Magazine July-September, 2016

MISSOURI Official Publication of the Missouri Academy of Family Physicians

Family Physician July-September 2016 Volume 35, Issue 3

Annual Board Reports 2015-16 Year in Review Page 4

Meet Your 2016 Family Physician of the Year Scott Griswold, MD, FAAFP Page 20

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

68th Annual Scientific Assembly Highlights from the Conference Page 28

TEAMS

WORK

WHERE HEALTH IS PRIMARY. In primary care, teams of health professionals provide patients what they need when they need it in a coordinated setting.

Family doctors work closely with team members to keep their patients healthy.

Let’s make health primary in America.

Learn more at healthisprimary.org.

Brought to you by America’s Family Physicians

#MakeHealthPrimary

Contents MAFP

MARK YOUR CALENDAR

executive commission Board Chair - Peter Koopman, MD, FAAFP (Columbia) President - Kathleen Eubanks-Meng, DO (Blue Springs) President-Elect - Mark Schabbing, MD (Perryville) Vice President - Sudeep Ross, MD, MBA (Kansas City) Secretary/Treasurer - James Stevermer, MD, FAAFP (Fulton)

AAFP National Conference of Family Medicine Residents & Students (NCFMRS) July 28-30, 2016 Kansas City Convention Center Kansas City, MO

board of directors District 1 Director: John Burroughs, MD (Kansas City)

Alternate: Jared Dirks, MD (Kansas City) Director: Lisa Mayes, DO (Macon) District 2

Alternate: Vacant District 3 Director: Sarah Cole, DO, FAAFP (St. Louis)

Director: Caroline Rudnick, MD (St. Louis)

Alternate: Kara Mayes, MD (St. Louis) Director: Jennifer Scheer, MD, FAAFP (Gerald) District 4

Alternate: Kristin Weidle, MD (Washington) District 5 Director: Lucas Buffaloe, MD (Columbia)

Alternate: Afsheen Patel, MD (Jefferson City) District 6 Director: Jamie Ulbrich, MD, FAAFP (Marshall)

Alternate: David Pulliam, DO, FAAFP (Higginsville) District 7 Director: Wael Mourad, MD (Kansas City)

Director: Vacant

Alternate: Ryan Sears, DO (Lee's Summit) District 8 Director: John Paulson, DO, PhD, FAAFP (Webb City)

Alternate: Charlie Rasmussen, DO, FAAFP (Branson) Director: Patricia Benoist, MD, FAAFP (Houston) District 9

Alternate: Vacant Director: Deanna Siemer, MD (Jackson) District 10

Alternate: Vicki Roberts, MD, FAAFP (Sikeston) Director At Large Emily Doucette, MD (St. Louis) resident directors Kevin Gray, MD (UMKC) Kanika Turner, MD (Alternate) (SLU) student directors Jenny Eichhorn (UMKC) Emily Gray (Alternate) (UMKC) aafp delegates David Schneider, MD, FAAFP, Delegate Todd Shaffer, MD, MBA, FAAFP, Delegate Kate Lichtenberg, DO, MPH, FAAFP, Alternate Delegate Keith Ratcliff, MD, FAAFP, Alternate Delegate mafp staff Executive Director - Kathy Pabst, MBA, CAE Education and Communications Manager - Sarah Mengwasser Membership and Programs Assistant - Lauren Eichelberger 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

AAFP Congress of Delegates September 19-21, 2016 Hyatt Regency Orlando, FL AAFP Family Medicine Experience (FMX) September 20-24, 2016 Hyatt Regency Orlando, FL MAFP 24th Annual Fall Conference & KSA Working Group November 4-6, 2016 Big Cedar Lodge Ridgedale, MO

MAFP Advocacy Day February 28 - March 1, 2017 (Tuesday - Wednesday) Capitol Plaza Hotel Jefferson City, MO AAFP Annual Chapter Leadership Forum/National Conference of Constituencies Leaders April 27-29, 2017 Sheraton Kansas City Hotel at Crown Center Kansas City, MO AAFP Family Medicine Congressional Conference May 22-23 2017 Washington Court Hotel Washington, DC MAFP 68th Annual Scientific Assembly (ASA) June 9-11, 2017 The Lodge at Old Kinderhook Camdenton, MO

INSIDE THIS ISSUE Pg. 2 4 12 14 16 20 22 24 26 30 32 41 42 44

Health is Primary Annual Reports Help Desk Answers (FPIN) Resident Grand Rounds Meet Your New President Family Physician of the Year Membership Anniversaries 2017 AAFP Board of Directors Candidate ASA Recap of Events Increased Naloxone Access In Missouri End of Session Report FMCC Recap ACLF/NCCL Recap Members in the News

Advertisements Pg. 2 Health is Primary 11 MPM/PPIA 13 United States Army 19 NORCAL 21 MACRA 27 Children's Mercy Kansas City 35 MHPPS 37 SEMO Drug 42 Direct Primary Care 43 AAFP FMX 44 Cox Health

Missouri Family Physician July-September 2016

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MAFP Annual Annual Reports Reports

"

peter koopman, md, faafp, board chair

A

s President of the Academy this past year, I have continued to promote the importance and centrality of family medicine for our state and country’s health care. Missouri family physicians are the primary source of comprehensive patient-centered care delivered to the citizens of our great state. We should be proud of the work we do. This year, I continue to see many reasons to be excited and optimistic about the future of family medicine.

Peter Koopman, MD, FAAFP

Advocacy efforts of your Academy carry on regularly in Jefferson City and through events such as our local Advocacy Day and the Family Medicine Congressional Conference (FMCC) in Washington D.C. I attended both events. The local Advocacy Day is a well-attended event which has impact locally. Based on feedback received from staff and the legislators themselves, our legislators do 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 continue 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. Although this state legislation failed to pass, Saint Louis County has begun a program that may be able to be adopted more widely across the state even without legislation being passed in Jefferson City. The Academy will continue to monitor these developments.

My time spent at FMCC in Washington, DC, this year again strengthened my belief that primary care and family physicians are seen as valuable and necessary by our federal legislators. Over the last 5 years, I continue to see our family medicine values gain more and more influence and traction.

The AAFP continues to work relentlessly on marketing our values and worth, and legislators are listening. A Primary Care Caucus now exists in DC based on these efforts. This comprehension of our importance is also evidenced by the valuebased payments in the MACRA law. Washington needs to value primary care better and they are struggling with how to accomplish that goal.

We still have much more work to do to define metrics that are reasonable and relevant to family medicine, but our legislators are more and more on the same page with us. We need to continue to voice our values and concerns without ceasing.

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My time spent at FMCC in Washington, DC, this year again strengthened my belief that primary care and family physicians are seen as valuable and necessary by our federal legislators."

I also attended the Congress of Delegates of the AAFP in Denver with our executive director Kathy Pabst and our delegates. The varied and thoughtful discussions at this event obviously serve to sharpen and define our values and future planning. I watched our national leaders in action and spoke at length to those speaking on national positions. Our Academy is in good hands and this event strengthened my commitment to serving as a member of the Academy. Skills I learned at this conference will help me strive for excellence for our Academy. I look forward to pushing our Academy to improve its function and ability to serve its members.

The Annual Scientific Assembly program this year is well designed and was an excellent opportunity for earning CME. We have spent resources to bring a national speaker on obesity and nutrition in Michelle May, MD. I am excited to continue to help bring forth new innovations and top-notch speakers for our conferences in the future. As academic faculty at Mizzou, I am challenged daily to figure out how to better educate our medical students and residents and I will continue to use these skills to better educate Missouri family physicians. Education remains a major focus and priority for the Academy.

As Board Chair in the coming year, I plan to learn and acquire new skills through Academy events and reflect on how to improve as one of your leaders for the Academy. I will unceasingly promote and support the value of family medicine through collaboration with our colleagues, advocacy for our specialty, research to inform patient care and public policy, and the education of our future and current workforce. At the center of all we do remains the care of our patients and we are privileged to be able to be family physicians doing this important work.

Annual Reports MAFP

kathleen eubanks-meng, do, president

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xciting. Challenging. Invigorating. As I reflect on the last year serving as your President Elect of the Academy, these words describe the Missouri family physicians I serve and with whom I share in the passion to advance family medicine in Missouri.

family medicine. These experiences continue to invigorate and challenge me. Speaking with other leaders allows further education opportunities and learning new approaches to issues our state faces. This collaborative effort allows Missouri to have a “seat at the table” and stay at the forefront of family medicine at a state and national level. We had the opportunity to listen to “The Rookie” baseball player and inspirational speaker,

"

Advocacy continues to be a priority for your Academy with an increased presence in Jefferson City and in Washington DC. For the fifth straight year, I was able to attend Advocacy Day in Jefferson City. This February was the most attended in its history.

Legislators at our capital are pleased about our increased presence. Our priorities this year included continued navigation regarding scope of practice, direct primary care, physician suicide prevention, maintenance of licensure, palliative care, healthcare workforce analysis and a prescription drug monitoring program. Although the MAFP strongly supports prescription drug monitoring, it failed to pass. As you establish a relationship with your legislators through participating in Advocacy Day, it allows further communication and establishment of an ongoing relationship while providing opportunities for effective advocacy. We will continue to offer this type of advocacy opportunity with ongoing training for any members who are willing to participate. On a national level with SGR gone, MACRA has become the new reality. While the AAFP is prepared and continues have a presence in Washington DC, they continue to need our help by attending the Family Medicine Congressional Conference in Washington DC and by establishing or nurturing a relationship with our legislators. Our legislators want to hear from those on the front lines of medicine, which is you. While this may seem like another to-do item, it is the future of how we will be able to provide the quality care for our patients that they deserve.

I had the opportunity to attend AAFP Multi State Conference in Dallas, TX, and ACLF in Kansas City, MO, with current vice president Dr. Mark Schabbing and our executive director Kathy Pabst. This allowed us to meet with the leadership of surrounding states and the leaders from across the nation regarding current issues and challenges in

As your incoming President, I will continue to develop leadership for our Academy, strive to assist our members in navigating MACRA and payment reform, as well as promoting our services to our membership."

Kathleen EubanksMeng, DO

Jim Morris. He inspired us with his words of wisdom, “The only legacy that matters is the one we are building together right now.”

As current co-chair of the Member Services Commission, I am proud of our ability to grow in our new membership, resident and student memberships and maintain our current active members. The MAFP magazine and more functional website continue to further support the needs of our members and develop improved communication of current events of the MAFP. We continue to strive to have a larger presence in social media on Twitter and Facebook.

As your incoming President, I will continue to develop leadership for our Academy, strive to assist our members in navigating MACRA and payment reform, as well as promoting our services to our membership. I look forward to working with our membership, advocacy and education commissions and continued learning and collaboration from my fellow officers. I look forward to being the super heroes of family medicine.

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MAFP Annual Reports Mark Schabbing, MD President-Elect

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s Vice President of the Academy this past year, I was surprised to see how fast the time has passed. I am excited about how active we are as a state chapter and to see what our national organization is doing to promote our profession. I Mark Schabbing, MD have learned a lot this past President-Elect year by attending several conferences and meetings and bringing this information back to the organization.

In September, we as an organization went through another strategic planning meeting and the report was included in the last issue of the magazine. This is to let you know that the board is always forward thinking. In February, I attended our Advocacy Day in Jefferson City. Large numbers of our members meet with legislators at one time

and give the MAFP a strong voice at the Capitol. It is an event like this that is planned by the MAFP and ongoing efforts by Pat Strader, our lobbyist, that gives us recognition in Jefferson City.

Two weeks later I attended the Multi-State Conference in Dallas Texas. This was another advocacy conference that allowed me to meet other organizational leaders from around the country. Here new ideas and shared struggles were discussed. Most recently, I attended the ACLF/NCCL leadership conference in Kansas City, in May. I was able to attend sessions to gain leadership skills to help prepare for the upcoming years on the Executive Commission. Some of the topics were board structure, strategic planning, staff networking, and upcoming concerns with MACRA. I look forward to the upcoming year of events and serving the MAFP.

Jim Stevermer, MD, MSPH, FAAFP Secretary-Treasurer

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. 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 increased our budget for education conferences in order to continue to improve attendance.

This spring, acting on the Board’s approval of an Executive Commission recommendation, the executive director shifted our long-term

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reserves to the American Academy’s reserve fund.

This move completes our implementation of a tobacco-free investment policy for the Missouri Academy and the Foundation. Tobacco-free investments do not return quite as well as those that Jim Stevermer, MD, include cigarettes and MSPH, FAAFP other tobacco products, but I think this is a small price to pay for an organization with as long standing commitment to reducing tobacco use as our Academy has demonstrated.

