| doctors-making-a-difference-carrie-horwitch-md | Doctors Making a Difference: Carrie Horwitch, MD | WSMA_Reports | Shared_Content/News/Latest_News/2024/doctors-making-a-difference-carrie-horwitch-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/september-october/dmd-website-image-horwitch-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Carrie Horwitch, MD, MPH" /></div>
<h5>Sept. 24, 20224</h5>
<h2>Doctors Making a Difference: Carrie Horwitch, MD</h2>
<p>
For Carrie Horwitch, MD, MPH, her work across a 30-year career in medicine to improve both patient health and the well-being of physicians and practitioners takes many forms: As an internal medicine physician specializing in transgender health and HIV care; as a Certified Laughter Leader using laughter techniques to improve health through her business Laugh Doctor LLC; and as a volunteer for the MAVEN Project, which connects physicians and clinicians at safety-net clinics with expert physician volunteers for medical advice, mentorship, and education. She talked with <em>WSMA Reports</em> about her volunteer work at the MAVEN Project and how the extra support for primary care physicians and practitioners can help reduce burnout and improve care for patients in underserved communities.
</p>
<p>
<strong><em>WSMA Reports:</em> How long have you been volunteering with the MAVEN Project, and can you tell readers about what your work entails?</strong>
</p>
<p>
<em>Dr. Horwitch:</em> I started volunteering with MAVEN Project in June 2022. The MAVEN Project supports safety-net clinics and their patients by connecting their physicians and practitioners with specialists in medicine, including adult and pediatric specialties. Most of this work is done virtually on their HIPAA- compliant telehealth platform. They have several areas of support for the clinics and practitioners including email and video consults, 1:1 clinical mentoring and leadership coaching, and free CME through lectures given by MAVEN Project volunteers. There are currently 63 sites across Washington state partnering with the MAVEN Project.
</p>
<p>
<strong>What was it about the project's model that drew you to it as an avenue for volunteering?</strong>
</p>
<p>
Some of the main attractions for me to work with the MAVEN Project were the diversity of volunteer opportunities, including consulting, mentoring, and giving didactic presentations. I also loved the idea that I was helping clinicians in resource-limited areas and clinics to serve their patients better. I have always been a believer that when doing volunteer work, I would like it to be a sustainable model. I feel the MAVEN Project is able to accomplish this as we focus on building knowledge and skills of the clinicians in these community clinics.
</p>
<p>
<strong>What are some of the most significant challenges that the primary care physicians you consult with face in their practices, and how does access to MAVEN's volunteer physicians help them to provide better patient care?</strong>
</p>
<p>
There are several challenges these clinicians and clinics encounter on a daily basis. One is there are not enough practitioners in primary care, especially in under-resourced safety-net clinics. Another is that many of the patients have complex conditions and do not have access in their communities to specialty care (including general internal medicine and pediatrics). The MAVEN Project provides specialty expertise to the clinicians on specific cases or a general approach to different conditions patients may have (such as HIV or diabetes). Offering continuing education and support for the clinicians positively impacts the care their patients receive.
</p>
<p>
In addition, some of the mentoring can focus on the well-being of the clinician, an important component of reducing burnout. It can also help develop an approach to quality improvement projects for their clinics.
</p>
<p>
<strong>Has your volunteer experience changed the way you provide care to your own patients?</strong>
</p>
<p>
The volunteer experience reminds me that there are a large number of people in our country facing many barriers to accessing primary and comprehensive care. Working with mentees on the challenges they face with their patients and the resource limitations helps me to consider my patients' struggles. It also energizes me to continue advocacy work to better our health care system for patients and caregivers.
</p>
<p>
<strong>What has been the most fulfilling aspect of your work with the MAVEN Project? </strong>
</p>
<p>
As a "later" career physician, I am so grateful that I am volunteering with MAVEN Project. It allows me to continue to give back to diverse communities using my knowledge and skills from over 30 years as an internal medicine physician. Working with my mentees and seeing their growth and confidence build over time is very rewarding.
</p>
<p>
If you want to refer a community health center partner or inquire about select volunteer opportunities go to <a href="https://mavenproject.org">mavenproject.org</a>.
</p>
<p>
<em>This article was featured in the September/October 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/24/2024 2:40:22 PM | 9/24/2024 2:34:29 PM | 9/24/2024 12:00:00 AM |
| men-we-need-you-to-go-to-the-doctor-and-to-become-doctors | Men: We Need You to Go to the Doctor, and to Become Doctors | WSMA_Reports | Shared_Content/News/Latest_News/2024/men-we-need-you-to-go-to-the-doctor-and-to-become-doctors | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/september-october/heartbeat-website-image-low-645x425px.png" class="pull-right" alt="Heartbeat: Daniel Low MD graphic" /></div>
<h5>
Sept. 19, 2024
</h5>
<h2>
Men: We Need You to Go to the Doctor, and to Become Doctors
</h2>
<p>
By Daniel Low, MD
</p>
<p>
When June ended, so did Men's Health month. The rare June article highlighting men's health typically focused on prostate cancer or heart disease. These are serious issues jeopardizing men's health, but as a physician whose panel is predominantly made of boys and men, what worries me most about men's health is the generalized male withdrawal from the health sector. Lonely, apathetic, or disinterested men are not seeking care. Men are half as<a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fintegrishealth.org%2Fresources%2Fon-your-health%2F2019%2Fjune%2Fwhy-dont-men-see-doctors%23%3A~%3Atext%3DThe%2520CDC%2520reports%2520that%2520women%2Cmaintaining%2520screening%2520and%2520preventive%2520care.&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369047634%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=2w9ApQvyMYXhgyE6l5pjcy1fjdp4I%2FdMp6vkMs2PBVM%3D&amp;reserved=0"> likely as women to maintain routine health screenings, and 33% less likely</a> to visit the doctor at all.
</p>
<p>
And it's not just disengaging from health care; men are also disengaging from social life. <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.latimes.com%2Flifestyle%2Fnewsletter%2F2023-10-10%2Fmore-than-1-in-7-men-have-no-close-friends-the-way-we-socialize-boys-is-to-blame-group-therapy&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369055278%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=qGZQA1pNmf%2BYr%2FxcqhM9r8GvRRlb0aXygkXVuSG4fNs%3D&amp;reserved=0">Fifteen percent of men now report having no close friends,</a> which is <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fnap.nationalacademies.org%2Fcatalog%2F25663%2Fsocial-isolation-and-loneliness-in-older-adults-opportunities-for-the&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369062482%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=X2UvguHfp0zvujjaG%2Fo1mlAxwUPVUjap0vIKIvgCDpY%3D&amp;reserved=0">worse for one's health than smoking</a>. Men are similarly disengaging from school. In 1972, when Title IX passed, men were graduating from college 13% more often than women; today, women graduate from college <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.nytimes.com%2F2023%2F03%2F10%2Fpodcasts%2Fezra-klein-podcast-transcript-richard-reeves.html&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369069682%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=bV8ZQJ%2BDVZ%2BSMpNwCHKKjpjYj1iW0iQc7FpEQp%2BNpDA%3D&amp;reserved=0"> 15% more often than men</a>. Similar graduation rate disparities pervade <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Flearningenglish.voanews.com%2Fa%2Fus-boys-graduate-high-school-at-lower-rates-than-girls%2F7346617.html&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369076762%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=wG2%2B2KnPulW2uACwH3ENlaRj7zvFaU9IyE1LDMDqXR0%3D&amp;reserved=0">high school, too</a>.
</p>
<p>
While social and educational engagement may seem unrelated to health, research repeatedly demonstrates their association with wellness. When boys and men aren't with friends and aren't in school, they disproportionately face worse health outcomes, including <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwaboysandmen.org%2Fwp-content%2Fuploads%2F2024%2F06%2FWhy-Washington-Needs-a-Commission-on-Boys-and-Men_2024_06_16.pdf&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369083829%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=GjJxzSyI77SwsoBo5TOMWXmsP2N9XWCl3mMrXdiAr98%3D&amp;reserved=0">increased rates of homelessness, drug addiction, incarceration, and death</a>.
</p>
<p>
I feel awkward writing about this. Focusing on men's struggles in the context of gender equality feels misplaced, a narrative violation, particularly given men have always occupied the dominant space in society. It's especially grating knowing that <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC9811825%2F&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369090990%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=kcoQknTWkL3y32UMeoZQD209u%2FCJXyRvl2Jk%2FSmRPxY%3D&amp;reserved=0">women's health research has been consistently underfunded</a>, <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.pewresearch.org%2Ffact-tank%2F2023%2F03%2F01%2Fgender-pay-gap-facts%2F%23%3A~%3Atext%3DThe%2520gender%2520gap%2520in%2520pay%2C-%2520and%2520part-time%2520workers.&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369097960%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=yYixIx9iXD4iU3HXF4fJfN%2BrAt7yyVldJH%2Fn%2FOABhKs%3D&amp;reserved=0">gender pay gaps persist, </a> and women and gender-diverse people are frequently and <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.weforum.org%2Freports%2Fglobal-gender-gap-report-2022%2Fin-full%2F2-4-gender-gaps-in-leadership-by-industry-and-cohort%2F&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369105205%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=43ZLwZ86G5MaW9EC%2BJc0I622DnsiKwJH8JIQN0B5fEM%3D&amp;reserved=0">unfairly overlooked for executive-level positions</a>, particularly within medicine.
</p>
<p>
It's why when I originally drafted this piece two years ago, I decided against publication; in highlighting the challenges of the privileged, I felt I'd also be unintentionally directing attention away from more marginalized groups. But I believe we can hold two truths at once. We can champion equality for women and gender-diverse people, <em>and</em> recognize that men are struggling.
</p>
<p>
Men's structural power is not translating into health advantages. In fact, men are dying, on average, five years earlier than women, while simultaneously <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.populationmedicine.eu%2FGender-differences-in-global-Disability-Adjusted-Life-Years-DALYs-a-descriptive-Analysis%2C163644%2C0%2C2.html&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369112343%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=EGWoN7zl8ovH1nEBlBNpNllfog7yoLzQzvDIZE2TC8w%3D&amp;reserved=0">suffering from significantly worse mental, neurological, and musculoskeletal disorders</a>.
</p>
<p>
Despite many theories, it's ultimately unclear why this is happening, which is why we should support the growing coalition pushing Washington to create a <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwaboysandmen.org%2F&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369121696%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=6iRf5vQbH5K9zaClEgcMucWkJqOgOdL2M7PMcwWvLKA%3D&amp;reserved=0">commission on men and boys</a>; we need to study the root causes of this public health crisis.
</p>
<p>
We also need representation. When young boys are most impressionable, they rarely see themselves in their doctors, <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Ffamilymedicine.uw.edu%2Fchws%2Fpublications%2Fwashington-states-physician-workforce-in-2021%2F%23%3A~%3Atext%3DWomen%2520comprised%252041%2525%2520of%2520the%2Cphysicians%2520age%252055%2520or%2520older.&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369129176%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=G7W%2B9KRRfwatsV6q%2BUE0qxOTWHWBxkgTJtMsPKoWaqU%3D&amp;reserved=0">as less than one-third of pediatricians in Washington are men</a>. For those with mental illness seeking care with a therapist or social worker, it is <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.zippia.com%2Ftherapist-jobs%2Fdemographics%2F&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369136749%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=TnntGPL8MqDiGSpt4UekamJREwgssutscnGcjyaiK88%3D&amp;reserved=0">even less likely to find a male practitioner</a> in Washington, which is particularly worrisome given the increasing rates of anxiety and depression in boys and men. To be clear, evidence shows <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.forbes.com%2Fsites%2Froberthart%2F2024%2F04%2F22%2Fpatients-fare-better-with-women-doctors-study-finds%2F&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369143733%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=n2tEObA46oY8TI4xdIFUfzB9zShMKwOKXU5QCPkRvt4%3D&amp;reserved=0">female physicians offer equal or better care</a> than male physicians. But if boys and men don't engage in care, the quality of care offered becomes a moot point.
</p>
<p>
And without intentional efforts, change will not arrive soon. Male medical student matriculants have decreased for eight consecutive years. The view is similar further up the pipeline. I lead a <a href="https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.healthpointchc.org%2Fjoin-our-team%2Fstudent-training-programs%2Fhealthpoint-health-scholars&amp;data=05%7C02%7Coped%40seattletimes.com%7C96e8e2080d1b41a24ef708dc9ae961fb%7Cfc2b8476b7f0473d82fbe0a89fd99855%7C0%7C1%7C638555574369150828%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=zT2hLczw6TPiEP1WvTQ%2BhkK1tItv4b1srnX9mQfOiKk%3D&amp;reserved=0">mentorship program</a> for racially and economically underrepresented high school students interested in careers in health care, and since our program's inception in 2021, we've only had one young man graduate.
</p>
<p>
We need proactive, targeted recruitment of men for patient-centered, healing professions like pediatrics, nursing, psychology, and social work. This requires incentivizing professionals to mentor; institutions should include mentoring activities as criteria for promotions.
</p>
<p>
Simultaneously, we need to cultivate a new masculinity in our young men that embraces the tenderness and sociability of excellent caregivers. We want our sons, brothers, and fathers to be compassionate, active listeners who practice grace. Let's start by modeling this behavior and acknowledging the real struggles boys and men are experiencing.
</p>
<p>
<em>Daniel Low, MD, </em><em>is a family medicine physician in Renton.&nbsp;</em></p>
<p>
<em>This article was featured in the September/October 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/19/2024 12:44:41 PM | 9/19/2024 12:27:20 PM | 9/19/2024 12:00:00 AM |
| cant-get-into-your-doctors-office-youre-not-alone | Can't Get Into Your Doctor's Office? You're Not Alone | WSMA_Reports | Shared_Content/News/Latest_News/2024/cant-get-into-your-doctors-office-youre-not-alone | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="Heartbeat column logo with Nariman Heshmati MD &amp; Jennifer Hanscom" src="/images/Newsletters/Reports/2024/july-august/heartbeat-website-image-heshmati-hanscom-645x425px.png" class="pull-right" /></div>
<h5>July 17, 2024</h5>
<h2>Can't Get Into Your Doctor's Office? You're Not Alone</h2>
<p>
By Nariman Heshmati, MD And Jennifer Hanscom
</p>
<p>
As The Seattle Times and other media outlets have reported, hospitals in our state-places Washingtonians depend upon for surgeries, births, inpatient, and emergency care-face ongoing financial instability from the pandemic, difficult-to-discharge patients, low reimbursements, and inflation.
</p>
<p>
But there's another story that doesn't get much attention in the press: The loss of the outpatient services every Washingtonian relies on for routine and preventive care.
</p>
<p>
The lack of access to care in the outpatient community, aka the physician's office, should be as concerning to every Washingtonian as our struggling hospitals. It is in these outpatient settings that your diabetes or other chronic condition is managed, where you receive wellness and prevention screening and care, and where your personal physician manages your health. Research shows that a consistent relationship with a doctor or other primary care clinician is associated with improved overall health and fewer emergency room visits.
</p>
<p>
Outpatient medical groups suffer from many of the same challenges hospitals do: thin margins, increased costs, low reimbursements (including underpayments from Medicare and Medicaid), and staffing issues. In the past few years, payment for physician services has dropped nearly 10% in Medicare, causing a ripple effect of reimbursement decline as Medicare is used as a benchmark for both Medicaid and commercial payments.
</p>
<p>
Patients and communities across Washington feel the effects of declining reimbursements and rising costs. As reported last November, Seattle OBGYN closed after 73 years, impacting more than 16,000 patients, more than 300 of whom are pregnant. Multispecialty clinic Palouse Medical in Pullman has decided to merge with a local hospital to keep its clinic open. Ear Nose &amp; Throat Associates SW in Olympia, having already dropped one Medicaid plan in 2023, reports that it will limit the remaining Medicaid patients over age 18 to just one per day to stay financially viable. Carol Milgard Breast Center in Tacoma reports booking crucial cancer screenings and exams six or more months out. Kitsap OBGYN reports routinely being double-booked and pregnant patients having to wait to see their physician until the second trimester.
</p>
<p>
Even nationally, Walmart, with 51 health centers across five states, noted they can't make the numbers work and are closing down all of their health centers, citing "the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time."
</p>
<p>
Care should be about the patients, not profitability. But when revenue is less than expenses, you can't pay your staff's salaries, you can't pay the lease on your office space, and you can't keep your lights on. It is not uncommon to talk to a group of physicians who own their practices who have cut their salaries or stopped taking a paycheck to care for their patients and pay their staff.
