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Weekly Rounds
News and insights from WSMA CEO Jennifer Hanscom.

Weekly Rounds

A newsletter from WSMA CEO Jennifer Hanscom, sent to health care industry leadership and WSMA members.

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weekly_rounds_2018_11_19_difficult_news_that_must_be_deliveredWeekly Rounds: November 19, 2018 - Difficult news that must be deliveredWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_11_19_difficult_news_that_must_be_delivered<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="Weekly Rounds logo" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <h5>November 19, 2018</h5> <h2>Difficult news that must be delivered</h2> <p> Jennifer Hanscom, Executive Director/CEO </p> <p> As physicians, you're no strangers to having to dispense difficult news. It's a burden you carry with grace, compassion, and empathy. As I write today's column, that aspect of your caring profession weighs heavy on my mind. In thinking about it, I came across <a href="https://www.medicalnewstoday.com/articles/318067.php">this quote</a> on the topic, from Steven Pantilat, MD, founding director of the Palliative Care Program at the University of California-San Francisco Medical Center: "No matter how well you deliver bad news, it's still bad. You can't make it somehow OK for the patient, but it's important not to make it worse." </p> <p> These thoughts have been with me as I've considered all the ways we can make sure you're aware of how opioid prescribing rulemaking from House Bill 1427, passed by the Legislature in 2017, will ultimately impact you. Despite our efforts, the rules—which, for most of you, will be effective starting in January—are complicated and will be a challenge for some practices to implement. </p> <p> Here's some background: Combatting the opioid epidemic is a top priority for the WSMA. Over the past several years, we have advanced both <a href="https://wsma.org/Shared_Content/News/Weekly_Rounds/2018/multi_pronged_efforts_seek_to_make_a_difference_in_opioid_epidemic">legislative</a> and <a href="https://wsma.org/Shared_Content/News/Press_Releases/2018/Public-private_safe_prescribing_initiative_results_in_reductions_in_Medicaid_opioid_prescriptions.aspx">patient-safety strategies</a>, partnering with the Washington State Hospital Association, the governor's office, the state Department of Health, and the state Health Care Authority. </p> <p> You'll recall that over the last year, we've <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180912/medical_commission_finalizes_opioid_prescribing_rules.aspx">regularly</a> <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180808/Last_chance_to_comment_on_rules_impacting_the_way_you_prescribe_opioids">communicated</a> our <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180228/doh_seeks_comments_on_draft_opioid_prescribing_rules_final_public_meeting_on_march_14">efforts</a> regarding the rulemaking on this bill. It's been an exceedingly rough road, as five separate medical commissions proposed varying—and sometimes conflicting—rules, over many iterations. Throughout the process, our team in Olympia has heroically had your backs, and has been unceasingly vigilant in working to protect you from undue burden and your patients from unintended consequences. </p> <p> At the same time, as a leading voice for the physician community, the WSMA has advocated for policies that reduce the amount of inappropriate prescriptions in our communities while ensuring access to medications for patients that need them. </p> <p> House Bill 1427 became the primary vehicle for many interventions, including opioid prescribing rules and data sharing by the state to improve opioid prescribing practices. After a year-long process, the boards and commissions that regulate prescribers in Washington state have finalized their rules. For allopathic physicians and physician assistants, Washington Medical Commission's final rules go into effect this Jan. 1 (read the final rule <a href="https://wmc.wa.gov/sites/default/files/public/documents/Ruleswithcoverpage.pdf" target="_blank">here</a>). For osteopathic physicians and PAs, Board of Osteopathic Medicine and Surgery rules went into effect on Nov. 1 (read that final rule <a href="https://www.doh.wa.gov/Portals/1/Documents/2300/2018/WSR-18-20-087.pdf" target="_blank">here</a>). </p> <p> As medical leaders, you will want to note the prescribing professions' differing requirements, given HB 1427 allowed each regulatory body to adopt new rules under its own authority. At the request of several leaders, we are working to create a rules overview slide deck that will help you prepare your care teams for these new requirements (we expect the slides to be ready in December). </p> <p> For now, together with Washington State Hospital Association and the Health Care Authority, we are recommending three key strategies for success in this new opioid prescribing environment: </p> <ul> <li><a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx#rules">Prepare for new opioid prescribing rules</a>.</li> <li><a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx#data">Leverage available data to understand prescribing patterns and receive alerts for patients who have experienced an overdose</a>. </li> <li><a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx#pmp">Integrate your electronic health record with the state's prescription monitoring program</a>. </li> </ul> <p> The links above contain details on these strategies and recommendations. You will need to develop a comprehensive strategy for engaging in this work, and I know it won't be easy. I'm chagrined at being one of the messengers on this news, but I appreciate your response to the opioid epidemic. </p> <p> I hope you know that we are fully committed caring for, and protecting you, just as you do for your patients. We'll keep working hard to prevent well-intentioned, yet problematic concepts for patient care. </p> <p> Thank you for all you do on behalf of Washington patients. </p> </div>11/20/2018 8:49:51 AM11/19/2018 10:04:33 AM11/19/2018 12:00:00 AM
weekly_rounds_2018_11_5_collective_effort_drives_effective_changeWeekly Rounds: November 5, 2018 - Collective effort drives effective changeWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_11_5_collective_effort_drives_effective_change<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="Weekly Rounds logo" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <h5>November 5, 2018</h5> <h2>Collective effort drives effective change</h2> <p> Jennifer Hanscom, Executive Director/CEO </p> <p> Late last week, the power of our collective voice and the clout of organized medicine became tangibly evident. As noted in the <a href="https://wsma.org/Shared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_09_03_five_things_you_need_to_know_this_week">Sept. 3 edition of Weekly Rounds</a>, the WSMA and 170 other physician and health care organizations united to vehemently oppose a proposal to collapse Medicare payment rates for office and outpatient visit services. And then, thanks to the house of medicine speaking out in full force, the Centers for Medicare and Medicaid Services delayed implementation of the proposed changes for two years. </p> <p> In the past few days, the American Medical Association—which led the effort to oppose the payment changes—reported that CMS "acknowledged the work of the AMA's CPT/RUC Workgroup on E/M and has <strong>postponed any coding and payment-related changes for E/M office visit services until CY2021</strong>." </p> <p> This delay in implementation allows the CPT Editorial Panel to "consider the Workgroup's proposal in February of 2019 prior to prompt consideration by the AMA/Specialty Society RVS Update Committee (RUC)." </p> <p> In further good news, CMS did finalize several changes to E/M documentation guidelines, which were strongly supported by organized medicine. These changes will take effect January 1: </p> <ul> <li>Eliminating the requirement to document medical necessity of furnishing visits in the home rather than the office. </li> <li>Physicians will no longer be required to re-record elements of history and physical exam when there is evidence that the information has been reviewed and updated. </li> <li>Physicians must only document that they reviewed and verified information regarding chief complaint and history that is already recorded by ancillary staff or the patient.