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a_new_look_for_a_new_eraA new look for a new eraWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/a_new_look_for_a_new_era<div class="col-md-12"> <div class="col-md-5 pull-right"><img alt="" src="/images/HeadShots/Hanscom.Jennifer-Circle-Portrait-645x425.png" class="pull-right" /></div> <h5>July 16, 2018</h5> <h2> A new look for a new era </h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> With medicine still relying on some outdated 20th-century technologies (800 numbers and fax machines), we didn't want the WSMA website to look like it was stuck in the last century too! So, over the course of many months, our team here at WSMA took on the challenge of updating and redesigning our online home. </p> <p> That team, a partnership between IT and communications, worked to achieve four specific goals: </p> <ol style="margin-left: 40px;"> <li> Refreshed and up-to-date design. </li> <li> Mobile-friendly and responsive function. </li> <li> User-friendly, intuitive navigation. </li> <li> Search-engine-optimized information, to improve visibility in searches and to make the information easier to find on the site. </li> </ol> <p> So rather than reading what's new in the politics of health care, check out what's new at the WSMA. Take the time you use to read Weekly Rounds to <a href="https://wsma.org"> review our redesigned website</a>. When you're finished, send your feedback to me at <a href="mailto:jen@wsma.org"> jen@wsma.org</a>. </p> <p> The WSMA is a member-driven organization, and we want to ensure that members have access to news, education, resources and services that cater to the physician community. Let me know what you like about the site, as well as what's missing. </p> <p> Thanks, and I look forward to hearing from you soon. </p> </div>7/18/2018 11:01:18 AM7/16/2018 3:13:16 PM7/16/2018 12:00:00 AM
5_things_you_should_know5 things you should knowWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/5_things_you_should_know<div class="col-md-12"> <div class="col-md-5 pull-right"><img alt="" src="/images/HeadShots/Hanscom.Jennifer-Circle-Portrait-645x425.png" class="pull-right" /></div> <h5>July 2, 2018</h5> <h2> 5 things you should know: </h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> Yesterday was "Second Half of the Year Day," so I'm feeling the pressure to maximize every moment, especially during the summer, which is already busy and speeding by. I'm sure you're feeling that way too, so here are five quick news items you need to know: </p> <ol style="margin-left: 40px;"> <li> Consumers get access to pricing data via state's all-payer claims database <br /> Last Friday (June 29), after a long time in the works, Washington state went live with its all-payer claims database <a href="https://www.wahealthcarecompare.com">Washington HealthCareCompare</a>. The database gathers claims information from Medicaid and commercial health care payers to better track the cost and quality of care. TVW recently reported out on how the database works. <a href="https://www.facebook.com/TVW.org/videos/10156608312093991/">View that report here</a>, which includes commentary from WSMA's own Katie Kolan. And for more detail about Washington HealthCareCompare, <a href="http://www.ohsu.edu/xd/research/centers-institutes/center-for-health-systems-effectiveness/wa-apcd-governance-information/Review-and-Reconsideration.cfm">click here</a>. </li> <br /> <li> New medical marijuana authorization form in effect<br /> The Department of Health released new requirements and changes to the forms physicians and other health care providers complete when authorizing the use of medical marijuana for their patients. As of July 1, physicians and providers must use the new single-page form on tamper-resistant paper. DOH clarified that physicians can order the medical marijuana tamper-resistant paper from the same vendor from which they order prescription tamper-resistant paper. For more information, visit the <a href="https://www.doh.wa.gov/YouandYourFamily/Marijuana/MedicalMarijuana/AuthorizationForm">Department of Health website</a>. </li> <br /> <li> Proposed Title X rule threatens access to care and physician-patient relationship<br /> The Trump administration moved to curtail abortions by proposing a rule that, if enacted, would eliminate federal funding for facilities (such as Planned Parenthood) that offer abortion services or referrals. These federal dollars—sometimes referred to as Title X funds—are used to pay for family planning and related preventive health services, such as birth control, screenings for cancer and sexually transmitted diseases, pregnancy tests, and other reproductive services.<br /> <br /> The <a href="https://www.federalregister.gov/documents/2018/06/01/2018-11673/compliance-with-statutory-program-integrity-requirements">proposed rule</a> could have a profound impact on how, and whether, physicians discuss abortion information with patients. Facilities would lose funding if they offered abortions or if their providers offered referrals. Some fear that the U.S. Department of Health and Human Services will interpret "indirectly facilitates" broadly enough to include discussions of abortion. In addition, while federal funds are currently banned from covering abortions, the new rule would go further by preventing facilities from using federal funds to subsidize other health care services.<br /> <br /> WSMA policy supports the ability of physicians to practice within their right of conscience, but states that "a conscientious objection should, under most circumstances, be accompanied by a referral to another physician or health care facility." Additionally, WSMA policy supports the sanctity of the physician-patient relationship and opposes regulations that would prevent providers from providing evidence-based, medically accurate health care services and information to patients in all care settings. HHS is accepting public comment on the proposed rule until the end of July. </li> <br /> <li> Succeeding in value-based payment: New WSMA webinar: Introduction to HCC coding<br /> The use of hierarchical condition categories is crucial to clinical management in population health models for assessing the illness burden of each patient. HCCs are used by commercial health insurers and Medicare Advantage plans in calculating financial risks and rewards. To help ensure you're coding correctly, the WSMA is presenting a lunchtime webinar on Wednesday, July 25 where we'll provide guidance on the use of this increasingly prevalent coding mechanism. <a href="https://wsma.org/WSMA/Events/Coding_and_HCCs_-_An_Introduction/WSMA/Events/Coding_and_HCCs_-_An_Introduction.aspx?hkey=53080f81-783b-41cd-ae3a-502f14543f32">Register online for the webinar</a>. If you're unable to participate, the session will be recorded and available from the WSMA website. </li> <br /> <li> Have a policy you think WSMA should lead on? Consider submitting a resolution to our House of Delegates<br /> Look for the July/August WSMA Reports publication in your mailbox this week. Inside, you'll find a special insert highlighting the WSMA Annual Meeting. I'm particularly excited about our keynote presentation "From Values to Action" with <a href="https://harrykraemer.org/about/">Harry Kraemer Jr</a>. Kraemer was recommended by WSMA Past President Jeff Collins, MD, who saw him speak at a Kaufman Hall event (and was so inspired that he bought Harry's book for every member of his regional leadership team—around 60 physicians). Based on this anecdote and Dr. Collins' past speaker recommendations, my expectations are high.<br /> <br /> The core of the WSMA Annual Meeting is the gathering of our House of Delegates, where some 200 voting delegates (representing the WSMA Board of Trustees, county medical and state specialty societies as well as special sections) set WSMA policy.<br /> <br /> A resolution is a proposal asking the WSMA to take a position or act on an important issue. Before authoring a resolution, please research existing WSMA policy by reviewing the <a href="https://wsma.org/WSMA/About/Policies/Policies.aspx">WSMA Policy Compendium</a>. Current policy may already address the issue in question, negating the need for a resolution. Alternatively, the author may wish to revise the resolution entirely or modify existing WSMA policy.<br /> <br /> We have resources on our site where you can learn more about <a href="https://wsma.org/WSMA/Events/Annual_Meeting/WSMA/Events/Annual_Meeting/Annual_Meeting.aspx?hkey=fea49254-3815-4dc9-8710-53ff2e3a100f">how to write a resolution</a> or to give input to the policy making discussion. Be sure to check those out and note that the deadline to submit resolutions is Aug. 17. </li> </ol> <p> As you can see there's never a dull moment at the WSMA. There's lots happening this summer, but I hope you'll be able to take some time for family, friends and fireworks on July 4. </p> <p> Happy second-half-of-the-year! </p> </div>7/18/2018 11:01:41 AM7/2/2018 9:01:14 AM7/2/2018 12:00:00 AM
