| member-profile-greg-may-md | Member Profile: Greg May, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/member-profile-greg-may-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/member-spotlight-greg-may-website-image-645x425px.png" class="pull-right" alt="Member Profile: Greg May, MD graphic" /></div>
<h5>Sept. 19, 2023</h5>
<h2>Member Profile: Greg May, MD</h2>
<p>
<strong>Works at:</strong> Harbor Regional Health Orthopedics in Aberdeen.
</p>
<p>
<strong>How long in practice:</strong> 28 years. Specialty: Orthopedics and hand surgery.
</p>
<p>
<strong>Why WSMA: </strong>I'm active in the WSMA because the politics of health care demand unity, and the WSMA supports physicians and physician leadership. I've been more active over time and have particularly enjoyed the WSMA Leadership Development Conference, which I try to attend annually.
</p>
<p>
<strong>Top concerns:</strong> One of my top concerns in medicine, which affects all specialties, is the onerous requirements of prior authorization. It is an additional burden the insurance industry has placed on us. My academy [the American Academy of Orthopaedic Surgeons] and the WSMA are actively working on changing this unnecessary delay tactic.
</p>
<p>
<strong>Why my specialty: </strong>I'm drawn to my specialty because I'm a happy tinkerer. I've always been mechanically inclined and enjoyed discovering how things work. My specialty is mechanically oriented, particularly regarding the intricacies of hand anatomy. Orthopedics also treats all musculoskeletal conditions and patients of all ages. I enjoy this variety that my patients bring to the clinic.
</p>
<p>
<strong>Proud moment in medicine:</strong> I'm proud that three of my four daughters have chosen medicine as their profession. My wife (WSMA member Anne Marie Wong, MD) is also a physician, and the fact that my children feel this is a worthy profession to pursue after living with their medical parents makes me feel like I've done something right. Unrelated to medicine, I am proud of my daughter who is in engineering and also a happy tinkerer.
</p>
<p>
<strong>Challenges in profession:</strong> The shortage of physicians and attempts to replace them with advanced practice practitioners is a major change challenging our profession. This lack of physicians, particularly in rural areas, contributes to the already exorbitant cost of care and affects those most vulnerable due to social determinants of health.
</p>
<p>
<strong>What people may not know:</strong> I have kept bees for the last three years. I have two hives in my backyard, and I enjoy them and their honey. Bees are wonderful and an important part of our ecosystem.
</p>
<p>
<strong>Spare time:</strong> When I'm not at work, I spend my time enjoying craft beer, going to yoga class, downhill skiing, and spending time with my grandchildren.
</p>
<p>
<strong>Favorite quote:</strong> "Always laugh when you can, it is cheap medicine." -English poet Lord Byron.
</p>
<p>
<em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/19/2023 10:05:51 AM | 9/19/2023 10:02:25 AM | 9/19/2023 12:00:00 AM |
| ya-es-tiempo-its-time | Ya Es Tiempo (It's Time) | WSMA_Reports | Shared_Content/News/Latest_News/2023/ya-es-tiempo-its-time | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/heartbeat-meljen-website-image-645x425px.png" class="pull-right" alt="Heartbeat: Vivienne Melvin MD logo" /></div>
<h5>Sept. 15, 2023</h5>
<h2>Ya Es Tiempo (It's Time)</h2>
<p>By Vivienne Meljen, MD</p>
<p>
Most of my patients have a look of surprise on their face when they first see me stepping into the exam or hospital room clad in casual scrubs, sneakers, a mask, and with my short wavy hair. Yet, so often I watch this common reaction melt away as it sets in that I'm speaking Spanish with them and I am their doctor. Just as my entrance often elicits surprise, my exit will end with some variation of them saying "Gracias, que Dios te bendiga doctora" (Thank you, God bless you, doctor). At the end of my day, these are the patients who fill my soul. Yet my heart hurts for them when I see how their struggles with the health care system affect their lives.
</p>
<p>
When I first started my OB-GYN practice, I felt patient questions about my age, life, and background were distractions from the care I was giving. I would try to address their questions honestly but briefly to maximize my time with them. That was, until I later recognized that for most of my patients, I am the first Latina physician and surgeon they are meeting. When I reflect on this, I realize that even at the diverse academic institutions where I trained, I hadn't met someone who was "like me" until I was a resident.
</p>
<p>
Patients are genuinely curious about how a young Latina, not unlike them, came to be in a position to care for them. They are hungry for culturally competent health care. They want someone to understand. I've never been more certain that maternal care in this country is not in a good place right now, and this is especially true for the ethnic minorities who make up much of Washington's medically underserved.
</p>
<p>
We know that diversity in the health care workforce improves the provision of care and patient experience. We also know that the few patients who can access health care in a culturally competent way are more likely to do so and thus have better outcomes. In this context, the closing of hospital maternity units across Washington and gaps in clinics accepting pregnant patients with Medicaid are creating wounds to our most sensitive communities that can only be fixed by taking the exact opposite actions and increasing access and care.
</p>
<p>
When compared to other gender-matched specialties, obstetric and gynecologic care is beyond disproportionally reimbursed. Health systems will say higher reimbursements are "not sustainable," but neither is providing high-risk services to the medically underserved on shoestring budgets and burning out the clinicians who are choosing to serve them.
</p>
<p>
I recognize each day that as the daughter of Cuban immigrants, my path could have been very different. As a teenager I interpreted for my Abuela (grandmother), who died unnecessarily from a preventable cervical cancer. I received Pell grants and went to medical school with not only student loans, but also medical debt. I've been a Medicaid patient. When patients tell me their struggles, I am looking at my own reflection. It's why I sought to work for an organization where I could have the greatest impact on the Latino community.
</p>
<p>
It will take deliberate work, but if we are going to support every woman in Washington there are no other options in my mind:
</p>
<ul>
<li>We need to bolster community-building around health care centers, so patients feel welcome and comfortable seeking care and the physicians and practitioners who are looking to serve these communities can be validated.</li>
<li>We need to support the education and pipeline programs of our youth in a meaningful way, much like the efforts of WSU's homegrown physician mission. I am an National Health Service Corps and Truman scholar-it is possible. These initiatives work.</li>
<li>We need to improve reimbursement for obstetric and gynecologic care so our clinicians and organizations can sustain care models that allow for the actual time it takes to counsel patients in their native tongue or with interpreters in a meaningful way. Not be rushed to meet the system's bottom line.</li>
<li>We need to maintain the caring clinicians we have and listen to the frontline voices.</li>
<li>We need to support women and diverse candidates to fill true leadership positions across all facets of this industry so they can be change agents.</li>
</ul>
<p>
Policy makers, insurers, leaders, and health care conglomerates may say they are "caring for mothers and infants," but their actions speak louder than words. Maternal services in Washington will continue to be plagued by staffing shortages and physician, midwife, and nurse burnout if we don't see radical change. Ya es tiempo. (It's time)
</p>
<p>
<em>Vivienne Meljen, MD, is an OB-GYN at SeaMar Vancouver Women's Health Center and an assistant professor at Elson S. Floyd College of Medicine, Washington State University.</em>
</p>
<p>
<em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/19/2023 10:07:47 AM | 9/19/2023 10:07:19 AM | 9/15/2023 12:00:00 AM |
| a_family_tradition | A Family Tradition | WSMA_Reports | Shared_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.&nbsp;</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.â€</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.â€</p>
<p>
<em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/15/2023 10:41:20 AM | 9/14/2023 11:46:21 AM | 9/14/2023 12:00:00 AM |
| a-growing-maternity-care-crisis-in-washington | A Growing Maternity Care Crisis in Washington | WSMA_Reports | Shared_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 11:46:14 AM | 9/14/2023 11:45:42 AM | 9/14/2023 12:00:00 AM |
| doctors-making-a-difference-sara-mazzoni-md | Doctors Making a Difference: Sara Mazzoni, MD | WSMA_Reports | Shared_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 11:33:33 AM | 9/14/2023 10:57:51 AM | 9/14/2023 12:00:00 AM |
| responding-to-dobbs | Responding to Dobbs | WSMA_Reports | Shared_Content/News/Latest_News/2023/responding-to-dobbs | <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. 5, 2023</h5>
<h2>Responding to Dobbs</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
Like many OB-GYNs around the country, Sarah Prager, MD, learned of the U.S. Supreme Court's decision to overturn Roe v. Wade and leave abortion policies up to individual states while she was at work. For Dr. Prager, division chief of complex family planning for UW Medicine in Seattle, the news of the Dobbs v. Jackson Women's Health Organization decision came during a team huddle before a full day of scheduled abortions.