Annual Reports MAFP

MAFP resident report

By: Kevin Gray, MD, Resident Director, UMKC

Cox Family Medicine Residency, Springfield

Graduating Seniors: Andrew Benbow, DO – Moonlighting at CoxHealth for a year while setting up his own clinic Chelsea Burnett, DO – clinical practice in Salina, KS Sarah Duda, MD – clinical practice in Arkansas Bridget Gruender, MD – Direct Primary Care Practice in Columbia, MO Dayna Jett, MD – Obstetrics Fellowship, Cox FMR Justin Nowlin, MD – CoxHealth Clinic Monett,MO Jessica standeford, MD – Obstetrics Fellowship, Cox FMR Mehdi Tajouri, DO – CoxHealth Hospitalist

Mercy Family Medicine Residency, St. Louis

Graduating Seniors: Andy Bryant, MD – Mercy Clinic Family Medicine Butler Hill, St. Louis County, MO Ted Eckelkamp, MD – SSM Health, Family Medicine, St. Mary’s Hospital, Richmond Heights, MO Melissa Lao, MD – UC Davis Midtown location in Sacramento, CA Sam Sparks, DO – Intermountain Health Care- Herefordshire Clinic, Ogden, UT Abbey Woods, MD – Mercy Clinic Family Medicine, Oklahoma City, OK Chris Young, MD – UC Davis Midtown location in Sacramento, CA

Research Family Medicine, Kansas City

Graduating Seniors: Lindsay Allan, MD – Outpatient, Critical access hospital - inpatient and ER, Fairfax, MO Marisa Argubright, DO – College Park Family Physicians, Outpatient with OB, Overland Park, KS Andrew Brouwer, MD – Centerpoint Medical Center, Hospitalist, Independence, MO Holly Gault, MD – Outpatient, Inpatient & OB, Pittsburg, KS Masud Hassan, MD – Overland Park Regional Medical Center, Hospitalist & Docs Who Care, Overland Park, KS Meghan McManus, DO – North Kansas City Hospital, Hospitalist, NKC, MO Jeffrey Mincher, MD – FQHC, Outpatient, Lawrence, KS Edward Moellmer, MD – Outpatient, Critical access hospital, inpatient & ER, ND and ID Nathan Norris, MD – Outpatient, Wichita, KS G. Wes Roodhouse, DO – Liberty Hospital Urgent Care & Docs Who Care, Liberty, MO Christopher Standley, DO – Lafayette Regional Health Center, hospitalist, Lexington, MO Zaynab Zarrabi, DO – Outpatient, Tipp City/Dayton, OH

Saint Louis University Family Medicine Residency

Graduating Seniors: Jackson C. Pugh, MD -- U.S. Navy, U.S.S. Constitution, Virginia Betsy P. Wan, MD -- Academic Faculty, Saint Louis University Family Medicine Residency-St. Louis Christopher D. Wedell, MD -- Private Practice, St. Louis, MO Matthew C. Witthaus, MD -- Everest Fellowship/MPH, Saint Louis University School of Medicine

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MAFP Annual Reports University of Missouri Family Medicine Residency, Columbia

Graduating Seniors: Scott Bartkoski, MD – Mercy East Kearney Clinic, Springfield, MO Josh Billington, MD – Springfield Clinic, Springfield, IL Megan Cates, DO – Family Health Center, Columbia, MO Amelia Frank, MD – University of Missouri, Academic Fellowship, Columbia, MO Kendal Geno, MD – Applegate Medical Group, Brookfield, MO Adam Harrold, MD – University of Utah, Sports Medicine Fellowship, Salt Lake City, UT Anna Hulbert, MD – University of Missouri, Palliative Care Fellowship, Columbia, MO Candy Lincoln, MD – Lincoln-Patton Medical Group – Mountain Home, AR Alicia Ludden-Schlatter, MD – University of Missouri, Academic Fellowship, Columbia, MO Gurdeep (Rick) Manhas, MD – Vancouver, Canada Andrew Patel, MD – West Olympia Family Medicine Practice, Olympia, WA Andrew Valleroy, MD – Mercy Family Medicine, Washington, MO

University of Missouri Family Medicine Residency, Kansas City

Graduating Seniors: Jason Arribas, DO – Outpatient practice, Overland Park, KS Misty Bowen, DO – Outpatient practice, Rural Iowa Kristen Duncan, MD – UMKC Sports Medicine Fellowship, Kansas City, MO Christopher Gifford, DO – International Medicine, Cameron, MO Gillian Housman, DO, MPH – Outpatient practice, Overland Park, KS James Kirkpatrick, MD, PhD – UMKC Geriatrics Fellowship, Kansas City, MO Christine Luke, DO – Undetermined Caitlyn Nguyen, MO – Outpatient practice, Independence, MO Cory Offutt, MD – Full spectrum with surgical OB, Houston, MO James Smith, DO, MBA – Emergency Department, Rural KS and MO Shawn Wadsworth, DO, MA – Direct primary care, Wichita, KS Doyle Witt, MD – Outpatient and inpatient medicine, Chester, IL

student report By: Jenny Eichhorn, MD, Student Director, UMKC and Emily Gray, Alternate Director, UMKC

Jenny Eichhorn, UMKC, MD, Student Director

Emily Gray, UMKC, Alternate Student Director

A.T. Still University, Kirksville Number of FMIG Members: 135 FMIG Contacts: • Faculty Advisor: Margaret Wilson (mwilson@atsu.edu) and Joseph Novinger (jnovinger@atsu.edu) • President: Gregory Daum (gddaum@atsu.edu) • Vice President: Jacob Ripp (jjripp@atsu.edu) • Secretary: Benjamin Cottrell (bcottrell@atsu.edu) • Treasurer: Kara Nuspl (knuspl@atsu.edu) Match Results: • # matching into FM: 46 • # staying in Missouri for FM: 5 • # of graduates at your school this year: 149 Meetings/Events: • November: OMM Workshop: 21 attended and learned how to incorporate OMM into an office visit, new OMM techniques, and what it is like to be a family medicine resident.

• November: First Years History Taking Practice: Second-year students acted as patients for 8 first-year students to practice their history and vital taking skills. Second year students offered feedback and tips for the first year students.

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Annual Reports MAFP • December: Monthly Meeting; 23 members viewed the BBC documentary, “Inside My Mind: Inside Mental Illness”. The film follows five young adults suffering from a mental illness to show the impact of their mental illness on their daily activities and new advancements in treatment and diagnosis.

• December Recruitment Drive: SAACOFP recruitment. Three gift cards to local restaurants were raffled off to 2 new members and the member who referred the most new members. 19 new students signed up to be SAACOFP members.

• January: Take Root Café Presentation; Take Root Café is a non-profit, pay-what-you-can café opening in Kirksville next fall. Their goal is to provide the community with locally grown, healthy food and help alleviate hunger in the Kirksville area. 70 students and faculty members attended.

• February: General Meeting; Joseph Novinger, DO spoke to 18 members about his experiences as a family physician. He discussed working in a private practice, as part of a hospital system, and for a community health care facility.

• February: Wiffle Ball Tournament; Held to raise money for a KCOM OMS-II student who suffered a stroke earlier this semester. Seven teams and around 40 players participated. Prizes were awarded to the top 2 teams, and we raised $200 for our classmate.

• February: Opportunities in Family Medicine; Dr. Wesley Ryle presented to 30 students on opportunities in family medicine. He discussed why he chose family medicine and what he enjoys about his practice; He also discussed differences between urban and rural family medicine physicians.

• March: CHAMP Assistance Dogs; This is a St. Louis-based non-profit that provides educational opportunities for individuals and groups to learn more about service dogs. ATSU-KCOM students traveled to St. Louis for the presentation.

We extended the invitation to students at Washington University School of Medicine, and two students from their family medicine club attended as well. The presenters discussed the benefits of service dogs, what medical professionals can do to make their offices more service dog friendly, and how to help patients cope with the loss of a service dog.

• March: Quincy Family Medicine Residency Splinting Workshop; Dr. Paula Mackrides, the PD, and 3 residents came to give a splinting workshop to 40 students.

• April: General Meeting, documentary viewing • April: Volunteering at Hope’s Kitchen making meals for the needy in the Kirksville area • May: Rotations and Residencies Panel; 3rd and 4th year students along with family medicine residents will talk with 1st and 2nd years about clinical rotations and residency.

Kansas City University, College of Medicine

Number of FMIG Members: 30 active members FMIG Contacts: • Faculty Advisor: Gautam Desai (gdesai@kcumb.edu) • President: Jacob Baer (jdbaer@kcumb.edu) Match Results: • # matching into FM: 33 • # staying in Missouri for FM: 6 • # of graduates at your school this year: 245 Meetings/Events: • April – Chalk Walk where health screenings are performed, especially for children, 20 volunteers • May – Plan to have UMKC Lakewood Family Medicine Residency PD come speak • June – School professor to discuss different specialties within family medicine • Monthly meetings with guest speaker or activity Upcoming Goals: • Increase events to 2 per month (one meeting and one volunteer event

Saint Louis University

Number of FMIG Members: 75 FMIG Contacts: • Faculty Advisor: William Manard (manardwt@slu.edu) • Co-Presidents: Bradley Waller (wallerbb@slu.edu)and Jasmine Lau (laujk@slu.edu) Match Results: • # matching into FM: 23 • # staying in Missouri for FM: 6 • # of graduates at your school this year: 172 Missouri Family Physician July-September 2016

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MAFP Annual Reports Meetings/Events: • Undergraduate Procedure Night – 11 attendees. We had SLU undergraduate students come to the medical school to learn suturing, heart sounds, history taking, and blood pressure.

• Belleville Procedure Night – 35 attendees. The Belleville Family Medicine Residency invited SLU medical students over to learn about delivery, skin biopsy, colonoscopy, suturing, and ultrasound.

• Match Panel – 40 attendees. We had a panel of 4 fourth year medical students who had matched into family medicine come and discuss their experiences with the match process.

• Social at Dr. Schneider's House – 30 attendees. We invited everyone to Dr. Schneider's house so students could talk to family physicians in a more informal, social setting.

• Direct Primary Care Talk – 75 Attendees. This was a lunch meeting about the direct primary care model, its benefits, and how it fits in with today's medical environment.

• Missouri Foundation for Health Talk – 25 attendees. This lunch talk covered the basics of the ACA and its effects in Missouri.

University of Missouri, Columbia

Number of FMIG Members: 130 FMIG Contacts: • Faculty Advisor: Amanda Allmon (allmona@health.missouri.edu) • Co-Chairs: Misty Todd (mftrz4@health.missouri.edu), Kayla Matzek (kbmy83@health.missouri.edu), Ashley Albertson (awajh8@health.missouri.edu), Elizabeth Worsowicz (ewdm2@health.missouri.edu) Match Results: • # matching into FM: 8 • # staying in Missouri for FM: 5 • # of graduates at your school this year: 82 Meetings/Events: • annual Spring Dinner Forum featuring an alumnae who spoke about Direct Primary Care • cooked a meal at the Ronald McDonald House • hosted a joint lunch and learn with the Geriatrics Interest Group about palliative care • prepared Grand Rounds lunches • went to three schools and did Doctors Back to School • did Ready, Set, Fit at multiple schools Upcoming Goals: • Host an M4 panel featuring students who matched into family medicine • Have at least 5 students attend national conference this summer

University of Missouri, Kansas City

Number of FMIG Members: 20 FMIG Contacts: • Faculty Advisor: Miranda Huffman (Miranda.Huffman@tmcmed.org) • President: Emily Gray (ejgz93@mail.umkc.edu) • Vice President: Mitchell Elting (mpe8cc@mail.umkc.edu) and Seenu Abraham (savhd@mail.umkc.edu) • Secretary: Nymisha Rao (nry74@mail.umkc.edu) • Treasurer: Banoo Amighi (Bac46@mail.umkc.edu) and Ravali Gummi (rg8z9@mail.umkc.edu) Match Results: • # matching into FM: 2 • # staying in Missouri for FM: 2 • # of graduates at your school this year: 93 Meetings/Events: • OB/GYN workshop with Dr. Shaffer (10 students) • EKG Workshop with Dr. Salanski (15 students) • Strolling through the Match: Post Match Panel (20 students) • RBI Sports Physicals Event (15 students) • This summer: We're working on doing a world health meeting with Dr. Comninellis.

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Annual Reports MAFP Upcoming Goals: • Increase awareness of the importance of family medicine in the health of our community.

• Increase student interest in family medicine at UMKC • Help students gain a better knowledge and understanding of primary care and common illnesses/diseases that are found in the primary care setting.

Washington University, St. Louis

Number of FMIG Members: 15 FMIG Contacts: • Faculty Advisor: Walt Sumner (WSUMNER@dom.wustl.edu) • President: Jessica Hao (jessica.hao@wustl.edu) Match Results: • # matching into FM: 1 • # staying in Missouri for FM: 0 • # of graduates at your school this year: 91 Meetings/Events: • No meetings or events recently to report on.

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HDAs HelpDesk Answers

DOES USE OF COMPRESSION STOCKINGS AFTER DEEP VEIN THROMBOSIS (DVT) IMPROVE OUTCOMES? EVIDENCE-BASED ANSWER

Jesse Hirner, MD Margaret Day, MD University of Missouri Columbia, MO

It is unclear if elastic compression stockings (ECS) reduce the risk of postthrombotic syndrome (PTS) (no SOR given, inconsistent results from a systematic review and large RCT). ECS do not reduce the risk of ipsilateral recurrent DVT after a proximal DVT (SOR: A, systematic review and RCT). ECS do not reduce acute leg pain within the first 2 months after symptomatic proximal DVT (SOR: B, RCT).

