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mukilteo-ob-gyn-named-president-of-wsmaMukilteo OB-GYN Named President of WSMALatest_NewsShared_Content/News/Press_Release/2023/mukilteo-ob-gyn-named-president-of-wsma<div class="col-md-12"> <div class="col-sm-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>Sept. 25, 2023</h5> <h2>Mukilteo OB-GYN Named President of WSMA</h2> <p> SEATTLE - Mukilteo obstetrician-gynecologist Nariman Heshmati, MD, MBA, FACOG, was named president of the Washington State Medical Association at its annual House of Delegates meeting on Sunday, Sept. 24. The WSMA represents nearly 13,000 physicians, physician assistants, resident physicians, and medical students throughout Washington state. </p> <p> Dr. Heshmati is the executive medical director of affordability, advocacy, and pharmacy for Optum Washington, which includes The Everett Clinic, The Polyclinic, and The Optum Care Network Pacific Northwest. In his role at Optum Washington, Dr. Heshmati has accountability for total cost of care, external relationships, and pharmacy services. </p> <p> Born in Iran to a family of clinicians-his father an orthopedic surgeon and his mother a psychologist-a young Dr. Heshmati and his family fled their home country during the Iranian Revolution, eventually emigrating to the United States and settling in Satellite Beach, Florida. Reestablishing medical careers in their new country, Dr. Heshmati's father and mother became role models for their children, inspiring them to pursue careers in medicine, with Dr. Heshmati's brother also becoming a physician and his sister a psychologist. </p> <p> Dr. Heshmati received his undergraduate degree in 2001 at the University of Florida in Gainesville, followed by a medical doctorate in 2005 from Florida State University in Tallahassee where he served as class president and founded the medical school college council. He completed a residency in obstetrics and gynecology in 2009 at Vanderbilt University in Nashville, Tennessee, during which time he was a contributor to the 5th edition textbook of Blueprints in Obstetrics & Gynecology. Dr. Heshmati recently received an MBA from Seattle University. </p> <p> Dr. Heshmati moved to Mukilteo, Washington, in 2009 with his wife Kathryne to join The Everett Clinic, where they continue to live with their two children, Robert and Sirena. Dr. Heshmati has served Everett and the surrounding Snohomish County communities as a practicing OB-GYN for more than 14 years and has pursued executive and leadership roles in local clinics and health systems. At Providence Regional Medical Center in Everett, he served as chief of women's and children's services and medical director of obstetrics. At The Everett Clinic, he has served on the clinical leadership board, as a senior regional medical director, as medical director of advocacy, and as associate medical director of surgical services, among other roles. </p> <p> Demonstrating a steadfast commitment to his community and to organized medicine, Dr. Heshmati has served on the Washington Health Alliance Low Back Pain Implementation Collaborative, was appointed by Gov. Jay Inslee to the Washington Pandemic After Action Review Task Force, and is on the March of Dimes Washington State board of directors. He is the Washington section legislative chair for the American College of Obstetricians and Gynecologists. Along with his membership in the WSMA and the national and state chapters of his specialty society, he is a member of the American Medical Association. In addition to his executive leadership at the WSMA, Dr. Heshmati serves as a WSMA delegate to the AMA and is past board chair of WSMA's political action committee, WAMPAC. </p> <p> Dr. Heshmati is widely published, has presented at numerous national conferences including AMGA (formerly American Medical Group Association), Becker's Hospital Review, America's Physician Groups, and State of Reform, and has received a number of awards, including Seattle Met Magazine "Top Doc." He is the host of a popular YouTube channel, "DrNari," featuring women's health informational videos and is active on X, formerly known as Twitter, under the handle "@nariheshmati." </p> <p> The following physicians were also elected as officers at the meeting: John Bramhall, MD, PhD, Seattle anesthesiologist, president-elect; Bridget Bush, MD, FASA, Anacortes anesthesiologist, vice president; and Matt Hollon, MD, MPH, FACP, Spokane internist, secretary-treasurer. The fifth officer of WSMA's executive committee is Past President Katina Rue, DO, FAAFP, FACOFP, Yakima family physician, who will serve as committee chair. </p> <p> WSMA members newly elected to the association’s board of trustees include Rajneet Lamba, MD, Kirkland internist; Amy Ellingson, MD, Brewster family physician; Lisa Ivanjack, MD, Bothell internist; John Scott, MD, Seattle gastroenterologist; Peter Barkett, MD, Silverdale internist; and Andy Shang, medical student, Pacific Northwest University of Health Sciences. For more information, see this <a href="">full roster of WSMA board of trustees members</a>. </p> <p> <a href="javascript://[Uploaded files/News and Publications/Press Room/nariman-heshmati-md-wsma.jpg]">Download a high-resolution portrait of WSMA President Nariman Heshmati, MD, FACOG</a>. </p> <p> For more information, contact: </p> <p> Graham Short<br /> WSMA Director of Communications<br /> 206.329.6851 (cell/text)<br /> <a href=""></a> </p> <p><strong>About the WSMA</strong><br /> The Washington State Medical Association represents nearly 13,000 physicians, physician assistants, resident physicians, and medical students across all specialties and practice types in Washington state. The WSMA has advocated on behalf of the house of medicine for more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care. </p> </div>9/25/2023 12:00:00 AM1/1/0001 12:00:00 AM
update-on-new-covid-19-vaccine-recommendations-and-availabilityUpdate on New COVID-19 Vaccine Recommendations and AvailabilityLatest_NewsShared_Content/News/Membership_Memo/2023/september-22/update-on-new-covid-19-vaccine-recommendations-and-availability<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/woman-covid-vaccine-645x425px.jpg" class="pull-right" alt="woman receiving vaccine" /></div> <h5>September 22, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>Update on New COVID-19 Vaccine Recommendations and Availability</h2> <p>The Advisory Committee on Immunization Practices met to vote on recommendations for the 2023-24 COVID-19 vaccines. It voted in favor of recommending these new monovalent COVID-19 vaccines including the XBB.1.5 component:</p> <ul> <li>Everyone 5 years and older without immunocompromise is recommended to receive one dose of the 2023-2024 COVID-19 vaccine regardless of prior vaccination history.</li> <li>Children ages 6 months-4 years should complete a multidose initial series (two doses of Moderna or three doses of Pfizer mRNA COVID-19 vaccine) with at least one dose of the 2023-2024 COVID-19 vaccine.</li> <li>People who are moderately or severely immunocompromised should complete a three-dose initial series with at least one dose of the 2023-2024 COVID-19 vaccine and may receive one or more additional 2023-2024 COVID-19 vaccine doses.</li> <li>Bivalent mRNA COVID-19 vaccines are no longer recommended (or authorized for use) in the United States.</li> </ul> <p>Detailed guidance is available on the Centers for Disease Control and Prevention's <a href="">Interim Clinical Considerations for Use of COVID-19 in the U.S. webpage</a>.</p> <h3>COVID-19 vaccine allocations in Washington state</h3> <p>The COVID-19 vaccines are available to order and are currently under allocation through the Washington State Childhood Vaccine Program and Adult Vaccine Program. Vaccine orders will be reduced initially to accommodate for the limited number of doses currently available. The state Department of Health advises practices and clinics enrolled as vaccine providers to order small amounts more frequently initially as DOH transitions these vaccines into the agency's routine vaccine distribution programs.</p> <h3>There is still time to enroll in the Adult Vaccine Program</h3> <p>There is still time to enroll in Washington's Adult Vaccine Program to be eligible to request COVID-19 vaccine for your patients. Practices and clinics that enroll now will also be eligible to request <a href="">other routine vaccines</a> in the next AVP vaccine order cycle in spring 2024. Use the <a href="">Adult Vaccine Provider Enrollment Guide</a> to help you through the enrollment process. </p> </div>9/22/2023 12:00:00 AM1/1/0001 12:00:00 AM
wsma-joins-wsam-in-requesting-bree-collaborative-review-of-oud-treatment-practicesWSMA Joins WSAM in Requesting Bree Collaborative Review of OUD Treatment PracticesLatest_NewsShared_Content/News/Membership_Memo/2023/september-22/wsma-joins-wsam-in-requesting-bree-collaborative-review-of-oud-treatment-practices<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/buprenorphine-butrans10mcg-645px.jpg" class="pull-right" alt="Packets of Butrans" /></div> <h5>September 22, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>WSMA Joins WSAM in Requesting Bree Collaborative Review of OUD Treatment Practices</h2> <p>Each year, the Dr. Robert Bree Collaborative identifies and selects health care services to review that either have high variation in the way care is delivered, are frequently used but do not lead to better care or patient health, or that have patient safety issues. Once topics are formally selected, the Bree Collaborative forms expert work groups to review existing data and current policies, regulations, and practices to develop related recommendations for the Washington State Health Care Authority to guide the type of health care provided to Medicaid enrollees, state employees, and other groups.</p> <p>Topic proposals from interested stakeholders were due July 2023. Citing existing WSMA policy, the Washington Society of Addiction Medicine formally requested WSMA's leadership to extend its support of WSAM's proposals on eliminating buprenorphine dose limits and expanding access to medication for opioid use disorder in residential treatment facilities. In advance of the Bree Collaborative finalizing 2024 topics, the WSMA submitted <a href="javascript://[Uploaded files/News and Publications/newsletters/2023/wsma-letter-of-support-wsam-2024-topic-proposals.pdf]">a letter of support of WSAM's proposals</a>, noting the state's need to improve health care delivery and outcomes for individuals impacted by opioid use disorder, especially as overdoses in Washington state have <a href="">increased 31%</a> between April 2022 and April 2023.</p> <p>The WSMA is monitoring the Bree Collaborative's discussions on 2024 proposals and will report out on final topics once they are selected.</p> </div>9/22/2023 12:00:00 AM1/1/0001 12:00:00 AM