physician_leadership_is_key_to_affecting_changePhysician leadership is key to affecting changeWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/physician_leadership_is_key_to_affecting_change<div class="col-md-12"> <h5>June 18, 2018</h5> <h2>Physician leadership is key to affecting change</h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> My oldest son's high school graduation was on Saturday. Where did the time go? It seems like only yesterday he was dancing around the house singing his favorite tunes from Schoolhouse Rock, which included "3 is a Magic Number" and "Conjunction Junction." It was all I could do to choke back the tears as he crossed the stage and I thought of those precious moments. </p> <p> I loved the original Schoolhouse Rock as a kid. I credit "I'm Just A Bill" for prompting my journey to be a political science major. I'll never forget how I loved singing along about how an idea could turn into the law of the land. What power! </p> <p> To this day, I'm still intrigued by the power of the people and the process by which we can affect real change. In fact, that's one of WSMA's most powerful membership benefits. Your dues dollars help fund our vigilant tracking of every bill that touches medicine and health care. Just this year, during the 60-day legislative session our team in Olympia monitored 400 bills (including budget items), a subset winnowed down from a total of 1,410 bills introduced. </p> <p> You can read about WSMA's legislative successes from this year in our legislative wrap-up report, which we mailed last week. You'll find it in your mailbox soon or you can check it out <a href="javascript://[Uploaded files/Advocacy/Legislative and Regulatory/WSMA_2018_Legislative_Report.pdf]" target="_blank">here</a> . But in the meantime, I wanted to highlight several new laws that are taking effect in June that may impact your practice. </p> <h3>New policies effective June 6</h3> <ul> <li> <strong>Prescription drug disposal, HB 1047:</strong> A statewide system for the safe and secure collection and disposal of unwanted medications is created, financed and operated by pharmaceutical manufacturers. The WSMA will provide more information to members on the availability of drop boxes as it becomes available. </li> <li> <strong>Maintenance of certification and licensure, HB 2257:</strong> Prohibits the Washington State Medical Commission (formerly MQAC) and Board of Osteopathic Medicine and Surgery from requiring board certification as a condition of licensure. </li> <li> <strong>Medical record requests, HB 1239:</strong> Requires physicians or facilities to provide a patient appealing the denial of federal Supplemental Security Income or Social Security disability benefits with one free copy of their medical record upon request. </li> <li> <strong>Budget issues subject to implementation, SB 6032:</strong> Provided additional funding on two matters: Medicaid payment rate increases for pediatric primary care and vaccine services and increased Medicaid reimbursement to clinicians treating patients suffering from opioid use disorder with medication-assisted treatment (MAT). </li> </ul> <p> We'll provide further information on these topics as it becomes available. In the meantime, the WSMA encourages members to become waivered by the federal government and provide MAT. Learn more at <a href="https://www.samhsa.gov/">samhsa.gov</a>. </p> <h3>Leadership skills matter</h3> <p> Continuing the theme of practice impact, remember that a healthy culture of patient care <em>and</em> business depends on effective physician leaders. The WSMA is committed to providing opportunities for our members to advance their leadership and business skills. </p> <p> Here are two upcoming opportunities to hone your leadership skill set: </p> <ul> <li> <a href="[@]WSMA/Resources/Physician_Leadership/Physician_Leadership_Course/Physician_Leadership_Course.aspx">WSMA Physician Leadership Course</a>: This training combines in-person and online learning to deliver 40 hours of curriculum over 10 weeks. It is designed for practicing physicians, requiring minimal time away from patient care, with two initial days of in-person coursework, eight weeks of online instruction and interaction, concluding with a one-day in-person session. Several hospitals and health systems throughout Washington have utilized this course, including Providence, Virginia Mason, Confluence and the Washington Rural Collaborative. The next course is scheduled from Sept. 7 through Nov. 9, with in-person classes on Friday, Sept. 7, Saturday, Sept. 8 and Friday, Nov. 9 in Seattle. Online instruction takes place during the intervening eight weeks. The course is open to 30 participants and the slots fill up quickly. To apply, email Lauren Beverly at <a href="mailto:lauren@wsma.org">lauren@wsma.org</a> before July 1). </li> <li> <a href="https://wsma.org/on-demand-leadership"> WSMA Physicians Business Skills Program</a>: The business side of medicine can be daunting to any clinician. WSMA's business skills education program prepares physicians by providing a deeper understanding of the health care marketplace, internal finances, financial relationships with external partners and general compliance issues. Topics include: </li> <ul> <li>Understanding the big picture: Business intelligence/organizational structures</li> <li>Internal finances of health care</li> <li>Financial relationships with external partners</li> <li>Compliance programs</li> <li>Coding and data capture</li> <li>Employment contracts</li> <li>Social media and the internet</li> </ul> </ul> <p> The program is offered via seven OnDemand webinars. To access these and other WSMA physician leadership resources, visit <a href="http://www.wsma.org">www.wsma.org</a>. </p> <p> Physician leadership within the practice, profession and policymaking is key to affecting change. It's more important than ever for medical professionals to speak up, step up and be heard. Just like in the "I'm Just a Bill" song: "Some folks back home decided they wanted a law passed." That might have been a childhood ditty, but it's true that if we don't decide and pursue what's best for medicine through legislative and regulatory actions, others will. </p> </div>7/13/2018 12:05:10 PM6/18/2018 9:35:33 AM6/18/2018 12:00:00 AM
confronting_burnout_by_easing_administrative_burdenConfronting burnout by easing administrative burdenWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/confronting_burnout_by_easing_administrative_burden<div class="col-md-12"> <div class="col-md-5 pull-right"><img alt="" src="/images/Logos/HDHP_600px.jpg" class="pull-right" /></div> <h5>May 28, 2018</h5> <h2> Confronting burnout by easing administrative burden </h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> Just over a week ago, I spent the weekend with more than 100 of our members at the WSMA Leadership Conference at Lake Chelan. We've intentionally designed this event to combine learning, networking and relaxation to give our members some respite from the pressures of their daily lives. We know from our research that burnout among physicians is a growing and an alarming concern. A <a href="https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL3NsaWRlc2hvdy8yMDE4LWxpZmVzdHlsZS1idXJub3V0LWRlcHJlc3Npb24tNjAwOTIzNQ==&ac=401#2" target="_blank"> report this year from Medscape</a> reported that 42 percent of physicians experience some degree of burnout or depression. </p> <p> That's more than one physician out of every three. Think about that for a moment. While we gathered together in meeting rooms and over meals, when we looked to those on either side of us, someone in that small circle was dealing with burnout. </p> <p> That was tangibly evident during our closing speaker's session. Allison Massari—an artist and survivor of a fiery car crash—spoke of the compassionate care she received during her torturous and lengthy recovery from second- and third-degree burns over 50 percent of her body. As she shared her story—at the heart of which were the physicians and caregivers who saved her—you could have heard a pin drop. Why? I believe it's because in telling her story she helped our members reconnect with their "why." They were not only riveted by her words, but also felt honored, uplifted and inspired by her. </p> <p> I'm proud of the way the WSMA has taken on the issue of burnout-it is one of our key priorities and is specifically part of our strategic plan. Our goal has been to improve physician satisfaction by building their leadership development skills while also seeking to reduce administrative burdens at the practice level. Our Chelan conference addressed the former, our Healthy Doctors, Healthier Patients initiative addresses the latter. In 2016, we launched the Healthy Doctors, Healthier Patients initiative with the basic premise of seeking to ensure that physicians are cared for, so that they can do what they do best: healing others. </p> <p> We have made significant progress thus far in two key areas: credentialing and prior authorization. In each case, there are new WSMA-supported and shaped state regulations designed to reduce your administrative burden now—or soon to be—in effect. </p> <p> <strong> New streamlined process for credentialing goes into effect this Friday </strong> </p> <p> As our members know too well, the process of credentialing-the evaluation of a physician's qualifications and practice history-used by insurers is often lengthy and unwieldy, frustrating and creates barriers to patient care. </p> <p> To ease the impact on physicians and patients, the WSMA supported <a href="http://apps2.leg.wa.gov/billsummary?BillNumber=2335&Year=2015" target="_blank"> legislation in 2016</a> that streamlined and standardized credentialing applications and limited turnaround time for insurers to approve or deny requests. </p> <p> Those changes are set to go into effect on June 1, so now is the time to prepare. The two major changes are: </p> <ul> <li> Insurers must credential physicians and other providers within 90 days (and an average of 60 days, beginning in 2020). </li> <li> Insurers, physicians and other providers must use ProviderSource to submit and process credentialing applications. ProviderSource is a free health care credentialing tool operated by OneHealthPort, the state's lead health information technology provider. </li> </ul> <p> <em> *Note: If there is a credentialing delegation arrangement between a facility that employs health care providers and a health carrier, then the single credentialing database is not required to be used. </em> </p> <p> The key to streamlining the process is the use of one dedicated source for credentialing. By using ProviderSource, you will be able to build a comprehensive professional profile that functions as a secure, universal credentialing and enrollment application. As all parties are required to use ProviderSource, we anticipate a reduction in the back-and-forth that tends to slow credentialing down, resulting in turnaround times even faster than the new 90-day maximum. </p> <p> To prepare for Friday's implementation date, visit OneHealthPort's <a href="http://www.onehealthport.com/credentialing/getting-startedlogin" target="_blank"> credentialing webpages</a> to set up your profile. <a href="http://www.onehealthport.com/credentialing/training-videos-guides" target="_blank"> Training videos and guides</a> are available to help you understand how to use the ProviderSource features. </p> <p> <strong>New prior authorization rules in effect</strong> </p> <p> As a result of WSMA's prolonged and extensive engagement, the Office of the Insurance Commissioner adopted a comprehensive set of regulations aimed at standardizing and streamlining the prior authorization processes used by insurers for medical services. Most provisions of the new rules went into effect in January. </p> <p> Snapshot