</p>
<p>
To have a healthy health care system, where patients can access care at the right place, right time, and in the right setting, we must not ignore the impact of these outpatient clinics. To help our struggling medical groups and patients, in 2024, the WSMA worked with legislators to introduce legislation to implement a "covered lives assessment" in our state, a funding mechanism that helps the state access federal funds to increase investments in Medicaid.
</p>
<p>
We will be pursuing this in next year's legislative session and will work with lawmakers to strengthen the proposal. The additional $400 million from the covered lives assessment and the federal matching funds will be a lifeline for these medical groups, will help physicians see more Medicaid patients- both primary care physicians and specialty care such as dermatology, immunology, neonatology, anesthesiology, and more-and help preserve the balance of care delivery in our state so routine community care and hospital care both are valued and available for Washingtonians.
</p>
<p>
<em>Nariman Heshmati, MD is an OB-GYN in Everett and presi- dent of the WSMA. Jennifer Hanscom is CEO of the WSMA.</em>
</p>
<p>
<em>*Note: A version of this article ran in The Seattle Times on May 20, 2024.</em>
</p>
<p>
<em>This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/17/2024 2:04:15 PM | 7/17/2024 2:01:47 PM | 7/17/2024 12:00:00 AM |
| committing-the-resources-for-equitable-care | Committing the Resources for Equitable Care | WSMA_Reports | Shared_Content/News/Latest_News/2024/committing-the-resources-for-equitable-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/july-august/cover-wsma-julyaug-2024-645x425px.png" class="pull-right" alt="cover of July-August 2024 issue of WSMA Reports" /></div>
<h5>July 17, 2024</h5>
<h2>Committing the Resources for Equitable Care</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
For years, data have shown the heavy toll that health inequities take on historically marginalized communities. Whether it's poorer outcomes for Black patients with chronic diseases like diabetes, low birth weights for Hispanic infants, or higher rates of behavioral health issues among LGBTQ+ youth, studies have shown a consistent gap among how patients access and fare in the health care system depending upon their identity.
</p>
<p>
But data alone is insufficient to address the problem of health inequities. Helping physicians understand the root causes, including their own contributions to them, no matter how unconscious, is essential to ensure all patients receive the highest-quality care.
</p>
<p>
"We've gone into medicine to help people," says Sonja Maddox, MD, a family medicine physician with Pacific Medical Centers in Renton. "As a society, we're not going to get there if we don't learn how people are taken care of. Unless people are willing to recognize the inequities and learn about them, we'll only perpetuate them."
</p>
<p>
To help physicians understand the problem and share solutions, the WSMA Foundation, which directs WSMA's health equity efforts, has teamed with Edwin Lindo, JD, assistant dean for social and health justice at the University of Washington School of Medicine, on a series of Health Equity M&amp;M Webinars (think "morbidity and mortality," but with a focus on health equity) and a four-part Health Equity in Medicine podcast to help train Washington's health care professionals to provide culturally sensitive care.
</p>
<p>
The podcast and webinars were a natural outgrowth of the increased focus on equity across society with the growth of the Black Lives Matter movement in 2020. "It's part of those larger social changes," says Alexander Hamling, MD, a pediatrician with Pacific Medical Centers in Bothell and chair of WSMA's CME program committee. "We saw a lot of other private institutions ask these questions about equity, so the programs naturally evolved from that."
</p>
<p>
Still, the challenge was not to make health equity seem like just another requirement. "We didn't want this to come out as one more task due and not be meaningful," says Dr. Hamling. "How could we wrap this up in a way that physicians would be excited about it, with high-quality education rounds, high-quality speakers, case studies, and physicians bringing their own real-world experiences into play."
</p>
<p>
The podcast and webinars rise to that challenge. They combine a background in the history that continues to feed health inequities with practical ideas on how to incorporate improvements in practice. Lindo says they take "theory and bring it into action."
</p>
<p>
The sessions acknowledge the importance of health disparity data but don't stop there. " 'Disparities' doesn't encapsulate the true weight of what's happening," says Lindo. "It merely says there's a delta between one member and another. The term I use is health inequities, meaning there is a factor or factors that causes the delta, or else we're obfuscating what's causing the disparity."
</p>
<p>
The podcast series, the newest of the health equity tools offered by the WSMA, provides listeners with the background on the history of racism in medicine and its impact on the medical profession. Importantly, rather than just a recitation of history, Lindo shares how some physicians have tackled these thorny issues, structurally and individually, and gives physicians ideas on how to incorporate equity principles into practice. The podcast is free for WSMA members and fulfills a new state requirement for health equity continuing education that applies to physicians and nonphysician clinicians.
</p>
<p>
The advantage of the podcasts is that they are available whenever a listener has time. "The luxury of being able to sit down and read without distraction isn't always there," says Lindo. "But the ability to put in headphones while you're working in the yard or going on a walk is."
</p>
<p>
While the podcasts are new, the WSMA and WSMA Foundation have been offering the Health Equity M&amp;M Webinars for three years. The webinars take the familiar format of "morbidity and mortality" and apply it to health equity. The webinars are free to WSMA members and offer CME credit.
</p>
<p>
"Physicians understand M&amp;Ms, and the webinar model is very similar to the traditional M&amp;M," says Lindo, who facilitates the webinars. "We're not talking about whether this specific exam or procedure is the right one, although sometimes that comes up. It's about how we are treating patients fundamentally differently because of their identity. At the core, we're talking about preventable harms to our patients."
</p>
<p>
Each webinar is protected under WSMA's CQIP, providing confidentiality for case discussions. As a result, physicians are able to talk frankly about how their own biases affected patient care.
</p>
<p>
"It may be where they are thinking maybe they would have done something differently or they didn't have the right language," says Lindo. "To me it's just phenomenal to see folks dig in and wrestle with it. I have had people say, 'I don't know if I believe in the DEI stuff, but I really appreciate these conversations.' "
</p>
<p>
"Edwin does a really good job of explaining not only the importance of health equity, but giving doctors real evidence, which we like," Dr. Maddox. "He does a very good job of providing historical information to help other people who may not experience racism in health care understand what it feels like to be a person of color and not feel well cared for."
</p>
<p>
"Seminars like Mr. Lindo's help us to understand the 'why' of our health system producing inequality whether or not any individual actually intends that outcome or not," agrees David Cundiff, MD, a public health physician at Discover Recovery in the small rural community of Long Beach. "One of the aspects of privilege is that people who have it don't even have to notice it exists. A forum in which we can all look at systems of privilege, power, and equity is a really important part of every physician's professional and personal growth."
</p>
<p>
Indeed, improving health equity isn't only good for patients, says Lindo. It's good for physicians, as well. Health inequities take a toll on their commitment to healing. Recognizing the challenges their patients face not only helps doctors find better outcomes, but reminds them of the humanity that is unique to their profession.
</p>
<p>
"We become numb to the harm that other people face," says Lindo. "It eats at our ability to have the empathy to make the change. When something wrong happens, we're so accustomed to things being not good, that we don't see it as severe. It's just another thing we'll get to at some point. That's the dehumanizing thing about all of this."
</p>
<p>
Ultimately, doctors recognize the need to make sure every patient receives the right care. But removing the biases that make that care impossible to deliver is the real challenge. It can't fall to just a handful of physicians who represent the marginalized communities.
</p>
<p>
"I can't tell you the number of new Black patients who have come to my practice since 2020," says Dr. Maddox. "If you have a doctor who looks like you, you live longer. Studies show this and patients know this." But as a Black female physician, Dr. Maddox represents just 2% of the profession.
</p>
<p>
"Not everybody can have a Black doctor," she notes. "We need to make sure everyone understands how to take care of everybody."
</p>
<p>
The webinars and podcasts can move Washington closer to that goal. It's the reason why Lindo signed onto the WSMA's health equity work to begin with.
</p>
<p>
"At its core, the rationale for joining WSMA as resident consultant was that the amount of impact WSMA has in the region is unmatched," says Lindo. "It has a true commitment to equity."
</p>
<p>
<em>John Gallagher is a freelancer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/17/2024 2:27:38 PM | 7/17/2024 2:23:16 PM | 7/17/2024 12:00:00 AM |
| member-spotlight-anukrati-anu-shukla-md | Member Spotlight: Anukrati 'Anu' Shukla, MD | WSMA_Reports | Shared_Content/News/Latest_News/2024/member-spotlight-anukrati-anu-shukla-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/july-august/member-spotlight-website-image-shukla-645x425px.png" class="pull-right" alt="WSMA Member Spotlight: Anukrati Shukla, MD graphic" /></div>
<h5>July 17, 2024</h5>
<h2>Member Spotlight: Anukrati 'Anu' Shukla, MD</h2>
<p>
<strong>Works at:</strong> Providence Medical Group, Monroe.
</p>
<p>
<strong>How long in practice: </strong>Four years.
</p>
<p>
<strong>Specialty:</strong> Internal medicine, obesity medicine.
</p>
<p>
<strong>Why WSMA:</strong> The WSMA offers wonderful opportunities to early career physicians for their global development. Working with the WSMA in various roles has not only strengthened my core identity and values as a physician, but also has given me a consistent and stable professional standing. I particularly felt the need for a sense of belonging during a recent transition between two jobs. The WSMA was my landing pad providing the cushion of stable connections, purpose, and roles. Suffice it to say, I derive a great sense of purpose from being a part of the WSMA. The WSMA is my one hope for a better future for physicians.
</p>
<p>
<strong>Proud moment in medicine:</strong> During the pre-vaccine era of the COVID pandemic, I was fortunate to work as a medicine resident at a community hospital in rural upstate New York. Despite the ever-looming fear and uncertainty of those times, the local community stepped up and partnered with their only local hospital system to help with anything and everything. The local brewery transitioned to manufacturing sanitizers, local restaurants kept the food coming for the hospital staff, retired doctors in the community came out of retirement to help, a local moms group sewed masks for visitors, and the list goes on. The hospital and its community becoming one with each other and their solidarity restored my faith in humanity. This time in that lovely small baseball village called Cooperstown strengthened my resolve to serve the community I work in and to acknowledge the roles of every member of the community we serve.
</p>
<p>
<strong>What inspires me in medicine: </strong>It is alluring to me how medicine can be so much science and yet so much an art of human connection. I love how my physician colleagues balance this confluence of art and science while walking the tight rope of ever-increasing demands of the regulatory landscape.
</p>
<p>
<strong>Major changes challenging our profession:</strong> The dilution of physician expertise with conflicting regulatory responsibilities in everyday life. The many "damned if you do, damned if you don't" scenarios that add to the sense of helplessness that many physicians are facing today. An example of a systems problem being blamed on individuals would be the interventions that came out of the opioid epidemic. With the majority of fault attributed to doctors, for us it became a matter of walking a thin line between maintaining DEA compliance to not overprescribe, patient satisfaction to control pain, and patient safety to mitigate risk of suicide from imposed inflexible taper plans, all while navigating psychosocial issues of the population during a "quick" office visit.
</p>
<p>
<strong>If I weren't a doctor, I'd be: </strong>A dance artist or yoga teacher.
</p>
<strong></strong>
<p><strong>
Best advice received:</strong> My ICU attending, Dr. Travis Hodgdon, advised us residents to always ask patients about what a good day looks like in their life when you see them on their worst day because it gives you the perspective you need to serve their need.
</p>
<p>
<strong>Spare time: </strong>Yoga, dancing, swimming, hiking, and snuggling up
with my son and dog.
</p>
<p>
<strong>What people might not know about me:</strong> I am a southpaw.
</p>
<p>
<em>This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/17/2024 2:47:20 PM | 7/17/2024 2:46:55 PM | 7/17/2024 12:00:00 AM |
| communication-and-the-use-of-interpreter-services | Communication and the Use of Interpreter Services | WSMA_Reports | Shared_Content/News/Latest_News/2024/communication-and-the-use-of-interpreter-services | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/july-august/cover-wsma-julyaug-2024-645x425px.png" class="pull-right" alt="WSMA Reports July/August 2024 cover" /></div>
<h5>July 16, 2024</h5>
<h2>Communication and the Use of Interpreter Services</h2>
<p>
By Shari L. Hendrickson
</p>
<p>
Communication is key to providing quality health care services to patients, including those who have limited English proficiency. For patients needing language interpretation and translation services, we recommend the use of a certified interpreter when communicating. This includes patient education, care planning, and obtaining informed consent, as it is vital to ensure improved clarity of the information being presented. The use of an interpreter may reduce health care disparities among different cultures while increasing trust and confidence in the health care team. Compliance is advised regarding federal and state laws (e.g., Title VI of the Civil Rights Act of 1964) that mandate the use of interpretive services in health care.
</p>
<h3>Why certified?</h3>
<p>
Communication between patient and physician or advanced practitioner is often made more complex by the lack of knowledge regarding each other's culture. We recommend the use of certified interpreters due to the training their certification requires, which should include knowledge of medical terminology, health care systems, accuracy of the language being interpreted, and training in the obligation of confidentiality.
</p>
<p>
We recommend exclusive use of certified interpreters and translators and advise against the use of staff, minor children, or other family members as routine interpreters. This is to prevent the risk of inaccurate translation, commissions, and potential conflicts of interests that may arise from personal or emotional connections. In a health care emergency, such use may be justified until a certified interpreter can be secured-and all measures to secure a certified interpreter should be exhausted. The emergent need and actions taken to secure a certified interpreter should be detailed and documented in the medical record.
</p>
<h3>Patient refusal</h3>
<p>
If the patient refuses the use of a trained medical interpreter, the physician should document the patient's decision. One way to document the decision is with a waiver that explains the risk of refusing a medical interpreter. With a trained medical interpreter present, the physician should review the waiver with the patient and have the patient sign the waiver once the contents are understood. The signed waiver should be kept in the patient's medical record.
</p>
<h3>Practice makes perfect</h3>
<p>
It is important for physicians to recognize and address potential cross-cultural communication barriers with their patients. Medical interpreters help improve patient-physician communication and may provide insight into common communication barriers that may lead to poor quality or life- threatening medical errors.
</p>
<p>
To increase competence in the use of interpreter services, consider simulation as a training tool. Simulation may provide an opportunity to identify ways to improve style, health literacy, and medical terminology, as well as how to gauge the pace of communication.
</p>
<h3>Medical records</h3>
<p>
Certified medical translators can provide the translation of a patient's medical records. To ensure that all information is correct, such individuals are required to be proficient in the technical and medical terms for the language they are translating. These individuals should be certified to perform such services. Staff, minor children, or other family members should not translate medical records. Mistakes during translation may lead to medical errors.
</p>
<h3>Interpreter services and telehealth</h3>
<p>
The recent increase in telehealth services presents unique challenges to the delivery of care. Access to interpreter services must be reviewed prior to confirming a patient's candidacy for telehealth care. Criterion must be developed, and patients should be evaluated for their ability to access required technology, for their appreciation for both the benefits and challenges of telehealth services, and for their consent for service. Criteria must also be in place regarding the physician's ability to obtain timely interpretive language services for all aspects of the telehealth visit.
</p>
<h3>Use of a certified language interpreter</h3>
<p>
Below are procedures to consider when communicating through a certified language interpreter:
</p>
<ol>
<li>
During the interaction, look at and speak directly to the
patient, not the interpreter.
</li>
<li>
Provide guidelines for the interpreter to keep
communication open and facilitate an understanding
of the goals and purposes of the interview or counseling
session. When possible, meet with the interpreter or
familiarize yourself with interpretative companies'
processes before meeting with the patient.
</li>
<li>
To increase competence in the use of interpreter
services, consider simulation as a training tool.
</li>
<li>
Encourage the interpreter to meet with the patient
before the interview to discover the patient's language
literacy and attitudes toward health care. This
information can aid the interpreter when explaining
process and setting expectations and can aid in gaining
insight into the patient's overall communication needs.
</li>
<li>
Speak in short units of speech. Avoid long, complex
discussions of several topics in a single visit
or interview.
</li>
<li>
Avoid technical terminology, abbreviations, and
medical jargon.
</li>
<li>
Avoid abstractions, idiomatic expressions, slang,
similes, and metaphors.
</li>
<li>
Encourage the interpreter to translate in the
patient's own words as much as possible rather than
paraphrasing.
</li>
<li>
Encourage the interpreter to refrain from omitting
information or from inserting his or her own ideas
or interpretations.
</li>
<li>
To check on the patient's understanding and the
accuracy of the translation, ask the patient to repeat
instructions, or whatever has been communicated, in
his or her own words, with the interpreter facilitating.
</li>
<li>
To facilitate timely access to all health care and services,
offer language assistance to individuals who have
limited English proficiency or other communication
needs, at no cost to them.
</li>
<li>
Inform all individuals of the availability of language
assistance services. Do this clearly and in their
preferred language, verbally and in writing.