wsma-urges-congressional-delegation-to-support-expanded-access-to-methadoneWSMA Urges Congressional Delegation to Support Expanded Access to MethadoneLatest_NewsShared_Content/News/Membership_Memo/2023/september-22/wsma-urges-congressional-delegation-to-support-expanded-access-to-methadone<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/pharmacist-stock-lores-645x425.jpg" class="pull-right" alt="Pharmacist with pill bottles" /></div> <h5>September 22, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>WSMA Urges Congressional Delegation to Support Expanded Access to Methadone</h2> <p>At the request of the Washington Society of Addiction Medicine, the WSMA submitted a <a href="">comment letter</a> to Washington's congressional delegation urging its support of the <a href="">Modernizing Opioid Treatment Access Act</a>, which expands access to methadone.</p> <p>Methadone, an important medication to treat opioid use disorder, is currently limited to a small number of opioid treatment programs in Washington state, which are concentrated in metropolitan areas, making it difficult to access. The act, as introduced, would expand access to methadone treatment by allowing board-certified addiction specialist physicians at opioid treatment programs to prescribe methadone that can be picked up by patients at a pharmacy. Expanding access would make it easier for vulnerable populations to receive this medication on a consistent basis.</p> <p>Existing WSMA policy recognizes the importance of methadone treatment and the need to reduce or eliminate barriers preventing patients from receiving methadone treatment. The WSMA is monitoring the progression of this legislation and continues to partner with WSAM on issues of mutual interest.</p> </div>9/22/2023 12:00:00 AM1/1/0001 12:00:00 AM
weekly-rounds-september-15-2023-on-the-state-of-physician-well-beingWeekly Rounds: September 15, 2023 - On the State of Physician Well-BeingLatest_NewsShared_Content/News/Weekly_Rounds/2023/weekly-rounds-september-15-2023-on-the-state-of-physician-well-being<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Weekly%20Rounds/Weekly-Rounds-Article-Graphic-2022-645x425px.png" class="pull-right" alt="Weekly Rounds logo" /></div> <h5>Sept. 15, 2023</h5> <h2> On the State of Physician Well-Being </h2> <p>Jennifer Hanscom, CEO</p> <p> In anticipation of <a href="">National Physician Suicide Awareness Day</a> this Sunday, The Physicians Foundation has announced findings from its annual survey on the state of physician well-being. Surprising to no one within health care, the findings paint a picture of low physician morale and well-being. Additionally, the survey breaks out young physicians and physicians in training for the first time, and notes that residents and medical students are also plagued by the effects of burnout and suicide. </p> <p> Key survey findings include: </p> <ul> <li>Medical students' overall well-being is lower than both residents and physicians. <ul> <li>More than six in 10 residents (61%) and seven in 10 students (71%) report experiencing feelings of burnout.</li> <li>Though just starting their careers, a shocking proportion of students (45%) know a colleague or peer who has considered suicide, compared to residents (38%) and physicians (36%).</li> </ul> </li> </ul> <ul> <li>Current and future physicians alike report stigma and structural barriers negatively affect their overall well-being and mental health. <ul> <li>Nearly eight in 10 physicians (78%), residents (79%), and medical students (76%) agree that there is stigma surrounding mental health and seeking mental health care among physicians.</li> <li>Nearly five in 10 residents and medical students were either afraid or knew another colleague fearful of seeking mental health care given questions asked in medical licensure/credentialing/insurance applications.</li> </ul> </li> </ul> <p> Find the full survey findings from the 2023 Survey of America's Current and Future Physicians on <a href="">The Physicians Foundation website</a>. </p> <p> Physician and clinician burnout and related resignations and early retirements continue to pose a major threat to a health care industry that remains in need of clinical leaders, physicians, and other front-line staff to ensure capacity. </p> <p> The issue has been in the forefront of industry news for years, with the pandemic bringing it firmly into the national spotlight: In May 2022, U.S. Surgeon General Dr. Vivek Murthy issued an <a href="" target="_blank" rel="noreferrer">advisory highlighting the urgent need to address the health worker burnout crisis across the country</a>, pointing to the record numbers of health workers who are quitting or reporting that they intend to quit. </p> <p> The future of medicine is dependent on change to offer the right resources and eliminate barriers that impact physicians' well-being. The solutions to improve physician well-being and prevent suicide are not a secret-physicians, residents, and medical students have identified the solutions they need. At the top of the list, physicians (80%) and residents (85%) agree that reducing administrative burdens, such as low-value work, insurance approvals, and unnecessary mandatory training, is helpful to improving well-being. </p> <p> The health worker burnout and workforce retention crisis, if not addressed, will make it harder for patients to get care when they need it, cause health costs to rise, hinder our ability to prepare for the next public health emergency, and worsen health disparities. </p> <p> To that end, the WSMA has convened a small work group with members from the Washington State Medical Group Management Association and several large group leaders to create a package of workforce policy solutions in advance of the 2024 legislative session. This workforce work group is putting the finishing touches on its draft recommendations, which will go before WSMA leadership this month. Look for a wider release of these recommendations later this year. </p> <p> In addition, the WSMA Foundation has been awarded a grant from The Physicians Foundation for a physician wellness initiative that will look at systemic solutions to physician and physician assistant burnout, including convening health systems and large groups to develop best practices and to pledge their commitment to meet those best practices. We are seeking physician and PA members to join a new committee to help lead this work, with compensation available for your time and commitment. To learn more about the expectations of service on the committee, reach out to WSMA Associate Director of Quality and Leadership Programs <a href="">Monica Salgaonkar</a>. </p> <p> For this Sunday's day of awareness around physician suicide, I hope you'll join me in doing what you can to raise the visibility of the issue. Find social media and other materials in the <a href="">Toolkit</a> section on the <a href="">NPSA Day website</a>. </p> </div>9/15/2023 12:00:00 AM1/1/0001 12:00:00 AM
a_family_traditionA Family TraditionLatest_NewsShared_Content/News/Latest_News/2023/a_family_tradition<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/sept-oct-2023-reports-cover-645x425px.jpeg" class="pull-right" alt="cover of September/October 2023 issue of WSMA Reports" /></div> <h5>Sept. 14, 2023</h5> <h2>A Family Tradition</h2> <p>By Milana McLead</p> <p> Nariman Heshmati, MD, is a problem solver; the more difficult the issue, the better it suits him. Whether it's automating his house so the lights are motion activated, programming the fireplace to function with a remote, operating on a patient in a life- threatening situation, or perhaps even more daunting, fixing what's broken in health care, he's up for the challenge. </p> <p> "We are designing a system that we will all need," he says. "Our patients want us to ensure that the health care system we have for them is the same one we want to be in, one that we would get care in ourselves. We've got the ability to design that system." </p> <p> His passion for doing just that is more than a mantra, it's personal. His efforts to that end literally made a difference to his own family's life. "My kids were born at Providence, where I was division chief for women's and children's services at the time," he says. It was then the second- busiest labor and delivery unit in the state. As division chief and an OB-GYN, Dr. Heshmati and his team worked to improve the neonatal intensive care unit, striving for process and quality improvements. </p> <p> "When my wife came in [for delivery], I knew it was too early," he says. As their newborn son, Robert, spent his first 10 days in the NICU, Dr. Heshmati understandably wanted him to have the best care and the best chance of surviving. "Then the irony hit me: All those things I'd worked on, that my team worked on ... my family was actually experiencing the result of those efforts," he says. "To me, it's not just a job. We are developing a system not only to take care of patients, but to take care of ourselves and our families." </p> <div class="col-sm-12" style="text-align: center;"> <blockquote style="text-align: center;"><strong> <em><span style="font-size: 18px;"> Our patients want us to ensure that the health care system we have for them is the same one we want to be in, one that we would get care in ourselves. We’ve got the ability to design that system</span>.