| hub_and_spoke_model_five_years_later | Hub-and-Spoke Model: Five Years Later | WSMA_Reports | Shared_Content/News/Latest_News/2022/hub_and_spoke_model_five_years_later | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/reports-cover-image-wsma-may-june-2022-645x425.jpg" class="pull-right" alt="cover illustration for WSMA Reports May/June 2022" /></div>
<h5>May 3, 2022</h5>
<h2>Hub-and-Spoke Model: Five Years Later</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
When Lora Jasman, MD, an addiction medicine specialist with the Healthy Behavior and Function Clinic at MultiCare Rockwood Clinic in Spokane, learned a long-time patient with opioid use disorder was thinking about starting community college, she cheered. Dr. Jasman had first treated him in her internal medicine practice, but the limited services she could provide weren't enough. As happens for many with the disorder, he returned to use.
</p>
<p>
"He had a period of time where he was very unstable, using a lot of methamphetamines, in and out of the hospital, and in and out of urgent care," she recalls. So, what changed to get him on this new path?
</p>
<p>
Dr. Jasman credits the patient's efforts, but also the comprehensive services her team has been able to provide since becoming a "hub" in August 2018 under Washington state's hub-and-spoke care model for treating opioid use disorder.
</p>
<p>
Hub-and-spoke networks in Washington state were launched as part of the federal 21st Century Cures Act to address the opioid epidemic. Modeled on a program in Vermont, it's a coordinated care approach to prevent return to use, overdose, and death by removing barriers to accessing medication. The 2021-2022 Washington State Opioid and Overdose Response Plan considers the networks an integral part of expanding capacity to provide medication for opioid use disorder, or MOUD (also referred to as medication-assisted treatment).
</p>
<p>
Many of the networks are now in their fifth year of operation. While the model has proven successful in helping patients with opioid use disorder, it also has challenges related to care coordination across the network and funding.
</p>
<p>
"Hubs" are designated primary care physicians and clinicians, behavioral health clinics, health professionals who offer office-based MOUD, or federally qualified health centers in a region that coordinate care for adults with opioid use disorder. To provide integrated MOUD, each hub subcontracts with organizations or "spokes," including emergency departments, residential treatment facilities, therapist's offices, drug courts, correctional facilities, needle exchanges, and tribal medical facilities.
</p>
<p>
Within each network, nurse care managers or spoke care navigators help reduce the burden on prescribing physicians by providing screening, care planning, and services and referrals needed to stabilize patients.
</p>
<h3>Meeting patient needs</h3>
<p>
When it comes to increasing capacity, the model has exceeded benchmarks. An analysis by the Institute for Behavioral Health at Brandeis University published in January 2020 found that in the first 18 months of operation, these networks added nearly 5,000 new people with opioid use disorder onto MOUD, double the projected goal.
</p>
<p>
"It's allowed us to individualize our approach to each patient and help provide them with the wrap-around care that they need in their recovery," says Dr. Jasman. "Before, I didn't have a coordinated team. So, if I wanted a patient to go into inpatient treatment, I would basically say, you need inpatient treatment, here's a list of places that do that."
</p>
<p>
While her internal medicine clinic served few patients with opioid use disorder, since becoming a hub, MultiCare's Rockwood Clinic has served over 2,000 such patients, says Dr. Jasman. Her team now includes two physician assistants, two medical assistants, a nurse care manager, hub care coordinator, and a receptionist.
</p>
<p>
Wrap-around services provided by these networks are crucial in helping patients navigate what life throws at them, says Shawn Andrews, MD, program director of family medicine residency and senior medical director of ambulatory care services for Summit Pacific Medical Center, a hub in Elma. Shortly after one patient went through several tough years and challenges to stop using, his brother was killed, recalls Dr. Andrews. "People will often return to use when something horrible like this happens." But even though he was distraught, he was able to remain stable.
</p>
<p>
"He came back to the MOUD clinic for a point of contact and some direction on how to protect his sobriety through this difficult time," she says. "He knew that people cared about him personally and he felt safe there."
</p>
<p>
The model also helps relieve pressure on emergency departments, says Dr. Andrews. "It's strengthened the alliance between ED, primary care, and MOUD clinics," she notes.
</p>
<p>
For Capital Recovery Center, a hub in Olympia, the hub-and-spoke model has increased access to treatment, says Malika Lamont, co-founder and director of harm reduction practices of Capital Recovery Center's Olympia Buprenorphine Clinic, a spoke. Since it opened in 2019, Capital Recovery Center has seen over 1,500 patients. Because of its high volume, the peer-led behavioral health facility has a nurse navigator and 10 physician prescribers.
</p>
<p>
"I remember the days when we did not have meaningful access to medication for opioid use disorder in a six-county area. It has helped us grow our capacity to provide treatment to folks, and to better engage with them," says Lamont. Olympia Buprenorphine Clinic clients know they can drop in anytime during operating hours and get their medications dispensed free of charge at the time of visit, says Lamont.
</p>
<h3>Persistent challenges</h3>
<p>
Hub-and-spoke networks are intended to help transition patients seamlessly between health professionals and organizations, depending on their level of stability and what else they need to remain stable, such as mental health and social services.
</p>
<p>
But coordinated care has been easier said than done. The Brandeis report found very little movement of patients across hubs and spokes.
</p>
<p>
"I know the state says we're a hub, but we don't get a lot of referrals. We mostly see people coming in literally right off the street," says Ryan Herrington, MD, medical director of Capital Recovery Center's Olympia Buprenorphine Clinic.
</p>
<p>
Financial challenges are also a problem. Hub-and-spoke models are funded through multiple federal and state grants to ensure low-barrier access to those on Medicaid and low-income populations. But the low payment structure can be a struggle for physicians and health professionals who participate in hub-and-spoke. "The vast majority of these patients are on Medicaid," says Dr. Jasman. "So, it's just difficult to make the budget work out well. That's a barrier [to participation] that the state of Washington is well aware of and trying to do something about."
</p>
<p>
Another issue with the state's model is that it leaves care design up to each network. While that provides flexibility, it also creates some confusion, as there is no agreed-upon standard for what constitutes patient stability and outcomes.
</p>
<p>
"A big challenge with the hub-and-spoke model is that you have different physicians and practitioners with different levels of expertise and different treatment philosophies," says Dr. Herrington. "It's not like blood pressure management, where everyone knows that the goal of treatment is 120 over 80 or better."
</p>
<p>
Defining patient stability and what dosage is needed to maintain stability remains a challenge, says Dr. Herrington. "Somebody who might be stable to me might be unstable to another physician."
</p>
<p>
Once patients are stable, the long-term goal is to get patients in with a primary care physician or practitioner to continue their care. But because of previous negative experiences, many patients are reluctant to change physicians. "We're finding that they are really attached to the people who help them enter recovery," says Dr. Andrews.
</p>
<p>
Still, despite all the challenges, the hub-and-spoke system has given people with opioid use disorder an option to lead stable lives that they might not have otherwise had.
</p>
<p>
"There's still just a lot of barriers [to treatment]," says Dr. Jasman. "But this is a start. And it's not perfect, but we are serving a lot of people in a way that they are getting a lot of benefit."
</p>
<p>
<em>Rita Colorito is a freelance journalist who specializes in writing about health care.</em>
</p>
<p>
<em>This article was featured in the May/June 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 5/3/2022 10:44:19 AM | 5/3/2022 10:43:15 AM | 5/3/2022 12:00:00 AM |
| embracing_empathy_in_complexity | Embracing Empathy in Complexity | WSMA_Reports | Shared_Content/News/Latest_News/2022/embracing_empathy_in_complexity | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/reports-cover-image-wsma-may-june-2022-645x425.jpg" class="pull-right" alt="cover illustration for WSMA Reports May/June 2022" /></div>
<h5>May 2, 2022</h5>
<h2>Embracing Empathy in Complexity</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
One of the consequences of the COVID-19 pandemic was its impact on another epidemic: drug overdoses. According to the Centers for Disease Control and Prevention's National Center for Health Statistics, there were more than 100,000 drug overdose deaths in the U.S. during the 12-month period ending in April 2021, an increase of 28.5% from the 78,056 deaths during the same period the year before.
</p>
<p>
The bulk of opioid-related deaths are attributable to synthetic opioids like illicit fentanyl, with 75,673 total opioid-related deaths in the 12-month period ending in April 2021, up from 56,064 the year before. About six people in Washington state die every day from an overdose. The rising numbers put new pressure on physicians and policymakers to develop fresh approaches to address the tide of addiction.
</p>
<p>
But the tragic toll also contains a success that underscores the confounding nature of the epidemic. A recent report from the American Medical Association shows that opioid prescribing nationwide has dropped 44% in the past decade and fell nearly 7% from 2019 to 2020. Even as physicians in Washington and other states have made tremendous strides addressing the overprescribing of opioids, the epidemic continues to shift its form, creating a new set of challenges.
</p>
<p>
"Deaths from prescription opioids continue to slowly decrease, yet a lot more work needs to be done," says Steven Stanos, DO, medical director of Swedish Pain Services in Seattle. "Prescription overdose deaths are now far overshadowed by the increase in deaths due to illicit fentanyl, a far more accessible, potent, and lethal opioid. Methamphetamine, heroin, and cocaine-related deaths also are rising."
</p>
<p>
There's no question that the COVID-19 pandemic contributed to the rising toll of drug overdoses. "The opposite of addiction is connection," says Lucinda Grande, MD, a physician at Pioneer Family Practice in Lacey, citing author Johann Hari. "The pandemic really increased isolation, boredom, and stress." Yet the picture is not entirely bleak. There have been successes. Moreover, the understanding of how to address the epidemic has deepened with time, with a more nuanced understanding of the clinical approaches that will work and a commitment of resources to help those in need of treatment.
</p>
<h3>Tackling opioid overprescribing</h3>
<p>
One of the major changes over the past several years has been the success in reducing overprescribing of opioids for acute pain conditions, including dental and hospital-based elective procedures. "Physicians and prescribers didn't appreciate the significant impact their unnecessary prescribing was contributing to a large supply of unused pain medication in our communities," says Dr. Stanos.
</p>
<p>
A typical example was seen with elective surgery. "Patients were commonly prescribed a one-month supply of pills out of convenience for an acute pain condition that normally needed only a few days of therapy at best," says Dr. Stanos. "This led to a significant number of unused pain medications finding their way into the hands of vulnerable individuals, including recreational users and people struggling with addiction."
</p>
<p>
Washington helped set a standard for other states with the Better Prescribing, Better Treatment program, launched in 2017 as part of the state's opioid response plan. The program, a joint effort of the WSMA and the Washington State Hospital Association, has three components: encouraging compliance with a prescribing policy that establishes pill limits for all prescriptions for acute pain, giving physicians discretion to override pill limits if they feel it is in the best interest of their patients, and allowing physicians to compare how their opioid prescribing practices compare to others in their specialty and health system.
</p>
<p>
Pill limits were an attempt to get at what seemed at the time the heart of the opioid problem. "Our goal in going upstream was to cut off the supply to those at risk for addiction," says Nathan Schlicher, MD, JD, an emergency room physician at St. Joseph's Medical Center in Gig Harbor and WSMA's lead on Better Prescribing, Better Treatment.
</p>
<p>
At the same time, providing physicians with clinical flexibility and data on how they compared to their peers were also important. "We recognized that no guideline is applicable to every patient," says Dr. Schlicher. "We said, let us give people feedback on performance compared to how their peers perform. If you are the only one performing with those guidelines compared to your peers, that should give you pause."
</p>
<p>
Overall, the results have been positive. "There have been a lot of improvements in addressing the opioid epidemic within the house of medicine," Dr. Schlicher says.
</p>
<h3>A changed landscape</h3>
<p>
As the epidemic has continued, the focus has shifted, bringing with it new challenges. "We handled what was a really bad prescription opioid problem, and now it's evolved into a synthetic street opioid problem," says Jeb Shepard, WSMA's director of policy.
</p>
<p>
Indeed, the bulk of the deaths reported by the CDC were attributable not to prescription opioids but to street drugs, and in particular fentanyl. Fentanyl and other synthetic opioids now account for about two-thirds of all drug overdose deaths.
</p>
<p>
One of the most immediate needs has been to stop overdose deaths. Starting in 2019, anyone in Washington was able to obtain naloxone, a medication which reverses opioid overdoses, simply by walking into a pharmacy.
</p>
<p>
"Unfortunately, the people who need it the most aren't compelled to go to a pharmacy," Shepard says. "Their lives are chaotic and complicated. There's been a lot of success with it but it's not the magic solution everyone had been hoping for."
</p>
<p>
Still, notes Dr. Stanos, naloxone prescriptions by physicians are rising. "Prescribers can do our part by getting more naloxone in our communities and in patients' homes, whether it will be needed by the individual patient, or a friend or family member." Naloxone can easily reverse an overdose and save a life, he says. "Some have likened community goals of increasing naloxone availability to having a fire extinguisher in every house."
</p>
<h3>Moving forward: More access, more nuance</h3>
<p>
Not surprisingly given the death toll, the state has focused increasingly on creating more opportunities for access to treatment for substance use disorders.
</p>
<p>
"The Legislature is making a generational investment in treating this problem and a whole other raft of behavioral issues," says Shepard. "If there's ever been a problem where money would help, this is one, because treatment has long been underfunded."
</p>
<p>
At the same time, the original zero-tolerance policy of opioids is giving way to a more nuanced perspective, even among pain specialists.
</p>
<p>
"I went through a phase where I believed that chronic opioid prescriptions were absolutely evil and harmful," says Dr. Grande. "Over time, I realized I was wrong because a lot of people benefit from it, and when you take it away from them it can be an absolute tragedy." Instead, Dr. Grande says, people will take matters into their own hands, seeking illicit opioids or even committing suicide.
</p>
<p>
The CDC issued guidelines on opioid prescribing in 2016 that were frequently interpreted as being proscriptive and rigid. "A lot of people in their haste to respond to the problem took the guidelines as gospel that needed to be adhered to strictly," says Shepard. The result was often harm to patients, who had their opioid treatments discontinued without any alternative.
</p>
<p>
The agency released a new draft guideline in February that is more patient-focused and that provides greater flexibility for physicians and prescribing clinicians. "Controversial and confusing dose thresholds are removed in the draft guideline," says Dr. Stanos. "There is more emphasis on how to integrate non-opioid therapies for pain, and to more safely select and manage patients that may benefit from opioids, better instruction on how to taper patients, more clarity in prescribing short-term for acute and subacute pain, and an overall emphasis on patient-centered care that appreciates the unique complexities of each patient."
</p>
<p>
Both the Trump and Biden administrations have loosened some regulations related to opioid treatments. In particular, it is now easier to prescribe buprenorphine, which is used to treat people with opioid use disorders.
</p>
<p>
"Increased use of buprenorphine is more effective and safer management of chronic pain for patients with or without an addiction," says Dr. Grande.
</p>
<p>
Properly managing chronic pain patients in the first place can help prevent the cycle of addiction and overdose that's exacting such a high toll currently. However, the financial realities don't always currently align with those goals.
</p>
<p>
"Greater improvements in insurance coverage and patient access for non-opioid therapies, like behavioral health, physical therapy, and many interventional therapies, have been slow to come by," says Dr. Stanos. "Even if an 'approved benefit,' reimbursement many times is so low it's an ongoing challenge to incentivize clinics and systems to keep offering services."
</p>
<p>
For many patients, coverage can be nonexistent or limited, with significant out-of-pocket expenses. In Swedish's pain clinic, patients participating in a structured four-hour therapy session that includes individual and group physical and occupational therapy, behavioral health, and patient education, can incur multiple out-of-pocket copay charges in a single day.
</p>
<p>
"If we're going to improve care, payers have to truly incentivize and support comprehensive pain management," says Dr. Stanos.
