| 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> | 1/12/2022 10:11:57 AM | 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 |
| meet_dr_umair_a_shah | Meet Dr. Umair A. Shah | WSMA_Reports | Shared_Content/News/Latest_News/2021/meet_dr_umair_a_shah | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2021/may-june-reports-article-graphic-645x425.jpg" class="pull-right" alt="May/June 2021 cover of WSMA Reports" /></div>
<h5>April 29, 2021</h5>
<h2>Meet Dr. Umair A. Shah</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
The power of medicine to impact society has been the defining thread in the life and career of Umair A. Shah, MD, MPH, Washington state's new secretary of health.
</p>
<p>
That seed was planted in Dr. Shah's life before he was even born. His parents emigrated from Pakistan to Cincinnati in 1960. The son of immigrants, Dr. Shah grew up watching his father cope with serious health challenges.
</p>
<p>
"One time, I remember he was in an incredible amount of pain and had to be taken into emergency surgery. I saw him going behind some doors ... and then a few hours later, the surgery was over, and he wasn't in pain. As a young boy, I attributed that to the doctors and nursesand health care professionals who took care of him," he says.
</p>
<p>
Despite those early experiences, Dr. Shah almost didn't go into medicine. He kept thinking about pursuing law. He nearly set on that path as an undergraduate at Vanderbilt. And then his mother had a devastating stroke.
</p>
<p>
That's when he made the mental shift to a career in medicine. "I felt so strongly that I wanted to help people through difficult times," he says. "I also started to recognize the absolute critical importance of not just medicine, but also public health."
</p>
<p>
In medical school, the history of smallpox eradication caught his interest and he began his foray into global public health. He traveled for a two- month internship at the World Health Organization in Geneva, Switzerland. Global health's symbiotic relationship with domestic health is something Dr. Shah hopes to highlight in Washington state.
</p>
<p>
Getting the public through health crises is something Dr. Shah has been doing throughout his 22-year career. Before taking the public health helm in Washington state in December 2020, Dr. Shah served as executive director for Harris County Public Health in Texas for seven years, managing a $100 million budget and 700 public health professionals, which grew to more than 1,500 staff during COVID-19. He not only led the community through numerous public health emergencies, he and his family (his wife and three children) have survived them, too.
</p>
<p>
As Houston residents, they've been through dozens of natural and man-made emergencies, including hurricanes, flooding, chemical incidents, novel H1N1, Ebola, Zika, and now COVID -19. Dr. Shah spent the bulk of 2020 fighting on the front lines of the pandemic, both as a physician and leading the public health response.
</p>
<p>
In late February, his family—including his wife (an accomplished dentist) and kids, all of whom stayed in Houston to see the school year through—saw so many people impacted during Texas' devastating winter storm. Even that couldn't disrupt Dr. Shah's whirlwind schedule as Washington's top doctor. Since late December, he's crisscrossed Washington state virtually and in person to meet with a wide net of public health and community stakeholders.
</p>
<p>
"I believe strongly that I am the secretary of health for the entire state of Washington," he says. "That's why it is so important for me to go to different parts of the state, whether it's Spokane, or Tri-Cities, Yakima, Mason [County], the Jamestown Tribe, Port Angeles, or the Puget Sound area. At the end of the day, it is important for me to understand and recognize what is happening in those communities."
</p>
<p>
Dr. Shah's lived experience is something he includes when given the opportunity to testify before local, state, and national legislators. In February, Dr. Shah testified in a virtual hearing of the U.S. House Appropriations Subcommittee on public health response capabilities, and the following month, he appeared before the U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee. His overarching message: Public health should be invested in and a fully funded, ongoing priority, not a line item.
</p>
<p>
Public health at the state level can't work as well as it should without committed and sizable federal funding and initiatives, says Dr. Shah. "Chronic underinvestment in public health, not just in Washington, but across the country, is a real issue," he says. "We're seeing it play out in the middle of COVID-19."
</p>
<p>
A big sports fan, Dr. Shah likes to use sports analogies when discussing public health needs. "Public health is the offensive line of the football team, yet everybody focuses on the quarterback, which is health care," he says.
</p>
<p>
His emergency department experience also deeply informed his view of theimportance of prevention. "I realized you could continue to just treat the trauma, or you could go out into the neighborhood and community and try to prevent it in the first place," he says. His other takeaway: Health happens outside of the four walls of a health care setting.
</p>
<p>
"I could tell Mrs. Johnson to exercise. And if Mrs. Johnson goes back into a neighborhood where there aren't parks, or it's not safe for her to walk, or if she has to take two buses to get her around town so time is short, how likely is it she is going to be able to exercise and come back losing weight the next visit?" he says.
</p>
<p>
"It's these social factors of equity—all the housing, transportation, education, and everything else ... that really drive health. And yet we spend so much of our precious dollars in this country on health care delivery, and not on prevention and public health," he says.
</p>
<p>
Equity, in fact, is the first of three core values, followed by innovation and engagement, that Dr. Shah says he will champion as Washington's public health leader. During WSMA's virtual Legislative Summit in February, he presented his big-picture priorities, which also include partnership, capacity building, and global-domestic health.
</p>
<p>
In a coronavirus-free world, Dr. Shah says he would have started his first 100 days focused on listening sessions to get at these core values—he pushed that down the road so he could focus on COVID-19. For now, pandemic response and vaccine rollout remain his top priorities. "The immediate goals are to protect Washingtonians and get us out of this horrific pandemic," he says.
</p>
<p>
Dr. Shah says he accepted Gov. Jay Inslee's appointment for several reasons. "Washington has always championed equity, championed taking care of its fellow Washingtonians," he says. The numerous opportunities for public- private partnerships in both domestic and global health also drew Dr. Shah to swap the sunny confines of Texas for the warmth of Washington's people, if not exactly its cold, rainy days—something he's still getting used to.
</p>
<p>
And then there's the innovation piece— the potential to tap some of the brightestminds at the intersection of technology and health located in Washington, particularly to create state-of-the-art public health data and response systems. "There's a real important opportunity for public-private partnership here," he says.
</p>
<p>
As Washington state's first secretary of health who is also a medical doctor, Dr. Shah wants WSMA members to know they've got a colleague in the public health sector.
</p>
<p>
"I'm somebody who has talked to patients, who has understood the challenges on the ground, in a health care setting, who knows what it's like to be in the middle of a code situation," he says. "Oftentimes public health and health care are in opposition to each other, but they're so intertwined. If we can really bring ourselves together, not because of a crisis, but because it really makes common sense, we have the opportunity to achieve the goal for everyone, which is optimizing their health."
</p>
<p>
He also knows firsthand the overwhelming exhaustion public health and health care professionals have felt throughout the pandemic. "My team had to force me to take a day away, around maybe September, I think, after about eight months of responding to the crisis," he says.
</p>
<p>
In the long term, Dr. Shah aims to transform public health "... to really think about how we can work together, not just in a traditional way, but in an innovative way with equity leading our efforts and engaging all partners and doing everything we can to champion health."
</p>
<p>
As Gov. Inslee rolls out his public health restructuring plan, Dr. Shah views his role and that of the Department of Health as supportive. "We want to provide information. We want to do what we can to explain where we think there are vulnerabilities in the system. We want to be good stewards of public funds. And we want to be subject matter experts providing what the data show," he says. "At the end of the day, our role is to champion the fact that public health must be prioritized."
</p>
<p>
The politicization and vilification of public health is another reason Dr. Shah believes in the power of positive engagement and communication. "We all know that COVID-19 has been politicized. And we've seen in this last year how horrific that can be. More than 500,000 Americans have died, and we have 5,000 Washingtonians who have died," he says.
