Mercy Convenient Care, Fort Smith, AR (Urgent care) Angela Conklin, DO, MBA: Cox Family Medicine Residency OB Fellowship, Springfield, MO Brett Mossberger, DO: Springfield Inpatient Physicians, Springfield, MO (inpatient) Shawn Stranckmeyer, MD: Elite Pain Management, Springfield, MO (outpatient) Samantha Wallace, DO, MBA: Ozarks Medical Center, West Plains, MO (inpatient) Steve Zinter, DO: Springfield Inpatient Physicians, Springfield, MO (inpatient)

Mercy Family Medicine Residency, St. Louis, MO 1.

2.

3.

4.

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Catherine Moore, DO: Affinia Healthcare, St. Louis, MO (outpatient) Alexander Mazzaferro, MD: Mercy Family Medicine, Butler Hill, MO (outpatient) Mihiret Belihu, MD: TBD Perini Shah, DO: St. Anthony’s Medical Group, St. Louis, MO Mallorie Rhymer, MD: Freeman Health System, Joplin, MO (outpatient) Alexander Meyer, DO: Mercy Family Medicine, Kirkwood, MO (outpatient)

Research Family Medicine Residency, Kansas City, MO

Alicia Brooks, MD Resident Alternate Director

1. Caleb Baughn, MD: North Kansas City Hospital Hospitalist, Kansas City, MO (Hospitalist) 2. Nida Dillon, DO: College Park Family Physicians, Overland Park, KS (private practice) 3. Katelyn Falk, MD: Via Christi Hospital, Pittsburg, KS (Hospitalist) 4. Casey Gee, MD: private practice, Hutchinson, KS 5. Harman Khosa, MD: private practice, Canada 6. Brittani Moeller, DO: private practice, Kearney, NE 7. Adam Morawski, MD: private practice, Canada 8. Genna Siemons, MD: Ottawa Family Physicians, Ottawa, KS (private practice) 9. Ben Skoch, DO: Palliative Care Fellowship, University of Kansas Medical Center, Kansas City, KS 10. Merlin Sunny, DO: Essentia Health System, Riverside, CA (private practice)

Saint Louis University Family and Community Medicine Residency

1. Kanika Turner, MD, MPH: Family Care Health Center and SLU Adjunct Faculty, St. Louis, MO (obstetrics, outpatient/inpatient/academics) 2. Preethi Schmeidler, MD: Mercy Clinic, Imperial, MO (outpatient) 3. Muhammad Dalal, DO: Gateway Regional Hospital and Independent Contractor for Integritas Emergency Medicine Group, Granite City, IL (Hospitalist/Emergency Medicine)

University of Missouri Family and Community Medicine, Columbia, MO

1. Chase Ellingsworth: Cox South Hospital, Springfield, MO (inpatient) 2. Megan Warhol: SSM Family Medicine, Troy, MO (outpatient) 3. Christine Wilson: University of Missouri, Columbia, MO (inpatient/outpatient) 4. Andrea Schuster: University of Missouri, Columbia, MO (inpatient/outpatient) 5. Veronica Sievert: University of Missouri, Columbia, MO (inpatient/outpatient) 6. Asa Chu: Family Care Medical Center, Don Mills, Ontario, Canada (inpatient/outpatient) 7. John Ballantyne: St. Francis Hospital, Barry’s Bay, Ontario, Canada (urgent care/outpatient) 8. Andrea Bickerton: (No organization reported), Naples, FL (outpatient) 9. Erin Pearson: TBD (taking time off for maternity) 10. Carlos Rubio-Reyes: North Columbia Clinic, Columbia, MO (private practice) 11. Ben Stevens: (No organization reported), Dewitt, AR (inpatient/outpatient) 12. Howard Tseng: University of Missouri Emergency Medicine Residency, Columbia, MO

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MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

UMKC Truman Medical Center Lakewood, Kansas City, MO

1. Hailey Avila, MD: UMKC Sports Medicine Fellowship, Kansas City, MO 2. Neil Bryan, MD: Labette Health, Emergency Medicine, Parsons, KS 3. Colleen Quinn, MD: Obstetrics Fellowship (No organization identified), Oak Park, IL 4. Whitney Trusty, MD: Associates in Family Medicine, Kansas City, KS, (private practice) 5. Aniesa Slack, MD: UMKC Family Medicine, Kansas City, MO (Faculty) 6. Kevin Gray, MD: UMKC Sports Medicine Fellowship, Kansas City, MO 7. Cierra Johnson, MD: Mowery Clinic, Salina, KS (private practice) 8. Rachel Seymour, MD: St. Luke’s, Leavenworth, KS (private practice) 9. Nicholas Miller, DO: Team Health/IPC, Shawnee Mission Medical Center, Merriam, KS (Hospitalist) 10. Christine Lilly, DO: Team Health/IPC, Shawnee Mission Medical Center, Merriam, KS (Hospitalist) 11. Michael Moreland, DO: The Urgency Room, Lees Summit, MO (urgent care) 12. Jayme Decker, DO: Harrisonville Family Medicine, Harrisonville, MO (private practice) 13. Emily Grewe-Nelson, DO: Utica Park Clinic, Tulsa, OK (private practice) 14. Jennifer Woodward, MD: University of Kansas City, Kansas City, KS (Academics) 15. Kristin Duncan, MD: Care NOW, Overland Park, KS

MO-AFP.ORG 13

MISSOURI ACADEMY OF FAMILY PHYSICIANS

g n i t a r b e l Ce

70

Ye ar s

OF STRONG MEDICINE FOR MISSOURI

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MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

T

he Missouri Academy of Family Physicians kicked off its 70th Anniversary at the 69th Annual Scientific Assembly, held June 9-10 at the Lodge at Old Kinderhook in Camdenton, Missouri. Started in 1947 as the Missouri Academy of General Practice, and chartered in 1948, the Missouri Academy is the oldest chartered state chapter.

The American Academy of Family Physicians (AAFP) has a chapter for each of the 50 states, the District of Columbia, Uniformed Services, Guam, Puerto Rico, and the Virgin Islands.

Friday kicked off with breakfast and visits with exhibitors. Sessions included a wide range of topics including an AAFP board update, dysuria, pediatric topics, chronic conditions, venous diseases, borreliosis, and updates in the American Board of Family Medicine's (ABFM) family medicine certification.

The Awards and Installation dinner was held that evening where MAFP's new President, Dr. Mark Schabbing was sworn in, new officers were installed, membership anniversaries were announced, the 2017 Tar Wars award winner, Jillian Meier, was introduced, and the 2017 Family Physician of the Year, Dr. Bruce Preston was honored.