</li>
<li>
Ensure the competence of individuals providing
language assistance, recognizing the importance of
certification, and acknowledge that the use of untrained
individuals or minors as interpreters should be avoided.
</li>
<li>
Provide health literate appropriate print resources,
multimedia materials, and postings on social media,
websites, and elsewhere.
</li>
<li>
Listen to the patient and watch his or her nonverbal
communication. Often, much can be learned regarding
the patient's response by observing facial expressions,
voice intonations, and body movements.
</li>
<li>
Exercise patience. An interpreted interview takes
longer. Careful interpretation often requires the use of
long explanatory phrases.
</li>
<li>
If using telehealth care for patients who require a
certified interpreter, ensure that patients meet the
criterion for telehealth care.
</li>
</ol>
<p>
For more information and guidance on the use of interpreters in your practice, including a sample waiver you can adapt for your setting, visit <a href="https://phyins.com">phyins.com</a>.
</p>
<p>
<em>Shari L. Hendrickson is a senior clinical risk consultant with Physicians Insurance.</em>
</p>
<p>
<em>This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/16/2024 10:44:25 AM | 7/16/2024 10:41:56 AM | 7/16/2024 12:00:00 AM |
| when-all-belong | When All Belong | WSMA_Reports | Shared_Content/News/Latest_News/2024/when-all-belong | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports July/August 2024 cover" src="/images/Newsletters/Reports/2024/july-august/cover-wsma-julyaug-2024-645x425px.png" class="pull-right" /></div>
<h5>July 16, 2024</h5>
<h2>When All Belong</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
In the summer of 2020, after the killings of Ahmaud Arbery, Manuel Ellis, Breonna Taylor, and George Floyd, many corporations and higher education institutions nationwide issued statements condemning racism and committing themselves to the hard work of diversity, equity, and inclusion. For a few years DEI efforts flourished, with colleges and universities creating related statements, policies, programs, and offices. But since Jan. 18, 2023, the backlash against these efforts has been sweeping and unrelenting. That's when the far-right Manhattan Institute and The Goldwater Institute issued a four-pronged approach to dismantling DEI efforts. Since then, 83 anti-DEI bills, many mirroring this language, have been introduced by state legislative bodies, according to The Chronicle of Higher Education. Of these, 14 anti-DEI bills have been signed into law, 14 have received final legislative approval, and 47 have failed to pass, been tabled, or vetoed.
</p>
<p>
Twelve states, including Idaho, Wyoming, and North Dakota, have signed at least one anti-DEI bill into law. Anti-DEI bills have also been introduced but were tabled, failed to pass, or vetoed in nine states, including Oregon and Montana.
</p>
<h3>The impact in Washington state</h3>
<p>
Washington state has a long history of promoting and safeguarding health equity. The Governor's Interagency Council on Health Disparities, which provides legislative recommendations to eliminate health disparities by race, ethnicity, and gender, was established by legislation in 2006. More recently, on May 12, 2021, Gov. Jay Inslee signed legislation requiring higher education institutions to provide professional development for faculty and staff on DEI and anti-racism.
</p>
<p>
Washington state's Legislature has not introduced any anti-DEI bills to date. But that doesn't mean Washington state and its medical schools are immune to the DEI backlash.
</p>
<p>
The U.S. Congress has also introduced two anti-DEI bills. Of particular concern to the WSMA and the state's medical schools is U.S. HR 7725, a bill introduced in March 2024 by North Carolina Republican Rep. Greg Murphy that would bar medical schools with DEI offices, statements, or programs from receiving federal funding. The bill, which as of this writing sits in committee, would still allow for instruction on health conditions related to sex, race, and other characteristics.
</p>
<p>
In June 2023, the U.S. Supreme Court also effectively ended race-based affirmative action in higher education with the Students for Fair Admissions case. The ruling did not impact Washington state's public universities, which have been barred from considering race in admissions since 1998. But private universities, including Pacific Northwest University of Health Sciences College of Osteopathic Medicine, must now follow suit.
</p>
<h3>WSMA and medical schools respond</h3>
<p>
Regardless of the anti-DEI shift underway, the WSMA remains undeterred in its efforts. On May 10, at the direction of its executive committee and girded by multiple policies in support of health equity efforts, the WSMA partnered with Washington's three medical schools-PNWU, the Elson S. Floyd College of Medicine at Washington State University, and the University of Washington School of Medicine-to release a joint statement to add their voices to those of national health care associations and organizations in support of DEI efforts in health care and society (see sidebar).
</p>
<p>
The events of 2020 also galvanized the WSMA Foundation, which historically has focused on clinical improvement efforts, to promote racial diversity within the profession as a response to current and historic racial inequities. To that end, it launched the WSMA Foundation Scholarship and Diversity Advancement Fund, an endowment to support students who are underrepresented in medicine.
</p>
<p>
"Studies have shown that increasing racial diversity within the physician profession actually improves the health care of our patients," says Brian Seppi, MD, board chair of the WSMA Foundation. "And it's not just having someone the same racial background as your own personal physician. But also, just having those physicians in the profession helps all of us, no matter our race, do better with serving the diversity within our patient population."
</p>
<p>
The fund's goal is to award scholarships for medical students in Washington beginning in 2026. To date, the fund has raised $800,000 toward its $1.5 million goal and the foundation encourages WSMA members to contribute to this worthy cause. Look for more information about the fundraising campaign this fall.
</p>
<h3>The medical school work continues</h3>
<p>
Washington state's medical schools also have been ahead of the curve when it comes to DEI:
</p>
<ul>
<li>
Founded in 2005 to serve rural and medically underserved communities throughout the Northwest, PNWU created its diversity, equity, inclusion, and belonging policy in 2018, revising it in 2023. In April 2021, PNWU launched its office of diversity, equity, and inclusion, with Mirna Ramos- Diaz, MD, as its inaugural chief diversity officer.
</li>
<li>
Since its founding in 2015, the Elson S. Floyd College of Medicine has had DEI in its DNA, says David Garcia, associate dean of community, health equity, and belonging, "serving as Washington's community-based medical school, focusing on rural communities, Tribal Nations, and people who have been historically marginalized."
</li>
<li>
The UW School of Medicine, which has had a longstanding commitment to DEI, launched its Office of Healthcare Equity in July 2020. Despite the political machinations nationwide and in nearby states, medical colleges in Washington state continue to focus on DEI work because they have seen the results firsthand.
</li>
</ul>
<p>
Getting rid of DEI in medical schools will only exacerbate problems medical students and physicians face as they try to manage an increasingly diverse patient population, says Dr. Ramos-Diaz.
</p>
<p>
"We need to support and educate our students on cultural sensitivity. So that when they go to practice, in whatever health care profession … that they are prepared to listen and to be present to people [whose background] may be different than their own, across many levels, ethnic, religious, political, gender, race, it doesn't matter," says Dr. Ramos-Diaz. "It's never about shaming anybody or forcing anybody to be different than who they are. But, rather, to be open to learning from the other. So that we all may have an environment in which we all can thrive."
</p>
<h3>A way to express universal ideals</h3>
<p>
Creating a health care profession and community where everyone feels they belong and can have their voices heard is at the heart of PNWU's DEI efforts. "The way that we view diversity plus equity plus inclusion equals belonging," says Dr. Ramos-Diaz. "When any of those parts of that equation is missing, then there are individuals that cannot achieve their full potential within our institution and really within our communities."
</p>
<p>
At PNWU, DEI is taught through the restorative practice lens, which begins during orientation, when students are placed in community-building circles. Students are asked to bring in an object that relates to their journey to the health sciences and share what it means to them.
</p>
<p>
"We give everyone an opportunity to be heard, equally," says Dr. Ramos-Diaz. "When they get to know each other, they're more likely to collaborate with that person, less likely to cause harm to that person, or are more likely to be thoughtful, and engage and share resources … And, holy moly, they begin seeing their similarities, amidst their differences."
</p>
<p>
From there, PNWU students are given lessons on restorative justice, which places community well-being at its center, says Dr. Ramos-Diaz. "It balances accountability with support," she says. "This is never about blaming. It is always about 'how do we repair harm in the community?'"
</p>
<p>
When issues crop up throughout medical school, students can ask for a community-building circle to come up with solutions. Recent building circles have focused on the Russia-Ukraine War and the Israel-Hamas War. It's a method of addressing conflict and harms they can then employ in their professional career and communities, says Dr. Ramos-Diaz.
</p>
<p>
"When we teach on implicit biases, on harms that occur within our institution, or at any level outside our institution, we place that harm in the middle," says Dr. Ramos-Diaz. "We never place people in the middle. It's never about shaming. It's never about 'you've got to include these people, otherwise you're gonna get in trouble for it.' It's never that way. It's always about, 'let's focus on the fact that we all belong.' "
</p>
<h3>Evidence- and research-based</h3>
<p>
Critics of DEI have seized on the public's lack of understanding of this robust, research-backed discipline, says Garcia. The disinformation that DEI efforts are based on a haphazard or nefarious set of rules could also not be further from the truth.
</p>
<p>
This includes the anti-DEI proponents' intentional selection of the acronym DEI, as it can be difficult to define by non-practitioners and can elicit fear. Garcia acknowledges diversity, equity, and inclusion as a body of work and stresses the crucial step of defining what we mean by the terms and then animating them. He adds the importance of health professions being foundational to combatting disinformation given their access to research that clearly illustrates the need for engaging in equity work.
</p>
<p>
"The perception is, oh, here's what they're trying to impose on us. When, in reality, with diversity, equity, and inclusion work, there's rigor to it, there's standardization," says Garcia. "What we're putting forth is not my opinion. What we're putting forth is sound strategies to improve not only the internal organizational health of the college, but also to make us better partners with our community and to serve our community." He is less concerned about what term or acronym, such as DEI, is being imposed on the work and more focused on improving health, well-being, and equity for all Washingtonians.
</p>
<p>
Garcia says his team grounds the work it does on the World Health Organization's definition of health as a fundamental right for every human being without distinction of race, religion, political belief, economic, or social condition to achieve, or to have the opportunity to achieve, the highest standard of health.
</p>
<p>
"The evidence that we have supports that health inequities exist, and also societal inequities, and the overall impact that they have on health and well-being," says Garcia. "It's important for students and future physicians to not only understand the patient, but to have an understanding of the societal context in which people live, work, and play, and the effects that those have on health and well-being, often referred to as social determinants of health."
</p>
<h3>A win-win</h3>
<p>
Focusing on DEI also helps prepare medical students for the population they will end up treating once they graduate, says Garcia. "These are the things that we're thinking about on a constant basis, what types of resources, what types of frameworks, what types of information do we need to provide to our students so they're providing that holistic care to anybody that walks into their clinical space."
</p>
<p>
DEI efforts work to affirm each physician's own background, says Garcia, so they can better serve their communities. "Something that we work on from day one is an understanding of the self in relationship to others, which is an extremely important tool and strategy, especially for physicians," says Garcia. "Learning more about yourself and how you move throughout the world is an extremely important aspect to connecting with other human beings."
</p>
<p>
Higher education, especially medical schools, should be a place of learning, curiosity, and intellectual stimulation, says Garcia. "It's beyond a binary of good or bad," he says. "It's moving and engaging in a paradigm shift away from the Golden Rule to the platinum rule. Instead of treating others how you want to be treated, what if we take the time to-and this is where I'm reminded that we were given two ears and one mouth for a reason-listen to what other people need, to what they deem to be the highest attainable standard of health for them, for their community."
</p>
<p>
Reversing DEI efforts would further strain the health care system in a state already facing a shortage of skilled physicians, and further exacerbate health care disparities and inequities, says Garcia.
</p>
<p>
"We know who [anti-DEI] impacts the most. It impacts the folks that we really saw highlighted during the COVID-19 pandemic, right? And oftentimes, it's our rural and historically minoritized communities," says Garcia.
</p>
<p>
The Elson S. Floyd College of Medicine recently adopted a new strategic plan which emphasizes a vision of an equitable Washington for all. But Garcia stresses no medical college can do this hard work alone and they can't do it without DEI in place.
</p>
<p>
"There's shared accountability and responsibility, in partnership with Washingtonians and with organizations, if we are … envisioning what optimal health looks like in Washington state," says Garcia. "People could argue for or against this work. The reality is that this work is important. We need to be doing this work. Otherwise, we will continue to see the catastrophic impact that it has on people, not as statistics, but as people and their full humanity, as family members and community members."
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/16/2024 10:57:45 AM | 7/16/2024 10:50:59 AM | 7/16/2024 12:00:00 AM |
| doctors-making-a-difference-alina-urriola-md-mph | Doctors Making a Difference: Alina Urriola, MD, MPH | WSMA_Reports | Shared_Content/News/Latest_News/2024/doctors-making-a-difference-alina-urriola-md-mph | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/july-august/dmd-website-image-urriola-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Alina Urriola MD, MPH" /></div>
<h5>July 9, 2024</h5>
<h2>Doctors Making a Difference: Alina Urriola, MD, MPH</h2>
<p>
A long history of volunteering to provide free care for patients who cannot access health care in traditional ways has led Alina Urriola, MD, to a place of personal and professional fulfillment and has given her a unique perspective on how best to serve those patients who have fallen through the cracks. As a volunteer family physician at Lahai Health, a free clinic providing care in King and Snohomish counties, and a member of WSMA's Latinx Advisory Council, she's working to patch the holes in the health care safety net.
</p>
<p>
<strong>Q: What inspired you to get involved with volunteering with Lahai Health, and can you
tell readers a little about what the organization does?</strong>
</p>
<p>
Throughout my career I have been thoroughly concerned with the well-being of my patients, as well as the well-being of those who do not have access to health care. Furthermore, I'm concerned with the well-being of those who, though qualifying for services, are unable to access them because of language or cultural barriers.
</p>
<p>
It is estimated that between 26 million and 30 million people in the U.S. have no health insurance. In Washington that number is around 500,000. Many of those people depend on clinics providing free medical services for their care, or neglect care all together. That is a big burden for people in need and for the health care system.
</p>
<p>
I carry a tradition of service to the underserved from my volunteering with the homeless in the streets of St. Louis, co-founding a clinic to serve the uninsured Latinx population of greater St. Louis, to my home in Seattle where I have volunteered with Lahai Health for 14 years.
</p>
<p>
I'm inspired by the spirit of generosity, resourcefulness, and can-do attitude of everyone working at Lahai, a volunteer-based, patient-centered health care organization where we care for most primary care needs, promote and provide preventive services, facilitate lower-cost medications and free labs, and refer patients to free consultants through the Project Access Program. More importantly, we do complex care coordination through our staff nurse team.
</p>
<p>
Despite the availability and the high-quality care provided by Federally Qualified Health Centers, patients still fall through the cracks and choose to come to Lahai because we offer evening hours in one of our centers, our appointments are one hour with a personal touch, and we provide a holistic approach that includes physical, mental, and spiritual care where patients enjoy a sense of community and full emotional support. We don't have a sliding scale; no one pays anything, and we supplement with telehealth, free dental care, nutrition and lifestyle education, prayer, food bank, help with kids' homework, as well as many other services.
</p>
<p>
My work at Lahai is thoroughly fulfilling, enriching, and joy generating. The team is devoted, empathetic, joyful, heartening, and just plain fun. A true antidote to burnout!
</p>
<p>
<strong>Q: Has your volunteer work taught you anything about what changes are needed in health care overall to better serve multilingual/multicultural patients?</strong>
</p>
<p>
Looking at the population we serve and the needs we face, it is clear that we have ways to go when it comes to equity in health care delivery and access to care in Washington. Free clinics care for the neediest and most vulnerable communities and do it with very little resources. We are the last link in the safety net and can fill the ultimate gaps and crevices of the health care system. We don't only serve patients, but we also save the system money on unnecessary visits to the emergency room, and on potentially complicated hospitalizations and advanced care. Any volunteer clinician at Lahai can tell you a story of a life saved, a hospitalization or complication prevented, or a gift of hope and joy endowed to many of our patients.
</p>
<p>
I've learned through my volunteer work that our safety net is fragmented and broken. The system has failed many and it is through free volunteer clinics like Lahai that many find a way to be heard and healed. But all that is not enough. We have a long waiting list and receive new inquiries every week. We need to strengthen our safety net and make care flexible, accessible, comprehensive, personalized, and simple for all, always and everywhere. Maybe one day Lahai and other free clinics will be redundant; but in the meantime, we continue to touch lives one person at a time.