of key provisions: </p> <ul> <li> Standard request: Insurer must decide within five calendar days. </li> <li> Expedited request: Insurer must decide within two calendar days. </li> <li> Extenuating circumstances: Insurers and their third-party administrators must have a provision for unforeseen situations. </li> </ul> <p> Criteria used by insurers or third-party administrators must be provided to physicians and facilities according to "patient specific information for determination" (details at <a href="http://priorauth.wsma.org/" target="_blank"> priorauth.wsma.org</a>). </p> <p> The response to a prior authorization request must clearly state if the service is approved or denied. </p> <ul> <li> If denied, the response must give the specifics in clear and simple language. </li> <li> If denial is based on medical necessity, the clinical review criteria used to make the determination must be provided. </li> <li> A denial must include information on the enrollee's appeal rights in addition to inclusion of the department, credentials and phone number of the person denying the request. </li> </ul> <p> WSMA is sending all members a handy one-page poster that succinctly covers the new provisions, along with our 2018 legislative session wrap-up report, in next few weeks. </p> <p> In addition, we've created a mobile-friendly website, the <a href="http://priorauth.wsma.org/" target="_blank"> WSMA Prior Authorization Navigator</a>, designed to be your partner and protector when you or your staff are working on prior authorization. Simply bookmark the website (<a href="http://priorauth.wsma.org/" target="_blank">priorauth.wsma.org</a>) on your desktop, laptop or mobile device, and you'll have the new requirements for medical services at your fingertips (we also include information on 2015 rules for prescription drugs). </p> <p> Most importantly, the Navigator includes an <a href="http://priorauth.wsma.org/file-a-complaint/" target="_blank"> easy-to-use complaint form</a> so you or your staff can easily message the OIC whenever you encounter an issue. Using this complaint form to report issues is critical, as the OIC's enforcement of its prior authorization rules rely upon a complaint-driven process. Your feedback will directly inform the OIC of concerns and ensure the rules' effectiveness. </p> <p> While these are significant accomplishments in administrative simplification, I realize helping our members overcome burnout and depression requires multi-pronged effort and action. We will aggressively continue our efforts to provide compassionate care to our members so that they can focus on their good work of healing others. Also, if you have administrative challenges that you want to bring to our attention, please let us know. Email me at <a href="mailto:jen@wsma.org" target="_blank"> jen@wsma.org</a>. </p> </div>7/16/2018 3:33:35 PM6/5/2018 11:08:28 AM5/28/2018 12:00:00 AM
good_conversations_yield_good_outcomesGood conversations yield good outcomesWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/good_conversations_yield_good_outcomes<div class="col-md-12"> <div class="col-md-5 pull-right"><img alt="" src="/images/Logos/HonoringChoices_645px.jpg" class="pull-right" /></div> <h5>May 14, 2018</h5> <h2>Good conversations yield good outcomes</h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> It's hard to talk about your own mortality, but I imagine you're like me in that you think about it from time to time, especially at life's milestones, like birthdays. </p> <p> I'll admit it; today is my birthday and these thoughts are on my mind. Certainly, as the half-century milestone draws closer, every new ache or pain causes me to wonder if something more frightening than aging is happening. </p> <p> Being in health care doesn't help. We know too much and we've all heard our share of end-of-life horror stories. As for me—with a husband who has operated an assisted living facility and a sister-in-law who's a hospice nurse, and having helped develop WSMA's work on end-of-life care—I am well aware of the importance of making my wishes known. </p> <p> I also know—up close and personal—that it isn't easy. A few years ago, I sat down in my lawyer's office to complete a durable power of attorney for health care and a health care directive. As I put pen to paper, I not only felt totally unprepared, I also felt challenged to write down my true thoughts. Knowing there are no absolutes in life or death or in health care, too many "what ifs" clouded my thinking. I'm still not sure what I wrote back then truly represents what care I would or wouldn't want when the time comes. </p> <p> What was missing from that well-intentioned effort was a thoughtful conversation in which I could have explored what a good life and a good death look like. And that's what I so value about the Honoring Choices® Pacific Northwest initiative, jointly sponsored by the WSMA and the Washington State Hospital Association. </p> <p> This program provides free training and consultation to help your facility integrate the Respecting Choices® First Steps® evidence-based advance care planning program into your internal systems. First Steps is a team-based, systems approach to assist patients with advance care planning and decision-making at the end of life. </p> <p> Through guided conversations, certified facilitators help patients consider their goals, values and preferences. These discussions help people identify a health care agent, explore past experiences that may inform their wishes for end-of-life care, reveal religious and cultural beliefs that may influence their care choices, and start completing their health care directive. </p> <p> Since October 2016, three cohorts have participated, encompassing 49 care teams from 27 organizations, including every major health system across Washington state. These initial cohorts saw a <em>62 percent increase</em> in completed advance directives after implementing the First Steps program, bringing us closer to realizing Honoring Choices Pacific Northwest's vision that everyone will receive care that honors their personal values and goals at the end of life. </p> <p> We know this work makes a difference to health care professionals and their patients. We've heard from our members that they can readily tell the difference when a family has participated in advance care planning vs. those who haven't. They see firsthand the trauma families experience when faced with difficult decisions while a loved one lingers between life and death. We can all imagine having to make those decisions without knowing what "an acceptable outcome" means for the patient. For families who have proactively engaged in advance care planning, there is greater peace of mind knowing their wishes will be honored. </p> <p> All participants in life's journey need this peace of mind, including your health care team members. Equipping them, and your systems, with a clear and compassionate pathway for patients may be one of the best things you could do to ease your team's burnout. </p> <p> I realize it's not easy to integrate this work, considering all the competing demands for limited resources. It may even be downright disruptive…but so worth it. Time and again, we've seen this person-centered, team-based model prove successful in improving patient engagement, satisfaction and outcomes. </p> <p> Honoring Choices Pacific Northwest is currently recruiting health care organizations for its fourth cohort, which will launch in September. If you'd like to learn more about how to participate, email <a href="mailto:info@honoringchoicespnw.org"> info@honoringchoicespnw.org </a> or <a href="https://register.gotowebinar.com/rt/8450384966563779586" target="_blank"> register here</a> to attend one of four free information sessions: </p> <ul> <li> Tuesday, May 22 from noon-1 p.m. </li> <li> Wednesday, May 30 from 4-5 p.m. </li> <li> Thursday, June 7 from 10-11 a.m. </li> <li> Friday, June 15 from 8-9 a.m. </li> </ul> <p> As for me, I think I'll give myself and my family a birthday gift: I'm going to revisit that directive I worked on with my lawyer and seek out a guided advance care planning conversation with one of our trained facilitators. I encourage you to do the same! </p> </div>7/13/2018 12:03:55 PM5/16/2018 11:54:05 AM5/14/2018 12:00:00 AM
leadership_is_more_than_title_hierarchy_or_the_corner_officeLeadership is more than title, hierarchy or the corner officeWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/leadership_is_more_than_title_hierarchy_or_the_corner_office<div class="col-md-12"> <h5>April 30, 2018</h5> <h2>Leadership is more than title, hierarchy or the corner office</h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p>I think a lot about leadership - not only how it relates to my own career and role at WSMA, but also how the physicians I know demonstrate leadership regardless of whether they sit in an executive's corner office or not. In my experience working with physicians, I've seen how they naturally embody this approach by virtue of their calling to this noble, and often heroic, profession.