</li> </ul> <p> Other Coding/Payment Proposals Related to E/M </p> <ul> <li>The following policies were also opposed by the AMA and will not be implemented by CMS:</li> <li>Payment reductions by 50 percent for office visits that occur on the same date as procedures (or a physician in the same group practice). </li> <li>CMS proposed to no longer allow for podiatry to report CPT codes 99201-99215 and instead would use two proposed G-codes for podiatry office visits. CMS also proposed a new prolonged service code that would have been implemented to add-on to any office visit lasting more than 30 minutes beyond the office visit (i.e. hour-long visits in total).</li> <li>Condensed practice expense payment for the E/M office visits, by creating a new indirect practice expense category solely for office visits, overriding the current methodology for these services by treating Office E/M as a separate Medicare Designated Specialty. This change would also have resulted in the exclusion of the indirect practice costs for office visits when deriving every other specialty's indirect practice expense amount for all other services that they perform, which would have resulted in large changes in payment for many specialties (e.g., a greater than 10 percent payment reduction for chemotherapy services). </li> </ul> <p> For CY 2021, CMS conveyed its intention to propose two basic payment rates for office visit services, one for straightforward visits and another for complex visits. In addition, CMS noted its intent to propose add-on codes for primary care and inherently complex specialty E/M visits. </p> <p> CMS noted they will also consider input from the AMA and the CPT/RUC Workgroup on E/M as well as input from across the medical community. </p> <p> We're grateful to the AMA for its quick analysis of the E/M sections of the final rule, and for leading the nationwide coordinated effort to oppose the problematic proposals offered by CMS. </p> <p> If you are in the position of deciding whether to renew/join the AMA, consider this as just one example of how organized medicine works on your behalf. Changes like these don't happen because of one individual's comment or one medical group's response. This type of high-level change requires the power of 170 organizations together in a critical mass that demands attention and forces policy makers to take notice and act. </p> <p> I hope this prompts <strong>you</strong> to act. Your membership in the AMA and the WSMA really does matter. There is no doubt that together we are stronger. </p> </div>11/5/2018 11:27:59 AM11/5/2018 10:41:26 AM11/5/2018 12:00:00 AM
weekly_rounds_2018_10_29_working_together_for_the_good_of_health_careWeekly Rounds: October 29, 2018 - Working together for the good of health careWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_10_29_working_together_for_the_good_of_health_care<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <h5>October 29, 2018</h5> <h2>Working together for the good of health care</h2> <p> Jennifer Hanscom, Executive Director/CEO </p> <p> Just over a week ago, hundreds of WSMA members convened at the Historic Davenport Hotel in Spokane for the annual meeting of our House of Delegates. It's always energizing to connect face-to-face with our members and to hear from them about issues of concern. </p> <p> The conversations I had at our meeting echoed other discussions I've had lately, including at a recent dinner with physicians from all over the country. Our broad-ranging dialog covered familiar ground: How do we engage today's physicians in our organizations, and how do we engage our members in the larger health care conversation? </p> <p> A full-blown crisis is often a catalyst to motivate like-minded folks to act. There's nothing like an immediate or impending threat to get people organized, engaged, and mobilized. Even recent history bears this out, if you think about public health concerns like lead in the water in Michigan; or longer ago, smallpox and flu epidemics, HIV/AIDS, polio, etc. </p> <p> A recent New York Times article, "<a href="https://www.nytimes.com/2018/10/06/opinion/sunday/climate-change-global-warming.html">Stopping Climate Change Is Hopeless. Let's Do It</a>," opined that "if the human species specializes in one thing, it's taking on the impossible." In that article, Auden Schendler and Andrew P. Jones wrote that: "…we must realize that real progress comes from voting, running for office, marching in protest, writing letters, and uncomfortable but respectful conversations with fathers-in-law. This work must be habitual. Every day some learning and conversation. Every week a call to Congress. Every year a donation to a nonprofit advancing the cause. In other words, a practice." </p> <p> That admonition applies to any situation where we must work to advance change, whether for the good of society, or in WSMA's case, the good of patients and the profession. Real change in health care comes about slowly, takes practice, and takes engagement. And it shouldn't take a crisis to motivate us to action. It should be an everyday ritual. </p> <p> Advancing change is exactly where "slow and steady wins the race" is the approach that works. The WSMA provides the structure for that approach to succeed. Day in and day out, our sole purpose is to advance an agenda that benefits the profession and the patients you treat. But to advance a meaningful agenda—one that will have a true impact on health care and medicine—we need your direction, feedback, expertise, and engagement. And we need your voice not just once, and not just on an issue that pertains solely to your specialty or practice setting. We need all physicians working together all the time to advance what's best for medicine. </p> <p> Members drive our work. It is our members who advise us on practical and workable solutions to balance billing and opioid prescribing. Our members charge us to take a leading role to address gun violence and suicide, clean air, and social determinants of health. Members inform us on what hinders quality patient care and depletes the joy of practice. And it's our members who are willing to stand up and challenge unnecessary care and waste in the system. </p> <p> That input drives our agenda, and from there it is WSMA's job to bring your voice to the forefront of debate on these issues. </p> <p> In the coming months, lawmakers will be making critical decisions that could have enormous implications to physicians and patients. </p> <p> Just as teamwork is a key part of health care, teamwork is also key to our efforts representing you. In effect, we are your dyad partner, working to represent your interests while soliciting your feedback and direction. </p> <p> The WSMA's superpower is its ability to bring specialties together, bridge generational divides, unite diverse perspectives, and democratically balance it all to find solutions to challenges faced by the profession, patients, and communities. We saw this in action at the House of Delegates in mid-October—see this work for yourself by <a href="https://wsma.org/WSMA/About_Us/Leadership/House_of_Delegates/WSMA/About/Leadership/House_of_Delegates/House_of_Delegates.aspx?hkey=e2c50002-384d-4ff7-9116-5ce7a51116e7">reviewing the policies adopted by delegates the 2018 WSMA Annual Meeting</a>. </p> <p> Your voice matters to us and to the profession. This is our strength that ensures a positive working and care environment and leads us to our vision of making Washington the best place to practice medicine and to receive care. </p> <p> Thanks for standing with us in this work. It really does matter. </p> </div>10/29/2018 9:59:22 AM10/29/2018 9:55:43 AM10/29/2018 12:00:00 AM