</p>
<p>
One of his first retweets as the state's top doctor was on COVID-19 vaccine equity. "COVID-19 didn't start public health inequities, but it certainly has unearthed [them] and made them markedly worse," he says.
</p>
<p>
Dr. Shah is adept at social media and uses it often to overcome what he calls public health's "invisibility crisis." From his parents, he learned one shouldn't just call out a problem but work toward a solution. And his solution to this problem requires visibility, value, and validation.
</p>
<p>
"We must raise the visibility of public health. When there is visibility, people seevalue. When people value something, they tend to want to validate it with pro-health policies and/or pro-health resources," he says. "The problem is I never thought public health would see its visibility raised with the fourth 'v', which was virus. COVID-19 has raised the visibility of public health not in a way that's systematic or methodical ... So I really hope COVID-19 is an inflection point for allofusasanationandasaglobeaswe think about transforming health."
</p>
<p>
He offers this assessment of the past year: "2020 was like the first half of the football game and we didn't do so well. We were behind. We came back at halftime, which was right around the holidays, and with the new administration coming in, we have come out of halftime with new strategies and reenergized. Now we're in the second half. And we're hoping we don't see a further surge and continue to move in the right direction."
</p>
<p>
While we don't know yet how the pandemic will end, there is the one certainty in public health. "There will be another emergency lurking around the corner, and we have to be ready for it," Dr. Shah says.
</p>
<p>
For his part, Dr. Shah is committed to investing in the public health offensive line, so the next time, public health isn't stuck scrambling for the next crisis.
</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 May/June 2021 issue of WSMA Reports, WSMA's print newsletter.</em></p>
</div> | 6/3/2021 4:39:22 PM | 4/29/2021 1:22:27 PM | 4/29/2021 12:00:00 AM |
| supporting_washingtons_safety_net | Supporting Washington's Safety Net | WSMA_Reports | Shared_Content/News/Latest_News/2021/supporting_washingtons_safety_net | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2021/may-june-reports-article-graphic-645x425.jpg" class="pull-right" alt="May/June 2021 cover of WSMA Reports" /></div>
<h5>April 29, 2021</h5>
<h2>Supporting Washington's Safety Net</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
For years, public health in Washington functioned largely beneath the radar. Occasionally, issues such as a 2019 measles outbreak in Clark County would raise the visibility of public health departments, only to have them fade into the background once the immediate crisis passed.
</p>
<p>
Then came COVID-19.
</p>
<p>
For more than a year, public health has been front and center in addressing the pandemic. What quickly became apparent was that years of underfunding left public health departments ill- equipped to handle the overwhelming volume of work that the pandemic triggered.
</p>
<p>
"Would we have been more prepared if we had invested in public health infrastructure?" asks Scott Lindquist, MD, Washington state's acting public health officer. "The answer is absolutely yes."
</p>
<p>
Under the state's last two-year budget cycle, foundational public health services received $28 million. A 2018 assessment by the state Department of Health, state Board of Health, local health jurisdictions, sovereign tribal nations, and Indian health programs estimated that fully funding foundational public health services would cost $450 million per biennium budget.
</p>
<p>
In fact, public health in Washington state has been underfunded for nearly two decades. In the 1990s, the state created a dedicated funding source for public health through the motor vehicle excise tax. A 1999 ballot initiative removed that funding, and another ballot initiative shortly afterward limited property tax increases that would have funded public health initiatives. (The WSMA has been calling for a dedicated funding source for public health since 2002.)
</p>
<p>
"I love the analogy that public health is a house that is 100-plus years old, but the foundation is crumbling and the infrastructure is showing signs of wear," says Dr. Lindquist. "But we keep having events like H1N1 where we get streams of funding, which is like getting a curtain for the third story of the house."
</p>
<p>
The failure to adequately resource public health infrastructure meant that a crisis was inevitable. Like the 100-year-old house where maintenance had been deferred for years, at some point the infrastructure for public health was bound to buckle under stress.
</p>
<p>
"COVID-19 just illustrates some of the outcomes you get" from underfunding public health, says Alan Melnick, MD, public health director and Clark County health officer. "I'm not blaming lack of public health funding for COVID, but in terms of having preparation early on and being able to respond quickly, we were challenged because of the way we've been underfunded and understaffed for many years."
</p>
<h3>An all-encompassing mandate</h3>
<p>
While the coronavirus has focused attention on communicable diseases, public health encompasses far more than that. Its portfolio covers everything from chronic disease and injury prevention to environmental health and maternal, child, and family health—from tobacco cessation to septic systems.
</p>
<p>
"It's not just infectious disease we're worried about," says Jeff Duchin, MD, health officer for Public Health — Seattle &amp; King County. "I'm increasingly concerned about climate change and [its] impact, and all of our chronic disease influenced by social determinants of health. These are chronically neglected areas of work that have never been adequately funded, yet are responsible for the largest portion of morbidity and mortality."
</p>
<p>
Indeed, public health is a critical component of patient care.
</p>
<p>
"It's easy to get lost in the day-to-day as an individual physician caring for patients," says Andrea Carter, MD, chief medical officer for Samaritan Health Care in Moses Lake. "But we don't reach the whole community."
</p>
<p>
By contrast, says Dr. Carter, public health can collaborate with all the clinics in the district on a coordinated response to local challenges. "When we do a gun safety event, it's spearheaded by the health district and all the clinics work together," she says. "It's a community- wide initiative. Those are big issues that can be addressed, and we can gain a lot more ground doing it that way." While individual providers may be addressing the same problems in one-on-one settings or even through an institutional effort, the impact can't be as great.
</p>
<p>
Dr. Carter says the pandemic brought home just how vital public health is for all patient care. "There has been a unified command and weekly public health briefings," she says. "We were able to have a common goal and the same message for patients. We learned to appreciate the important role of public health through COVID."
</p>
<p>
Dr. Lindquist notes that despite its limitations, the public health system and the people working within it performed heroically in the face of the pandemic.
</p>
<p>
"COVID did not break the public health system in Washington state," he says. "We identified the first case in the country. We got this person tested, got results the next day, and got him hospitalized, all seamlessly because the system was in place. COVID probably wasn't in Washington first, but our system was intact enough to detect it."
</p>
<p>
Still, the pandemic revealed cracks in the system that are undeniably deep. Long-standing problems with data systems, lab capacity, and staffing became abundantly and painfully clear.
</p>
<p>
"One of the big things the pandemic pointed out was how fragmented our data systems are, in terms of providing real- time access to data," says Amy Person, MD, the health officer for the Benton- Franklin Health District. "We still get a lot of our info from labs and hospitals by fax. It's one thing when in a normal year you have at most 1,500 to 2,000 cases, and it's another when at the high point you have hundreds of cases a day. Then people couldn't even fax to us."
</p>
<p>
Dr. Duchin notes that states had to scramble to create a large-scale immunization system. "We had to scale one up cobbling together new data- management technology," he notes.
</p>
<p>
Limited lab capacity constrained testing at the start of the epidemic. Staffing problems were inevitable after years of budget cuts.
</p>
<p>
"During the pandemic, it was all hands on deck," says Jaime Bodden, managing director of the Washington State Association of Local Public Health Officials. "You had environmental public health staff who normally work with restaurants or permitting septic systems working on the pandemic."
</p>
<h3>A lack of advocacy</h3>
<p>
All of these challenges were the result of a long and steady decline in public health funding.