</em></strong> </blockquote> </div> <p> Working to fix that system also drives his involvement in the WSMA, advocacy, and organized medicine. During his earliest days in medical school at Florida State University, getting involved was heavily encouraged. He served on the political action committee of the Florida Medical Association, even spending a month embedded with the association's lobbying team at the Capitol in Tallahassee at the height of Florida's medical malpractice reform. The "sea of white coats on the steps of the Capitol demanding action" launched him into advocacy efforts that continue today. </p> <p> "One of the hardest challenges being a physician is that we are in such a regulated industry, it's easy to feel that you lose autonomy and control. The system around you is deciding how you can provide care and all you want to do is provide that care," he says. "Being involved in the WSMA gave me visibility to how decisions are made, how to improve the system, and how to give voice to the physician perspective. </p> <p> "When you're part of the WSMA, instead of feeling like the health care system is crumbling and patients can't get the care they need, you can feel like you're in the driver's seat to speak up to say, 'This system is not OK, and here is what we need to take care of the community.' " </p> <div class="col-sm-5 pull-right newsbody" style="text-align: center;"> <p><img alt="Dr. Heshmati" src="/images/Newsletters/Reports/2023/september-october/Nariman_Heshmati_0051_425x650.jpg " class="pull-right" width="425" height="650" /></p> </div> <p> Taking care of the community is a thread that's woven into most, if not all, of what Dr. Heshmati thinks about in terms of leadership, advocacy, and impact. While he's done the clinical 80-hour week, been on call around the clock, developed departments, argued legislation, and testified in front of elected officials, he is now focused on where he can make the greatest impact: physician leadership. "In my leadership roles, I might be able to help 10 people, or 100 people, or maybe 1,000 people. That ability to make a broader impact is what drives me," he says. "I feel strongly that medical organizations need physician leaders. To take care of patients, we need to have the right ingredients, the right rules, the right system around us. If we're not at the table helping guide that process, that's when we see regulations we don't need, policies that don't make sense, and interference in the patient-physician relationship." </p> <p> Early in his life, he saw firsthand the value and importance of the patient- physician relationship. As a child, he watched his parents taking care of patients. It was practically destiny that Dr. Heshmati would become a physician, considering that his father, two uncles, and older brother are physicians, and his mother and older sister are psychologists. Growing up near Florida's Cape Canaveral, instead of dreaming about space adventures, he hung out at his parents' primary care medical offices while they worked. "While my dad was seeing patients, my mom ran the office," he says, "and I was there too, playing with toys." </p> <p> That childhood may sound idyllic, but his family's journey to that point was anything but. Dr. Heshmati was born in Iran on New Year's Day 1980. As he entered the world, revolution had upended his country; it was day 59 of the seizure of the American Embassy in Tehran and the Iran-Iraq war was raging. His father was an orthopedic surgeon and head of surgery at the major army hospital in Tehran, so though his work was deemed necessary, it wasn't necessarily safe for him or his family to remain in Iran. After months of covert planning, the elder Dr. Heshmati and family left everything behind, fleeing their homeland, first to Europe and ultimately to Florida's Satellite Beach. </p> <p> His father reestablished his credentials and served the community in primary care, then as Brevard County's public health director, and ultimately as a revered public health advocate: When he retired, the building he worked in was renamed in his honor. He was widely known for innovative programs he created to ensure access to care, maternity care, vaccines, and more. </p> <p> "My dad was a huge influence," Dr. Heshmati says. His father modeled, well before it was popular, that everyone should have access to health care. "Everyone knew my dad and would tell me 'My child was sick and was able to use this program [your dad created].' That had an impact on me. I realized if I go into medicine, the positive impact I can make on a community can be significant." </p> <p> His parents shaped and inspired his life, from making a positive impact in everything you do ("keep your community healthy") to having a strong work ethic ("work hard to get results"). Their journey of leaving everything behind and rebuilding-new land, new language- also inspired a sense of optimism for the younger Dr. Heshmati. "They had a sense of no matter what the challenge is, we have the ability to get things done here," he says. </p> <p> As incoming president of the WSMA, he's optimistic about getting things done, together. "What speaks to me is the power we have when our voices are unified," he says. "When we come together, we have significant power to implement change. Some of the brightest and most dedicated people I've ever seen are in health care. If you had to pick a team to improve health care, this is the team. Our members are that team. We can make this the best place to practice medicine and receive care." </p> <p> <em>Milana McLead is WSMA's senior director of strategic communications and membership.</em> </p> <h3>Snapshot </h3> <p><strong>Family:</strong> Met his wife, Kathryne, during his undergraduate studies at the University of Florida. Their son, Robert, is 10; their daughter, Sirena, is 7.</p> <p><strong>First language: </strong>Farsi. He still understands it but must work at speaking it. </p> <p><strong>Day job:</strong> Senior regional medical director for surgery and specialty for Optum’s Washington market. Oversees more than 40 departments and multiple ambulatory surgical centers between The Polyclinic and The Everett Clinic and has accountability for more than $400 million in revenue. </p> <p><strong>Office décor</strong>: Drawings by his kids: “I love having these reminders of my family in my office. Why do we do what we do? It’s for our kids.” </p> <p><strong>Social media:</strong> Includes his “DrNari” YouTube channel and an endless stream of selfies on Twitter. “The first thing patients do when they have concerns is go to Google. Better to put the right information out there because they’re going to look there anyway.”</p> <p> <strong>Starting the day: </strong>A 4 a.m. wake-up alarm, a work out, then a 10-mile e-bike ride to his office in a nondescript, highly secure building in Everett. “Every day we have an opportunity to make an impact. When I wake up, I look forward to that.” </p> <p><strong>Favorite quote:</strong> “Coming together is a beginning, staying together is progress, working together is success.”</p> <p> <em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em> </p> </div>9/14/2023 12:00:00 AM1/1/0001 12:00:00 AM
a-growing-maternity-care-crisis-in-washingtonA Growing Maternity Care Crisis in WashingtonLatest_NewsShared_Content/News/Latest_News/2023/a-growing-maternity-care-crisis-in-washington<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/sept-oct-2023-reports-cover-645x425px.jpeg" class="pull-right" alt="cover of September/October 2023 issue of WSMA Reports" /></div> <h5>Sept. 14, 2023</h5> <h2>A Growing Maternity Care Crisis in Washington</h2> <p> By John Gallagher </p> <h5> <em>Members only; sign-in required.