A

fter acute DVT, the outcomes of primary concern are PTS and recurrent DVT. PTS consists of some combination of leg pain, edema, heaviness, fatigue, pruritus, paresthesias, erythema, hyperpigmentation, induration, telangiectasias, varicosities, lipodermatosclerosis, and venous ulcers.1 PTS occurs in 12% to 54% of patients after DVT,1–3 usually within 2 years.2,3 Severe PTS develops in 3% to 11% of patients.2,3 A 2006 systematic review that included 4 RCTs (N=537, range 47–194 patients, mean ages 40– 63 years), 1 of which was blinded, evaluated use of ECS after DVT.1 Follow-up ranged from 36 to 76 months. Three of the studies (n=421) evaluated ECS after DVT for PTS prevention and

TABLE: Diagnostic Criteria for Post-Thrombotic Syndrome Ginsberg's Criteria5

Villalta's Scale3

Ipsilateral leg pain and swelling of ≥1 month that worsens at the end of the day or with prolonged sitting or standing and improves after a night's rest or leg elevation

Symptoms: Heaviness, pain, cramps, pruritis, parasthesias in limb

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Signs: Pretibial edema, induration, hyperpigmentation, new venous ectasia, redness, pain upon calf compression Scoring: Each sign and symptom listed above is scored from 0 (absent) to 3 (severe).

Mild: 5–9 Moderate: 10–14 Severe: ≥15 or lower limb venous ulcer

found a reduction in PTS from 54% to 25.2% (RR 0.47; 95% CI, 0.36–0.61; NNT=4). Three RCTs (n=490) evaluated ECS to prevent recurrent symptomatic DVT and found no significant reduction in recurrence (RR 0.79; 95% CI,0 .50–1.26). Heterogeneity evaluated by the Cochrane Q statistic was not significant; inconsistency was moderate.1 A 2014, multicenter, double-blinded RCT assigned patients (N=806, mean age 55 years) with a first symptomatic proximal DVT to belowknee ECS with pressures of 30 to 40 mmHg at the ankle (active ECS) or placebo ECS with pressures <5 mmHg.3 Stockings were applied within 2 weeks of DVT diagnosis and worn for 2 years. Patients wearing their stockings at least 3 days weekly comprised 86% of the study population at 1 month and 57% at 2 years.

By Ginsberg’s criteria (see TABLE), cumulative incidence of PTS from 6 to 24 months of followup was 14.2% in the active ECS group versus 12.7% in the placebo ECS group (HR 1.13; 95% CI, 0.73–1.76). The cumulative incidence of PTS using the more inclusive Villalta scale was 52.6% in the active ECS group and 52.3% in the placebo group (HR 1.00; 95% CI, 0.81–1.24).

Recurrent ipsilateral DVT occurred within 2 years in 3.9% of patients using active ECS and 4.3% of controls (RR 0.91; 95% CI, 0.47– 1.78). In a secondary analysis, no statistically significant difference was noted in leg pain scale between active ECS and placebo groups at 14, 30, or 60 days.4 Both groups’ pain scores declined to <1.5 on a 0 to 10 scale by 60 days.

1. Kakkos SK, et al. Thromb Haemost. 2006; 96(4): 441–445. [STEP 1] 2. Prandoni P, et al. Ann Intern Med. 2004; 141(4): 249–256. [STEP 2]

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3. Kahn SR, et al. Lancet. 2014; 383(9920): 880–888. [STEP 2] 4. Kahn SR, et al. Thromb Haemost. 2014; 112(6): 1137–1141. [STEP 2] 5. Ginsberg JS, et al. Arch Intern Med. 2001; 161(17):2105–2109. [STEP 2]

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MAFP Resident Grand Rounds

IS VITAMIN D EFFECTIVE IN PREVENTING STRESS FRACTURES? EVIDENCE BASED ANSWER There is some evidence that vitamin D supplementation may reduce the risk of stress fractures in adolescent and adult females (SOR B, based on a single randomized control trial). Several studies show low serum 25(OH) vitamin D levels is correlated with increased risk of stress fractures.

Melissa Lao, MD Mercy Family Medicine Residency St. Louis, Missouri

Kara Mayes, MD Mercy Family Medicine Residency St. Louis, Missouri

EVIDENCE SUMMARY A 2012 prospective cohort of 6712 predominantly white adolescent girls age 9-14, assessed vitamin D, calcium, and dairy intake and the development of stress fractures over a 7 year period.4 Subjects were part of the Growing Up Today Study conducted throughout the United States. During the study, 90% of stress fractures occurred in girls who participated in â&#x2030;Ľ1 hour/day of high impact activity. Among these girls, those who consumed vitamin D in the highest quintile (mean: 663 IU/day) had lower risk of developing stress fractures compared to those consuming vitamin D in the lowest quintile (mean: 107 IU/day) (HR=0.48, CI: 0.22-1.02, ptrend = 0.04). There was no evidence that dairy or calcium intake was protective.

A 2008 double-blind, placebo-controlled, randomized control trial evaluated daily calcium (2000mg) and vitamin D (800 IU) oral supplementation and the incidence of stress fractures in U.S. female navy recruits age 1735.2 In a 24 month period, recruits were followed during their 8-week long training. A total of 3,700 subjects completed the study and 309 subjects were diagnosed with stress fractures.

The supplementation group had a reduced incidence of stress fractures of 20% compared to placebo (RR=0.80, 95% CI: 0.64-0.99, P=0.026).

Unfortunately, serum 25(OH)D levels were not drawn for comparison and supplementation included calcium rather than vitamin D alone.

A 2015 systematic review and meta-analysis included 6 prospective cohorts and 2 case-control studies evaluating lower extremity stress fractures and serum 25-(OH) vitamin D levels.1 Study duration ranged from 3 months to 6.5 years with 2 studies conducted in US, 1 in Greece, and 4 in Israel. A total of 2,634 military personnel (1153 male, 1481 female; 701 cases, 1873 controls) age 18-30 were evaluated. The mean serum 25(OH) vitamin

14 Missouri Family Physician July-September 2016

D level was significantly lower in stress fracture cases than controls with a mean difference of -2.44ng/mL (95% CI: -4.05 to -0.84, P=0.003, study heterogeneity I2 = 53%). The authorâ&#x20AC;&#x2122;s concluded that the large study heterogeneity is attributed to variations in ethnicity, gender, location, season, diet, and methods of serum 25(OH) vitamin D measurement.

A 2015 prospective cohort of British Royal Marine recruits compared serum 25-(OH) vitamin D levels measured at weeks 1, 15 and 32 to stress fracture incidence.3 The study followed 1,082 male recruits ages 16-32 over a 32-week training period and found a higher incidence of stress fractures in recruits with serum 25(OH)D <50nmol/L or <20ng/ mL (OR=1.6; 95% CI: 1.0-2.6). A case-control subanalysis of 75 stress fracture cases retrospectively matched for age, body weight, height and aerobic fitness with recruits who did not endure stress fractures. Serum 25(OH)D <50nmol/L at week 1 had a higher incidence of stress fracture (OR=2.3; 95% CI: 1.1-4.8; P=0.004).

Works Cited: 1. Sonneville KR, et al. Vitamin D, Calcium, and Dairy Intakes and Stress Fractures Among Female Adolescents. Arch Pediatr Adolesc Med. 2012 Jul 1; 166(7): 595-600 [Step 3] 2. Lappe J, et al. Calcium and Vitamin D Supplementation Decreases Incidence of Stress Fractures in Female Navy Recruits. J Bone Miner Res. 2008; 23(5): 741-749 [Step 2] 3. Dyda D, et al. Serum 25-Hydroxyvitamin D Levels and Stress Fractures in Military Personnel: A Systematic Review and Meta-analysis. Am J Sport Med. 2015 Aug; 43(8): 2064-72 [Step 1] 4. Davey T, et al. Low serum 25-hydroxyvitamin D is associated with increased risk of stress fracture during Royal Marine recruit training. Osteoporos Int. 2016 Jan; 27(1): 171-179 [Step 3]

CME Question, HDA 50305, Is Vitamin D effective in preventing stress fractures?, Answer C Daily supplementation of how much vitamin D has been shown to reduce the risk of stress fractures by 20%?

A. 1200 IU B. 1000 IU C. 800 IU D. 600 IU

New Quality Payment Program MAFP

WHAT SHOULD YOU KNOW ABOUT THE NEW QUALITY PAYMENT PROGRAM?

J

ust when your physician practice successfully participated in the Physician Quality Reporting System (PQRS) or used your electronic health record correctly, beginning next year your practice will be evaluated for the data you report in 2017, which will effect payments in 2019. The good news is that you are moving in the right direction by participating in PQRS and meaningful use now. The work you are doing for those programs will help you transition to participating in either the Merit-based Incentive Payment System (MIPS) or an advanced alternative payment model (APMs). What do you need to know now to start to prepare to make the transition?

Lucky for you, the Centers for Medicare & Medicaid Services has created several documents and resources to help you become familiar with components of the new Quality Payment Program which The TMF Quality Innovation Network provides up to date information on the latest quality reporting and incentive program updates. Network membership is free. Visit their website at: https://www.tmfqin.org/ Networks/Value-Based-Improvement-and-Outcomes Article provided by

Missouri Family Physician July-September 2016

15

MAFP President Annual Reports meet your new 2016-2017 mafp president, Kathleen Eubanks-Meng, DO

Julie Wood, MD, FAAFP, (right) presents Kathleen Eubanks-Meng, DO with the President’s Oath.

I

want to start by saying thank you. There are too many to thank individually, but there are many mentors, colleagues, nurses, hospital chef’s, housekeepers and many more who have supported me over the last 20 years in medicine.

I am thankful most for my family and my good friend and mentor, Dr. Julie Wood and her husband John. Mark, thank you for continuing to be my rock for the last 21 years and continuing to share our anniversary weekends with medicine.

I graduated from medical school on our 5th wedding anniversary.

Tonight almost didn’t happen. It is not a tragic story; it’s about overcoming odds mostly created in my own head. I sat in my medical school Dean’s office after my first quarter of medical school with my resignation letter in hand…yes the old fashioned kind, an actual letter, not an email, not a text or a tweet, but a letter. I was literally seconds from leaving a career in medicine behind 16 Missouri Family Physician July-September 2016

and never looking back. Every super hero has their back story and I thought since I don’t have three or four movies worth of material, it might be best to go back only a few years instead of a hundred. And no, I am not nor do I consider myself a superhero, but I promise I will get to that part too.

As most of us in medicine know, the road to medical school is not always easy. I come from a family of educators. None of my family is in medicine. My mom was a teacher, my dad retired from finance and banking, but has his degree in education, my sister is a principal, my brother-in-law is a teacher and my husband is a teacher. I honestly think they thought I was a little crazy when I said I just wanted to be a doctor. Undergraduate education and the medical college admission test ensured that my family may have had a point when they thought I was a little “crazy”.

AnnualPresident Reports MAFP About 46,000 applicants applied for medical school in the year I was accepted. Approximately 20,000 of those applicants matriculated medical school the following year. The numbers decrease with only 90% of those first-year medical students going onto graduate medical school in four years.

Back to the dean’s office, I was in my first year of marriage after marrying my high school sweetheart after graduating college. My husband, Mark, was working three jobs and attending graduate school for a master’s in education and I was struggling in gross anatomy. It was the first true challenge I had faced academically. My final had not gone well and after wanting to become a doctor since I was young, I decided maybe medicine just wasn’t meant to be for me. I just couldn’t cut it. The statistics were right. I was not going to be a doctor.

I will never forget the day I went to meet with Dr. Gaber. I said a prayer before I left for his office asking God to continue to guide my path as He had so many times before. Dr. Gaber told me he would not accept my letter until I checked my student mailbox. I had not done well on my anatomy final, but several in my class were in the same boat and were given the opportunity to retake the final after Christmas break. Needless to say, I withdrew my letter of resignation and thanks to God, Dr. Gaber and the anatomy department, I am standing before you today.

My moms, whom we have lost in the last three years, were a big part of me continuing on in medicine. Prior to my visit with the dean, my mother-in-law, reminded me that my passion was not that of my family members, but I had my own path to forge.

I had never been afraid to do so before and now was not the time to start being scared. My mom gave me a bookmark to use in my studies during medical school and now sits on my dresser as a daily reminder. It goes like this: “When things go wrong as they sometimes will, when the road you’re trudging seems all up hill, when the funds are low and the debts are high and you want to smile, but you have to sigh, when care is

"

Family doctors are the superheroes of medicine, so of course I wanted to join the revolution."

pressing you down a bit, rest, if you must, but just don’t quit.”

It goes on to say, “Stick to the fight when you’re hardest hit, it’s when things seem worst that you must not quit.”

Why be a family doctor? When I was in my third year of medical school, I wanted to be a surgeon. I loved the challenge of the hours and intellectually. However, I also wanted a family and to be a mom who was present. I had rotated with several female surgeons and saw the struggle of balance between

Dr. Eubanks-Meng is a superhero of family medicine. their career and their family. I knew I wanted a family and ultimately didn’t want to sacrifice my family. But, why family medicine? They don’t get paid well, they have to know a lot about a lot, and the hours were not the best. However, I could have a family and a career that I loved. I enjoyed the challenge of using much of what I had learned in school, the ability to perform multiple procedures I loved, and taking care of newborns, teenagers, and the elderly. Family doctors are the superheroes of medicine, so of course I wanted to join the revolution.

I was asked by a mentor to join the Kansas City Academy in my second year of residency. I spent several years on the board and served as an officer and two years as their president. What started out as a way to network and meet physicians in family medicine turned into developing a deeper understanding of why advocacy for our profession turns into advocacy for our patients and our future existence. Everyone has a voice, but you have to learn how to use it. I am always energized by my fellow colleagues across the country at the National Conference for Constituency Leaders. I started going as a new physician representative for Missouri. I didn’t even know what that was, but I showed up anyway. It was there that I met the soon to be future leaders in not only family medicine but who would be the face of medicine in the coming years.