</p>
<p>
"We have woefully underfunded public health," says Rep. Marcus Riccelli, D-Spokane, the House sponsor of Senate Bill 5149, which would strengthen public health funding. Riccelli is also the sponsor of House Bill 1152. That measure, which passed the House by a 56-41 vote in March, would create four regional centers to coordinate shared services across local health jurisdictions and the state.
</p>
<p>
"We talk about public health as the front line of defense, and we see what happens when we don't fund it," he says. "Everyone everywhere should be able to get some standardized level of public health that is reliable. We know that a strong public health system is possible with intentional investments."
</p>
<p>
Part of the challenge for public health is that its work is easily overlooked. "There's no advocacy group for people who don't get sick," says Dr. Melnick.
</p>
<p>
"You can't point to a road and say, 'This was brought to you by public health,'" Bodden says. "When public health does its job, nothing happens, and that's not a good selling point."
</p>
<p>
Since the loss of a dedicated revenue source, "our funding has become very destabilized, very piecemeal and stagnant," Bodden says. "It's been the same amount for the past 20 years." Over that period of time, the population in the state has grown by more than 1.7 million.
</p>
<p>
The lack of funding may make sense to legislators in the short term, but in the long term, the costs are simply deferred, not eliminated. Dr. Duchin notes that there are thousands of undetected cases of latent tuberculosis in King County alone. Treating latent tuberculosis costs about $500. Treating active tuberculosis costs about $17,000.
</p>
<h3>Chasing dollars</h3>
<p>
To make up for the revenue shortfall, health districts end up chasing dollars from other sources. Unfortunately, the funding that is available is often structured in a way that limits its impact.
</p>
<p>
"There are programs that come and go," says Dr. Duchin, citing chronic disease and injury prevention as examples. "The funding is episodic and not stable, and it requires competition. It's a significant investment in time and energy just applying for grant funding."
</p>
<p>
"The funding tends to be very project- based and very specific, which is a challenge because in public health things aren't separated," agrees Dr. Person.
</p>
<p>
The project-specific grants also create other problems. "You have funding to work on tobacco-related things, so you build up a network of community partners and start moving things forward," says Dr. Person. "Then tobacco is not a big issue, but diabetes is. Suddenly, the work you've done with tobacco is done, and you can't just shift that over to diabetes."
</p>
<p>
The emphasis on projects and deliverables rubs against the long-term emphasis that public health should have. However, desperate for some funding sources to help their communities, health districts feel the need to pursue them, despite the downside.
</p>
<h3>Politics over science</h3>
<p>
Simply increasing funding for public health will not solve all its problems. Like all too many institutions, the system and its leadership have become targets of intense politicization. Last November, the Spokane health board fired health commissioner Bob Lutz, MD. Dr. Lutz was a focus of attention from Spokane Mayor Nadine Woodward, who complained that the county was not moving forward rapidly enough toward reopening. She also criticized Dr. Lutz for talking about what she termed "controversial" topics, such as climate change, without the board's consent.
</p>
<p>
Such episodes highlight the delicate role that public health plays.
</p>
<p>
"Public health officers are sometimes forced to implement policy that will have a significant negative impact on some individuals and their livelihood," says William Hirota, MD, a gastroenterologist at Virginia Mason Franciscan Health and a member of the Tacoma-Pierce County Board of Health. The Tacoma-Pierce County Health Department faced its own political firestorm in November, when several Pierce County Council members proposed to dissolve the joint city and county department. "You end up with some animosity."
</p>
<p>
In retrospect, some of the problem could have been alleviated with closer ties to community stakeholders, he says.
</p>
<p>
"Part of the problem of not being completely prepared is a lack of relationship building," says Dr. Hirota, who is the immediate past president of the WSMA. "One of the lessons learned is that in order to build an effective public health foundation, we're going to need to have a clear reassessment of our needs, develop policies that are going to be timeless, build these plans out, and be accountable for them. That means we need to be very engaged in public-private partnerships."
</p>
<p>
Even with improved funding and structural change, other challenges will remain. "Our workforce is diminishing" as a result of funding cutbacks over time, says Dr. Melnick. "We have to train a workforce to do this work, and we need to have a more diverse workforce."
</p>
<p>
Ultimately, says Dr. Lindquist, the goal should be to provide enough unrestricted funding so that every public health district in the state can provide the same level of services.
</p>
<p>
"When I look at rabies, am I going to get the same level of protection in Seattle as I will in Othello?" he asks. "No matter where you are a resident of Washington state, you should have the same level of public health protection."
</p>
<p>
Dr. Lindquist is cautiously optimistic that such a goal is attainable as a result of the pandemic. "I have been in public health since 2001," he says. "We have never had as much attention paid to the need to fund the infrastructure for public health as we are seeing now."
</p>
<p>
<em>John Gallagher is a freelance journalist who specializes in covering health and the health care system. He is a regular contributor to WSMA Reports.</em>
</p>
<p><em>This article was featured in the May/June 2021 issue of WSMA Reports, WSMA's print newsletter.</em></p>
</div> | 6/3/2021 4:39:36 PM | 4/29/2021 10:36:59 AM | 4/29/2021 12:00:00 AM |
| health_equity_101_class_is_in_session | Health Equity 101: Class Is in Session | WSMA_Reports | Shared_Content/News/Latest_News/2021/health_equity_101_class_is_in_session | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2021/march-april-cover-645x425.jpg" class="pull-right" alt="WSMA Reports March/April 2021 cover image" /></div>
<h5>March 22, 2021</h5>
<h2>Health Equity 101: Class Is in Session</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Pat Curry
</p>
<p>
After working as a street medic and having extensive involvement in the anti-war movement in New York, Luis Manriquez, MD, decided to go to medical school to gain "the technical skills to address social justice."
</p>
<p>
As a student at the University of Washington School of Medicine, he founded the Health Equity Circle, an interprofessional group that equips students to take action on health equity using the tools of community organizing.
</p>
<p>
"When I started medical school, people knew about social determinants of health and thought it was cool, but it wasn't expected to be part of your medical training," says Dr. Manriquez, who now is an assistant clinical professor at Spokane's Washington State University Elson S. Floyd College of Medicine, where he also leads health equity development efforts. "Now, it's an expectation when students come in, and I think that's great. The mindset of students is that this is part of being a doctor."
</p>
<p>
Indeed, health equity has become part of the fabric of medical training in Washington state. All three of the state's medical schools have extensive ongoing efforts to incorporate equity into their curriculum, and they are working to address systemic implicit bias and expand the diversity of their student bodies.
</p>
<p>
There's no better time than during medical school to plant the seeds, says Michael Lawler, MSW, PhD, president of Pacific Northwest University of Health Sciences in Yakima.
</p>
<p>
"If you train people to work with each other, they'll do that when they go out in the field," Lawler says. "It's an aspirational vision, but when we think about COVID, the two issues facing us are health and equity. They're both apparent."
</p>
<h3>Creating an inclusive environment</h3>
<p>
At PNWU, equity and inclusion are being integrated across the university's strategic five-year plan. That includes organizing an office dedicated to equity, diversity, and inclusion. Workshops on bias and microaggression have been held for students, faculty, staff, and the board of trustees "at their request," says Mirna Ramos-Diaz, MD, MA, FAAP, who recently was named PNWU's first chief diversity officer. The university also is creating a restorative justice model, which emphasizes repairing harm through collaboration.