</em> </h5> <p> Imagine if cardiac care was only spottily available. Hospitals were shutting down their cardiac care units, with patients needing immediate treatment traveling significant distances. Physicians who offered the care were overwhelmed with huge patient panels. Access to care was particularly difficult for patients in rural areas, disproportionately impacting communities already suffering disparities in care. </p> <p> If that sounds far-fetched, just replace "cardiac care" with "maternity care." Because that's the current reality in Washington. </p> <p> When it comes to maternity care, many parts of Washington are in a state of crisis. While the large population centers still offer the full spectrum of care, many counties are seeing maternity services reduced or disappear altogether. The result is worrying physicians faced with fewer resources to help their patients. </p> <p> "I get a lot of calls from my colleagues who are struggling, asking, 'Where can I send patients? What can I do?' " says Nariman Heshmati, MD, an OB-GYN and WSMA's incoming president for 2023-2024. "Historically, if you were in a rural area, you had access to maternity care but not access for the small minority of care for the highest risk. Now we're seeing lack of access to basic maternity services." </p> <p> The crisis comes at a time when the nation as a whole is experiencing a rise in maternal mortality. Between 2018 and 2019, the rate increased from 17.4 maternal deaths per 100,000 live births to 20.1. It then continued to rise to 23.8 in 2020 and to 32.9 in 2021. While Washington's pregnancy-related death rate is lower than the national average, with 15.9 pregnancy- related deaths per 100,000 live births from 2014-2020, preliminary state Department of Health data indicate an increase in the rate of pregnancy-associated deaths in 2021 compared to the previous year, and Washington's rate is higher than those of wealthy countries outside of the U.S., according to the World Health Organization. </p> <p> As a whole, the state looks no worse than the rest of the nation in terms of access. Indeed, in some ways the state is much better at offering maternity care to women than others. The problem is delivering it. </p> <p> "The state of Washington does a really good job compared to many other states," says Rita Hsu, MD, an OB-GYN with Confluence Health in Wenatchee and chair of the Washington State Perinatal Collaborative. "It's relatively easy to qualify for Apple Health. In many counties, you can get access in the first trimester, which is a good predictor of outcomes. The challenge is when you get into these geographically big counties, which tend to be lower resourced." </p> <p> Indeed, portions of the Evergreen State are maternity care deserts. As of 2020, one-fifth of the counties in the state didn't have a hospital or birthing center offering obstetric care and don't have any practitioners whose licensures allow practice of obstetrics (OB-GYNs, family practice physicians practicing obstetrics, certified nurse midwives, or licensed midwives). Things have only gotten worse since then. Since 2022, labor and delivery units have closed in Covington, Forks, Bremerton, and Toppenish. </p> <p> Of the 39 critical access hospitals in the state, 24 do not offer obstetric care, according to the state Department of Health. Eight counties have no maternity services, while five others have limited access to services. In maternity care deserts, women have to drive on average more than 30 miles to the nearest labor and delivery service. </p> <p> Moreover, in rural areas, patients frequently present with more complex issues. "Patients in general are higher acuity," says Dr. Hsu. "We see more pregnant persons with hypertension, diabetes, or a higher BMI. If you look at the most recent year for which we have complete birthing data, which is 2021, the maternal age group of 21-29 is shrinking while 30 and above is growing, which means more risk." </p> <h3>A hospital closing devastates a poor community</h3> <p> The closure of the labor and delivery unit at Astria Toppenish Hospital, located on the Yakama Reservation, last December highlights how devastating the impact can be on both physicians and patients. Citing a loss of $3.2 million for the unit over the previous 12 months, the hospital said it could no longer afford to provide the services. While the hospital had announced it planned to close the unit in mid-January, it shut it down suddenly before Christmas. </p> <p> "We worked hard," says Jordann Loehr, MD, an OB-GYN who worked at Astria Toppenish. "We treated people with dignity and respect. The nurses were here for 20 years. Now it's all over. People down here have no place to go." </p> <p> Dr. Loehr's patients had few resources, so losing access to maternity care presents an agonizing dilemma for them. </p> <p> "I have more than one patient who walks to clinic," says Dr. Loehr. "One patient's plan is to walk to the Toppenish hospital in labor and hope that they will call an ambulance and transport her to Yakima Memorial. I don't have a solution for these women." </p> <p> The closure has turned Dr. Loehr's life upside down, as well, since she is no longer working at Astria Toppenish. "Now I have nowhere to deliver," says Dr. Loehr. "I have to leave. It's breaking my heart. I haven't delivered a baby in six months." </p> <p> Still, says Dr. Loehr, "I am the least victim of the victims here. I can get another job. All of the options are better than what's happening to the women in Toppenish. I will be fine with a broken heart." </p> <p> Dr. Loehr has been advocating for the creation of a public hospital district to fill the gap caused by the closure at Astria Toppenish. "I feel wholeheartedly that a public hospital district in the Lower Valley would thrive," she says. While a recent vote on a proposition to consider a public hospital district in the Lower Valley received support, it did not pass due to not meeting the voter turnout threshold. Supporters say they will work to get the proposition back on the ballot. </p> <p> Such closures are only exacerbating existing disparities in care. In rural areas of the state, maternal mortality is 40% higher than the state average. According to a study released in JAMA last July, the maternal mortality ratio in the state increased a staggering 71% for American Indian and Alaska Native women from the period 1999-2009 to 2010-2019. For Black women, the increase was 20%. For Hispanic women, the increase was 22%. </p> <p> "Maternal mortality persists as a source of worsening disparities in many U.S. states and prevention efforts during this study period appear to have had a limited impact in addressing this health crisis," the authors of the study concluded. </p> <h3>High cost, low payment</h3> <p> Low Medicaid reimbursement rates are a major reason why labor and delivery units are closing. The overhead for keeping the units operating is high. They require specialized nurses and specialized services such as neonatal care. But Medicaid reimbursement rates fall far short of matching the costs to physicians and hospitals, even though Medicaid pays for nearly half the births in Washington. In some rural communities, that figure approaches 80%. </p> <p> "I get paid $2,000 for a delivery," says Kathy Hebard, MD, an OB-GYN at Kitsap OBGYN. "That's for all prenatal visits, hospital care, the delivery, and postpartum care. For an uncomplicated pregnancy, it's somewhere between $50 and $75 an hour. And these situations aren't always uncomplicated. It doesn't matter how risky. You get paid roughly $2,000. It's demoralizing." </p> <p> Dr. Hebard says that her global reimbursement hasn't changed since 2005. "I don't know any other industry where you don't see a cost increase every few years, let alone over two decades." She says that the failure to value the work OB-GYNs are doing sends a clear message. </p> <p> "What you pay somebody for a job is how you value it, and clearly they don't value us or the women we care for," she says. </p> <p> Given all these problems, it's unsurprising that fewer medical students are pursuing OB-GYN as a specialty. The average age of OB-GYNs in the state is 50. As more physicians retire, the odds of finding replacements are shrinking. </p> <p> "It's not a very appealing job to sign up for when you have to work long hours, pay a huge amount for malpractice, and probably get sued once or twice in your career no matter how good you are," says Dr. Hebard. </p> <h3>A case study in Kitsap County</h3> <p> Dr. Hebard's experience is illustrative of how changes over time have brought the state to this crisis. A graduate of the University of Washington School of Medicine, she chose to work on the Kitsap Peninsula because it was an attractive place to start her career. </p> <p> "I joined a private practice," she recalls. "Initially there was another group in town, plus a smattering of family practice clinicians. Of course, there was also the Naval Medical Center, which was a full-time source of care for Navy members and their families." (Bremerton has the third-largest naval installation in the country.) </p> <p> Over time, says Dr. Hebard, "the community kept growing, but the numbers of physicians and advanced practitioners did not. The volume was steadily increasing over the past 20 years, but we had the same number of physicians and practitioners." That changed in the past five years. </p> <p> First, family practice physicians stopped offering maternity services. "It didn't make sense for them to pay the malpractice insurance, so they quit doing the job," says Dr. Hebard. Then there were a series of retirements. While a few physicians came to replace those who retired, eventually they left, as well. </p> <p> The most devastating blow in Kitsap County came in the spring of 2022, when the Naval Hospital in Bremerton closed its labor and delivery services, citing staffing and cost issues. A few months later, Peninsula Community Health Services, also in Bremerton, followed suit. That left a single hospital on the Kitsap Peninsula-St. Michael's- providing birth services. </p> <p> As a result, Kitsap County went from having eight OB-GYNs per 100,000 people to just three per 100,000 people. Washington has an average of 15 OB-GYNs per 100,000, well below the 27 per 100,000 recommended as the optimal number in a 2011 study published in Surgical Science, but about average for the U.S. </p> <p> Dr. Hebard says that the impact has been overwhelming. "I look at the number of babies we delivered in our practice last year, and it was well over a thousand," she says. "That's 200 babies a physician or nurse. It's exhausting. We're delivering babies all the time, and taking on the risk. How much can you take on and still provide good care? It's just a hard scenario." </p> <p> To handle the volume, patients often have to wait to see their physician until the second trimester. Initial lab and ultrasound results are handled over the phone without an initial physician interaction, for example. </p> <p> "We have to prioritize the urgency," Dr. Hebard says. "We're routinely double-booked, seeing more patients than the time allotted. I'm routinely an hour late. A lot of patients understand we're strapped, but it's still