</p> <p>Now, more than ever, we need strong physician leadership across all aspects of the profession. With today's challenges in the house of medicine, the shifting landscape of health care, the unpredictable fate of federal legislation, and the need to emphasize the quadruple aim in medicine, physicians must be directly involved in leadership to navigate a better way forward for the profession and patients. </p> <p> I believe all physicians are leaders, regardless of title, hierarchy or workplace. The nature of their work demands it. What other career requires years of training, confidence and calm in the face of trauma, and split-second life-and-death decision-making, all while orchestrating precision teamwork despite sleep deprivation? To be able to handle the incredible demands on the front lines of care requires an incredible range of skills. In every moment of every day, physicians contribute expertise, experience, knowledge, vision and wisdom to their patients, teams and communities. </p> <p> In the extraordinary position they hold, physicians experience both the culture of patient care as well as the culture of business. They stand at the intersection of these often-competing cultures—right between patient-focused care and the bottom line. It follows that physicians—who, along with their patients—are on the receiving end of business decisions, ought to be in positions of influence to drive patient-centered care and efficient delivery of health care outcomes. </p> <p> More physicians are moving into titled leadership positions, which bodes well for patients and the businesses that serve them. But an official title or role isn’t required to lead. No matter what their role is, they are living out their oath to “do no harm,” put patients first, and act on evidence-based care. </p> <p> Still, leadership isn’t for the faint of heart, and skills need to be developed. That’s why the WSMA offers leadership development opportunities as part of our commitment to advancing knowledge, skills and abilities of physician leaders. </p> <p> One of those opportunities is just a few weeks away—the annual WSMA <a href="[@]WSMA/Events/LDC/Leadership_Development_Conference.aspx">Leadership Development Conference</a> at Campbell’s Resort on Lake Chelan, May 18-19. </p> <p> The LDC is one of the WSMA’s most popular gatherings, combining top-quality programing and speakers amid a spectacular resort setting. This year’s attendees will hear from national speakers on innovation and transformation, in addition to what local groups are doing to improve care while reducing hassles in practice. Other sessions will offer practical advice on how to motivate colleagues, improve physician engagement and manage burnout. </p> <p> And speaking of leadership, WSMA depends upon strong leadership to represent the voice of physicians and patients as we seek to shape the future of health care in Washington state. You could be part of that leadership by nominating yourself or a colleague for consideration for a position on the WSMA board of trustees or executive committee. Interested in the AMA? Consider our AMA delegate positions (AMA delegates and alternates hold seats on WSMA’s board of trustees). Are you passionate about parliamentary procedure? Note the positions of speaker and vice speaker for our House of Delegates (also WSMA board positions). </p> <p> Here are a few things to note about the nomination process: </p> <ul> <li>The WSMA Nominating Committee meets in late May to prepare a slate of nominees.</li> <li>The slate is presented to the House of Delegates at its 2018 Annual Meeting, scheduled for Oct. 12-13 at the Davenport Hotel in Spokane.</li> <li>The deadline for nominations Thursday, May 10, although additional nominations may be made from the floor of the House of Delegates.</li> <li> In reviewing local colleagues for nominations, consider whether they are:</li> <ul> <li> Well-informed.</li> <li> Forward thinking.</li> <li> Committed to the future of the profession.</li> <li> Experienced, enthusiastic, credible and open-minded.</li> <li> Able to put the WSMA first.</li> <li> Capable of serving as a future president of our state medical association.</li> </ul> </ul> <p> For more information, contact to Shannon Bozarth at <a href="mailto:slb@wsma.org">slb@wsma.org</a>. It takes bold leadership to tackle the challenges facing the profession, your patients and our communities. Maybe you or someone you know is up to the task. If you believe in our mission to provide strong physician leadership and advocacy to shape the future of medicine and advance quality of care for all Washingtonians, I hope you will consider this opportunity. </p> <p> Whether you join us at Lake Chelan or consider becoming part of our leadership here at WSMA, we are grateful for the leadership you bring to your work. It takes bold and visionary leaders to tackle the challenges facing the practice of medicine, patients and our communities. Thank you for all you do. </p> </div>7/13/2018 12:04:34 PM6/6/2018 9:52:13 AM4/30/2018 12:00:00 AM
multi_pronged_efforts_seek_to_make_a_difference_in_opioid_epidemicMulti-pronged efforts seek to make a difference in opioid epidemicWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/multi_pronged_efforts_seek_to_make_a_difference_in_opioid_epidemic<div class="col-md-12"> <div class="col-md-5 pull-right"><img alt="" src="/images/Logos/BPBT_logo_645px.png" class="pull-right" /></div> <h5>April 16, 2018</h5> <h2>Multi-pronged efforts seek to make a difference in opioid epidemic</h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <div class="shrink"> <p> I've been reading Sam Quinones' award-winning book "Dreamland," as I'm sure many of you have. I'm struck-again-by the layers of complexity and multitude of influences that brought this epidemic to its epic proportions of today. </p> <p> But through it all, we know that caring physicians need support in navigating the best way forward, and patients experiencing legitimate pain need relief. </p> <p> That is why the WSMA has been deeply invested in identifying solutions to address the opioid crisis in our state, leading with a clinician- and data-driven approach that will work long-term for the benefit of all. </p> <p> These efforts include a voluntary prescribing feedback program that we are inviting physicians, clinics and medical groups to opt in to. The WSMA-WSHA Opioid Prescribing Reports program, part of our new <a href="[@]WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx">Better Prescribing, Better Treatment campaign</a>, was created in exchange for an exemption to the Health Care Authority's new opioid clinical policy establishing pill limits for acute pain-an important exemption that allows physicians and other providers to exercise their clinical judgement when treating pain and avoid unnecessary paperwork. The Opioid Prescribing Reports program, run jointly with the Washington State Hospital Association, provides program participants simple feedback in quarterly reports that look at their compliance with the acute policy relative to their peers. To date, more than 9,000 Washington providers have signed up for these reports. If you're not among them, we encourage you to reach out to Jeb Shepard at <a href="mailto:jeb@wsma.org" target="_blank"> jeb@wsma.org </a> for more information. </p> <p> The intent of this feedback initiative is to drive appropriate prescribing and other best practices that will help reduce prescription opioid addiction and overdose. This work will also protect the exemption in the HCA policy and prevent other burdensome and ineffective approaches. We reported out on this program in the <a href="[@]WSMA/News_Publications/Publications/WSMA_Reports_Archive/WSMA_Reports_Archive.aspx">March/April issue of WSMA Reports</a>. For more information, contact Jeb Shepard at the email above. </p> <p> In conjunction with our efforts to address acute prescribing in the Medicaid and public employee populations, the Department of Health is moving forward with implementation of House Bill 1427, passed in 2017. One of the bill's provisions calls for the dissemination of additional feedback reports using data from the state's prescription monitoring program, including: </p> <ul> <li> Data to individual physicians with a comparison of their prescribing patterns relative to peers in their specialty. </li> <li> Data to groups with five or more prescribers and facilities for the purposes of quality improvement initiatives. </li> <li> Data to the WSMA-WSHA Chief Medical Officer Safe Table for quality improvement initiatives. </li> </ul> <p> We anticipate these data will be available and actionable in 2018. The WSMA will inform members when they are able to access their individual reports. </p> <p> Additionally, HB 1427 sets in motion overdose notification for physicians and other prescribers when a patient they have prescribed to has experienced a controlled-substance overdose. The WSMA is working with the Department of Health and WSHA to pilot the program this summer on the Olympic Peninsula where communities have been heavily impacted, with plans to go statewide in the near future. </p> <p> Finally, from HB 1427, opioid prescribing rulemaking is currently taking place at the Medical Commission that must be enacted by Jan. 1, 2019. Review WSMA's feedback on the DOH's conceptual draft (<a href="javascript://[Uploaded files/Resources/Clinical Quality/Opioids/WSMA-WSHA-comments-HB1427-opioid-rulemaking-conceptual-draft-cover.pdf]" target="_blank">cover letter</a> and <a href="javascript://[Uploaded files/Resources/Clinical Quality/Opioids/WSMA-WSHA-comments-HB1427-opioid-rulemaking-conceptual-draft-comments.pdf]" target="_blank">comments</a>) and stay tuned for updates and opportunities to provide your feedback to the commission. </p> <p> On the treatment front, the state is implementing a "hub-and-spoke" model for expanding access to medication-assisted treatment (naltrexone, buprenorphine and methadone) to serve Medicaid-eligible or low-income adults with opioid use disorder (OUD) as part of its Washington State Targeted Response to the Opioid Crisis effort. </p> <p> These hub-and-spoke networks offer collaborative, tiered levels of behavioral and physical health care to address OUD. The care is provided at the regional level by a "hub" agency supported by five or more contracted behavioral health, primary care, wrap-around or referral agencies (the "spokes"). The networks receive federal grant funding to employ nurse care managers and care navigators who help patients navigate the network and assist with medication-assisted treatment, reducing the administrative and clinical burdens of the physicians prescribing medications for OUD. </p> <p> In addition, the hubs are also working to train more providers within the spokes to prescribe and administer medication-assisted treatment, expanding the availability of these treatments. </p> <p> Hub-and-spoke networks are now available in 12 of the state's 39 counties and while they are primarily located on the west side of the state, new funding in the state supplemental budget will go toward adding more sites in Eastern Washington. Download a directory with information on the available networks, their geographic reach and detailed contact information for referrals. </p> <p> If you personally want to do more to address addiction in your patients and communities, consider becoming certified in addiction medicine. Nearly 20.5 million Americans age 12 or older have a substance use disorder, yet only an estimated one in 10 people with the disorder receive treatment. To raise awareness and support for addiction treatment, the American Society of Addiction Medicine designated April 23-29 as National Addiction Treatment Awareness Week. They are calling all interested