</p>
<p>
"I felt an immediate sense of doom, also tearful," says Dr. Prager. "We had colleagues coming into our OR all day to commiserate." Their sadness quickly turned to anger and an invigorated sense of purpose, says Dr. Prager, who talked to reporters in between cases that day and drafted a statement reinforcing her department's commitment to the full spectrum of reproductive health care.
</p>
<p>
That commitment to abortion and evidence-based care between a doctor and patient has long been the foundation of reproductive health care in the Evergreen State. Washington first legalized abortion in 1970-the first state to do so by referendum and three years prior to the Supreme Court's landmark Roe decision making abortion a constitutional right nationwide. It's a commitment Washington and the WSMA have rededicated themselves to as the rights of patients and doctors come under attack in ways never imagined.
</p>
<h3>Legal repercussions from and in response to Dobbs</h3>
<p>
The fallout from the Dobbs decision was immediate and wide-ranging, affecting reproductive health beyond abortion care. Numerous conservative states have passed laws not only to severely restrict or ban abortion within their own borders (14 states to date have a full ban in effect), but also to penalize those seeking and providing abortion care out of state.
</p>
<p>
"There's a lot of uncertainty and confusion-that's the point of these abortion restrictions. They're intended not only to make it harder to seek out these services and perform these services, but also to create chaos, which in itself diminishes the ability to access care," says Alex Wehinger, WSMA's associate director of legislative advocacy.
</p>
<p>
To counter these efforts, 20 Democrat- controlled states, including Washington, have put new and additional laws in place to expand access to care within their borders and to protect those seeking or providing care from laws in other states. On April 27, Washington Gov. Jay Inslee signed a package of laws protecting reproductive care (see sidebar on facing page).
</p>
<p>
"We are doing what we can in Washington state to insulate both the patients and the physician community here to the extent possible under Washington state law," says Wehinger.
</p>
<p>
In addition, Washington is leading 17 states and the District of Columbia in a lawsuit to preserve and expand access to mifepristone, a safe and effective drug prescribed for medication abortions. On April 13, Judge Thomas O. Rice of the U.S. District Court for the Eastern District of Washington issued an order affirming that mifepristone access remains protected in Washington and in the other states involved in the lawsuit. This means any certified health care professional can prescribe mifepristone for up to 10 weeks gestation. Patients can get it through the mail and via telehealth appointments.
</p>
<p>
"This past year was a very successful year in Washington for reproductive rights. I was honored to be at that signing," says Nariman Heshmati, MD, WSMA's incoming president for 2023-2024 and legislative chair for the American College of Obstetricians and Gynecologists Washington section, who attended the reproductive health legislation package signing ceremony presided over by Gov. Inslee. The WSMA worked with WA- ACOG and other advocacy groups to fight for these necessary protections.
</p>
<p>
Medical record privacy issues remain a big concern for both out-of-state and Washington patients, says Dr. Prager. She's had Washington residents ask her not to document abortion care in their electronic records for fear of someone accessing them in states with onerous abortion laws.
</p>
<p>
To protect patient and physician and physician assistant privacy regarding reproductive health care, the WSMA supports the U.S. Department of Health and Human Services' proposed modifications to the HIPAA Privacy Rule (see sidebar on following page).
</p>
<p>
Nationwide, 42% of OB-GYNs report that after Dobbs they are very or somewhat concerned about their own legal risk when making decisions about patient care and abortions, according to a survey by the Kaiser Family Foundation.
</p>
<p>
To this end, last year WSMA's endorsed liability insurer, Physicians Insurance A Mutual Company, developed criminal defense reimbursement coverage. It provides up to $250,000 in legal defense costs incurred in response to criminal allegations arising in connection to patient care.
</p>
<p>
"Historically, medical professional liability policies only provide coverage for civil suits and do not include coverage for any criminal defense costs. This means that in the absence of this coverage, a physician facing criminal charges related to the provision of abortion would be responsible for payment of any legal defenses related to those charges. This coverage provides physicians with the financial ability to seek a vigorous criminal defense," says Melissa Cunningham, general counsel and senior vice president for Physicians Insurance.
</p>
<p>
As new challenges unfold, the WSMA will continue working with advocates and legislators to identify opportunities to ensure access and protection for patients and the physician community, says Wehinger. There are already new bills in development for the next legislative session.
</p>
<h3>The impact on the ground in Washington</h3>
<p>
Since the Supreme Court's June 2022 decision, the number of monthly abortions in Washington has increased by an average of 166, according to data from the Society of Family Planning.
</p>
<p>
As expected, Washington has seen an increase in the number of out-of-state abortion patients. Since Dobbs, the number of such patients coming to Washington has risen by 36%, according to Planned Parenthood of Greater Washington and North Idaho. The bulk come from Idaho, which bans abortion at all stages of pregnancy with few exceptions- Washington has seen an increase of 56% coming from that state for abortion care.
</p>
<p>
An out-of-state patient population is nothing new for Washington OB-GYNs. "Even prior to Dobbs, there weren't many or any [abortion care] professionals past the first trimester in Wyoming, Alaska, Montana, and Idaho. So, we have taken care of patients in the region, particularly with more complicated pregnancies, for a long time," says Dr. Prager. Recently, she's also seen patients from further away, including from Oklahoma, Texas, and Louisiana.
</p>
<p>
With the specter of prosecution from their home state hanging over them, Dr. Prager does her best to reassure these patients. "What we can say to them is that the care you are getting is safe and legal here. And you have no obligation to share this information with anybody. And your records are as secure as we can make them."
</p>
<p>
Another concern for OB-GYNs here is that lack of access to care elsewhere means that by the time patients come to Washington for reproductive care, physicians are seeing them in later stages of gestation or with serious complications, says Dr. Prager.
</p>
<p>
Across the country, the uncertainty caused by restrictive abortion laws has prompted both individuals and families to make preemptive decisions about their reproductive health. Dr. Prager has seen a 10- fold increase in patients seeking sterilization procedures or permanent contraception.
</p>
<p>
"I'm not just inferring this. Patients were very blatantly saying, 'I don't want any chance that I will have a pregnancy that I can't manage. And I don't want to be pregnant in this context,' " she says. "People are concerned that they may not always live in Washington state or that their job might take them elsewhere, to a state where they can't access abortion care."
</p>
<p>
Worried that contraception is next on the conservative chopping block, patients are also asking for their IUD or long-acting contraception to be replaced early. "They want to have the longest time possible for the device to remain effective," says Dr. Prager.
</p>
<h3>Far-reaching consequences</h3>
<p>
Dr. Heshmati has heard from colleagues around the country regarding the Dobbs decision and how it impacts them. Beyond concerns over losing their right to make evidence-based patient care decisions, Dobbs has already begun to change the medical landscape in other negative ways, says Dr. Heshmati. "Many doctors who are in restrictive states have chosen to relocate. In some cases, physicians looking for OB-GYN training programs are avoiding states that do not offer the full complement of reproductive health."
</p>
<p>
A study by the Association of American Medical Colleges found that medical students starting residency programs, regardless of specialty, were far less interested in matching in states with abortion bans or gestational limits than in states without those restrictions.
</p>
<p>
"There's a concern for practicing abortion care, but also of having access to the full spectrum of evidence-based reproductive health care for themselves or their partners," says Dr. Prager, who was not involved in the study. "There is going to be difficulty recruiting physicians to states where abortion is illegal because of these reasons. And that's going to lead to huge problems around the country for general medical care."