frustrating for both myself and them." </p> <h3>Advocating for changes</h3> <p> Some help is on the way, at least for hospitals. Washington has finished its Medicaid safety net assessment. As a result, Medicaid reimbursement rates will be increasing, but not until next year. </p> <p> Jennifer Hanscom, the chief executive officer of the WSMA, notes that the state has a statutory requirement to intervene in "maternity care distressed areas." The statute directs local officials to develop a report recommending remedial action, which the state Health Care Authority will review and use "to the extent possible, in developing strategies to improve maternity care access in the distressed area." </p> <p> In a written appeal to the Health Care Authority, the WSMA has urged the agency to respond to the crisis in maternal care in the state. "As more pregnant individuals begin to experience the worsening impact of these closures, the WSMA strongly urges the HCA to consider available resources and engage in the statutorily required remedial work to ensure safe and appropriate access to maternity services no matter where a person lives in the state." </p> <p> "Our work is focused on drawing attention to the obligation that policymakers have," says Hanscom. "People need to have safe places and skilled individuals to deliver their babies. If policymakers are going to commit to expand access to Medicaid, they have to make sure that the second set of that equation is fulfilled, which is there are people available to meet patients' needs." </p> <p> Ultimately, Hanscom acknowledges, "It's going to be related to money, and state policymakers need to fulfill their promise of offering medical services to people covered by Medicaid. They have to stop overpromising and underdelivering on these services. By extending access to Medicaid coverage, the state has an obligation to provide those services and make it a priority to address those communities having to go without them." </p> <p> In the long run, argues Dr. Heshmati, the lack of care is only adding more cost to an already overburdened system. </p> <p> "The irony is that the health care system is having to table these patients' needs because of economic issues, but when patients don't have access, they have more complications and more downstream costs that end up costing us more as a society." </p> <p> Dr. Hsu says that everyone recognizes the problem, but developing a comprehensive response will be difficult. "I talk to people on both sides, and we share the same goals, but sometimes it's really hard to find a place where we overlap," she says. </p> <p> In the meantime, alternatives are at least being explored. An expert panel convened by the state Department of Health has endorsed more out-of- hospital birthing care. Dr. Hsu believes it's worth exploring whether the state could use Accountable Communities of Health to develop a kind of hub-and- spoke model, which would allow rural hospitals to continue to provide access to maternal services while directing more complicated or risky cases to a referral hospital. </p> <p> Despite all the challenges, Dr. Hsu says that being an OB-GYN remains a fulfilling career. "It's the most joyful experience you can have and call it work." </p> <p> <em>John Gallagher is a freelance writer specializing in health care.</em> </p> <p> <em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em> </p> </div>9/14/2023 12:00:00 AM1/1/0001 12:00:00 AM
doctors-making-a-difference-sara-mazzoni-mdDoctors Making a Difference: Sara Mazzoni, MDLatest_NewsShared_Content/News/Latest_News/2023/doctors-making-a-difference-sara-mazzoni-md<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/dmd-mazzoni-website-image-645x425px.png" class="pull-right" alt="Doctors Making a Difference logo: Sara Mazzoni, MD" /></div> <h5>Sept. 14, 2023</h5> <h2>Doctors Making a Difference: Sara Mazzoni, MD</h2> <p> For Sara Mazzoni, MD, MPH, division chief of OB-GYN at Harborview Medical Center in Seattle, quality maternal health care goes hand in hand with the professional well-being of the physicians providing it. At the OB-GYN clinic at Harborview, she's focusing on both fighting burnout among physicians and the issues that can lead to inequitable care for patients often left behind in health care. She talked with WSMA Reports about the landscape of maternal and reproductive care. </p> <p> <strong><em>WSMA Reports:</em> What are the most challenging issues in maternal care and reproductive care right now?</strong> </p> <p> <em>Dr. Mazzoni:</em> The issues at the top of my mind are the attacks on reproductive health care inclusive of the Dobbs [v. Jackson Women's Health Care] decision and its aftermath, our nation's abysmal maternal mortality rate, and the disparities in all reproductive health outcomes. </p> <p> <strong>As a medical director at Harborview, are there aspects of improving maternal and reproductive care that you're focusing on? </strong> </p> <p> I'm constantly focused on two things: centering our most marginalized patients and improving the well-being of our physicians and clinicians. At Harborview, we care for the full spectrum of our community. If we can focus on the patient experience and outcomes of our most underserved patients, then all patients will benefit. We are continuously striving to improve our delivery of equitable and inclusive care for all patients, but especially those often left behind in our health care system. </p> <p> With the second issue, our group of physicians and clinicians are all women. We know following the pandemic that female physicians are facing a level of burnout higher than their male peers. Every day I do what I can to fight burnout and increase professional satisfaction for our physicians, knowing that if they have improved well-being, our patients will have better outcomes. </p> <p> <strong>What are the biggest factors you see in your practice that influence maternal and reproductive health outside of the care they receive in clinic, such as social factors?</strong> </p> <p> So many! Prenatal care is such a small piece of a pregnant person's experience, and often doesn't have a huge impact on overall maternal health. The places we live, work, and play impact our health to a large degree, and this is no different for reproductive health. Stress plays a role in pregnancy in a way we don't yet understand. Social factors that increase a person's stress, such as unstable housing and food insecurity, clearly impact maternal health in a way greater than medical care. </p> <p> <strong>Are there things that physicians and physician assistants from other specialties can do to support good maternal and reproductive care for patients?</strong> </p> <p> Other clinicians can put contraception on their radar. We frequently see people who are interacting with the health care system due to serious health problems who then have an unintended pregnancy. If a physician is treating a reproductive- aged person for poorly controlled diabetes, for example, add contraception to the checklist! </p> <p> <strong>What system-level changes in the greater health care ecosystem need to be made to ensure all women and pregnant people receive the highest-quality care? </strong> </p> <p> There are seismic changes needed in the entire system for all people to receive highest-quality care. Following the pandemic, it is abundantly clear the system is broken. Clinicians are burned out and disillusioned. Patients don't trust the system. We are largely functioning in an insurance system rather than a health care system. These are overarching issues, however, and don't answer the question. </p> <p> Administrative bloat in the entire system needs to be addressed; there are layers upon layers of administrators, all of whom may not be improving the quality of care. The administrative burden on clinicians needs to be decreased so that we can spend more time focused on patient care and less drowning in the electronic medical record. We need more mental health professionals and social workers trained and integrated into all aspects of health care. Finally, we need to address systemic racism throughout our health care system so that Black women aren't terrified to give birth in our hospitals and all people have equitable health outcomes. </p> <p> <em><em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em></em> </p> </div>9/14/2023 12:00:00 AM1/1/0001 12:00:00 AM
ama-to-host-webinar-on-making-care-primary-model-sept-27AMA to Host Webinar on Making Care Primary Model Sept. 27Latest_NewsShared_Content/News/Membership_Memo/2023/september-7/ama-to-host-webinar-on-making-care-primary-model-sept-27<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/maxresdefault.jpg" class="pull-right" alt="Making Care Primary Model diagram" /></div> <h5>September 8, 2023</h5> <h2>AMA to Host Webinar on Making Care Primary Model Sept. 27</h2> <p>Earlier this summer, the Centers for Medicare and Medicaid Services announced a new, voluntary 10.5-year primary care model intended to improve care management and care coordination, foster partnerships between primary care and specialists, and leverage community resources to address patients' health and social needs. CMS is testing this "Making Care Primary" model in eight states, including Washington state, and recently released its <a href="" target="_blank" rel="noreferrer">request for applications</a>, which serves as an introduction to the model for prospective applicants. The Making Care Primary application went live this week and will close on Nov. 30. Participants will be selected for the model in early 2024 and onboarding will take place between April-July 2024.</p> <p>In preparation for applications to go live, the American Medical Association is collaborating with American College of Physicians and American Academy of Family Physicians to host an informative webinar where physicians and physician assistants interested in applying can hear directly from CMS staff. Additional details, including registration link, are forthcoming. For the time being, interested individuals are encouraged to mark their calendar for Wednesday, Sept. 27, 4-5 p.m. PT. Reach out to <a href=""></a> with questions. Otherwise, stay tuned for more information.</p> </div>9/8/2023 12:00:00 AM1/1/0001 12:00:00 AM