physicians to become board certified in addiction medicine subspecialty and are offering resources to help. </p> <p> For doctors interested in becoming certified in addiction medicine, ASAM is offering a free webinar on April 25 at 3 p.m. PDT. The webinar will address the role of the addiction medicine specialist, the different settings in which an addiction medicine clinician can work, and the future pathways to become ADM-certified. Register online for the free webinar. This activity has been approved for <em>AMA PRA Category 1 Creditâ„¢</em>. </p> <p> To learn more about addiction medicine and resources offered through the American Society of Addiction Medicine, visit their website at <a href="http://treataddictionsavelives.org/">TreatAddictionSaveLives.org</a>. </p> <p> We all know too well that there are endless aspects to the opioid crisis. The WSMA-through collaboration with medical experts, state agencies, policymakers and hospitals-is working to help you find clinically effective, long-term solutions. </p> <p> In "Dreamland," author Quinones compellingly documents the history, implications and ramifications of the opioid epidemic. This problem wasn't created overnight, and simple one-size-fits-all solutions aren't the answer. Instead, it will take intentional, collaborative and multi-pronged efforts to address it. And at the WSMA we believe in the wise words of William James: "Act as if what you do makes a difference. It does." </p> <p> Working together on this issue, we can make a difference. </p> </div> </div>7/13/2018 12:04:47 PM4/18/2018 11:52:13 AM4/16/2018 12:00:00 AM
Strong_wins_for_the_profession_this_sessionStrong wins for the profession this sessionWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/Strong_wins_for_the_profession_this_session<div class="col-md-12"> <h5>April 5, 2018</h5> <h2>Strong wins for the profession this session</h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> Understandably, and perhaps, predictably, I am often asked about what the WSMA's value is. In my response, I liken it to insurance: You always have it and you never think about it...until you need it. When that time comes, you're grateful. </p> <p> The WSMA's legislative advocacy is your "insurance" and provides protection from problems, loss and risk. Sure, it's somewhat intangible, but that work protects you and the profession from dangers, seen and unseen. </p> <p> Take this year's legislative session. Our team in Olympia reviewed every one of the 1,410 bills brought before the state House and Senate, watching for issues that could impact you. It turned out that 400 bills might have impacted your life and work, but our team was on top of every single one on your behalf. </p> <p> As the sole statewide organization representing the interests of physicians and physician assistants regardless of specialty or practice, the WSMA's strength in advocacy carried the day on some very challenging and concerning issues. </p> <p> I urge you not to take this work for granted. In fact, if WSMA didn't exist, neither would these protections. </p> <h3> MOC not tied to licensure in Washington state </h3> <p> While appreciating the principles behind what maintenance of certification seeks to accomplish, the WSMA opposes MOC as a requirement for licensure. (By the way, that position is an example of a resolution that passed the WSMA House of Delegates.) To ensure that never happens in Washington state, the WSMA successfully advocated for the separation of certification and licensure in law. The final bill (<a href="http://lawfilesext.leg.wa.gov/biennium/2017-18/Pdf/Bills/House%2520Passed%2520Legislature/2257.PL.pdf">House Bill 2257</a>) was signed by Gov. Jay Inslee on March 22. </p> <p> At the national level, work continues on MOC. The <a href="https://visioninitiative.org/commission/selection-process/">planning committee</a> of the <a href="https://visioninitiative.org/">Continuing Board Certification: Vision for the Future initiative</a> (Vision Initiative) selected <a href="https://visioninitiative.org/commission/members/">members</a> to serve on the Vision Initiative Commission. As part of its comprehensive assessment of the current continuing certification system, the commission is obtaining feedback from various stakeholders through multiple methods, including a <a href="https://www.surveymonkey.com/r/S5YLCN7">survey</a> that is now open and available for comment. Don't miss this opportunity to frame the future continuing certification program. Take the survey today! </p> <h3> Attempts to ban balance billing quashed for now </h3> <p> As mentioned in the last issue of Weekly Rounds, WSMA was able to defeat House Bill 2114, which would have prohibited balance billing without ensuring adequate protections for physicians who aren't able to come to contract with insurance carriers. </p> <p> You should know, however, that victory may be short lived. The Seattle Times just <a href="https://www.seattletimes.com/seattle-news/providence-swedish-services-to-pay-1-4m-over-lab-work-complaint/">reported on a settlement</a> by Providence Health & Services and Swedish Health Services regarding a complaint brought against them by the Washington attorney general's office alleging the health-care providers used a laboratory that was out of network for many patients. </p> <p> Stories like these compel legislators to seek legislative solutions. That's why our Olympia team is working right now with WSMA members, as well as various specialty societies, to advance our own solutions that will protect patients, while also protecting physicians' ability to negotiate reasonable contracts with payers. </p> <h3> Wrongful death liability expansion staved off </h3> <p> Our team worked to defeat another important bill, despite heartbreaking stories from patients and their families. Senate Bill 6015 and House Bill 2262, which sought to expand wrongful death lawsuits and awards provisions, would have changed the current legal standard from financial dependence to "substantial involvement" in the life of the decedent and would have expanded awards beyond economic damages to include non-economic damages. If passed, this legislation could have increased the frequency of wrongful death claims, increased tort payouts, raised premiums and destabilized the medical malpractice insurance market. </p> <p> Every wrongful death is a tragedy. But the WSMA believes current standards and case law strike a delicate balance, providing justice and compensation for financially dependent family members affected by wrongful death, but including limits where there is no financial dependence. </p> <p> This careful balance would have been undone by these bills, potentially passing dramatic cost increases along to taxpayers, employers, patients, rate payers and consumers. No doubt it would have ultimately led to more physicians leaving medical practice, which would impact rural communities hardest, as those areas already experience physician shortages and other barriers to care. </p> <p> These major wins are only three examples of the protection WSMA provided to the profession during the 2018 legislative session. Our post-session report, which encompasses our advocacy on behalf of both the profession and our patients—including how your legislators voted on WSMA priority issues—will be coming your way in May. As always, you can learn more about how the WSMA works on your behalf at <a href="https://wsma.org/">wsma.org</a>. </p> <p> Your WSMA "insurance" is your safety net. We'll keep raising the physician voice and protecting the profession where it matters most. This is the value of the WSMA. Thanks for your partnership in making it so. </p> </div>7/13/2018 12:05:20 PM4/5/2018 1:13:06 PM4/5/2018 12:00:00 AM
its_time_for_a_public_health_approach_to_gunsIt's time for a public health approach to gunsWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/its_time_for_a_public_health_approach_to_guns<div class="col-md-12"> <h5>March 6, 2018</h5> <h2>It's time for a public health approach to guns</h2> <p>Donna Smith, MD, WSMA President</p> <p> </p> <p> </p> <p> Perhaps fortuitously, on Valentine's Day this year I was in Washington, D.C., with WSMA leadership to meet with our congressional delegation on issues of import to the physicians of Washington state. We were there to advocate addressing the high cost of prescription drugs, the opioid epidemic and stabilizing the health care marketplace. </p> <p> But instead of a day happily filled with hearts, chocolates and expressions of love, it took a tragic turn with guns, violence and heartbreak as news of the shooting in Parkland, Florida emerged. My WSMA colleagues (President-elect and Spokane family physician Tom Schaaf, CEO Jennifer Hanscom, Associate Director of Federal Policy Tierney Edwards) and I were together when our phones lit up with a rush of notifications. We took in the breaking news with sorrow and disbelief. </p> <p> In the weeks since, I realize we're not alone in our disbelief that such a tragedy has happened, again. We're not alone in our incredulity that on average 96 people a day are killed with guns. We're not alone in our alarm that this may be the least-mitigated epidemic of our time. </p> <p> As our colleagues and fellow frontline physicians <a href="https://www.psychiatry.org/newsroom/news-releases/america-s-frontline-physicians-call-on-government-to-act-on-the-public-health-epidemic-of-gun-violence">wrote in their joint statement</a>, "This senseless loss of life has become all too common in our country, ending lives, shattering families and disrupting the fabric of another community forever branded by this act of violence…we must treat this epidemic no differently than we would any other pervasive threat to public health." </p> <p> We're not alone in noting that in these post-9/11 years, we easily accept the security requirements asked of us as we travel through airports and into the nation's Capitol building-mitigations that were swiftly implemented and readily accepted in the wake of tragedy. </p> <p> Why are mass shootings that target children still happening? Because we seem to collectively lack the will to take preventative action. As Marjory Stoneman Douglas High School student David Hogg admonished us all: "We're children. You guys are the adults. You need to take some action and play a role. Work together, come over your politics, and get something done." </p> <p> It's a call to action we must heed. Physicians