</p>
<p>
The fact remains that the opioid epidemic is just one part of a larger problem fraying the fabric of society. While drug overdoses have been among the fastest rising death rates among Americans in the past two decades, so too have suicide and alcohol liver disease.
</p>
<p>
A recent study published in the Journal of the American Medical Association found that more than 99,000 people died in 2020 of alcohol-related causes. Addressing those societal problems and "deaths of despair" go well beyond the range of medicine.
</p>
<p>
But there are things that physicians can do, starting with how they approach their pain patients, says Dr. Grande.
</p>
<p>
"Physicians need to increase their awareness and empathy," she says. "They need to treat them with kindness."
</p>
<p>
<em>John Gallagher is WSMA Reports' senior editor.</em>
</p>
<p>
<em>This article was featured in the May/June 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 5/2/2022 11:45:47 AM | 5/2/2022 11:40:22 AM | 5/2/2022 12:00:00 AM |
| pre_visit_planning_is_increasing_efficiency | Pre-Visit Planning Is Increasing Efficiency | WSMA_Reports | Shared_Content/News/Latest_News/2022/pre_visit_planning_is_increasing_efficiency | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/latest-news/2022/may/thrive-cover-image-wsma-may-june-2022-thrive-645x425.jpg" class="pull-right" alt="Thrive cover, May/June 2022" /></div>
<h5>May 2, 2022</h5>
<h2>Pre-Visit Planning Is Increasing Efficiency</h2>
<p>
"Addressing burnout at the clinic and organization level is the primary way to increase well-being and professional satisfaction for physicians," says Pratima Sharma, MD, executive medical director at EvergreenHealth Primary Care.
</p>
<p>
EvergreenHealth is one of the Washington health care organizations that took part in the American Medical Association's Wellness Practice Transformation Initiative, which tasks participants with implementing and examining the impact of workflow redesign interventions. The initiative is funded by a grant from The Physicians Foundation.
</p>
<p>
After implementing pre-visit planning at the EvergreenHealth Redmond Primary Care Clinic, there was a measurable increase in care team efficiency. In fact, 92.8% of physicians in the intervention group reported that the degree to which "my care team works efficiently together" was "optimal" or "good" compared to their baseline of 77% and compared to the control groups' steady average of 62% pre- and post-survey results. Notably, the proportion of physicians in the intervention group that reported a high degree of care team efficiency was nearly 30% higher than the AMA national benchmark.
</p>
<p>
Physicians in the intervention group also saw an increase in time spent on direct patient care and a decrease in time spent on indirect patient care as compared to the control group. Time spent on indirect patient care in the intervention group was less than that of the AMA national benchmark.
</p>
<p>
The results also showed that burnout was less severe in the intervention group, although the proportion of people experiencing burnout had risen.
</p>
<p>
"What this meant for the physicians is that there was an increased level of engagement, which positively impacted our staff and patient experience," says Besty Hail, executive director of primary care at EvergreenHealth Primary Care Administration.
</p>
<p>
"Participating in the wellness PTI was one of several ways that EvergreenHealth demonstrated its commitment to improving wellness," says Dr. Sharma. The organization sought feedback from its physicians and advanced practice providers through monthly town-hall style meetings as well as their regularly scheduled meetings. "Common themes were the need for increased administrative support for prescription refills and inbox management," Dr. Sharma says. "We are launching new pilots to address these concerns."
</p>
<p>
The WSMA Foundation and the AMA continue to work on several fronts to address the physician burnout crisis, which has only been exacerbated by the pandemic. Through research, collaboration, advocacy, and leadership, we are working to center the patient-physician relationship and to make physician burnout a thing of the past.
</p>
</div> | 5/2/2022 12:11:14 PM | 5/2/2022 12:08:27 PM | 5/2/2022 12:00:00 AM |
| improving_care_for_underserved_patients | Improving Care for Underserved Patients | WSMA_Reports | Shared_Content/News/Latest_News/2022/improving_care_for_underserved_patients | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/march-april-2022-reports-cover-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports March/April 2022" /></div>
<h5>March 8, 2022</h5>
<h2>Improving Care for Underserved Patients</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
By any measure, the Puget Sound region would be considered one of the friendliest places in the U.S. for members of the lesbian, gay, bisexual, transgender, queer, intersex, and asexual community. Yet when Amish Dave, MD, MPH, moved here from Boston after training in Chicago and the Bay Area, he was surprised at what he found.
</p>
<p>
"This is a super progressive place, but medical care for LGBTQIA patients is still lacking compared to other places in the country," says Dr. Dave, a rheumatologist at Virginia Mason Franciscan Health. "When I first moved here, not every primary care physician knew how to prescribe PrEP. That's not an issue I had seen in the Bay Area or Boston. Something that has such great efficacy was not regularly being discussed."
</p>
<p>
Pre-exposure prophylaxis, or PrEP, is a drug regimen that has been proven to reduce the risk of HIV transmission from sex by 99%. As such, PrEP has become a cornerstone for primary care for many in the LGBTQIA community.
</p>
<p>
Dr. Dave's experience underscores one of the ongoing challenges in medical care: addressing the needs of underserved patients. Despite the progress made so far, race, ethnicity language, and sexual identity can all still serve as barriers to care, no matter how inadvertently.
</p>
<h3>Unnecessary barriers</h3>
<p>
For some patients at Virginia Mason, getting PrEP was a cumbersome process. "People were being referred to the infectious disease department," says Dr. Dave. "It was unfair to them to pay two copays and wait a long time to get their prescription."
</p>
<p>
Dr. Dave embarked on a campaign more than five years ago to help educate his colleagues about PrEP and more generally the importance of understanding their patients' sexual history. "We formed a task force and did a road show across the campuses," he recalls. What conversations with physicians and clinicians revealed was that many didn't feel comfortable taking a patient's sexual history. As a result, "they were missing opportunities to do appropriate screenings for things that the queer community might be at higher risk for, such as certain cancers or depression."
</p>
<p>
"We talked about the importance of taking a sexual history, the importance of PrEP, the importance of templates," says Dr. Dave. The upshot was a process that eliminated the barriers that were sometimes in place before for LGBTQIA patients.
</p>
<p>
Unfortunately, such barriers are hardly uncommon for patients in underserved populations. Sometimes they are actually part and parcel of standard treatment regimens.
</p>
<h3>Outdated race-based standards of care</h3>
<p>
For several years, Mabel Bodell, MD, a nephrologist at Confluence Health in Wenatchee, regularly treated a patient who identified as African American. "She's very savvy about her numbers," Dr. Bodell says. "She always looks at her creatinine levels and her GFR."
</p>
<p>
The patient regularly asked Dr. Bodell why test results were interpreted differently for white patients and African American patients. "I would always answer, 'Because there were differences in the original study'" upon which the treatment standards were based.
</p>
<p>
The test in question, which measures estimated glomerular filtration rate, or eGFR, has been widely used to determine whether a patient is a candidate for a kidney transplant. A healthy patient has an eGFR of 60. Patients with an eGFR of 20 or lower are transplant candidates.
</p>
<p>
But for years, that was true only if they were white. The original study in 1999 misinterpreted higher creatinine levels in Black patients as a sign that they had a higher muscle mass. As a result, the test multiplied Black patients' eGFR numbers by 1.2. That meant Black patients had to wait longer for a kidney transplant, even though they were far more likely to suffer from serious kidney disease.
</p>
<p>
About a year ago, Dr. Bodell's patient came to back to her office with a surprise. She had taken a DNA test and learned that she was more than 50% white. Suddenly, the patient qualified for a kidney transplant after years of being told she did not, solely on the basis of the race-based standard.
</p>
<p>
"It was really hard for me to explain," said Dr. Bodell. "Maybe this race-based stuff should not be in our calculations. Examples like that make you think about all of those formulas that include race. Maybe they are harming more patients than helping them."
</p>
<p>
The conversation with her patient crystalized a conversation that was happening within Confluence. "There were a lot of people internally already asking questions, knowing that African Americans are more likely than white Americans to have kidney failure and higher rates of end-stage kidney disease but less likely to get a kidney transplant," said Dr. Bodell, who is a member of the Health Equity, Diversity and Inclusion Council at Confluence. "We took our time to reassure ourselves it was the right thing to do." The review process included a wide range of internal partners, from risk management to the laboratory medical directory.
</p>
<p>
Ultimately, Confluence eliminated the race-based standard in July of 2021. The American Society of Nephrology recommended eliminating the standard last September.
</p>
<h3>The role of physician champions</h3>
<p>
There are plenty of other examples of disparities affecting care. Endometrial cancer is one of the most common gynecological cancers, with a high survival rate. But the rate of survival for Black women is much lower. While a series of issues contribute to the reduced survival rate, one of them is the diagnostic test used to determine whether a biopsy is needed.
</p>
<p>
According to a study led by Kemi Doll, MD, a gynecologic oncologist with the University of Washington School of Medicine, the use of transvaginal ultrasound to determine whether a biopsy was warranted was four times more likely to miss endometrial cancer in Black women than in white women. That's because Black women are more likely to have fibroids and other non-endometrial growths, which lead to false negative results.
</p>
<p>
Dr. Doll's analysis of her research was published in the August 2021 issue of JAMA Oncology, and the study has widely been hailed as groundbreaking advancement in addressing endometrial cancer disparities.
</p>
<p>
While change is difficult, it can be accomplished. What it takes is leadership from physicians to advocate for improvement. "Having a champion or a series of champions is important," says Dr. Dave. "Dedicating time for people to teach people about it is very important, and that lies at the system level."
</p>
<p>
<em>John Gallagher is WSMA Reports' senior editor.</em>
</p>
<p>
<em>This article was featured in the March/April 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 3/8/2022 10:56:01 AM | 3/3/2022 1:10:29 PM | 3/8/2022 12:00:00 AM |
| doctors_making_a_difference_mary_beth_bennett_md | Doctors Making a Difference: Mary Beth Bennett, MD | WSMA_Reports | Shared_Content/News/Latest_News/2022/doctors_making_a_difference_mary_beth_bennett_md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/dmd-website-image-bennett-645x425px.png" class="pull-right" alt="Doctors Making a Difference logo with Mary Beth Bennett, MD" /></div>
<h5>March 4, 2022</h5>
<h2>Doctors Making a Difference: Mary Beth Bennett, MD</h2>
<p>
Mary Beth Bennett, MD, a first-year pediatric resident in Seattle, says it was opposite extremes of weathera widely reported severe winter storm that left her family and thousands of others without power and enduring freezing temperatures for days in Texas, followed by last summer's record-setting heat wave after relocating to Seattlethat inspired her to sound the alarm on the connection between climate change and public health. As a member of the Washington Physicians for Social Responsibility's Climate and Health Task Force, Dr. Bennett is helping to advocate for policies such as building electrification and more funding for climate change mitigation and public transportation. Here, she talks with <em>WSMA Reports</em> about these efforts and how physicians can help patients connect the dots between climate change and their personal health.
</p>
<p>
<strong><em>WSMA Reports:</em> Last summer you wrote a guest column in the Seattle publication <em>The Stranger</em> urging everyone to treat climate change as a public health emergency. You advocate for transitioning away from the use of natural gas for cooking and heating in homes; why is that such an important component of how climate change and public health intersect?</strong>
</p>
<p>
<em>Dr. Bennett:</em> Kids who grow up in homes with gas stoves are more likely to develop asthma and experience wheezing related to asthma, which can mean a trip to the emergency room or even worse. And we see from new data that our gas-powered homes and buildings are a major source of air pollution in cities. I can't think of a clearer example of a policy win-win than this: Reduced pollution from gas-powered appliances will lead to healthier cities and families, while also addressing global warming through reduced fracking.
</p>
<p>
<strong>The extreme heat we saw last summer in the Pacific Northwest is a tangible effect of climate change. What are some other less-obvious public health effects that physicians should be aware of? </strong>
</p>
<p>
Vector-borne illnesses are increasing, so diseases that were previously seen almost exclusively in tropical climates are now hitting communities thousands of miles away. We're also seeing increased rates of depression caused by fears about the climate. Related to this is the fact that the U.S. birth rate has declined six years in a row: A quarter of childless adults cite worries about the climate as a key factor in their decision not to have children (Morning Consult, 2020).
</p>
<p>
<strong>What is the Washington Physicians for Social Responsibility's Climate and Health Task Force working on in terms of policy or public health messaging?</strong>
</p>
<p>
WPSR's Climate and Health Task Force is currently advocating for policies related to building electrification, increased investment in public transportation, enhanced funding for climate change mitigation, and adaptation efforts in low-income communities. We approach this advocacy with a specific focus on health equity, since we know the people most likely to suffer the harmful effects of climate change include historically marginalized groups.
</p>
<p>
<strong>How can physicians talk with their patients about climate change and how it relates to their personal/family health?</strong>
</p>
<p>
It's a great question because doctors already have too much to cover in too little time during primary care visits. Step one is for doctors to educate themselves better on how climate issues affect healththere's so much data out there that experienced and newer doctors didn't learn in medical school.
</p>
<p>
Step two is to look for opportunities to link climate issues to health situations that patients are currently facing. For example, when I'm talking with a family whose child has asthma, I'm careful to mention all the potential irritants and exposures that could trigger wheezing, including smoke from cigarettes and fumes from a cooking with a gas stove.
</p>
<p>
Outside of patient visits, I think we should use our platform as medical professionals to advocate for better climate policies to improve health for entire communities. Patients rely on us to tell them how to be healthier and we're not doing our jobs if we're unaware of how the climate affects health.
</p>
<p>
</p>
<p>
<strong>Are there ways health care organizations and practices can support climate change goals?</strong>
</p>
<p>Yes, we should be leaders in reducing energy waste, in incentivizing employees to use public transit, and in composting and recycling. It's important for every organization with a public health mission to be adopting practices that reduce emissions. "Do no harm" is an ethos that we should apply not only to patients but to the larger ecosystem in which our health
care organizations exist.</p>
<p><em>This article was featured in the March/April 2022 issue of WSMA Reports, WSMA's print newsletter.</em></p>
</div> | 3/4/2022 11:43:43 AM | 3/3/2022 12:35:43 PM | 3/4/2022 12:00:00 AM |
| increasing_physician_diversity | Increasing Physician Diversity | WSMA_Reports | Shared_Content/News/Latest_News/2022/increasing_physician_diversity | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/march-april-2022-reports-cover-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports March/April 2022" /></div>
<h5>March 3, 2022</h5>
<h2>Increasing Physician Diversity</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
As a Black female physician, Nwando Anyaoku, MD, the first chief health equity officer for Swedish Health Services in Seattle, knows all too well how lack of physician diversity affects health outcomes for patients from marginalized communities.
</p>
<p>
On the day Dr. Anyaoku spoke with WSMA Reports, another Black woman had shared how five white male gynecologists had once each recommended a hysterectomy for treating her uterine fibroids. It wasn't until the young woman saw a Black female doctor that she was given other options, thus preserving her fertility. "That doctor gave her different care and that completely changed the course of her life," says Dr. Anyaoku.
</p>
<p>
Changing the course of people's health care experience is a critical reason for increasing physician diversity. Studies have shown that having racial, ethnic, gender, and socioeconomic diversity in the physician workforce has powerful benefits for the health care system. Diversity leads to better access, better quality of care, and therefore, better outcomes for patients.
</p>
<p>
Diversifying the workforce requires addressing both the immediate shortfall and long-term needs of physician diversity. That's important not only in the Puget Sound region among the most rapidly diversifying areas of the countrybut throughout the state, as population growth accelerates diversity statewide.
</p>
<h3>Addressing the immediate shortfall</h3>
<p>
Over the last decade, health organizations throughout Washington state have prioritized health equity, galvanized in part by the 2012 national call to action
to eliminate health care disparities by the American Hospital Association, the Association of American Medical Colleges, and other organizations.