</p>
<p>
In 2020, the University of Washington School of Medicine created the Office of Healthcare Equity. The office has been hard at work to make addressing equity and implicit bias central to how the school runs. Almost all of UWSOM's 32 clinical teams currently have an equity team and a bias reporting tool is making it easier for members of the community to speak up.
</p>
<p>
"After the events of the summer— the killing of George Floyd and others and the protests—our leadership took the strong stance to require equity, diversity, and antiracist training for all members of our community," says Paula Houston, EdD, chief equity officer for UW Medicine, the parent health care system for UWSOM. "The fact that people are having the conversation has really built awareness and the realization they need to change behavior."
</p>
<p>
The office also has created an equity impact review tool so that policies and procedures can be viewed through an equity lens. The goal is to make it as easy as possible to say who a policy will benefit, who it will burden, and how to mitigate that burden.
</p>
<p>
Houston says that when she presented it at a leadership meeting, she thought one or two people might be interested in piloting it.
</p>
<p>
"Nine departments wanted to do it immediately," she says. "People want to do the right thing; they just didn't know how to do it. They want to make this a better environment."
</p>
<p>
David Garcia, MEd, WSU's assistant dean for health equity and inclusion, says the work being done today on health equity and implicit bias is much like it was with technology in the early 1990s, when organizations had to develop the infrastructure to embrace the digital world.
</p>
<p>
"At some point, we all had to get email," Garcia explains. "With inclusion, we are at a point where we need to develop the infrastructure and become healthier as organizations. We want to be able to look back in 10-15 years and say we're doing our part. Our communities depend on it. The rationale has never been clearer to me on why we need to be doing this work."
</p>
<h3>Weaving equity into curriculum</h3>
<p>
How do medical schools ensure the educational experience doesn't perpetuate stereotypes?
</p>
<p>
"That is the million-dollar question," Garcia says. "We do case-based learning and a lot of small-group learning. When we introduce a case at the beginning of the week, how are we ensuring cases are reflective of the state of Washington?"
</p>
<p>
Dr. Manriquez says a health equity thread is woven through all four years of training at the WSU medical school.
</p>
<p>
"My approach is that medical school doesn't make you an expert in anything; you get an introduction," he says. "If that's true of the liver and the heart and the kidneys, it's also true of health equity. We want to develop a foundation to understand the concept. So, in the first two years, we have foundational sessions; in the session on bias, we explain the science of bias, how it works, and antibias tools. We do the same thing with racism, sexism, disabilities, health literacy, and making use of an interpreter."
</p>
<p>
In the third year's longitudinal integrated curriculum, there's more content in understanding bias and equity in a clinical setting. "Why do you see this difference in health outcomes by race or status? Some are assumptions on the part of the provider or the patient; some are actual barriers to access. ... These inequities in health are a huge deal; the differences in black and white life expectancies are tremendous."
</p>
<p>
UWSOM went through a curriculum renewal in 2015 that added eight themes that go across all four years of study, says Suzanne Allen, MD, MPH, vice dean for academic, rural, and regional affairs for the medical school. Those themes are communication, diversity, ethics, health equity, inter- professionalism, lifelong learning, quality and safety, and professionalism.
</p>
<p>
The school also recommends that all students read a common book each year on a social justice issue. For 2020-2021, the book is the thought-provoking "How to Be an Antiracist" by Ibram X. Kendi.
</p>
<p>
Through its Pathways programs, students can focus on serving a marginalized population.
</p>
<p>
"The idea is they do an elective course in the first year or two of medical school and do a summer clinical experience with that population," Dr. Allen says. "We then ask them to do one of their required third-year rotations with a clinic or facility where they'll see a large number of those patients."
</p>
<p>
Standardized patient encounters provide a great opportunity for faculty to make students think about their own bias and whether it is creating blind spots in care, says Thomas Scandalis, DO, dean of the College of Osteopathic Medicine at PNWU.
</p>
<p>
Sometimes, it's as simple, and as crucial, as making students aware that assumptions can lead them astray.
</p>
<p>
"A student sees a mom with a child and says, 'Where's the dad? Tell me about your husband,' " says PNWU's Dr. Ramos-Diaz. "They're assuming the other parent is a man."
</p>
<p>
Students also need to be prepared "for working with [older] people like me who aren't current on how to address people," Dr. Scandalis says. "Our students are very comfortable in their own skin. Some get a little freaked out, though, when they get on rotation and hear that bias."
</p>
<p>
"That is why we have training at the beginning of the year," Dr. Ramos-Diaz says. "Their eyes are opened."
</p>
<h3>Recruitment</h3>
<p>
Perhaps the most exciting and potentially impactful effort at the medical schools is in recruiting future classes of medical students. All three schools are looking closely at the methods used to select applicants.
</p>
<p>
Both the WSU Elson S. Floyd College of Medicine and PNWU take a holistic approach to the admissions process and avoid making decisions solely on grades and MCAT scores. "An overreliance on GPA and MCATs can really eliminate diverse populations you want to enroll," says Leila Harrison, PhD, MA, MEd, senior associate dean for admissions and student affairs at the WSU medical school. "It can be a barrier; we focus on the mission."
</p>
<p>
The school also recruits at rural colleges and community colleges. "That's not common for medical schools," Harrison says.
</p>
<p>
But efforts go far beyond that, even to connecting with children as young as elementary school age to spark an interest in becoming a doctor. PNWU's communications staff has produced a children's book, "I Want to Be a Doctor! A Day at Medical School." The book also has been translated into Spanish.
</p>
<p>
A year-long peer mentoring program called Roots to Wings pairs Native American and Mexican American middle and high school students with PNWU students.
</p>
<p>
"We use cultural values and traditions as a conduit to teach sciences," Dr. Ramos-Diaz says. "When you bring cultural values and science together, students have a greater desire to participate and that science has meaning. Then, they're excited. I remember a student saying to a med student, 'So does that mean as a Native, I can be a doctor?' Of course, yes! It was like an awakening."
</p>
<p>
Students who are particularly interested are invited to participate in a two-month summer internship at the National Institutes of Health in Bethesda, Maryland, where they are paired with scientists from their own background when possible.
</p>
<p>
LeeAnna Irvine Muzquiz, MD, associate dean for admissions at UWSOM, is a member of the Confederated Salish and Kootenai Tribes and grew up on the Flathead Reservation in Montana. She says the admissions office has moved away from the concept of creating "pipelines" of applicants to more of an "ecosystem" approach.
</p>
<p>
"When we think about pipelines, they tend to break and leak," Dr. Muzquiz explains. "A pipeline seemed to work for me, but it was the mentoring and the surrounding ecosystem that helped me make it through [medical school]. All of us have a role to play in nurturing the next generation; we can all have an influence on what the ecosystem looks like."
</p>
<p>
UWSOM's efforts include Doctor for a Day. The vision of the program, which is organized by medical students, is to bring a hands-on, educational day of activities to students of color, featuring volunteer doctors, physical therapists, nurses, and dental students who look like them.
</p>
<p>
At that age, having someone believe in and encourage you can have a tremendous impact, says UWSOM's Dr. Allen. She was planning to be a nurse until a visit to her family physician for a school physical. On hearing her plans for nursing, "He asked me, 'Why don't you want to be a doctor?' and he let me follow him around," Dr. Allen says. "I can trace five women from the same era who became physicians because of him."