are on the front lines of public health and patient care. While the decades-old debate about guns continues to rage, it's doctors whose hands probe the wounds and seek to save lives. As WSMA member <a href="http://www.thenewstribune.com/opinion/article202752174.html">Dr. Mauricio Escobar Jr. wrote</a> in The News Tribune last week: "As a physician, I can do my best to care for kids after they've been shot. But the Legislature has the power to help prevent these shootings from occurring in the first place." </p> <p> With semi-automatic weapons becoming the mass shooters' firearm of preference, saving the lives of the wounded is hopelessly pushed ever further out of reach. Radiologist Heather Sher graphically described treating the Parkland school victims in her <a href="https://www.theatlantic.com/politics/archive/2018/02/what-i-saw-treating-the-victims-from-parkland-should-change-the-debate-on-guns/553937/">article in The Atlantic</a>, saying: "With an AR-15, the shooter does not have to be particularly accurate. The victim does not have to be unlucky… Most of [the Parkland victims] died on the spot; they had no fighting chance at life." </p> <p> What can we do? </p> <p> First, we can increase our observance, attentiveness and education around the mental health of our patients. As physicians, we can be alert to the subtexts our patients are dealing with, learn what to do and how to be a resource. The <a href="https://www.sandyhookpromise.org/">Sandy Hook Promise</a> offers a model of education from which we can learn. </p> <p> Second, we can advocate for guns to be stored properly. Not so many years ago, the WSMA was at the forefront of advocacy for a safe storage initiative. Today, some of our members (<a href="http://www.seattlechildrens.org/classes-community/community-programs/gun-safety/">Seattle Children's</a>) are leading the way in giving away lockboxes for free-that's something to build upon. (By the way, the next giveaway is this Saturday, March 12 at Sportsman's Warehouse in Federal Way.) </p> <p> Third, we can advocate for comprehensive reform as it relates to military-style weapons. According to <a href="http://time.com/5160267/gun-used-florida-school-shooting-ar-15/">Time magazine</a>, "AR-15-style rifles have been used in recent mass shootings at in Aurora, Colo.; Santa Monica and San Bernardino, Calif.; Orlando, Florida and now Parkland." Does a 19-year-old really need access to an assault weapon? Senate Bill 6620, which is currently being considered by our Legislature, raises the age limit to purchase semi-automatic rifles from 18 to 21 years old and will strengthen the law so that semi-automatic rifles are no longer easier to purchase than handguns. Urge your local legislators to act on this bill before session adjourns on Thursday. </p> <p> The WSMA supports a public health approach to reduce gun-related injuries and fatalities. A public awareness campaign for safe gun storage and suicide prevention is necessary, along with continued investment in and improvement of behavioral health by integrating with physical health care, a goal of the state's Healthier Washington initiative. </p> <p> Together with these improvements, it is important to implement the <a href="https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Publishes-Teen-Depression-Guidelines.aspx">recommendations of the American Academy of Pediatrics</a> to regularly screen young people for depression, and when identified, to help these individuals receive family-centered and evidence-supported early intervention. </p> <p> There is more to be done. All we need is the will to make it so. </p> <p> <em>Donna Smith, MD, is president of the WSMA, chief medical executive of the Virginia Mason Clinics, and a pediatrician.</em> </p> </div>7/13/2018 12:04:18 PM3/28/2018 1:22:51 PM3/6/2018 12:00:00 AM
democracy_demands_attention_and_actionDemocracy demands attention...and actionWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/democracy_demands_attention_and_action<div class="col-md-12"> <h5>February 22, 2018</h5> <h2>Democracy demands attention...and action</h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> Across the country, state legislative sessions are being closely watched by citizens and stakeholders, but perhaps none more so than the Florida Legislature. Seeing the Marjory Stoneman Douglas High School students act so swiftly-taking their "Never Again" message from the streets to the legislature-is inspiring, even though the catalyst was so tragic. </p> <p> It's also a powerful reminder that true democracy requires the action of the people. It's our duty and responsibility to advocate, influence and affect change on issues of concern. And with our own state Legislature closing in on its final days, it's important for us to take a close look at the just-released budget proposals as the countdown toward March 8 (the session's scheduled end date) continues. </p> <p> Earlier this week, majority party legislators in both the House of Representatives and the Senate released budget proposals. Buoyed by a recent report indicating state revenues will rise considerably in coming years, Senate Democrats released their spending plan on Monday, with House Democrats following suit with their proposal on Tuesday. Coming to agreement on a "supplemental" operating budget-intended to make necessary adjustments to the $43 billion, two-year spending plan enacted last year-is the primary objective of the 2018 session. </p> <p> Let's take a closer look at the two budget proposals, focusing first on WSMA's budget priorities. The proposals are similar on our key funding items, which bodes well for their prospects in the final budget (inclusion in both budgets is often an indicator of success in the budget that is ultimately adopted). </p> <ul> <li>Neither budget relies on tax increases on physicians or includes cuts to past funding priorities such as medical residencies or student loan repayment. </li> <li>Medicaid reimbursement received needed consideration, with both budgets increasing pediatric primary care rates (for privately owned facilities) at a cost to the state of $5.8 million.</li> <li>Addressing the opioid epidemic continues to be a priority of the legislature: </li> <ul> <li>Crucial investments were also made in increasing reimbursement for medication-assisted treatment (MAT) under Medicaid to the rates paid by Medicare at a cost of just over $6 million. </li> <li>An additional investment of $4.7 million was included to cover expansion of access to MAT through the development of four additional regional centers in the "hub and spoke" model.</li> <li>Naloxone availability is increased in both budgets.</li> <li>The House proposal includes nearly $1 million to implement a statewide drug take-back system (pending legislative approval of House Bill 1047).</li> </ul> <li>Both budgets propose to backfill $2 million that was swiped from the Health Professions Account (made up of licensure fees of physicians and other health care professionals) in 2015 to establish the state's medical marijuana database. The relief is short-lived, however, as the Department of Health proposes to spend the money on a "one-time" staffing increase at the Health Systems Quality Assurance division.</li> </ul> <p> Taking a broader look at the two budget proposals, there are some stark contrasts in how they're structured-particularly given both chambers of the legislature are controlled by the same party. Responding to concerns about a property tax increase included in last year's budget, both proposals "buy down" pending property tax hikes. But while the Senate does so without raising new revenue, the House relies on the establishment of a new capital gains tax. And the Senate invests an additional $1 billion in basic education to finish meeting the Washington State Supreme Court's mandate to fully fund education, while the House opted to put the cost off until 2019. </p> <p> Those differences-and numerous other small ones-will need to be ironed out between the two budget proposals before a final budget can be adopted and session can adjourn. With Democrats controlling both chambers by razor-thin margins, bipartisan support will likely be required before final budget votes can be taken. </p> <p> As I've said before, WSMA's legislative team in Olympia has your back as they work around the clock in the waning days of session to ensure the physician voice is heard and well-represented. We will continue to keep you informed as things progress. In the meantime, mark your calendars now for a post-session wrap-up webinar on March 21 at noon. </p> <p> While well-represented in the halls of Olympia, our advocacy team's message is amplified when physicians and physician assistants get involved. In the past weeks, we've sent you calls to action to contact your legislators regarding their votes on the wrongful death and balance billing legislation-and you responded. We don't know yet if we turned the tide on these bills-still, your voice was heard. </p> <p> As the American author Louis L'Amour once said, "To make democracy work, we must be a nation of participants, not simply observers." Thank you for participating! </p> </div>7/13/2018 12:03:45 PM3/28/2018 12:51:29 PM2/22/2018 12:00:00 AM