</p>
<p>
<strong>Q: What has been the most fulfilling part of volunteering to care for patients from underserved communities?</strong>
</p>
<p>
The most fulfilling part of volunteering is the impact I make on the individual, the community, and to society one patient at a time. I also cherish the relationships I build with my patients and with the team. The collective sense of devotion, commitment, and gratitude we all experience and share with one another is deeply satisfying.
</p>
<p>
<strong>Q: You're also a member of WSMA's Latinx Advisory Council; why did you want to serve and what are your goals for the Latinx Section?</strong>
</p>
<p>
My participation at the WSMA Latinx Advisory Council is an extension of my personal mission: to serve and to collaborate. The Latinx Council advocates for quality equitable access to care for the Washington Latinx population, and for the inclusive promotion and expansion of Latinx physicians' availability in the state.
</p>
<p>
<strong>Q: Are there any specific strategies you've found that are effective in reducing care inequities among Latinx patients?</strong>
</p>
<p>
One of the most impactful strategies for reducing care inequities among Latinx patients is increasing the availability of and access to language and culturally concordant clinicians. That concordance facilitates communication, mutual understanding, respect for values and preferences, joint decision-making, and adherence. When care is provided by a clinician who shares a history, a journey, the idioms and idiosyncrasies, and who has experienced the smells, sounds, and flavors of "antaño," connection happens. That connection is particularly important for patients with vulnerabilities, trust issues, history of trauma, and health-related social needs and simply does not happen solely with the use of an interpreter.
</p>
<p>
We also need to improve access to affordable health care services by expanding Medicaid eligibility, increasing payment for providers and funding for community health centers, and implementing outreach programs to enroll eligible individuals in health insurance plans. At the same time, we need to implement community-based health education programs to raise awareness about preventive care, chronic disease management, and available health care resources leveraging community leaders, organizations, and "promotores de salud" (community health workers) to disseminate information and facilitate access to care.
</p>
<p>
<em>This article was featured in the July/August 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/9/2024 3:41:14 PM | 7/9/2024 3:22:17 PM | 7/9/2024 12:00:00 AM |
| is-direct-primary-care-right-for-you | Is Direct Primary Care Right for You? | WSMA_Reports | Shared_Content/News/Latest_News/2024/is-direct-primary-care-right-for-you | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/may-june/may-june-2024-reports-cover-645x425px.jpg" class="pull-right" alt="cover of March-April 2024 issue of WSMA Reports" /></div>
<h5>June 3, 2024</h5>
<h2>Is Direct Primary Care Right for You?</h2>
<p>
By Rita Colorito
</p>
<p>
Like many owners of direct primary care practices, Jlyn Pritchard, DO, a family medicine doctor in Spokane, had struggled for years with the constraints and burdens of working in a fee-for-service model.
</p>
<p>
"It was an 8-to-5, no negotiation, no wiggle room," says Dr. Pritchard. As a mother of three young children, that meant she often missed being there when they were sick or had a special event. "The corporate system of medicine is a tough business. And it doesn't really allow moms, in particular, to really show up," she says.
</p>
<p>
To achieve the autonomy she values, Dr. Pritchard opened her direct primary care practice, Thread Health Clinic, in October 2022. And she's never looked back.
</p>
<p>
Direct primary care is a membership- based practice model where the physician contracts directly with the patient instead of with an insurance company. For a small but growing number of physicians in Washington, direct primary care presents an attractive option to sidestep the headwinds facing traditional primary care practices today. And they are substantial: shrinking reimbursements from government payers, high overhead costs, high rates of physician burnout, ever- increasing administrative burdens from insurance carriers, and, as Dr. Pritchard faced, schedules not conducive to a work- life balance. It's no wonder interest in primary care specialties among medical students continues to decline.
</p>
<p>
Those headwinds convinced Kim Ha Wadsworth, DO, to start Essential Direct Primary Care in Olympia in January 2022. During her locum tenens assignment immediately after residency in Yakima only six months earlier, she saw some 30 patients a day.
</p>
<p>
"We are supposed to do no harm, and yet I looked around at the lack of continuity, gaps in care, not having readily available appointments for patients to follow up ... I just looked at that and said I don't want to practice medicine this way. It seems like I would do more harm than not," says Dr. Wadsworth.
</p>
<h3>The state of innovation</h3>
<p>
Washington state is the birthplace of the direct primary care model, with the Legislature codifying it into law in 2007. Since the beginning, the WSMA has supported physicians' ability to choose the model of care delivery that fits their career needs. "The WSMA does not express a preference for any one practice model but supports the availability of a variety of practice options for physicians to meet the diverse care needs of the state and to create a strong health care system," says WSMA President Nariman Heshmati, MD, MBA, FACOG.
</p>
<p>
In recent years the care model has gained traction. There are 81 direct practices registered in Washington state, a net increase of 25 over the previous year, according to the December 2023 Direct Practice Report by the Office of the Insurance Commissioner. "That's a significant increase," says Dr. Heshmati, "particularly in our current health care landscape, when you consider that the number of independent fee-for-service practices is dwindling."
</p>
<p>
So far, direct primary care practices in Washington have yet to gain a significant market share. Out of an estimated 7.9 million Washington state residents, only 0.4% are enrolled in a direct primary care practice, up from 0.31% in 2022, according to the OIC report. "A big part of the lack of utilization likely has to do with how many residents are familiar enough with direct primary care to seek its services," says Dr. Wadsworth, a point echoed by other direct primary care practitioners.
</p>
<p>
There's also a question of whether regulatory hurdles contribute to this slow growth, unlike the notable expansion seen in states like Colorado. The WSMA has heard from members of the direct primary care community who have pointed to onerous annual reporting requirements from the OIC, for example. To that end, the WSMA House of Delegates in 2023 passed a resolution, spearheaded by Dr. Wadsworth, to approach the OIC about these regulatory hurdles for direct primary care practices, with the goal of supporting the ability of physicians to utilize the practice model.
</p>
<h3>Benefits and challenges</h3>
<p>
When the 2007 legislation was passed, many theorized that the direct primary care model would help relieve problems caused by a shortage of primary care physicians. Today, proponents are more likely to see the model as helping to further the Quadruple Aim: enhanced patient experience, improved population health, reduced cost, and a more fulfilling and balanced life for doctors.
</p>
<p>
"Direct primary care is an incredible model, but it doesn't address the physician shortage," says Dr. Pritchard. "What it does address is the patient backlog that often happens when people can't access care ... Urgent cares are great. But they were created because people couldn't get in to see their PCP. So, we sort of transition that relationship back to what it should have been all along."
</p>
<p>
Among Dr. Wadsworth's first direct primary care patients were two she had seen in residency. They made the switch to Essential Direct Primary Care, she says, because they could not get timely appointments with their physician.
</p>
<p>
"They were always seeing the PA or nurse practitioner. They were tired of getting handed off to whoever happened to be there that week," says Dr. Wadsworth. They now travel from Yakima to Olympia twice a year for checkups and via telehealth or call otherwise.
</p>
<p>
Running a direct primary care practice comes with its own set of challenges. The promised one-on-one patient-physician relationship means physicians are on call as needed.
</p>
<p>
Dr. Pritchard now works more hours than she did in a fee-for-service practice. "I view it as a time exchange," she says. "I have the ability to show up to the things that are really important in my life ... instead of being obligated to someone else's schedule."
</p>
<p>
Most of her patients have been very respectful of her time, says Dr. Wadsworth. In the last two years, she's only needed to go into the office twice on a weekend for an urgent patient issue.
</p>
<p>
"I have to almost pull teeth to say, hey, you know, you could have called me about that," she says. "It brings back the joy of medicine, that we can really take care of patients when they need us."
</p>
<p>
Direct primary care practices charge a set monthly fee for all primary care services, regardless of the number of visits or care provided. Setting pricing that's affordable but factors in resources, time, and care needs of your patient population is a major challenge, says Dr. Pritchard.
</p>
<p>
Direct primary care tends to attract patients with complex conditions who often aren't getting what they need in the traditional care system, says Dr. Pritchard. "Time management, resource management, as well as just expectation management from people has been a challenge," she says.
</p>
<h3>Solutions to care</h3>
<p>
Physicians practicing direct primary care pride themselves on offering patients same-day or next-day appointments for urgent medical issues. Under a direct primary care model, Dr. Pritchard says she's able to offer creative solutions that fit her patients' needs.
</p>
<p>
On one recent morning, she had a young father scheduled for osteopathic manual therapy. His wife texted to say their two kids were sick. Dr. Pritchard suggested he bring them in during his appointment so she could see what was going on.
</p>
<p>
"It really didn't take a whole lot of extra effort on my part to see them," she says. Under a fee-for-service model, says Dr. Pritchard, everyone would need separate appointments, if they could get them that day, or use urgent care-the default when patients can't get in to see their primary care physician.
</p>
<p>
The direct primary care model allows physicians much more time with their patients so they can practice to their full scope, says Dr. Wadsworth. This, in turn, she says, also helps alleviate pressure on specialists.
</p>
<p>
"They have waiting lists three to six months out. So, they really appreciate it when we, as family physicians, take care of a lot of that initial workup," says Dr. Wadsworth. "I'm not sending patients right away to a specialist because there are many things that I can do in house first."
</p>
<h3>Physician autonomy</h3>
<p>
Getting rid of insurance burdens for the care they provide appeals to many primary care physicians.
</p>
<p>
"I get to make decisions about how to take care of my patients, as opposed to being beholden to whatever rules the insurance company imposes on me," says Dr. Wadsworth. "I often joke that the insurance companies are practicing without a medical license."
</p>
<p>
Under a direct practice model, physicians opt out of insurance billing, significantly reducing the administrative overhead involved in reimbursement from insurance payers. But that doesn't mean direct primary care physicians avoid all insurance paperwork. Drs. Wadsworth and Pritchard often need to write prior authorizations for medications, labs, or imaging.
</p>
<p>
Dr. Wadsworth, for example, has a patient on Cosentyx who needs prior authorization for refills. "There's no way she can afford that without her insurance," she says. Because the patient can't get in to see a rheumatologist for another nine months, Dr. Wadsworth manages her arthritis care in the meantime.
</p>
<p>
"To have that autonomy ... It's worth something that I'm not burnt out five years from now," says Dr. Wadsworth.
</p>
<h3>Affordability</h3>
<p>
Cost and affordability are common criticisms of the direct primary care model. One fundamental misunderstanding: That direct primary care is concierge care-very low patient panels and very high cost.
</p>
<p>
More than half of direct primary care practices reported average monthly fees between $61 and $120. The most expensive monthly fee, at $1,253, belonged to the Bellevue location of a multistate, self-described "luxury concierge" group.
</p>
<p>
"I have yet to meet a direct primary care doc who wasn't first and foremost focused on affordability and accessibility," says Dr. Wadsworth. "I like to say that direct primary care is concierge without the Cadillac prices."
</p>
<p>
Essential Direct Primary Care charges tiered monthly membership fees by age group, each tier priced at less than $100 per person per month. Thread Health offers individual, family, and employer- paid memberships at different price levels, depending on patients' needs.
</p>
<p>
The direct primary care model gives physicians latitude to provide additional discounts to patients who are struggling financially, says Dr. Wadsworth, who has several patients on Medicare and Medicaid. "If I were to see that same Medicaid patient and bill Medicaid, I can't make exceptions to their rules, because I have to treat all the patients the same."
</p>
<p>
For care outside their practice, direct primary care physicians spend considerable time negotiating reduced prices on ancillary services, such as medication, lab work, and imaging. "We pride ourselves on finding the best deals," says Dr. Wadsworth. "I can get patients $41 X-rays now. I worked two years on that deal."
</p>
<p>
For lab work, Thread Health works with a group-purchasing organization. "They negotiate prices on our behalf to offer the cheapest rates to our patients," says Dr. Pritchard. Most of the time, typical labs are a fraction of what patients might pay with insurance: a lipid panel costs less than $4.
</p>
<p>
Some critics worry direct primary care practices will worsen the physician shortage in rural areas. Dr. Pritchard argues the direct primary care model may incentivize physicians to move to underserved communities.
</p>
<p>
"There are hundreds of direct care practices across the country that are located in these rural locations that are serving patients in a completely different capacity," she says. In Washington state, direct primary care practices operate in 20 counties, many in rural areas.
</p>
<h3>A tough sell</h3>
<p>
Attracting and retaining patients is a constant concern when running a direct primary care practice. It's the reason why Rebecca Hoffman, MD, shuttered her Vancouver direct primary care practice, New West Family Care, in 2012 after two years.
</p>
<p>
The misconception that direct primary care only caters to the wealthy may be one of the reasons the care model hasn't taken off, says Dr. Hoffman. "It's a tough sell. People in this country aren't used to paying retainer fees," she says. "You have to know your market and who you're drawing from. It requires constant promotion."
</p>
<p>
Another reason for the lack of marketplace traction: Some patients use direct primary care as a waystation, says Dr. Hoffman. It's why one colleague recently closed his direct primary care practice. "After doing this for several years, he wasn't getting many long-term patients. They were in it for a bit but would leave when they got a new job," she says.
</p>
<h3>Making ends meet</h3>
<p>
Many direct primary care practices have adjusted their business from a direct- practice-only-or-bust approach. In 2023, only 49% of direct primary care practices reported that 100% of their business is direct practice. Twenty-one direct primary care practices reported also participating as in-network providers in a health carrier's network in 2022, a significant change from 2007 when all reporting practices performed direct primary care exclusively.
</p>
<p>
Neither Dr. Wadsworth nor Dr. Pritchard practice direct primary care exclusively. Dr. Wadsworth also offers fee- based osteopathic manipulative therapy (OMT). Dr. Pritchard also works for a Washington-based clinic doing telehealth part-time, and offers fee-based OMT, a guided weight loss program, and lifestyle counseling (included in Thread Health's advanced and deluxe memberships).
</p>
<p>
Having a hybrid practice, suggests Dr. Hoffman, who had both a direct primary care and a fee-for-service practice, may help transition patients who would otherwise leave once they got a job or health insurance. "Then you can still see them and that will be great for continuity of care," she says.
</p>
<p>
"This model is not for everyone," says Dr. Pritchard. "But what it has gifted me is the ability to show up for my family, to be seen as a human being, and to interact with patients the way I have always hoped ... and to give patients back the ability to feel heard."
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the May/June 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 6/7/2024 12:34:36 PM | 6/3/2024 11:07:09 AM | 6/3/2024 12:00:00 AM |
| wearable-device-technology-in-health-care | Wearable Device Technology in Health Care | WSMA_Reports | Shared_Content/News/Latest_News/2024/wearable-device-technology-in-health-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/may-june/may-june-2024-reports-cover-645x425px.jpg" class="pull-right" alt="WSMA Reports May/June 2024 cover" /></div>
<h5>May 30, 2024</h5>
<h2>Wearable Device Technology in Health Care</h2>
<p>
By Sharon Hall, RN
</p>
<p>
Wearable technology has advanced beyond federal Food and Drug Administration-approved medical devices to monitor acute or chronic health conditions. Ask someone today if they are familiar with wearable health care technology and the chances are they'll think of wearable "smart" devices that are also capable of tracking wellness parameters.
</p>
<p>
A 2019 National Trends Survey of 4,100 participants revealed that about 30% of respondents used a wearable device, and of these adopters, 46% had shared the data with their physician or practitioner. While studies to validate the predictive quality of wearables are mostly lacking, that isn't stopping consumers from using wearables to track their wellness.
</p>
<p>
Should a physician or health care professional consider providing care to patients incorporating wearable data? Let's consider some of the benefits-and some of the risks.
</p>
<h3>About our smart devices</h3>
<p>
Common types of wearables today include smartwatches, smart bracelets, and smart glasses. They are not usually approved by the FDA. The data collected by wearables include metrics such as pulse, blood pressure, temperature, blood oxygenation, glucose levels, sleep patterns, and movement. Wearables often track identified metrics continuously to identify a baseline and reveal trends over time, with the resulting data potentially used by the individual's physician or health care practitioner to aid in diagnosis and treatment or changes in care.
</p>
<p>
Some examples: Continuous monitoring of glucose levels may allow a patient to adjust their diet and activity in real time, leading to more consistent blood-sugar levels and fewer in-person practitioner visits. Smart watches with EKG capabilities may lead to considering the diagnosis of atrial fibrillation. Pairing another application with a smartwatch may detect an infection such as the onset of COVID-19 before symptoms become obvious.
</p>
<p>
Other potential benefits of wearable technology include improved motivation in activities such
as quitting smoking, managing diabetes, and exercising; higher patient activation as data demonstrates how choice influences health; better management of chronic diseases through shared decision-making; and improved patient engagement in preventative care, resulting in fewer office visits.