weekly_rounds_2018_10_18_if_physicians_do_not_lead_someone_else_willWeekly Rounds: October 18, 2018 - If physicians don't lead, someone else willWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_10_18_if_physicians_do_not_lead_someone_else_will<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/weekly_rounds_tom_schaaf.jpg" class="pull-right" /></div> <h5>October 18, 2018</h5> <h2>If physicians don't lead, someone else will</h2> <p> Tom Schaaf, MD, WSMA President </p> <p> <em>On Sunday at the 2018 Annual Meeting of the WSMA House of Delegates, we inaugurated our new incoming president, Tom Schaaf, MD, MHA. For those of you who couldn't be with us, we wanted to be sure you had an opportunity to read his speech, so I've invited him to be our guest columnist for Weekly Rounds. - Jennifer Hanscom, WSMA executive director/CEO</em> </p> <p><strong> Tom Schaaf, MD, WSMA 2018-19 incoming president's speech, Sunday, Oct. 14, 2018, 9 a.m. at the Historic Davenport Hotel in Spokane.</strong> </p> <p> I'd like to thank you all for being here today. It's a significant chunk of time to be away from your families, your practices and your weekend, and I know it's tough to sit inside—even in the Davenport Hotel—on a classic fall day in Spokane. I'd also like to say a special thanks to my family, friends, and colleagues from Providence for their support this morning. </p> <p> I'm grateful to you for allowing me the privilege of representing you as president of the WSMA as we face challenging times in the house of medicine. </p> <p> Many of these issues you experience every day: </p> <ul> <li>The rise—and then the disruption—of the Affordable Care Act along with complicated programs for value-based payment causing anxiety about our economic futures. </li> <li>EMRs brought us access to overwhelming amounts of information—or no useful information at all—while drawing our attention to the ever-demanding keyboard and away from our patients. </li> <li>Prior authorization, pharmacy benefit managers, and CMS-mandated visits to approve care are maddening. </li> <li>The relationship with our patients has fractured as health plans change, practices are purchased, internet medicine expands, and convenience becomes the key driver of the health care "consumer." </li> <li>And the opioid crisis has led to increasing regulation and oversight of our care, in addition to becoming another point of distrust between our patients and ourselves. </li> </ul> <p> Through all these challenges, the WSMA is working to advocate on your behalf, educate the public and our civic leaders, and bring you the tools to cope, and hopefully thrive, as we all navigate the journey ahead. </p> <p> Now, my day-to-day job title may make some of you skeptical about my ability to represent you in this work. First of all, I work for Providence St Joseph Healthcare. While many folks here actually work for Providence, Swedish, or Kadlec, some of you in the audience may view our employers skeptically. My role there is the chief medical officer for home and community care. </p> <p> I realize that for some of you that is the epitome of "going to the dark side." In fact, one of my WSMA colleagues has even given me a hairless cat statue to bolster my "Dr. Evil" cred. </p> <p> My hope this morning is to share some insight into why I pursued leadership roles, why physician leadership roles are critical to the future of the house of medicine, and why leaderships skills are worth learning. </p> <p> I'd like to share a bit about my background. My father was a practicing family doctor for almost 60 years. When I was a youngster, his office was in our home. My earliest memories are of driving to the hospital with him to make rounds, and playing with the models of hearts, brains, and knees in his office. When I was older, I even answered the phone and made appointments. </p> <p> I was the kind of kid who read everything. I still have a 1926 edition of "Microbe Hunters" on my bookshelf. The scientists profiled in that book were my heroes growing up. Koch, Pasteur, and Ehrlich not only saved lives, they also had to work against tradition and engrained practices. I was inspired by the possibilities, the adventure, the potential that adapting to change can bring to improving health and life. To me this was exciting stuff. A job as diener and phlebotomist as a high school student pushed me to commit to a pre-med course of studies at Whitworth. </p> <p> At UCLA, I enjoyed nearly every clinical rotation I did, leading me to a family medicine residency. My scope narrowed a bit when I joined my dad's geriatric practice at Laguna Hills Leisure World. It was fun to be a practicing physician at the hospital where I had been a phlebotomist in high school. It took a while to overcome the "what are you doing?" reactions! </p> <p> Eventually, I left southern California, returning to the Northwest where I spent more than 20 years with Group Health. During that time, I became involved in quality programs, process improvement, and system redesign. In 1996, I had the opportunity to create the hospitalist program that still serves Kaiser patients at Providence Sacred Heart, and I moved from the outpatient clinic to a hospitalist role. </p> <p> That experience was pivotal for me. Clinically, I had to adapt my practice from mostly outpatient geriatrics to purely inpatient. From a leadership perspective, I had to learn a thousand things in a short timeframe. </p> <p> One of the key things I learned was to shut up and listen to people trying to cope with a changing world. I also learned to be humble in the presence of people of who often knew more than I did. But they did need help fixing broken systems and adapting to a changing environment. </p> <p> After some time, I became regional medical director for the Group Health clinics in Spokane and Couer d'Alene, leaving in 2014 when they laid off a number of physician leaders. </p> <p> At that point in my career I was 55, a bit salty about the layoff, and had to figure out what I really wanted to do when I grew up. It was clear that our health care system was not going to fix itself, and that physicians were needed to lead the effort to get things on track. I realized that my on-the-job training in leadership wouldn't be sufficient if I wanted to be a useful part of the solution. </p> <p> I spent two years getting my Master of Health Administration at University of Washington with Dr. Ed Walker and his crew, while also working as a hospitalist at Sacred Heart and at St. Joseph Care Center. I realized that the skills we learn as clinicians are necessary—but not sufficient—to influence CEOs, CFOs, and other health system administrators. Understanding their perspective and the business financials is a necessity in communicating with them. Knowledge of law and health care policy is also helpful to effectively advocate for appropriate policy decisions. Administrators tend to speak a different language than physicians, which makes it hard for them to understand us. But when we effectively translate the language of medicine and tell the story of patients and doctors to non-clinicians in leadership, we can shape the outcome of decisions that dramatically affect our lives. </p> <!