House_of_medicine_makes_the_news_and_takes_to_the_HillHouse of medicine makes the news and takes to the HillWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/House_of_medicine_makes_the_news_and_takes_to_the_Hill<div class="col-md-12"> <h5>February 5, 2018</h5> <h2>House of medicine makes the news and takes to the Hill</h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p>I'm sure you took note of some of the headlines published last week, prompted by the release of the Washington Health Alliance report, "First, Do No Harm."</p> <p>It's a headline grabber in the daily news, but the subject of the report actually isn't news to the physician community. In fact, as part of our ongoing effort to improve care and promote good health in Washington state, the WSMA launched the Know Your Choices-Ask Your Doctor campaign back in 2012. Our campaign encompassed three physician-led quality initiatives: Choosing Wisely®, better end-of-life care, and ER is for Emergencies.</p> <p>Since 2012, our Choosing Wisely campaign continues to evolve and expand. I’m proud to say that our association helped take a concept—first published in a national journal—and successfully integrated it not only into physician practices, but also into the broader community through collaboration with the Washington State Hospital Association and the Alliance. We’ve collectively been working on reducing overuse and low-value care via the Washington State Choosing Wisely Task Force.</p> <p>We know that achieving culture and technical change will require leadership, tenacity, innovation and commitment over the long haul. Fortunately, there is already progress. Here are two notable examples:</p> <ul> <li>Group Health (now Kaiser Permanente Washington) implemented a number of interventions to reduce antibiotic prescribing. To reduce patient demand for antibiotics, educational materials were distributed at the time the appointment is made, while the patient is roomed, during the exam and in the visit summaries. Physicians also shared a “symptom duration chart” to inform patients about the typical progression of the common cold (which lasts longer than most people think). Group Health also reduced physician prescribing through training, scripting, tools and local CME. Through these interventions, <strong>Group Health physicians reduced their rate of prescribing antibiotics for upper respiratory infections from 41.5 percent in the second quarter of 2015 to 21.5 percent in the third quarter of 2016.</strong></li> <li>Leaders at Samaritan Healthcare saw in the Alliance’s 2014 statewide Choosing Wisely data report that their county’s rate for prescribing antibiotics for sinusitis was 45 percent—which they thought was too high. They made this one of the quality measures on their 2016 institutional scorecard, which was tied to their annual staff incentive bonuses. <strong>Samaritan successfully reduced their rate for prescribing antibiotics for sinusitis from 33 percent in January 2016 to 14.9 percent in December 2016.</strong></li> </ul> <p>I’m sure you’ll want to read the <a href="https://www.wacommunitycheckup.org/media/47156/2018-first-do-no-harm.pdf">Alliance report</a> in full. It looked at claims data for 2.4 million commercially insured lives in Washington state, finding that 11 measures (out of 47) account for 93 percent of the low-value services. The 11 measures include the following, in descending order based on volume:</p> <ul> <li>Too frequent cervical cancer screening in women.</li> <li>Preoperative baseline laboratory studies prior to low-risk surgery.</li> <li>Unnecessary imaging for eye disease.</li> <li>Annual EKGs or cardiac screening in low-risk, asymptomatic individuals.</li> <li>Prescribing antibiotics for acute upper respiratory and ear infections.</li> <li>PSA screening.</li> <li>Population-based screening for OH-vitamin D deficiency.</li> <li>Imaging for uncomplicated low back pain in the first six weeks.</li> <li>Preoperative EKG, chest X-ray and pulmonary function testing prior to low-risk surgery.</li> <li>Cardiac stress testing.</li> <li>Imaging for uncomplicated headache.</li> </ul> <p>The report doesn’t capture the successes I noted above because those were accomplished outside of the report’s timeframe (July 2015–June 2016). Nonetheless, it’s clear that when we put effort into reducing unnecessary care, we can make a difference. And WSMA is <a href="https://wsma.org/wcm/For_Patients/Choosing_Wisely/For_Physicians/Choosing_Wisely_Clinical_Toolkit/wcm/Patients/Know_Your_Choices/Choosing_Wisely_Clinical_Toolkit.aspx?hkey=1544e596-7c0c-43a0-98d6-24fb4a8de186">sharing and promoting the tools</a> used by those organizations so that others may follow their lead.</p> <p>Physicians are on the frontlines of care because they care. They are dedicated, compassionate public servants who put patients first, always. They are trained, committed and obligated by oath to “do no harm” and that is what guides and drives us to improve quality and ensure access to appropriate care for all Washingtonians.</p> <p><strong>Physicians make House (and Senate) calls in Olympia</strong><br /> In other news, more than 130 physicians, physician assistants and practice staff gathered in Olympia last Wednesday at the WSMA Legislative Summit to talk about how lawmaking impacts the profession and patients. Top issues included:</p> <ul> <li>Advancing an evidence-based approach to ending opioid-related abuse, addition and overdose at all points on the care continuum.</li> <li>Increasing Medicaid rates to those of Medicare for physicians in <span style="text-decoration: underline;">all</span> specialties.</li> <li>Supporting access to affordable prescription drugs.</li> <li>Addressing balance billing in a fair and equitable manner.</li> <li>Raising the age for sale of tobacco products to 21.</li> <li>Oppose efforts to increase taxes on physicians and/or their services.</li> </ul> <p>See WSMA's <a href="[@]WSMA/News_Publications/Newsletters/WSMA_Advocacy_Report.aspx">Advocacy Report newsletter</a> for a recap of the Summit and more information on these priority issues.</p> <p>Last week was quite the week! If you have thoughts about the Alliance report, let me know. And I’d like to say thanks to our members who wore their white coats on the Hill last Wednesday at the Summit. It made a powerful visual impression—check it out in <a href="https://vimeo.com/254065964">this brief video</a>.</p> <p>All of this work—from reducing unnecessary care to taking the Hill for medicine—is made stronger when we stand together. This is the value of membership in the WSMA, now nearly 11,000 members strong. We represent <span style="text-decoration: underline;">you</span>, so if you haven’t remembered yet to renew—as one member mentioned at our lobby day—now’s the time! Meanwhile, we’ll keep advocating and raising up your concerns wherever, and whenever, we can.</p> </div>7/13/2018 12:04:06 PM2/6/2018 9:16:38 AM2/5/2018 12:00:00 AM
WSMA_standing_up_for_physicians_in_OlympiaWSMA standing up for physicians in OlympiaWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/WSMA_standing_up_for_physicians_in_Olympia<div class="col-md-12"> <h5>January 28, 2018</h5> <h2>WSMA standing up for physicians in Olympia</h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p>Today marks the 22nd day of our state legislative session, but you may not know that today also marks the first day of this year's tax season. Who files taxes this early? According to a <a href="https://fivethirtyeight.com/features/everyone-files-their-taxes-at-the-last-minute/">2016 report</a>, it looks like I'm in good company with most Americans who procrastinate right up to the deadline.</p> <p>Thankfully for WSMA members, our diligent team in Olympia is not made up of procrastinators. Quite the opposite--they have been aggressively on top of issues concerning physicians since day one of session. In fact, in the past three weeks, they’ve monitored more than 350 bills—not to mention monitoring numerous general issues—and literally shown up to testify at nearly 90 hearings. Believe me, this team has your back.</p> <p>And speaking of deadlines, the first session deadline for state lawmakers is this Friday, when policy bills must be voted out of the committees of origin in order to move forward. After that, Olympia-watchers will have a clearer picture on which issues might gain traction in the weeks ahead.</p> <p>In the meantime, WSMA’s legislative team will keep doing what they do best—standing up for what matters to our members and their patients. If you’d like to be in the know on those activities, check out WSMA’s <a href="[@]WSMA/News_Publications/Newsletters/WSMA_Advocacy_Report.aspx">Advocacy Report newsletter</a>.</p> <p>If you’d like to get more involved, committee hearings are open to the public and the physician perspective is critical. It really helps to have physicians come to Olympia to testify on certain pieces of legislation. If that’s something you can do, contact Trevor Justin at <a href="mailto:trevor@wsma.org">trevor@wsma.org</a>.</p> <p><strong>WSMA members take the hill</strong></p> <p>We are also busy preparing for the WSMA’s annual Legislative Summit—scheduled for this Wednesday, Jan. 31. More than 100 WSMA members—your colleagues and peers—have registered to attend. Be part of the action and come join us! Walk-in registration is welcome and free of charge for our members. Be sure to wear your white coat, as we want to make a visual statement that physicians and physician assistants are “on the hill.”</p> <p>This is a great event and opportunity for your voice to be heard on issues of import. The Olympia team will provide all the information you need about our priorities and recommendations on how to most effectively meet with your legislators.</p> <p>The WSMA’s legislative team will equip you with specific details on our priority issues, including:</p> <ul> <li>Addressing the high cost of prescription drugs</li> <li>Market stabilization and Medicaid payment</li> <li>Addressing the opioid epidemic</li> <li>Raising the purchasing age for tobacco to 21</li> <li>Fight against any physician-specific tax increases</li> <li>Efforts to improve network adequacy and address balance billing</li> </ul> <p><strong>Narrow networks and balance billing</strong></p> <p>Last week’s Membership Memo reported that the state’s recent action against Coordinated Care renewed attention on health insurer provider networks and the balance billing that often results from “narrow,” or inadequate networks. It also prompted action from state lawmakers. Sen. Randi Becker introduced Senate Bill 6470, which aims to address inadequate provider networks—and prevent associated balance billing—by requiring greater oversight by the Office of the Insurance Commissioner.</p> <p>That bill would:</p> <ul> <li>Require the OIC to affirmatively approve provider networks submitted by carriers (rather than assuming them to be accurate and investigating if/when patients complain after the fact);</li> <li>Require the OIC to consider carrier contracting within a facility, rather than just a region, when determining network adequacy (to help ensure that physicians working in a hospital are also contracted with the insurance carrier);</li> <li>And, require carriers to maintain accurate directories of contracted providers, so that patients know whether their physician is in network or not.</li> </ul> <p>The WSMA supports Sen. Becker’s bill, having advocated for years for the OIC to be more proactive regarding network adequacy.