</p>
<h3>Practitioner risks and responsibilities</h3>
<p>
When patients share health data from wearables, questions arise about a physician's or health care practitioner's responsibility to accept this data, act on it, and incorporate it into the patient's medical record. Both patient and practitioner expectations for wearable use and monitoring should be clear from the outset.
</p>
<p>
Current resources do not suggest existing case law involving wearables, so it's not clear whether monitoring
a patient's personal wearable device creates a physician- patient relationship requiring a duty of care. However, when wearables are part of the patient's plan of care, a duty may exist, and physicians and practices can minimize malpractice risks through planning and documentation. Risks include inappropriate patient selection, limited usability of the device to monitor selected parameters, failure to educate or train patients and staff, data management issues, communication issues, privacy, and security.
</p>
<h3>Choosing patient candidates</h3>
<p>
Patient selection is an important component when considering a plan of care that involves remote monitoring using a wearable. Not all individuals are appropriate candidates, nor do all medical conditions lend themselves to remote monitoring. Consider the following when determining if your patient is an appropriate candidate for remote monitoring using a wearable device:
</p>
<ul>
<li><strong>Equity and inclusion: </strong>If the patient's insurer does not pay for the wearable, can the patient afford to purchase the device and any necessary accessories?</li>
<li><strong>Accessibility:</strong> Does the patient have a smartphone if one is required by the wearable? Does the patient have internet access and sufficient internet speed to transmit data? If the objective is to monitor a health condition or well-being through the device and the patient cannot transmit the data, the device may not be helpful for that patient.</li>
<li><strong>Compliance:</strong> Is the patient comfortable and capable of operating the wearable correctly? Physicians and health care professionals recommending the wearable can improve patient compliance through a shared-decision- making informed-consent process. The informed consent should include an explanation of the wearable, patient responsibilities, benefits and risks of using the wearable, the technology's limitations, and possible alternatives. Consent should also address the rights of the practitioner and patient to discontinue use of the wearable. As with telehealth, confidentiality and potential security issues are also important to discuss.</li>
<li><strong>Service and support:</strong> Who maintains the device? How is troubleshooting conducted if the device fails to function properly? Who addresses potential device recalls?</li>
<li><strong>Usability:</strong> Since wearables are generally not FDA approved, they may not be as accurate or dependable as approved devices. Does the wearable have a good track record for safety and reliability, which impact data integrity? Can data easily be retrieved and transmitted? For non-FDA- approved devices, we recommend investigating the medical community's consensus and reviewing scientific evidence for the acceptance of the proposed off-label use for the patient's condition.</li>
</ul>
<h3>Training of staff and patients</h3>
<p>
Physicians and health care professionals must ensure they are trained in the use of any new technology and must be prepared to teach patients. For FDA-approved wearables, the manufacturer may offer or require training; otherwise, instruction may be offered in accompanying product materials. Designate staff experienced in the setup, use, and remote monitoring of security and privacy issues for wearables to provide patient training. Document the patient's training on the device in the patient record.
</p>
<p>
Patient training should include setup, use, maintaining, troubleshooting, and sending data from their wearable. Training should include scheduling and determining the frequency for review of data by the physician or office.
</p>
<h3>Be specific in documentation</h3>
<p>
Medical record documentation of the wearable technology should include the specific technology and model number, patient training, informed consent, plan of care to reflect use of the device, data transmitted, and any actions taken related to data transmission. Lack of adherence to the plan of care should be noted, as well. Device-specific informed consent should be obtained for wearable devices that generate real- time data. Patient responsibilities should be defined, including a responsibility to follow up after a data-point deviation has been transmitted and becomes known to the patient.
</p>
<h3>Administrative considerations</h3>
<p>
Remote-monitoring technology references should be added to your notice of privacy practices. Include wearables in the organization's security and product-recall procedures. Be aware of manufacturer warnings, FDA alerts (if applicable), or recalls of patient wearables. If you have any wearable vendor or subcontractor contracts, there may be a need for business- associate agreements. Recommendations for using specific wearables may fall under federal fraud and abuse guidelines. A health care practitioner cannot accept anything of value in exchange for recommending the use of a wearable medical device.
</p>
<h3>The future is wearable</h3>
<p>
Given the potential risks, why should a physician or health care professional consider providing care to patients incorporating wearable data? Because there are benefits for patient involvement in their care and compliance, and it's very likely that patients will be sharing their health data with you. Plus, more companies are seeking FDA approval for their wearable products.
</p>
<p>
While many health care practitioners consider wearables to be fun consumer gadgets, many are currently changing their viewpoint. Wearables can be used as a motivational tool to facilitate shared decision-making regarding a patient's condition and have the potential to be utilized as a predictor of health and even lead to improved health outcomes.
</p>
<p>
<em>Sharon Hall, RN, MPH, ARM, is a senior clinical risk consultant with Physicians Insurance.</em>
</p>
<p>
<em>This article was featured in the May/June 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/30/2024 1:02:58 PM | 5/28/2024 4:42:53 PM | 5/30/2024 12:00:00 AM |
| member-spotlight-dave-cundiff-md-mph | Member Spotlight: Dave Cundiff, MD, MPH | WSMA_Reports | Shared_Content/News/Latest_News/2024/member-spotlight-dave-cundiff-md-mph | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/may-june/member-spotlight-website-image-dave-cundiff-645x425px.png" class="pull-right" alt="WSMA Member Spotlight: Dave Cundiff, MD graphic" /></div>
<h5>May 29, 2024</h5>
<h2>Member Spotlight: Dave Cundiff, MD, MPH</h2>
<p>
<strong>Works at:</strong> Discover Recovery, Long Beach; Smart Moves Health, Ilwaco (under development).
</p>
<p>
<strong>How long in practice:</strong> 41 years.</p>
<p>
<strong>Specialties:</strong> Public health; addiction medicine.
</p>
<p>
<strong>Why WSMA: </strong>In a time when the most powerful players in health care are oriented toward money, power, and control, the WSMA presses for physicians' ability to survive, serve our patients, and thrive. Besides, it's fun! Organized medicine includes some of the smartest, most idealistic people I know. WSMA involvement is one of the best ways to give back to the profession that has given me so much.
</p>
<p>
<strong>Why I became a physician: </strong>Three big contributing factors: I was raised by a World War II veteran who found joy in serving our country. I was probably saved from long-term disability and early death by the pediatrician who diagnosed and treated my rheumatic fever. I find joy in learning and teaching-the word "doctor" comes from the Latin word for "teacher"-and physicians' teaching role remains extremely valuable.
</p>
<p>
<strong>Best advice received: </strong>"If you're winning all your battles, maybe you're not fighting all the right battles." In the WSMA House of Delegates, and in the American Medical Association, sometimes I've been part of an overwhelming majority. And sometimes I've been in a very small minority. It's all good, as long as we're all committed to the future of our profession and the well-being of those we serve. Good leaders make sure that everyone who cares about the group is heard.
</p>
<p>
<strong>Why rural Washington:</strong> Many things about Ilwaco remind me of the Pennsylvania town of 500 people where I grew up. In a small city, you know a lot of people and they know you. If you want to serve, you can. You can make as big a difference here as you can anywhere!
</p>
<p>
<strong>What people might not know about me: </strong>I majored in Spanish in college, and I've used it off and on through life. My wife and I hope to open a bilingual integrated care clinic in the old Ilwaco Medical Building, welcoming many who aren't as well-served now as they should be.
</p>
<p>
After Russia invaded Ukraine, I also started studying Ukrainian on Duolingo. Ukrainian is hard for me, both because I didn't start earlier and because the Cyrillic alphabet is hard to learn from scratch. You get fluent by actually using a language, and I haven't found anyone in Ilwaco who speaks Ukrainian. We recently visited a Ukrainian grocery in Fife, where I was able to try out, "Thank you," and "You're welcome," with an employee I thought might speak Ukrainian. You should have seen her smile! Learning someone else's language, even if you speak it poorly, is still a big sign of respect in much of the world.
</p>
<p>
<strong>Final thoughts:</strong> Being a physician is one of the greatest privileges in the world. People allow us to touch their bodies, minds, and spirits in ways other careers don't. When we do this work respectfully and put the best interest of the patient first, last, and always, we are compensated in many ways and we are respected in our communities.
</p>
<p>
In a world where others try to reduce us to technicians and pretend we're interchangeable, it's important to remember that medicine is about relationships, professionalism, and service. Others may forget this, but we can't. That's one reason we need each other, in the WSMA and elsewhere.
</p>
<p>
<em>This article was featured in the May/June 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/29/2024 1:48:01 PM | 5/29/2024 1:47:20 PM | 5/29/2024 12:00:00 AM |
| its-time-for-equal-acceptance-of-comlex-and-usmle | It's Time for Equal Acceptance of COMLEX and USMLE | WSMA_Reports | Shared_Content/News/Latest_News/2024/its-time-for-equal-acceptance-of-comlex-and-usmle | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/may-june/heartbeat-website-image-katina-rue-645x425px.png" class="pull-right" alt="Heartbeat: Katina Rue, DO graphic" /></div>
<h5>May 28, 2024</h5>
<h2>It's Time for Equal Acceptance of COMLEX and USMLE</h2>
<p>
By Katina Rue, DO
</p>
<p>
It's been a few years since I was a doctor of osteopathic medicine student, but I still remember the anxiety and stress I felt as I moved through the medical school and residency process. These feelings increased tenfold as I prepared to take the Comprehensive Osteopathic Medical Licensing Examination-the three-level nationally standardized examination for licensure to practice osteopathic medicine.
</p>
<p>
Fast forward to today. As the program director of Trios Health Family Medicine Residency Program in Kennewick, I've noticed a troubling trend among DO residents. To improve their chances of matching, DO students are taking both the COMLEX and the United States Medical Licensing Examination-the equivalent three-step licensure exam for allopathic physicians (MDs). By contrast, their MD colleagues are only taking the USMLE. In fact, more than half (56%) of graduate medical education programs that consider DOs mandate the USMLE-meaning DO students wishing to attend those programs are required to take both exams.
</p>
<p>
As physicians, we all know how significant and exciting the time we spend in both medical school and residency is. It shapes who we become as physicians, the specialties we choose, and the care we ultimately deliver. While we all know how deeply important this experience is, we also know how uniquely challenging, even grueling, it can be. This seminal period in a physician's development should not be additionally burdened with unnecessary challenges.
</p>
<p>
And make no mistake: This is a burden to osteopath students, and the burden isn't limited to the 32 hours of exam time required to take two exams. DO students foot the bill to take both of these exams. The price to complete all three levels of the COMLEX currently stands at $2,340. The price to complete all three levels of the USMLE is $2,265. These figures do not include the cost of travel to the test sites (transportation, lodging, etc.), preparation costs, rescheduling fees, and other factors. Altogether, DO students spend more than $3,000 to take an exam that is not designed for the osteopathic profession or necessary for licensure.
</p>
<p>
Medical school and residency are challenging enough. We don't need to make it harder. Let's remove the additional barriers currently facing our DO students.
</p>
<p>
In 2018, the American Medical Association passed policy to encourage equal acceptance of the COMLEX and the USMLE. I and other physicians working as mentors in residency programs across the state are uniquely positioned to educate our colleagues on the COMLEX and advocate for removing this unnecessary barrier for DO students.
</p>
<p>
We are all acutely aware of the unique physician workforce shortages we face, and DO students are critical to meeting these challenges. In 2023, 55.9% of DO seniors went into primary care. Moreover, 43% of graduating 2021-2022 osteopathic medical students plan to practice in a medically underserved or health shortage area; of those, 40% plan to practice in a rural community. More than 73% of DOs practice in the state where they do residency training, so additional barriers impact rural and primary care access.
</p>
<p>
I encourage you to learn more about your residency program's requirements and advocate for removing duplicative and unnecessary requirements for DO students. Lifting these barriers will enable DOs to more effectively pursue their preferred residency programs and serve the communities that need them most.
</p>
<p>
<em>Katina Rue, DO, FAAFP, FACOFP, is the program director of Trios Health Family Medicine Residency Program in Kennewick and the immediate past president of the WSMA.</em>
</p>
<p>
<em>This article was featured in the May/June 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/28/2024 3:44:46 PM | 5/28/2024 3:17:17 PM | 5/28/2024 12:00:00 AM |
| doctors-making-a-difference-andrea-kalus-md | Doctors Making a Difference: Andrea Kalus, MD | WSMA_Reports | Shared_Content/News/Latest_News/2024/doctors-making-a-difference-andrea-kalus-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/may-june/dmd-website-image-andrea-kalus-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Andrea Kalus MD graphic" /></div>
<h5>May 22, 2024</h5>
<h2>Doctors Making a Difference: Andrea Kalus, MD</h2>
<p>
Andrea Kalus, MD, a dermatologist practicing at UW Medicine, is working to make specialty care more accessible to all Washington patients, in the short term through volunteering with the Seattle King County Clinic, which provides free medical care to anyone who needs it, and long term by advocating for an increase in Medicaid rates in Washington (earlier this year, she participated in a WSMA media briefing on raising Medicaid reimbursements). She talks with WSMA Reports about why specialty care is essential care, and why raising Medicaid rates is a key component of ensuring patients get the specialty care they need.
</p>
<p>
<strong><em>WSMA Reports: </em>There is sometimes a misconception that specialty care isn't as "essential" as primary care. As a dermatologist, why do you see specialty care as essential care?</strong>
</p>
<p>
<em>Dr. Kalus: </em>Before going into dermatology, I trained in internal medicine and practiced in a primary care clinic for a short period of time. Primary care is so important for patients and physicians in primary care can manage a wide and deep number of diagnoses. But when the diagnosis is not clear, or a procedure like a biopsy is needed for diagnosis, or the condition doesn't respond to the usual treatments, patients need access to specialists.
</p>
<p>
Seeing a dermatologist is not simply a luxury. It means having your psoriasis finally get better, treating a blistering skin disease, controlling eczema so a child can sleep and focus on school instead of itching, determining what allergens a hair stylist is reacting to so they can work, and managing autoimmune diseases like lupus to decrease permanent scarring and hair loss. In my experience as a primary care physician, I knew what I could manage and what I needed help with. I really valued the input from specialists when my patients needed it.
</p>
<p>
<strong>How is raising Medicaid rates an essential component of making specialty care more accessible?</strong>
</p>
<p>
Studies show Medicaid rates are a factor that determines access, and addressing this disparity is an issue of equity. Our state has one of the lowest reimbursement rates in our nation! The current reimbursement doesn't cover the cost of care. It's important to understand-this isn't about physician salaries, it's about covering the cost of staff like MAs and RNs, rent, and materials needed for the visit. When these costs are not covered, physicians limit or stop taking patients with Medicaid.
</p>
<p>
This has an echoing impact on the health of people in our state. Our patients can't find care, their condition worsens, it impacts employment; on and on the echo goes. Sadly, the echo eventually fades away and these patients are forgotten.
</p>
<p>
At UW, where I practice, we still take Medicaid insurance and I have patients who are forced to travel across the state to get care. Wait times for dermatology are way up because people have to queue to get care in the few places that still take Medicaid.
</p>
<p>
<strong>Have you faced barriers in your own practice in terms of having to limit Medicaid patients?</strong>
</p>
<p>
Our practice would not be sustainable if we only saw patients with Medicaid since it doesn't cover the cost of care. We have to balance numbers of patients with private and public insurance because the reality is the reimbursement from patients with private insurance is covering the gap in reimbursement for patients with Medicaid. As more and more dermatology practices in our state stop accepting patients with Medicaid, our wait times go up. For physicians, this adds to moral distress when we know we have the skill to help but we can't see patients who need us either because Medicaid doesn't cover the cost of care or the list of patients waiting is insurmountable.
</p>
<p>
<strong>What did your volunteer experience with the Seattle King County Clinic tell you about needing to make specialty care more accessible?</strong>
</p>
<p>
The Seattle King County Clinic is a wonderful project of the Seattle Center Foundation that hosts a four-day clinic each year offering free medical, dental, and vision care. Many of the patients we see have jobs and some insurance but high deductibles, high copays, or lack of access to physicians who will accept their insurance.
</p>
<p>
My work at the free clinic feeds my drive to advocate for better approaches that support patients in our state to get the care they need. The work of the clinic highlights the gaps we have in our state. I hope as the years go by fewer and fewer patients come see us at the SKCC because they can get care when they need it.