-- div class="col-md-5 pull-leftt" style="text-align: center;"><img alt="" src="/images/News/2018-10-WSMADrSchaaf-1.jpg" /></div --> <p> The outcome of my MHA efforts, combined with my clinical work in geriatrics, led to me creating the CMO role at Providence Home and Community Care. This role includes working with administrative and clinical staff to improve care in skilled nursing, home health, and hospice services. It also involves working with Providence system leaders to improve the way care flows across inpatient, outpatient, and continuum services. I'm privileged to work with incredibly creative and committed folks to improve care for the elderly across the whole Providence system, and it is really fun work. There are few other systems where I can have that much impact on a daily basis, and the heart of that work is to make it easier for physicians and nurses to give great care to our patients. </p> <p> I do still have a stethoscope, and I still know how to use it. I see hospice patients in Olympia every week, and I help out with patients in King County and Everett when they are short staffed. It's no surprise that this work grounds me in the real world of patient care and helps me understand the systems I'm working to fix. Those who do hospice care know that it is the ultimate in team-based care, and the privilege of caring for people in their homes is hard to describe if you've never done it. </p> <p> I am fortunate to be in this leadership role and still get to see patients. Some physician leaders aren't so fortunate. Those physicians who have had to give up direct patient care to help lead our health systems should have our respect and support. I know this idea might be uncomfortable for some of you, but when we scorn our peers who become full time CMOs and leaders, we overlook the fact that they are making a sacrifice to work on issues and systems that affect us all. </p> <p> This is all to say, here is my real request of you today: Embrace the leadership roles that come your way, even if—at a minimum—that means embracing the role of clinical leader that is implicit in being a physician working with nurses and support staff. </p> <p> Our choice isn't whether we are leaders, it is whether we are good ones or not. Be a good one. The WSMA has tools and classes to help. Attend the Leadership Development Conference in Chelan. Take the leadership courses we run with Dr. Ed Walker. Read books. Look for opportunities to work on committees and to push physician knowledge and experience into the "dark areas" of the hospital and your health system. </p> <p> If we don't lead, we will be led by folks who may be talented—and even well-meaning—but who don't know what it means to stand at the bedside and care for patients the way we do. </p> <p> It's easy to assume that someone else will do this work and to complain about what they do. If we want to fix what makes us angry, what makes it hard to do good work, what steals our hope, we have to lean in. </p> <p> You are leaders. Get even better at it and then do good with what you know. You have a hand in creating the future of medical practice. Most of us will be practicing in that future world. My son, Liam, is applying to medical school this year, and I look forward to him practicing in a better world than we tolerate now. And soon enough, all of us will become patients in that world. </p> <p> Thank you for hearing me out and thank you for accepting my service as your president. I look forward to working with you, with the board, and with Jennifer and the staff. I am anxious to hear from you, to learn from you, and am honored to be able to serve you. </p> </div>10/19/2018 2:18:46 PM10/19/2018 9:42:40 AM10/18/2018 12:00:00 AM
weekly_rounds_2018_09_17_a_time_to_care_a_time_to_speak_upWeekly Rounds: September 17, 2018 - A time to care, a time to speak upWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_09_17_a_time_to_care_a_time_to_speak_up<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <h5>September 17, 2018</h5> <h2>A time to care, a time to speak up</h2> <p> Jennifer Hanscom, Executive Director/CEO </p> <p> Perhaps, like me, you've seen numerous #SuicidePreventionMonth messages scrolling past on your social media feeds since the beginning of the month. I've been thinking a lot about this issue lately, and not only because I wrote about physician depression <a href="https://wsma.org/Shared_Content/News/Weekly_Rounds/2018/physician_depression_its_time_to_care_for_our_own">in this column recently</a>. </p> <p> Knowing that an <a href="https://emedicine.medscape.com/article/806779-overview">estimated 400 physicians take their lives every year</a>, this topic weighs heavily on my mind and heart. Just last week, the statistics became more than mere numbers when I learned about the suicide of a physician known by many of our members. </p> <p> Physicians do die by suicide, but it is rarely discussed. And yet, as above, I imagine there are few degrees of separation between those who have taken this most tragic step and ourselves. In fact, when physician and author Abraham Verghese, MD, asked attendees <a href="https://med.stanford.edu/news/all-news/2017/10/good-leadership-self-compassion-key-to-tackling-physician-burnout.html">at a conference</a> if they knew fellow physicians who had killed themselves—nearly all raised their hands. He said: "We rarely expose our emotions. There's a fear of showing weakness." </p> <p> It's time for that to change, and we shouldn't need a special month to remind us to take care of ourselves and watch out for others. With suicide rates in Washington state rising, and knowing our very own members, friends and colleagues may be in pain, I urge you to be mindful not only of yourself and your patients, but also your colleagues. </p> <p> We also <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180912/september_is_suicide_prevention_month">covered this topic recently in our Membership Memo</a>. The statistics reveal a tragic irony: Physicians, who devote their lives to easing the suffering of others, die by their own hands at higher rates than the general population. </p> <p> We can take heart by taking action. </p> <p> A national campaign, <a href="http://www.bethe1to.com/">#Bethe1To</a>, centers on five steps people can take to help prevent suicide: </p> <ol> <li> ASK: Be the one to ask the tough question. If someone you know shows warning signs: "Are you thinking about killing yourself?" </li> <li> KEEP THEM SAFE: Do they have access to medications, firearms or other means of suicide? Ask if they've thought about how they would do it and separate them from anything they could use to hurt themselves. Learn more from Washington's <a href="https://makeitasafehome.org/">Safe Homes Coalition</a>. </li> <li> BE THERE: People thinking about suicide can feel they are a burden to their loved ones. Listen to their concerns with compassion and empathy and without judgement. <a href="https://www.nowmattersnow.org/">Now Matters Now</a> has videos from people who have experienced suicidal thoughts speaking about what friends can do to help manage those thoughts. </li> <li> HELP THEM CONNECT: Help your friend connect to a support system so they have a network for help, whether it's 800.273.TALK (8255), the crisis text line (text "HEAL" to 741741) family, friends, faith-based leaders, coaches, co-workers, health care professionals or therapists. The <a href="https://win211.org/">Washington 2-1-1 online database</a> is another way to find local resources. </li> <li> FOLLOW UP: Check in with the person you care about on a regular basis. Contacting a friend in the days and weeks after a crisis can make a difference in keeping them alive. </li> </ol> <p> And remember: If you want to connect with help anonymously, call the National Suicide Prevention Lifeline at 800.273.8255 or text "HEAL" to 741741 to text with a trained crisis counselor. More information on suicide prevention in Washington and the state's <a href="https://www.doh.wa.gov/YouandYourFamily/InjuryandViolencePrevention/SuicidePrevention/SuicidePreventionPlan">Suicide Prevention Plan</a> is online. </p> <p> Let's not only care for our patients, let's break through the culture of silence and the stronghold of stigma so we can care for each other. </p> </div>9/17/2018 10:13:26 AM9/17/2018 10:08:00 AM9/17/2018 12:00:00 AM