In honor of the 70th anniversary, past presidents were

treated to complimentary attendance at the dinner. (see a list on page 19), and Representative Diane Franklin spoke to the crowd on advocacy and reminded us that we all must take a role in advocating for our passion of family medicine.

Saturday continued with exhibitors, and sessions on overactive bladder, telehealth, child obesity, issues in high altitude medicine, pediatric chest pain, and a new poster presentation session by residents and students. Saturday afternoon, the Annual Business Meeting and Legislative Luncheon was hosted by Governmental Consultant, Pat Strader, and members were brought up to date on the 2017 legislative session. Saturday evening, members gathered with family and friends for an evening of face painting, music, balloons and a photo booth at the Family Fun Fiesta. Sunday wrapped up the conference with the commission and board meetings.

Join us in the Fall for the Annual Fall Conference at Big Cedar Lodge, November 10-11, 2017, and see our 70th Anniversary display table which will include historic pictures and artifacts, including items from over 70 years ago. Take a trip back in time and see what a general practice physician's office, library, and some of the tools used during practice would have looked like.

It [70th Anniversary display] was like a trip down memory lane."

Clemens Haggerty, DO

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Mark Schabbing, MD, delivers his Presidential speech to the crowd during the Awards and Installation dinner Friday evening.

Jim Stevermer, MD, FAAFP, pins the President's pin onto Dr. Schabbing following his installation.

Bruce Preston, MD, FAAFP, after being announced as the 2017 Family Physician of the Year.

Kathleen Eubanks-Meng, DO, and Representative Diane Franklin. Franklin was recognized for her support of family medicine.

Jim Stevermer, MD, FAAFP, installs Mark Schabbing, MD. Kathleen Eubanks-Meng, DO, presents Peter Koopman, MD, FAAFP, with his Soaring Eagle (outgoing president) award.

Kara Mayes, MD, and her family pose for a funny photo booth picture at the Family Fun Fiesta on Saturday evening.

Sarah Cole, DO, along with her daughter.

Pat Strader joins in on the fun too, with a tattoo from Merry Mary.

Kanika Turner, MD, Jason Arribas, DO, and Kara Mayes, MD. Robert Heiger, Student, Kanika Turner, MD, and Alicia Brooks, MD. Bruce Preston, MD, FAAFP, and family.

Becki Hughes and Kathy Pabst, MAFP staff.

MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

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Resident and Student Poster Contest Winners

T

he resident and student poster contest was again held in conjunction with the Annual Scientific Assembly.

This year’s contest was changed to include case study and research categories with winners in each category.

Winners received $300, $200, and $100 for 1st, 2nd, and 3rd place, respectively, for each category.

Research Category First Place (Tie): Neil Bryan, MD, UMKC/Truman Medical Center Family Medicine Residency Program Poster Topic: Extended Effectiveness of Paraspinous Bupivavaine Injections in the Ambulatory Setting First Place (Tie): Aneisa Stack, MD, UMKC/Truman Medical Center Family Medicine Poster Topic: Vaginal Versus Oral Misoprostol in Uncomplicated Induction of Labor: Maternal and Fetal Outcomes Third Place: Nicholas Miller, DO, Jacob Shepherd, MD, Whitney Trusty, MD, and Noushin Ansari, MD, UMKC/Truman Medical Center Family Medicine Residency Program Poster Topic: Prospective QI Study Comparing Usage of Apollo Sepsis App Verses Traditional Identification Method in Identifying Sepsis Case Study Category: Second Place: David Dalton, DO, Northeast Regional Medical Center Poster Topic: Recurrent Abdominal Pain in a Nine-Year-Old Female

Past Presidents Attend Awards Dinner

F

ormer MAFP Presidents were invited to attend the Awards and Installation dinner on Friday evening on a complimentary basis, in honor of the Missouri Academy's 70th Anniversary. We again would like to extend a thank you to each of them for their dedication and service to family medicine in Missouri.

The academy has grown under their leadership and vision, and we wouldn't be where we are today without them.

Pictured right: Kathleen Eubanks-Meng, DO, presents Arturo Montes, MD, FAAFP, a past president of the academy, with his certificate of appreciation for 50 years of membership with the AAFP/MAFP. Donald Potts, MD, FAAFP, was also presented with a certificate for 50 years of membership with the academy.

Thank you to all who attended: Arturo C. Montes, MD, FAAFP, 81-82 David W. Glover, MD, FAAFP, 92-93 Bruce Preston, MD, FAAFP, 01-02 Larry Huffman, MD, 03-04 Darryl K. Nelson, MD, FAAFP, 04-05 Elizabeth Garrett, MD, MSPH, 07-08

Arthur G. Freeland, MD, FAAFP, 09-10 Keith Ratcliff, MD, FAAFP, 10-11 Todd Shaffer, MD, MBA FAAFP, 11-12 Peter Koopman, MD, FAAFP, 15-16 Kathleen Eubanks-Meng, DO, 16-17

CMH care.

CMH CONGRATULATES

Missouri Academy of Family Physicians on 70 great years!

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MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

Citizens Memorial Hospital is recruiting Family Medicine physicians for a variety of openings including Full Scope Family Medicine in beautiful Southwest and West Central Missouri.

417-399-4333 citizensmemorial.com

2017 Tar Wars Poster Contest Winner Jillian Meier, a fifth grader from Houston Elementary School in Houston, Missouri, was this year's first place Tar Wars poster contest winner. Jillian received $100 and was recognized at the Annual Scientific Assembly, along with her mother and younger sister.

Thank you to Central Bank for donating the gift cards for the second and third place Tar Wars winners.

2017 Exhibitors & Sponsors

We are dedicated to rural and underserved areas of our great state! MHPPS partners with safety-net providers and health care systems throughout Missouri to help health care professionals, like yourself, find a community that best fits your personal and professional needs. Whether it’s a scenic rural se�ng, dynamic urban loca�on, or somewhere in between, we are commi�ed to focusing on your interests and careers that count!

Happy 70th Anniversary MAFP!

Find Out More: Contact Us Today!

Joni Adamson Manager of Recruitment 573.636.4222 jadamson@mo-pca.org www.3rnet.org/missouri

   

Opportuni�es t�roug�out our Rura� � Ur�an Areas: �oan Repayment Op�ons Compe���e �a�ary � Compre�ensi�e �ene�ts Team �ased Mode�s of Care / Care Coordina�on �i��e or no Ca�� / Mo�ing A��owance / �igning �onus

Ask us about complimentary career planning luncheon presenta�ons for FMIG and Residency Programs on topics such as: CV Wri�ng; Compensa�on Packages; �ob Search Strategies; Interviewing; �ob Selec�on; �oan Repayment Incen�ve Programs; Finance Basics; Contract �ego�a�on, and�or �ob �ransi�on.