</p>
<p>
<em>Pat Curry is senior editor of WSMA Reports.</em>
</p>
<p>
<em>This article was featured in the March/April 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 3/22/2021 1:01:53 PM | 3/22/2021 1:00:41 PM | 3/22/2021 12:00:00 AM |
| trial_by_covid_19 | Trial by COVID-19 | WSMA_Reports | Shared_Content/News/Latest_News/2021/trial_by_covid_19 | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2021/march-april-cover-645x425.jpg" class="pull-right" alt="WSMA Reports March/April 2021 cover image" /></div>
<h5>March 18, 2021</h5>
<h2>Trial by COVID-19</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
Vera Schulte had two weeks left in her third year of medical school when the University of Washington School of Medicine locked down due to COVID-19. Because UWSOM has a condensed pre-clinical curriculum, Schulte finished almost on time. Friends in other medical schools, she says, weren't so lucky.
</p>
<p>
"They were delayed in finishing their third year, which makes applying for residency quite a bit more difficult. If
you haven't rotated in pediatrics, family medicine, or general surgery, etc., it's hard to realize that's the kind of doctor you want to be," says Schulte, whose chosen specialty is obstetrics and gynecology.
</p>
<p>
Much of clinical training is trial by fire. Being in the room where health care happens is critical to medical education and residency. Under normal circumstances, that means long hours
interacting directly with faculty and patients in a team-based approach.
</p>
<h3>Starting from scratch</h3>
<p>
COVID-19 burned medical-education- as-usual to the ground—at least in the short term. As the pandemic surged, medical schools and residency programs grappled with staying safe. Personal protective equipment was running low. Preceptors manning the pandemic front lines couldn't oversee usual rotations. Statewide clinical training and rotations ceased mid-March, going virtual over risking the unknowns. Most wouldn't resume in-person training until July.
</p>
<p>
Nationwide, the American College of Surgeons shut down clinics and operating rooms to fellows and residents. "[It was] very frightening because this had never been done in the history of the ACS," says Byron Joyner, MD, MPA, UWSOM's vice dean of graduate medical education, who sent residents and fellows home to ensure their safety.
</p>
<p>
"We didn't know how our trainees should be involved in a pandemic and we didn't have enough PPE at the time," says Dr. Joyner. He spent the first weeks of lockdown fielding calls from anxious students and calling the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties for guidance.
</p>
<p>
"Residents and fellows were afraid that they might not be able to take their boards after graduation without having done enough rotations," says Dr. Joyner. "The most subtle and nerve-wracking concern was just the uncertainty and the ambiguity. What was next? When would this be over?"
</p>
<p>
The response to the shutdown from students was a mixed bag, says Suzanne Allen, MD, MPH, UWSOM's vice dean for academic, rural, and regional affairs. Some didn't feel safe on their clerkships, while others expressed frustration at missing a once-in-a-lifetime opportunity to care for patients during a pandemic.
</p>
<p>
The solution to both: a virtual course in pandemics the first half of spring
quarter, followed by virtual rotations the second half. These proved very popular, says Dr. Allen.
</p>
<p>
Being honest about what they knew and didn't know helped Washington State University's Spokane-based Elson S. Floyd College of Medicine quell anxiety, forge forward safely, and build institutional resilience, says Judith Bowen, MD, PhD, its associate dean for curriculum.
</p>
<p>
"In this way, we are able to help students understand our obligation to keeping them, their family members, and our faculty (and staff) safe, and to avoid having any of us inadvertently contribute to ongoing viral transmission," says Dr. Bowen.
</p>
<h3>Embracing opportunity, virtually</h3>
<p>
WSU College of Medicine's longitudinal integrated clerkship design allowed students pulled from clerkship to continue learning through a virtual, case-based curriculum, says Dr. Bowen. The longitudinal design meant that all students had completed some direct patient care experience in all of the clerkship disciplines before moving to the virtual curriculum. As the clinical environment settled and more PPE became available, in-person training resumed in June. "Although we planned for future disruptions, third- and fourth- year students have been fully engaged as part of the clinical workforce since then," says Dr. Bowen.
</p>
<p>
Despite initial drastic measures, medical schools not only adapted, but also strengthened the way they teach thanks to the pandemic, says Anita Showalter, DO, associate dean for clinical education at Pacific Northwest University of Health Sciences in Yakima.
</p>
<p>
Used only sporadically pre-COVID-19, medical schools and residencies fully embraced Zoom and other online platforms for town halls, webinars, team meetings, and to provide eyes-on patient care. Within a week of the shutdown, all PNWU core rotations were online. To replicate the in-clinic experience, PNWU used standardized patient simulations via teleconferencing (one example: working through videos of a vaginal birth).
</p>
<p>
"The goal was to make them work through analyzing patients and clinical decision-making as they would have if they had been in the clinic with their preceptors," says Dr. Showalter. As students have returned to rotations, PNWU has maintained the online curriculum to accommodate students and preceptors testing positive for COVID-19 or needing to quarantine.
</p>
<p>
Even though rotations have resumed, they still look different. To reduce the risk of transmission and to be sensitive to patients, rotations have limited team size. "It didn't seem right to let medical students participate when the patient's own family couldn't come in," says Dr. Showalter.
</p>
<p>
Wherever medical schools can go virtual, they have. At UWSOM, that includes clerkship orientations and lectures. "We don't want large groups of people congregating in the same place," says Dr. Allen. The benefit to that, she says, is all clerkship students, regardless of where they are across UWSOM's six regional campuses and 200 clinical sites, can now attend all lectures.
</p>
<p>
Amid the chaos, the goal remains to give students enough experiential learning to graduate, says Dr. Showalter. That's where newfound teleconferencing skills have come in. "We had one situation where the doctor contracted COVID. The student went into the clinic and via teleconferencing, connected the patient with the doctor. [The student] could be the hands for the doctor who was not able to be on site," she says.
</p>
<p>
The pandemic has also affected residents who aren't patient-facing, says Elizabeth (Libby) Parker, MD, a third- year UW resident in anatomic pathology last spring. As elective procedures were cancelled or delayed, Dr. Parker saw a shift in the kinds of specimens she received.
</p>
<p>
"We're very closely linked to what our clinical and surgical colleagues are able to perform, procedure-wise. What they're able to do really impacts our clinical work," she says. As elective procedures have increased, Dr. Parker is now seeing the full spectrum of cases.
</p>
<h3>Silver linings</h3>
<p>
While students are required to complete yearly infection control reviews, the hyper-awareness surrounding COVID-19 has had a measurable impact. "It's already led to a decrease in other kinds of hospital infection rates," says Dr. Allen; it's something she sees continuing.
</p>
<p>
"Students who are in medical school right now, who are 'growing up' during a pandemic, are going to be so much better at infection control, because that's what they've known from the start," she says.
</p>
<p>
Resident research and scholarly activity also increased because of the pandemic, says Dr. Parker, who co- published medical education literature on her experience teaching remotely. "There's been a bolus of research on COVID-19. It's been exciting to have so many minds working on the same problem from so many different specialties," she says.
</p>
<p>
Dr. Parker has also welcomed the didactic creativity offered by online platforms. She still uses Path Presenter, a virtual platform where pathologists worldwide can share digital slides. "We're able to use it to teach and still be interactive and simulate our day-to-day work," she explains.
</p>
<p>
COVID-19 also highlighted inequities in health care—and the need for clinical training to address those concerns head on. Graduating doctors with more robust telemedicine experience is one downstream effect of the increase in virtual clinical training and a real benefit for rural patients, says J. Miguel Lee, MD, residency program director for Providence St. Peter Family Medicine's Chehalis Rural Training Program (CRTP). "It was actually one of the silver linings, if you will, of this catastrophe," he says.