</p>
<p>
The events of 2020, including significant COVID-19-related health disparities, the murder of George Floyd, and the Black Lives Matter movement, spurred organizations to redouble their efforts. During a special meeting in June 2021, the American Medical Association adopted a policy to increase diversity among physicians to further its "commitment to racial justice and equity within the medical profession."
</p>
<p>
In 2021, Swedish Health Services launched a new office of health equity, diversity, and inclusion to tackle health equity from all angles. Since March 2021, Dr. Anyaoku has directed the organization's programs to measure and improve equity in care delivery and outcomes. To address workforce development and workplace culture, Swedish also named a diversity, equity, and inclusion officer. Mardia Shands, who previously served as the chief diversity officer at TriHealth in Greater Cincinnati, started in that inaugural role in April 2021.
</p>
<p>
Shands says Swedish takes an intentional two-pronged approach to increasing physician diversity. The first prong is tapping their residency pipeline, particularly those residents who've already gone through Swedish's cultural competency training, to fill vacant physician positions. "We're home growing our underrepresented minority physician staff... And that's how we're being intentional about building the clinic [physician] staff," says Shands.
</p>
<p>
To attract Black physicians to the Pacific Northwest, Swedish recently partnered with Meharry Medical School, a historically Black college in Nashville, Tennessee. The first cohort of third-year residents arrived for surgical rotations at Swedish in January. The program provides them with housing and living expenses. Eventually other specialties will be added. "When it's time for them to do their residency matching, then they've had that visibility, and they've had experience with us. And that helps to build that pipeline going forward," says Dr. Anyaoku.
</p>
<p>
Recruiting diverse physicians in pairs is the second prong. "It lessens the burden on you being the only one. Then you have a support mechanism that's kind of built in," says Shands.
</p>
<h3>Focusing on retention</h3>
<p>
Recruiting diverse talent isn't enough if those physicians don't feel they belong once they get there, says Dr. Anyaoku. "One of the challenges that health systems have is that they go out and recruit diverse candidates, but they don't work on having a welcoming community and an organization that values their diversity," says Dr. Anyaoku. "Then they're pressured to conform. And if they conform, then you lose the value of their diversity."
</p>
<p>
To ensure retention, Swedish focuses on creating an environment where diversity is respected and accepted, says Shands. It does so by training all new and existing residents and medical staff on cultural competency. "It orients them to the fact that this is the environment we are creating for our physician staff ... the behavioral expectations in terms of being accepting of people from other cultures, backgrounds, and ethnicities, and so forth," says Shands. "They feel as though this is a place where I belong. And that helps to retain people."
</p>
<p>
To foster a workplace culture where diversity thrives, Swedish is also developing a mentorship program for minority physicians and an online learning platform to introduce medical staff to concepts around cultural competencies, DEI, and health equity.
</p>
<p>
But focusing on overall physician diversity can be a "false equivalence," says Shands, if some marginalized groups continue to be underrepresented. Even when physician diversity matches the community diversity, that doesn't mean those patients will see a doctor who represents them.
</p>
<p>
"Representation may not necessarily equate to the health outcomes that we're looking for," says Shands. "What we try to do is to augment the fact that we may not always get one-for-one with building cultural competence of the majority population, so that if we have a white [physician] who has passed cultural competence in dealing with minority patients, that suffices as well."
</p>
<h3>Taking the long view</h3>
<p>
Barriers to workplace diversity often begin in childhood. For many Black and other marginalized youth, medicine doesn't seem like a possible career choice because they don't see themselves reflected among physicians. And many often lack access to educational programs that put them on a path to a career in medicine.
</p>
<p>
The University of Washington School of Medicine's "Doctor for a Day" program has been filling those gaps since 2014. The program provides middle and high school students of color in the greater Seattle area with hands-on learning in health care fields taught by health care professionals from similarly diverse backgrounds. The all-day events take place about 10 times a year at Harborview Medical Center, UW Medical Center, and other locations around Seattle. Since it first began, more than 2,500 students have participated in Doctor for a Day, now run by the medical school's Center for Health Equity, Diversity and Inclusion.
</p>
<p>
Estell Williams, MD, the program's executive director, credits her own childhood experience in Oakland, California, through the Stanford Medical Youth Science Program, with laying the foundation for her own success. "They were helpful to me being able to see the profession and really have that direct mentorship that was so integral in my growth and development along my educational path," says Dr. Williams.
</p>
<p>
While UW encourages physicians of color to lead the programs, it welcomes participation from all physicians interested in inspiring the next generation. For physicians, participating has positive effects, as well. "This really does affect physician wellness and burnout," says Dr. Williams. "Seeing what that excitement about medicine and learning medicine looks like, being able to have an impact on what those future physicians will look likeI think all of that is a huge takeaway for those physicians, residents, and fellows to volunteer."
</p>
<p>
Johnnie Orozco, MD, a UW hematologist and oncologist had that first-hand experience after he led a Doctor for a Day event.
</p>
<p>
"The most important thing for a lot of these Black and brown faces is for them to say, 'You mean, I could do this, too?' which is a big hurdle in these communities that we don't really appreciate unless you're in it. The idea is that if you don't see it, you can't be it," says Dr. Orozco, who shares his experiences as a first-generation Mexican American. "For me it was exciting to lead a session, and a moment of hope... to have people who are living that kind of marginalized health care experience to now all of a sudden realize, 'I can potentially find my way to this medical field and take care of my community.'"
</p>
<p>
When it comes to the next generation, the Doctor for a Day program takes the long view, says Dr. Williams. "When you start that investment at the third-grade level, you have a 15-year investment at least before you're going to know if students actually matriculate into health professions," she says. Her office hopes to publish data later this year on the program's impact.
</p>
<p>
To reach high school students, often the last chance to impact career choice, UW is relaunching its U-DOC summer enrichment program, which ended in 2012 due to a funding shortage. Targeted to rising juniors and seniors from disadvantaged communities throughout Washington state, this intensive learning experience mimics college life and includes peer-to- peer mentoring, science classes, and shadowing in a clinical setting. Students selected for the U-DOC program receive a full scholarship, which covers on-campus costs and reimbursement for a round trip to Seattle. Several U-DOC graduates are now in medical school or residency.
</p>
<p>
Whether it's now or in the future, better patient and community outcomes are the end goal for increasing workforce and workplace diversity, says Shands. "We're not doing this work for PR purposes, or to, you know, right the wrongs of racism, discrimination, and whatnot. From a clinician perspective, this is all about creating equitable health outcomes for every patient that comes through our doors."
</p>
<p>
<em>Rita Colorito is a freelance journalist who specializes in writing about health care.</em>
</p>
<p>
<em>This article was featured in the March/April 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 3/3/2022 12:22:49 PM | 3/3/2022 12:20:30 PM | 3/3/2022 12:00:00 AM |
| teaching_the_skills_of_leadership | Teaching the Skills of Leadership | WSMA_Reports | Shared_Content/News/Latest_News/2022/teaching_the_skills_of_leadership | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/jan-feb-2022-reports-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports January/February 2022" /></div>
<h5>January 12, 2022</h5>
<h2>Teaching the Skills of Leadership</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
A roomful of students sit together composing haiku as an exercise in putting their thoughts into words. Each of the three stanzas reveals a range of emotions, from excitement to apprehension. "I have much to learn," one composition begins. It's a thought widely echoed by others.
</p>
<p>
The class isn't in literature or any of the liberal arts. It's a class in leadership. And the students aren't your normal collection of pupils. Most of them are physicians, and all of them are health care professionals with years of experience.
</p>
<p>
The exercise is part of the WSMA Physician Leadership Course. The course is taught by Ed Walker, MD, MHA, the driving force behind WSMA's Center for Leadership Development, the home of WSMA's expanded leadership education curriculum whose beginnings can be traced to the launch of the course in 2010.
</p>
<p>
For physicians taking on new leadership roles, whether as the head of a physician-led team or in an administrative capacity, the course provides skills that aren't taught in medical school.
</p>
<p>
"Medicine has always looked for people who have the ability to stay disciplined and push themselves to their limits. But while that works in the emergency room, so that people will stay on task, it doesn't bode well for teams. Because in a team-oriented environment, you want to use the strength of the team, not your individual skills," says Dr. Walker. "The idea of this course is to tell people what's important, so that they can learn what they need to learn to lead."
</p>
<h3>Driving force</h3>
<p>
Along with Dr. Walker's original physician leadership course, or PLC for short, WSMA's leadership development catalog now includes the Dyad Leadership Course, a by-invitation Leadership Masterclass, Leadership Seminars, and the Effective Board Governance Course. Complementing the Center for Leadership Development's curriculum is WSMA's annual Leadership Development Conference.
</p>
<p>
WSMA's physician training focuses on making physicians feel safe in learning to lead-admitting they don't have all the answers, says Dr. Walker. Team building exercises like haiku writing break down defensive reflexes and foster a sense of camaraderie. "Physicians have to feel comfortable in front of each other, making mistakes and saying, 'Hey, I don't know how to do this'-that's a very important part of the course," he says.
</p>
<p>
Kristi Lineberry, MD, medical director of the department of imaging for St. Michael's Medical Center in Silverdale, is a graduate of the course. Along with technical expertise gained, Dr. Lineberry says the PLC helped her recognize her leadership style and, more importantly, how that style relates to other members of her team.
</p>
<p>
"I was able to apply that immediately," says Dr. Lineberry. "It's realizing that maybe you yourself have some weaknesses, and that you need to surround yourself with people who can complement not only your strengths, but your weaknesses. For instance, I'm not a good numbers person. I'm better at other aspects of leadership, so I need to have on my team people who understand numbers and finances."
</p>
<p>
Part behavior-modification course, part competency-based learning, the PLC- what Dr. Walker calls a 101 course-is an amalgam of everything he brings to the table. Dr. Walker's 40-year background in medical education and executive coaching includes being the founding director of the University of Washington Healthcare Leadership Development Alliance, working as a trained psychiatrist, and serving as medical director at the UW Medical Center.
</p>
<p>
Dr. Walker's reputation is an important factor in why many health care systems choose the WSMA for their leadership training. "His reach is pretty remarkable. It wouldn't be a stretch to say that either the physician has been to an Ed Walker course or has had mentoring or support from somebody who has," says Jamie Park, MD, chief medical officer at UW Medicine Valley Medical Center in Renton.
</p>
<h3>Partnering opportunities</h3>
<p>
Along with offering open-enrollment courses, WSMA's Center for Leadership Development actively partners with health care systems to create targeted programs for them.
</p>
<p>
MultiCare has partnered with the WSMA since 2017, bringing both the PLC and dyad course in house. Each year the program trains 25 to 30 physician leaders and advanced practice providers. Some 125 MultiCare providers, and 40 to 50 dyad partnerships have already completed the training.
</p>
<p>
"It truly is a partnership. We'll do a briefing ahead of time with them on what the organization is going through. Ed comes in knowing the dynamics and the big things eating up our time and our emotional energy," says Karen DeLorenzo, director of provider leadership and organizational development and wellness for MultiCare Health System in Tacoma.
</p>
<p>
All of MultiCare's CMOs have been through the partnered program, says DeLorenzo, including some front-line medical directors, part-time medical directors, and even some informal leaders who have been identified by their CMOs as influential.
</p>
<p>
"That's been a huge relationship builder for them and helps them have the same language to look at things and understand each other... and have each other's backs," says DeLorenzo.
</p>
<p>
The pandemic added a new urgency to the need for leadership development. Seattle Cancer Care Alliance, which had its own medical leadership development program since 2007, began its partnership with the WSMA during the pandemic.
</p>
<p>
The WSMA modified the dyad course to create a team-based leadership course specific to SCCA. Anyone the physician leader deems critical, such as service line managers, operational managers, intake scheduling leads, nurse leads, or advanced practice providers, can participate.
</p>
<p>
"We did that because very often our [physician] leaders have to work not just with a single operational dyad partner, but also other team members that are critical to success," says Brittany McCreery, MD, director of medical staff practice for SCCA. SCCA launched the WSMA-led program in spring 2021, with six clinical teams going through it. Another six to eight teams will participate in spring 2022.
</p>
<p>
"Our physician leaders appreciated some dedicated time to stop and slow down from all that was happening around them in the pandemic, and actually work on their team building and communication," says Dr. McCreery. "Oftentimes we just assume that by putting a physician in a leadership role with an operational leader that they're just going to get together on their own and make a partnership happen. And, in reality, a lot of things get in the way of that."
</p>
<h3>Creating a wellness system</h3>
<p>
The goal of physician training is creating a health care system that's designed for wellness both for patients and physicians, says Dr. Park. "Physicians have to be involved in change. And to be involved in change, you have to be trained in the concepts that allow you to help organizations change."
</p>
<p>
For the last decade, each year Valley Medical Center has sent a group of physician leaders to WSMA's physician leadership course. Last year, Valley Medical Center partnered with the WSMA to do a system-wide training in house.
</p>
<p>
Over the years, the investment in WSMA leadership courses has paid off both for the physicians and for Valley Medical Center. "We were lucky enough to partner with Ed when he was developing the first dyad course. In the first two courses, we had something like 14 dyads... and many of them still work here," says Dr. Park. "The training that WSMA offers, I don't think there's a better one out there. There's no scenario in which this would not be a good usage of a physician leader's time."
</p>
<p>
<em>Rita Colorito is a freelance journalist who specializes in writing about health care.</em>
</p>
</div> | 2/9/2022 1:11:41 PM | 1/5/2022 3:54:21 PM | 1/12/2022 12:00:00 AM |
| doctors_making_a_difference_tiffany_spanier_md | Doctors Making a Difference: Tiffany Spanier, MD | WSMA_Reports | Shared_Content/News/Latest_News/2022/doctors_making_a_difference_tiffany_spanier_md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/dmd-website-image-dr-spanier-645x425px.png" class="pull-right" alt="Doctors Making a Difference logo with Tiffany Spanier MD" /></div>
<h5>January 11, 2022</h5>
<h2>Doctors Making a Difference: Tiffany Spanier, MD</h2>
<p>
Burnout is a well-documented problem affecting the physician community-one that has been
exacerbated by the stresses and traumas of the COVID-19 pandemic. For the past decade, pediatrician Tiffany Spanier, MD, who practices at Allegro Pediatrics in Bellevue, has been motivated to
help other physicians combat burnout through physician coaching. While the roots of and solutions for burnout need to be addressed on a systemic level, coaching can help physicians build a foundation for well-being in their daily lives and practices.
</p>
<p>
<strong>WSMA Reports: What is physician coaching?</strong>
</p>
<p>
Dr. Spanier: Physician coaching is a process that allows physicians to better understand their present circumstances and empowers them to be who they want to be and create the future they desire. Physicians partner with a coach in a safe space that allows deep reflection to increase self-awareness. Coaching assists physicians in clarifying goals and values, identifying obstacles that are holding them back, and developing strength-based strategies. How can coaching help physicians in their day-to-day practice? Similarly, how can it help outside of practice? Doctors participate in coaching for a variety of issues, including work-life balance, career fulfillment, burnout prevention, personal well-being, leadership, and effective interpersonal communication. Through coaching, physicians can better understand their beliefs, mindsets, and blind spots. Understanding these foundational elements supports physicians in seeing more clearly where they are stuck, what needs to change, and finding that first step forward, both personally and professionally.
</p>
<p>
<strong>How did you get involved with coaching and how have you incorporated it into your practice as a physician?</strong>
</p>
<p>
I have been passionate about addressing physician burnout and supporting well- being for the past decade. After my own pursuit to improve my well-being and find greater satisfaction in my career, I obtained certification as a mindfulness teacher, and I also completed training in self-compassion for health care communities. After learning about physician coaching in a 2019 study by Liselotte Dyrbye, MD, I decided to become a master certified physician coach. I find that coaching fosters a presence of openness and curiosity that has enabled me to be more present with my work, patients, and colleagues.