Pride, Passion, Purpose: Careers That Count!

Wishing youOf: many Proud Partners more years of continued success!

MHPPS is non-profit and located within the MO Primary Care Associa�on

MO-AFP.ORG 19

Dr. Preston: "My doctor, and a very fine man..."

Bruce Preston, MD, FAAFP and family.

D

r. Bruce Preston is a long-time supporter of family medicine and the Missouri Academy of Family Physicians. A rural physician in West Plains, Dr. Preston can remember the only thing he have ever wanted to be was a doctor. Since completing his residency in Kansas City, he has been in practice at the same clinic for the past thirtyeight years. He, and his wife of forty years, Fran, reside in West Plains and have raised three children there as well.

Dr. Preston has seen the medical community and hospital in his community flourish as well as his medical group expand from a group of three physicians to now eight physicians, one physician assistant and three nurse practitioners. He has been engaged in the full gamut of family medicine including surgery, hospital, ICU and OB. He delivered approximately three thousand babies including several sets of twins. Preston served on the original board of directors for the South-Central Missouri Rehabilitation Center for the treatment of drug and alcohol addiction.

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MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

Dr. Preston received multiple nominations for this prestigious award, and three words were continually expressed in his nominations: caring, gentle, and thorough. One patient shared an experience that Dr. Preston would make house calls, 20 miles out in the country, for his terminal father until he passed. “He is MY doctor, and a very fine man.”

Dad is a great doctor, but he's really a better person."

In another testimony, a patient was without housing due to a tragedy. Dr. Preston and colleagues ensured the patient had somewhere to stay while also coordinating the patient’s admission to a nursing facility until his home was rebuilt. “Dr. Preston cares about the person, not just the patient.”

His personal interests drew him to be active in the local soccer association serving as president, its original board of directors to establish a program benefiting thousands of children in the area, and Dr. Preston was instrumental in establishing a boys and girls soccer program at the local high school. When there were not enough established referees, he became a certified Missouri State High School Association Referee for the high school teams. He also served as the original director for the Occupational Medicine Clinic for the hospital to establish a presence to help service our local industries; President of the Ozark Physician's Association which negotiated contracts with the largest employer in town; and he has been the medical director for Hospice Compassus in West Plains for the past thirteen years. Preston enjoys serving as a volunteer physician for the Free West Plains

"

Despite his busy life, our dad always found time for his family."

Christian Clinic, which serves the indigent of the area. As previously mentioned, he has been very involved with the Missouri Academy of Family Physicians, attending his first meetings back in the mid 1970s when he was a medical student.

The West Plains Daily Quill wrote a story about Dr. Preston in which he stated, “the best thing about being a doctor is making a meaningful difference in the lives of people.� He has done just that not only in West Plains, but also in Missouri and through his service representing Missouri family physicians at the national level.

Dr. Preston with his wife of forty years, Fran.

Dr. Preston's daughter, Brittany, delivering kind words about her father during his 2017 Family Physician of the Year recognition.

The print which was presented to Dr. Preston was not the traditional print presented to the Missouri Family Physician of the Year. Dr. Preston was involved in the commissioning of the original painting of a country doctor visiting a patient in a rural area. Because of his direct involvement in this effort, he was presented with the first numbered and signed print of the original painting, which hangs in the MAFP office. So, rather than Dr. Preston receiving a duplicate of this print, he selected the Terry Redlin print, House Calls, which was presented to him during the awards dinner on Friday evening of ASA.

MO-AFP.ORG 21

MEMBERS the

IN NEWS NEWS TO SHARE?

The Missouri Family Physician magazine welcomes your input.

Please submit newsworthy items for review to: office@mo-afp.org

Family Medicine Leads Scholarships The following Missouri students and residents were recognized by the AAFP for their interest in family medicine and commitment to providing patient-centered care. Each winner received a $600 scholarship provided by the AAFP Foundation to attend National Conference.

• Sirui Liu, St. Louis University • Dalton Lohsandt, University of Missouri - Columbia • Theresa Wertin, St. Louis University

SLU and UMC Promote Philosophy of Family Medicine Saint Louis University School of Medicine Family Medicine Interest Group earned the 2017 Program of Excellence Categorical Award: Excellence in Promoting the Value of Primary Care.

University of Missouri - Columbia received the Program of Excellence Award (they were one of ten award recipients). Please extend our congratulations to the students, faculty, and staff who contributed to this achievement. We applaud your efforts to promote the values and philosophy of family medicine.

UMKC Hosts 10th Annual Research Day

Graduating residents at UMKC Family Medicine's 10th Annual Research Day.

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MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

Shepherd on Population Health

Celebrating 50 Years

Clinical Advances in Pediatrics Symposium Sept. 27–29, 2017

• Earn up to 17 hours of CME and 17 points of MOC Part 2 • Guest faculty includes: • Kristina Bryant, MD • Jose Clemente, PhD • Mark Del Monte, JD

Jacob Shepherd, MD – 2nd year FM resident (soon to be 3rd yr) on a panel at the Cerner Conference regarding population health with one of his patients.

Shepherd received a stellar patient outcome review and was brought on stage for a Q&A.

• Avery Faigenbaum, EdD, FACSM, FNSCA • Lonnie Zeltzer, MD

Children’s Mercy Park Kansas City, Kan. childrensmercy.org/CAPS

Hoekzema Receives Faculty of the Year Award

Mercy chief residents, Alex Mazzaferro, MD, (middle) and Catherine Moore, DO, give the family medicine Faculty of the Year award to the family medicine department Chair, Grant Hoekzema, MD.

L-R: Catherine Moore, DO; Mallorie Rhymer, MD; Perini Shah, DO; Mihiret Belihu, MD; Alex Mazzaferro, MD; and Sarah Cole, DO, Program Director. Not pictured: Alex Meyer, DO.

MAFP Necrology Report 2016-2017 Our sympathies to the families of our members who passed away last year.

Robert J. Bareis, MD (Marshfield) Samuel C. Bonney, Jr, MD (Glencoe) Leroy J. Miller, MD (Columbia)

Lawrence G. Stuerman, MD (O’Fallon) Michael Wulfers, MD (Cape Girardeau) MO-AFP.ORG 23

Take the Next Step and Stand Up for Family Medicine [Dr. Schabbing's speech from the Awards and Installation dinner after his installation as the 2017-18 MAFP President.]