</p>
<p>
A small residency program and clinic, CRTP gathered its faculty and nine residents to develop a plan for patients who couldn't get to the clinic or were too wary of coming. "We went from no virtual care to 100% virtual care in a matter of two days," says Dr. Lee.
</p>
<p>
In the neighboring communities, telemedicine has been embraced, he says. "We had 95-year-olds with their grandkids holding their phone up for virtual care and it's really worked quite well."
</p>
<p>
Even though residents have seen patients virtually, it hasn't taken away from their experience serving rural communities. "It's just an added tool
in our toolbox," Dr. Lee says, "and, you know, potentially, it will increase access to people who can't drive for two hours for an appointment but can turn on the computer at home."
</p>
<h3>From health care to human care</h3>
<p>
Amid the winter surge, many of the same trainee concerns around safety, education, and patient care remain, says Dr. Joyner from UWSOM. "They're worried about getting sick and getting others sick," he says. "They're worried about not having enough education to graduate, not enough competence and confidence. It strikes at their very core of being a doctor."
</p>
<p>
The availability of vaccinations for themselves and their families also worries residents, says Dr. Joyner, adding that most of UWSOM's 1,400 trainees have already received their first dose.
</p>
<p>
One year after the first COVID-19 cases, Dr. Showalter says her biggest concern is students' mental health and well-being. "Medical school tends to be a very alone time, with students working very hard but isolated from other social supports," she says. "With all the COVID restrictions, that was doubly bad. So, we're really watching our students to make sure they're staying in a good place mentally," she says.
</p>
<p>
Dr. Lee echoes her concerns. "Wearing masks all the time and not being able to gather, I think that is taking away one of our tools for wellness—the activities we normally did together," he says. "Despite the fact we can't do those things, I think we still feel very, very united with our group."
</p>
<p>
"In some ways we are missing out on human connection," Dr. Parker says. "But I think that hopefully time will show we're still able to do a lot of good and we're still able to have enthusiastic engagement."
</p>
<p>
To keep students engaged and feeling connected during isolation, medical schools encouraged service and research projects. "When vaccine supplies began to arrive, our clinical partners reached out to invite student volunteers to assist with administration," says WSU's Dr. Bowen.
</p>
<p>
UWSOM created many opportunities for COVID-19-related service learning. Many, like Schulte, volunteered for the Seattle Coronavirus Assessment Network to assist with screening and testing. In her spare time, Schulte also babysat for health care workers. Academically, she participated in a research project on COVID-19's impact on pregnant women in Washington state.
</p>
<p>
"Although being pulled from clinical duties was difficult, I was tremendously grateful for the plentiful opportunities during this time to continue supporting the community and continue my medical education, even if it was outside of the hospital," Schulte says.
</p>
<p>
Residents and faculty have shown incredible resilience throughout the pandemic, says Dr. Joyner. Many trainees have repeatedly asked to be redeployed to the COVID-19-dedicated ICUs. "They have contributed enormously to our effort to keep our community safe and to care for our sickest patients," he says.
</p>
<p>
Last fall, Schulte's six-days-a-week clinical training schedule returned to pre-COVID-19 levels. During her gynecologic oncology sub-internship, she started pre-rounds by 5:45 a.m. and signed out at 6 p.m. After a quick dinner, she reviewed medical student projects and worked on her own research, finally getting to bed by 11 p.m. The more things change, the more they stay the same.
</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 March/April 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 3/18/2021 4:11:48 PM | 3/18/2021 4:02:28 PM | 3/18/2021 12:00:00 AM |
| stormy_seas | Stormy Seas | WSMA_Reports | Shared_Content/News/Latest_News/2021/stormy_seas | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/Newsletters/Reports/2021/Jan-Feb-2021-Reports-Cover-645x425px.jpg" class="pull-right" /></div>
<h5>January 19, 2021</h5>
<h2>Stormy Seas</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>By John Gallagher</p>
<p>
When the COVID-19 pandemic exploded in early March, Ki Shin, MD, was on
vacation in Hawaii with his wife, also a physician, taking a break from
their practice in the small town of Montesano. "We got there on Monday
and then the governor's restriction happened," Dr. Shin recalls. "All
of a sudden, we were out of town and my staff was freaking out. It was
an immediate crisis. Not a lot of information was available to us, and
we had a lot of scared people, staff and patients included."
</p>
<p>
Upon their return home, the Shins immediately set about trying to
stabilize their practice. Faced with a 40% drop in appointments, the
couple took a 50% pay cut so that they could keep their staff on
payroll.
</p>
<p>
"For us not to get paid for a couple of months was totally doable, but
that was not true for the staff," says Dr. Shin.
</p>
<p>
After a rough few months, some of the financial pressures eased. The
Shins obtained a loan under the Paycheck Protection Program (PPP), the
part of the federal Coronavirus Aid, Relief, and Economic Security Act
designed to help small businesses. They also received $30,000 from
Medicare, which covered the practice's overhead for a month.
</p>
<p>
Eventually, patients started returning, and Dr. Shin's practice is
stable again, but still not entirely recovered. "The [patient] volume
is coming up, but it's not back to normal," he says. "It's about 90% of
what it was previous to COVID."
</p>
<h3>Survey answers detail challenges</h3>
<p>
The recovery of Dr. Shin's practice, and other practices around
Washington, is a hopeful sign. However, the new normal falls short of
the old one. Moreover, the ever-changing course of the pandemic,
including the potential for another lockdown, makes the outlook for
practices in Washington uncertain at best.
</p>
<p>
"Physicians are doing okay right now, but they are still so
vulnerable," says Jennifer Hanscom, executive director and CEO of the
WSMA. "The ground they're standing on is shaky. There might be an
earthquake brewing underneath."
</p>
<p>
Shawn Andrews, primary care medical director at Summit Pacific Medical
Center in Elma, says that the effects of the pandemic seem to vary by
type of practice.
</p>
<p>
"In terms of finances, the larger practices will survive," she says.
"Our budgets are not pretty but we're viable, and that's not a given
for everyone this year. We're not in the same boat as folks in private
practice or even some other critical access hospitals."
</p>
<p>
A fall 2020 survey of WSMA members found that the pandemic has taken a
significant toll on practices, making their financial viability a real
concern. Of 69 members from a range of practices and specialties who
responded to the survey, more than half reported a temporary reduction
in compensation because of the pandemic. Nearly half the survey
respondents said that they had to lay off or furlough staff, including
physicians.
</p>
<p>
Almost a quarter of the respondents said that the financial impact of
the pandemic on their practice is between $500,000 and $1 million.
Those figures echo a national survey of 3,500 physicians conducted by
the AMA last summer, which found practice revenue dropped by roughly
one-third.
</p>
<p>
While the worst of the pandemic appears to be over, the ripple effects
continue. The vast majority of the physicians who responded to the WSMA
survey said that their patient volume was down compared to before the
pandemic, with more than a third saying it was down between 25% and
75%. Even more troubling was that fact that more than 40% reported
having a month or less of cash on hand to pay operating expenses. The
WSMA benchmark is 18 weeks.
</p>
<h3>
Extra costs, curtailed services drive need for more financial help
</h3>
<p>
As it did for Dr. Shin's practice, the federal PPP loan provided a
financial lifeline for many practices.
</p>
<p>
"Luckily we got one of the PPP loans," says Juliette Erickson, MD, a
physician in a private practice in Grays Harbor. "That helped us
tremendously and got us over the hump. We stopped having weekly
meetings on how to pay the next paycheck and started focusing on
medicine again."
</p>
<p>
However, as much as the loans helped, their benefit was limited. More
than 80% of the physicians in the WSMA survey said that additional
financial support would be helpful. In part, that's because new safety
protocols have also meant more expenses.