</p>
<p>
All physicians and physician assistants, not just OB-GYNs, must play a vital role in advocating for abortion care, say Dr. Prager and Dr. Heshmati.
</p>
<p>
"We all have a moral obligation to still take care of our patients as much as we can in the state in which we live," says Dr. Prager. "But every specialty needs to fight for access to abortion to be safe and legal across the country. And not to be this piecemeal patchwork of different legislation that is not tested and not understandable."
</p>
<p>
"As WSMA president, I will continue the legacy of physicians standing together regardless of specialty to ensure patients have access to quality care and make our state the best place to practice medicine and receive care-and that includes ensuring access to the full scope of reproductive care because reproductive care is health care," says Dr. Heshmati.
</p>
<p>
<em>Rita Colorito 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> | 9/5/2023 4:23:08 PM | 9/5/2023 4:21:11 PM | 9/5/2023 12:00:00 AM |
| doctors-making-a-difference-clint-hauxwell-md | Doctors Making a Difference: Clint Hauxwell, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/doctors-making-a-difference-clint-hauxwell-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/july-august/july-aug-reports-cover-645x425px.jpeg" class="pull-right" alt="WSMA Reports cover July/August 2023" /></div>
<h5>August 9, 2023</h5>
<h2>Doctors Making a Difference: Clint Hauxwell, MD</h2>
<p>
As an assistant professor teaching clinical medicine at the University of Washington School of Medicine in Spokane and faculty advisor for UW's Family Medicine Interest Group, Clint Hauxwell, MD, is working to encourage medical students to get involved in shaping the future of medicine through legislative advocacy. Dr. Hauxwell talked with <em>WSMA Reports</em> about his work with medical students and their unique perspective on the policymaking process.
</p>
<p>
<strong><em>WSMA Reports:</em> Tell our readers a little about your work with medical students around the importance of advocacy and organized medicine.</strong>
</p>
<p>
<em>Dr. Hauxwell:</em> In my roles with the UW, I have had the privilege of observing medical students as they serve the community-for example, by treating patients at the local homeless shelter or by meeting with high school students who are interested in pursuing a career in health care. I work with students who entered medical school with a desire to make a difference in the lives of their patients, but few of them understand the concept of organized medicine and how institutions such as the WSMA and Washington Academy of Family Physicians can act as conduits for positive change.
</p>
<p>
I have been inspired by the advocacy opportunities afforded by membership in the WSMA and wanted to challenge local medical students to take advantage of those opportunities as well. At UWSOM Spokane we have coordinated an annual workshop where representatives from the WSMA and WAFP discuss advocacy from the perspectives of their organizations. This year, [2022-23 WSMA President] Katina Rue, DO, and [WSMA CEO] Jennifer Hanscom did an excellent job of introducing the resolution process and its impact on WSMA's policy and legislative agendas.
</p>
<p>
<strong>What motivated you to get involved with that work?</strong>
</p>
<p>
I saw a desire on the part of medical students to effect change on the local and state levels, and I recognized that both the WSMA and WAFP eagerly encourage student and early-career physician involvement. I distinctly remember being at the WSMA Leadership Development Conference in Chelan when a medical student stood up to make comments during one of the workshops. His input was received with enthusiastic applause from the other participants, and really highlighted the fact the students and residents are valued members of the WSMA.
</p>
<p>
<strong>What advocacy or policy issues in health care have you found that medical students are most passionate about?</strong>
</p>
<p>
Students are consistently interested in issues that directly impact patient health and are less concerned about policies that are aimed specifically at improving the lives of physicians. At the WSMA House of Delegates, student resolutions often focus on improving health care for the underprivileged. In a sense, students serve as the conscience of an organization such as the WSMA, reminding us that our focus should always be patient-centered. Over the past several years, students have proposed resolutions at the HOD focusing on prediabetes care, transgender health, and migrant worker safety.
</p>
<p>
<strong>How do you connect the dots between advocacy and how its outcomes can have a tangible impact on students' daily practice once they become physicians?</strong>
</p>
<p>
I think it is important to provide concrete examples of how advocacy, through the resolution process, has impacted WSMA lobbying efforts and has resulted in new legislation. We try to walk the students through the process: "Here is the issue, here is the successful [House of Delegates] resolution that addressed the issue, and, finally, here is the legislation that was eventually passed, with the support of the WSMA." Fortunately, we have many examples of successful student resolutions that have directed WSMA's policy or legislative agenda.
</p>
<p>
<strong>What advice would you give to students as the first step to getting involved with advocacy?</strong>
</p>
<p>
The first thing that I recommend is that they join an organization! This could be their county medical society, a specialty society, or the WSMA. Students are encouraged to identify an issue that they are passionate about and that needs to be addressed in Washington state. Historically we have held a resolution writing workshop and have directed them to the tutorial on the WSMA website. I find that medical students need minimal encouragement to get involved!
</p>
<p>
<em>This article was featured in the July/August 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 8/10/2023 12:01:54 PM | 8/10/2023 12:01:30 PM | 8/9/2023 12:00:00 AM |
| the-reluctant-leader | The Reluctant Leader | WSMA_Reports | Shared_Content/News/Latest_News/2023/the-reluctant-leader | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/july-august/heartbeat-website-image-walker-645x425px.png" class="pull-right" alt="Heartbeat column logo with Ed Walker MD" /></div>
<h5>July 25, 2023</h5>
<h2>The Reluctant Leader</h2>
<p>
Edward Walker, MD
</p>
<p>
I couldn't answer. I had no idea. The awkward silence felt embarrassing.
</p>
<p>
The physician sitting across from me had come for leadership coaching. I always enjoyed interacting with rising physician leaders, especially in the early stages of their development when they are first realizing their true potential. Her question was harmless, but it stopped me in my tracks: "When did you first decide to become a physician leader?"
</p>
<p>
Honestly, I didn't know. I still don't. It wasn't a single decision at a specific point in time, more of a slow realization that I was doing things that were consistent with being a leader, the formal roles I was slowly adopting evolving naturally rather than from ambition.
</p>
<p>
Having reflected on that moment, I've realized that many of the major decisions we make over the course of our lives are not simple transitions. I decided today at 11:30 a.m. to go out to lunch, but I don't recall the exact moment I decided to marry the woman I love. Some decisions are lightning strikes, but the really important ones often resemble the imperceptibly slow dawning of a new day.
</p>
<p>
To be honest, I don't think I ever aspired toward any of the many leadership positions I've held. Each chapter started out with a desire to be the best doctor I could be at that phase of my career. In the process of making care more safe, efficient, patient-centered, satisfying, and cost-effective, I ran into resistance and obstacles that could only be surmounted by assuming responsibility and authority. I recall several moments when I reluctantly concluded that the person to whom I reported was less interested or able to raise the bar in these areas, so I couldn't move forward without moving up.
</p>
<p>
Each time, something remarkable happened. As I assumed the responsibility and accountability of the role, a vision of what could happen beyond my initial plans would slowly materialize. To make things happen, I needed to inspire people to be different, to share in the transformation of our work together, and to involve everyone in a team effort to realize change. Yes, there were often colleagues with competing, sometimes self-interested visions, but the key was always to build the coalition around best practices in quality and fiscally responsible, patient-centered care.
</p>
<p>
Several times a year I stand in front of a group of future physician leaders in my WSMA Physician Leadership Course and we own up to why we're there. For some, it's the realization that they have already accepted the responsibilities of being a clinic medical director and they need the skills. For a small number of others, they've seen a path to being a chief medical officer, and they like what they see. But for many, maybe half the class, there are looming questions: "Should I be a leader?" "Can I make a difference?" "Do I have the right stuff?" By the end of the course, most have answered these questions for themselves.
</p>
<p>
They know what they need to do. They have been reluctant leaders all along. Now they have the path.