B

efore I really get started, I would like to take a few moments to thank a few people. To some of you who are Catholic, this may sound a little like a Litany of the Saints. The first person is my best friend, my high school sweetheart, and now my wife. We all have that rock in our life that we hang on to, and she is that for me.

When I get down, she picks me up and when my head swells and I get stuck in the clouds, she knows how to pop it so I find my feet more firmly planted on the ground. Tracey reminds me, by her example, the importance of faith and the strength of family. I thank my children for putting up with me when I missed parties, school events, and all those other moments that we all know about which are so important. My parents, for supporting my goals, pushing me when I wanted to slack, and instilling the values that I have today. I would like to thank my partners for taking care of my practice when I am away at meetings and conferences. David Kapp, my senior partner, invited and then politely pushed me into joining this board eight years ago. There were also many others along the way; for example, Jim Stevermer and Alan Gill, nurses and friends, but if I continue, this could go on forever.

When I began to think about a career I was on a slightly different road. I thought I was going to be a veterinarian. I was in my father’s hip pocket from the age of five going on one farm visit to another. I loved the outdoors and enjoyed large animal medicine. I knew I wanted to move back to southeast Missouri, but I noticed that the

Dr. Schabbing and wife, Tracey.

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MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

small farmer was being swallowed up by large farms. The job of the rural veterinarian was changing; much like the independent practice physician has been bought up by our hospital conglomerations. I changed my mind wanting to stay rural and began to think about medicine as a career. I was majoring in agriculture and this changed to Interdisciplinary Studies meaning I did not have enough hours in any one subject, but minors in biology, chemistry and agriculture.

In Columbia, Missouri, I finished medical school and residency. I moved to Perryville, Missouri in 1998 after residency to begin my career.

Our group has grown from three doctors and a nurse practitioner, to five doctors and five NP’s.

When beginning my career, I did the full scope of family medicine -- inpatient and OB. Now I focus primarily on ambulatory medicine with nursing homes and I help with a local hospice.

Getting up here and talking to you is not an easy thing for me to do. One of my first experiences in front of a group was to read at Mass. This was one of my father’s requirements or commands to give back to the church when I was in high school. I locked my knees and when they popped loose from shaking, I think I lost six inches. It was not funny then and it is not funny now. I am most comfortable in a 10 by 12

foot room with a patient, and maybe one or two family members. I feel like I am in command of the situation. I suspect that many of you feel the same way. I am telling you this because I feel like we all need to step out of comfort zones occasionally. I am going to ask you to step out of your box today.

I did not initially want to become active part of the MAFP board. I felt I was too busy trying to keep up with my patient load. My oldest daughter was just beginning high school and this would be

"

It is your duty to voice your concerns (and encourage your colleagues to do the same) to your local and national boards so they (we) can effectively navigate the goals of the constituency."

taking more time away from the family. I believe many of you may feel the same way. My senior partner, David Kapp, was on the board and had taken a leadership role which left our district open for a delegate. His words were, "we need to remain active and give input. If not, someone else will and we may not like the outcome." If we say nothing then we really do not have much to complain about.

Medicine is experiencing new changes and has gone through more changes in the last generation than it may have in any previous. Not only have advances in surgery, medicines, and procedures been phenomenal; I believe there is more on the way! Yet, along with those improvements we have experienced the “joy” of changing from the paper chart to the electronic medical record; and for some of us we may have gone from one EMR to another. We have gone from a workforce that was predominantly self employed to one that is now hired by large hospital-based systems. We are challenged with ICD-10, MACRA, and the almighty Prior-Authorization. Our members are struggling with burnout. As a physician from Oklahoma

stated at a recent leadership conference to our leadership at the AAFP, “I do not ever remember talking about burnout until the introduction of the EMR.” Locally, we continue to struggle with the need for our nurse practitioners to have independent practice. There are more changes on the horizon. Currently we have a crumbling health care system based on the Affordable Care Act or “Obama-Care” but tomorrow it may be “TrumpCare.” This nation is facing an opioid epidemic that is not leaving Missouri out of its path.

These issues may seem daunting or even overwhelming. None of these issues seem to be easily changed and may seem more like a boulder rolling down a mountain and gaining speed. There are days, and my nurses would say “many,” where I would like to borrow Harry Potter’s wand and make the Prior-Authorization just disappear. If I did have that wand, I would use a Killing Curse because if I made it just vanish, I’m afraid it would reappear around the corner.

This is where I am going to challenge you to step outside of your box. We cannot stay and hide in that 10 x 12 foot exam room where we feel comfortable, and then go home. I believe we have done that in the past and dropped the reins on the horse carrying medicine on its back. We have allowed the government, insurance companies, and hospital systems to take the reins, and we are now just along for the ride. Insurance companies, government regulations, and hospital systems dictate what we do and how we take care of patients inside that 10 x 12 foot room. I am not saying all the changes that have been made are bad, but the execution of some of these plans have been anything but smooth, and I do not believe that physicians have been at the forefront of the changes. Today, the AAFP has a foot in the door and is speaking for our needs and the needs of our patients on a national level. We at the MAFP do the same thing in Jefferson City.

continued on page 26...

Kyle Maynard MO-AFP.ORG 25

New President, continued fom page 25...

At the leadership conference I attended in Kansas City this past April, I listened to an inspirational speaker, Kyle Maynard.

I encourage you to Google or Youtube this gentleman. He has an amazing story. Kyle was born with congenital amputation of all four limbs. He had arms only to the elbow “no hands." His legs only led to his knees. His family chose to make sure he had a life as close to normal as possible. Kyle wrestled in high school and played football in junior high. He has become an entrepreneur and a motivational speaker. He is independent in all ADL’s, drives a vehicle and most amazingly bear crawled two different mountains. Talk about stepping out of your box. Kyle grew up in Georgia, and at the age of ten moved to another state. He was with the same classmates from preschool to middle school and then had to adjust to another school and start over. In order to get over people’s reaction to his disability, Kyle’s grandmother would push him in the grocery store down the aisles. When they would run into a stranger, she would introduce Kyle and ask him to shake their hand.

One of the many things that stuck out to me during his speech was when he was talking about setting goals. He hated motivational speakers who would say "the sky is the limit.” He stated in his words, “this is Bullshit.” Kyle knew no matter how hard he would try, work, or train, “I am never going to be a tennis player or world class sprinter.” The object is to know where our limits are, and when we reach them, to keep pushing.