weekly_rounds_2018_09_03_five_things_you_need_to_know_this_weekWeekly Rounds: September 3, 2018 - Five things you need to know this weekWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_09_03_five_things_you_need_to_know_this_week<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <h5>September 3, 2018</h5> <h2>Five things you need to know this week</h2> <p> Jennifer Hanscom, Executive Director/CEO </p> <p>"That's just crazy!" exclaimed an Overlake Medical Center physician I met at a meeting in Bellevue last week. She was referring to proposed changes to Medicare billing and documentation, proposed rate changes for evaluation and management (E/M) services.</p> <p>I'd been invited to share with Overlake's leadership about the advocacy and other work the WSMA does on behalf of the profession. A question came up about E/M and her comment came during the conversation as I explained the proposal. I was glad to share with her that just last week the WSMA, along with 100+ other health care organizations, signed on to a letter of opposition to the proposed rule. In fact, while our letter was 1 1/2 pages long, the list of signatories ran to 3 1/2 pages! You can read the letter <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180822/comments_due_sept_10_on_cms_proposal_for_physician_fee_schedule_and_quality_payment_program">here</a>.</p> <p>There's plenty more to say on that, but I'll keep it brief as I also wanted to highlight a few other things for you this week as well.</p> <ol> <li><strong>Medicare fee schedule mixed bag for physicians</strong><br /> At the WSMA, we agree with the physician's comment above, and that's why we signed on to the letter of opposition to the Centers for Medicare & Medicaid Services regarding the 2019 Medicare physician payment rule.<br /> <br /> The new rule proposes comprehensive and significant changes to Medicare billing and documentation, including the E/M single rate, provisions to incentivize EHR interoperability and telehealth services, and much more.<br /> <br /> In the letter, we praised CMS for its "Patients Over Paperwork" efforts, and notable efforts to alleviate administrative burden, but we also shared our opposition to collapsing payment rates for eight office visit services for new and established patients down to two each – noting the proposal could hurt physicians in specialties who treat the sickest patients, as well as those who provide comprehensive primary care. We urged that the new multiple service payment reduction policy in the proposed rule not be adopted, as the issue of multiple services on the same day of service was factored in to prior valuations of affected codes. The entire health care community appears to be on the same page on this issue, so we have hope that the CMS will listen and make necessary changes before the rule is finalized later this year. You can offer your comments on the proposed rule until Sept. 10 at <a href="https://www.federalregister.gov/documents/2018/07/27/2018-14985/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions">this link</a>.</li> <br /> <li><strong>Wanted: Experienced parliamentarian</strong><br /> Are you a leader who thrives on bringing order to chaos? Is Robert's Rules of Order on your nightstand? This volunteer position is for you! The WSMA has an unexpected vacancy on its board of trustees for the speaker of the House of Delegates. If you are an experienced parliamentarian and have attended the WSMA Annual Meeting in the past, we encourage you to apply.<br /> <br /> The speaker of the House of Delegates presides at the annual meeting of the House, serves on the WSMA board of trustees and performs other duties as required. The term of office begins after the conclusion of the 2018 WSMA Annual Meeting and continues through the 2019 meeting.<br /> <br /> A <a href="https://wsma.org/doc_library/about/leadership/nomination_form_2018.pdf" target="_blank">nomination form</a>, <a href="https://wsma.org/doc_library/about/leadership/disclosure_form_2018.pdf" target="_blank">conflict of interest disclosure statement</a> and <a href="https://wsma.org/doc_library/about/leadership/candidate_info_sheet_2018.pdf" target="_blank">candidate information sheet</a> along with a curriculum vitae must be submitted for all suggested nominations. Read about board of trustees qualifications <a href="https://wsma.org/doc_library/about/leadership/qualifications_2018.pdf" target="_blank">here</a>. Please email completed forms to Shannon Bozarth at <a href="mailto:slb@wsma.org">slb@wsma.org</a> (or fax to 206.441.5863) by Sept. 12.<br /> <br /> Many of you may know the WSMA's previous speaker, Dick Whitten, MD. Dr. Whitten has served in many capacities for the past 30 years. We will miss his thoughtful leadership as he wielded the speaker's gavel. Kudos and gratitude to you, Dr. Whitten. The WSMA is better for your dedication to our work and that of the profession.</li> <br /> <li><strong>Naturopath scope creep…again</strong><br /> Once again, the naturopathic licensing board at the Washington State Department of Health is proposing an amendment to an existing rule to add a new section that clarifies the practice of non-surgical cosmetic procedures performed by naturopathic physicians. The WSMA is on record opposing this attempt to allow the scope of practice for naturopaths to include administration of botulinum toxin, dermal fillers or other inert substances for cosmetic purposes, <a href="http://www.informz.net/WSMA/data/images/Documents/NaturoBotox_08142018.pdf" target="_blank">for numerous reasons</a>, not the least of which is that it puts patients at unnecessary risk of harm. Should this rule move forward, it may necessitate that the WSMA bring forward a legal or legislative remedy to ensure patient safety.</li> <br /> <li><strong>Great minds think alike</strong><br /> It's not often that our own flagship publication, WSMA Reports, gets scooped by national newspapers, but on Aug. 18, The New York Times <a href="https://www.nytimes.com/2018/08/18/health/opioid-addiction-treatment.html">published an article</a> on opioids and the hub-and-spoke model for treatment. If only they had waited a few more days, Reports could have scooped them! Even so, they didn't cover how Washington state is deploying the hub-and-spoke model to address opioids here, so don't miss the September/October issue of WSMA Reports, which will be in member mailboxes next week. Writer Marcia Frellick interviewed several WSMA members for the article, and I know you'll find the article of interest.</li> <br /> <li><strong>It's Women in Medicine Month</strong><br /> During the month of September we celebrate women in medicine. At the WSMA, we are proud to have Donna Smith, MD, as this year's president, along with numerous female members of our board of trustees. In fact, 37 percent of WSMA members are female.<br /> <br /> This month serves as a platform to showcase the accomplishments of women physicians. It also highlights advocacy needs related to professional concerns of women physicians and health issues impacting women patients.<br /> <br /> Take a moment to celebrate female physicians by viewing <a href="https://www.youtube.com/watch?v=ooTKLLN5bVo&feature=youtu.be">this historical profile</a> of pioneers who led the way for us today. The AMA also has activities and social media tools promoting September as <a href="https://www.ama-assn.org/women-medicine-month">Women in Medicine month</a>. The AMA's current president and president-elect are women, and we're excited that AMA President Barbara McAneny, MD, will speak at the <a href="https://wsma.org/WSMA/Events/Annual_Meeting/WSMA/Events/Annual_Meeting/Annual_Meeting.aspx?hkey=fea49254-3815-4dc9-8710-53ff2e3a100f">WSMA Annual Meeting</a> this October in Spokane.</li> </ol> <p>As I told the leaders gathered at Overlake last week, the WSMA is in this work for the long haul, serving your evolving needs as the profession changes. Soon our policymaking body, the House of Delegates, will meet in Spokane to debate a host of policy resolutions. All members are invited to share their thoughts on proposals being offered. You can join the discussion in our online <a href="https://wsma.org/WSMA/Events/Annual_Meeting/Online_Reference_Committees_and_Forum/WSMA/Events/Annual_Meeting/Online_Reference_Committees_and_Forum/Online_Reference_Committees_and_Forum.aspx?hkey=4ea4ed56-61ce-4121-89b9-636415daa863">virtual reference committees</a>.</p> </div>9/4/2018 10:29:37 AM9/4/2018 10:19:49 AM9/3/2018 12:00:00 AM