</p>
<p>
<em>Edward Walker, MD, MHA, is a professor emeritus in the departments of psychiatry and behavioral sciences and health services at the University of Washington in Seattle and senior physician advisor for the <a href="[@]wsma/physician_leadership/center-for-leadership-development.aspx">WSMA Center for Leadership Development</a>.</em>
</p>
<p>
<em>This article was featured in the July/August 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/1/2023 5:01:39 PM | 9/1/2023 5:01:12 PM | 7/25/2023 12:00:00 AM |
| raising-our-voices | Raising Our Voices | WSMA_Reports | Shared_Content/News/Latest_News/2023/raising-our-voices | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="cover of July-August 2023 issue of WSMA Reports" src="/images/Newsletters/Reports/2023/july-august/july-aug-reports-cover-645x425px.jpeg" class="pull-right" /></div>
<h5>July 18, 2023</h5>
<h2>Raising Our Voices</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<br />
<p>
Health care consolidations have been part of her medical career since Joanne Roberts, MD, former senior vice president and chief value officer at Providence, entered medicine in 1985. By the time the palliative medicine specialist retired in 2021, she had been through eight consolidations- an economic trend that has accelerated in recent years. Today, several major corporations dominate in Washington state, with the locus of control often moving from local hospital or practice administrations to corporate offices. Virginia Mason Health System and CHI Franciscan forming a joint operating company is the most recent local merger.
</p>
<p>
The economic sea change is due, in part, to the cost of doing business today and in response to similar consolidations nationwide. Many WSMA physicians work within these consolidated systems or soon will. A 2021 analysis by the Physicians Advocacy Institute found nearly seven in 10 doctors are either employed by a hospital or a corporation.
</p>
<p>
Consolidation isn't the only economic trend creating turbulence in health care today-that list would include escalating prescription drug costs, medical debt, staggering corporate profits, and an influx of profit-driven private equity into health care, among others. But the phenomenon certainly tops the list, and, together with those other trends, helps to form what physicians sometimes feel is the broken umbrella under which they must work today.
</p>
<h3>Navigating the new normal</h3>
<p>
The concern many physicians often express, either publicly or privately: Consolidation minimizes the patient and physician experience at the expense of maximizing margins. The newly created systems point to greater fiscal efficiencies, better coordinated patient care, and increased ability to move toward the value-based care models that many organizations, including the WSMA and the Washington State Department of Health, embrace as the future of medicine.
</p>
<p>
"The toothpaste is out of the tube, and we can't shove it back in," says Jennifer Hanscom, CEO of the WSMA. "As physicians navigate this consolidated practice environment, we must ensure that the physician- patient relationship and physicians' professional and independent judgment remain protected, even in our quest to have a healthy bottom line. What's essential is that physicians don't shy away from this conversation but instead lean in. Their ability to see the delivery system through a physician-patient lens is a unique perspective that they bring to the table."
</p>
<p>
Market pressures have often been blamed for increasing physician demoralization. It's a serious concern, says Hanscom, as health care systems face a growing physician shortage.
</p>
<p>
"We often hear the term 'no margin, no mission.' And yes, finances matter. But on a basic level, if you want to be financially successful, you have to deliver good care. And to deliver good care, you need to attract a workforce that is committed and able to do their best work," says Hanscom. "We need physicians who have that lived experience to be at those decision- making tables. That's crucial not only to good patient care, but also to having a good care delivery system."
</p>
<p>
During and after consolidations, Dr. Roberts has noticed a sense of helplessness among front-line physicians and middle-level managers who often respond, she says, with a "just-keep-my-head-down-and-take- care-of-my-patients" approach.
</p>
<p>
But there are things physicians can and should do to navigate what can feel like an economic tsunami, say experts. It starts with remembering the unique and necessaryroletheyoccupy,saysDr.Roberts, who now serves as a leadership development coach based in St. Paul, Minnesota.
</p>
<p>
"Physicians are the most key people in making these consolidations and mergers successful," she says. "The finances are in service to caring for patients. It's on physicians to keep reminding leaders that is the way the systems are set up to operate."
</p>
<h3>Leading through change</h3>
<p>
To better advocate for their patients and themselves, Dr. Roberts recommends all physicians-both those aspiring to leadership roles and front-line physicians-learn basic leadership skills, something not traditionally taught in medical school.
</p>
<p>
"If you are part of a large system, it's not your clinical skills that are going to make you feel like you are having an effect on the system. It's your leadership skills," says Dr. Roberts. "If I understand the basics of finances, I understand why certain decisions are made. If I understand and learn negotiation skills, then I can work with my colleagues across the new organization and we can agree on the way we're going to work together. But if you don't step up and develop those leadership skills, then I imagine you feel like a cog in a big system."
</p>
<p>
Hanscom encourages all WSMA members to take comprehensive leadership training through WSMA's Center for Leadership Development. During WSMA's first-ever Physician Leadership Course, the basic leadership "boot camp" that anchors the center's curriculum, Hanscom recalls physician leaders admitting to not understanding several common business acronyms. "It was this 'Aha!' moment for them," says Hanscom. "By learning the language of leadership, they learned to be more effective in bringing their perspective to the table, to do what's best for their patients and community."
</p>
<p>
Effective communication is bidirectional, says Jamie Park, MD, who recently became the new chief medical officer at Providence Swedish North Puget Sound. A family physician by craft, Dr. Park previously served as CMO for Valley Medical Center, a system which has a strategic alliance with UW Medicine. He's also gone through several consolidations during his 25-year career.
</p>
<p>
"It's also important for physicians to be able to listen and understand what organizations are trying to accomplish, because it doesn't work when you say, 'This is what I need,' when you don't understand what the other side is trying to accomplish," says Dr. Park. "Leadership training and understanding for even front-line positions can really open people's eyes as to what makes an organization tick, how process improvement works, all those kinds of things. So even though physicians may not be planning those things, they can interact with people who are doing those things in a more successful way."
</p>
<h3>Understanding market economics</h3>
<p>
Jeff Collins, MD, who retired from his last leadership role as regional chief physician executive for Providence's Washington and Montana region in December 2019, says physicians need to understand the economics of health care to effect meaningful change.
</p>
<p>
"When I started out in private practice in the late 80s, about 80% of doctors were in one- or two-doctor offices. We were criticized for being inefficient and old-fashioned," Dr. Collins recalls. Starting in the 1990s, Dr. Collins, like many other private- practice physicians, joined progressively larger physician groups, spurred in large part, he says, by the burden of ever- changing Medicare rules and growing administrative complexities.
</p>
<p>
"I can remember myself in an interview at the time saying, 'Physicians didn't invent this market, we're just trying to learn how to be successful in the marketplace,' " says Dr. Collins, who served as WSMA president from 2004- 2005. Even back then, one of WSMA's goals was helping physicians deal with the rise of health care consolidations.
</p>
<p>
In 2006, Dr. Collins became chief medical officer for Sacred Heart Medical Center in Spokane, the biggest hospital in the Providence system at the time. Like Dr. Roberts, he went through several consolidations with Providence.
</p>
<p>
Now on the outside looking in, Dr. Collins echoes a general criticism often leveled at consolidations. "[Consolidations] are not really delivering on the promises of scale that are supposed to happen when you consolidate," he says. "It's really part of a larger dynamic in the whole country of market fundamentalism, where the whole business community has decided that the market is going to solve all our problems."
</p>
<p>
Rather than alleviating economic burdens, consolidations can add new financial pressures on physicians, says Dr. Collins. "Physicians are often given data on their cost efficiency. And the data are incorporated into their compensation formula ... So, their patients' needs are put into direct conflict with the physicians' financial and career well-being, which contributes to burnout."
</p>
<p>
But Dr. Collins emphasizes that physicians shouldn't fall into the victimhood mindset, something he says he still sees all too often. "It's important when consolidations happen to understand what the value structure is at the core of the merged corporation and how they're going to incentivize behavior going forward," he says. Once physicians understand the system's value framework, they can bring their insights and experiences to the table to make it better, says Dr. Collins.
</p>
<p>
Although Dr. Collins says physicians are inherently conflict avoidant, he encourages them to embrace conflict when it matters. He recalls times when he challenged data or data analysis used to drive health care decisions. "I was able to engage the folks I worked with in a productive way by saying, 'You know, that is really not very patient-centric. It's pretty hospital-centric. If you were a patient, how would you deal with that situation?' " he says.