Most of us, including myself at times, will voice our concerns about the current issues we have been facing in medicine with each other. It is comfortable to do this with our colleagues. But far too few of us will take that next step and pick up the phone or write an email to our legislators to let them know how we

feel and where we stand on certain issues. I guess if we all felt comfortable with this, we would be lawyers. It is your duty to voice your concerns (and encourage your colleagues to do the same) to your local and national boards so they (we) can effectively navigate the goals of the constituency. Our board locally provides support to our members. It provides education, updates of what we are doing with a quarterly magazine, and advocacy with an advocacy commission and lobbyist. Every one of us are leaders. We do it every day in that 10 x 12 foot exam room. Here, we provide guidance, support, and comfort to our patients and to their families. This is where I am asking you to step out of that room, your box, and give support and guidance to your board.

I started this talk with a comment that my thank you's may sound like a Litany of the Saints. To stay with the same theme, no church service is complete without a plea for money.

Unfortunately in government, money talks. The AAFP PAC took in nearly a million dollars the last couple of years. It is this PAC that allows them to get a seat at the table of legislation being made. And we are there. Here in Missouri our PAC raises about three to six thousand. We support those who support our causes. This is on both sides of the aisle. It is important not only to contact our legislators but to support those who support us. I am asking each of you to make a contribution to the MAFP PAC, then urge or push your colleagues to do the same. Thank you again for letting me serve you this year.

Mark Schabbing, MD lives in Perryville, Missouri with his wife, Tracey. Together, they have three children. Schabbing completed medical school and residency at the University of Missouri-Columbia.

     

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MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

Visit: www.CoreContent.com Call: 888-343-CORE (2673) Email: mail@CoreContent.com

MO-AFP.ORG 27

New Initiative Draws Residents to Jefferson City

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he Family Health Foundation of Missouri, the philanthropic arm of the Missouri Academy of Family Physicians, hosted 20 residents in Jefferson City in May. This two-day conference brought together new physicians sharing their experience and knowledge with PGY2 and PGY3 residents as they transition to practice.

Great opportunity to gain insight into the process of employment and see several different models of care delivery. The topics were relevant, and residents close to graduation who already had jobs were great resources."

Alicia Brooks, MD

Thank you to our speakers: Jennifer Wessels, MD, (Fenton), Jennifer Allen, MD, (Hermann), Wael Mourad, MD, (Kansas City), Peter Koopman, MD, FAAFP, (Columbia), Emily Doucette, MD, (St. Louis), and Catie Benbow, DO, (Springfield).

The purpose of this conference was to provide resources and practical tools to residents as they begin their careers after residency. Participants experienced a welcoming environment at the Doubletree Hotel to exchange information and ideas with fellow residents. Sessions included learning the leadership skills essential to performing well in their role as a family physician, access to resources as well as valuable peer and family medicine expert connections, the power of engagement at the community, state, and national levels, and practice management skills such as licensing, credentialing, insurance, billing processes and more.

The residents provided excellent feedback to improve this conference for those that follow them. Your continued support of the Family Health Foundation of Missouri enables programs such as this one to be offered at no cost to the attendees.

The transition to practice conference was an amazing experience. It provided me with the tools I needed going into third year. I really appreciated the opportunity to embark on the state prison tour and the state lab tour. The MOAFP provided great lecturers, wonderful food and a great opportunity to network with other resident physicians. I would love the opportunity to participate in this CME conference again next year."

Jacob Shepherd, MD A little fun was included late in the afternoon.

After a tour of the Missouri State Health Lab, residents boarded the trolley for a tour of the oldest penitentiary West of the Mississippi River, and wrapped up the night with dinner at a local restaurant, Prison Brews.

It was a great opportunity to interact with other family medicine residents, and fun to experience some of the sights in Jefferson City."

Maggie Barnidge, MD

Peers + Leaders + Influencers = Change = You! 28

MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

Key Policies Shared with U.S. Legislators

M

issouri delegates shared key policy positions at this year’s AAFP Family Medicine Advocacy Summit that convened in Washington, D.C., on May 22 with a record attendance of more than 250 family physicians and medical students.

The attendees heard from 18 political and policy experts on a wide variety of topics including health coverage reform, new payment models, the Teaching Health Center program and others. This annual meeting provides information and support so that AAFP members can coordinate their advocacy with federal legislators on issues affecting family medicine.

Missouri’s delegation included: Todd Shaffer, MD, MBA, FAAFP (Kansas City) Peter Koopman, MD, FAAFP (Columbia) Keith Ratcliff, MD, FAAFP (Washington) (Dr. Ratcliff is also an AAFP Key Contact) John Burroughs, MD (Liberty) Emily Levinson, Student, University of Missouri-Columbia Cherry Cockrell, MD, Resident (Mercy FMR), St. Louis Kathy Pabst, MBA, CAE, MAFP Executive Director Pictured L-R: John Burroughs, MD, Cherry Cockrell, MD, Peter Koopman, MD, FAAFP, Kathy Pabst, MAFP Executive Director, Todd Shaffer, MD, MBA, FAAFP, and Keith Ratcliff, MD, FAAFP.

Missouri Sends Full Delegation to Leadership Conference

t

he AAFP’s Annual Chapter Leadership Conference and the National Conference of Constituency Leaders once again drew key leaders to Kansas City. The Missouri Academy of Family Physicians was not an exception as we had a full slate of delegates representing the following constituencies:

Women – Amelia Frank, MD (Columbia) Minority – Joule Stevenson, MD (St. Louis) New Physician – Kelsey Ryan, MD (Kansas City) IMG – Afsheen Patel, MD (Kansas City) LGBTQ – Tess Garcia, MD (Kansas City)

This year’s budget included funding for the Executive Commission to attend as well as we develop future leaders within the state. Peter Koopman, MD, FAAFP, Past President; Mark Schabbing, MD, President; Sudeep Ross, MD, (past vice president who has relocated out of state), and Kathy Pabst, your Executive Director attended sessions on board/staff relations/responsibilities and strategic planning. Many concurrent sessions were available for staff, board members and physicians. Becki Hughes, Member Services and Programs Coordinator, also attended a one-half day session for new employees on AAFP meetings, marketing, communications, public relations, social media, and students/ residents.

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POSITION YOUR PRACTICE FOR MIPS SUCCESS

Pick Your Pace to Payment Success

Start now to avoid a negative payment adjustment in 2019.

Let the AAFP guide you through the Quality Payment Program (QPP) and MIPS.

aafp.org/MACRAReady

You already know about MACRA, but are you ready to master it? If so, don’t miss the Making Sense of MACRA Conference.

Don’t wait. Register by September 27 and save.

Approved for 3 AAFP Prescribed credits. Taught

by AAFP MACRA Quality Payment Program experts, this interactive, 3-hour live event is designed to position your practice for MIPS success.