weekly_rounds_2018_08_27_you_the_people_guide_wsma_policyWeekly Rounds: August 27, 2018 - You, the people, guide WSMA policyWeekly_RoundsShared_Content/News/Latest_News/2018/August/weekly_rounds_2018_08_27_you_the_people_guide_wsma_policy<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /> </div> <h5> August 27, 2018 </h5> <h2> You, the people, guide WSMA policy </h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> The WSMA's House of Delegates was established back in 1889, and since that time it has served us well by being "of the people, for the people, by the people." This is a time-honored structure that allows policy to be shaped at a grassroots level. But the structure only works if members are aware of it and use it to advance patient-focused, physician-driven policy. The following is a primer to help you understand the role of the House in policymaking and to help you prepare for the <a href="https://wsma.org/WSMA/Events/Annual_Meeting/WSMA/Events/Annual_Meeting/Annual_Meeting.aspx?hkey=fea49254-3815-4dc9-8710-53ff2e3a100f"> 2018 WSMA Annual Meeting</a> this Oct. 13-14, when WSMA members from across the state will join their delegate peers to debate and determine policy, elect officers and network with colleagues. </p> <h3> How it works </h3> <p> There are approximately 200 voting members of <a href="https://wsma.org/WSMA/About_Us/Leadership/House_of_Delegates/WSMA/About/Leadership/House_of_Delegates/House_of_Delegates.aspx?hkey=e2c50002-384d-4ff7-9116-5ce7a51116e7"> House of Delegates</a> (if all county medical and specialty societies send their allotted delegates). This is the entity that sets WSMA policy. </p> <p> The House convenes its opening session on Saturday morning of the WSMA Annual Meeting. In addition to addressing official business, at this time all reports and resolutions submitted by delegates are referred to reference committees. Reference committee hearings at the WSMA Annual Meeting are key to the deliberations of the House. The reference committees start hearing testimony once the full House recesses for the morning, typically around 10 a.m. on Saturday. </p> <p> WSMA has two reference committees: B and C. Each reference committee is made up of three members of the House who are appointed by the speaker and vice speaker. Typically, matters related to WSMA's advocacy agenda are heard in Reference Committee C. Most other matters are directed to B. (If you are interested in volunteering to serve as a reference committee member, contact Shannon Bozarth at <a href="mailto:slb@wsma.org"> slb@wsma.org</a>.) </p> <h3> What to know about reference committees </h3> <p> All WSMA members are welcome to attend and provide testimony at the reference committee hearings. The chair of each reference committee has the prerogative to permit nonmembers to present testimony. Committee meetings are open to the press. </p> <p> The reference committee meeting is the most appropriate place for you to express your opinions, and those of your constituents, on the resolutions and reports to be considered by the House. When offering testimony, identify yourself and the society or organization which you represent. You can also note that you are speaking on behalf of yourself. Unless raising a point of order or asking a question, it's helpful if you indicate whether you are speaking in favor of, or in opposition to, the resolution or report under discussion. </p> <p> Typically, a reference committee hearing runs two to three hours on Saturday. Once they have finished hearing testimony, reference committee members and staff sequester themselves to develop the official reference committee reports. These reports are published (under the direction of the speaker and vice speaker) on the WSMA website by Saturday evening and in hard copy by 7 a.m. on Sunday. </p> <p> The House then convenes for a second, final session on Sunday morning. During this final session, the reference committees present their reports for consideration by the House. </p> <h3> Your opinion matters </h3> <p> While the House is organized by delegates from county medical societies, state specialty societies and special sections, any member of WSMA can make their opinion known on proposals being considered by delegates for action—but they can't vote unless they serve in a delegate position. </p> <p> For members unable to attend the annual meeting and provide testimony at the reference committees, the WSMA website features <a href="https://wsma.org/WSMA/Events/Annual_Meeting/Online_Reference_Committees_and_Forum/Online_Reference_Committees_and_Forum.aspx"> "virtual" reference committees</a> : password-protected, members-only online discussion forums where members can review and discuss resolutions. Members of the reference committees will read these comments in advance of the annual meeting. </p> <h3> So, what's heard at a reference committee? A resolution! </h3> <p> A resolution is a proposal asking the WSMA to take a position or act on an important issue. Before authoring a resolution, we ask that you 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. However, if you are seeking to change or modify existing WSMA policy you can do so through the resolution process. </p> <p> A resolution typically consists of a series of "whereas" clauses that explain the reason for the resolution, in addition to one or more "resolved" clauses that state the specific action proposed. </p> <p> Whereas clauses carry a message and develop a set of statements that require a solution. Include a few relevant facts that help frame an outline of the problem. Statements of fact in whereas clauses should be cited with references. Resolved clauses address what the WSMA should do or what position should be taken on the identified issue. </p> <p> If adopted by the House, the resolution may become the foundation of a new WSMA program or policy. The resolved clauses must make sense as standalone statements—if a resolution is adopted by the House, only the resolved clauses become WSMA policy; the whereas clauses do not. </p> <h3> How should I format a resolution? </h3> <p> A resolution includes basic elements: </p> <ul> <li> A title, concisely reflecting the action for which it calls. </li> <li> An author (see "Who can introduce a resolution" below). </li> <li> Whereas clauses. </li> <li> Resolved clauses. Each resolved clause in a resolution must be followed by one of the following notations indicating its purpose: </li> <ul> <li> New House of Delegates (HOD) policy. </li> <li> Modify current HOD policy. </li> <li> Modify bylaws. </li> <li> Rescind HOD policy. </li> <li> Reaffirm HOD policy. </li> <li> Directive to take action. </li> </ul> <li> A fiscal note. The fiscal note will be determined by WSMA staff in consultation with the resolution author. </li> </ul> <h3> Who can introduce a resolution? </h3> <p> While any WSMA member can draft a resolution, all resolutions must be sponsored by a WSMA delegate, alternate delegate or member of the board of trustees to be considered by the House of Delegates at the annual meeting. If you are interested in authoring a resolution but you are not a delegate or a member of the board, the WSMA will work with you to develop your resolution idea and enable its introduction. Email <a href="mailto:hod@wsma.org"> hod@wsma.org</a> or call 206.441.9762 for assistance. </p> <h3> Resolution deadlines </h3> <p> The resolutions that were submitted prior to Aug. 17 will be included in the WSMA Delegate Handbook—the compilation of resolutions and other business to be considered by delegates at the annual meeting. Though that date has passed, there is still time for board members or delegates/alternates to submit resolutions via email ( <a href="mailto:hod@wsma.org"> hod@wsma.org</a> ) by the final deadline of Sept. 13. Resolutions received after Sept. 13 will be distributed to the House of Delegates at the opening session and require a two-thirds affirmative vote by the House to be accepted as official business. </p> <h3> Need help? </h3> <p> WSMA staff are here to help you develop your resolution idea. If