new-episodes-of-better-prescribing-better-treatment-podcast-now-availableNew Episodes of Better Prescribing, Better Treatment Podcast Now AvailableLatest_NewsShared_Content/News/Membership_Memo/2023/september-7/new-episodes-of-better-prescribing-better-treatment-podcast-now-available<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/wsma-bpbt-podcast-logo-645x425px.png" class="pull-right" alt="Better Prescribing, Better Treatment podcast logo" /></div> <h5>September 8, 2023</h5> <h2>New Episodes of Better Prescribing, Better Treatment Podcast Now Available</h2> <p>Episodes 7 and 8 of WSMA's new Better Prescribing, Better Treatment Podcast hosted by Nathan Schlicher, MD, JD, are now available. In these new episodes, Dr. Schlicher speaks with WSMA President Katina Rue, DO, and Audriana Mooth, DO, about opioid prescribing in family medicine; and Camille Puronen, MD, a hematologist-oncologist, and Ran Huo, MD, a palliative care physician, about opioids and caring for patients with oncology pain.</p> <h3>About the podcast</h3> <p>Through the course of this 14-episode series, host Nathan Schlicher, MD, JD, talks with experts on an array of topics addressing the gaps in practice that exist between the current state of prescribing and the best practices surrounding opioid and controlled substance prescriptions. A sole production of the WSMA and offering continuing education credit for physicians and physician assistants, the podcast is available at no cost to all physicians, PAs, and health professionals and supports the goals of the <a href="[@]wsma/resources/opioids/better_prescribing_better_treatment/wsma/resources/opioids/better-prescribing-better-treatment.aspx?hkey=b6fb0ec0-8bc2-4e53-bf4c-9f148599cbeb">Better Prescribing, Better Treatment safe-prescribing program</a>.</p> <h3>About episode 7: Opioids in Family Medicine</h3> <p><a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode7">In this episode</a>, Dr. Schlicher talks with Katina Rue, DO, FAAFP, FACOFP, WSMA's 2022-2023 president and program director for Trios Health Family Medicine Residency; and Audriana Mooth, DO, a second-year family medicine resident in East Pierce County. They discuss the generational shift in opioid prescribing experienced by seasoned and new-to-practice family physicians, make the case that family medicine includes acute and chronic pain management, and more.</p> <h3>About episode 8: Opioids in Cancer-Related Pain</h3> <p><a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode8">In this episode</a>, Dr. Schlicher chats with Camille Puronen, MD, a hematologist/oncologist at Kaiser Permanente Washington, and Ran Huo, MD, a palliative care physician at Kaiser Permanente. They discuss the close connection between oncology and palliative care when caring for patients with oncology pain.</p> <p>These activities are approved for <em>AMA PRA Category 1 Credit</em><sup>TM</sup>.</p> <p>Previous episodes</p> <ul> <li>Episode 1: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode1">The Future of the Better Prescribing, Better Treatment Program at WSMA</a></li> <li>Episode 2: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode2">The History of Opioid Prescribing Legislation</a></li> <li>Episode 3: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode3">Prescribing Opioids in a Rural Setting</a></li> <li>Episode 4: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode4">Opioids in Obstetrics</a></li> <li>Episode 5: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast/wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?hkey=5d4ff39d-6d34-45da-a94f-d95e682b2863#episode5">Opioids in Pediatrics</a></li> <li>Episode 6: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx#episode6">Opioids and Hospice</a></li> </ul> </div>9/8/2023 12:00:00 AM1/1/0001 12:00:00 AM
ukrainian-newcomer-continuing-education-now-availableUkrainian Newcomer Continuing Education Now AvailableLatest_NewsShared_Content/News/Membership_Memo/2023/september-7/ukrainian-newcomer-continuing-education-now-available<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/ukrainian-flag-645x425px.jpeg" class="pull-right" alt="Ukrainian flag" /></div> <h5>September 8, 2023</h5> <h2>Ukrainian Newcomer Continuing Education Now Available</h2> <p>The Washington State Department of Health has created a training specifically designed to help health care professionals who work with Ukrainian new arrivals, titled <a href="">"Connecting with Ukrainian refugees: Meeting their needs with better care and key services."</a> This course, informed during development by input from WSMA members, is free and will confer continuing education credits for nurses, physicians, pharmacists, and medical assistants.</p> <p>The training hopes to empower anybody working with newly arrived Ukrainians with tools and resources to</p> <ul> <li>Help build positive relationships</li> <li>Conduct screenings for physical and mental health needs</li> <li>Provide information about available benefits and services</li> <li>And more.</li> </ul> <p>For those working with Ukrainian newcomers, this training is important because it highlights the needs specific to this population and provides crucial background information for practitioners to consider as they form treatment plans and engage in conversations with their patients and clients.</p> <p><a href="">We invite you to take the training yourself and share with anyone interested</a>. The DOH offers a big thank you to the WSMA members who pilot tested this training and ensured it met the needs of Washington physicians and health care professionals.</p> </div>9/8/2023 12:00:00 AM1/1/0001 12:00:00 AM
update-on-implementation-of-balance-billing-lawsUpdate on Implementation of Balance Billing LawsLatest_NewsShared_Content/News/Membership_Memo/2023/september-7/update-on-implementation-of-balance-billing-laws<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/invoice_645x425.jpg" class="pull-right" alt="Calculator, stethoscope, bill, pen" /></div> <h5>September 8, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>Update on Implementation of Balance Billing Laws</h2> <p>Your WSMA has engaged extensively in recent years on state and federal legislation relating to balance billing, seeking to ensure fair reimbursement and associated policies in circumstances where physicians provide care to enrollees of health plans they are not contracted with. With the passage of a state law, the Balance Billing Protection Act, in 2019 and a federal law, the No Surprises Act, in 2020, our attention has turned to how the two laws are implemented. WSMA members should be aware of recent important updates on both laws.</p> <p>At the state level, disputes on appropriate reimbursement are governed by an arbitration process under the Balance Billing Protection Act. The state arbitration system was slated to be decommissioned on July 1, with dispute resolution migrating to the federal independent dispute resolution system under the No Surprises Act. Due to WSMA advocacy, the state's Office of the Insurance Commissioner <a href="">recently announced</a> that the state arbitration system will remain in place at least until July 1, 2024. This is a positive development as state arbitration has produced favorable results for physicians, in terms of payment determinations as well as maintaining incentives for insurance carriers to contract.</p> <p>By contrast to the experience of the state arbitration system, the implementation of federal independent dispute resolution system has been disastrous. Federal regulators repeatedly went beyond the bounds of the law passed by Congress to skew the dispute resolution process towards insurance carriers. The Texas Medical Association has brought <em>four</em> successful lawsuits challenging the implementation of the dispute resolution process (the fourth favorable <a href="">ruling issued just last week</a>), and as a response, <a href="">federal regulators have paused the implementation of the dispute resolution system</a> "until the departments can provide additional instructions." </p> <p>For questions, contact WSMA Director of Government Affairs Sean Graham at <a href=""></a>.</p> </div>9/8/2023 12:00:00 AM1/1/0001 12:00:00 AM
stay-abreast-of-covid-19-developments-and-earn-cmeStay Abreast of COVID-19 Developments-and Earn CMELatest_NewsShared_Content/News/Membership_Memo/2023/august-25/stay-abreast-of-covid-19-developments-and-earn-cme<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/august/child-vaccine-645x425px.jpeg" class="pull-right" alt="Child getting a vaccine while her mother stands near" /></div> <h5>August 25, 2023</h5> <h2>Stay Abreast of COVID-19 Developments-and Earn CME</h2> <p>The state Department of Health's Power of Providers initiative has added CME to its no-cost peer-to-peer webinars. Of particular interest to physicians and physician assistants is the most recent webinar, <a href="">The Landscape of Post Covid-19 Conditions - Where We Are Now in 2023</a>, which was attended by almost 500 people. The webinar was held on Aug. 11, and continuing education credits are available until Nov. 14, 2023. This activity has been approved for <em>AMA PRA Category 1 Credit</em><sup>TM</sup>. More webinars addressing vaccine fatigue, disaster cascade recovery, burnout, and more are coming soon. See the <a href="">DOH initiative webpage</a> for more information.</p> <p>For WSMA members who are vaccinators, the DOH encourages enrollment in the <a href="">Children's Vaccine Program</a> and the <a href="">Adult Vaccine Program</a>. These programs will offer COVID-19 vaccines, as well as routine childhood and some adult vaccines, at no cost after COVID-19 vaccines become commercialized this fall. Also, for a limited time, vaccines for the uninsured and underinsured will be available through the <a href="">CDC's Bridge Access Program</a> later this fall.</p> </div>8/25/2023 12:00:00 AM1/1/0001 12:00:00 AM