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IMPORTANT! October 2 is the last day to begin gathering data in order to fully or partially participate in MIPS.

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3/29/17 4:07 PM

Making Sense of MACRA Conference Thursday, October 26 or Friday, October 27, 2017 (Pick your day) Pointe Hilton Squaw Peak Resort Phoenix, AZ

Community Preceptors Developing the skills to excel and inspire learners of

Family Medicine

Teaching credit may be claimed for instruction for health professions learners in formal individual (e.g., preceptorships) or live educational formats. Credits should be claimed commensurate with participation, with a maximum of 60 credits per re-election cycle.

Clinical teaching often occurs in busy outpatient settings, where time is at a premium.

Perhaps your local or regional medical school or residency has invited you to become a community preceptor. Perhaps you are considering reaching out to an educational institution to volunteer as a community preceptor. To do so can be a rewarding experience - community preceptors report not only satisfaction with the experience but also high (93.7%) overall satifation with their professional life.

(Source: Latessa R. Colvin G, Beaty N et al. Satisfaction, motivation and future of community preceptors: what are the current trends? Acad Med. 2013 Aug;88(8):1164-70.)

A great clinical preceptor is humble enough to say, "I don't know" when presented with a challenging point of care question."

Sarah Cole, DO, FAAFP

MAFP 2017 End of Session Report

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he 2017 legislative session ended at 6:00 p.m. on Friday evening, May 12. A number of omnibus licensing and health care bills made it to the finish line (SB 50, SB 139, SB 501). The Senate literally shut down around 3:00 p.m. on the last day when leadership used a maneuver called the previous question to bring HB 1194 & 1193 to a vote. This legislation was designed to preempt and nullify all political subdivision ordinances in effect or later enacted that would establish minimum wages that exceed state laws. Earlier St. Louis had adopted a $10/hour minimum wage. The “PQ” is used frequently in the House, but rarely in the Senate. Every time it has been used in the Senate, legislative movement usually shuts down soon after.

Pat Strader, MAFP Legislative Consultant

Almost 2,000 bills, resolutions, joint resolutions and concurrent resolutions were introduced; 83 bills and resolutions (which include the 18 appropriations bills) were Truly Agreed to and Finally Passed. Following are the major bills that passed and those that failed to pass. Many of the measures of interest to MAFP were included in omnibus bills. As you will see below, the prescription drug monitoring program failed to pass but was still being discussed up until the last day of session. Bills will become effective August 28 unless they have an emergency clause or a specific operative date.

State Funds Sweep (HCB 3) – Vetoed by the Governor House Committee Bill 3 would have given the Commissioner of Administration authority to sweep certain state funds. We were successful in getting boards and commissions (Chapters 324 to 346) under Professional Registration exempted out. This bill was aimed at providing funds for senior services to replace cuts in nursing care and in-home care. An attempt to sweep funds was tried earlier in the House but failed.

Look for this to be a major issue next session as legislators search for ways to balance the budget without cutting services.

Real ID Fix (HB 151) – Signed by the Governor This legislation needed to pass for Missouri to be in compliance with federal law so that Missourians could use their drivers’ licenses next year to board flights and enter military bases. The bill provides that a person may obtain a Real ID compliant license or choose to obtain a regular license that would not allow it to be used for the above purposes. Missouri has now received a waiver from the federal government giving the state time to implement the Real ID license.

BILLS THAT PASSED

(All Bills Shown Below That Passed Have Been Signed by Governor Greitens) Epinephrine Auto-Injectors (SB 139; SB 501) – This act allows a physician to prescribe epipens in the name of an authorized entity for use in emergency situations. “Authorized entity” is defined as any entity or organization at or in accordance with locations where allergens capable of causing anaphylaxis may be present, including but not limited to, restaurants, recreation camps, youth sports leagues, amusement parks, and sports arenas.

Medical Records (SB 501) – This bill changes the fees for the search, retrieval, and copying of a patient’s health care records by a provider. The bill also provides that a health care provider may disclose a deceased patient’s health care records or payment records to persons as specified in the act.

Drug or Alcohol Overdoses (SB 501) – Under this act a person who, in good faith, seeks or obtains medical assistance for himself or herself or someone else who is experiencing a drug or alcohol overdose or other medical emergency shall not be arrested, charged, prosecuted, convicted, or have his or her property subject to civil forfeiture or otherwise penalized for offenses specified in the act if the evidence, charge, prosecution, conviction, seizure, or penalty was gained as a result of seeking or obtaining medical assistance.

Statewide Standing Order for Opioid Antagonist (SB 501) – ThisShaffer, act gives the MD, DirectorMBA, of DHSS,FAAFP or Todd a licensed physician with the express consent of the Director of DHSS if the Director is not a licensed physician, the authority to issue a statewide standing order for an opioid antagonist. A physician issuing such order shall not be subject to any criminal or civil liability or professional disciplinary action associated with the order.

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Medication-Assisted Treatment (SB 501) – This act allows participants in drug courts, family courts, and veteran courts to receive medication-assisted treatment under the care of a licensed physician if the participant requires such treatment for substance abuse dependence.

Drug Take-Back Program (SB 501) – This act gives the Board of Pharmacy the ability to allocate funds to develop a drug take-back program to collect and dispose of Schedule II and III controlled substances.

Polypharmacy & Antipsychotic Medications (SB 139) – This act repeals existing language relating to psychotropic medications and adds new language relating to the establishment of a polypharmacy program and the prescribing of antipsychotic medications. The MO HealthNet Division shall establish a polypharmacy program for high-risk MO HealthNet participants with numerous or multiple prescribed drugs and establish a behavioral health pharmacy and opioid surveillance program to encourage the use of best medical evidencesupported prescription practices. The division shall issue provider updates to enumerate specified treatment and utilization principles for MO HealthNet providers, including treatment principles relating to antipsychotic drugs.

Immunization Education (SB 501) – This act provides that Missouri assisted living facilities shall, no later than October 1 each year, notify residents and staff where in the facility the latest edition of the Vaccine Information Sheet published by the CDC has been posted. Nothing in the act requires an assisted living facility to pay for an influenza vaccination.

Health Care Directives Registry (SB 50; SB 501) – This provision requires DHSS to contract with a third party for the establishment of a health care directives registry for the purpose of providing a place to securely store an advance health care directive online and to give authorized health care providers immediate access to the directive. The department will promulgate rules to carry out these provisions, which may include but not be limited to, a determination of who may access the registry, including physicians, other licensed health care providers, the declarant, and his or her legal representative or designee.