Missouri faces similar issues as California, New York and Florida. Not to be cliché’, but we are all in this together.

My colleague, Dr. Jay Lee, just completed his year as the California Academy’s president. We were once the “new physicians” together. In his acceptance speech, he talked about how family docs were the “Hulk’s” of family medicine.

See I told you I would get to the superhero part. Since I am not green and I am not even close to the height of the Hulk, I Missouri Family Physician July-September 2016

17

MAFP President Annual Reports >> decided to pick a superhero a little closer to my heart. While you should not expect an invisible jet to come and pick me up and I don’t have the red boots or the lasso, the red shirt will get the job done, for now. Dr. Lee’s point was we are the superheroes. Family physicians are at the front lines of meaningful use. We are the patient centered medical homes.

We may or may not welcome the changes of the electronic health record, ICD-10 or MACRA. Superheroes don’t quit, we embrace and conquer challenges. This year, we had the opportunity to meet retired professional baseball player, Jim Morris. Do any of you remember the movie The Rookie?

is spinning, don’t be discouraged, you can still make a difference. There are multiple opportunities for you to get involved. This can be as simple as sitting at your computer and writing to your legislator or stepping up to travel to Jefferson City to testify to our legislators.

Jim spoke to us at lunch after a meeting involving CMS answering questions about the upcoming 900-page change to physician reimbursement. We will just say my head was spinning a bit. However, he grabbed my attention…Jim said, “The only legacy that matters is the one we are building together right now.”

How are we supposed to build a legacy for our future when it seems the very infrastructure of what we knew as family medicine is crumbling around us? Remember my mom’s advice? We don’t quit. Michael Jordan said it best, “I’ve missed more than 9,000 shots in my career. I’ve lost almost 300 games; 26 times I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed.” We are the superheroes of medicine. Every superhero has their back story and we all make mistakes, but it is through those mistakes and failures we learn to succeed. I believe even though the future in medicine may seem overwhelming and there are still days despite all of this, I still want to throw my hands up after a long day and quit. But, I am reminded in that moment of the “why.” I work on Tuesday evenings and at the end of one of those long days, I had a patient bring me a gift.

We have not known each other more than a few years and she made a blanket in Mizzou black and gold for me. She wanted to say thank you and she didn’t know how else to say thank you for going above and beyond. This is the “why”.

In the next year, Missouri family physicians will face the challenge of being the first state to rule against an insurance merger affecting group Medicare Advantage plans, standing alone as the only state without a prescription drug monitoring program, a shrinking family medicine workforce nationwide and in our state with an increase in the number of patients to provide care for, challenges regarding collaborative practice and scope of practice from our nurse practitioner colleagues, the reality of the unknown with reimbursement changes brought about by MACRA, and physician burn out.

Our Advocacy Commission at a state and at a national level is committed to these and many more issues that face us in the coming year. If you feel overwhelmed and your head 18 Missouri Family Physician July-September 2016

One of my favorite poets, Maya Angelou wrote.

“I’ve learned that people will forget what you said, (although I hope you have remembered a few words from tonight), people will forget what you did, but people will never forget how you made them feel.”

I hope you will walk into the future with me this next year and remember we are the superheroes of medicine.

Superheroes don’t quit. We embrace the changes and conquer the challenges together. And always be yourself… unless you can be Wonder Woman, then always be Wonder Woman.”

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MAFP 2016 Family Physician of the Year

GRISWOLD NAMED MISSOURI FAMILY PHYSICIAN OF THE YEAR

D

r. Scott Griswold of Eldon, Missouri was chosen as the 2016 Missouri Family Physician of the Year at the 68th Annual Scientific Assembly, Award and Installation dinner, June 4, 2016. Dr. Griswold was selected by a committee of family physicians from nominations made by patients, community members and fellow physicians. Dr. Griswold is employed with Capital Region Medical Clinic in Eldon.

Dr. Dan Purdom’s introduction summarized Dr. Griswold’s philosophy for being a family physician.

“I can’t even remember wanting to be anything else,” Dr. Griswold said about becoming a doctor.

He knew his calling at a very early age, and hasn’t looked back since. “Work hard and give back.”

This is Griswold’s motto, a reflection of the values

"

"A good doctor understands the soul and heals the body as a vessel, so no ailment will keep that person from being the best they can be.”

- Galspare Calvaruso, President, Capital Region Medical Center

20 Missouri Family Physician July-September 2016

he was taught by his hardworking parents. Working hard is a true Griswold family value; one of which cannot be denied.

Scott, his father Joe, and his uncle Doug, have all been recognized as Eldon Chamber-Citizen of the Year. I guess you could say it’s a Griswold family tradition The Griswold family’s kitchen table is one that could tell many stories we are sure. “Our dad’s office is open Monday through Sunday, we can’t even count the number of babies with ear infections our father has checked out on that table, and—is it normal to stitch people up on the dining room table?” asked his daughter, Emery.

From diagnosing and treating at the dining room table, to mending the ankles of high school student athletes on the sidelines of countless football games, Dr. Griswold is a true asset to his community.

Thomas Niekamp, Vice President of Physician Relations at Capital Region, quoted, “Dr. Griswold’s practice is extremely busy and he consistently has some of the highest patient satisfaction scores and routinely provides support for his patients after business hours when unexpected needs occur. If we were to name all of the community

MAFP

2016 Family Physician of the Year MAFP

activities, programs, and events Dr. Griswold is involved in and with, we would be here all evening. One of the best compliments our organization can provide for Dr. Griswold is a phrase often used by administration, “We would love a dozen more just like him.”

Galspare Calvaruso, President of Capital Region Medical Center in Jefferson City said, “In 2015 when Dr. Griswold was named Capital Region Medical Center’s Physician of the Year, during the awards presentation, Dr. Jay Allen, a former Physician of the Year, summarized so well, Dr. Griswold’s character. He stated: Scott practices medicine extremely well, but what he does best is care for his patients – not only when his office doors are open but whenever he is needed. You see, Dr. Griswold practices medicine because he values life. He believes in life, love and the beauty of living. He knows there is a purpose for every man, woman, and child on this earth, and looks after their well-being so they can achieve that purpose. A good doctor understands the soul and heals the body as a vessel, so no ailment will keep that person from being the best they can be in the eyes of God. “ There is one common theme each and every person who nominated Dr. Griswold wrote and that was: “how lucky they feel to have Dr. Griswold in their community.”

Congratulations Dr. Scott Griswold, 2016 Missouri Family Physician of the Year.

Dr. Scott Griswold’s Acceptance Speech

(June 4, 2016, at the Awards and Installation Dinner) Thank you so much. I am very honored and humbled to receive this award. Most people who know me well would know I prefer to not draw attention to myself for my work. I would like to take a few moments to shine a light on all of those for whom I feel are responsible for helping me get to this point tonight. I would like to thank my parents for supporting and teaching me how to be a caring person and give back to others. Also, thank you to the Department of Family and Community Medicine at the University of Missouri for giving me the foundation to grow on as a physician. My community and patients for all their support and trust over the past 18 years. Capital Region Medical Center for not only employing me for the past 18 years but also giving me the freedom to practice medicine the way I want to. Thank you to my staff, mainly for putting up with me on a day-to-day basis, but also for all the hard work they do every day in clinic to make sure we are giving our patients the best care we can. My children for all the sacrifices they had to endure over the years and the understanding -- when Dad had to leave a game or miss dinner because of work. But most of all, I want to thank my wife, Michele. She has been a partner by my side for the past 30 years and I truly would not be up here without her love, support, and patience. Thank you.

The AAFP has your back.

Count on the AAFP to find out what MACRA means for you and your practice.

Learn more | aafp.org/MACRAReady

Missouri Family Physician July-September 2016

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MAFP Membership Anniversaries

Membership ANNIVERSARIES 60 Years

Donald Kuenzi, MD

55 Years

C W Chastain, MD, FAAFP Charles Peterson, MD, FAAFP

50 Years

Wilbur Dabbs, MD Lee Heutel, MD Arturo Montes, MD, FAAFP L Silvers, MD, FAAFP

45 Years

Fritz Byrum, MD, FAAFP L Magruder, MD, FAAFP

Peter Koopman, MD, FAAFP, presents Charles Peterson, MD, FAAFP, his anniversary certificate honoring 55 years with the Academy.

Other members recognized during the Assembly included: Melissa Hatcher, MD, FAAFP – 25 Years Arturo Montes, MD – 50 Years Cheryll Rich, MD – 25 Years

22 Missouri Family Physician July-September 2016

Congratulations to all of our MAFP members celebrating a milestone anniversary in 2016. The Academy thanks you for your continued support of family medicine.

40 Years

David Brunworth, MD, FAAFP Jimmy Presley, MD Kenneth Scott, MD, FAAFP

35 Years

Jerald Chaffin, MD, FAAFP James Conant, MD, FAAFP Paula Davis, MD Curtis Dyer, MD Wendell Elliott, MD David Glover, MD, FAAFP Michael Good, MD Rashid Hamid, MD, FAAFP James Hawk, MD, FAAFP Douglas Kenney, MD, FAAFP Jay Kimball, MD Robert Kunkel, MD, FAAFP Hsien-Ell Lai, MD, FAAFP Carl Ledbetter, DO Timothy Long, MD James Lord, MD William Miller, MD, FAAFP John O'Connor, MD, FAAFP Douglas Parashak, MD Ronald Phillips, MD, FAAFP Richard Price, MD Gilbert Smith, MD Mark Suenram, MD Mark Ward, MD, FAAFP Steven Warlick, MD, FAAFP

30 Years

Stephen Adams, MD Michael Ausmus, MD Brian Basham, MD Gerianne Bliss, MD, FAAFP Richard Bowles, MD, FAAFP Jayne Brockhaus, MD, FAAFP Steven Buie, MD, FAAFP Robert Buzard, MD, FAAFP Miguel Cannon, MD Darwin Davis, MD, FAAFP

Stephen, Dorsch, MD Janet Elliot, MD Bonnie Friehling, MD Gena Gardiner, MD William Gilbirds, MD, FAAFP Marcia Graham, MD, FAAFP William Graham, MD, FAAFP Nathan Granger, MD, MBA Gurprakash Grewal, MD, FAAFP Janet Hankins, MD Felix Herrera, MD, FAAFP Brent Hoke, DO Craig Holzem, MD, FAAFP Aubra Houchin, DO Christine Jacobs, MD, FAAFP Michael Jones, MD Douglas Koehn, MD, FAAFP Alexander Mammen, MD Mitzi Mathews, MD, FAAFP Harold Maxey, MD, FAAFP Marsha Mertens, MD Mica Newman-Koehn, MD, FAAFP John O'Brien, MD Lisa Pierce, MD Steven Radel, MD Thomas Robbins, MD, FAAFP Stephen Salanski, MD, FAAFP Alan Scharrer, MD, FAAFP Ralph Schmitz, MD, FAAFP Bruce Scully, MD, FAAFP Jeffrey Sharp, MD, FAAFP Morton Singer, MD Thomas Smith, MD, FAAFP Stephen Staten, MD Stephen Stewart, MD Walton Sumner, MD Terry Suppes, DO Randy Tarvin, MD Janet Theby, MD Rebecca Turner, MD Jack Wells, MD, FAAFP Russell Yocum, DO, FAAFP

Membership Anniversaries

25 Years

Debra Ahern, DO, FAAFP Kelly Bain, MD Robert Bieser, DO, FAAFP Christopher Billings, DO, FAAFP James Blankenship, MD, FAAFP Mark Brady, MD, FAAFP Kirk Brockman, MD Scott Darling, DO, FAAFP Mark Ellis, MD, FAAFP Neal Erickson, MD Rosa Galvez Myles, MD Susan Graves, MD, FAAFP Kelly Hartel, MD Melissa Hatcher, MD, FAAFP Laurain Hendricks, MD, FAAFP Patricia Inman, MD Justin Jones, MD, FAAFP Mark King, MD Byron Law, DO Lisa Leonhart, MD Ann McLaren, MD Scott Moose, MD John Mruzik, MD Timothy Murphy, MD Michael Myers, MD David Nill, MD Robert Pierce, MD, FAAFP Robert Pozzi, DO, FAAFP Yvonne Prince, MD Steven Rettinger, MD Cheryll Rich, MD Paul Rosenthal, DO Caroline Rudnick, MD Kim Smith, MD Steven Stahle, MD Shari Thompson, MD Tuongvan Tran, MD

MAFP

Pabst Earns CAE Credential

Kathy Pabst, MBA, CAE, Executive Director

The American Society of Association Executives (ASAE) has announced that Kathy Pabst, MBA, Executive Director of the Missouri Academy of Family Physicians (MAFP) has earned the Certified Association Executive (CAEÂŽ) designation. The CAE is the highest professional credential in the association industry.

To be designated as a Certified Association Executive, an applicant must have a minimum of three years experience with nonprofit organization management, complete a minimum of 100 hours of specialized professional development, pass a stringent examination in association management, and pledge to uphold a code of ethics. To maintain the certification, individuals must undertake ongoing professional development and activities in association and nonprofit management. More than 4,000 association professionals currently hold the CAE credential. The CAE Program is accredited by the National Commission for Certifying Agencies (NCCA).

Kathy joined the MAFP in April, 2014, as the executive director. She is responsible for the general and strategic management, membership development, communication, programs and services, leadership, and administration of the statewide association. She is a graduate of William Woods University earning her undergraduate degree in Business Management and a Masterâ&#x20AC;&#x2122;s Degree in Business Administration.