</p>
<h3>Protecting autonomy</h3>
<p>
Physicians often worry that consolidation will further erode their autonomy, a component often cited as critical to physician motivation and job satisfaction. Assuming the worst will happen can become a self-fulfilling prophecy, says Dr. Park.
</p>
<p>
"It's very easy to develop assumptions about what the new partnership either means or doesn't mean," says Dr. Park. "And if two people are acting on assumptions, if they're acting from two different playbooks, it just makes things more complicated."
</p>
<p>
Mentoring from someone who has gone through the consolidation process can help override some of those knee-jerk reactions, says Dr. Park, who counts Edward Walker, MD, MHA, who developed and teaches WSMA's Center for Leadership Development basic and advanced course curriculum, which now includes the Physician Leadership Course, the Dyad Leadership Course, and the Leadership Masterclass, as his mentor. "The benefit of that is not necessarily that you're going to know exactly how it's going to go for you or your group. But you're going to know better what questions to ask, what things to look for. It's an opportunity to turn an unknown into a known."
</p>
<h3>Rethinking "patient first"</h3>
<p>
Every consolidation is different. What physicians can do to ensure that any health care system doesn't shortchange patient care or physician autonomy will vary depending on the system structure.
</p>
<p>
"There is no perfectly green grass in the world of health care. Everywhere I have been does some things well and has opportunities in other areas," says Andrew Jones, MD, who became CEO of Confluence Health in July 2022. Prior to joining Confluence, Dr. Jones was the chief medical officer and vice president of medical affairs for St. Mary's Medical Center in Grand Junction, Colorado, and served in medical leadership for nearly 25 years for various organizations.
</p>
<p>
C-suite leaders, including Dr. Jones and Dr. Park, increasingly believe a patient-first care model is insufficient for integrated systems.
</p>
<p>
"I often see physicians want to focus only on 'quality care' or 'patients first' as a way to avoid the messiness of health care today and the questions about cost, workforce, community, diversity, and a host of other [issues]," says Dr. Jones. "That is shortsighted. To be a leader in health care is to take on the whole work of not only making our system better, but also to have it work better for our patients, which is so much more than simple slogans like 'patients first' or 'high-quality care.'"
</p>
<p>
Rather than a patient-first mindset, both Dr. Jones and Dr. Park say effective consolidations and organizations focus on the Quadruple Aim medical model: improving population health; enhancing the patient experience; reducing the cost of care; and improving caregiver satisfaction and well-being.
</p>
<p>
"If physicians want to be leaders in health care, they can't avoid any of these areas," says Dr. Jones. "Physician leaders can add amazing value with their knowledge of the system and their commitment to patients. Physicians can also struggle when they don't respect areas of health care that they either don't understand or don't like."
</p>
<p>
"It's better to say that we put the patient at the center of our decisions. But those things surround it and affect all of our decisions," says Dr. Park.
</p>
<p>
Though Dr. Park never worked as a private-practice physician, he understands the fear some may feel at the prospect of consolidation. "It's human nature to think about all the bad things that may happen," says Dr. Park. "But these types of moves can be beneficial for all involved. There are financial benefits to consolidation. We can leverage organizational capabilities to deliver even better care for patients. But, again, to do that it's key to understand what's the same, what's different, and then have a good plan for moving forward, for developing some shared values. And everyone has to be part of that conversation."
</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 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/25/2023 10:03:17 AM | 7/18/2023 8:57:13 AM | 7/18/2023 12:00:00 AM |
| leading-in-a-changing-landscape | Leading in a Changing Landscape | WSMA_Reports | Shared_Content/News/Latest_News/2023/leading-in-a-changing-landscape | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="cover of July-August 2023 issue of WSMA Reports" src="/images/Newsletters/Reports/2023/july-august/july-aug-reports-cover-645x425px.jpeg" class="pull-right" /></div>
<h5>July 17, 2023</h5>
<h2>Leading in a Changing Landscape</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
Medicine has always been a business, but business has never driven the profession as much as it does today. Consolidation, financial pressures, hiring shortages, administrative burdens-a series of business issues ostensibly unrelated to the delivery of care but having a tremendous impact on it-have converged to create a crisis situation for physician leaders in Washington state and across the nation.
</p>
<p>
Unfortunately, physicians starting their careers are frequently unprepared for that side of the profession. "Physicians spend significant time learning about the human body and how to effectively manage disease processes," says Vanessa Carroll, MD, chief medical officer of Mary Bridge Children's Hospital in Tacoma. "But health care is a team sport, and being able to interact with people having different perspectives is important not just in patient care but in operations. How do you keep a hospital open? How do you communicate effectively with people? Some of these skills are not taught in medical school or residency."
</p>
<p>
Having the skills necessary to navigate through a rapidly changing landscape is critical for physicians moving into leadership roles. Some skills are practical, like understanding budgets and strategic planning, while others are soft skills, like how to build teams and communicate effectively.
</p>
<p>
Barbara Thompson, MD, who was appointed chief medical officer of Mary Bridge Children's Hospital's health network earlier this year, agrees. "All physicians are leaders, but they are never really taught to lead in school," she notes. "Since COVID, we really see how important leadership is, not just leadership through the pandemic, but to keep physicians inspired and provide direction back to the 'why' of medicine."
</p>
<p>
This combination of skills-a firm understanding of the business side of medicine along with the tools to coach toward a desired outcome-come at a particularly fraught time for the profession. Finding the training that provides that set of skills is an important part of ensuring successful leadership.
</p>
<p>
Unsurprisingly, physicians are turning to business programs to prepare them for the new landscape that they are facing. Indeed, the number of medical school graduates who have also earned an MBA has been steadily rising. According to the American Association of Medical Colleges, a total of 85 MDs had earned both degrees in 2003-2004. By 2021-2022, that number had more than tripled, to 237.
</p>
<p>
However, the challenge facing today's leaders isn't just a matter of grappling with financial pressures and staffing issues. It's how to address a system that is, in many ways, fundamentally broken when it comes to addressing the needs of physicians and advanced practice clinicians. Chief among these challenges is addressing the underlying causes of burnout.
</p>
<p>
"We're not burning out, we're being burned out," says Edward Walker, MD, MHA, a professor emeritus in the departments of psychiatry and behavioral sciences and health services at the University of Washington in Seattle and senior physician advisor for the WSMA Center for Leadership Development. "Burnout is a feature, not a bug. COVID just drove that home."
</p>
<p>
"Even before COVID, physicians and advanced practice clinicians felt the job was getting too hard to do," Dr. Walker says. "As the amount and complexity of our daily work started piling up, it felt like the administrative burden was disproportionate to direct patient care." Previously, the focus was on physicians taking care of themselves, but Dr. Walker believes that now only changing the system itself will help restore physicians' well-being.
</p>
<p>
"I think the sine qua non for the next decade for physician leaders is training up to help redesign the system," Dr. Walker says. "The key insight now is how do you join with an administrative partner to redesign the system to reduce burnout."
</p>
<p>
Physicians and advanced practice clinicians with the right skills are uniquely positioned to help move the system toward a more sustainable place. "If we're partnering effectively and speaking a common language, that's where the creative solutions can develop," says Dr. Carroll. "It's about being informed and understanding the 'why' in decision-making to understand what's mission critical and then being able to communicate that to our colleagues in order for them to understand the rationale."
</p>
<p>
Some of that communication begins with leaders knowing how to encourage their colleagues to remember why they became physicians to begin with.
</p>
<p>
"I don't think we're going to get past burnout just by paying people better or giving someone a course on resilience," says Dr. Thompson. "I'm not saying those things can't help. Ultimately, what we have to do is connect people back to the 'why,' that everyone ends your day feeling that you made a difference. We still need to be reminded that we're doing good things and we're keeping the humanity in corporate medicine."
</p>
<p>
Being able to speak the language of business is great, but it needs to be combined with the ability to coach others toward agreeing on a course of action. "Reading the spreadsheet and talking about planning are important to establish our operational credibility," says Dr. Thompson. "But it's not enough to have the info if you don't have the skills to bring people along with you."