Neonatal and Maternal Levels of Care (SB 50) – Under this act, DHSS shall hold public hearings and establish criteria for levels of maternal care designations and neonatal care designations for birthing facilities. Beginning January 1, 2019, any hospital with a birthing facility and any such hospital operated by a state university shall report to the department its appropriate level of maternal care and neonatal care designations.

Suicide Awareness and Prevention (SB 52) – Medical Student Suicide Prevention and Elementary/ Secondary School Suicide Prevention. This bill included provisions for schools as well as the “Show-Me Compassionate Medical Education Act." It contains an emergency clause and became effective upon signature by the Governor.

Expert Witness (HB 153) – This act changes the procedures for expert witness testimony. It requires Missouri courts to adopt the Daubert standard for vetting witnesses in certain civil actions. Federal courts and 42 other states apply this standard. The Daubert standard includes provisions for a judge to rule on whether or not the testimony provided by experts is based on reliable scientific facts and data.

Professional Registration (SB 501) – This act provides acceptable ways a professional licensee may submit payment, application, requests for educational time extensions, or notify his or her licensing board for changes to items required as part of licensure to the Division of Professional Registration or its component boards, committees, offices and commissions.

Sports Medicine Team Physicians (SB 501) – This provision permits a physician to travel into Missouri with an athletic team and provide sports-related medical services to individuals related to the athletic team, band, dance team, or cheerleading squad, so long as the physician is currently licensed to practice medicine in another state and has a written agreement with the athletic team located in the state where the physician is licensed. The act prohibits the physician from providing medical services at a health care facility in Missouri.

Assistant Physician Date Fix (SB 50; SB 501) – Allows any medical school graduate who has met the requirements to be an assistant physician between August 28, 2014, and August 28, 2017, to be deemed to be in compliance with the requirements of becoming an assistant physician.

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Physician Assistants (SB 501) – The language in this bill was designed as “clean up." Currently, the statute says that a PA may prescribe and dispense under a supervision agreement with a physician. As PA’s do not dispense, the reference to dispensing was removed from the statute.

Vaccine Protocols (SB 501) – This act requires pharmacists to administer vaccines by protocol in accordance with treatment guidelines established by the Centers for Disease and Control. This bill intends to clarify the language in statute; it does not add vaccines that pharmacists may administer as spelled out in Section 338.010, RSMo. Collateral Source (SB 31) – This act modifies provisions relating to medical malpractice cases and provides that parties may introduce evidence of the “actual cost” rather than the “value” of the medical care rendered. It modified the current rule that prevents evidence from being admitted to show that a plaintiff’s losses have been compensated from other sources such as insurance or workers’ compensation.

Actions Against Health Care Providers (HB 452) – This bill creates a definition for the term "employee" and repeals the definition for the term "physician employee" in provisions relating to causes of action for damages against a health care provider for personal injury or death. With certain exceptions, no health care provider shall be liable to any plaintiff for the negligence of another entity or person who is not an employee of the health care provider. The bill was designed to “fix” earlier case law – known as the Jefferson Case -- that resulted from previous tort reform statute changes. It limits liability of hospitals for actions of nonemployed healthcare providers.

Stemi and Trauma Center Designations (SB 50) – Under this act, the Department shall promulgate rules for the designation of a trauma center and a stemi center without site review if such hospital is certified by a national body.

Newborn Screening (SB 50) – This act requires DHSS, beginning January 1, 2019, and subject to appropriations, to expand current newborn screening requirements to include spinal muscular atrophy and Hunter syndrome.

BILLS THAT FAILED TO PASS Prescription Drug Monitoring Program (HBs 90 & 68) – Negotiations were continuing up to the last day of session. The last version CCR SS SCS for HBs 90 & 68 changed the data purge requirement from 180 days to 2 years and added a 6-year sunset provision. It still required prescribers to check the database for Schedule II, III, or IV controlled substances but maintained a number of exemptions. If a nonopioid controlled substance, other than a benzodiazepine, was being prescribed by a provider for a patient with whom they had a previous prescriber-patient relationship, they would not be required to access the database. It also allowed political subdivisions to continue operating their programs until such time as the department’s program was available for utilization by prescribers and dispensers throughout the state.

Advanced Practice Registered Nurses While nothing passed this session, there were a number of amendments included on various bills. The main one would have changed geographic proximity by increasing the mileage from 50 to 75 which we believe addresses the concerns we’ve heard during the past couple of years for various rural areas of the state.

In addition to the mileage change, the provision allowing collaborative agreements between physicians and APRNs increasing from 3 to 5 was also added to CCS HCS SCS SB 139. Both of these provisions were removed during conference committee on SB 139. In summary the main APRN issues debated this session included: • Geographic Proximity – Repeal of mileage requirements • Increased geographic proximity from 50 to 75 miles • Collaborative Practice Agreements – Allow physicians to collaborate with 5 APRN FTEs vs. 3 • Independent Practice • Increased Scope of Practice • Creation of an APRN license • APRN Schedule II Prescribing

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Motorcycle Helmet Repeal (HB 576) – Numerous bills were filed on this subject. HB 576 did pass the House and a Senate Committee but was later added to an omnibus transportation bill – SB 8. In conference this provision was removed.

Athletic Trainers (SB 454; HB 882) – This bill would have increased the scope of practice for athletic trainers by changing the definition of an athletic trainer to “health care professional” and changed language from “practices prevention” to “promotes health and wellness, provides injury and illness prevention, clinical evaluation and assessment." It also expanded the population they could serve from “athletes” to “physically active individuals."

Physical Therapy: • HB 211 – This act would have allowed direct access to physical therapy services with no referral from a physician. Instead, a physical therapist would only be required to refer any patient whose medical condition is beyond the physical therapist’s scope of practice to a medical doctor.

• HB 157 – This bill would have allowed for physician ownership of physical therapy practices.

Any Willing Provider (HB 388) – This act would have required health carries to contract with any Missouri provider who is willing to meet the terms and conditions established for such health plan, including MO HealthNet and Medicare programs.

Covenants Not to Compete (HB 479) – This bill would have eliminated covenants not to compete between hospitals and physicians; this version also included business in general.

Radiology Technologists (SB 407; HB 789; HB 601) – This bill would have required anyone performing x-rays to be certified or licensed by a newly-created Missouri Radiologic Imaging and Radiation Therapy Board of Examiners. It created a number of new licensing categories, including the “limited x-ray machine operator” which still required the applicant to pass an examination administered by the American Registry of Radiologic Technologists for a certificate and permit in chest, extremities, skull/sinuses, podiatric, or spine radiology. It would also have required annual continuing education for recertification.

Texting While Driving – Numerous bills were filed on this subject with one actually having a hearing. Most included provisions for hands free and would have included all drivers –not just those under 21.