Missouri Family Physician July-September 2016

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MAFP 2017 AAFP Board of Directors Candidate

Meet Todd Darian Shaffer, MD, MBA, FAAFP

2017

Candidate for AAFP Board of Directors

Personal Statement Growing up in a small rural town as the son of the local mortician and coroner, I was able to be involved with seeing first hand how rural America suffers with the lack of adequate health care.

On coroner calls with my dad, I saw how people died and thought if only medical care was more accessible or if emergency services were better, many of these people would have survived. Seeing these tragedies only strengthened my resolve to first become part of the solutions as a family physician, and then become a teacher and mentor to so many more to fill these spots of real need in our country with full spectrum family physicians.

I am honored to be a candidate for the 2017 AAFP Board of Directors. For the past 25 years I have been involved in the Academy at the local, state, and national level. I have championed training the next generation of family physicians utilizing the new methods that the digital age brings us, anchored by the full spectrum that family medicine offers while valuing the personal relationships with patients.

During my career, I have been fortunate as a servant leader to follow great leaders and learn from them. I have completed a MBA program in physician leadership to experience the academic side of leadership. I have been able to hone those servant characteristics and use the hard 24 Missouri Family Physician July-September 2016

and soft skills in organizations to work together to reach new outcomes while valuing the personal relationships along the way.

As many new stresses have been thrown on the primary care system of this country, we must realize that the broken US healthcare system is on our backs. Only we can rise up and work with our colleagues to make it better. Being fortunate the last several years to be a part of Working Party, I was able to serve among many of our other leaders in family medicine by forming Family Medicine for Americas Health. Through this project, we were all amazed on how highly family physicians are valued by patients, the general public, other physicians,

"

Serve Before you Lead"

and employers. We need to use this momentum to advance the primary care discipline. We are the answer, not the problem. We need to help our colleagues find joy in medicine, while improving the pipeline, process of medical education, practice transformation, and payment reform. In my job and in my professional position, I have been able to affect all of these ever so slightly. I want to be

2017 AAFP Board of Directors Candidate MAFP able to make these a priority in my years of further national service in larger and effective ways.

“Serve before you lead” is something I have been teaching for years to my students, residents and fellow family physicians. I have had many opportunities with the AAFP and other family medicine organizations to serve and finally lead. It is now my time to step forward to lead and inspire others on a national basis for the true meaning of family medicine - caring for all with no limitations on who or what we see.

Biography Todd Darian Shaffer, MD, MBA, FAAFP, a family physician, is the Program Director at the University of Missouri-Kansas City.

He has been a leader in striving for educating full spectrum family physicians to meet the needs of rural America.

Dr. Shaffer received his medical degree from the University of Missouri-Columbia in 1992, completed his residency at the University of Missouri-Kansas City in June of 1995. He continued on as faculty because of a fortunate loan repayment program Missouri began offering to primary care physicians.

During this payback time, he fell in love with the change in education that was occurring at that time, and seeing how digital and other methods of education were more effective for adult learners. He started early with hands on courses like ALSO, PowerPoint distribution, became a pioneer in wiki education in 2001 and introduced Blackboard to resident education in 2005. As time has advanced, even more effective forms of education are evident and he continues to innovate and move education to be a better value. He completed the National Institute of Program Directors fellowship in 2003 and is a fellow in the American Society of Colposcopic and Cervical Pathology receiving their highest award in Colposcopic Recognition in 2001.

Dr. Shaffer assisted in integrating an MBA program into the UMKC residency program’s three-year curriculum in 2004. He took the option to complete it himself over the next 3 years with four of his residents. He graduated from Rockhurst University’s Helzberg Physician Leadership MBA program in 2007 and received the Rockhurst University MBA Service Award. He is also a lifetime member of the AOA Honor Medical Society.

Dr. Shaffer is currently the University of Missouri - Kansas City Residency Program Director, since 2002, and leads one of the largest family medicine programs in the country with

42 residents, 3 fellowship programs and dual certification by the AOA and ACGME. He lead the project to integrate the program into the AOA certification. He has led multiple quality improvement projects and incorporated research into family medicine education where little existed before. He was part of the leadership team transforming to a PCMH certified clinic and created one of the first rotations in the country specifically as part of the required residency curriculum in PCMH at their program. He is a full professor of medicine and is very active faculty member practicing full scope family medicine including obstetrics, inpatient, outpatient, pediatric, and procedural care. He values full spectrum training so that all his graduates have the capabilities to enter any type of practice. He is an IT super user and has innovated rounding, medical record documentation, hosts EHR vendor visits and speaks at the Cerner World Conference on a regular basis.

Dr. Shaffer is currently a member of the AAFP’s Commission on Continuing Professional Development. He has served on the Commission on Finance from 2003-07. He is also a member of the Association of Family Medicine Residency Directors (AFMRD) and has served in all leadership positions during his 7 years serving as board member, treasurer in 2011-13, president elect in 2013-14, president in 201415 and is the recent past chair of AFMRD in 2015-16. He was elected by his peers in the Council of Academic Family Medicine (CAFM) in 2015 and is currently the chair of CAFM. During the past 4 years he has attended the AAFP’s Working Party meetings as a leader in his organization. He is past president and chair of the Missouri Academy of Family Physicians (MAFP) in 2011-12 and had previously been the Education Commission chair for the MAFP for 8 years directing the two educational conferences the Academy has each year.

He is currently serving as a Missouri delegate to the AAFP, Congress of Delegates. He is an ALSO advisory faculty and has taught and directed in over 35 ALSO courses and multiple ALSO instructor courses. He is an annual presenter at the Program Directors Workshop and also presents annually at the National Conference of Family Medicine Residents and Students. He also regularly attends ACLF, FMCC, and takes his second year residents to Jefferson City for the family medicine Advocacy Day. He applied and received a grant from HRSA for $1.9 Million in 2011 to expand his residency by two slots per year for a rural training area of concentration.

Dr. Shaffer enjoys outside activities including landscaping (digging in the dirt!), water gardening, water skiing, and biking.

He has three children, Olivia, Alec, and Ian.

Missouri Family Physician July-September 2016

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MAFP 68th Annual Scientific Assembly

ANNUAL SCIENTIFIC ASSEMBLY COMBINES EDUCATION, BUSINESS AND LEISURE

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estled in the beautiful Lake of the Ozarks area, the MAFP’s 68th Annual Scientific Assembly at the Lodge at Old Kinderhook, Camdenton, started with the timely topic of chronic pain management. Over 50 family physicians and students heard from eleven speakers on topics from child abuse, diabetes, maintenance of certification, infertility, and dental care. Keynote speaker, Michelle May, MD, energized the attendees with an opportunity to “Eat What You Love, Love What You Eat” presentation and luncheon demonstration. Louis Kuritsky, MD, presented an entertaining session on Five Things I Wish I Knew Last Year, but more seriously, on the contentious role of vitamin D supplementation.

New officers were elected during the 68th Annual Meeting and installed during the Awards and Installation Dinner:

• Chair – Peter Koopman, MD, FAAFP (Columbia) • President – Kathleen Eubanks-Meng, DO (Blue Springs) • President Elect – Mark Schabbing, MD (Perryville) • Vice President – Sudeep Ross, MD, MBA, (Kansas City) Jim Stevermer, MD, MSPH, FAAFP (Fulton) will continue his three year term as Secretary/Treasurer.

The Missouri delegates to the AAFP Congress of Delegates were presented for ratification by the membership: AAFP Delegates - Todd Shaffer, MD, MBA, FAAFP, (Kansas City) and David Schneider, MD, FAAFP (St. Louis) AAFP Alternate Delegates - Kate Lichtenberg, DO, FAAFP (Kirkwood) and Keith Ratcliff, MD, FAAFP (Washington)

Residents and students displayed posters during the Awards and Installation Reception. Prices of $300, $200, and $100 were awarded. There were 14 entries with 23 participants. The winners were:

First Place: Doyle Witt, MD, Resident, UMKC TMC Lakewood Topic: Paracentesis Workshop Efficacy in Resident Training Programs

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Second Place: Jayme Decker, DO, MS, Resident, Gillian Houseman, DO, MPH, Resident, and Caitlyn Nguyen, MD, Resident, UMKC TMC Lakewood Topic: Will Physician Encouragement Regarding Elimination of Soft Drinks for 3 Months Decrease A1C Levels?

Third Place: Cory Offutt, MD, Resident, and Shawn Wadsworth, DO, MA, Resident, UMKC TMC Lakewood Topic: Oral vs. Vaginal Misoprostol in Uncomplicated Inductions of Labor

68th Annual Scientific Assembly MAFP

THANK YOU TO OUR EXHIBITORS FOR YOUR CONTINUED SUPPORT

Tar Wars Poster Contest Winner Recognized Kyra Christopher from Pickett Elementary School in St. Joseph, Missouri received an award and $100 check at this year’s Awards and Installation Dinner for her winning poster in the Annual Tar Wars Poster Contest. The Poster Contest is sponsored by the Family Health Foundation of Missouri and was funded by an AAFP Foundation Mini Tar-Wars Grant.

Congratulations Kyra.

Advanced Net Providers CoxHealth Direct Primary Care Clinics EMS Kowa Pharmaceuticals MedCareerGuide Missouri Beef Industry Council Missouri Health Professional Placement Services MPM-PPIA ProfitableMD Sanofi Genzyme Southeast Hospital St. Louis Children’s Hospital

Up to 18.25 CME hours!

Three Physicians Conferred Degree Of Fellow The Degree of Fellow was established in 1971 by the Congress of Delegates as an avenue for special recognition of those members of the AAFP who have distinguished themselves among their colleagues, as well as in their communities, by their service to family medicine, the advancement of health care to the American people and by their professional development through medical education and research. As a Fellow of the American Academy of Family Physicians, the following distinguished individuals received this degree at the MAFP’s Annual Scientific Assembly last month: Justin Puckett, MD, FAAFP Vicki Roberts, MD, FAAFP Scott Roos, MD, FAAFP

49th Annual Clinical Advances in Pediatrics Symposium September 21 to 23, 2016 Children’s Mercy Park | Kansas City, Kansas

www.childrensmercy.org/caps

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MAFP 68th Annual Scientific Assembly

"

Me and my family had the greatest time at Old Kinderhook! Thanks for making it special! We are looking forward to next year's conference."

Dr. Melissa Hatcher

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68th Annual Scientific Assembly MAFP

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MAFP Increased Naloxone Access in Missouri

COMING SOON: INCREASED NALOXONE ACCESS IN MISSOURI

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issouri has thus far been largely unsuccessful in addressing increasing opioid related deaths. While the 2016 legislative session adjourned without passing a state wide prescription drug monitoring program, there is some room for optimism in the fight to curb opioid deaths with the passage of HB 1568.

Emily Doucette, MD Saint Louis University Department of Family and Community Medicine

As family physicians, we are well aware of the opioid epidemic locally and nationally. In 2014, there were 1,067 drug overdose deaths in Missouri (18.2 per 100,000 persons), most of which were secondary to prescription opioids and heroin.1 Between 2005 and 2014, hospital utilization for opioid abuse increased 137% in Missouri.2 Both the CDC and The Department of Health and Human Services have called on states to address opioid deaths by increasing access to substance abuse treatment services, sterile injection equipment, and training surrounding naloxone use.3,4 Missouri is moving in the right direction with the passage of HB 1568. The law provides that “any licensed pharmacist in Missouri may sell and dispense an opioid antagonist under physician protocol.”5 The physician protocol, like a standing order, will allow an individual to present to a pharmacy and buy an FDA approved naloxone product without a prescription from their physician.

The bill absolves the pharmacist and physician from any liability or professional disciplinary action associated with prescribing and dispensing. It makes it permissible for any person to possess an opioid antagonist, legally protects an individual who administers the medication in good faith, and requires that emergency personnel be contacted after naloxone use. HB 1568 was sponsored by Representative Steve Lynch, a republican from Waynesville, who dedicated two sessions to educating legislators on this issue. The effective date is August 28, 2016. 5 Fourteen other states have passed similar laws.6 Naloxone hydrochloride is an opioid antagonist which competes for the mu, kappa and sigma opiate receptors in the central nervous system.