you have questions or need assistance, help is just an email or phone call away at <a href="mailto:hod@wsma.org"> hod@wsma.org</a> or 206.441.9762. </p> <h3> WSMA delegate responsibilities </h3> <p> Serving as a delegate to the House carries responsibilities, including: </p> <ul> <li> Be familiar with <a href="https://wsma.org/WSMA/About/Who_We_Are/Who_We_Are.aspx"> the WSMA</a>. </li> <li> Learn about <a href="https://wsma.org/WSMA/About/Who_We_Are/Who_We_Are.aspx"> our strategic priorities</a>. </li> <li> Read <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA_Reports_Archive/WSMA_Reports_Archive.aspx"> WSMA Reports </a> and the <a href="https://wsma.org/WSMA/News_Publications/Newsletters/WSMA_Membership_Memo.aspx"> Membership Memo</a>. </li> <li> Review the <a href="https://wsma.org/WSMA/About/Policies/Policies.aspx"> official actions of the previous House of Delegates </a> and the <a href="https://wsma.org/WSMA/About/Policies/Policies.aspx"> WSMA Bylaws</a>. </li> <li> Alert your colleagues that you are a delegate to the WSMA. </li> <li> Seek their comments and recommendations on WSMA programs and policies. </li> <li> Communicate your society's or your individual recommendations for the establishment of WSMA policies or programs through the introduction of a resolution. </li> <li> Be thoroughly familiar with the reports and resolutions contained in the delegate handbook. </li> <li> Work with your delegation. Divide reference committee responsibilities so your members are represented in the deliberations of each of the reference committees. Encourage all members to attend and participate in reference committee hearings. </li> <li> Take action! If you have an issue or concern, write the president, call the executive director, introduce a resolution or volunteer for a WSMA committee. </li> </ul> <p> Policies influence the direction of any organization. And that direction is guided by the people—that's you! Make your voice heard today. </p> </div>8/30/2018 11:04:27 AM8/24/2018 1:38:59 PM8/27/2018 12:00:00 AM
physician_depression_its_time_to_care_for_our_ownPhysician depression: It's time to care for our ownWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/physician_depression_its_time_to_care_for_our_own<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <h5>August 13, 2018</h5> <h2>Physician depression: It's time to care for our own</h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> The headlines, such as in <a href="https://www.npr.org/sections/health-shots/2018/07/31/634217947/to-prevent-doctor-suicides-medical-industry-rethinks-how-doctors-work">this story</a> that ran on NPR last week, are alarming. If we needed a wake-up call, this is it. The data show that physicians suffer from higher rates of burnout, depression and suicide than the general population. And yet we know, better than most people, the result of untreated or inadequately treated depression. </p> <p> The WSMA has long been concerned about this, which is why we launched our Healthy Doctors, Healthier Patients initiative in 2014. That effort embraced the concept of the Quadruple Aim, adding a fourth component of improving the work life of clinicians and staff to the Institute for Healthcare Improvement's Triple Aim (improving care quality, improving population health and lowering costs). </p> <p> We worked to address an area that is known to cause physicians to feel overwhelmed: administrative burden. For the past several years, our advocacy agenda focused on reducing that burden, improving workflow and finding efficiencies in health care. We've made solid progress (<a href="https://wsma.org/WSMA/Resources/Administrative_Simplification/Healthy_Doctors__Healthier_Patients/Healthy_Doctors__Healthier_Patients.aspx">read more here</a>), but must continue to be vigilant in warding off efforts that add documentation and bureaucratic tasks to already overloaded physicians. </p> <p> The external pressures heaped upon physicians by government, insurance companies and regulatory entities steal time from patient care. A <a href="http://annals.org/aim/article-abstract/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties">study published in the Annals of Internal Medicine</a> shows that for every hour of face-to-face patient care, a physician spends up to two hours entering data in electronic medical records, filling out forms, sorting through pharmacy formularies and dealing with prior authorization. Add to that reduced payments, endless quality measures, data reporting and regulatory mandates and it's little wonder that physicians are feeling the pain. </p> <p> Sarri Gilman, a marriage and family therapist, speaker and author, describes this as "overwhelm"—a state of having too much to do, too many expectations, too many unsolvable problems and too many issues at home. She differentiates overwhelm from burnout: Physicians often are told they are burned out ("it's your responsibility to fix it"), rather than leaders and systems recognizing that they are overwhelming their medical staff and employees ("it's our responsibility to fix it together"). </p> <p> She contends that overwhelm must be addressed to improve physician wellness. Overwhelm impacts thinking, planning and decision-making—behaviors critical to providing quality care to patients. If left unaddressed, we put patients at risk. (Read more in the <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA_Reports_Archive/WSMA/News_Publications/Publications/WSMA_Reports_Archive/WSMA_Reports_Archive.aspx?hkey=d3cb4400-8f2b-4fd4-9e4f-f970296623b3">July/August issue of WSMA Reports</a>, pp 4-5.) </p> <p> Beyond the tragic toll of depression and suicide risks, there is also reduced productivity, clinical inefficiency, medical mistakes, increased malpractice risks, negative health outcomes, reduced patient satisfaction, poor compliance with self-care and dysfunctional teams. And there is a documented financial price as well: The data show that 40 percent of doctors who are burned out are more likely to change jobs. According to a <a href="http://wellmd.stanford.edu/content/dam/sm/wellmd/documents/2017-ACPH-Hamidi.pdf" target="_blank">Stanford Medicine study</a>, that costs the business between $270,000 and $1 million per person who leaves, depending on specialty and practice setting. </p> <p> Even so, it's impossible to put a price on the well-being of the physician community. This is a caring profession—shouldn't we first take care of our own to ensure we are well enough to care for others? </p> <p> At the WSMA we definitely think so. We are taking action now through the WSMA Foundation to identify areas we can target for improvement initiatives. As a first step, the WSMA is partnering with the Washington State Hospital Association and Stanford Medicine to launch a unique survey that will provide baseline data in Washington state for overwhelm, burnout and professional well-being for physicians, PAs and ARNPs. </p> <p> The Physician and Advanced Practitioner Wellness Survey will launch shortly, reaching health care professionals across the state. It is specifically crafted to help us understand how you are impacted by variables such as the EHR, control over your schedule, leadership and workload. The information we gather will drive initiatives to achieve tangible change that improves your well-being, professional satisfaction and personal fulfillment in your work. </p> <p> When you receive the survey email from <a href="mailto:physician_wellness@stanford.edu">physician_wellness@stanford.edu</a>, I hope you will take 15 minutes to complete it. To have credible data that can be used to promote wellness and professional fulfillment, we need at least a 65 percent response rate. I'll report back to you here and in other WSMA communications on what we learn and what we'll strive to do about it. </p> <p> We're used to facing life-and-death situations in our profession. With one in two doctors currently experiencing burnout and signs of being overwhelmed, it's time to act. </p> </div>8/30/2018 11:06:09 AM8/13/2018 9:19:08 AM8/13/2018 12:00:00 AM