</p>
<p>
Chelsea Unruh, MD, a physician at Yelm Family Medicine, says that the
expenses related to COVID-19 requirements have added up. Like other
clinics, Yelm Family Medicine does initial screenings of patients in
its parking lot, but the costs don't stop there.
</p>
<p>
"We have had to rebuild our back parking lot for these car visits,"
says Dr. Unruh. "We have had to outfit our front desk with shields. We
are investing in rapid testing and signing contracts for long-term use
of specific machines."
</p>
<p>
Then there is the extra expense of additional personal protective
equipment. "The cost of PPE went up," notes Hanscom. Now practices are
having to bear the costs of full PPE, masks, and sanitizers that
previously were used much more sparingly.
</p>
<p>
Like Dr. Unruh, Dr. Erickson also sees clients with COVID-19 symptoms
in the clinic parking lot. "I'm dressed in full PPE," she says. "It's
not the best way to see an ill person, but it's the best we can do and
still protect our staff and patients."
</p>
<p>
The need to sanitize exam rooms thoroughly between patient visits can
also have a direct impact on patient volume. "We decreased the number
of patients we're seeing per hour," says Dr. Shin. "I was able to see
four patients an hour, but with the cleaning between visits, we chose
to limit it to three patients per hour."
</p>
<p>
Even with such precautions in place, some staff still have to
quarantine because they were exposed to the virus outside of work.
</p>
<p>
"The other income challenge has been the loss of time from our staff,
from exposures or from being ill themselves," says Dr. Unruh. "None of
those exposures happened at work, but we don't get to control the
private lives of our staff. To exclude someone for 14 days because they
made a poor choice has been rough on morale and staffing."
</p>
<p>
To protect staff and patients, some practices have curbed services,
including Dr. Shin's. "In Montesano, there are no blood draw labs, so
lots of patients were coming into our clinic even though [the labs]
were for someone else," Dr. Shin says. The practice eliminated that
service, forcing patients in the area to travel farther for it. Dr.
Erickson says that she is referring more patients to the ER because her
clinic lacks the proper PPE to treat suspected COVID-19 patients.
</p>
<p>
But Dr. Andrews says that patient volume at her hospital's ER, as well
as its urgent care clinics, is still down significantly. "Many people
wait until they are very ill to seek services, and often suffer much
worse outcomes," she says. Nonetheless, she says that larger practices
have been better positioned to withstand the pressures from the
pandemic for a variety of reasons, including business plans less
impacted by long term drops in volumes, better PPE availability, and
space to separate well patients from symptomatic ones.
</p>
<h3>Telehealth use soars</h3>
<p>
The pandemic accelerated several trends that were already underway.
Chief among these has been the growth of telehealth. Three-quarters of
the physicians in the WSMA survey said that they implemented telehealth
as a result of the pandemic.
</p>
<p>
"We had never done telehealth before," says Dr. Unruh. "Then suddenly
we had half a day per provider devoted to telehealth visits."
</p>
<p>
As helpful as telehealth has proven, it has its drawbacks. In rural
areas, internet connections can be spotty, if patients have broadband
service at all.
</p>
<p>
"It's hard to do telehealth where people don't have iPads or iPhones,"
says Dr. Erickson.
</p>
<p>
For Dr. Erickson, telehealth has also inadvertently caused a staffing
problem. One of the three doctors in her practice began doing
telehealth at the start of the coronavirus outbreak as a way of
bringing income into the practice and fell in love with it. She has
accepted a full-time job as a telehealth physician and will be leaving
the practice.
</p>
<p>
"This is her way of moving with her career, but she would never have
found that job if we were not financially struggling in the first
place," says Dr. Erickson.
</p>
<p>
Moreover, as useful as telehealth has proven, its long-term future as a
viable option is still in doubt. "CMS holds the key for that," says Dr.
Andrews. "CMS will decide what we can and can't get paid to do." If
telehealth is not reimbursed or not reimbursed at a reasonable rate,
practices will not be able to sustain it. Accordingly, the WSMA has
made telehealth reimbursement a priority for its advocacy efforts in
the 2021 state legislative session.
</p>
<h3>Independent practices face tough challenges</h3>
<p>
Among the other changes hastened were retirement decisions. "We have a
group of anesthesiologists who are in their late 50s to late 60s," says
Brian Nyquist, MD, a partner at Olympic Anesthesia in Bremerton. "We
had several people who were close to retirement that retired. We knew
it was coming, but it's not like you can hire people before you need
them."
</p>
<p>
The flip side of the retirements, says Dr. Nyquist, is that the
"business kerfuffle of COVID" has made recruiting easier. While
previous attempts to recruit were uphill battles, he says that there
are more physicians applying for open positions at his practice. He
believes that because of COVID-19, "a lot of corporate owners,
management services, and practices have clamped down on people and
contracts," leading physicians to look for new opportunities.
</p>
<p>
Whether that applies to rural practices is an open question.
"Recruiting is incredibly challenging, but more physicians are
realizing that independent practices are a joy to work in because you
are more autonomous," says Dr. Erickson.
</p>
<p>
However, the financial pressures of the past year may make it harder
for independent practices to survive. "There's been a nationwide trend
away from private groups," says Dr. Nyquist. "We are privileged to
continue to be a private group. For now we're positioned pretty well,
but there are lots of pressures—most of them financial, some
societal—that want to drive physicians to work for hospitals. I
fear that this is probably going to exacerbate that."
</p>
<p>
Even when a vaccine is available, the effects of the pandemic will
still be felt. "For the next year, I don't see how we don't do things
we're doing now, like not have a waiting room," says Dr. Shin. "I don't
think we're going to change the number of patients we serve per hour. I
think we're looking at this as a long- term issue."
</p>
<p>
While the financial situation for Washington physicians had stabilized
by year's end, the specter of another spike in coronavirus cases still
haunts practices. "If we went back to a dark winter where we couldn't
even see patients in the office, we would absolutely struggle again,"
says Dr. Erickson. "It keeps you up at night."
</p>
<p>
Still, she remains committed to keeping the clinic afloat. "We've been
here 35 years, and there are literally not many options in town," she
says. "The most important thing is how we continue to do our work."
</p>
<p>
<em>John Gallagher is a freelance journalist specializing in covering
health care.</em>
</p>
<p>
<em>This article was featured in the January/February 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 1/19/2021 12:13:40 PM | 1/19/2021 11:57:02 AM | 1/19/2021 12:00:00 AM |
| virtual_advocacy | Virtual Advocacy | WSMA_Reports | Shared_Content/News/Latest_News/2021/virtual_advocacy | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="WSMA Reports Jan-Feb 2021 cover art" src="/images/Newsletters/Reports/2021/Jan-Feb-2021-Reports-Cover-645x425px.jpg" class="pull-right" /></div>
<h5>January 19, 2021</h5>
<h2>Virtual Advocacy</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>By Pat Curry</p>
<p>
As with so many other institutions, the 2021 session of the Washington State Legislature has been fundamentally changed by the coronavirus pandemic. No one thinks it’s a good idea to put hundreds of people together in a room for hours a day over several weeks.
</p>
<p>
So, the structure of this year’s session will be quite different. It will be conducted largely—or entirely—remotely, and the Capitol campus will be closed to the public.
</p>
<p>
Due to the remote nature of the session, fewer bills will likely be considered, with a focus on the state budget and responding to the pandemic. Given the public’s outpouring of support for health care workers, it might seem that this would be the year to shoot for the moon in terms of asking the legislature for health care funding.