</p>
<p>
<strong>Among physicians you see for coaching, what are some of the most common challenges they're facing?</strong>
</p>
<p>
Stress, dissatisfaction, a lack of fulfillment, and the desire to grow personally and professionally. Many physicians are looking for a way to practice with integrity and authenticity, while seeking more work-life balance and passion for their work. They want to foster a sense of agency, the feeling of control over actions and their consequences, that allows them to make a difference and serve from a place of excellence.
</p>
<p>
<strong>Have you seen an increase in physicians with pandemic-related burnout?</strong>
</p>
<p>
According to a survey by Medscape, about two-thirds of physicians surveyed say their burnout has become more intense during the pandemic. This is consistent with the increased levels of stress, burnout, and exhaustion that I have seen in physicians I have coached.
</p>
<p>
<strong>Are there a few simple coaching tricks physicians struggling with COVID-19 burnout can start to incorporate into their daily lives?</strong>
</p>
<p>
One of my favorite concepts is "intention plus attention equals manifestation." Being intentional helps us recognize how we want to be, how we want to show up, and how we can purposefully align with our values and vision. It is the compass that influences us in the moment.
</p>
<p>
Philosopher William James states, "At the end of your days, your life will have been what you paid attention to." When we keep bringing our attention back to our intention, we develop focus, clarity, and the creativity needed to transform intention into action. Our manifestation then becomes a life well lived, one step at a time.
</p>
<p>
<em>This article was featured in the January/February 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 1/11/2022 12:47:29 PM | 1/10/2022 4:48:58 PM | 1/11/2022 12:00:00 AM |
| health_care_as_a_team_sport | Health Care as a Team Sport | WSMA_Reports | Shared_Content/News/Latest_News/2022/health_care_as_a_team_sport | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/jan-feb-2022-reports-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports January/February 2022" /></div>
<h5>January 10, 2022</h5>
<h2>Health Care as a Team Sport</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
As the state Legislature convenes for its working session this January, scope of practice issues will be a topic for potential action yet again. The legislative debate is likely to center around two separate approaches.
</p>
<p>
The first involves addressing the problem of the shortage of health care practitioners. "Washington state, like many other states, has a shortage with its health care workforce," says Sean Graham, WSMA's director of government affairs. "Those shortages have been exacerbated for a number of reasons by the pandemic."
</p>
<p>
Solving that issue will require a long- term investment. In the meantime, however, there continues to be pressure to expand scope of practice for existing practitioners, something unrelated to the pandemic. Supporters of expanding scope often argue that changes are needed to ensure patient access to practitioners.
</p>
<p>
"A lot of those proposals have been kicking around for years, if not decades," says Graham. "There's nothing novel about them other than the time in which they are manifesting. They are perennial proposals that have a COVID racing stripe on them."
</p>
<p>
Scope of practice has long been a thorny issue. "It's a complex dynamic for which there are many inputs and changes occurring in society, at the legislative level, in training, and in the expectations of different groups," says Mika Sinanan, MD, PhD, president of the WSMA and a professor of surgery at the University of Washington.
</p>
<p>
Exactly what the legislative proposals may be remains to be seen as the Legislature returns to session (for several proposals we do expect, see sidebar on p. 12). But one solution to the impetus behind such proposals has already been successfully adopted without legislative intervention. That solution is increased use of physician-led teams. The teams allow practitioners to perform at the top of their license under the leadership of a physician, which eases workforce shortages while also protecting patient safety and access.
</p>
<p>
"Expanding the scope of practice is just one possible solution," says Dr. Sinanan. "Until we are assured that the quality and safety and level of collaboration is clear- and it often is not clear-then we're taking a risk by going that route. Developing the communication ties that are present within high-function clinical teams led by physicians is a better approach."
</p>
<h3>The value of physician-led teams</h3>
<p>
In some ways, physician-led teams are already built into the health care system. With their extensive training, physicians are naturally expected to lead, even though they may need to learn the skills to do so. On medical teams, roles are clear.
</p>
<p>
"As an OB-GYN, I don't enter the OR with the thought of who is in charge of this or that," says Nariman Heshmati, MD, WSMA's vice president. "We all have a part to play based on our experience."
</p>
<p>
The real issue, says Dr. Heshmati, is having each team member perform at the top of their license.
</p>
<p>
"I push people to consider talking less about scope of practice and more about acknowledging that everyone on the team has a critical role to play," he says. "We have to reduce the variability of training at all levels in order to ensure the level of care."
</p>
<p>
At the same time, the team is not about a strictly hierarchical approach to care. "A team means you are working closely with somebody," says Dr. Sinanan. "Someone who is available to bounce things off of, to test hypothesis and challenge assumptions. That makes the quality of care better."
</p>
<p>
This collaborative attitude acknowledges that every member of the team has strengths-and gaps. "Even as physicians, we're continually looking up things," says Dr. Sinanan, who says a team's success depends upon "all members of the health care team having the same openness to what they know or don't know."
</p>
<p>
Teams in certain specialties, such as palliative care, involve a wide range of health care practitioners and others, such as social workers and chaplains. Yet the team approach actually enhances the importance that each team member brings to the group.
</p>
<p>
"There's an exultation of various roles for the people involved," says John Bramhall, MD, PhD. "That's not to diminish the value of non-physicians. If anything, the value of non-physicians is amplified by being coordinated."
</p>
<h3>Improving outcomes by working together</h3>
<p>
Physicians who have led teams readily testify to the benefit such a structure provides. By bringing together all members of a patient's care team, each member gets a fuller picture of the issues to be addressed, offering the potential for better care and outcomes. It also helps to ease the problem of too few health care practitioners, particularly outside of western Washington.
</p>
<p>
"We're in a position here that it's necessary because there aren't enough physicians to go around," says Katina Rue, DO, a family medicine physician in Yakima. She notes that necessity may be a culture shock for older physicians, who weren't taught to work in teams.
</p>
<p>
But her own experience has taught her the value of teams. "When teams work together, it brings about better patient care with better outcomes," says Dr. Rue. "Medicine can continue to improve by getting the disciplines together, with physicians in a place where they can lead the groups collaboratively."
</p>
<p>
When she worked with a homeless population in her clinic, Dr. Rue led a team that included a nurse care coordinator, a pharmacist, and a behavioral health consultant, among others. "Everyone has a piece to play," she notes. "It's really much bigger than the physician piece. But the physician piece is important. The physician needs to have a pulse on what's going on with the rest of the team."
</p>
<p>
The team approach also offers physicians a broader perspective than they can get just from time in the exam room. "It's part of our responsibility to our patients to really understand what their needs are, but also the needs of their families and community," Dr. Rue notes. "If we are not listening to the other members of the team- actively communicating with them and reviewing their notes, seeking their input-we're going to miss the boat on what patients and the community need."
</p>
<p>
As the conversation about scope of practice heats up in the Legislature, the focus should remain on what's best for patient care. "We have strongly believed that physician-led teams, based on physicians' training, background, and experience, is the best approach," says Dr. Sinanan. "Until such time as the training, background, and experience of other groups is equal to that, we don't believe that they are able to handle the same standardized level of quality care." Meanwhile, the problem that prompts the Legislature's interest will require longer-term investment to create more opportunities for training to solve the shortage of workers.
</p>
<p>
Having a physician-led team won't solve all those workforce issues, but it can make a difference. It can also build on the structures already in place to ensure better care and outcomes.
</p>
<p>
"Health care is a team sport," says Dr. Heshmati. "We've got to do it together, but we've got to ensure that we're doing it the right way. How do we all bring the best of what we have to the table to improve outcomes?"
</p>
<p>
When that succeeds, as it can on a physician-led team, the results can tran- scend the debate about scope of practice.
</p>
<p>
"When everyone is focused, it's not about you or me," says Dr. Heshmati. "It's about the patient. They always come first."
</p>
<p>
<em>John Gallagher is WSMA Reports senior editor.</em>
</p>
<p>
<em>This article was featured in the January/February 2022 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 1/10/2022 11:58:01 AM | 1/5/2022 3:28:56 PM | 1/10/2022 12:00:00 AM |
| moving_the_needle | Moving the Needle | WSMA_Reports | Shared_Content/News/Latest_News/2021/moving_the_needle | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports cover November-December 2021" src="/images/Newsletters/Reports/2021/nov-dec-2021-reports-cover-645x425px.jpg" class="pull-right" /></div>
<h5>November 8, 2021</h5>
<h2>Moving the Needle</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
For nearly 20 years, Geoff Jones, MD, has practiced family medicine in Newport, the largest city in Northeast Washington's Pend Oreille County. Sharing borders with Idaho and Canada, Pend Oreille (pop. 13,000) is known for its wilderness beauty and pioneer spirit. Timber and mining have long been the region's largest employers. The Washington Academy of Family Physicians' 2016 family physician of the year, Dr. Jones spends his spare time enjoying fly fishing, hiking, and camping. He loves the people in this rural community.
</p>
<p>
Every time he is in the exam room at the Newport Health Center talking to a long-time patient, he asks a question he has asked many, many times: 'What are your thoughts on the COVID vaccine?'
</p>
<p>
"From there the conversation can proceed however they want to take it," he says. "The key has been the open- ended question and having the vaccine in the clinic to give them a shot right then and there."
</p>
<p>
By most standards, Washington state has done a great job with COVID-19 vaccinations. The state has consistently ranked in the top 10 states with the highest vaccination rates and is outpacing the United States as a whole. But the big picture veils a more nuanced reality. While vaccination rates are extremely high in the heavily populated western part of the state, figures in eastern rural areas tell a far different story.
</p>
<p>
In counties such as Pend Oreille, Ferry, and Stevens, vaccination rates are less than half of those in urban areas. By early fall, little more than a third of people in those counties have been fully vaccinated. By contrast, about 80% of the population in King County was fully vaccinated.
</p>
<h3>Rural doctors speak out</h3>
<p>
For physicians in the region, the hope is that they can use their trusted role in their communities to allay patient concerns and lead to a better vaccination rate.
</p>
<p>
"People want to sit down and talk about specific questions they have about the vaccines," says Samuel Artzis, MD, health officer for the Northeast Tri County Health District, which encompasses Ferry, Pend Oreille, and Stevens counties. "About the only person with whom they can have an educated conversation and get accurate information is going to be a private physician."
</p>
<p>
Dr. Artzis and Dr. Jones are two of the physicians participating in WSMA's "Talk to Your Doctor" campaign, a partnership with the Washington State Department of Health to improve confidence in COVID-19 vaccination in Artzis' health district. The campaign, featuring videos with local doctors, will be promoted across popular web platforms and supplemented with traditional media outreach and print resources to try to increase vaccination rates in the region.
</p>
<p>
Physicians engaged in the effort believe that the campaign will be effective.
</p>
<p>
"A good percentage of people here are in a category where they're highly unlikely to ever receive a vaccination," says Dr. Jones, citing the current polarization around the COVID-19 vaccine. "But we do have a good chunk of people who I think are amenable to having a conversation with their local physician about getting a vaccination. We've really been targeting that population, and it's been a surprising success. ... I made a commitment to myself that I was going to talk to every single patient who hasn't had a shot about COVID vaccination."
</p>
<h3>A host of challenges</h3>
<p>
Trying to convince one patient at a time won't be easy. For one thing, the pandemic may have exacerbated the impact of vaccine resistance, but it didn't invent it. Childhood vaccination rates in the state's rural counties are significantly lower than the state average.
</p>
<p>
"Stevens County has an issue of not addressing vaccine hesitancy previously with our under-two population and new moms," says Caleb Holtzer, MD, a family physician at Providence Northeast Washington Medical Group in Chewelah. "It's certainly amplified by the current political rhetoric, but even before that, we had significant health disparities around preventive medicine and vaccinations for children."
</p>
<p>
Such challenges take place in the context of months of mixed messages, even if they were understandably so. Because the virus is of such recent origin, knowledge about how to fight it changed rapidly. Unfortunately, pronouncements about it didn't always reflect the shifting understanding of the virus.
</p>
<p>
"Every time the government comes out with a recommendation, it's an absolute," said Edward Johnson, MD, a family physician at Providence Northeast Washington Medical Group in Colville. "They say, 'You have to do this and it will do that.' Then three weeks later, it didn't do that."
</p>
<p>
Underpinning all of these issues is a culture that is generally more conservative and opposed to government interventions. Add in a polarized political environment and a seemingly endless stream of misinformation, and you have what Dr. Holtzer calls "a militant anti- vaccination campaign that is a whole different level than run-of-the-mill resistance." Instead of just refusing to get vaccinated themselves, some people are actively advocating against vaccination.
</p>
<h3>A delicate balance</h3>
<p>
Still, conversations between physicians and patients can succeed in moving the needle-literally-if done properly.
</p>
<p>
"The best strategy is to listen to people's concerns, even if they seem far-fetched," Dr. Holtzer says. "Give them an open, honest listening and then provide them with information about safety and the effect the disease is having on our community."
</p>
<p>
Dr. Johnson says that the impact of COVID-19 on the community has resonated with patients, but perhaps not in the way most people would expect. Rather than talk about the suffering the disease itself causes, patients respond to how it might affect people who don't have COVID-19.
</p>
<p>
"I get more buy-in with a message that by getting this vaccine, you can save your loved one's life," he says. "If they come in to the hospital with a motor vehicle accident, there are no beds. That's a more effective message."
</p>
<p>
That sobering statement is far from theoretical. Critical-access hospitals in rural areas are so overwhelmed that there is no room for accident victims or heart attack patients.
</p>
<p>
"We are trying to send people to Spokane or elsewhere in the state," says Ramon Canto, MD, a pulmonologist at Providence in Colville. "We even have feelers (out) to Montana and Idaho."
</p>
<p>
No matter the message the physician uses, the conversation needs to strike a delicate balance.
</p>
<p>
"As physicians, we have to walk a fine line between confronting people on vaccination while maintaining our credibility to treat them for other conditions," says Dr. Holtzer. "We have to respect what people want to focus on."
</p>
<p>
As it does with other medical conditions, it may take multiple conversations before a patient agrees to be vaccinated. "Sometimes they don't quit smoking the first time you bring it up, but they do after the third or fourth time," says Dr. Johnson. "It may be the same for vaccinations, too."
</p>
<p>
Despite the misinformation that patients have, they often respect their physician's position, even if they choose not to be vaccinated.
</p>
<p>
"To a certain extent, that trust seems to stay intact," Dr. Canto says. "Some of them are almost ashamed to tell me and avoid the topic. They trust me as a doctor and don't want to offend me."
</p>
<h3>Physicians face frustration</h3>
<p>
The failure to convince people to be vaccinated does take a toll on physicians.
</p>
<p>
"I don't handle this as well as I do people with other self-injurious behaviors, like smoking, drinking, or IV drug use," says Dr. Jones. "I honestly don't know why, but it's harder from a personal, emotional level."
</p>
<p>
It's especially hard for physicians to hear anti-vaccination misinformation from within the ranks of health care workers, including other physicians. Dr. Canto notes that some nurses even counsel patients not to get vaccinated.
</p>
<p>
"It's almost like they have two different lives," he says. "They are really good nurses, compassionate. Then they take off their nurse's uniform and they say they would never put that 'poison' in their body. If you can't convince the people who know the science, how much more difficult is it to deal with the general public?"
</p>
<p>
Unfortunately, the same is true of COVID-19 survivors. People who themselves refused to be vaccinated and then got seriously ill from the virus would seem a natural source to talk to the vaccine hesitant. Yet, survivors are unlikely to take that step, despite having first-hand experience of the toll the virus takes.
</p>
<p>
"The interesting thing is that they won't talk to others in the community," says Dr. Artzis. "There's some stigma attached to it. It would be better than a doctor talking to have a friend say, 'I thought I was going to die, please get vaccinated.'"
</p>
<p>
Ultimately, as more people are vaccinated, physicians will have more availability to treat patients' other health issues.