Chiropractors (HB 209; SB 263) – These bills would have required that chiropractors be reimbursed for services under MO HealthNet. CDC Guidelines – Opioid Prescribing (SB 72) – This bill provided that health care providers could have their professional licenses disciplined for failure to follow the “CDC Guidelines for Prescribing Opioids."

Vaccine Protocols (HB 1106) – This measure would have allowed a pharmacist to prescribe and administer any vaccine as recommended by the CDC’s Advisory Committee on Immunization Practices. It would have expanded the number of vaccines that are permitted to be administered by pharmacists, (which is currently spelled out in Section 338.010, RSMo).

MOL/MOC (HB 529) – This bill provided that no provision of law could be construed to require any form of maintenance of licensure, including any form of maintenance of certification as a condition of physician licensure, reimbursement, employment or admitting privileges at any hospital within the state.

Volunteer Health Care Services (HB 854) – The bill would have allowed health care providers to contract with DHSS or a governmental contractor to provide volunteer health care services to uninsured and underserved individuals. The provider would have been considered an agent of the state for purposes of sovereign immunity while acting within the scope of the contracted duties which comply with the requirements outlined in the bill.

Sunrise Act – Professional Registration (HBs 480, 272, 413 & 609) – This bill created a review process for unlicensed professions seeking to become licensed as well as for those licensed professions seeking to substantially increase their scope of practice.

MO-AFP.ORG 35

BNDD Funding (HB 103) – This bill would have created a Controlled Substance Abuse Prevention Fund to collect fees from entities registering with DHSS to manufacture, distribute, or dispense controlled substances. The purpose of the monies was to increase funding for the Bureau of Narcotics and Dangerous Drugs to facilitate hiring additional investigators. Currently, the bureau is required to employ no less than one investigator for every 2,500 registrants.

Contraceptives • HB 233; HB 373 – Would have added the prescribing and dispensing of hormonal contraceptives to the definition of the practice of pharmacy; allowed pharmacists to prescribe them to a person who is 18 years of age or older regardless of whether the person has evidence of a previous prescription and to a person under 18 years of age if they have evidence of a previous prescription.

• HB 1188; HB 774 – Would have permitted a long-acting reversible contraceptive (LARC) that is prescribed to and obtained for a MO HealthNet participant to be transferred to another MO HealthNet participant if the LARC was not delivered to, implanted in, or used on the original MO HealthNet participant to whom the LARC was prescribed. The bill contained certain provisions to allow such a transfer.

Maintenance Medications – Several bills filed would have increased the medication supply limit for certain maintenance medications to 180 days. An amendment was added but deleted in an omnibus bill that added this language for maintenance medications “for customers paying cash” only.

Medical Marijuana – A number of bills were filed that would have allowed the prescribing of marijuana for medical reasons.

CBD Oil – Several bills were filed relating to the use of CBD (Hemp) oil. Current law allows people with intractable epilepsy to possess and use hemp extract to treat their condition. This act would have allowed people with serious conditions including but not limited to epilepsy to use hemp extract.

MO HealthNet Global Waiver – A number of bills were introduced that would have required the Department of Social Services to apply for a global waiver for the MO HealthNet program designed to give the state greater flexibility to “implement a patient-centered, sustainable, and cost-effective market-based health care system that emphasizes competitive and value-based purchasing”.

Simon’s Law (HB 440) – This bill would have changed the laws regarding life-sustaining or nonbeneficial treatment policies of health care facilities.

Predetermination of Benefits (HB 549) – This bill would have created standards for predetermination of health care benefits requests and responses.

Receipt of Gifts by a Practitioner (HB 1021) – This bill would have prohibited manufacturers and wholesale drug distributors from offering or giving any gift of value to practitioners with certain exceptions.

Professional drug samples were exempted.

Primary Care Increased Reimbursement for After Hours (HB 544) – This bill had a large fiscal note for costs to the MO HealthNet program. Committee members liked the concept but just couldn’t seem to get a handle on who should be included, what hours should be included, and how to track whether or not the increased access was making a difference. The modest increased rate in the bill would not have been attractive for many practices to stay open the extra hours.

Legislative Task Force on Advanced Practice Nursing (HB 939) – This bill would have established a task force comprised of 22 members from organizations representing nurses, physicians, FQHCs, hospitals, State board of Nursing and the Board of Healing Arts -- whose mission would be to improve the health of patients by providing optimal methods of care for Missourians at a reasonable cost.

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PATIENTS ARE

A VIRTUE

WHERE HEALTH IS PRIMARY. Long-term relationships built on trust between patient and doctor are the foundation of good health. That’s why primary care practices treat patients and their families as core members of their health care team.

Family doctors are dedicated to treating the whole person and are seen by their patients as partners. We believe every patient should have access to a health care team that understands and respects them.

Learn more about how you can play an active role in your health care at healthisprimary.org. #MakeHealthPrimary

MO-AFP.ORG 37

DATE in

THE

E M C N R A E K R O W T E N RELAX

SAVE

17/18

ANNUAL SCIENTIFIC ASSEMBLY

2018 JUNE 8-9

THE LODGE AT OLD KINDERHOOK

ANNUAL FALL CONFERENCE

NOVEMBER 10-11

BIG CEDAR LODGE

Connect with the MAFP on Facebook, Twitter and Instagram Visit us online at www.mo-afp.org

2017

Missouri Academy of Family Physicians 722 West High Street Jefferson City, Missouri 65101 Website: mo-afp.org Email: office@mo-afp.org Phone: 573.635.0830

WHITE COAT NIGHT AT THE BALLPARK VS

FRIDAY, AUGUST 11 @ 7:15

Join the St. Louis Cardinals for “White Coat Night at the Ballpark” on Friday, August 11th when the Cardinals take on the Atlanta Braves. Join your fellow members of the Missouri Association of Osteopathic Physicians & Surgeons, the Missouri Academy of Family Physicians, and the Missouri State Medical Association and wear your white to cheer on the Redbirds! Field Level tickets in the Right Field Box are only $27 and each ticket comes with $12 of Cards Cash loaded onto the barcode that can be used at concession stands or merchandise stands throughout the ballpark!

TO PURCHASE THESE EXCLUSIVE TICKETS, VISIT CARDINALS.COM/WHITECOAT

MO-AFP.ORG 39

Serve Before You Lead Developing an appropriate primary care workforce of the four P's through advances in: • Pipeline • Process of medical education • Practice transformation • Payment reform 40

MISSOURI FAMILY PHYSICIAN JULY-SEPTEMBER 2017

Todd Shaffer, MD, MBA, FAAFP