wsmas-2024-legislative-agenda-a-previewWSMA's 2024 Legislative Agenda: A PreviewLatest_NewsShared_Content/News/Membership_Memo/2023/august-25/wsmas-2024-legislative-agenda-a-preview<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/august/wa-capitol-dome-645x425px.jpeg" class="pull-right" alt="Washington capitol dome" /></div> <h5>August 25, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>WSMA's 2024 Legislative Agenda: A Preview </h2> <p>Washington state may have a part-time Legislature, but WSMA's government affairs team in Olympia works year-round to advance the interests of the physician community, and today is busy preparing for the 2024 legislative session. The 2024 session will begin on Monday, Jan. 8, and will last 60 days (per the state's constitution, even-numbered years are "short" sessions). Legislators will have the opportunity to tweak the state's two-year budget passed during the 2023 session, and bills that did not pass this year will once again be in play. Among the hundreds of issues the WSMA will track and engage on in the 2024 session, the following are rising to the top of our tentative legislative priorities:</p> <ul> <li><strong>Medicaid reimbursement rate increases</strong>: While the 2023 state budget made a down payment on our request for across-the-board increases for Medicaid professional services to at least the rates paid by Medicare, continued advocacy is needed to ensure that the state fully funds the Medicaid program to reflect the cost of delivering care and ensure patient access.</li> <li><strong>Health care workforce</strong>: The pandemic put an immense strain on our entire health care system and exacerbated workforce shortages across health care professions. Efforts are needed to support and retain the existing workforce, as well as to invest in education and training to support care delivery and bolster physician-led teams.</li> <li><strong>Scope of practice</strong>: A number of scope of practice proposals are expected to be considered again and the WSMA will prioritize patient safety and education and training requirements as <a href="[@]wsma/about/policies/whats_our_policy/scope-of-practice/scope-of-practice-general.aspx">guided by our policy</a> when engaging on these issues. Of note, the WSMA is currently working with the Washington Academy of Physician Assistants to consider revisions to the PA Practice Act that would maximize flexibility and employment opportunities for PAs while ensuring appropriate safeguards remain in place.</li> </ul> <p>Don't forget to save the date for the WSMA Legislative Summit on Jan. 24, 2024, in Olympia! If you have questions or feedback regarding WSMA's legislative advocacy, reach out to Sean Graham at <a href=""></a>.</p> </div>8/25/2023 12:00:00 AM1/1/0001 12:00:00 AM
congressional-action-needed-to-fix-medicareCongressional Action Needed to Fix MedicareLatest_NewsShared_Content/News/Membership_Memo/2023/august-11/congressional-action-needed-to-fix-medicare<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/august/medicare-blocks-645x425px.jpeg" class="pull-right" alt="horizontal set of blocks spelling Medicare" /></div> <h5>August 11, 2023</h5> <h2>Congressional Action Needed to Fix Medicare </h2> <p>Following the news of the decision by the Centers for Medicare and Medicaid Services to <a href="">propose cuts in physician payments in its 2024 physician payment schedule</a>, the WSMA is joining the American Medical Association in renewing calls for Congress to act quickly and decisively to fix a broken Medicare payment system.</p> <p>The WSMA and the AMA strongly support the Strengthening Medicare for Patients and Providers Act (<a href="">H.R. 2474</a>), a bipartisan measure now pending in Congress that would provide the crucial link between the Medicare physician payment schedule and annual inflation-based payment updates and finally put physicians on an equal fiscal footing with other entities drawing Medicare payment. Physicians can <a href="">contact their representatives in Congress to urge passage of H.R. 2474</a>.</p> <p>For those physicians who are meeting virtually or in person with their legislators and staff, a variety of resource materials are available at <a href="">,</a> including plain language explanations of the need for automatic, annual inflation-based payment updates, reforms to budget neutrality policies, and simplifying the Merit-Based Incentive Payment System.</p> <p>The WSMA and the AMA intend to fight tirelessly for a financially stable and wholly predictable Medicare physician reimbursement model that protects both physicians and the patients they serve. We urge you to join us in urging Congress to ensure that Medicare continues to fulfill its crucial role in safeguarding both the health and financial well-being of tens of millions of Americans.</p> </div>8/11/2023 12:00:00 AM1/1/0001 12:00:00 AM
out-of-state-risk-and-your-compact-licenseOut-of-State Risk and Your Compact LicenseLatest_NewsShared_Content/News/Membership_Memo/2023/august-11/out-of-state-risk-and-your-compact-license<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/august/washington-state-evergreen-645x425px.jpeg" class="pull-right" alt="illustration of Washington State with silhouettes of people overlaying it" /></div> <h5>August 11, 2023</h5> <h2>Out-of-State Risk and Your Compact License</h2> <p>The 2023 state legislative session saw the passage of bills putting in statute important protections for physicians and health professionals providing reproductive health and gender-affirming care, including a legal shield against predatory subpoenas and restrictions on both regulatory discipline and license application denials by the Washington Medical Commission based on reproductive health care services. This week, the commission issued an important reminder that physicians and practitioners licensed through the Interstate Medical Licensure Compact do not enjoy similar protections due to compact requirements in statute, and that actions should be considered to minimize the legal risk to their licenses.</p> <p>The commission offers the following optional guidance for physicians and practitioners with compact licenses:</p> <ul> <li>The state of principle license is your entry point into the compact. If that license has received discipline or is revoked, all compact licenses in member states issued dependent on that state of principle license must receive a similar action or be revoked, per law. If you hold a compact state of principle license that is not based in Washington and you provide reproductive services or gender affirming care, consider transferring your state of principle license designation to Washington.</li> </ul> <ul> <li>Physicians participating in the compact may change their state of principle license at any time by using the compact redesignation process. Learn more and redesignate <a href="">here</a>. It is advisable to take this action soon as the criteria may be changing.</li> </ul> <ul> <li>As a reminder, you must show one of the following to designate Washington your state of principle license:</li> <ul> <li>Your primary residence is Washington.</li> <li>Twenty-five percent of your practice of medicine occurs in Washington.</li> <li>Your employer is located in Washington.</li> <li>Washington state is your state of residence for federal income tax purposes.</li> </ul> </ul> <ul> <li>Reciprocal license is based on a valid state of principle license. Action taken against a reciprocal license may allow other compact licenses, including the state of principle license, to stand depending on the circumstances. If you hold a reciprocal compact license, consider contacting the commission to convert the license free of charge to a standard MD license. There is no impact on scope or use and you will save $25 in renewal fees paid to the compact. The added benefit is you will be insulated from automatic disciplinary actions of the compact system. To change your license in this way please fill out <a href="" target="_blank" rel="noreferrer">this form</a>. </li> </ul> <p>For questions, contact the Washington Medical Commission licensing unit at <a href=""></a> or 360.236.2750 (choose option #1).</p> </div>8/11/2023 12:00:00 AM1/1/0001 12:00:00 AM