</p>
<p>
"If one person gets vaccinated, that takes me less time sitting in the clinic talking to folks [about vaccination]," says Kal Kelley, MD, a physician with Ferry County Public Health District. "I'm very frustrated with the investment of time to talk to patients."
</p>
<p>
Still, says Holtzer, there is nothing like the feeling a physician gets when a patient finally agrees to be vaccinated.
</p>
<p>
"It's one of the most satisfying experiences to move people along the spectrum toward getting vaccinated," he says.
</p>
<p>
<em>John Gallagher is a freelance journalist in Washington state who specializes in covering health care. He is a regular contributor to WSMA Reports.</em>
</p>
<p>
<em>This article was featured in the November/December 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 11/8/2021 9:32:34 AM | 11/8/2021 9:29:08 AM | 11/8/2021 12:00:00 AM |
| no_jab_no_job | No Jab, No Job | WSMA_Reports | Shared_Content/News/Latest_News/2021/no_jab_no_job | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports cover November-December 2021" src="/images/Newsletters/Reports/2021/nov-dec-2021-reports-cover-645x425px.jpg" class="pull-right" /></div>
<h5>November 8, 2021</h5>
<h2>No Jab, No Job</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
On Aug. 31, the chief physician executive at PeaceHealth in Vancouver, Doug Koekkoek, MD, braced for protests by employees against its COVID-19 vaccine mandate. It was their last day to comply or face the consequences, including regular COVID-19 testing, additional masking, and removal from patient care settings or from the work schedule entirely.
</p>
<p>
Dr. Koekkoek had reason to worry: There had already been several vocal protests outside PeaceHealth's locations statewide since the mandate's announcement on Aug. 3. Encountering significant resistance to COVID-19 vaccinations from medical professionals is not something Dr. Koekkoek anticipated when he joined PeaceHealth at the end of March, a time when health care systems were still euphoric about a vaccine roll out.
</p>
<p>
Since the beginning of the pandemic, vaccines have been the best hope in getting the country through COVID-19. But as WSMA Reports goes to press-a timeframe many had hoped would be the homestretch for containing the pandemic- health care systems in Washington state and nationwide find themselves spinning in reverse, with surging cases and hospitalizations fueled by the virus' delta variant. And the unvaccinated.
</p>
<p>
Some of the PeaceHealth protests were organized by fringe online groups, such as Waking Up Washington, that dismissed that a delta variant crisis even existed.
</p>
<p>
When PeaceHealth decided to mandate COVID-19 vaccines, 80% of its workforce was vaccinated. Through educational initiatives and open dialogue, administrators had spent months trying to convince the remaining 20% to get vaccinated. With the delta variant at its doors, PeaceHealth decided to require the vaccine, says Dr. Koekkoek. "We were watching outbreaks in hospitals and in our community, and we thought we can do better in terms of protecting our staff and patients if we had a workforce that was fully vaccinated."
</p>
<h3>Mandate is needed</h3>
<p>
Outbreaks in hospitals throughout Washington state since the pandemic began, including as late as August, highlight the need for mandatory vaccinations in health care settings, says Nathan Schlicher, MD, JD, MBA, WSMA's immediate past president and an emergency physician at Virginia Mason Franciscan Health. "We're still on the front lines of the explosive delta wave," he says.
</p>
<p>
Virginia Mason Franciscan Health and Providence Hospital issued their vaccine mandates on Aug. 6, following in the steps of PeaceHealth, Kaiser Permanente, and MultiCare. UW Medicine was the state's first large health care system to announce a COVID-19 vaccine mandate- on July 19-effective Sept. 10.
</p>
<p>
Shortly after these systems put their facility-specific mandates in place, Gov. Jay Inslee issued an emergency order requiring that employees of most health care and long-term care organizations statewide, as well as K-12 and higher education employees, state employees, and childcare employees, be fully vaccinated by Oct. 18-or risk losing their jobs. Gov. Kate Brown of Oregon issued a similar mandate and deadline for health care organizations for her state. On Sept. 9, President Joe Biden ordered sweeping new federal vaccine requirements for private-sector companies with more than 100 employees, as well as health care workers and federal contractors.
</p>
<p>
With the addition of these mandates, more than 90% of PeaceHealth employees were fully vaccinated and another 4% were partially vaccinated by mid-September, says Dr. Koekkoek. By the state's mid-October deadline, PeaceHealth expects over 94% of employees to be fully vaccinated. "There are clearly nurses and physicians who don't want to be vaccinated. Some of them have more sound reasons than others; some are just fearful. But they're a vocal few," says Dr. Koekkoek.
</p>
<h3>Physicians struggle with implementation</h3>
<p>
In the days after Gov. Inslee's announcement, the WSMA was flooded with messages from members worried about how they should handle compliance. Outpatient practices, many small-staffed and already overworked, were particularly feeling the impact of employees who refuse to get vaccinated.
</p>
<p>
WSMA Reports spoke with a physician in a small primary care practice who tried unsuccessfully-even offering $100 bonus incentives-to convince staff to follow her lead to get vaccinated. "The people who weren't going to get a shot still wouldn't get a shot. The bonus didn't help," says the physician, who asked to remain anonymous.
</p>
<p>
The physician's practice was already having difficulty recruiting an advance practice provider after one announced he was moving. "It's the general problem of finding workers right now, and has nothing to do with the mandate," she says.
</p>
<p>
The state mandate, plus the risk of office closure, finally convinced another partner in the practice to get vaccinated. "I don't know whether one pressure alone would've done it," says the small practice doctor. Sadly, she says the other two providers are adamant they won't get vaccinated.
</p>
<p>
She worries her practice may need to close for good if unvaccinated clinical staff aren't allowed to work even remotely. "The practice has existed for 50 years. It's small, but until now there was no reason to think it wasn't going to continue to be here for a long time," she says. "And if we suddenly have to close, that's 5,000 patients who have to find a new provider."
</p>
<p>
Prior to the pandemic, health care was already grappling with a looming workforce crisis-a shortage of 122,000 physicians by 2032 and 200,000 nurses needed each year to keep up with demand, according to the American Hospital Association.
</p>
<p>
The physical and emotional toll of COVID-19 has made many health care workers re-evaluate their careers. In a 2021 Washington Post-Kaiser Family Foundation survey, nearly 30% of health care workers said they are considering leaving their profession entirely. How COVID-19 vaccine mandates will further impact health care systems remains to be seen.
</p>
<p>
As of this writing, the state mandate hasn't created the hoped-for impetus for some vaccine-resistant employees to get vaccinated. "When the state mandate came out, my first thought was, 'Wonderful. This is going to make people get it.' But, in fact, it's not going to make people in my office get it. What it's going to do is just add turmoil," the small practice physician says.
</p>
<h3>WSMA pushes for clarity</h3>
<p>
For PeaceHealth and other health care organizations with facility mandates, the state mandate was a welcome endorsement of their decision, says Dr. Koekkoek. "The vast majority of our nurses and physicians are vaccinated and feel like [the state mandates] are a validation around the positions they've taken. It's made it easier in their various practices and hospitals to get the rest of the staff on board."
</p>
<p>
Like other employers, PeaceHealth now faces an additional workforce gap left by those who refuse to comply. "People who are still vaccine-hesitant are going to either drop out of the workforce entirely, do something different, or move to a state with fewer requirements to practice there," says Dr. Koekkoek.
</p>
<p>
Unlike smaller physician practices, PeaceHealth is able to pivot by rearranging schedules and filling that void using agencies to staff their workforce, says Dr. Koekkoek.
</p>
<p>
To address member concerns surrounding the state mandate, the WSMA continues to work with the governor's office and the Washington State Department of Health for clarity on implementation. "While WSMA strongly supports the governor's mandate, it recognizes the administrative burden it puts on physician practices," says Jeb Shepard, director of policy at WSMA. "We are seeking guidance from the state based on WSMA member feedback, have conducted several webinars with legal counsel who have expertise in health care labor law, and have provided templated practice policies and accommodation documents."
</p>
<p>
Despite an entrenched group of hold- outs, Dr. Schlicher remains confident that health care workers will continue to do the right thing. "I'm hopeful that we'll get folks to line up and get vaccinated, and for those already vaccinated, to get their booster soon," he says. "At the end of the day, it's the best way that we both keep all our patients and workers healthy-our physicians, nurses, techs, custodial staff, administrators ... but it's also a way that we keep our own families and community safe."
</p>
<p>
<em>Rita Colorito is a freelance journalist who specializes in covering medicine and health care. She is a regular contributor to WSMA Reports.</em>
</p>
<p>
<em>This article was featured in the November/December 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 11/8/2021 9:34:14 AM | 11/8/2021 9:32:51 AM | 11/8/2021 12:00:00 AM |
| covid_long_haulers | COVID Long-Haulers | WSMA_Reports | Shared_Content/News/Latest_News/2021/covid_long_haulers | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2021/sept-oct-2021-reports-cover-645x425px.jpg" class="pull-right" alt="WSMA September-October 2001 cover image" /></div>
<h5>September 1, 2021</h5>
<h2>COVID Long-Haulers</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>By John Gallagher</p>
<p>
When the coronavirus pandemic first hit, Jason Goldman, MD, MPH, recognized the importance of researching the impact of the virus. An infectious disease physician with Swedish Medical Center in Seattle, Dr. Goldman, who's also a clinical researcher, instituted a study on immune response in COVID-19 patients.
</p>
<p>
"We enrolled the first patients in March 2020," he says. "At the time, we were thinking about COVID as an acute viral infection." So, it was a bit of a shock when patients returned after a few months for follow-up testing and were still exhibiting problems.
</p>
<p>
"It was surprising to find that the immune system had not calmed down in study participants that we tested at one to two months after their acute infection," Dr. Goldman recalls. "The manifestations after COVID persisted a long time and affected many organ systems."
</p>
<p>
What the study was finding were the early signs of what is now known as post-acute COVID-19 syndrome (PACS), or what is commonly called long-haul COVID. More than a year and a half into the pandemic, PACS remains a perplexing problem, frustrating patients and doctors alike, while adding stress to an already overburdened health care system.
</p>
<p>
Sequelae from infectious diseases are hardly surprising; chronic fatigue syndrome, Epstein-Barr virus, and Lyme disease can cause a confusing array of problems. What's different is the sheer volume of PACS patients. Although precise incidence rates don't exist, the number of people who experience significant sequelae for several months after an acute COVID-19 infection has been estimated to be about 10% to 30%.
</p>
<p>
"We have millions of persons in this country now who have had COVID, and even though it's a small percentage with long-haul symptoms, that number is still very large," says Leslie Linares-Hengen, MD, an infectious disease specialist at St. Joseph's Medical Center in Tacoma. "It's much greater than with other post- infectious syndromes."
</p>
<p>
Moreover, because COVID-19 was such a new disease, at the outset, no one had any idea what the long-term effects might be. "We had to live through the epidemic and the care of the patients to understand what was going to happen," says Dr. Linares-Hengen.
</p>
<h3>A tricky diagnosis</h3>
<p>
One major challenge for physicians is that PACS doesn't present as a clear-cut syndrome. "Patients' symptoms seem to be all over the board," says Peter Barkett, MD, an internal medicine physician at Kaiser Permanente Silverdale Medical Center. "It's such a new thing with such variety in presentation that it's really difficult to pin down."
</p>
<p>
Patients with PACS can suffer from pulmonary and cardiovascular problems. They may report brain fog or less ability to taste and smell. They may have intermittent fevers or severe post-exercise fatigue. They may feel anxious or have trouble sleeping. Or they may have some combination of all of these problems. While PACS seems more prevalent in people with severe acute infection from COVID-19, plenty of PACS patients had mild or even asymptomatic infections.
</p>
<p>
"These are complex, multidimensional presentations that are hitting patients," says Aaron Bunnell, MD, a physical medicine and rehabilitation physician with UW Medicine. UW opened a post- COVID clinic in April 2020 at Seattle's Harborview Medical Center, initially targeting those recovering from critical illness, but soon expanded it as the need grew. At present, patients are waiting three months for an appointment.
</p>
<p>
Some patients are putting off treatment in the belief that their symptoms will fade. When they finally do present to a physician, they "are at their wits' end," says Dr. Barkett. "There are a lot of patients who are suffering in silence with long COVID symptoms." Dr. Barkett now makes a point of asking every patient who has had COVID-19 about lingering symptoms and if there are things that they are no longer able to do.
</p>
<p>
Because some patients never tested positive for COVID-19, it's not always clear that their symptoms are related to the disease. Diagnosis can be difficult, particularly for patients who may have been infected early in the pandemic when testing was scarce. Antibody tests are helpful, but not foolproof.
</p>
<p>
Once they do seek help, patients frequently have faced a battery of tests to figure out what's wrong with them. "Because the symptoms are so broad, a lot of these patients are getting a lot of very expensive workups, with largely negative results," says Dr. Bunnell.
</p>
<h3>Time frame for recovery a moving target</h3>
<p>
Treatment is focused on lessening the severity of symptoms. "We don't have any approved therapies for PACS," notes Dr. Goldman. "Mostly it's symptomatic management."
</p>
<p>
Supporting patients and being transparent with them is also important. "When I talk to patients, I tell them we're not going to be able to fix this in one stroke," says Dr. Barkett. "We're going to try some things, check them, and adjust. We will be working on this over the long term."
</p>
<p>
The good news is that for most patients, symptoms seem to resolve over time.
</p>
<p>
"It's comforting for patients to hear that they will get better eventually," Dr. Goldman says.
</p>
<p>
Still, even with that positive news, there are caveats. For some patients, says Dr. Linares-Hengen, "it's a picket-fence recovery: good days and bad days."
</p>
<p>
There is also a subset of patients who don't get better. "For some patients, six months along, they are still having debilitating symptoms," says Dr. Barkett.
</p>
<p>
Moreover, the very definition of "long-haul" keeps moving further out as time goes on. "The longer the studies go post-COVID, the more we see symptoms lingering because of the nature of real- time research," says Dr. Linares-Hengen. "First it was a few months, then six, then eight, and now reports of a year out."
</p>
<p>
Multiple research studies are underway to better understand PACS. One nationwide master cohort study is seeking to enroll 10,000 patients. "If we knew what causes the different manifestations of PACS, we could treat people better," says Dr. Goldman.
</p>
<p>
Meanwhile, the medical system will be faced with how to handle the influx of PACS patients. A lot of the burden may fall on primary care physicians and providers.
</p>
<p>
"It's going to be very taxing to our medical system, probably in a way we haven't seen before," says Dr. Linares-Hengen. "Most of these patients will present in primary care settings. There is not going to be the infrastructure to be managed only by some specialists."
</p>
<p>
Still, says Dr. Barkett, the primary care physician may have a unique advantage in treating PACS patients. "One of the things we can do in reassuring patients is leveraging our existing relationship with them," he notes. "With a lot of things in medicine, the trust and comfort with the clinician making a recommendation makes a big difference. We can be a support system for them."
</p>
<p>
Dr. Linares-Hengen agrees.
</p>
<p>
"Many of these patients are looking for some relief in a world of uncertainty," he says. "We need to be able to listen to them with compassion when it's hard to pinpoint the exact physiological derangement, as well as to help through the uncertainty of treatments. Even though we don't have great answers, they still need our ear."
</p>
<p>
<em>John Gallagher is a freelance writer who specializes in covering health care. He is a regular contributor to WSMA Reports.</em>
</p>
<p>
<em>This article was featured in the September/October 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 9/1/2021 2:35:03 PM | 9/1/2021 2:30:51 PM | 9/1/2021 12:00:00 AM |
| telehealths_time_has_come | Telehealth's Time Has Come | WSMA_Reports | Shared_Content/News/Latest_News/2021/telehealths_time_has_come | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2021/sept-oct-2021-reports-cover-645x425px.jpg" class="pull-right" alt="WSMA September-October 2001 cover image" /></div>
<h5>September 1, 2021</h5>
<h2>Telehealth's Time Has Come</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
When Katina Rue, DO, testified via Zoom before state legislators in January, they interrupted to let her know they could no longer see her. As a family physician in rural Yakima, Dr. Rue is used to dropped signals from unreliable, limited broadband. The all-too-common glitch proved her point about needing to pass House Bill 1196, a bill supported by the WSMA on reimbursement parity for audio-only telehealth visits.