It is indicated for the reversal of life threatening

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respiratory depression secondary to opioid overdose and works by competing with and displacing opioids at these receptor sites. It has been used by medical professionals for this purpose for decades.7 Naloxone does not produce physical dependence and does not have abuse potential.8 There is no overdose phenomenon or toxic dose. The adverse effects of naloxone are the result of acute opioid withdrawal and include pain, hypertension, diaphoresis, muscle cramping, nausea, vomiting and agitation.7 In July 2014, the pharmaceutical company Kaleo launched a naloxone auto-injector called Evzio which is FDA approved for reversal of opioid overdose.6 When the device’s safety guard is removed, it injects 0.4mg/0.4mL of naloxone intramuscularly or subcutaneously. The needle is immediately retracted into the device after use.9 In November 2015, the FDA approved the first intranasal naloxone delivery system, Narcan nasal spray, made by Adapt Pharma, Inc.10 This device delivers a 4 mg dose of naloxone through an intranasal nozzle.11 Additional doses should be alternated between nostrils and may be repeated every 2-3 minutes. All doses should be administered with the patient in the supine position.7 In the 1990s, several metropolitan areas adopted pilot studies to determine if addicts could be trained to rescue persons experiencing symptoms of drug overdose with naloxone. Pilots were largely successful in San Francisco, Boston, New York City, Baltimore and the state of New Mexico. A naloxone distribution program in Chicago in 2006 reported a 20% decrease in opioid deaths in the first year and an additional 10% reduction in opioid deaths in both the second and third years after dispensing over 3,500 vials of naloxone. Well controlled research on naloxone distribution is lacking, but programs report hundreds of thousands of naloxone doses dispensed, thousands of reversals and no serious adverse events.12 In the United States from 1996 to 2014, naloxone distribution programs were associated with 26,463 overdose reversals.13

Increased Naloxone Access in Missouri MAFP A study of naloxone distribution programs in heroin users found such programs to be cost-effective. Quality adjusted life years increased by 0.12, with an incremental cost-effectiveness ratio of $438. One death was prevented for every 227 naloxone kits distributed.14 A study of claims data from across the United States estimated the cost of opioid related premature deaths in 2007 to be $11.2 billion nationally.15 While naloxone will soon be more easily obtained by Missouri residents, issues of access and cost will still limit use. Naloxone itself is inexpensive, costing less than $1 per dose a decade ago. The cost of the medication has risen 4,000% in the past decade, partially because newer delivery devices do not have generic alternatives.6 The fiscal notes for the house bill estimated the cost of these medications to the Medicaid budget to be $87.50 per prescription for Evzio and $50.00 per prescription for Narcan nasal spray. Missouri Medicaid will cover naloxone prescriptions for patients with active diagnoses of opioid dependence.5 However, at St. Louis pharmacies, the price of Narcan nasal spray without insurance coverage ranges from $131-150, while the price of Evzio ranges from $1,969-4,500. Some coupon programs are available and some insurance programs offer coverage. Further, many pharmacies do not routinely stock the medication.

Increased naloxone availability among the general population is safe, and distribution programs are cost effective and associated with decreased opioid overdose deaths. While HB 1568 does not directly distribute naloxone, there is hope that increased access will decrease mortality and societal costs associated with opioid deaths in Missouri. Addressing the opioid epidemic will require multiple strategies, but it is exciting to see Missouri move progressively towards a harm reduction measure that has been proven to be successful.

As Family Physicians, we should promote naloxone distribution.

We can increase public awareness through education using public platforms. As recommended by the recently released CDC Guideline for Prescribing Opioids for Chronic Pain, we should prescribe naloxone to our high risk patients and educate them about appropriate use.16 The cost of naloxone is the current limiting factor. While naloxone will be available to Missouri Medicaid patients, we can utilize pharmaceutical assistance programs for Evzio for patients who are at high risk but cannot afford naloxone. We can also encourage and support naloxone distribution programs in our counties so the medication is available to more patients at reduced cost.

The passage of HB 1568 provides Family Physicians with an important new tool to mitigate opioid overdose deaths. We should embrace the opportunity to advance the solution at least this one step forward.

Works Cited: 1. Injury Prevention & Control: Opioid Overdose State Data, 2016.

Centers for Disease Control and Prevention Website. http://www. cdc.gov/drugoverdose/data/statedeaths.html. Updated May 2, 2016. Accessed May 19, 2016.

2. Porth, L. Opioid Use in Missouri: Strategy for Reduced Misuse and Abuse. Missouri 3. Hospital Association Website. http://www.mhanet.com/ mhaimages/opioid/MHABoardRecs.pdf. Updated November 2016.

Accessed April 24, 2016.

4. Todayâ&#x20AC;&#x2122;s Heroin Epidemic, 2015. Centers for Disease Control and Prevention Website. http://www.cdc.gov/vitalsigns/heroin/.

Updated July 7, 2015. Accessed April 24, 2016.

5. HHS Announces Actions to Attack the Opioid Abuse Crisis, 2015.

National Institute on Drug Abuse Website. https://www.drugabuse. gov/about-nida/noras-blog/2015/03/hhs-announces-actions-toattack-opioid-abuse-crisis. Updated March 26, 2015. Accessed April 24, 2016.

6. HB 1568, 2016 Missouri House of Representatives Website. http://www.house.mo.gov/billsummary.aspx?bill=HB1568&year=2 016&code=R. Accessed May 19, 2016.

7. Brennan Z. OTC Opioid Overdose Antidote: Why is it not FDA Approved? Regulatory Affairs Professional Society Website. http:// www.raps.org/Regulatory-Focus/News/2016/02/24/24400/OTCOpioid-Overdose-Antidote-Why-is-it-not-FDA-Approved/. Updated February 24, 2016. Accessed April 25, 2016.

8. Naloxone, Record No. 233109. Truven Health Analytics, Dynamed Plus Website. EBSCO Information Services. http://www.dynamed. com/login.aspx?direct=true&site=DynaMed&id=233109.

Registration and login required. Updated May 6, 2016. Accessed May 19, 2016.

9. Robinson A, Wermeling DP. Intranasal naloxone administration for treatment of opioid overdose. American Journal of Health-System Pharmacology. 2004;71:2129-2135.

10. How to Use Evzio, 2016. Kalio Website. http://www.evzio.com/ hcp/about-evzio/how-to-use-evzio.php. Updated February 2016.

Accessed April 25, 2016.

11. FDA moves quickly to approve easy-to-use nasal spray to treat opioid overdose, 2015. U.S. Food and Drug Administration Website. http:// www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ ucm473505.htm. Updated November 19, 2015. Accessed April 24, 2016.

12. Traynor K. FDA approves first intranasal naloxone product. American Journal of Health-System Pharmacology. 2016;73:e2-e3.

13. Wermeling DP. A Response to the Opioid Overdose Epidemic: Naloxone Nasal Spray. Drug Delivery and Translational Research.

2013;3(1):63-74.

14. Wheeler E, Jones S, Gilbert MK, Davidson PJ. Opioid Overdose Prevention Programs Providing Naloxone to Laypersons United States, 2014. Morbidity and Mortality Weekly Report.

2015;64(23):631-635.

15. Coffin PO, Sullivan SD. Cost-Effectiveness of Distributing Naloxone to Heroin Users for Lay Overdose Reversal. Annals of Internal Medicine, 2013;158:1-9.

16. Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL. Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States. Pain Medicine.

2011;12:657-667.

17. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. Morbidity and Mortality Weekly Report. 2016; 65:1-49.

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MAFP End of Session Report

MAFP 2016 END OF SESSION REPORT The Missouri Legislative Session ended at 6:00 p.m. on Friday, May 13. Over 2,000 bills and resolutions were introduced. I’m pleased to report that a number of MAFP priority bills were passed, while various bills we opposed did not. Legislation becomes effective August 28, 2016, unless it has an emergency clause or other operational law date.

At publication, most of the healthcare related omnibus bills have been signed by the Governor; however, SB 608 was vetoed on July 5, 2016. Many of the items in SB 608 were included in other bills as noted below.

BILLS THAT PASSED Health Care Workforce Data Analysis – Signed by Governor Allows various professional licensing boards, including the Board of Healing Arts, to collect and analyze workforce data to assess the state’s health care workforce needs. (SB 635)

Pat Strader MAFP Govermental Consultant

Telehealth – Signed by Governor This act defines "telehealth" or "telemedicine" as the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while such patient is at the originating site and the health care provider is at the distant site. Physicians practicing telemedicine shall ensure that a properly established physician-patient relationship exists with the person receiving telemedicine services. The act addresses the use of asynchronous store-and-forward technology in the provision of telehealth services for MO HealthNet participants and establishes the “Telehealth Services Advisory Committee” to advise DHSS on proposed rules. The original bills became targets for numerous amendments (SB 621 and HB 1923), so final passage came as a part of the infection reporting legislation. (SB 579) Maintenance of Licensure Provisions – Signed by Governor This act prohibits the state and the Board of Healing Arts from conditioning physician licensure on maintenance of specialty certification. As the bill moved through the process it also included language that prohibits discrimination against non-board certified physicians in the state and allows reciprocity to out-ofstate physicians who are not board certified. (HB 1816) Palliative Care – Signed by Governor This bill creates the Missouri Palliative Care and Quality of Life Interdisciplinary Council which will consult with DHSS. It also creates the Palliative Care Consumer and Professional Information and Education Program, to maximize the effectiveness of palliative care in the state by ensuring the public availability of comprehensive and accurate information about palliative care. (SB 635; SB 865; SB 866) Naloxone Prescribing – Signed by Governor This bill allows any licensed pharmacist to sell and dispense naloxone under physician protocol and creates immunity from criminal prosecution, disciplinary actions from a professional licensing board, and civil liability for an individual who, acting in good faith and with reasonable care, administers an opioid antagonist to an individual whom he or she believes is suffering an opioid-related drug overdose.

Any individual or organization may store and dispense an opioid antagonist without being subject to the licensing and permitting requirements in Chapter 338, RSMo, if he or she does not collect a fee or compensation for dispensing the opioid antagonist when the person or organization is acting under a standing order issued by a health care professional who is authorized to prescribe an opioid antagonist.

(HB 1568) Step Therapy Protocols – Signed by Governor While the bill that passed does not include all of the provisions in the original bill, such as the three-day response time, it is a step forward. If a patient has gone through step therapy once, they will not have to do so again even though they change health carriers or physicians. Insurers must provide a clear and convenient process for requesting an override. (HB 2029)

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End of Session Report MAFP Vaccinations – SB 635 Signed by Governor Under this bill, DHSS must provide information brochures that state immunizations against the meningococcal disease are available and to include information on all vaccines receiving Category A or B recommendation from the Advisory Committee on Immunization Practices of the CDC. It updates the vaccination requirements for college students who reside in on-campus housing. It was amended to include the provision that requires long-term care facilities to offer annual influenza vaccines to employees who have direct contact with residents. (SB 608-Vetoed; SB 635) Infection Reporting – Signed by Governor This act requires DHSS to include carbapenem-resistant enterobacteriaceae (CRE) in its list of communicable or infectious diseases which must be reported to the department. It also requires the Infection Control Advisory Panel to make recommendations by January 1, 2017, to the department regarding CMS’ reporting requirements. The bill also provides that by August 28, 2017, each hospital and ambulatory surgical center, excluding mental health facilities, shall establish an antibiotic stewardship program. (SB 579) Newborn Screening for SCID – Signed by Governor This bill expands Missouri’s newborn screening requirements to include severe combined immunodeficiency (SCID), also known as bubble boy disease. (HB 1682) Medical Practice Freedom Act – Signed by Governor This bill prohibits the Board of Healing Arts from conditioning medical licensure on participation in any health insurance plan, public health care system, public service initiative, or emergency room coverage. State licensure for physicians and optometrists shall not be conditioned upon or related to compliance with the “meaningful use” of electronic health records as set forth in 45 CFR 170.

(HB 1682) Prescription Eye Drops – HB 1816, SB 635, SB 973 Signed by Governor Extends the sunset provision to continue allowing for early refills of prescription eye drops. (SB 608-Vetoed; HB 1816, SB 635, SB 973) Missouri Health Insurance Rate Transparency Act – Signed by Governor This act adds uniformity in insurance and financial services regulation. It adds the U.S. Department of Health and Human Services to the list of entities with which the Director of the Department of Insurance, Financial Institutions and Professional Registration may cooperate to regulate insurance and financial services. (SB 865; SB 866) Use of Patient Restraints – Signed by Governor Physician assistants and assistant physicians (in a supervision agreement with the attending physician) are added to the current statute that already allows APRNs to determine that the physical or chemical restraint or seclusion of a patient in a mental health facility or program is or is not necessary. (HB 1682) Optometry Students – Signed by Governor This bill provides that unlawful practice of optometry does not apply to students enrolled in an accredited school and under the direct supervision of a licensed physician or optometrist. (HB 1816) Certificates of Need (CON) – Signed by Governor Requires hospitals operated and licensed by the state, with the exception of DHMH operated psychiatric hospitals, to obtain a CON and to comply with statutes relating to certificate of need; however, CON shall not be required for the purchase and operation of medical equipment used by an academic health center operated by the state in furtherance of research or instruction. (SB 988)

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MAFP End of Session Report MO HealthNet Co-Payments – Vetoed by Governor Beginning October 1, 2016, DHSS shall require MO HealthNet participants to pay an $8 co-payment fee for the use of a hospital emergency department for the treatment of a condition that is not an emergency medical condition. DHSS shall promulgate rules for the implementation of this provision. (SB 608) MO HealthNet Missed Appointment Fees – Vetoed by Governor To the extent provided by law pertaining to the termination of patient care, this bill would allow fee-for-service MO HealthNet providers to charge a missed appointment fee to participants. The bill creates a scale of charges for missed appointments. My understanding is that this provision would require a Medicaid waiver. (SB 608) Physical Therapy Licensure Compact – SB 635 Signed by Governor This act allows the state to enter into a multi-state licensure compact for physical therapists. (SB 608-Vetoed; SB 635) MO HealthNet Reimbursement for Behavioral Health – Vetoed by Governor Subject to appropriations, MO HealthNet providers of behavioral, social, and psychophysiological services, including psychologists, shall be reimbursed for the prevention, treatment, or management of physical health problems. (SB 608) Emergency Supplies of Medication – SB 635 Signed by Governor Last session legislation passed providing that a pharmacist or pharmacy technician could make the determination to dispense an emergency supply of medication without the authorization from the prescriber. This correcting bill “removes “pharmacy technician” from the statute – which was not intended to be included in that law. (SB 608-Vetoed; SB 635) Maintenance of Medication – HB 1816, SB 973 Signed by Governor Under this bill, a pharmacist may dispense varying quantities of maintenance medication per fill up to the total number of dosage units as authorized by the physician, unless the prescriber has specified that dispensing a prescription for maintenance medication in an initial amount is medically necessary. When the dispensing of the maintenance medication is based on refills then the pharmacist shall dispense no more than a 90 day supply and the patient must have already been prescribed the medication for three months.