5_things_to_know_while_beating_the_heat5 things to know while beating the heatWeekly_RoundsShared_Content/News/Weekly_Rounds/2018/5_things_to_know_while_beating_the_heat<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <h5>July 30, 2018</h5> <h2> 5 things to know while beating the heat </h2> <p>Jennifer Hanscom, Executive Director/CEO</p> <p> Not only are temperatures heating up lately, but my schedule seems to be doing the same! As you read this, I'll be prepping to welcome the Physicians Foundation board to Seattle for meetings, and next week I'll participate in a board retreat with Physicians Insurance. Despite it being summer, I'm sure your schedule is busy too, so today I'm just quickly highlighting five things for you. </p> <ol> <li> <strong> CMS released proposed changes to physician fee schedule </strong> <br /> Last Friday, the Centers for Medicare & Medicaid Services began accepting public comments on its proposed rule updating payment policies and quality provisions for Medicare's physician fee schedule and Quality Payment Program. CMS Administrator Seema Verma has said the proposals intend to " <a href="https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2018-Press-releases-items/2018-07-12.html"> put patients over paperwork</a>," and they do include some significant policy changes-including a single new rate for evaluation and management (E/M) services, provisions to incentivize EHR interoperability and telehealth services, and much more. However, reaction from the <a href="https://www.nytimes.com/2018/07/22/us/politics/medicare-payments-trump.html"> health care community</a> so far is <a href="https://www.mobihealthnews.com/content/cms-new-rule-industry-reacts-big-changes-telehealth-clinical-documentation-and"> mixed</a>. <br /> <br /> We covered this issue in last week's WSMA Membership Memo. Click <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180725/new_cms_rule_proposes_significant_changes_to_medicare_billing_and_documentation"> here to quickly access highlights of the proposed changes</a>. And for more information, <a href="https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-12-2.html"> CMS provided a fact sheet</a> on the major components of the rule, which is now open for comment on the <a href="https://www.federalregister.gov/documents/2018/07/27/2018-14985/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions"> Federal Register </a> website.</li> <br /> <li> <strong> Quality Payment Program changes also released </strong> <br /> Medicare's Quality Payment Program consists of two payment pathways intended to move physicians and other providers to value-based care: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models. You can review the <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180725/new_cms_rule_proposes_significant_changes_to_medicare_billing_and_documentation"> key changes to MIPS for 2019 here</a>. For more info, CMS has provided a <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2019-QPP-proposed-rule-fact-sheet.pdf" target="_blank"> fact sheet</a> on the proposed changes to both payment pathways. </li> <br /> <li> <strong> CMS approves state's opioid treatment waiver </strong> <br /> CMS approved our state Health Care Authority's request to receive federal funding for services provided to Medicaid patients receiving treatment for opioid addiction and other substance use disorders when those services are received in facilities known as institutions for mental disease. Since federal rules restrict the use of Medicaid funds for treatment in IMDs, a waiver was needed to expand access to treatment. The waiver came in the form of an amendment to Washington's existing Section 1115 waiver, known as the Healthier Washington initiative. </li> <br /> <li> <strong> Single payer initiative fails to quality for fall ballot </strong> <br /> Signature gatherers for Initiative 1600 fell short of acquiring the 300,000 signatures required to put a universal health care initiative on the ballot. As described in campaign literature, I-1600 would have "replaced Washington's current multi-payer system and established a state health plan to finance medically necessary care including hospitalization, doctor visits, dental, vision, mental/behavioral health, prescribed occupational and physical therapy, prescription drugs, medical devices, and rehabilitative care. The plan would offer this comprehensive coverage to all residents and would pay for it with broad-based, progressively graduated premiums assessed by the state on payrolls and on non-payroll income." </li> <br /> <li> <strong> The latest on MOC </strong> <br /> Back in <a href="https://wsma.org/Shared_Content/News/Weekly_Rounds/2018/Speaking_up_for_physicians__patients_and_children"> December</a>, I reported that I participated-along with many other peers from state medical associations, national specialty societies and national boards-in a stakeholder meeting to discuss grassroots angst over maintenance of certification. We discussed how some of the boards were addressing those complaints, while some state associations-like the WSMA-were moving to limit the reach of MOC. (In fact, the WSMA supported a bill signed into law on March 22 that separates certification from licensure in law.) Out of that meeting, a commission was formed called "Continuing Board Certification: Vision for the Future Commission," which is charged with reviewing and understanding continuing certification. Just recently, the commission completed a series of meetings and open sessions for public testimony. <a href="https://cdn.ymaws.com/www.aamse.org/resource/resmgr/docs/Vision_for_the_Future_Public.pdf" target="_blank"> Here</a> is a summary of the testimony from those meetings. </li> </ol> <p> Thanks for taking time out of your busy schedule to read this update-hopefully while staying well-hydrated and cool! </p> </div>8/30/2018 11:05:25 AM7/30/2018 9:10:02 AM7/30/2018 12:00:00 AM
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" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></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>9/4/2018 5:24:29 PM7/16/2018 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" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></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>9/4/2018 5:24:56 PM7/2/2018 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"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <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>9/4/2018 5:25:18 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" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></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>9/4/2018 5:39:34 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" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></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>9/4/2018 5:39:14 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"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <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>9/4/2018 5:25:40 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" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></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>9/4/2018 5:38:53 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"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <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>9/4/2018 5:26:00 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"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <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>9/4/2018 5:26:16 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"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <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>9/4/2018 5:26:35 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"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <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>9/4/2018 5:26:51 PM2/6/2018 9:16:38 AM2/5/2018 12:00:00 AM
 

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