</p>
<p>
"It's pretty typical to lose internet connection, and that goes for a lot of the patients around here," says Dr. Rue, who also serves on the WSMA's executive committee, and who at the time worked for Community Health of Central Washington. Many of her patients also lacked internet access, didn't have smartphones, or didn't know how to use Zoom, so they were only able to do phone calls.
</p>
<p>
During the public health emergency, the Washington State Office of the Insurance Commissioner temporarily offered a critical flexibility for physicians like Dr. Rue, requiring state-regulated insurers to reimburse audio-only visits at the same rate as face-to-face encounters. This temporary flexibility greatly improved access to care and provided the impetus for WSMA's advocacy in support of HB 1196, which aimed to make that parity permanent.
</p>
<p>
With advocacy from Dr. Rue, the WSMA, and others, the bill passed and Gov. Jay Inslee signed it into law. "It's a big win for patient access to care," says Jeb Shepard, WSMA's director of policy. However, he cautions that vigilance is still needed. "We're on the lookout for efforts that might encumber a physician's ability to provide audio- only services to their patients." That watchfulness includes being careful not to incent patients to disassociate their care from longitudinal relationships with physicians and care teams.
</p>
<p>
Like many telehealth policy changes in response to COVID-19, audio-only payment parity-and how or when the modality may be utilized-could be reconsidered once the threat of the pandemic is over.
</p>
<h3>The fight continues</h3>
<p>
HB 1196 requires implementation studies of audio-only telemedicine, to be conducted by the Washington State Telehealth Collaborative, also known as the Collaborative for the Advancement of Telemedicine (or simply the Collaborative). The group, which the WSMA helped found, works to develop telemedicine recommendations, including reimbursement, access, best practices, and technical assistance.
</p>
<p>
From these studies, the Office of the Insurance Commissioner must report findings and recommendations to the Legislature by Nov. 15, 2023.
</p>
<p>
One aspect of the law must be studied and recommendations submitted to the Legislature by Dec. 1 of this year. HB 1196 requires that an established relationship, defined as one in-person visit during the last year, is in place before audio-only payment parity is applicable. The WSMA advocated for the requirement. "We heard from WSMA members that audio-only should be supplemental to in-person care, which is the gold standard; not instead of in- person care," Shepard says.
</p>
<p>
Telehealth requires knowing more about a patient up front, which is why an established physician-patient relationship is crucial, says Jessica Schlicher, MD, medical director of Mission Control and the virtual hospital for Virginia Mason Franciscan Health, who testified on behalf of the legislation. "You have to know, 'Can this patient provide me with a good history? Can the patient cognitively give me information that could help me keep them safe?' "
</p>
<p>
With the bill signed and celebrated, the WSMA is already looking at what's next. "Now it's time to engage in these other arenas-with the Telemedicine Collaborative, the Bree Collaborative, the work required by the Office of the Insurance Commissioner-to make sure the physician perspective is considered and we don't lose the progress we made," Shepard says.
</p>
<p>
"As the research comes in, we're really digging down in what's appropriate for care to see if we can come up with some more agreed-to standards because not everything should be telehealth," says State Rep. Marcus Riccelli, D-Spokane, the lead sponsor of HB 1196.
</p>
<p>
To ensure continued improved access, the legislator says it's important not to go backward on telehealth regulations. "We have a lot of folks still struggling to get online, even in our urban areas," he says. "One of the big things we can do to promote access to health care is to increase broadband access, and put forward infrastructure dollars, either state dollars or in combination with the federal level."
</p>
<p>
Where Dr. Rue lives, audio-only telehealth visits proved particularly helpful to low-income and essential workers in the agriculture and service industries. "They could do a telehealth visit in their car ... get their needs taken care of, and then they're back at work. They didn't have to use paid time off."
</p>
<p>
Audio telehealth is a core patient equity issue, says Dr. Schlicher. "Patients should not be denied access to care based on their access to the internet. The standard of care doesn't change whether a patient is in person or via any telemedicine modality," she says. "It's important for people to understand that these audio-only telehealth visits aren't quick phone calls. They're full visits in which a provider performs the normal evaluation and management of health problems."
</p>
<h3>Making temporary changes permanent</h3>
<p>
Along with audio-only telehealth, the pandemic accelerated adoption of telehealth services across providers and patient populations. Even as health care returns to normal, many patients continue to utilize telehealth. Across the UW Medicine health system, telemedicine visits jumped from about 250 in February 2020 to over 31,100 in in just three months, and still average 20,000 to 25,000 visits a month, says John Scott, MD, medical director of UW Digital Health and chair of the Collaborative.
</p>
<p>
"Washington state was already ahead of the curve because we had a lot of telehealth laws on the books that really allowed us to pivot to a lot greater proportion of visits done by telemedicine," says Dr. Scott. State legislation requiring payment parity for audio-visual telehealth visits was passed just prior to the novel coronavirus outbreak. (The first coverage law in Washington was signed in 2016, for Medicaid and private payers.)
</p>
<p>
To facilitate health care's response to the pandemic, state and federal legislatures eased numerous telehealth regulations. WSMA's focus is making sure these temporary changes become permanent, says incoming WSMA president Mika Sinanan, MD, PhD, a general surgeon in charge of value-based care at UW Medical Center.
</p>
<p>
"There are changes in the interstate licensing compact that many states have adopted during COVID that would allow physicians to deliver care across state lines," Dr. Sinanan says. "But those are now being rescinded or changed and that's going to make it more difficult to maintain relationships and take care of patients. We don't see telemedicine going away. It's certainly not going back to where it was pre-pandemic, but there's a concern the regulations will roll back."
</p>
<p>
Patients have several reasons for wanting to access care across state lines, says Dr. Scott. This includes students who attend college out of state; people who come to Washington state for complex procedures and want to follow up with their care team; and retirees and others who split their residency between living in Washington state and elsewhere.
</p>
<p>
Washington state signed onto the Interstate Medical Licensure Compact in 2017 after passage of legislation strongly supported by the WSMA. The compact allows states to streamline the licensing process for physicians who want to practice in multiple states. But the compact is only as good as the states that have joined it, says Shepard. While 26 states now participate, neighboring Oregon has not signed on. (According to Dr. Schlicher, Washington Medical Commission regulations allow specifically for continuity of care for patients who have received in-person care in Washington, even prior to the pandemic.)
</p>
<p>
The hope is to develop federal interstate licensure regulations for telehealth so physicians can continue to practice across state lines as they did early in the pandemic when regulations were relaxed, says Dr. Sinanan.
</p>
<p>
Elsewhere at the federal level, Medicare temporarily relaxed geographic restrictions for telehealth, one of the biggest barriers to providing telemedicine, says Dr. Scott. "Prior to the pandemic, patients had to either be in a rural or medically underserved area. And you couldn't be in your home; you had to go to one of eight approved areas or locations. So, it really wasn't all that convenient. Congress needs to act to make those waivers permanent."
</p>
<p>
To that end, the WSMA supports the reintroduction of the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021. The legislation would permanently remove Medicare's geographic restrictions on telehealth services and expand originating sites to include the home and other sites, among other provisions. The CONNECT Act has broad bipartisan support, including from key members of Washington's congressional delegation.
</p>
<p>
"For folks living in remote and rural communities especially, access to telehealth can make a world of difference to access quick, convenient care," says U.S. Rep. Jaime Herrera Beutler, R-Battle Ground, who, along with Rep. Suzan DelBene, D-Medina, are among the bill's co-sponsors.
</p>
<h3>Making the case for telehealth</h3>
<p>
For their part, regulators want to make sure that telehealth is held to the same levels of professionalism and HIPAA privacy standards as in-person visits, says Dr. Sinanan. They're also concerned about potential fraud.
</p>
<p>
"The key is reassuring the Legislature that we know what we're doing and that we have rigorous clinical standards in telemedicine," says Dr. Schlicher, who helped write guidelines on the appropriate use of telehealth for Virginia Mason Franciscan Health.
</p>
<p>
"In order for the Legislature to be certain that we're providing an equivalent standard of care, it's important for WSMA members to carefully consider how they will maintain safety within visits using audio only," she says, "and also to create templates and checklists to ensure they're not missing critical pieces of information."
</p>
<p>
Outside of his legislative duties, Rep. Riccelli is a community relations manager for CHAS Health, a federally qualified health clinic in Eastern Washington and Northern Idaho. He saw firsthand the importance of being able to expand telehealth services during COVID-19. "It was a huge shift, but we were grateful to be able to do that with our patients who are some of the most in need of access," says Rep. Riccelli.
</p>
<p>
Physician experiences using telehealth, especially on how it relates to patient access to care, is particularly helpful for legislators to hear, says Rep. Riccelli. "Being able to communicate that to legislators, whether in email communications or in-person communications, when they see relevant policy coming up, will be important."
</p>
<p>
For the WSMA and physicians throughout Washington, advances such as the medical licensure compact and payment parity are significant steps toward greater access to quality, affordable care for more patients.
</p>
<p>
"What we suspected from all our years working on this issue is that telemedicine is a safe and effective way to deliver health care services. And our beliefs were supported during the pandemic," says Shepard. "Our goal now is to take those lessons we learned and really push for improved access to care by keeping some of those flexibilities in place."
</p>
<p>
<em>Rita Colorito is a freelance journalist who specializes in writing about health care. She is a regular contributor to WSMA Reports.</em>
</p>
<p>
<em>This article was featured in the September/October 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 9/1/2021 2:42:40 PM | 9/1/2021 2:35:34 PM | 9/1/2021 12:00:00 AM |
| building_a_new_legacy | Building a New Legacy | WSMA_Reports | Shared_Content/News/Latest_News/2021/building_a_new_legacy | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/latest-news/2021/July/july-aug-2021-reports-cover-article-graphic-645x425.jpg" class="pull-right" alt="WSMA Reports July-August 2021 cover graphic" /></div>
<h5>July 20, 2021</h5>
<h2>Building a New Legacy</h2>
<p>
By Nathan Schlicher, MD, JD, MBA
</p>
<p>
As we guide the activities of the Washington State Medical Association in 2021, we are building on the legacy of forward-thinking physicians stretching back to the late 1800s who were striving to make Washington the best place to practice medicine and receive care.
</p>
<p>
When this was still - quite literally - the wild, wild West, our predecessors acted on a desire to meet the care needs of their communities. In those early meetings, an idealistic few cast a vision for the house of medicine: to encourage the unity and harmony of the profession, to advance its interests, and to promote the advancement of medical science.
</p>
<p>
Today, we continue to build on that legacy and vision. We seek to create a sustainable medical association that reflects the times in which we live and practice medicine. We engage tomorrow's leaders today, as we create an association that reflects the population it serves. We look to the past - and the present - to realize a future that is relevant, nimble, and responsive.
</p>
<p>
As with any undertaking, there are challenges. While the tradition of our House of Delegates remains strong, with passionate advocates driving good policy, attendance and engagement in our policymaking process have sharply declined. Reinvigorating our House is central to the work before us, to ensure our physician-driven strategies reflect engagement and diverse, informed perspectives.
</p>
<p>
On identifying and engaging those diverse voices, our membership has spoken clearly and passionately through recent policy passed by our House. Overcoming systemic bias and institutionalized racism requires all voices at the table if we are to effectively address inequities in health care. Change is needed at all levels, including the makeup of our House and its leadership.
</p>
<p>
Another challenge before our medical association is posed by the rapid changes that are a hallmark of today's health care environment. We must equip our WSMA with streamlined and modernized strategies to remain responsive to the fast-changing needs of our state's physicians and their patients, and to engender a culture of connectedness and trust in governance that is key for any healthy organization.
</p>
<p>
The 2019 House of Delegates recognized these challenges and directed the WSMA to develop strategies that would help improve the value of the House. Since then, your WSMA has been hard at work doing just that.
</p>
<p>
To develop these recommendations, the WSMA engaged an external association strategy consulting firm to explore our organizational directives and concerns and to review today's association best practices and market benchmarking.
</p>
<p>
After stakeholder interviews, the recommendations were reviewed by our board of trustees in September and again in November 2020, then submitted to our bylaws committee for development. The board reviewed drafts in January and May and now the final amendments will be up for a vote during the 2021 House of Delegates meeting in the fall.
</p>
<p>
In this issue, you'll find the proposed amendments to the WSMA bylaws (printed in the insert), which reflect the recommended restructuring of our governing bodies. We urge all members to review them prior to the September meeting of the 2021 House of Delegates, when they will be considered for adoption. Your feedback will be solicited via our secure and private online discussion forums.
</p>
<p>
The changes proposed do not alter the policymaking process of the House of Delegates. Instead, the proposal seeks to make the House of Delegates stronger, giving all WSMA members an opportunity to have their voices heard during our policymaking process.
</p>
<p>
These recommendations reflect a transformed path that builds on the best of our traditions, achieves a greater sense of community, ensures a diverse and equitable board of trustees and House of Delegates, and yields a sustainable and relevant association for the next 100 years.
</p>
<p>
Our path forward is in view. Standing together, we can take a bold step into a future we have built that honors the best of who were yesterday, and who we are today.
</p>
<p>
<em>Dr. Schlicher is president of the WSMA.</em>
</p>
</div> | 7/20/2021 3:06:36 PM | 7/20/2021 1:10:37 PM | 7/20/2021 12:00:00 AM |
| by_the_numbers_getting_comfortable_with_discomfort | By the Numbers: Getting Comfortable With Discomfort | WSMA_Reports | Shared_Content/News/Latest_News/2021/by_the_numbers_getting_comfortable_with_discomfort | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports July-August 2021 cover graphic" src="/images/Newsletters/latest-news/2021/July/july-aug-2021-reports-cover-article-graphic-645x425.jpg" class="pull-right" /></div>
<h5>July 20, 2021</h5>
<h2>By the Numbers: Getting Comfortable With Discomfort</h2>
<p>
During the 2021 WSMA Leadership Development Conference, keynote speaker Bill Eckstrom had this to say about change: “What makes you comfortable can ruin you, and only in a state of discomfort can we continually grow.†His talk about getting comfortable with discomfort rang true for attendees and speaks to us today as we consider a transformation of our House of Delegates. As these attendance numbers from recent House of Delegates meetings show, a reinvigorated House is needed to better position your WSMA for the future. To learn more about this transformation effort, read the “<a href="[@]Shared_Content/News/Latest_News/2021/building_a_new_legacy.aspx">Building a New Legacy</a>†column.</p>
<p>
<a href="javascript://[Uploaded files/News and Publications/Newsletters/2021/by-the-numbers-wsma-july-aug-2021.pdf]">Click here to see the numbers</a>.
</p>
</div> | 7/20/2021 3:27:09 PM | 7/20/2021 1:10:34 PM | 7/20/2021 12:00:00 AM |
| facing_the_demands_of_change | Facing the Demands of Change | WSMA_Reports | Shared_Content/News/Latest_News/2021/facing_the_demands_of_change | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/latest-news/2021/July/july-aug-2021-reports-cover-article-graphic-645x425.jpg" class="pull-right" alt="WSMA Reports July-August 2021 cover graphic" /></div>
<h5>July 20, 2021</h5>
<h2>Facing the Demands of Change</h2>
<p>Jennifer Hanscom, Executive Director/CEO</p>
<p>
In the early days of the COVID-19 pandemic, WSMA's executive committee gathered weekly to strategize the association's response to the crisis. With Washington's "Stay Home, Stay Healthy" mandate in place, it wasn't long before we started hearing comments like "It's quiet, like on a Sunday," from a
member describing his medical facility at the time. Another chimed in saying, "Same here, our hospital has the lowest census we've ever had in 20 years." Someone else noted that their emergency department had open beds and no waiting.