</p> <p><strong>Tackling administrative simplification</strong></p> <p>WSMA's Healthy Doctors, Healthier Patients campaign works to improve physician satisfaction by decreasing administrative burden and allowing physicians to do what they do best: provide excellent patient care.</p> <p>It’s not surprising that a recent WSMA poll of physicians in Washington state affirmed that reducing administrative and regulatory burden is a high priority for physicians of all specialties and practice arrangements.</p> <p>It is through this lens that our team in Olympia evaluates bills moving through the legislature. Bills currently on our HDHP advocacy list include:</p> <ul> <li>Step therapy: The legislature is considering placing parameters around a health plan’s use of step therapy. SB 6233 would ensure step therapy protocols are based on widely accepted clinical guidelines so that medicine—not cost—dictates requirements and protects patients whose conditions are well-controlled on a prescription, from being required to try a new medication, if step therapy protocols are added to the formulary at contract renewal.</li> <li>Electronic prescribing: HB 2689 would reduce both administrative burden and diversion of controlled substances by removing statutory references to state requirements for approval of electronic prescribing systems. Deferring to federal DEA requirements will eliminate an approval backlog at the state and facilitate more electronic prescribing in Washington.</li> <li>Advance directives: Both HB 1640 and SB 5478 would eliminate the notary requirement added to advance directives’ law in 2016. Advance directives would only need two witnesses if the bills pass the legislature.</li> <li>Unpaid accounts: HB 1145 and SB 5456 would specifically call out medical debt as an accounts receivable, ensuring collection agencies are able to collect interest on medical debt.</li> </ul> <p><strong>Governor’s opioid legislation</strong></p> <p>Last week, the WSMA and the Washington State Hospital Association’s Joint Opioid Safe Practices Task Force issued <a href="[@]Shared_Content/News/Press_Releases/2018/wsma_and_wsha_joint_statement_on_governors_opioid_legislation.aspx">a statement</a> in support of Gov. Jay Inslee’s legislation (HB 2489 and SB 6150) aimed at addressing the opioid epidemic in Washington state. <a href="https://medium.com/wagovernor/inslee-takes-next-steps-to-continue-work-on-opioid-crisis-b7b2b5f0d1e6">Read more about the governor’s proposals</a>.</p> <p>The WSMA and the task force are monitoring a number of opioid-related bills introduced this month during the state legislative session. </p> <p><strong>WSMA in the news</strong></p> <p>In addition to press coverage on WSMA’s work on opioids, the Puget Sound Business Journal recently published <a href="https://www.bizjournals.com/seattle/news/2018/01/12/opinion-physicians-also-keep-the-economy-healthy.html">our op-ed</a> that highlights the economic impact physicians, their practices and medical groups have on communities around the state. I made the point that when physicians close their doors, it not only hurts patients and communities, it also hurts the economy.</p> <p>It’s good business to ensure that Washington state offers a healthy environment that benefits physicians, and therefore benefits the well-being of all Washingtonians. And that’s why we’re on top of issues that matter to you!</p> </div>7/13/2018 12:05:43 PM2/6/2018 10:20:36 AM1/28/2018 12:00:00 AM
Volk_decision_a_few_words_make_a_huge_differenceVolk decision: A few words make a huge differenceWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/Volk_decision_a_few_words_make_a_huge_difference<div class="col-md-12"> <h5>January 15, 2018</h5> <h2>Volk decision: A few words make a huge difference</h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p>We have been deeply concerned about the Washington State Supreme Court's decision in Volk v. DeMeerleer. As you may recall, that decision substantially expanded the responsibility of physicians and other health care providers to warn all foreseeable victims of violence if a patient under their care makes a specific threat during outpatient treatment.</p> <p>What a difference a few words can make. The language revision from previous state law, which called for notification to a "reasonably identifiable victim," to the new language of "all foreseeable victims," clearly has a profound impact on our members and the patients they serve.</p> <p>From the moment that decision was announced, the WSMA’s legal and legislative teams worked aggressively to oppose such an unreasonable and far-reaching expectation of law. In fact, we assembled a group of prominent national and state organizations to participate in an initial amicus curiae brief at the state Supreme Court, followed by a second amicus brief asking for reconsideration of the court’s unfortunate decision.</p> <p>Stymied by the court, during the 2017 legislative session the WSMA worked with numerous partners to achieve a correction in law that would protect physicians and their patients from this mandate. Rather than make a correction to the law, the legislature instead elected to fund a study regarding the impacts of the court’s decision.</p> <p>That recently published study, <a href="https://wsma.org/doc_library/LegalResourceCenter/JudicialOpinions/Volk-Report-Addendum-Appendix.pdf">conducted by the University of Washington School of Law</a>, echoed many of WSMA’s concerns, noting the following conclusions:</p> <ul> <li>The Volk decision <em>substantially</em> broadened the duty of physicians and other providers to protect and warn third parties in the outpatient setting when a patient makes a threat of physical violence.</li> <li>The decision created different levels of duty to warn and protect: The broader duty to warn and protect all foreseeable victims in the outpatient context, and ironically, a narrower duty to warn or protect reasonably identifiable victims of a patient's threat in the involuntary commitment inpatient context.</li> <li>Many physicians and other mental health providers are worried that their relationships with patients in the outpatient setting may be compromised by the broad duty to warn and protect:</li> <ul> <li>70 percent of mental health physicians and other providers are considering changes to their practice to forestall liability.</li> <li>50 percent of mental health physicians and other providers surveyed indicated they had already instituted changes in their practices and the manner in which they will treat potentially violent patients.</li> </ul> <li>The study reports that Washington state is now an outlier compared to the rest of the country regarding the duty to warn and protect in face of a patient's threat.</li> </ul> <p>With the 2018 legislative session now convened, what policy makers plan to do with this study is uncertain. A legislative approach to address the devastating impact of the Volk decision faces strong opposition from some members of the House Judiciary Committee who do not believe that the Volk decision changed the law, contrary to the findings of the UW study. Whatever happens, the WSMA will continue to seek options—such as a legislative work group or legislative efforts—to reconcile the different duties to warn and protect.</p> <p>In the meantime, what’s a physician to do?</p> <p>While no assessment or checklist can fully protect a physician under this new law, the WSMA recommends that physicians who treat patients with violent tendencies or ideations consider implementing the following guidelines:</p> <ul> <li>Continue to use reasonable care to act consistent with the standards of your profession.</li> <li>Complete and update suicide and violence risk assessments with findings documented in the patient’s medical record.</li> <li>Develop a policy and procedure to assess whether a patient has dangerous propensities and use it consistently.</li> <li>Document in the patient’s medical record why you reached your clinical decision and measures you recommend to mitigate potential risk, even when you are assessing a patient who has violent tendencies or ideations and do not believe the patient will harm others.</li> <li>In all cases, carefully consider and document in the patient’s medical record the measures taken to mitigate risk. Measures fall into two categories: measures to treat the patient and measures to warn potential victims. Measures to treat the patient may include but are not limited to: seeking to hospitalize the patient; seeking to initiate involuntary commitment proceedings; scheduling more frequent visits or contacts with the clinic; starting injectable medication, etc. Measures to warn potential victims may include notifying law enforcement and notifying “foreseeable” victims.</li> <li>When you decide to issue a warning, notify law enforcement before contacting potential victims. Document in the patient’s medical record your notification efforts and the individuals or groups notified.</li> <li>In Volk, the court held that it is a jury’s responsibility to determine who may be a foreseeable victim. In assessing the scope of foreseeable victims, consider people close to the patient, such as family members, work colleagues and others within the person’s social circle. Depending on your assessment, notification to a broader group could be required. In that case, coordination with law enforcement may be necessary. You must assess every case individually.</li> <li>For any action taken, document in the patient’s medical record the reasons the action is necessary to warn or protect foreseeable victims, and if applicable, to prevent or lessen a serious and imminent threat to a person or the public’s health or safety, as described above.</li> </ul> <p>Consider these points in the clinical context, act in good faith and document in the patient’s medical record your thought process in sufficient detail to justify any course of action you decide to take (<a href="javascript://[Uploaded files/Resources/Legal/Volk recs-FINAL.pdf]">click here for a handy guidance document</a>). Adequate documentation will be key to reducing your risks of professional liability in face of the uncertainty that the Volk decision has created in outpatient mental health treatment.</p> <p>I know this issue is of great concern to us all. The WSMA will continue to follow developments closely, advocate aggressively and report out to you regularly. Stay tuned.</p> </div>7/13/2018 12:05:30 PM2/6/2018 9:23:35 AM1/15/2018 12:00:00 AM
 

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