</p>
<p>
<em>This article was featured in the May/June 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/22/2024 11:53:43 AM | 5/22/2024 11:40:04 AM | 5/22/2024 12:00:00 AM |
| how-ai-will-reshape-medicine | How AI Will Reshape Medicine | WSMA_Reports | Shared_Content/News/Latest_News/2024/how-ai-will-reshape-medicine | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/may-june/may-june-2024-reports-cover-645x425px.jpg" class="pull-right" alt="cover of March-April 2024 issue of WSMA Reports" /></div>
<h5>May 20, 2024</h5>
<h2>How AI Will Reshape Medicine</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
The heart of medicine is the relationship between physician and patient. So, it's no wonder that the potential impact of artificial intelligence may strike many physicians as unsettling and even a little frightening. The idea that a computer program, no matter how advanced, can take data, analyze it, and produce something that could change the way medicine is practiced is unnerving.
</p>
<p>
"The models are basically algorithms, and we don't know what's in them," says John Scott, MD, an infectious disease physician and chief digital health officer at UW Medicine in Seattle. "We ask a question and get a result, but that middle box is totally opaque to us. It makes a lot of people uncomfortable."
</p>
<p>
But the potential benefits of AI are significant. AI can sort swiftly through massive amounts of data and discover patterns with implications for diagnosis and treatment. Moreover, the technology can assist with some of the administrative tasks eating up physicians' time and contributing to their burnout.
</p>
<p>
The benefits of AI and its inevitability make knowing about the technology a requirement for every practice in the future. "Every physician needs to know about AI," says Dr. Scott. "This isn't a technology you can just avoid and hope will go away."
</p>
<p>
AI is already a part of practically every part of medicine, whether it's acknowledged as such or not. AI has been useful in helping to read images for several years. Many of the most current versions of chatbots rely on AI. The first scientific paper to accurately project the spread of COVID-19 relied upon AI for its predictions.
</p>
<p>
"It's absolutely everywhere," says Teresa Girolami, MD, internal medicine physician in solo practice with BelRed Internal Medicine in Redmond. "I'm following an algorithm by checking a box every time I do an MRI or get a preauthorization."
</p>
<p>
What is different is that the technology has taken a giant leap forward in the past several years. "The latest models are really ready to transform medicine and a lot of things we do in our everyday life," says Dr. Scott. "The big thing that's different is generative AI, models that have been trained on a suite of data but can then predict what can happen in a set of contexts. It's brought up applications in a lot of things a typical physician can do."
</p>
<p>
Even physicians who were originally doubters about the hype around AI have come to embrace its potential once they look at it more closely. "I've reviewed a few use-case scenarios," says Áine Kelly Yore, MD, an emergency medicine physician with North Sound Emergency Medicine in Mill Creek. "I was a skeptic, but now I'm all in for its promise and utility."
</p>
<h3>The hope for improving diagnosis and outcomes</h3>
<p>
Clinically, AI has been in use to some extent for more than five years in radiology. With thousands upon thousands of images to learn from, AI had a treasure trove of data to draw upon to learn to identify abnormal results.
</p>
<p>
"We have used a handful of machine- learning algorithms for four or five years now," says Scott Henneman, MD, a neuroradiologist in charge of clinical informatics at TRA Medical Imaging in Tacoma. The first use of AI was simply assigning location values between scans taken at different times. Because of slight differences between each scan, parts of the anatomy don't precisely correspond from scan to scan, making the process of comparing lesions tedious and time consuming.
</p>
<p>
"Radiologists used to match up everything manually," says Dr. Henneman. "The algorithm matches up everything automatically, so we can quickly see what has changed and what is the same. It was useful right out of the gate."
</p>
<p>
Since then, says Dr. Henneman, TRA has looked into other AI applications. One identifies large vessel occlusions, which by itself is something radiologists can do but which is incredibly helpful in an emergency setting.
</p>
<p>
"Essentially, the algorithm grabs a CT scan of the head, knows the typical distribution of vessels and does a quick analysis," says Dr. Henneman. "It can then alert the entire team."
</p>
<p>
Another algorithm detects head bleeds. Because of the shortage of radiologists, it can take time before images get read. The advantage of the technology is that it immediately flags the possible bleed so that the radiologist sees the exam ahead of the other exams, and the patient can get attention quickly. "The ability to detect isn't greater than ours, but it's incredibly helpful for triage," says Dr. Henneman.
</p>
<p>
Dr. Henneman's experience illustrates how Dr. Yore can see practical applications for her work as an emergency room physician. "AI is good at pattern recognition," she notes. "When I'm looking at a patient and talking to a patient, I'm coming up with a working theory about what is wrong. If it's chest pain, I'm really good at thinking it could be a heart attack or a blood clot."
</p>
<p>
However, if AI had access to a patient's electronic health records, it might recognize something that a physician might not immediately consider. "If AI is getting the same info from the EMR, it could say, based on this medical and family history, you should think about a dissection of the aorta. I see a lot of potential to help in the diagnosis at bedside," says Dr. Yore.
</p>
<p>
Dr. Yore cautions that a lot of AI technology still needs to undergo rigorous testing before it's ready for the market. "If you have a medical diagnosis test that is 99% accurate, we consider that very good," she says. "If an autopilot lands a plane 99% of the time, that's not very good. We need to consider AI applications more like autopilot and less like lab tests. We're not there yet, but we're surprisingly close."
</p>
<p>
Dr. Yore does express some concern that by itself AI still doesn't have enough nuance to understand what is a legitimate concern and what is not. "For example, if a patient comes in with abdominal pain and might have a little twinge in their chest, a computer may say having chest pain opens up a whole new diagnostic tree."
</p>
<p>
Still, for all the advantages that AI has shown, some physicians are still wary. Dr. Henneman notes that the practice did a three-month trial of another algorithm, which had the potential to reduce the noise in scans. "Normally, in an MRI, you are scanning the entire body part of interest at the same time," he says. "You get a ton of noise and not much info. You have to scan and scan until you get more and more of a signal." The algorithm used statistical inference to get rid of typical noise artifacts, reducing the amount of scanning time by half.
</p>
<p>
However, uncertainty among some radiologists about just what was behind the algorithm has resulted in the technology not being adopted. "These types of algorithms are a black box," says Dr. Henneman. "The radiologists thought the picture looked pretty good, but because of this black box they were concerned that maybe it was erasing lesions." In fact, says Dr. Henneman, a check of the images showed that the AI images hadn't erased any lesions.
</p>
<p>
While he understands those concerns, he believes that the speed of adoption of AI will eventually overcome them. At conferences he attends, the volume of AI technology is exploding, citing potential uses for pulmonary emboli and triaging collapsed lungs. "The space is large and they are working on so many things."
</p>
<h3>Relieving time-consuming tasks</h3>
<p>
Where many physicians may see AI first is where they most need relief. "I'm seeing its first-use case has to do with a lot of administrative tasks," says Dr. Scott. "A lot of tasks we do are slow and not a good use of our time. A lot of physicians want to get away from the computer and get back to taking care of patients. The first couple of use cases are trying to address physician burnout and reduce the administrative burden we're facing right now."
</p>
<p>
In fact, some systems are employing AI to take on these tasks. "There are large academic health systems that are already using AI to respond to portal messages and to help write their notes," says Dr. Scott.
</p>
<p>
For physicians, one of the most promising AI models is a scribe. "If I have a 10-minute conversation with a patient, I have to write that down right away," says Dr. Yore. "If you match an AI with a voice recognition system, AI can listen to the conversation and distill it into a reasonable history."
</p>
<p>
Dr. Yore says that the technology is evolving so rapidly that before last year she would have predicted it was at least five years away from the market. Now she believes it will be ready within a year. "I've seen the work in prototype," she says. "It seems like magic."
</p>
<p>
There are other ways AI can help with office work. Even with an electronic health record, it can take physicians a while to find what they want. AI could help streamline that process. "One thing AI seems pretty good at is summarizing and distilling a large corpus of material," says Dr. Yore. "If I have a patient coming in, and I ask for echo results and history, AI could spit out a nice narrative. That's incredible. From my perspective of taking care of patients I don't know, the ability to provide me with relevant information almost instantly is amazing."
</p>
<p>
Dr. Henneman says TRA has been using AI to help radiology reports for more than two years now. The reports generally have two sections, one for the findings, and another called the impressions, which is the summary or actions for the patient's physician. "The impression contains no new information," says Dr. Henneman. "It's just a recategorization of some of the important information in the findings." AI can look at the findings and generate an impression on that basis. "For a complicated exam with lots of findings, it's not just used for time savings but to make sure you don't miss anything," he says. "It's very popular among radiologists using it."
</p>
<p>
Even a task as mundane as a job posting can be made easier with the help of AI. Dr. Girolami used ChatGPT to help write an ad for a nurse practitioner. "It was surprisingly good," she says.
</p>
<h3>Complicated questions</h3>
<p>
Even as physicians grapple with how AI may change the way they practice, health plans are already making use of the technology. Not all the uses may be beneficial for physicians or their patients, who are already used to rising cases of prior authorizations and rejections.
</p>
<p>
Multiple lawsuits have been filed against health plans, including UnitedHealthcare, Cigna, and Humana, alleging that AI was used to deny coverage for necessary treatment. In general, the lawsuits allege that AI allows the plans to eliminate the need for physicians to make a determination about the claim, relying instead on algorithms that determine what a patient meeting a similar profile would need. The issue of denied claims was concerning enough for the Centers for Medicare and Medicaid Services to issue guidelines in February saying that health plans cannot rely solely on AI when denying claims for Medicare Advantage patients.
</p>
<p>
When it comes to implementing AI, "the insurance companies are already ahead of physicians," says Dr. Scott. "They're going to have better models because they have more money." The lack of transparency in the algorithms is concerning for many physicians, particularly in cases like these when AI is used by insurers for determinations.
</p>
<p>
The problem of how other stakeholders in health care may use AI is just one concern. Another worry is the possibility of bias in AI itself. The problem of bias, no matter how unconscious its origin, could be exponentially worse in a technology whose premise is to extract patterns from large amounts of data.
</p>
<p>
"If you have biased information going into your model, you are going to get magnified bias in the results," says Dr. Scott. "That has the potential to worsen health inequities."
</p>
<p>
"We already have tons of data on how implicit biases by physicians can leave people of color with pain poorly managed or missed diagnoses," says Dr. Yore. "When you take a large model that's been fed biases, you don't know how that will impact patients."
</p>
<p>
It's not just physicians who are worried about bias. Dr. Girolami has connections with one large firm at the cutting edge of AI technology, and even AI architects worry about how bias may affect how AI interprets data. "There is inherent bias in AI," says Dr. Girolami. "As much as you try to screen it out, you can never really do so. Some little hint of it will be there because there are humans behind the algorithms."
</p>
<p>
Dr. Scott notes other potential pitfalls around AI, including patient privacy. Models may want to use patient identifiable information, which Dr. Scott says should be discouraged. Dr. Scott says that patients are rightly going to be concerned about how AI is going to be used. "We need to be very transparent about how their information is going to be used and not used," he says.
</p>
<p>
There's also an issue of intellectual property. Data is valuable, and controlling the data could be lucrative. "That's one of the big ethical questions in medicine," says Dr. Scott. "They really need a massive amount of data. I don't think we've really decided as a society and as a medical community who owns the data. There needs to be a very considered response to that question."
</p>
<p>
To consider some of these thorny issues, as well as the upsides of AI, the WSMA formed an AI work group in January. (Dr. Scott, Dr. Girolami, and Dr. Yore are members of the work group.) The group's goal is to review and update WSMA's existing principles on AI and provide expert perspective on AI-related issues. Among the issues the work group will help with are ensuring nondiscriminatory use of AI in medicine and counseling WSMA staff and leadership on issues under consideration by the Legislature.
</p>
<p>
"One of the hopes of this work group is that we can educate all the physicians in the state about the use cases and the pitfalls so that they can practice in the 21st Century and have a better quality of life doing so," says Dr. Scott.
</p>
<h3>Physicians in the driver's seat</h3>
<p>
Ultimately, as helpful as AI may be, it will still require physicians to oversee the final product.
</p>
<p>
"The analogy I use is semiautomated cars," says Dr. Scott. "You're still going to have to be behind the steering wheel and pay attention. You're still going to have to review the note that goes out to the patient before it's finalized. But it's going to take away 80 to 90% of the time you spend on it."
</p>
<p>
Just as importantly, AI will never change the fundamental relationship at the heart of medicine: the relationship between patient and physician.
</p>
<p>
"Who really makes the decisions here?" says Dr. Girolami. "It's not going to be ChatGPT. It should be the physician and patient together."
</p>
<p>
If anything, the skill and humanity of a physician simply can't be duplicated by technology.
</p>
<p>
"It's going to be really hard to remove the human element to understand the context and vocal cues that might escape a computer," Dr. Girolami says. "You can read a person in a way that a computer is not able to. AI will never be able to supply your uncanny sense of what you think you should do next or the compassion required for healing."
</p>
<p>
"There is a place for AI," continues Dr. Girolami, "but you can never substitute for the experience of physicians." She knows that from firsthand experience. She was at a party with a group of AI architects when she suddenly needed to perform the Heimlich maneuver on a guest who was choking. After successfully doing so on the first try, Dr. Girolami thought to herself, "Let's see AI do that."
</p>
<p>
<em>John Gallagher is a freelancer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the May/June 2024 issue of WSMA Reports, WSMA's print magazine</em>
</p>
</div> | 5/20/2024 2:54:10 PM | 5/20/2024 2:53:30 PM | 5/20/2024 12:00:00 AM |
| responding-to-a-subpoena-for-medical-records-or-deposition | Responding to a Subpoena for Medical Records or Deposition | WSMA_Reports | Shared_Content/News/Latest_News/2024/responding-to-a-subpoena-for-medical-records-or-deposition | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/march-april/march-april-2024-reports-cover-645x425px.jpg" class="pull-right" alt="cover of March/April 2024 issue of WSMA Reports" /></div>
<h5>April 16, 2024</h5>
<h2>Responding to a Subpoena for Medical Records or Deposition</h2>
<p>
By Anne Flitcroft, RN
</p>
<p>
Physicians, practices, and medical groups frequently ask for advice about subpoenas and court orders requesting disclosure of protected health information in the form of medical records or through deposition testimony. The following information is designed to clarify areas of confusion regarding the subpoena process. Any recommendations in this article are for educational purposes only and not intended to be followed in all cases and are not medical or legal advice.
</p>
<h3>Subpoena and subpoena duces tecums</h3>
<p>
A subpoena is a formal process by which a party involved in litigation can compel testimony from a witness or the production of specific documents, medical records, books, papers, or other items relevant to the matter at issue.
</p>
<p>
There are two types of subpoenas: a subpoena and a subpoena duces tecum. A subpoena is a command to personally appear at a certain time and place to provide testimony, either in court or at deposition. A subpoena duces tecum (Latin for "bring with under penalty of punishment") is a type of subpoena compelling the production of specific medical records, books, articles, or other tangible things by a specific date.
</p>
<p>
Both types of subpoenas are a formal command and they should never be ignored. Failure to comply with the terms of a properly issued subpoena may result in a contempt-of-court citation and monetary fines, imprisonment, or other sanctions. It is important that you respond to any subpoena in a timely fashion.
</p>
<p>
It is standard procedure for a subpoena duces tecum to state that the records custodian is to appear at a certain time and place with records in hand to complete a records deposition. When your intent is to simply respond to a properly issued subpoena by mailing the records, make certain that you notify the attorney's office well in advance of the records deposition date so that the requesting party does not expect and plan for your personal appearance.
</p>
<h3>Subpoenas and court orders</h3>
<p>
There is a common misperception that only a judge can issue a subpoena. In fact, a subpoena may be issued by a court, an attorney of record, or a governmental agency, such as the Department of Health or the Department of Labor &amp; Industries. The HIPAA requirements for disclosure of PHI in the course of a judicial or administrative proceeding differ depending on whether the disclosure is requested pursuant to a (1) court order, or (2) a subpoena or discovery request. A court order is a subpoena or other order of a court or administrative tribunal signed by a judge or magistrate.
</p>
<p>
Most requests for PHI that practices and medical groups receive are subpoenas signed by attorneys (not court orders), which means that specific criteria must be met before releasing the PHI requested in the subpoena. These criteria can include providing a valid written authorization, proof of notice to the patient and/or a protective order. If you are uncertain regarding the production of PHI in response to a subpoena or court order, please contact your carrier for assistance.
</p>
<h3>Charging copy fees</h3>
<p>
You are entitled to charge the allowable copy fees as you would with any other request for records. HIPAA permits charging a reasonable, cost-based fee for copies and for summaries and explanations of the record. The fee may include only labor costs for copying PHI, not any cost of retrieval, plus costs of supplies for paper copies or electronic media if requested, such as flash drives and compact discs, plus postage costs if the practice or medical group is requested to provide the copy through the mail or by courier. The requesting party must agree in advance to any fee for explanations or summaries of the record. Maintenance and capital costs may not be included in the fees charged.