(HB 1816; SB 973; SB 608-Vetoed) Medication Synchronization – SB 865 Signed by Governor This bill requires a health carrier or managed care plan that provides prescription drug coverage to offer medication synchronization services; they shall not charge any amount in excess of the otherwise applicable copayment for dispensing a prescription drug in a quantity that is less than the prescribed amount and shall provide a full dispensing fee to the pharmacy that dispenses the prescription drug so long as the terms of the medication synchronization services are met. (SB 865; SB 608-Vetoed) Insurance Coverage for Occupational Therapy Services – Signed by Governor This act provides that an occupational therapy co-payment shall not be higher than that of a primary care physician office visit.

(SB 635) Health Care Cost Reduction and Transparency Act – Vetoed by Governor This bill requires heath care providers to provide patients (upon their written request) with a cost estimate when presented with a written medical treatment plan, within three business days. Beginning July1, 2017, hospitals must make available to the public through a publicly available website, the amount that would be charged without discounts for each of the 100 most prevalent diagnosis-related groups. (SB 608) Health Care Price Transparency – Vetoed by Governor Under this act, no contract provision between a health carrier and a health care provider shall be enforceable if such provision prohibits, conditions, or in any way restricts any party to such contract from disclosing to an enrollee, patient, or potential patient the contractual payment amount for a health care service if such payment amount is less than the health care provider's usual charge for the health care service, and if such contractual provision prevents the determination of the potential out-of-pocket cost for the health care service by the enrollee, patient, or potential patient. (SB 608) End of Session Report, con't on page 36.

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MAFP End of Session Report Interchangeable Biological Products – Signed by Governor This bill allows pharmacists to dispense a less expensive interchangeable biologic product approved by the FDA in place of a brand name product. It does require that a pharmacist who switches a patient to such a product must inform the patient’s prescriber within five days of dispensing. (SB 875) Nurse Licensure Compact – Signed by Governor This language updates current Missouri law to conform to the multi-state nurse licensure compact. There are currently 26 states participating in the compact. (SB 635) Dyslexia Screening and Support – Signed by Governor This act requires DESE, by December 31, 2017, to develop guidelines for screening of students for dyslexia and related disorders and to develop the necessary classroom support for students. Beginning in the 2018-19 school year, each public and charter school shall conduct dyslexia screenings and provide reasonable classroom support. In addition, a Legislative Task Force on Dyslexia is created.

(HB 2379; SB 635) CPR Curriculum – Signed by Governor Requires high school pupils in public and charter schools to have received 30 minutes of CPR instruction and training in the Heimlich maneuver or other first aid for choking prior to graduation; Training shall be included in the district’s existing health or physical education curriculum. (SB 711; SB 635) CBD Oil Liability – Signed by Governor This bill gives civil, criminal, and professional immunity to physicians who prescribe hemp extract known as cannabidiol oral solution (CBD oil). (HB 1682) Alternative Stroke Center Designations/Collection of Emergency Care Data – Signed by Governor This bill allows (through DHSS) an alternative stroke center designation for a hospital. It also gives sole authority to establish education requirements for physicians who practice in an emergency department of a facility designated as a trauma, STEMI, or stroke center by DHSS to the Board of Registration for the Healing Arts. (SB 635; SB 988) MO HealthNet Asset Limits Increased – Signed by Governor This bill increases the asset limits for MO HealthNet permanent and totally disabled claimants, MO HealthNet blind claimants, and MO HealthNet aged claimants starting in fiscal year 2018, from no greater than $1,000 for individuals to $2,000 and from no greater than $2,000 for married couples to $4,000. For each fiscal year after 2018 through 2021, those asset limits will be increased $1,000 and $2,000 respectively so that by fiscal year 2021 the limit for individuals will be $5,000 and for married couples $10,000. Beginning in fiscal year 2022, these limits must be modified to reflect any cost-of-living adjustments. The bill excludes from asset limit calculations medical savings accounts and independent living accounts as defined in the Ticket to Work Health Assurance Program. (HB 1565) Youth Suicide Awareness and Prevention – Signed by Governor This bill allows, beginning in the 2017-18 school year, any licensed educator to annually complete up to two hours of training or professional development in youth suicide awareness and prevention as part of the professional development hours required for State Board of Education certification. The bill requires DESE to develop guidelines suitable for this training. By July 1, 2018, each district must adopt a policy to address strategies that can help identify students who are at possible risk of suicide. By July 1, 2017, DESE must develop a model policy that districts may adopt. By July 1, 2021 (and at least every three years thereafter), DESE must request information and feedback from districts on their experience with this policy. (HB 2379; HB 1583) Bullying in Schools – Signed by Governor This bill modifies the requirements for school anti-bullying policies. The definition of "bullying" is modified to include intimidation, unwanted aggressive behavior, or harassment that substantially interferes with the educational performance, opportunities, or benefits of any student without exception, or that substantially disrupts the orderly operation of the school and that is repetitive and substantially likely to be repeated. (HB 1583)

End of Session Report, con't on page 38.

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MAFP End of Session Report Joint Committee on Public Assistance – SB 608 Vetoed by Governor; SB 607 Pending This bill modifies the Joint Committee on MO HealthNet to create a permanent Joint Committee on Public Assistance, charged with the following purposes: (1) studying, monitoring, and reviewing the efficacy of public assistance programs; (2) determining the level and adequacy of resources needed for the programs, and (3) developing recommendations on the public assistance programs and on promoting independence from safety-net programs among participants as may be appropriate. The committee shall conduct an annual rolling 5-year forecast of the state's public assistance programs and make recommendations to the General Assembly.

(SB 607; SB 608-Vetoed) Expert Witness Standards – Vetoed by Governor This bill changes Missouri's standard for expert witness testimony in civil suits by bringing the standard in line with federal court standards. (SB 591) Collateral Source Rule – Vetoed by Governor This measure modifies provisions of the collateral source rule and provides that parties may introduce evidence of the actual cost, rather than the value, of the medical care rendered. (SB 847)

BILLS THAT FAILED TO PASS APRN Scope of Practice and Collaborative Practice Provisions – Numerous bills were filed relating to the scope of practice of advanced practice registered nurses. Provisions included removing the geographic proximity rule; changing the familiarity rule and chart review; increasing the number of APRNS a physician could collaborate with from three to five; creating a licensure category for APRNS and broadening their scope of practice. In one bill, all that remained of the collaborative agreement were the names and addresses of the parties. All of the provisions were offered repeatedly as amendments to other bills, but none of the bills or amendments made it through the process.

Narcotics Control Act/Prescription Drug Monitoring Program – The Legislature again failed to pass a prescription drug monitoring program. While the House did pass the bill and sent it to the Senate with plenty of time to debate and negotiate, the bill only came up for a short time before being laid over.

Physician Examinations/Three Strikes - Currently, physicians must complete Steps 1, 2 and 3 of their licensing exams within seven years and only get three chances to pass. This language would have allowed the Board of Healing Arts to allow a physician to file an appeal asking for a waiver or extension of time. Some examples given for the need for this extension were health issues of the physician and/or family members and military service. A number of Senators were opposed to changing this law.

Contraceptives Dispensed by Pharmacists – This bill would have allowed hormonal contraceptives to be dispensed over the counter by a pharmacist. The bill passed the House but was not taken up by the Senate. The sponsor added the provision to numerous omnibus bills, but the provision was continually removed. Some Senators complained that the legislation had not been filed, heard, nor discussed by the Senate.

Prior Authorization Standardized Forms – This bill would have required insurance carriers to use a standardized prior authorization form.

Medical Marijuana – This legislation would have allowed for the prescribing of medical marijuana. While the bill was amended on the House floor to include its use for only terminally ill cancer patients, it was still voted down by the House.

Athletic Trainers Practice Act – This act would have expanded the scope of practice of athletic trainers by allowing them to diagnose and provide preventive health services. The legislation was filed in both the House and Senate, but only the Senate bill had a hearing.

MAFP opposed the legislation but agreed to review any revised language offered by the Athletic Trainers Association.

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End of Session Report MAFP Physician Covenants Not to Compete – This legislation would have prohibited the use of non-compete clauses in contracts between physicians and non-profit hospitals and entities.

Motorcycle Helmet Repeal – Numerous bills were filed that would have repealed Missouri’s helmet law. The bills were heard in multiple committees in both the House and Senate and received some floor debate.

Show Me Compassionate Medical Education Act – This bill which would have created the Show-Me Compassionate Medical Education Research Project Committee, specified the tasks of the committee, and would have permitted medical schools in the state to collaborate with the committee to conduct a study of how to reduce medical student depression and suicide. The requirements of any study conducted under the provisions of the bill were specified and the committee would have been required to produce an annual report to be made available on each medical school's website and provided to the General Assembly. Unfortunately, the bill died on the Senate calendar.

Perinatal Regionalization – Determination of Hospital Levels of Care – The original version created the Perinatal Advisory Council to establish standards for neonatal and maternal levels of birthing hospital care. The bill faced opposition in the Senate and was revised to remove the Council and authorize the Department of Health and Senior Services to promulgate rules regarding hospital levels; however, the bill ran out of time and died in the Senate.

Missouri Patient Safety in Radiologic Imaging Act/Radiology Technicians – Would have created some form of certification/ licensing under the Board of Healing Arts for any person (other than physicians) performing radiologic imaging. Bills were filed and heard in both the House and Senate. MAFP opposed this legislation.

Pain Management Clinics – A bill that was filed to regulate pain management clinics was later amended to create a “controlled substance abuse prevention fund”. The fees collected by DHSS deposited in the fund when issuing registrations to manufacture, distribute or dispense controlled substances would be used to fund BNDD, including employing one investigator for every 2,500 controlled substance registrations.

Texting While Driving – Numerous bills were filed that would have prohibited texting while driving to include all operators. Currently, the law only applies to those 21 years of age or younger. Most provided for use of a hands-free device.

Approved Health Information Organizations – This legislation would have required all approved HIEs to exchange standards-based clinical summaries for patients and all clinical and claims data from any agency with the state with all other approved HIEs within the state; would have created the Missouri Health Information Exchange Commission authorized to govern how an HIE would obtain approval status; become reapproved; and develop a process for investigation of complaints.

Emergency Administration of Epinephrine by Auto-Injector – This bill would have authorized entities – such as restaurants, recreation camps, amusement parks, and sports arenas to stock and supply Epi-Pens.

Chiropractic MO Health Reimbursement – This bill would have provided reimbursements to chiropractors to include meridian therapy, acupressure, or acupuncture; subject to a co-payment of $4 per visit, limited to 36 visits in a calendar year.

Youth Sports Brain Injury Prevention (Concussions)– This act would have required any municipality, business, or nonprofit organization that organizes a youth athletic activity where an activity fee will be charged to distribute a concussion and brain injury information sheet to each athlete participating. Each athlete’s parent or guardian would be required to sign the information form and submit it to the athletic activity governing body before the athlete could participate in the activity. Coaches, umpires, referees, etc. would be required to complete initial on-line or in-person training and receive updated training at least once every three years thereafter.

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MAFP End of Session Report Tobacco Settlement Funds - This bill modified the formula for determining how much money a tobacco product manufacturer who does not participate in the Master Settlement Agreement (small tobacco companies) would receive back from the escrow fund in which the manufacturer is required to deposit money from the sale of cigarettes.

Predetermination of Health Care Benefits – This bill required health benefit plans that receive electronic health care predetermination requests from health care providers to provide the requesting health care provider information on the amounts of expected benefits coverage on the procedures specified in the request.

Health Maintenance Organizations- Deductibles – Currently, HMOs can offer health benefit plans that contain various co-payments.

This act would have allowed that co-payments to exceed 50% of the total cost of the service.

MO HealthNet Managed Care – In anticipation of the state expanding managed care statewide, this act would have modified provisions in contracts between the state and vendors of prepaid capitated health services, issued, reauthorized, or renewed after August 28, 2016. Numerous standards were specified in the act such timely appeals of utilization reviews and payment authorizations, network adequacy standards, penalties for failure to reduce non-emergency use of hospital emergency rooms, shared savings and riskand-gain sharing arrangements between vendors and health care providers, and timely payment of providers – to name a few.

Notifications to Licensing Boards – This legislation would have updated Missouri statutes to provide acceptable ways a professional licensee could submit payment, application, requests for educational time extensions or other notifications to his or her licensing board. Currently, much of these processes are not available via the internet and must be submitted in writing only. The original bill was bombarded with amendments in the House. The Senate sponsor chose not to take up the House Committee Substitute when it returned to the Senate.

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FMCC MAFP

FAMILY MEDICINE ADVOCATES CALL ON FEDERAL LEGISLATORS

Missouri Delegates at FMCC: Left to Right: Keith Ratcliff, MD, Peter Koopman, MD, Todd Shaffer, MD, Emily Doucette, MD, and Kanika Turner, MD (Resident)

T

his year’s annual Family Medicine Congressional Conference (FMCC) attracted nearly 250 family physicians and students to Washington, DC, to learn about and advocate for legislative issues affecting family medicine. Attendees heard from political and policy experts on issues including new payment models under MACRA, the Teaching Health Center program, the Congressional Primary Care Caucus, prescription drug abuse, chronic disease management, direct primary care and federal mental health policy reforms.