</p>
<p>
While many of these skills are taught in an MBA curriculum, a formal degree is not necessarily essential for all physician leaders, says Dr. Walker. "You don't need to be able to formulate the strategic plan, but you need to implement it," he points out. "You don't have to construct a budget, but you have to understand it and explain it to your doctors."
</p>
<p>
WSMA's Center for Leadership Development offers a curriculum that allows physicians to gain that understanding, along with other leadership skills, for their career journey.
</p>
<p>
The Physician Leadership Course is essentially a "boot camp" for physicians and physician assistants who want to know more about health care leadership or who would like to brush up on their leadership competencies. The Dyad Leadership Course allows physicians and their administrative dyad partners the opportunity to improve team function and achieve greater operational success within their clinical system. For those seeking to develop their skills even further, the intensive three-day Leadership Masterclass examines the complex challenges facing leaders and provides the tools necessary to solve them.
</p>
<p>
Both Dr. Carroll and Dr. Thompson have MBA degrees and also attended the WSMA Physician Leadership Course.
</p>
<p>
"I was actually in the process of getting my MBA while I had the chance to take this course," says Dr. Carroll. "It was fascinating to see just how well it aligned with the MBA curriculum. It doesn't go into the detail, but it hits the pearls of business and operation."
</p>
<p>
"One of the great things about the program was learning from each other," says Dr. Thompson, who took both the Physician Leadership Course and the Dyad Leadership Course. "It was wonderful to spend time with other physician leaders, because going into leadership can be a little bit lonely."
</p>
<p>
As the Dyad Leadership Course underscores, many administrators are interested in partnering with physician leaders committed to improving the system.
</p>
<p>
"The notion now is to acquire the skills you need that will help you be valuable to an administrator also interested in redesign," he says. "What I have found over the past decade is that administrators respect physicians who are broadly trained and can understand what the administrator is doing." At the same time, says Dr. Walker, "Physicians look to a physician leader and will be more likely to believe you if you say, 'I have a strong partner here in this administrator.' "
</p>
<p>
Ultimately, as the profession undergoes sometimes wrenching changes, it will take the combined efforts of everyone in the system to effect the changes needed to fix it. Physicians and advanced practice clinicians will have to play pivotal roles for that effort to succeed.
</p>
<p>
"We're seeing organizations and health care systems really struggle," says Dr. Carroll. "Just imagine if we could leverage the strengths of the people working with us to find the solutions encompassing all of our roles."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the July/August 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/25/2023 10:02:19 AM | 7/17/2023 3:03:20 PM | 7/17/2023 12:00:00 AM |
| better-prescribing-better-treatment | Better Prescribing, Better Treatment | WSMA_Reports | Shared_Content/News/Latest_News/2023/better-prescribing-better-treatment | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/may-june/may-june-reports-cover-cropped-645x425px.jpeg" class="pull-right" alt="cover of May/June 2023 issue of WSMA Reports" /></div>
<h5>May 8, 2023</h5>
<h2>Better Prescribing, Better Treatment</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<br />
<p>
As the ravages of the opioid epidemic became increasingly apparent a decade ago, lawmakers began to look for ways to stop the escalating toll from addiction. Unfortunately, the options they frequently came up with were ham-fisted and likely to cause more harm to clinical practice than help to patients. In Washington state, the suggestions being considered were prior authorization for any opioid prescription and a seven-day pill limit.
</p>
<p>
Still early in her role as chief executive officer of the WSMA, Jennifer Hanscom knew that prior authorization was an inefficient approach that was unlikely to get to the heart of the problem. Instead, she realized that all sides needed to collaborate to find a solution that would work for everyone.
</p>
<p>
"I still remember the moment in the conference room when we decided to tackle this," Hanscom recalls. "I was really focused on how do we get away from this contentious situation. We don't want opioids to be misused and overprescribed and the state doesn't either. Let's get everyone around the table. Put the stick away and focus on the carrot."
</p>
<p>
Working with the state Health Care Authority and the Washington State Hospital Association, the WSMA worked to develop a program that would provide meaningful data and change long-term behavior. The result was the Better Prescribing, Better Treatment program, which celebrates its sixth anniversary this year.
</p>
<p>
The program has multiple components. It encourages compliance with Health Care Authority opioid prescribing guidelines that establish pill limits
for all prescriptions for acute pain while allowing prescriber discretion to override those limits if they feel it is in the best interest of their patients.
</p>
<p>
Importantly, physicians and physician assistants can see data to understand how they compare to the guidelines, if their system opts in. Each quarter, the WSMA sends prescribers in the state an opioid prescribing feedback report. Using data from the state prescription monitoring program, the report shows how their opioid prescribing practices compare to others in their hospital, health system, or medical group, as well as within their specialty.
</p>
<p>
The program also provides coaching on opioid management. The coaching is done in partnership with the Six Building Blocks program, developed by the University of Washington Department of Family Medicine and Kaiser Permanente Washington Health Research Institute, which provides an evidence-based quality improvement roadmap to help primary care teams implement effective guideline-driven care for their chronic pain and long-term opioid therapy patients.
</p>
<p>
By any standard, Better Prescribing, Better Treatment has seen tremendous success in a relatively short period of time. The initiative now encompasses more than 20,000 clinicians with 62 hospitals, health systems, and medical groups in the state. Nearly 11,000 prescribers receive regular peer-to-peer comparative data reports and accompanying guidelines. These guidelines serve as educational interventions to help ensure clinicians maintain quality care and better control how opioids are prescribed. Collectively, thanks to Better Prescribing, Better Treatment, opioid prescriptions above the prescribing guidelines have been reduced by an impressive 46% since 2018.
</p>
<p>
Those numbers have a two-fold effect, says Nathan Schlicher, MD, JD, WSMA's lead on Better Prescribing, Better Treatment. For one, fewer people are being exposed to the possibility of getting opioids longer than the three days considered optimal in most cases of acute pain. "The longer the initial prescription, the more likely you are to develop tolerance and conversion to addiction down the road," he says.
</p>
<p>
At the same time, as a result of the drop in prescriptions, says Dr. Schlicher, "the number of excess pills or opioids in the community is less, which helps prevents kids from getting access." Data show that teenagers and young adults often misuse drugs for the first time by stealing or borrowing them from friends or family.
</p>
<p>
"These two things together-fewer prescriptions and fewer opioids in the community-are hopefully helping reduce the creation of chronic use and the risk of addiction," says Dr. Schlicher.
</p>
<h3>Implementing in a system or networked setting</h3>
<p>
There's no question that undertaking any kind of organizational change is challenging, and a topic as sensitive as opioid prescribing could seem especially fraught. However, many systems embraced the opportunity to understand not just their prescribing patterns but their entire approach to pain treatment. The result could be unexpectedly exhilarating.
</p>
<p>
"It was exciting to engage a cross- continuum multidisciplinary team and patients in this effort," says Donna Smith, MD, president of Franciscan Medical Group and Virginia Mason Franciscan Health and senior vice president of the PNW Division of CommonSpirit Health, recalling the work to implement Better Prescribing, Better Treatment systemwide. "We engaged team members and changed practices. We surfaced the myths and fears and helped create safety on the team about what was not known or did not feel right. People really cared about the work."
</p>
<p>
Virginia Mason brought together a cross-disciplinary team that included physicians, nurses, pharmacists, social workers, and even front-desk workers. Just as important as this multidisciplinary approach was the individual experience that each person brought to the group, making the work as much personal as professional.
</p>
<p>
"People on the team had family members who had died from overdoses," says Dr. Smith. The team also brought in family members of people who suffered or died from opioid use to hear their perspectives. "Team members would talk about the assumptions they were making about not sharing the risks and family members were saying, 'Are you kidding me? Tell us! I need to know if I should get off pain medications by a certain day or my risks increase,' " Dr. Smith recalls.
</p>
<p>
The work was an opportunity to, in Dr. Smith's words, "connect the dots and connect our care."