</p>
<p>
We marveled at the slowdown of the pace at our members' practices and ambulatory settings. We collectively crossed our fingers, hoping this meant we did enough to have the capacity to care for COVID-19 patients. However, no one anticipated that our chronic or urgent care patients might delay care or necessary procedures. A member at Overlake was the first one to flag for us that the volume of stroke patients had plummeted at his stroke center. It was a harrowing harbinger of things to come, as we knew without a doubt that it wasn't because people weren't having strokes. It was because they weren't seeking care. Soon after, among other disturbing stories, we learned about a heart attack patient who delayed care so long that he died in the emergency clinic's parking lot before he could receive care.
</p>
<p>
For all of us, the pandemic has taken so much. For some patients it took away the will to seek care or it caused critical care to be delayed. For some medical practices, it stole their financial viability, causing reductions in staff or worse, closures.
</p>
<p>
The pandemic was a perfect storm for disastrously compromising the health of patients and practices. It may yet be years until we can assess the full extent of its impact. What we know for now is that the unforeseen consequences will be with us, much as long-haul COVID-19 will be as well.
</p>
<p>
As we emerge on the other side of a pandemic, as well as a racial awakening, among the lessons learned is that we must recognize and face the demands of change head on. I've been reflecting on that lesson as your WSMA leadership contemplates how best to ensure a sustainable organization that reflects the times in which we live, all the people we represent, and the practice of medicine. It's time to look forward and create an opportunity for all voices to be at the table, now and into the future.
</p>
<p>
I urge you to review the insert within this magazine, which outlines the bylaws updates that will be voted on at the annual meeting of our House of Delegates this September. Be sure to also read "<a href="@/Shared_Content/News/Latest_News/2021/building_a_new_legacy.aspx" name="Building a New Legacy"><a href="[@]Shared_Content/News/Latest_News/2021/building_a_new_legacy.aspx">Building a New Legacy</a></a>" for background into the transformational changes these bylaws amendments represent.
</p>
<p>
I'm grateful to the bylaws committee for their diligence and thoughtfulness as they prepared these proposed amendments. Their work captures several months of debate at the WSMA board of trustees. To learn more or to share your thoughts, visit the virtual reference committee discussion forum at <a href="https://wsma.org/vrc">wsma.org/vrc</a>.
</p>
</div> | 7/20/2021 3:05:47 PM | 7/20/2021 1:09:15 PM | 7/20/2021 12:00:00 AM |
| proposed_bylaws_amendments_for_2021 | Proposed Bylaws Amendments For 2021 | WSMA_Reports | Shared_Content/News/Latest_News/2021/proposed_bylaws_amendments_for_2021 | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/latest-news/2021/July/july-aug-2021-reports-cover-article-graphic-645x425.jpg" class="pull-right" alt="WSMA Reports July-August 2021 cover graphic" /></div>
<h5>July 20, 2021</h5>
<h2>Proposed Bylaws Amendments For 2021</h2>
<p>
Your state medical association - its governance and regulation of affairs - is defined by a set of bylaws. And each year a committee, consisting of volunteer WSMA members, convenes to consider changes to these bylaws. Those proposed amendments are then put before the WSMA House of Delegates for consideration.
</p>
<p>
At the 2021 WSMA Annual Meeting this September, delegates will be asked to weigh in on five separate amendments to the bylaws. These proposed amendments reflect discussions at the WSMA board of trustees on restructuring our governing bodies in response to a resolution passed by the 2019 House of Delegates (see "<a href="[@]Shared_Content/News/Latest_News/2021/building_a_new_legacy.aspx">Building a New Legacy</a>" for details). WSMA Reports provides notice of these proposed amendments to members as required by Article XIX of the bylaws.
</p>
<h3>Summary of amendments</h3>
<p>
The proposed bylaws amendments would:
</p>
<ul>
<li>Restructure the board of trustees
<ul>
<li>Remove the AMA alternates from the board of trustees;</li>
<li>Reduce the number of the trustees-at-large from twenty-one (21) to fourteen (14); and</li>
<li>Remove the finance committee chair and designate the secretary-treasurer to be the finance committee liaison to the board of trustees.</li>
</ul>
</li>
<li>
Restructure the House of Delegates
<ul>
<li>Require component county societies to be "functioning component county societies" when apportioning delegates to the Houses of Delegates;</li>
<li>Define "functioning component county society;"</li>
<li>Reduce the number of special sections that receive delegates (removes senior section and osteopathic section);</li>
<li>Create "delegates-at-large" to the House of Delegates;</li>
<li>Require all proposed resolutions be sponsored by two (2) members of the House of Delegates.</li>
<li>Amend the number of days the secretary-treasurer must furnish each member of the House of Delegates and the secretary of each component society and section with a copy of each such resolution from thirty (30) days before the next meeting of the House of Delegates to twenty (20) days (to allow adequate time to process resolutions); and</li>
<li>Add clarification to board of trustees composition regarding the AMA delegation.</li>
</ul>
</li>
<li>
Establish a diversity, equity, and inclusion committee, with responsibilities that include reviewing candidates for delegates-at-large to the House of Delegates.
</li>
</ul>
<p>
In the proposed amendments relating to the items listed above, those portions of the bylaws that are struck out are to be deleted and those colored and underlined are to be added. Bylaws text that remains unchanged and that has been omitted from this document in the interest of brevity is represented by an ellipsis [...]. A complete set of the current bylaws can be downloaded from the WSMA website at <a href="https://wsma.org/policies">wsma.org/policies</a>.
</p>
<p><a href="javascript://[Uploaded files/News and Publications/Newsletters/2021/wsma-julyaug-2021-bylaws-final-amendments-only.pdf]">Download a PDF of all proposed amendments for 2021</a>.
</p>
</div> | 7/20/2021 3:16:35 PM | 7/20/2021 1:10:39 PM | 7/20/2021 12:00:00 AM |
| covid_19s_unforeseen_consequences | COVID-19's Unforeseen Consequences | WSMA_Reports | Shared_Content/News/Latest_News/2021/covid_19s_unforeseen_consequences | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="" src="/images/Newsletters/Reports/2021/july-aug-2021-reports-cover-article-graphic-645x425.jpg" class="pull-right" /></div>
<h5>June 25, 2021</h5>
<h2>COVID-19's Unforeseen Consequences</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
It's been more than 18 months since Washington state reported its first case of COVID-19. During that time, and still today, the pandemic has had far-reaching effects on Washingtonians' health. Beyond those who battled the disease, countless others faced health consequences because the pandemic made them reluctant or unable to receive the care they needed.
</p>
<p>
With the pandemic still not over, the true downstream effects on health care won't be evident for years to come. But preliminary tallies by public health agencies are sobering.
</p>
<p>
Health care avoidance and delay may have contributed to excess deaths outside of COVID-19, according to a February 2021 report from Public Health - Seattle &amp; King County. Age- adjusted death rates in King County were 12% higher in 2020 compared to the previous three years, including a 23% increase for both diabetes-related deaths and overdose deaths, and a 7% increase in cardiovascular deaths.
</p>
<p>
<em>WSMA Reports</em> spoke with doctors from four specialties-pediatrics, general surgery, radiation oncology, and addiction medicine-to find out the impact of the pandemic on their patients.
</p>
<h3>Pediatrics</h3>
<p>
Of all the age groups, children have largely been spared from the devastating health effects of COVID-19. But they've been impacted in other ways, says Amy Carter, MD, chief medical officer for Allegro Pediatrics, which serves families in the eastern Seattle metropolitan area.
</p>
<p>
In the early days of the pandemic, Allegro saw its total visits drop by 70%, says Dr. Carter. "Parents were very worried, so [they] did not want to come in."
</p>
<p>
Data from the Washington State Department of Health show some children may be missing needed vaccinations. From the start of the pandemic through September 2020, DOH data show overall pediatric vaccinations down nearly 19%.
</p>
<p>
Pre-pandemic, same-day appointments made up half of Allegro's daily schedule, with 30% of those dedicated to sick-child visits. Today, Allegro is still only at 80% of pre- pandemic volume. In a parent survey, 10% to 15% said they still don't feel comfortable bringing their children in for any reason.
</p>
<p>
On the plus side, sick-child visits are nearly non-existent, says Dr. Carter. "The vast majority of normal kids would have colds in the winter, or get the flu, or have an ear infection. Those stopped happening because social distancing and masks work," she says. "While it was positive for kids that so few got sick this past year, it was hard for our outpatient pediatric business model to compensate for such a decrease in patient demand."
</p>
<p>
In the pediatric population, the biggest impact was on mental health. "We've never had a higher volume and higher acuity for mental health issues," says Dr. Carter. "(We saw) every mental health diagnosis you can think of-more suicides and suicide attempts, more kids where it's impacting their functioning, or kids who need to go on medication."
</p>
<p>
Parental mental health during the pandemic also affected children. As schools start to open back up, Dr. Carter says she's seen a spike in reports to child protective services-abuse hidden during the pandemic.
</p>
<p>
The developmental fallout for newborns remains to be seen, says Dr. Carter. "We have children who haven't seen anyone outside their immediate family, or left their house, in a year. ...We don't really know long-term what it will do."
</p>
<p>
The pandemic affected childhood physical growth. "Normally children follow their predicted growth line year over year. But this last year was remarkable because we saw a huge increase in weight gain," she says.
</p>
<p>
The percentage of children ages 2 to 17 who are obese increased to 15.4% from June to December 2020, up from 13.7% in the year-earlier period, according to a May 2021 study in Pediatrics.
</p>
<p>
Allegro also saw an increase in children with eating disorders. "This surprised us a little at first, but it shouldn't, in retrospect. For an anxious temperament, with no control over life, in general, eating is one of the few things that you can have control over," says Dr. Carter.
</p>
<h3>General surgery</h3>
<p>
Elective surgery was on the government- mandated cutting block early in the pandemic. As a result, total elective surgery dropped by about 60% to 70%, says Mika Sinanan, MD, PhD, medical director of contracting and value-based care for the general surgery clinic at the UW Medical Center - Montlake.
</p>
<p>
Once those surgeries resumed, some patients further delayed surgery out of COVID-19 fear. Others delayed because of visitor restrictions, says Dr. Sinanan. "It made it harder for patients and their families to support each other. For many patients, that was unacceptable."
</p>
<p>
In some cases, delaying surgery has caused disease conditions to worsen, says Dr. Sinanan, a board member of the Washington Chapter of the American College of Surgeons and president- elect of the WSMA. "I deal a lot with inflammatory bowel disease. And there were some people who were in pretty good shape a year ago who are more malnourished and more ill now. It will take more work to get them better and it will take them longer to recover."
</p>
<p>
UW's general surgery clinic is now operating at full capacity, and then some-continuing to affect elective surgery in a different way. "We had a couple of days where we actually had to cancel or delay elective surgery for up to five days because we didn't have enough hospital beds for our staff to actually offer them surgery," says Dr. Sinanan.
</p>
<p>
Those hoping to schedule their surgery have been frustrated by wait times caused by a backlog, says Dr. Sinanan. "By the time they get to the clinic, they want to have their surgery the next day or as quickly as possible. And sometimes it's not possible to get them scheduled in the time frame they want."
</p>
<h3>Radiation oncology</h3>
<p>
When you're facing cancer, time is often of the essence.
</p>
<p>
"Cancer care is not really elective. We had to rapidly figure out how to safely treat our patients," says Edward Kim, MD, medical director for radiation oncology at the UW Medical Center and a physician at the Seattle Cancer Care Alliance.
</p>
<p>
While current cancer patients continued to receive care, oncologists saw fewer people undergoing preventive screenings. Delayed screening and diagnosis remain the biggest concern for oncologists, says Dr. Kim, treasurer of the Washington State Radiological Society.
</p>
<p>
"I'm starting to see in my practice patients that developed symptoms concerning for cancer last year, but for whatever reason-hesitancy or difficulty getting access to care-they didn't come in. Some of these patients ended up having later diagnoses, or more advanced disease by the time they were actually diagnosed," says Dr. Kim.
</p>
<p>
Nationwide, screening for breast, prostate, and colorectal cancers dropped sharply from March through May of 2020, according to a study published in JAMA Oncology. And while screenings for breast and prostate cancer rebounded in July, the overall estimated COVID-19-associated screening deficit across those three cancers was 9.4 million in 2020 compared to 2019.
</p>
<p>
Dr. Kim and his colleagues have observed a drop in patients presenting with early-stage breast and prostate cancers. "Those are cancers that are often diagnosed with screening. ... I think it's possible they will eventually be diagnosed. And the concern is that those patients may have more advanced disease," he says.
</p>
<p>
More advanced disease means a longer treatment road ahead. "Even if we are able to cure a patient with a more locally advanced tumor, they still may have to go through more treatment and have different side effects than if the cancer been caught earlier," says Dr. Kim.
</p>
<p>
The focus now is to convince people to resume cancer screenings, says Dr. Kim. "We have to reinforce the message that we have protocols to keep patients safe to deliver the care they need."
</p>
<h3>Addiction medicine</h3>
<p>
Pandemic mitigation measures exacerbated the social determinants of stability and recovery that many with substance use disorders contend with on a daily basis, including mental health issues, homelessness, and joblessness, says Lucinda Grande, MD, a family medicine physician with Pioneer Family Practice in Lacey.
</p>
<p>
As a result, those with such disorders were especially hard hit. Not only was this already vulnerable population at 8.7 times higher risk of COVID-19 infection and at a higher risk of hospitalization and death, they also fared worse indirectly.
</p>
<p>
More people died in Washington of drug overdoses in 2020 than any year in the last decade, according to preliminary data from the Department of Health. Overdose deaths from all drugs skyrocketed, up 38% during the first half of 2020 compared to the first half of 2019.
</p>
<p>
"That's up from an average 3% increase over the previous four years," says Dr. Grande.
</p>
<p>
Opioid overdose deaths also increased 36%, with the greatest increase among people of color and tribal communities, says Dr. Grande. If it weren't for previous measures in the state to ensure the availability of naloxone, overdose deaths may have been even higher, she says.
</p>
<p>
The primary reasons for higher rates of substance use are increased social isolation and other stresses, says Dr. Grande. "It's a well-known saying that the opposite of addiction is connection."
</p>
<p>
Though Pioneer never closed its facilities-early in the pandemic, its staff conducted patient visits outdoors- it saw a nearly 30% reduction in patient volume in mid-March, says Dr. Grande. "The most rapid acceleration in overdose deaths occurred between March and May of 2020, coinciding with the implementation of the mitigation measures," she says.
</p>
<p>
Overdose deaths are the tip of the iceberg, says Dr. Grande. Among people who had previously been stable or in a fragile recovery state, she's has seen a significant increase in recurrence of substance use.
</p>
<p>
"A patient stable on Suboxone lost his construction job due to the pandemic and was stuck at home, where long- brewing conflicts exploded," Dr. Grande says. "He turned to alcohol and ultimately, back to heroin to numb the emotional pain. After he got a new job, he finally developed the impetus to return to care."
</p>
<p>
<em>Rita Colorito is a freelance journalist who specializes in writing about health care. She is a regular contributor to WSMA Reports.</em>
</p>
<p>
<em>This article was featured in the July/August 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 6/25/2021 4:35:48 PM | 6/25/2021 10:16:48 AM | 6/25/2021 12:00:00 AM |
| financial_fallout | Financial Fallout | WSMA_Reports | Shared_Content/News/Latest_News/2021/financial_fallout | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="" src="/images/Newsletters/Reports/2021/july-aug-2021-reports-cover-article-graphic-645x425.jpg" class="pull-right" /></div>
<h5>June 25, 2021</h5>
<h2>Financial Fallout</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
On March 19, 2020, with Washington state on the front lines of the surging COVID-19 pandemic, Gov. Jay Inslee took the drastic step of halting all elective surgery. That effectively closed the practice of Seattle-based ophthalmologist Aaron Weingeist, MD. Almost all ophthalmic surgeries, including most cataract surgeries, were sidelined under the governor's initial guidelines. Dr. Weingeist's 18,000-square-foot office building, which includes a surgical center, was suddenly quiet.