weekly-rounds-august-4-2023-listen-and-learn-with-wsma-podcastsWeekly Rounds: August 4, 2023 - Listen and Learn with WSMA PodcastsLatest_NewsShared_Content/News/Weekly_Rounds/2023/weekly-rounds-august-4-2023-listen-and-learn-with-wsma-podcasts<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Weekly%20Rounds/Weekly-Rounds-Article-Graphic-2022-645x425px.png" class="pull-right" alt="Weekly Rounds logo" /></div> <h5>August 4, 2023</h5> <h2>Listen and Learn with WSMA Podcasts</h2> <p>Jennifer Hanscom, CEO </p> <p> At our all-staff appreciation luncheon this week, a few of us were discussing the first show we ever streamed. Can you remember what you first streamed? I believe mine was The Sopranos on HBO, if that counts. When Netflix moved from mailing videos to streaming online, I was busy balancing my career while starting my family, so those years are a little blurry for me. </p> <p> Some of us were also talking about our commutes-with staff traveling to our Seattle event from Olympia, Port Orchard, Bainbridge Island, Shoreline, and other points around the Sound. As I thought about it, I realized I've never had a commute of less than 45 minutes. That's a lot of time with NPR. In fact, sometimes I'm in the car long enough that the morning news starts to repeat before I arrive at my destination. When that happens, I turn to music, audio books, or a podcast. </p> <p> Lately, I've been tuning into WSMA's new podcast series on opioid prescribing. Hosted by former WSMA President Nathan Schlicher, MD, JD, the podcast series includes conversations with policymakers, physicians, and WSMA staff on an array of topics about the opioid crisis: How we got there; myths about treatment; and how to reduce the dependence on opioids for pain management where appropriate, help those suffering with chronic conditions safely, and help those with addiction. </p> <p> In less than 30 minutes, the podcast can be listened to or viewed at your convenience, with a new episode posted every couple of weeks. Even better, each podcast has CME credit, as well. </p> <p> If you are a commuter or are looking for something to listen to during your workouts or walks with your dog, give the Better Prescribing, Better Treatment Podcast a listen. Dr. Schlicher is so engaging and his conversations with guests on the podcast are informative and insightful. I've even recommended the series to my friends, particularly those who have read the excellent book "Dreamland" or watched the show "Dopesick." The podcast similarly explains how the opioid crisis has evolved in Washington state and provides useful information about work that is being done at the bedside to improve care for patients and our communities. </p> <p> For your convenience, here is the current episode guide. Just click on a link below via your phone or computer to listen. We'll soon be launching an official podcast station, so stay tuned. Meanwhile, enjoy these episodes! </p> <h3>Episode Guide</h3> <p> Episode 1: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?_zs=B3aFd1&_zl=His89#episode1">The Future of the Better Prescribing, Better Treatment Program at WSMA</a> </p> <p> Episode 2: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?_zs=B3aFd1&_zl=Iis89#episode2">The History of Opioid Prescribing Legislation</a> </p> <p> Episode 3: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?_zs=B3aFd1&_zl=Jis89#episode3">Prescribing Opioids in a Rural Setting</a> </p> <p> Episode 4: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?_zs=B3aFd1&_zl=Kis89#episode4">Opioids in Obstetrics</a> </p> <p> Episode 5: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?_zs=B3aFd1&_zl=Lis89#episode5">Opioids in Pediatrics</a> </p> <p> Episode 6: <a href="[@]wsma/resources/opioids/better-prescribing-better-treatment-podcast.aspx?_zs=B3aFd1&_zl=Mis89#episode6">Opioids in Hospice</a> </p> </div>8/4/2023 12:00:00 AM1/1/0001 12:00:00 AM
more-medicare-physician-payment-cuts-on-the-horizonMore Medicare Physician Payment Cuts on the HorizonLatest_NewsShared_Content/News/Membership_Memo/2023/july-28/more-medicare-physician-payment-cuts-on-the-horizon<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/july/doctor-piggy-bank-illustration-shutterstock-1860228250-645x425px.png" class="pull-right" alt="doctor with piggy bank illustration" /></div> <h5>July 28, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>More Medicare Physician Payment Cuts on the Horizon </h2> <p>The Centers for Medicare and Medicaid Services is once again proposing cuts in physician payments in its 2024 physician payment schedule.</p> <p>Top lines from the <a href="" target="_blank" rel="noreferrer">proposed rule</a>, courtesy of the American Medical Association:</p> <ul> <li>The 2024 Medicare conversion factor is proposed to be reduced by 3.36% from $33.8872 to $32.7476. Similarly, the anesthesia conversion factor is proposed to be reduced from $21.1249 to $20.4370.</li> <li>CMS also proposes to increase the performance threshold to avoid a penalty in the Merit-based Incentive Payment System from 75 points to 82 points. CMS estimates this would result in an increase in the number of MIPS-eligible clinicians who would receive a penalty of up to -9%.</li> <li>CMS proposes to delay mandatory electronic clinical quality measure adoption by Medicare Shared Savings Program participants, who would have the option to continue using the CMS web interface in 2024. As finalized in previous rulemaking, Medicare Shared Savings Program participants would have been required to report their quality measures electronically starting in 2024. We are glad to see CMS recognize the lack of maturity with health information technology standards to seamlessly aggregate data from electronic health records from physicians who practice at multiple sites or are part of an accountable care organization.</li> </ul> <p>As we do each year, the WSMA will join the AMA and organized medicine to stop these cuts before year end.</p> <p>CMS' decision to propose cuts in physician payment is disappointing, particularly as it follows a recommendation earlier in the year by the Medicare Payment Advisory Commission that physician payment updates be tied to the Medical Economic Index, the government's measure of inflation on medical practices. Unlike virtually all other health professionals participating in the Medicare program, physician services do not receive an annual inflationary update.</p> <p>In the coming months, the WSMA will also join the AMA in continuing to draw attention to the need to reform the Medicare payment system to ensure that physicians can continue to care for Medicare patients. At its recent annual meeting, the AMA <a href="[@]Shared_Content/News/Membership_Memo/2023/june-23/ama-strengthens-commitment-to-medicare-physician-payment-reform-at-annual-meeting.aspx?_zs=A3aFd1&_zl=ON959">redoubled its commitment to Medicare physician payment reform</a>.</p> <p>Visit <a href="">Fix Medicare Now</a> for information on how you can take action to support the effort.</p> </div>7/28/2023 12:00:00 AM1/1/0001 12:00:00 AM
new-tools-to-help-physicians-and-pas-address-patients-drivers-of-healthNew Tools to Help Physicians and PAs Address Patients' Drivers of HealthLatest_NewsShared_Content/News/Membership_Memo/2023/july-28/new-tools-to-help-physicians-and-pas-address-patients-drivers-of-health<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/july/lets-take-5-image-645x425px.png" class="pull-right" alt="Let's Take 5 graphic" /></div> <h5>July 28, 2023</h5> <h2>New Tools to Help Physicians and PAs Address Patients' Drivers of Health</h2> <p>This spring, the Physicians Foundation launched <a href="">Let's Take 5 to Address Drivers of Health</a>, a new campaign that supports physicians and physician assistants in addressing their patients' drivers of health, such as food security and transportation access.</p> <p>The Let's Take 5 campaign supports physicians and PAs by providing steps to start conversations with patients and integrate evidence-based approaches in clinical care settings, so patients' overall health and well-being are less dependent on the five key types of drivers of health. The initiative offers two critical resources to help physicians and PAs:</p> <ol> <li><a href="" target="_blank" rel="noreferrer"><em>Let's Take 5 Conversation Starter</em></a><em>: </em>A guide for physicians to prepare their teams to have empathetic and empowering conversations with patients about drivers of health.</li> </ol> <ol> <li><a href="" target="_blank" rel="noreferrer"><em>Let's Take 5 Steps Implementation Guide</em></a><em>:</em> A resource with five key steps to help physicians and their teams integrate patient screenings through clinically validated workflow approaches.</li> </ol> <p>For more information, visit <a href="">Let's Take 5 to Address Drivers of Health</a>.</p> </div>7/28/2023 12:00:00 AM1/1/0001 12:00:00 AM
physicians-insurances-2022-annual-report-shows-carrier-in-strong-shapePhysicians Insurance's 2022 Annual Report Shows Carrier in Strong ShapeLatest_NewsShared_Content/News/Membership_Memo/2023/july-28/physicians-insurances-2022-annual-report-shows-carrier-in-strong-shape<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/july/pi-annual-report-2022-645x425px.png" class="pull-right" alt="2022 Physicans Insurance Annual Report cover" /></div> <h5>July 28, 2023</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>Physicians Insurance's 2022 Annual Report Shows Carrier in Strong Shape</h2> <p>This month, Physicians Insurance A Mutual Company, our endorsed physician-owned carrier, issued its 2022 annual report recapping another notable year and celebrating 40 years as the Northwest's leading medical professional liability insurance company.</p> <p>A few 2022 highlights from the report:</p> <ul> <li>$105 million in dividends were returned to policy owners, continuing a long tradition of giving back to its members, and essentially lowering the cost of yearly premiums.</li> <li>AM Best affirmed PI's A- (Excellent) financial strength rating.</li> <li>PI's surplus remains strong at $270 million, despite market volatility.</li> <li>PI became the first medical malpractice carrier in the nation to provide criminal defense reimbursement coverage, created in partnership with the WSMA to reimburse the defense costs that physicians and hospitals may incur in responding to criminal allegations arising from direct patient care.</li> </ul> <p>Download the <a href="" target="_blank" rel="noreferrer">Physicians Insurance 2022 Annual Report</a>.</p> <p>Most WSMA members receive a $300 discount on their liability premium with <a href="">Physicians Insurance</a>. Call Physicians Insurance at 206.343.7300 for details.</p> </div>7/28/2023 12:00:00 AM1/1/0001 12:00:00 AM
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