</p>
<p>
"We were coming together to establish organizational standards and help everyone realize that the care we provide to a patient in the ED or hospital post- operative period impacts the care we provide for that same patient in primary care, and vice versa," she says. "For example, if someone dealing with an opioid addiction had it under control and then needed surgery, the surgeon needed to be aware of the patient's history to optimize pain control and long-term outcomes for that person."
</p>
<p>
"We worked to get this in the frame of a chronic disease," said Dr. Smith. "You don't opt out of treating diabetes, so you wouldn't opt out of treating this either."
</p>
<p>
At the same time, physicians and PAs needed to understand their own biases. "We had a team of amazing educators-pain doctors, social workers, pain psychologists, an ethicist-so people could start to understand a patient's experience and how medication could be influencing patient communication," says Dr. Smith. Physicians and PAs learned how to listen and talk compassionately to patients while setting limits. "We developed a curriculum to build these skills that helped the team feel that they could make a difference," says Dr. Smith.
</p>
<p>
That experience is duplicated in other systems, as well. Christine Hancock, MD, is the medical director for Sea Mar Bellingham Medical Clinic, one of 32 community health centers under the Sea Mar umbrella located along the I-5 corridor stretching from Vancouver to Bellingham.
</p>
<p>
"We started with the Six Building Blocks program in 2017 with improvements to the process for opioid prescribing that ran the gamut from fixing the patient agreement to changing the language we use with patients," says Dr. Hancock. "We worked with WSMA to get prescribing data from different sites across our system."
</p>
<p>
That wasn't always simple. "There are certain things you can pull out of the health record easily and other things you have to build complex and time- consuming reports to try and figure out," says Dr. Hancock. However, the work has paid off.
</p>
<p>
"In the last year, we've gotten all of the processes in place to look at acute prescribing and present that to the medical directors group," says Dr. Hancock. "WSMA gives us individual-level reports, and physicians can sign up for those voluntarily. In addition, they give us data on our practice as a whole. At a system level, it's good to get a bird's-eye view." The data is divided by practice types, which allows Sea Mar to understand if a prescribing practice is out of line with a whole group. "It's a powerful suite to have at our fingertips," says Dr. Hancock.
</p>
<p>
Physicians have been receptive to seeing the data. "Sometimes someone will write back to me and say, 'Thanks, I totally missed that,' " says Dr. Hancock. "That level of intentional intervention is where people will retain the learning and change their behavior going forward."
</p>
<p>
One of the key elements of the state's opioid prescribing rules is that they provide physicians and PAs with flexibility in making clinical decisions. "It's important that you prescribe appropriately, but it's also important that you treat patients with chronic pain," says Dr. Hancock. "We're trying to walk the fine line where we're accountable to the standard of care and not shutting the door completely." In addition to creating barriers of care to the largely Latino population that Sea Mar serves, suddenly cutting off a patient's access to pain medications increases their risk for suicide and use of street drugs.
</p>
<h3>Safer communities</h3>
<p>
One of the specialties that was contributing to excess opioids in the community, despite the best of intentions, was hospice care. Thomas Schaaf, MD, who was involved with Better Prescribing, Better Treatment at the beginning, was also increasingly responsible for Providence's hospice services in Washington and realized that the way pain medications were being prescribed was excessive.
</p>
<p>
"Many of our patients would have pain crises in the middle of the night or on weekends, so depending on their locations, we sent them an emergency kit, or e-kit, to put in the back of the closet," he says. "If they suddenly became symptomatic at 3 a.m., rather than try to find a pharmacy that was open, they could get the e-kit out."
</p>
<p>
The problem was that the e-kits contained a lot of medication. "We were using liquid medications for ease of administration," says Dr. Schaaf. "Those tend to come in largish quantities. We were putting a lot of morphine, oxycodone, and lorazepam into the community that might not ever get used. The patient dies, the family pulls the e-kit out of the closet, and my gosh, here are these very large doses."
</p>
<p>
To reduce the risk of having the drugs misused, physicians revamped the nature of the e-kits. "We changed to pills and substantially lowered the number of doses," says Dr. Schaaf. "They didn't need a month of stuff, just enough to get them through until they could use a regular pharmacy for a new dosing strategy."
</p>
<p>
The change resulted in a "staggering" decrease in the volume of opioids being prescribed. "It was a remarkable quantity," says Dr. Schaaf. "At the same time, it wasn't just cutting the amount of medications. We also changed the protocols around how we would think about a patient's baseline symptom management regimen. In the end, we believed patients were getting better symptom management and less probability that these leftover meds were ending up in the hands of people other than the patient. It accomplished both the goal of better treatment for patients and a safer community."
</p>
<h3>Growing the success, short-term and long-term</h3>
<p>
The Washington State Department of Health recently awarded the WSMA a $425,000, nine-month grant to expand Better Prescribing, Better Treatment. The money will help create reports focused on prescriptions for chronic opioid use and co-prescribing of opioids; previously, reports have concentrated on prescribing for treatment of acute pain. As with the earlier reports, the new reports will be an opportunity to identify outliers who are high prescribers to engage them in discussion about their prescribing practices.
</p>
<p>
Providing data on opioid prescriptions beyond treatment for acute conditions is an important next step, says Dr. Schlicher. "The prescribing of opioids with sedatives like Ambien can increase the risk of respiratory depression and death," he notes. "We want to provide feedback on that danger and how often that's happening. Getting at that challenge would be a next step."
</p>
<p>
The grant is just one step in the effort to expand the safe-prescribing initiative in the coming months and years. The program is looking to continue to expand its reach.
</p>
<p>
"Over the next five years, we want to reach as many prescribers as possible with the initiative on acute prescribing," says Dr. Schlicher. "We're looking at our own membership that hasn't been able to participate through their own clinics." The idea is to create an enrollment category for member physicians and PAs who are not in enrolled health systems and clinics but who wish to participate in the program, with the option to opt out.
</p>
<p>
The program's sights for growth extend beyond physicians and PAs. "We also want to reach out to other professional societies, like dentists, nurse practitioners, and podiatrists, to expand the program to everyone," says Dr. Schlicher. Dr. Schlicher is also planning an education series to add to the existing library of resources for physicians and PAs.
</p>
<p>
Still, the spine of the program remains the data, which shows physicians and PAs how they compare to others. "Data management is not an easy job," says Dr. Hancock. "You have to work really hard to provide valid, good quality data that are meaningful. I have to give a shout out to the folks at WSMA. I appreciate all their efforts to get that info into an accessible place."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the May/June 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 12:22:48 PM | 5/8/2023 11:26:00 AM | 5/8/2023 12:00:00 AM |
| so-long-x-waiver | So Long, X-Waiver! | WSMA_Reports | Shared_Content/News/Latest_News/2023/so-long-x-waiver | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/may-june/may-june-reports-cover-cropped-645x425px.jpeg" class="pull-right" alt="cover of May/June 2023 issue of WSMA Reports" /></div>
<h5>May 8, 2023</h5>
<h2>So Long, X-Waiver!&nbsp;</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<br />
<p>
In her 11 years treating those struggling with substance abuse, Lucinda Grande, MD, a family practice and addiction medicine specialist in Lacey, has seen firsthand the benefits of initiating buprenorphine to treat opioid use disorder. People who were once unhoused now have a job and a place to live. Estranged families are reunited. Someone caught in a cravings- usage-overdose-withdrawal cycle now has hope of managing their disorder so they don't end up a statistic. And the stats from the Centers for Disease Control and Prevention are startling: Nearly 75% of overdose deaths nationwide in 2020 involved an opioid. Here in Washington state, provisional data show 1,831 opioid-related deaths in the most recent 12-month period ending in October 2022.
</p>
<p>
In the U.S., some 7 million people are currently living with opioid use disorder. For them, buprenorphine is life-changing, says Dr. Grande. "Buprenorphine reduces mortality rates. It relieves cravings and withdrawal without causing respiratory depression, so overdose is nearly impossible."