</p>
<p>
Note that the allowable copy fees and charges for producing the copies may be further limited by state law, so we recommend that you consult legal counsel to determine whether any state law limits apply to you.
</p>
<h3>Subpoenas in criminal vs. civil matters</h3>
<p>
State law often specifies an advance notice requirement that requires attorneys requesting disclosure of PHI pursuant to a subpoena in a civil matter to provide advance notice to the physician and the individual whose PHI is requested (or the individual's attorney) that the subpoena request is forthcoming, with the purpose of allowing the individual or physician an opportunity to seek a protective order from the court to prevent the disclosure from taking place.
</p>
<p>
However, in a criminal case there is no such advance notice requirement. In a criminal case, your records or testimony may be subject to subpoena on very short notice without any advance notification. It is important that you notify our office (or your medical professional liability carrier, if you are not insured by Physicians Insurance) immediately if you are served a subpoena in a criminal matter so that, if necessary, we can assist in a timely fashion on your behalf.
</p>
<h3>Subpoenas for deposition testimony</h3>
<p>
If you receive a subpoena for deposition testimony, it is important that you contact your medical malpractice carrier to discuss the underlying matter and obtain tips on safeguarding your interests. It is very common for a treating physician or clinician to be subpoenaed for testimony as a fact witness when the patient is involved in an underlying personal injury case. Generally, this type of testimony should cause you little concern and does not require representation by counsel.
</p>
<p>
However, the potential always exists for unexpected surprises during questioning. If at any time during the deposition you become uncomfortable or alarmed with the nature of the questioning, we recommend that, while still on the record, you make a request to discontinue the deposition and indicate that it is your desire to seek advice of legal counsel before proceeding further.
</p>
<p>
If you receive a subpoena for deposition testimony and you are concerned or unsure about the purpose for the deposition, contact your carrier to determine whether assignment of counsel for deposition representation is necessary.
</p>
<h3>Out-of-state subpoenas</h3>
<p>
Carefully examine any subpoenas you receive. If the subpoena is from a court in another state, it is likely not valid in your state.
</p>
<p>
Never hesitate to contact your medical malpractice insurer if you have questions about subpoenas or any other medical liability issue that causes you concern.
</p>
<p>
<em>Anne Flitcroft, RN, BSN, is associate vice president of risk management at Physicians Insurance.</em>
</p>
<p>
<em>This article was featured in the March/April 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 4/16/2024 10:22:40 AM | 4/16/2024 10:18:26 AM | 4/16/2024 12:00:00 AM |
| why-should-a-doctor-care-about-trains | Why Should a Doctor Care About Trains? | WSMA_Reports | Shared_Content/News/Latest_News/2024/why-should-a-doctor-care-about-trains | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/march-april/heartbeat-website-image-lebegue-645x425px.png" class="pull-right" alt="Heartbeat: Breck Lebegue, MD graphic" /></div>
<h5>April 10, 2024</h5>
<h2>Why Should a Doctor Care About Trains?</h2>
<p>
By Breck Lebegue, MD
</p>
<p>
While driving in heavy traffic from Tri-Cities to Seattle recently, I wondered, "Who are these people, and why are they all going west?" It turns out that some of you reading this who practice along that route sent some of those people to see some others of you who practice in Seattle for specialty care.
</p>
<p>
Before we look at how our common transportation routes evolved, some facts: Transport is the main contributor to air pollution in our state, especially along I-5, but also along I-82 and I-90. We know that contributes to heart and lung disease. By law, Washington requires fewer vehicle miles traveled to reduce greenhouse gases and PM2.5 (fine particulate matter). Even diesel trains are much better for environmental health than planes or cars. Trains use only a third of the fuel and create only a third of the pollution as cars and trucks. Diesel or electric trains are the main travel mode in most of the world and were in the U.S., as well, prior to our costly freeway system. Short-distance plane flights, such as from Seattle to Portland or Spokane, are the worst carbon transport offenders.
</p>
<p>
A map of the train system in Washington shows Amtrak Cascades running north-south. The Empire Builder from Chicago splits at Spokane, half to Seattle and half to Portland. The line through Central Washington is the former Hiawatha, which ran until 1981, when personal preference for cars on I-82 and I-90 drove it bankrupt. But freeways are busy, and travel over Snoqualmie Pass in winter is dangerous and often blocked by wrecks.
</p>
<p>
"How's that related to medicine?" we asked. Pacific Northwest University of Health Sciences College of Osteopathic Medicine, with support from the WSMA, the Washington Physicians for Social Responsibility, and All Aboard Washington, conducted a survey of physicians along the route, asking how patients get to specialty care not available close to home. Response rate was low, but the results are striking. About a third of referrals go to Seattle over Snoqualmie Pass, except in winter. Another third go to Yakima, 20% to Tri-Cities, and less than 10% to Spokane. Almost 90% go by car. None use an intercity bus. As for a minimum service schedule, 72% said a daily morning departure and evening return are needed, 11% said a few times per week was sufficient, and 11% said trains would not help their patients access specialty care. Only 28% said they had personal experience with light or commuter rail. None had used trains.
</p>
<p>
Finally, we asked for patient stories. Not surprisingly, Snoqualmie Pass in winter was a significant barrier to accessing specialty care in Seattle, especially for the elderly and the poor. They missed appointments for cancer evaluations, high-risk prenatal care, and eye care, leading to poor outcomes and loss of function.
</p>
<p>
Bottom line: Lack of frequent reliable transport from Central Washington to Seattle is harming patients.
</p>
<p>
What can you do? The Federal Railroad Administration and the Washington State Department of Transportation are evaluating the need for intercity rail service in our state, especially where passenger trains used to run. BNSF Railway still runs freight trains on that route over Stampede Pass, so the rails are there and available. A daily passenger train from Pasco to Seattle could help Central Washington patients get the care they need and cut vehicle miles traveled and the pollution that's a contributing factor to heart and lung disease. Tell your legislator to fund a benefit- cost analysis of restoring the Hiawatha line.
</p>
<p>
<em>Breck Lebegue, MD, MPH, is a retired physician with the Washington Physicians for Social Responsibility. He lives in Steilacoom.</em>
</p>
<p>
<em>This article was featured in the March/April 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 4/10/2024 12:59:39 PM | 4/10/2024 12:57:17 PM | 4/10/2024 12:00:00 AM |
| member-spotlight-elizabeth-liz-brallier-md | Member Spotlight: Elizabeth (Liz) Brallier, MD | WSMA_Reports | Shared_Content/News/Latest_News/2024/member-spotlight-elizabeth-liz-brallier-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/march-april/member-spotlight-website-image-brallier-645x425px.png" class="pull-right" alt="WSMA Member Spotlight: Elizabeth Brallier, MD" /></div>
<h5>April 9, 2024</h5>
<h2>Member Spotlight: Elizabeth (Liz) Brallier, MD</h2>
<p>
<strong>Works at: </strong>Trios Family Medicine Residency, Tri-Cities.
</p>
<p>
<strong>How long in practice:</strong> Two years.
</p>
<p>
<strong>Specialty:</strong> Family medicine.
</p>
<p>
<strong>Why WSMA: </strong>I am a recent addition to the WSMA family, joining just over a year ago. I was interested in the organization for many reasons, including the opportunities it provides in advocacy and policy reform, but have since delighted in discovering the additional resources available through membership. I'm excited about the chance for collaboration among peers from every profession, the new career networking groups, and the inspiration I get from attending events such as the Leadership Development Conference.
</p>
<p>
<strong>Why my specialty:</strong> I'm drawn to family medicine because I love the continuity of care: the ability to manage patients and their families across a life span. In a typical day, it's not unusual for me to perform a newborn exam before turning around to do a gynecology procedure, address an addiction medicine need, and finish the day with a palliative care conversation with a family. I also work in-patient in our local hospital, where I see my own patients or attend on the family medicine service. There's never a dull day, and the diversity keeps me passionate about the job.
</p>
<p>
<strong>Why academic medicine:</strong> I always knew I wanted to be a part of shaping the next generation of physicians through teaching. I have found that training new physicians grows our profession as we help our newest doctors discover their passions and perform to the best of their abilities. Selfishly, nothing helps you learn material like teaching it. The residents and students I work with challenge me daily, forcing me to stay up to date. By training residents to the best of my ability I can make sure they have the tools to best care for their patients for the entirety of their careers.
</p>
<p>
<strong>Best advice I've received: </strong>"Stop standing in the way of your own light." Like many trainees, I suffered from imposter syndrome along with the accompanying anxiety. One of my supervisors encouraged me to get out of my own way, nudging me to devote more of my brain space to the medicine instead of self-chastisement. It was invaluable advice that follows me to this day.
</p>
<p>
<strong>In my spare time:</strong> When not at work I enjoy spending time with my husband and adventurous husky. We are outdoor enthusiasts who love running, biking, backpacking, scuba diving, skiing, you name it! When indoors, I'm an avid video gamer who used to compete nationally before scaling back for medical school. I'm also excited to note that our family is about to expand as we prepare for the addition of our first child, a baby boy due in June.
</p>
<p>
<strong>What people might not know about me:</strong> I find it hard to do things halfway. When I started running I went from zero distance to completing my first ultramarathon in 15 months, a fact that would make any sports medicine or orthopedic doc cringe.
</p>
<p>
<strong>If I weren't a doctor, I'd be:</strong> A coral reef ecologist or yoga instructor.
</p>
<p>
<em>This article was featured in the March/April 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 4/9/2024 4:25:13 PM | 4/9/2024 4:13:39 PM | 4/9/2024 12:00:00 AM |
| doctors-making-a-difference-gautam-nayak-md | Doctors Making a Difference: Gautam Nayak, MD | WSMA_Reports | Shared_Content/News/Latest_News/2024/doctors-making-a-difference-gautam-nayak-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/march-april/dmd-website-image-nayak-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Gautam Nayak, MD logo" /></div>
<h5>April 8, 2024</h5>
<h2>Doctors Making a Difference: Gautam Nayak, MD</h2>
<p>
A cardiologist practicing at Confluence Health in Wenatchee, Gautam Nayak, MD, is working to change how physicians connect and collaborate on patient care. Dr. Nayak created Coltrain, a mobile app that allows physicians to easily communicate electronically with each other regardless of which electronic medical record system they're using. He talked to <em>WSMA Reports</em> about how Coltrain is enhancing digital connectivity among physicians.
</p>
<p>
<strong><em>WSMA Reports:</em> Can you tell WSMA members about Coltrain and what it does?</strong>
</p>
<p>
<em>Dr. Nayak:</em> Coltrain is a free, simple, HIPAA-compliant mobile app. Any clinician in any location or system can use Coltrain to connect with colleagues for case-based discussions. Coltrain is as easy as text messaging, with more functionality and a focus on clinical care.
</p>
<p>
<strong>What spurred you to create Coltrain?</strong>
</p>
<p>
For many years, it has been nearly impossible to effectively communicate with my colleagues here in rural Washington. We have 13 smaller hospitals and countless community clinics that send patients to Wenatchee, and none of them are connected or use the same EMR. Even within our own system, getting care teams on the same page quickly is a challenge since we still rely on pagers, fax machines, and scanners. As a cardiologist, getting information quickly is critical, and I'm often multitasking and can't wait for a fax. After a patient died as a direct result of my inability to quickly connect with an ER doctor in a remote small town, I decided to invest my own resources and time to solve this problem.
</p>
<p>
<strong>What has been the response from physician users?</strong>
</p>
<p>
We have nearly 800 clinicians currently on Coltrain, and the response has been great. My colleagues love the convenience, organization, and time savings Coltrain affords. For example, if I am communicating with a hospitalist about a complex inpatient, we can add in the nephrologist to the case and she can see everything we've discussed without redundancy or confusion. That small step is impactful, saving me 10-15 minutes, and can't be done with any other health care tool. Since Coltrain was developed by physicians, we recognize the barriers physicians face daily.
</p>
<p>
<strong>Are there specific advantages for physicians in rural areas?</strong>
</p>
<p>
Coltrain is purpose-built for all physicians, but rural physicians benefit significantly. In Washington, patient care traverses many health care systems and large geographies. Since we aren't formally connected, Coltrain provides an infrastructure for clinicians in smaller hospitals and clinics to quickly connect with colleagues in larger systems in which they might share patients.
</p>
<p>
Many colleagues in Seattle and Spokane are on Coltrain, and this ensures our patients in rural Washington have access to the same care as those living in larger cities, and when needed, gets them to life-saving care more efficiently. Simply reducing barriers to effective collaboration makes a big difference.
</p>
<p>
<strong>How do better-connected EMRs translate to better care for patients?</strong>
</p>
<p>
There is no question that better- connected systems are better for patients given the importance of rapid information exchange in patient care. EMRs are not well-connected, even if one system is on the same EMR as another system. We've given legacy EMR systems decades to figure out interconnectivity, but it's a complex problem and a viable solution has yet to materialize.
</p>
<p>
Rural health care systems are hurting, with no financial margins, and most likely, any EMR-driven solution will be expensive and trickle down to us in rural Washington last. With Coltrain, we don't need to wait. We can simply connect and do the right thing for ourselves and our patients with a tool that is free, HIPAA-compliant, and has leapfrogged legacy EMR systems in terms of connectivity.
</p>
<p>
<strong>What are your goals for the future of Coltrain?</strong>
</p>
<p>
We are currently leveraging Coltrain to form the Washington Cardiogenic Shock Network, the first statewide shock network in the country. This impacts every community and hospital in the state and can be a model for other disease- specific networks.
</p>
<p>
We want to empower all physicians to innovate and be the HIPAA-compliant infrastructure to enable that innovation. The first step is for all physicians in Washington to get on Coltrain and try it with your local colleagues. The clinical community in Washington is like no other in the country, and we are lucky to have each other to deliver incredible care to our region. Coltrain embodies this ethos by connecting us all, reducing care disparities, and helping physicians in every part of the state.
</p>
<p>
<em>This article was featured in the March/April 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 4/8/2024 3:56:39 PM | 4/8/2024 3:41:35 PM | 4/8/2024 12:00:00 AM |
| when-disruptive-innovation-is-technocratic-arrogance | When Disruptive Innovation Is Technocratic Arrogance | WSMA_Reports | Shared_Content/News/Latest_News/2024/when-disruptive-innovation-is-technocratic-arrogance | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/march-april/march-april-2024-reports-cover-645x425px.jpg" class="pull-right" alt="cover of March-April 2024 issue of WSMA Reports" /></div>
<h5>April 3, 2024</h5>
<h2>When Disruptive Innovation Is Technocratic Arrogance</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
As a social scientist and futurist, Jeff Goldsmith, PhD, has spent decades looking at the changes in the health care system. The president of Health Futures Inc. and the keynote speaker at WSMA's 2024 Leadership Development Conference, Goldsmith has thought a lot about "disruption." And when it comes to disruption in health care, Goldsmith is no fan of the concept. What disruption has wrought on the health care system too often more closely resembles destruction, with the loss of high-quality institutions, leaving doctors discouraged and their contributions discounted. "Disruption is simply disruption," says Goldsmith. In a 2022 article on The Health Care Blog, he declared that "it has reached its 'sell-by' date … when it comes to health care, it is now doing more harm than good." The result is that physicians have suffered tremendous harm, both professionally and personally.
</p>
<p>
"I'm with physicians," Goldsmith says. "They have been disrespected. The quality of their contributions to our lives has been massively underestimated."
</p>
<p>
Goldsmith's opinions are backed by more than four decades of experience. He was a lecturer on health services management and policy in the Graduate School of Business at the University of Chicago. He served as National Advisor for Health Care both for Ernst and Young and for Navigant, providing strategy consultation to a wide variety of health care systems and plans. He also served as director of planning and government affairs at the University of Chicago Medical Center and special assistant to the dean of the Pritzker School of Medicine.
</p>
<p>
The concept of disruption, outlined in 1997 by Harvard Business School professor Clayton Christiansen in his book "Innovators Dilemma," became the cornerstone for business strategy, as a way of coping with technological change. The idea was adapted from Joseph Schumpeter's idea of "creative destruction," a core phenomenon in competitive markets.
</p>
<p>
But the impact of disruption on the health care system from such forces as consolidation and wealthy new entrants has often been destructive. "In health care, we've seen a tremendous amount of churn," Goldsmith says. "We've seen some really valuable, high- quality institutions destroyed in that churn. I'd make a strong argument that the destruction of those high-quality groups isn't progress at all. It's not a good net gain for society that we lose these places."