The following day, they met with legislators in the House and Senate and their staff to share federal policy recommendations concerning opioid abuse, primary care research and training, and graduate medical education.

The Missouri delegation included Peter Koopman, MD; Keith Ratcliff, MD; Emily Doucette, MD; Todd Shaffer, MD; Kanika Turner, MD (Resident); and Kathy Pabst, MAFP Executive Director. The group met with the staff of Senator Roy Blunt and Senator Claire McCaskill and their respective Congressmen/ women.

Talking Points with Federal Legislators Curbing Prescription Drug Abuse • Authorize and support prescription drug monitoring programs (PDMPs) in all states to monitor real-time opioid prescribing and also make this information available to physician practices across state lines; • Provide for greater access to the life-saving drug naloxone; and • Raise the cap on medication assisted treatment (MAT) of addiction care to at least 200 patients from the current cap of 100 patients.

Teaching Health Centers GME Permanency • Authorize a permanent funding stream for the Teaching Health Center Graduate Medical Education program and Establish an annual perresident payment to cover the direct and indirect expenses associated with sponsoring an approved graduate medical residency program.

House Primary Care Caucus Join the Congressional Primary Care Caucus. Staff contacts Michelle Greenhalgh in the office of Rep. Joe Courtney (D-CT) or Kyle Sanders with David Rouzer (R-NC).

FY 2017 Appropriations Request Provide at least $59 million for Title VII Section 747, Primary Care Training and Enhancement (PCTE) administered by the Health Resources and Services Administration (HRSA); • Include $364 million for the Agency for Healthcare Research and Quality (AHRQ); and • Provide an additional $70 million for the National Health Service Corps (NHSC) at least $20 million should be appropriated, discretionary funds.

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MAFP ACLF/NCCL

MISSOURI SENDS FULL DELEGATION TO ACLF/NCCL

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he MAFP was once again well represented at the AAFP Annual Chapter Leadership Forum (ACLF) and the National Conference of Constituency Leaders (NCCL) in Kansas City, May 4-7, 2016. Kathleen Eubanks-Meng, DO, President, Mark Schabbing, MD, President Elect, and Kathy Pabst attended the leadership conference. The ACLF is an opportunity for emerging leaders to learn about organizational behavior and association management of a state chapter. Sessions included board/staff relations/ responsibilities and strategic planning. Many concurrent sessions were available for staff, board members and physicians. This conference was once again informative and an excellent opportunity to meet and network with other chapter officers and staff.

Mark Schabbing, MD, in preparation for his transition to President-Elect, attended meetings that discussed the relations and responsibilities of the board and the importance of Mark Schabbing, MD strategic planning. He noted that, “Strategies were discussed on how to effectively disseminate the strategic plan to our constituents and to respond to their needs. There was time for the senior leadership to address the current issues addressing the AAFP at this time.

Information was given for the upcoming MACRA and how this is going to be affecting all of us in the very near future. This was an excellent learning opportunity for me to learn and grow for the board.”

The Missouri Chapter was recognized during the keynote luncheon for the following membership efforts: 2nd Place Highest Percent Retention of Active Members (tie with Colorado and Kansas)

42 Missouri Family Physician July-September 2016

2nd Place Highest Percent Retention of New Physicians 100% Resident Membership Held concurrently with the ACLF, the Missouri delegates selected to attend the National Conference of Constituency Leaders conference were: Women – Afsheen Patel, MD Minority – Wael Mourad, MD New Physician – Kara Mayes, MD IMG – Sudeep Ross, MBA, MD LGBT – Ashley Millham, MD Wael Mourad, MD, the International Medical Graduate delegate, stated that, “I once again had the opportunity to attend NCCL this year, which I would not miss. I testified Wael Mourad, MD in support of resolutions near and dear to my heart, which included support for not linking patient satisfaction scores to physician compensation, and opposition to criminalizing mothers for drug addiction during pregnancy. I felt that I had a real opportunity to impact the lives of families far and near. What more could I want as a family physician?”

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ACLF/NCCL MAFP First time attendee, Ashley Millham, MD, represented the LGBT constituency shared, “I was able to collaborate with other AAFP members from around the country who were passionate about family medicine issues impacting our patients and our practices. It taught Ashley Millham, MD me how change comes about within the AAFP and how individual physicians can come together to have an influence in this process. Dr. Nivet’s opening plenary session provided great inspiration and a reminder of the imperative nature of diversity in our healthcare system, in education, in research, and in patient care. Diversity is the solution to advance health equity and, also, health quality. The resolution that I was most involved in addressed the ABFM’s current maintenance of certification requirements which is a source of frustration for many family medicine physicians at this time. This conference allows those frustrations to be brought forward along with proposed solutions from family medicine physicians with diverse backgrounds.”

I love learning new information and applying it to my patients.

Nish Shah, MD | Houston, TX

From left to right: Mark Schabbing, MD; Kathy Pabst, Executive Director; Kara Mayes, MD; Ashley Millham, MD; Sudeep Ross, MD; Julie Wood, MD; Kathleen Eubanks-Meng, DO; and Afsheen Patel, MD Not pictured: Wael Mourad, MD

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Attended 2015 AAFP Annual Meeting

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MEMBERS IN THE NEWS

MAFP

In Memoriam

Carl Baker, MD, FAAFP, passed away on April 19, 2016 in St. Louis. Dr. Baker was a member of AAFP/MAFP/SLAFP since 1977. He also served as president of the St. Louis Chapter in 2002.

George Williams, MD, passed away on February 28, 2016 in Raymore, MO. Dr. Williams served as president of the Missouri chapter in 1984-85. He is also responsible for the creation of the “Soaring Eagle Award” presented to the outgoing MAFP Chair of the Board.

Our condolences to your families.

top graduating medical students entering family medicine The Family Health Foundation of Missouri annually provides a scholarship to the top Missouri graduating medical students entering family medicine. These new residents each received a $500 scholarship from the Foundation. These scholarships could not be possible without your donations and support!

• Benjamin Crary, DO, AT Still University (Residency: University of Missouri Columbia) • Cory Brown, DO, Kansas City University of Medicine and Biosciences (Residency: St. Anthony Family Medicine Residency, Westminster, CO)

NEWS TO SHARE? The Missouri Family Physician magazine welcomes your input. Please submit newsworthy items for review to: office@mo-afp.org

• Peony (Catherine) Khoo, MD, Saint Louis University (Residency: University of California at Los Angeles) • Brian Bouchard, MD, Washington University (Residency: Christ Hospital Family Medicine Residency, Cincinnati, OH) • Kristen Allcorn Killen, MD, University of Missouri Columbia (Residency: University of Missouri Columbia) • Jenny Eichhorn, MD, University of Missouri Kansas City (Residency: Cox Family Medicine Residency) The MAFP received the following thank you note from one of this year’s recipients, Brian Bouchard, MD, Washington University:

Dear Ms. Pabst, I am writing today to thank you and the Family Health Foundation for the Scholarship Award I received at my graduation from Washington University School of Medicine. I am the only member of my graduating class entering family medicine, and support from MAFP as well as the St. Louis Academy has been crucial over the last few years. Thank you so much for your continued support of students at my school. I will be attending University of Cincinnati for my residency. Please convey my gratitude to the rest of MAFP and the Foundation.

Sincerely, Brian Bouchard 44 Missouri Family Physician July-September 2016

MAFP Members In The News New MAFP board members District 10 Director: Deanna M. Siemer, MD, is a board-certified family physician in Jackson, MO. She has a solo practice and continues to practice in clinic, hospital, and obstetrics. She has a special interest in sports medicine and works closely with the trainers at Jackson High School.

Medical students, as well as nurse practitioner students, are often part of the clinic. Dr. Siemer is the chief or the Family Medicine Department at Southeast Hospital in Cape Girardeau, MO. District 10 Alternate Director: Vicki Roberts MD, FAAFP, is a board certified family physician in a solo practice in rural southeast Missouri. She regularly precepts medical students and is bilingual in Spanish/English. Her involvement includes the PACE program through North American Primary Care Research Group (NAPCRG) that utilizes physician/patient dyads to facilitate patient engagement in the clinical research process. She is also involved in the AAFP National Research Network (NRN). Through the NRN, she participated in a number of practice-based research and training programs. She became a Diabetic Master Clinician and utilizes innovative techniques, including a monthly diabetic group visit, to achieve very good outcomes on patients with chronic conditions. Through the American Board of Family Medicine (ABFM), I have become a part of the TCPI/PTN payment transformation project. Since MACRA is inevitable, she wanted to be ahead of the game.

Dr. Roberts’ vast health care experience, both professionally and personally through her fight with breast cancer (and won!), enables her to be a patient advocate, but feels that she is better prepared after being a patient.

District 10 Director

Deanna Siemer, MD (Jackson)

District 10 Alt. Director

Vicki Roberts, MD, FAAFP (Sikeston)

UMC FMIG ACTIVITIES Mizzou FMIG has 130 members and hosted their annual Spring Dinner Forum featuring Mizzou Alumae, Dr. Kylie Vannaman, who spoke about Direct Primary Care. Other activities include cooking a meal at the Ronald McDonald House, hosted a joint lunch and learn with the Geriatrics Interest Group about palliative care, prepared Grand Rounds lunches, presented Doctors Back to School at three schools, and shared Ready, Set, Fit at multiple schools as well. Missouri FMIG is expecting at least 6 students to attend National Conference this summer! They elected four co-chairs this year in order to accommodate the school’s expansion into Springfield: Misty Todd M4, Kayla Matzek M4 , Ashley Albertson M3, and Elizabeth Worsowicz M3.

SANDHU POSTER ON DISPLAY AT NATIONAL CONFERENCE Jeena Sandhu, University of Missouri-Kansas City School of Medicine, will have a poster on display at the upcoming National Conference for Family Medicine Residents and Students. The focus of her poster is “Assessing Basic Skin Protection and Skin Cancer Knowledge Amongst Sojourner Health Clinic Patients. Congratulations Jeena!

Dr. Kylie Vannaman with current M3 Ashley Albertson

CATHERINE MOORE, DO RECEIVED 2016 AAFP AWARD FOR EXCELLENCE IN GME

Catherine Moore, DO (Resident)

46 Missouri Family Physician July-September 2016

Catherine Moore, DO, Mercy Family Medicine Residency, was selected to receive the 2016 AAFP Award of Excellence in Graduate Medical Education. Dr. Moore’s performance during residency training ranks her among the top family medicine residents in the country.

Dr. Moore is one of twelve recipients of this prestigious award and will be recognized during the Family Medicine Experience conference in September.

Members in the News

MAFP

COX FMR RESIDENTS VOLUNTEER AT CAMP QUALITY Second-year residents from Cox Family Medicine Residency volunteered at Camp Quality in Neosho, MO. Camp Quality is a free camp for children with cancer that provides exciting activities for the kids to be kids again while making new friends who understand what they are going through. Cox FMR residents have been volunteering at Camp Quality for several years. Senior Resident, Bridget Gruender, said, “Residency can be demanding and at times exhausting. To be able to volunteer at Camp Quality and see the smiles on the kid’s faces puts it all into perspective. Camp Quality was a rewarding experience and I am glad our residents get this opportunity.”

MERCY FMR ADJUSTS TO CHANGES Mercy Family Medicine Residency expressed their appreciation to Dr. Marsha Mertens for over 30 years of teaching and mentoring. Dr. Mertens is transitioning to a practice in Hillsboro, MO which is closer to home. Her patients and our residents and staff will miss her wisdom dearly. She has been a role model to the Mercy FMR faculty over her many years.

Another farewell is extended to Dr. Sandra Minchow-Proffitt, who after more than 10 years of teaching is pursuing her dream of opening a family-centered maternity care birthing center and practice.

Dr. Grant Hoekzema, Program Director for the past 17 years, is stepping down and Dr. Sarah Cole is taking the reins. Dr. Cole has completed the National Institute of Program Director Development fellowship and has served as Associate Program Director for the last 6 years. Dr. Hoekzema will assume the role of Senior Associate Program Director in addition to his Chairman duties. In addition, Dr. Hoekzema began a six-year term on the ACGME Review Committee for Family Medicine (RC-FM) starting in July. The RC-FM is the national accreditation body for family medicine residency programs and fellowships.

In July, Mercy FMR welcomed new faculty members: Dr. John Campbell and Dr. Christian Verry. Dr. Campbell, a 2008 graduate of the program, completed a fellowship in Geriatrics at St. Louis University in 2009 and has most recently served as part of the faculty of Georgetown University School of Medicine's Department of Family Medicine. Dr. Verry is a fellow trained in sports medicine and comes to Mercy after serving as a faculty member at the University of Vermont and St. Louis University School of Medicine.

Grant Hoekzema, MD

Sarah Cole, MD

UMKC RESEARCH DAY Back L to R Misty Bowen, DO Doyle Witt, MD James Kirkpatrick, MD, PhD Chris Gifford, DO Shawn Wadsworth, DO, MA

Front L to R Kristin Duncan, MD James Smith, DO, MBA Jason Arribas, DO Christine Luke, DO Caitlyn Nguyen, MD Gillian Housman, DO, MPH Cory Offutt, MD Missouri Family Physician July-September 2016

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