</p>
<p>
"It was pretty scary for a few months," says Dr. Weingeist, legislative affairs director for the Washington Academy of Eye Physicians and Surgeons. "We shut everything down and sent 30 employees home," while still keeping the employees on payroll.
</p>
<p>
According to the American Medical Association, ophthalmology saw the biggest reduction in Medicare physician spending in the first half of 2020, with a 29% drop in payments. Without revenue, Dr. Weingeist's fixed costs loomed large.
</p>
<p>
"We have a very large loan, which was a huge stressor," he says. Fortunately, the practice, Clearview Eye &amp; Laser, was able to work out an interest-only payment plan with its bank. Still, he says, "it's a shockingly large amount of overhead when you don't have any revenue coming in."
</p>
<p>
Dr. Weingeist's experience is far from unusual; the pandemic caused havoc for specialists across the state. A Commonwealth Fund study from February found "a substantial cumulative reduction in visits across all specialties over the course of the pandemic in 2020."
</p>
<p>
The governor "definitely did the right thing" shutting down elective surgery, says Arooj Simmonds, MD, executive medical director of surgical services- anesthesia at Swedish Health Services, which serves the Seattle metropolitan area. Yet patient and provider safety came at a high cost.
</p>
<p>
"There was a financial fallout," Dr. Simmonds notes. "You could talk to some surgical groups and they would say they were not paid for months." She notes that physicians tied to hospital groups were less likely to have been impacted.
</p>
<p>
Anesthesiology practices saw "a lot of partners at home, working one day a week, getting a significantly smaller paycheck," she says. "Some practices laid off non-partner physicians."
</p>
<p>
In addition to the elective surgery ban, many patients postponed care to avoid risking exposure to COVID-19. Samuel Lien, MD, president of the Washington State Society of Plastic Surgeons, says that more than half of his practice's business vanished overnight.
</p>
<p>
"If a normal week was 50-60 hours, it was cut back to half or three-quarters of a day in clinic and the same for surgeries," says Dr. Lien, who practices at Providence Mill Creek Plastic and Reconstructive Surgery in Everett. Self- pay cosmetic surgery came to a halt.
</p>
<h3>A return to normalcy-somewhat</h3>
<p>
By the second half of the year, practices had adapted to the new reality and saw patients returning to pre-pandemic levels. "From a surgical perspective, things are getting back to normal," says Dr. Simmonds. "I'd say the same for anesthesiology."
</p>
<p>
For some specialties, the return to normal was even more robust.
</p>
<p>
"We saw a big uptick in elective surgery," says Dr. Lien. "People fortunate enough not to have lost their job were not vacationing and were having a relatively low cost of living, so they suddenly had money. If you can Zoom from home, then it's pretty easy to recover from cosmetic surgery while still performing your work duties. People saw that as a great opportunity."
</p>
<p>
In other cases, however, the rebound is taking longer. "We've gradually ramped back up, but we're still at 75% to 80% of our normal volume," says Dr. Weingeist.
</p>
<h3>Reimbursement challenges ahead</h3>
<p>
This year, as specialty practices recover from the acute impacts caused by the pandemic, they face being squeezed by Medicare and well-meaning initiatives that threaten to divert resources away from them toward primary care.
</p>
<p>
"Our state needs to adequately invest in primary care, that's for certain," says Jennifer Hanscom, executive director/ CEO of WSMA. "Yet we can't further compromise patients' access to care by reducing specialist payments to fund better primary care reimbursement. That's not in anyone's interests-not patients', not the profession's, not the community's."
</p>
<p>
The tumult of the past year has brought those concerns into bright relief. Specialties that are still recovering are now faced with the prospect of a significant reduction in payments as legislators and government agencies look to redistribute money within health care.
</p>
<p>
The pandemic paused many of those initiatives as attention was diverted to the public health response. Chief among the changes put on hold was a revision to the Medicare fee schedule that would have had an outsized impact on specialties. Now that the pandemic is fading, those initiatives will be returning to the fore.
</p>
<p>
As the impact of the pandemic on specialties still lingers, efforts continue to reduce the total cost of health care in Washington state and at the federal level.
</p>
<p>
"There are still a lot of headwinds for the practices, including reimbursement changes at the federal level," says Nathan Schlicher, MD, WSMA president. "It's the challenge of trying to maintain a practice while you're experiencing death by a thousand cuts."
</p>
<p>
Those cuts include the 2021 Medicare fee schedule released late last year. The proposed schedule would have instituted payment cuts to specialties to increase primary care reimbursement. Organized medicine, including the AMA and the WSMA, successfully opposed the move, but the cuts have only been temporarily avoided.
</p>
<p>
"Everyone breathed a huge sigh of relief this year," says Hanscom. "But we're in a situation where if and when the Medicare fee schedule does go into effect, it will be devastating to specialties. On average, the specialty community will be negatively impacted by at least 11%."
</p>
<p>
Then there are Washington state initiatives that aim to bolster primary care. The Health Care Authority's primary care transformation project could be massively consequential as it seeks to reimagine primary care, including financing and how care is delivered, across all payers. Yet details are lacking on how the state intends to pay for that effort.
</p>
<p>
"I'd say at the WSMA, we are feeling a little anxious and uneasy about this effort," Hanscom says. "They are working on a very rapid timeline and we don't know how HCA intends to pay for the transformation. Without a significant and stable long-term infusion of cash, which we are not counting on, then that leads me to believe they will be looking to shift costs. It's not clear if they are looking more broadly than physician reimbursement. I hope so, but if they follow Medicare's playbook, that's when things will get contentious. To date, we don't have these details."
</p>
<p>
Specialists emphasize that they believe that primary care does deserve to be paid better. "Everybody thinks primary care should get more," notes Dr. Weingeist.
</p>
<p>
Hanscom notes that many cost- control efforts focus solely on physicians. These include Cascade Care, which the state describes as a "higher value" health insurance option designed to increase access to care. However, its reimbursement structure often pencils out to be below the cost of delivering services.
</p>
<p>
"I support things like Cascade Care," say Dr. Simmonds. "But we just need to make sure it pays physicians the appropriate rate for what they do."
</p>
<p>
Recently, the governor appointed members to the state's new health care cost transparency board. One of its roles: setting a health care cost growth benchmark for providers and payers.
</p>
<p>
"When we're looking at driving down the cost of care, we should really be looking at the total cost of care, not just physicians," adds Hanscom. "Policymakers can't ask physicians to unilaterally bear responsibility for cutting costs in the system. Our concern is they will try to force physician payments down without addressing any of the underlying cost drivers and overhead, like regulatory and other burdens, and significantly threaten practice viability."
</p>
<p>
Ultimately, says Hanscom, it's the patient who suffers.
</p>
<p>
"If a patient can't get access to specialty care in their community, where does the patient end up? Either the hospital emergency department or in worse condition in a hospital bed," she says. "That's not better, higher- value care. Preventative care is not only delivered by primary care physicians, but specialists as well."
</p>
<p>
<em>John Gallagher is a freelance writer who specializes in covering health care. He is a regular contributor to WSMA Reports.</em>
</p>
<p>
<em>This article was featured in the July/August 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 6/25/2021 4:35:54 PM | 6/25/2021 10:04:20 AM | 6/25/2021 12:00:00 AM |
| q_and_a_with_melanie_de_leon_jd_mpa | Q&A with Melanie de Leon, JD, MPA | WSMA_Reports | Shared_Content/News/Latest_News/2021/q_and_a_with_melanie_de_leon_jd_mpa | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/News/WSMAReports-Extras-Website-645x425.jpg" class="pull-right" alt="WSMA Reports Extra logo" /></div>
<h5>June 16, 2021</h5>
<h2>Q&amp;A with Melanie de Leon, JD, MPA</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
Washington Medical Commission Executive Director Melanie de Leon, JD, MPA, began her involvement with the commission starting in 2003, when, as an assistant attorney general, she litigated cases for several state Department of Health boards and commissions. Through that work, she became "enamored of the medical commission," as she puts it, eventually becoming the commission's executive director. De Leon is directing a dramatic overhaul of the commission's disciplinary and licensing functions, both to bring them up to date and to bring greater transparency and clarity to processes that act as guardrails for the practice of medicine in Washington state.
</p>
<p>
<em>WSMA Reports</em> sat down with de Leon to update WSMA members on these important changes.
</p>
<p>
<strong><em>WSMA Reports</em>: What improvements has the commission made to the disciplinary process? </strong>
</p>
<p>
De Leon: The commission moved to all-electronic case files, decreasing the time to process investigations and the case disposition. We initiated a new classification for health care investigators who complete our standard of care investigations; as such, we now have a clinical health care investigator who must be an MD, DO, PA, ARNP, or RN to qualify. This classification ensures the investigator understands the issues involved in this type of matter.
</p>
<p>
We overhauled the way we conduct our cases involving sexual misconduct. Now each case is assigned two reviewing commissioners, one female and one male; one is a clinician and one is a public member and both must have completed a training regarding a trauma-informed approach to sexual assault/misconduct cases.
</p>
<p>
All the investigators and staff attorneys have completed training regarding a trauma-informed approach to sexual assault/misconduct (which is two-day course).
</p>
<p>
We redesigned the respondent notification letter [read more about the letter below].
</p>
<p>
We are currently developing performance metrics for different steps within the investigative process instead of one overarching measure.
</p>
<p>
We have begun offering settlement conferences for stipulations to informal disposition). This change has led to the commission closing cases and finding that no action was necessary in several instances. While this step for STIDs is voluntary, many commissioners use it.
</p>
<p>
We revamped the compliance process to add an initial phone meeting (now virtual) with a licensee who has a new STID, or order, to explain next steps and to help them through this process.
</p>
<p>
We are researching how to track and manage the cost of disciplinary cases to better manage our litigation costs going forward.
</p>
<p>
<strong>Tell WSMA members about the commission's new notification letter. What is a notification letter? </strong>
</p>
<p>
A letter is sent out to the physician or PA notifying them that the commission has opened an investigation into allegations made against them via a complaint filed with us. In the past, this was a form letter devoid of any information regarding the nature of the allegations. Commission staff met and rewrote the letter to make it customer-oriented and to include, in all cases except those regarding allegations of sexual misconduct, a copy of the redacted complaint. This provides the respondent an opportunity to read the allegations and understand the issues. The respondent also has the opportunity to respond to the allegations later in the investigative process.
</p>
<p>
<strong>Why did you decide to make those changes? </strong>
</p>
<p>
It is important for the person against whom the complaint is filed to know what the complaint is about, so they are not left speculating. While most of our investigations are closed without taking any action, it is still a very stressful time for the respondent, especially if they have no idea what the complaint is about.
</p>
<p>
<strong>When did you roll this out? </strong>
</p>
<p>
The new letter went into practice on Feb. 1.
</p>
<p>
<strong>What steps has the commission taken during your tenure to improve the licensure process? </strong>
</p>
<p>
We have done many things to improve and streamline the licensing process for both initial applications and renewals. We worked very hard to get the Interstate Medical Licensure Compact legislation passed. Our team has created new procedures to process licenses requested through the compact.
</p>
<p>
In 2017, we restructured the personal data questions in our licensing application. We redefined the term "current" regarding medical conditions that might impair the licensee's ability to practice safely by reducing the timeline from two years to six months. We inserted a "safe harbor" option so that a licensee may answer "no" if the behavior or condition is already "known" to the Washington Physicians Health Program. We define "known to WPHP" as "the practitioner has informed WPHP of the behavior or conditions and are complying with all WPHP's requirements for evaluation, treatment, or monitoring."
</p>
<p>
Starting In 2019, we entirely revamped the initial licensing application and did the following:
</p>
<ul>
<li>Changed NPI number requirement (now optional).</li>
<li>Gender "X" option is being added.</li>
<li>Removed fax number requirement (outdated technology).</li>
<li>Education: In most cases, we use information contained in the AMA Physician Masterfile that meets selected primary source verification requirements of the Joint Commission, the Accreditation Association for Ambulatory Health Care, the American Accreditation Health Care Commission, and the AAHCC Utilization Review Accreditation Commission. The AMA Physician Masterfile is a National Committee for Quality Assurance-approved source for verification of medical school, post-graduate training, ABMS board certification, and federal DEA registration. In rare instances, we may request transcripts.</li>
<li>Professional experience: Applicants only need to detail seven years of history, with a requirement to explain any gaps of 90 days or more.</li>
<li>Hospital privileges: Instead of applicant-provided answers, we use the National Practitioner Data Bank.</li>
<li>Licenses in other states: Instead of applicant-provided answers, we use the AMA Physical Profile, FSMB Practitioner Profile, and NPDB report.</li>
<li>AIDS education and training attestation are no longer needed.</li>
<li>A photograph is no longer requested.</li>
</ul>
<p>
In spring 2020, all the licensing processes were mapped and moved to an all-electronic file system. Due to the pandemic, staff were not able to access paper files, so this change enabled them to work remotely.
</p>
<p>
In January 2021, we analyzed the licensing unit workload and developed performance measures for each step of the licensing process, as well as developed reports to track the measures. We reviewed and updated staffing levels to meet new performance expectations. This review resulted in the creation of three new positions:
</p>
<ul>
<li>to process Interstate Medical Licensure Compact applications </li>
<li>entirely dedicated to e-mail and phone call response </li>
<li>and an administrative position to process all the paperwork the unit still receives.</li>
</ul>
<p>
With our new hires, licensers will be free to focus specifically on reviewing applications and moving them forward. Two of these positions are in recruitment and we hope to have them filled by May 1, 2021.
</p>
<p>
Renewals are done online at the present time, other than a few instances when the pandemic fee waiver expired, creating technical systems issues and some limited applications where providers are unable to use this capability. We are still working to get late and retired active renewals online.
</p>
<p>
As of March 2021, we have implemented a process change that will notify applicants that the licensing unit has begun working on their application. The notification provides them with resources to follow up before we do a formal review.
</p>
<p>
Starting January 2021, the licensing manager and licensing lead have conducted several "Coffee with the Commission" live virtual presentations and an FSMB webinar to help provide information and helpful tips to help improve the application process and experience for the applicants.
</p>
<p>
<strong>What is the best way for licensees to provide feedback or ask questions to the commission? </strong>
</p>
<p>
Our <a href="https://wmc.wa.gov/">website</a> has a "contact us" tab that provides a list of topics licensees can select and provide their feedback or pose a question. Based upon the issue, the contact form gets routed to the unit who can respond.
</p>
<p>
<strong>Anything you want our members to know about yourself or the commission? </strong>
</p>
<p>
We do much more than process complaints. We promulgate rules that implement statutes and work closely with stakeholders in developing those rules and to mitigate any adverse impact on licensees. We stand up for physicians and physician assistants regarding scope of practice, the practice of telemedicine, and in all issues that affect the Medical Practice Act. We provide interpretive statements and guidance regarding issues not covered in rule or law. We provide a robust website for licensees to gather information or make inquiries. We develop and provide free educational seminars, webinars, and podcasts to licensees on a myriad of topics, many that also provide free CME credits. While the WMC is a regulatory body, we are unique in our thoughtful and innovative approach.
</p>
<p>
<em>This WSMA Reports Extra is exclusive to the WSMA website. An edited version of this interview is featured in the July/August 2021 issue of WSMA Reports.</em>
</p>
</div> | 6/16/2021 3:42:20 PM | 6/16/2021 3:37:40 PM | 6/16/2021 12:00:00 AM |