</p>
<p>
At the same time, a number of players with a connection to health care have undertaken their own efforts to change the system, or at least their position in it. "When this meme of the disruptor- Walmart, Amazon, CVS, Walgreens- surfaced, I had a very different view of whether they were going to have a positive impact on our payer system and our health care system," says Goldsmith. "I think the subsequent decade of floundering by those organizations has been a validation" of that view.
</p>
<p>
From Goldsmith's perspective, the main mistake that would-be disruptors have made was believing that the health care system was like any other industry. They were bringing Silicon Valley thinking to health care, thinking that it would apply equally as well.
</p>
<p>
"Making semiconductors is pretty darn complicated but it's basically an engineering feat," he says. As a baby boomer, Goldsmith recalls getting a transistor radio that had six transistors powering it. By contrast, today's iPhone has 15.8 billion transistors. "That's 50 years' worth of incremental engineering progress," he marvels.
</p>
<p>
But even that technological advance cannot remotely compare to the complexity of medical practice.
</p>
<p>
"Medicine is more complicated than semiconductor electronics," Goldsmith says. "It's more highly variable. That's a human component to it that is not present in the semiconductor world. The need to communicate with and listen to the patient, see the patient in the family and community context, look at the results of diagnostic work and figure out what's going on with the patient-that's damned complicated. It's the most complex thing we do in our economy. It's more complicated than making a computer chip with 15.8 billion transistors."
</p>
<p>
Yet disruptors insist on bringing an almost engineering-like approach to health care. "What bugs me about the Silicon Valley types is that they have consistently and grossly underestimated the complexity of medicine and what the doctor does every day," says Goldsmith. "To reduce to algorithms and you have the answer-come on. These folks haven't gotten sick yet. They have no idea what it's like to have cancer and how scary and uncertain it is."
</p>
<p>
"It's not clear to me that it was the absence of capital that is holding physicians back today or the absence of a really great web interface," he says. "Rather, it's the increasing complexity of medical practice imposed on physicians by a technocratic policy community and gigantic megapayers like UnitedHealthcare and Elevance."
</p>
<p>
A prime example of what Goldsmith terms "technocratic arrogance" is the electronic health record. (Goldsmith once served on the board of Cerner.) "The systems that we have tried to insert into the physicians' world have not made medical practice easier," he says. "They've made it more complicated. Technology has given leverage to corporate actors with an agenda. We now have machine intelligence and AI combing through all of the data with the not-so-hidden agenda of paying a whole lot less for care. It allows them to meter the doctor."
</p>
<p>
If anything, Washington and the western states have suffered more as a result of the overall trends in health care because of how successful they have been in the past.
</p>
<p>
"I don't think there is any more brutally competitive medical marketplace in the country than the Pacific coast," says Goldsmith, who grew up in Oregon. At the same time, he says, it has also been the center of some of the greatest innovation in health care. "You have a longer history of managed care, a longer history of complex collaboration among doctors and between doctors and institutions," he says.
</p>
<p>
The upshot has been a more efficient system, which makes the current trends all the more painful. "As a consequence [of the history] there's less waste," Goldsmith notes. "There's less pointless utilization of medical care in these communities than in any place else in the country. The opportunities for easy savings are considerably less impressive in Washington, California, or Oregon. You have this meme that 30% of medical care is unnecessary, but not in Washington."
</p>
<p>
Goldsmith says that Washington was fortunate to have a lot of institutions that valued high-quality care-Group Health, Virginia Mason, Everett Clinic, UW. "There is a culture of medical practice that was different than most of the rest of the country," he says. "It wasn't because of incentives. It was because of their value systems." Unfortunately, Goldsmith believes that culture is rapidly fading as consolidation leads to the absorption of these practices into huge health care systems.
</p>
<p>
Despite the bleak outlook, Goldsmith says that physicians are not powerless. "Physicians have tremendous power, whether they use it or not," he says. "It's inherent in their relationship to us patients. The fact is that they are with us at our birth, at our death, and they help us to the very best of their ability. Many physicians have bought into the narrative that they can't do anything about [their situation], and that's not right." Goldsmith believes that the upcoming shortage of clinicians offers an opportunity for physicians to make more demands on the system.
</p>
<p>
Ultimately, says Goldsmith, the heart of medicine is not an industry. It's the physician-patient relationship. "The idea that you acquire a physician practice in order to increase the number of orders to your website or prescriptions to your drugstore I find both repugnant and difficult to accept," he argues. "The interaction between the doctor and patient is the most complex and important thing we do in our health care system. It's not something you acquire and manipulate to influence your market position."
</p>
<p>
<em>John Gallagher is a freelancer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the March/April 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 4/4/2024 9:33:34 AM | 4/4/2024 9:32:59 AM | 4/3/2024 12:00:00 AM |
| drug-shortages-and-the-impact-on-patient-care | Drug Shortages and the Impact on Patient Care | WSMA_Reports | Shared_Content/News/Latest_News/2024/drug-shortages-and-the-impact-on-patient-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2024/march-april/march-april-2024-reports-cover-645x425px.jpg" class="pull-right" alt="cover of March-April 2024 issue of WSMA Reports" /></div>
<h5>April 2, 2024</h5>
<h2>Drug Shortages and the Impact on Patient Care</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
For two weeks last fall, Blair Irwin, MD, an oncologist at MultiCare Regional Cancer Center in Tacoma, had to put a hold on any new patient starts of vinblastine, a key drug for Hodgkin's lymphoma and commonly used for pediatric sarcomas and bladder, testicular, and non-small cell lung cancer. The reason: The chemotherapy agent had been added to a growing list of drug shortages nationwide. "At any given time, we have 10 to 20 patients receiving vinblastine," says Dr. Irwin. While she's now able to start new patients on the medication, getting there hasn't been easy, often requiring transferring supply within MultiCare's system and maintaining a careful daily inventory.</p>
<p>
"It's a constant guessing game of making sure that we can treat our existing patients and consider each new patient," says Dr. Irwin. "We're spending a significant amount of manpower every day hunting down any supplier that might have a few vials of vinblastine to give us. In a time of labor shortages and with health care systems struggling to control expenses, it's hard to dedicate so much staff to hunting down drugs. We're doing it for our patients and sometimes we're having to make hard choices, such as delayed starts."
</p>
<h3>Scope of the problem</h3>
<p>
From cancer treatment to surgical procedures to condition management and pain relief, drugs play a critical role in patient care. Yet, the last several years have seen a startling increase in the depth, breadth, and duration of drug shortages. As of this writing, the U.S. Food and Drug Administration's online drug shortages database lists 125 drugs, including anesthetics, cancer medications, and benzathine penicillin G/Bicillin L-A (the only treatment for syphilis in pregnancy), in short supply.
</p>
<p>
"I've been the medical director for about eight years, and 2023 had the worst supply shortages that we've seen in cancer care," says Dr. Irwin, who, like other physicians and health care teams, worries her patients may not be able to get critical, lifesaving medication.
</p>
<p>
Members of the health care community are doing everything they can in response to these shortages, such as not mixing chemo drugs until patient arrivals, securing supplies from other institutions, and, like the MultiCare cancer center, dedicating more people and extra hours contacting manufacturers and suppliers.
</p>
<p>
In some cases, physicians must prioritize treatments or recommend alternative treatments. This can be devastating for patients to hear, particularly if their treatment is delayed or unavailable. When other options aren't available or when the second-line treatment is less effective, there's real concern over patient harm. Impacts can be worse in rural areas where fewer resources are available, resulting in patients commuting long distances for necessary care.
</p>
<p>
While Dr. Irwin says treatment plan adjustments have not resulted in patient harm in terms of cancer outcomes, it may result in other harms. "I think the stress associated with knowing that the drug you want may be in short supply is hard on patients," she says. "It's also harmful on the physician, in this era of burnout. We've been trained to give what we think is the best regimen. We want to do the best by our patients and when the supply is short, especially in a disease like cancer where this is life and death, it's really frustrating not being able to offer that care."
</p>
<h3>How we got here</h3>
<p>
"Supply chain issues" is the catch- all phrase to explain drug shortages. Depending on the drug, however, a shortage may occur because of shipping delays, increased demand, a halt in manufacturing, quality control issues, or discontinuation of drug production by manufacturers. Low-profit drugs, such as antibiotics and generics, typically offer little financial incentive for manufacturers to produce more product quickly, if at
all, to relieve shortages.
</p>
<p>
"Some of these shortages blend from the pandemic and national supply chain issues. Some of it is situational. But a lot of it is not," says WSMA President-elect John Bramhall, MD, PhD, a professor at the University of Washington and associate medical director of Harborview Medical Center in Seattle. "A lot of it has to do with reorganizations of drug companies, intermediaries, the pharmacy benefit groups, and what have you in bulk buying groups."
</p>
<p>
In his work as an anesthesiologist at Harborview's busy trauma center, Dr. Bramhall has navigated numerous drug shortages over the last few years. Current medications that have been difficult for his team to access include ketamine, opioids such as alfentanil, and barbiturates like methohexital.
</p>
<p>
"For us the threat of drug shortages is a steady background to our work," says Dr. Bramhall. "Having worked in the ORs here for 30 years, I have never known a time when we were unable to provide safe anesthesia for surgery. But there have been many instances when specific medications that would have been the optimal choice have been unavailable and we have had to 'work around' the situation. Part of our strategy for dealing with the effects of long, tenuous supply chains is simply to have an adequate local stock of vital drugs that are in constant use."
</p>
<p>
Exacerbating drug shortages, says Dr. Bramhall, is the fiscal reliance on just-in-time supply purchasing in health care. "Gone are the days when hospitals would have a large store of medications and fluids in inventory. The tendency now is to keep inventory tight … And when you get a supply chain disruption- it may be from political or natural causes or a commercial decision-that disruption wrinkles through the system very quickly as a result. What we have intermittently and regularly are changes in the immediate availability of medications we use," he says.
</p>
<p>
Another major concern that's often overlooked is switching from a commonly used, but unavailable, drug formulation to a different formulation or delivery method. While this may sound trivial, it's anything but, says Dr. Bramhall. "What it does is affect your workflow," he says. "You have to know what you're giving. A lot of that is muscle memory and confidence just as much as the objective reading of labels and expiry dates and things like that. And you can get things like syringe swap errors- people injecting the wrong thing at the wrong time because it's not what they are used to giving."
</p>
<h3>Concerns over prior authorization</h3>
<p>
Because of the exorbitant cost of chemotherapy drugs, the WSMA was concerned about issues with prior authorizations arising from drug shortages. Last spring, the WSMA, the Washington State Hospital Association, and the Association of Washington Healthcare Plans asked the Washington Healthcare Forum to convene a pre- service work group to look specifically into the issue of chemotherapy drug shortages and drug preauthorization. Through its Administrative Simplification Program, the Forum brings together health plans, physician practices and networks, hospitals, and associations like the WSMA to make it easier for clinical organizations and health plans to do business together.
</p>
<p>
On this front, there's good news from subject matter experts in health plans and health organizations, says Rick Rubin, Washington Healthcare Forum's executive director. "They told us that they were not experiencing many problems with prior authorization related to the chemotherapy drug shortage," he says. "Most plans and [clinical organizations] were already working fairly collaboratively on this. And while there were, obviously, clinical challenges and concerns, most of the organizations that we spoke with in this process were not experiencing added or unusual delays in the administrative process from health plans."
</p>
<p>
In 2017, the pre-service work group developed a best practice recommendation on how to handle extenuating circumstances, available on the website of the Forum's contractor, OneHealthPort (onehealthport. com/adminsimp-overview). "That's the subject matter experts coming together and saying, 'we agree as clinical organizations and plans that when you encounter this extenuating circumstance, this is how you should handle it' and that gets documented in the [recommendation]," explains Rubin. Because no one could anticipate the shortage of chemotherapy drugs back then, the pre-service group that convened in June made sure the best practice recommendation covered these concerns. There's good news here, too.
</p>
<p>
"When this group looked at the chemotherapy drug shortage problem and compared it to what they developed in 2017, they felt that most of the issues were covered under this extenuating circumstances [recommendation]," says Rubin.
</p>
<p>
They did, however, note two issues: One was that the existing recommendation did not provide adequate guidance for situations when no clinically equivalent drug could be substituted for the preauthorized one. The recommendation has since been updated to include this guidance.
</p>
<p>
The other thing the pre-service group noticed was missing language around how physicians and clinical organizations notify the health plan when something has changed because of a drug shortage. So, language was added to the best practice recommendation that the physician include identification of the original medication being replaced due to shortage.
</p>
<p>
"This group of subject matter experts was not seeing widespread administrative challenges between health plans and clinical organizations around prior authorization. And that they felt that this best practice recommendation was a good tool to use with the additions to it," says Rubin, who adds that if WSMA members feel the recommendations have overlooked something, the pre-service group is always willing to take another look.
</p>
<h3>Public health concerns</h3>
<p>
In some cases, unexpected (or unheeded) increased demand is stretching an already limited supply. That's the case with long-acting injectable Bicillin L-A, the first-line treatment for syphilis and the only recommended treatment for pregnant people with syphilis. The current nationwide shortage comes amidst a sharp rise nationwide in the number of syphilis cases.
</p>
<p>
Not too long ago, syphilis was a rare sexually transmitted infection. In 1996, only nine cases were reported in Washington, according to the Washington State Department of Health. By 2021, that climbed to 1,488 reported cases of primary and secondary syphilis. The shortage prompted the Department of Health last July to issue guidance for the treatment of syphilis.
</p>
<p>
Fortunately, there's some tempered good news. The Bicillin L-A supply delivery began again in December 2023, according to the FDA. Based on manufacturer indications, the agency expects estimated supply recovery to occur sometime in the second quarter of 2024. But the pediatric formulation has a next delivery estimate of January 2025 and does not currently have an estimated shortage recovery time.
</p>
<p>
So far, lack of access to Bicillin L-A has not been noted as a barrier to treatment or attributed to an increase in syphilis cases in Washington state, says Zandt Bryan, sexual health and prevention manager of disease control and health statistics at the Department of Health. "Up to this point, Washington has not experienced a shortage of this medication to such a degree that pregnant people have not been able to access treatment with Bicillin," says Bryan.
</p>
<p>
Of equal concern, says Alan Melnick, MD, public health director and health officer for Clark County, is making sure pregnant people who need the medication-who are often unreachable after testing positive-receive the treatment. To that end, the Washington State Association of Local Public Health Officials is supporting a statute change to allow medical assistants, under supervision, to provide Bicillin L-A injections in the field, says Dr. Melnick.
</p>
<p>
Another drug shortage of concern to obstetricians and pediatricians is the limited availability of erythromycin 0.5% ophthalmic ointment. It's considered standard neonatal care by the U.S. Preventive Services Task Force as the only recommended regimen to prevent ophthalmia neonatorum caused by N. gonorrhoeae. At least one of only three manufacturers of the ointment has ceased manufacturing the drug entirely.
</p>
<p>
And, though the U.S. has not yet reported a shortage of drugs to treat scabies, the United Kingdom is seeing a surge in scabies cases because of a shortage of permethrin and malathion.
</p>
<h3>Public health and national security</h3>
<p>
Just as there are many causes for drug shortages, there's no one-size-fits- all solution. "It's gonna get worse, unfortunately, before it gets better. I haven't heard anybody say that the problem is going to be solved, or we have a quick solution. It's one of those supply chain issues that just doesn't lend itself to quick and easy changes," says Rubin.
</p>
<p>
Recently, however, the Biden administration announced it will look at the Defense Production Act to open up funding to help relieve some medication shortages.
</p>
<p>
With many drug manufacturers now based outside the U.S. and amid numerous global conflicts, the drug and medical equipment supply chain has never been more precarious. These shortages are not only a public health problem, but they may also be a national security issue. A panel of experts and lawmakers speaking at the Milken Institute's Future of Health Summit echoed that warning this past November.
</p>
<p>
While pandemic woes crystallized the urgency for lawmakers, the medical community sounded the public health alarm as far back as September 2018. That's when the American Hospital Association, American Society of Anesthesiologists, American Society of Clinical Oncology, American Society of Hospital Pharmacists, and the Institute for Safe Medication Practices convened a summit on drug shortages as a matter of national security, drafting preliminary recommendations for potential policy and marketplace changes to help prevent and mitigate drug shortages.
</p>
<p>
As with other public health warnings that have gone unheeded, what remains clear, says Dr. Bramhall, is that there needs to be more political will to finally take meaningful action. He urges WSMA members to remain engaged on the topic and to continue to add urgency to the issue by contacting their legislative representatives.
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the March/April 2024 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 4/2/2024 10:12:11 AM | 4/2/2024 10:09:12 AM | 4/2/2024 12:00:00 AM |