</p>
<p>
That would absolutely be true if there was a surplus of cash.
</p>
<p>
“The state’s budget outlook has improved somewhat from the nadir in the spring, but there remains a revenue shortfall,†says WSMA Government Affairs Director Sean Graham. “Actions will need to be taken to keep the budget in balance in the short term and the longer outlook our top priority in the budget realm is staving off any cuts that would impact access to care for the state’s patients.â€
</p>
<p>
“I’m grateful we represent the individual physician because we can put a human face on the situation and speak for people who were racing in to solve the problem,†says WSMA Executive Director/CEO Jennifer Hanscom. “That’s an added benefit.â€
</p>
<p>
Even with the sympathy that physicians and other health care providers have garnered from policymakers, any number of tax increases are likely to be proposed in the 2021 session and some will impact physicians. Among WSMA’s legislative priorities this year is ensuring the financial viability of practices, including opposing tax increases that will unduly impact the physician community.
</p>
<p>
“We know that virtually all our state’s businesses have been impacted by the pandemic, but that’s particularly true of physician practices and medical groups,†Graham says. “Most physician practices have had a substantial loss of patient volume and some are teetering on the brink financially.â€
</p>
<h3>Advancing telemedicine</h3>
<p>
The top policy issue for the WSMA this year relates to increasing the availability of telemedicine. Washington state has been a leader in telemedicine policy, but more can be done. For example, the state’s telemedicine coverage is limited to services that require a patient to have internet access.
</p>
<p>
“A lot of our state doesn’t have access to reliable broadband,†Graham explains. “We need insurance coverage for services offered over the phone. We also need to make sure there’s reliable broadband; it’s a health equity and education issue. The pandemic has made it clear that access to the internet isn’t a luxury; it’s a necessity.â€
</p>
<p>
In the regulatory realm, the WSMA will be working to address telemedicine reimbursement inequities.
</p>
<p>
“We found out that some of the insurers are trying to play games with the reimbursement parity requirement passed by the Legislature last year,†he says. “We’ll be working to ensure that payment parity means just that—services are reimbursed the same whether they’re delivered in person or via telemedicine.â€
</p>
<h3>Monitoring scope of practice</h3>
<p>
The WSMA also will be paying close attention this year to attempts to promote inappropriate scope of practice increases.
</p>
<p>
“Just about every provider advocacy group with a presence in Olympia will be
bringing a scope of practice increase in 2021, most of which will have ostensible ties to the pandemic,†Graham explains. “As an example, we know of several provider groups that will look to be granted prescriptive authority or to have their prescriptive authority increased.
</p>
<p> “They have wanted it for years,†Graham says. “They’ll come in 2021 and say, ‘There’s this need for access to care. Physicians are overwhelmed. Let us take this off their hands.’ When the WSMA looks at those proposals, our lens is balancing access to care with patient safety. We want to make sure any scope of practice increase would include sufficient training to ensure quality of care.†</p>
<p>
WSMA President Nathan Schlicher, MD, JD, MBA, is more pointed in his position on the issue.
</p>
<p>
“We believe that if you want to be a doctor, you should go to medical school,†says Dr. Schlicher, who also is a former Washington state senator. “We value all our fellow professionals and we want them to be an incredibly important part of the team, but physicians should lead the team and people should practice within their scopes.â€
</p>
<h3>Facing structural racism</h3>
<p>
In light of the global protests against racism, the WSMA is taking a strong stand in this year’s legislative session to promote health equity and racial justice. To that end, the association is taking the rare stance to advocate for having professional boards develop continuing medical education for physicians and other health care providers to address structural racism and health disparities within the medical community.
</p>
<p>
“This is so outside our box,†says Hanscom. “At the WSMA we have traditionally opposed mandating clinical education. How do you make sure the content, especially clinical content, you’re mandating is accurate? Medicine is ever evolving.
</p>
<p>
“But with this topic, the Legislature wouldn’t be mandating the content and it’s not clinical in nature,†she says. “I think it’s well recognized that we need to look deep in medicine’s history and develop content that addresses what has led to disparities in health care, particularly in the areas of race and culture. It’s a first step to overcoming larger societal issues. You have to start at home first.â€
</p>
<p>
And while it might seem like improving cell phone and broadband access is off topic for WSMA’s advocacy efforts, telemedicine has made it important for the WSMA to join with other groups to support those efforts.
</p>
<p>
“With this new way of delivering care, we find it particularly beneficial to physicians to get to know patients in their own environment,†Hanscom says. “Imagine what you can pick up. You’re seeing things that might give you clues to why their chronic conditions aren’t well managed.â€
</p>
<p>
In an example the WSMA used in a newspaper op-ed, a physician had a patient who was a cellist and was struggling with her wrists.
</p>
<p>
“She’ll never bring her cello into the clinic,†she says. “In telemedicine, the physician saw her play her cello. Seeing her movements helped the physician develop a course of treatment for her.â€
</p>
<p>
Telemedicine visits delivered over the phone are also helping physicians connect with chronic disease patients who aren’t able to take time off from work for a clinic appointment. But they might take a break from work and talk to their doctor on the phone.
</p>
<p>
“That’s just better patient care,†Dr. Schlicher says.
</p>
<h3>New opportunities for physician advocacy</h3>
<p>
If there is a silver lining to the elimination of in-person lobbying in the Legislature this year, it's that it exponentially increases the opportunities for WSMA members to serve as advocates. Committee testimony won’t be limited to individuals on the Capitol campus; anyone in the state could testify, Graham says.
</p>
<p>
“People in more rural areas that often feel left out have the same opportunity to participate,†he says. “Those are the areas often with the most dire need for access to care. They have unique needs in their areas; it’s a good opportunity to highlight those disparities.â€
</p>
<p>
Plus, the WSMA has been a vital source of information for the state’s elected officials during the pandemic, making them aware of the issues facing physicians. Legislators already know what the medical community is facing and they’re willing to listen.
</p>
<p>
“No one will be surprised by what we have to say,†Hanscom says.
</p>
<p>
Even better, WSMA members can advocate from their own offices.
</p>
<p>
“We need people to send emails and letters and set up virtual meetings, which we’re all getting more familiar with,†Dr. Schlicher says. “It takes a little more planning, but it’s a lot easier on your schedule.â€
</p>
<p>
With many of the traditional avenues for advocacy closed in terms of lobbyist access, it will be imperative that the physician community is fully engaged, he says. The 2021 Legislature is still going to be dealing with the pandemic and how to control it, and it’s vital that physicians are there to guide the discussions.
</p>
<p>
“Social determinants of health, access to education, food, internet—all those things impact the health of our community,†he says. “All those issues need our voice.â€
</p>
<p>
In addition to the issues affecting patients, Dr. Schlicher notes, the WSMA needs members to remind legislators that the same physicians risking their lives on the front lines of the pandemic are struggling financially. They need and deserve help to be able to keep their doors open and keep serving their patients.
</p>
<p>
“If we’re not involved and we’re not at the table, then we’re on the menu; the Legislature will look at us as a source of revenue,†he says. “Practices are facing significantly higher costs, fewer patients, and impending CMS cuts. Small practices risking their lives shouldn’t be the source of revenue for the budget.â€
</p>
<p>
<em>Pat Curry is senior editor of WSMA Reports.</em>
</p>
<p>
<em>This article was featured in the January/February 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 1/19/2021 12:12:56 PM | 1/19/2021 12:10:27 PM | 1/19/2021 12:00:00 AM |