</p>
<p>
Despite the safety and efficacy of buprenorphine, until recently Dr. Grande was among only 5% of physicians and medical professionals licensed by the Drug Enforcement Administration to prescribe the drug for opioid use disorder, a result of onerous training requirements to get a DATA-Waiver, or "X-waiver," added to their DEA registration. The X-waiver requirement was eliminated, effective immediately, with the passage of the bipartisan Mainstreaming Addiction Treatment Act of 2023, included in the Consolidated Appropriations Act of 2023 signed into law by President Joe Biden on Dec. 29, 2022.
</p>
<p>
The X-waiver removal represents a watershed moment in the fight against the opioid epidemic, says Dr. Grande. "The most important thing about passage of the MAT Act is the opportunity to galvanize the medical community into engaging in treatment of opioid use disorder."
</p>
<h3>Removing legislative barriers to treatment</h3>
<p>
The WSMA hopes to partner with the Washington State Department of Health, the Washington State Health Care Authority, and other state agencies to get the word out and develop workflow guidance, says Jeb Shepard, WSMA's director of policy. "Ideally, we'd like to connect our members with a start- to-finish overview on how they can incorporate buprenorphine, including pharmacological education and how to bill public and private payers," says Shepard. It's part of WSMA's ongoing efforts to remove barriers to medications for opioid use disorder, or MOUD.
</p>
<p>
Buprenorphine is one of three Food and Drug Administration-approved medicines, including methadone and naltrexone, proven to benefit those with opioid use disorder. Use of these medications decreases the duration people use opioids, reduces hospitalization, prevents deaths, and reduces drug-seeking behavior. Yet in the U.S., only 27% of people who qualify for these life-changing drugs currently receives them.
</p>
<p>
The WSMA supported a provision in Senate Bill 5380, opioid omnibus legislation passed by the Legislature in 2019, that prohibits prior authorization for MOUD. That law, which requires insurance carriers to cover at least one FDA-approved MOUD drug, became effective in January 2021. "We didn't want people who would benefit from these treatments and perhaps are in a fleeting moment where they were willing to move their life in a different direction have to wait to get started because insurance carriers needed to approve it first," says Shepard. "But we could only do so much at the state level when that DEA waiver was in place."
</p>
<p>
In 2019, the WSMA also joined the fight to remove the federal buprenorphine X-waiver, spearheaded by a resolution put forth by Dr. Grande, then serving as a member of the WSMA House of Delegates, which called on the WSMA to support American Medical Association advocacy on the issue. "There were joint letters that we signed on to and we also reached out to our congressional delegation, who were pivotal in getting the MAT Act passed. Sen. Patty Murray and Rep. Cathy McMorris Rodgers were key votes," says Shepard.
</p>
<h3>Removing the stigma</h3>
<p>
Removal of the X-waiver alone won't change the trajectory of the opioid epidemic unless other system-level changes take place, says Richard Waters, MD, a family physician with Neighborcare Health in Seattle and an advocate for low- barrier buprenorphine access. "We have all created this divide where addiction medicine for a long time, and to a certain extent continuing now, was set apart from the rest of health care."
</p>
<p>
In the U.S., removal of the X-waiver was long overdue, says Dr. Waters. France, for example, has allowed doctors to prescribe buprenorphine without special education or licensing since 1995. As a result, within three years deaths from opioid overdoses there fell 79%. Research found X-waiver removal in the U.S. would translate to more than 30,000 fewer opioid overdose deaths in the U.S. each year.
</p>
<p>
Dr. Waters hopes the U.S. will continue being proactive in removing other barriers to MOUD, such as those surrounding methadone therapy. "There is also a continued imperative, given the overdose crisis, to look at what has been effective elsewhere and how we can move toward these evidence-based practices," he says.
</p>
<p>
A safe and effective treatment for chronic pain, buprenorphine can also help prevent opioid use disorder by replacing addictive narcotics, says Dr. Grande. Even before the MAT Act, physicians and physician assistants could legally prescribe it for chronic pain, but confusion caused by the X-waiver kept doctors from using it, she says.
</p>
<p>
Removal of the X-waiver comes amidst a growing fentanyl crisis nationwide. From 2019 to 2021, Washington state saw a 66% rise in overdose deaths, more than half due to fentanyl.
</p>
<p>
Despite this increasingly urgent backdrop, many physicians and PAs may still be hesitant to prescribe buprenorphine, in part because of the impression created by the X-waiver that buprenorphine is a riskier, scarier, and more complicated medicine than it is, says Dr. Waters. "The jarring contradiction was that any [physician] could prescribe as much fentanyl, oxycodone, and hydromorphone as they wanted, without necessarily any training, but could not prescribe buprenorphine, which is a far safer medication than all of those."
</p>
<p>
As more medical schools and residency programs embrace teaching addiction medicine, Dr. Waters remains hopeful for the future. "The X-waiver going away was a symptom of an ongoing cultural shift in modern medicine that is starting to embrace the care of people with substance use disorders as people worthy of care for whom we have a variety of effective tools that can help improve their lives."
</p>
<h3>How you can get started</h3>
<p>
While the MAT Act eliminates the X-waiver, it doesn't remove the need for buprenorphine education. The appropriations bill also included the Medication Access to Training Expansion Act of 2023, supported by the American Society of Addiction Medicine, which calls for new training requirements for all prescribers scheduled to go into effect on June 21, 2023. According to the DEA, these requirements don't impact the specific changes related to the X-waiver elimination. The WSMA and the AMA did not support the MATE Act, concerned that eight hours of mandated training requirements would add additional burden to already overwhelmed physicians, says Shepard.
</p>
<p>
Some education is still needed before prescribing buprenorphine, says Greg Rudolf, MD, immediate past president of the Washington Society of Addiction Medicine. But the society wants to ensure that training doesn't create additional obstacles for physicians. "We're hoping for something modest, in the one- to three-hour range of educational commitment ... understanding a little bit more about how to start somebody, how to dose appropriately, how to keep them engaged and in treatment," he says.
</p>
<p>
One immediate way physicians and PAs can get comfortable prescribing buprenorphine is assuming management of patients already stable on the medication, says Dr. Rudolf. "Some of my patients come from great distances to see me. If primary care physicians in their local area can take over their prescriptions, they don't have to worry about transitioning the patient from an unstable situation to stability ... This can help take the burden off specialists, who, at this point, are having a hard time meeting demand."
</p>
<p>
X-waiver elimination also benefits underserved populations who have historically struggled with access to buprenorphine because there were few or no X-waivered prescribers nearby. In rural communities, even if just one additional physician now provides care with buprenorphine that can make a real difference, says Shawn Andrews, MD, senior medical director for ambulatory care services at Summit Pacific Medical Center in Elma. Rural patients often don't have the money, time, or means to travel for MOUD elsewhere, she says.
</p>
<p>
"Geographic barriers are very significant in rural areas," says Dr. Andrews. "The MAT Act will make it much easier to staff our low-barrier MAT clinic. It also decreases the administrative burden of tracking how many waivers each [physician] has available."
</p>
<p>
Addiction medicine professionals <em>WSMA Reports</em> interviewed emphasized the need for mentorship in prescribing buprenorphine. "Physicians should not feel helpless. If they see someone who's a good candidate for it, they should not delay when there are resources to help physicians initiate buprenorphine. They shouldn't let that patient get away without treatment," says Dr. Grande.
</p>
<p>
Dr. Grande especially encourages emergency department professionals- often on the front lines of the opioid epidemic-to consider initiating buprenorphine. She cites a 2015 study showing that those who were started on buprenorphine in the ED were twice as likely to be engaged in formal addiction treatment at 30 days compared to people given a referral to treatment alone, even with a brief psychosocial intervention.
</p>
<p>
"They don't come back to the ED because their life is better. Their habits are healthier," she says. But ED physicians can't do it alone, says Dr. Grande. "Hospitals and health care systems need to be motivated and incentivized to make changes to how they treat those with opioid use disorder."
</p>
<p>
At minimum, physicians and PAs can play a vital role in educating patients about MOUD, says Dr. Waters. "Learning how to talk about the benefits of methadone, buprenorphine, and extended-release naltrexone is the kind of thing all of us should be able to do."
</p>
<p>
Whenever she can, Dr. Andrews appears on local radio stations to promote MOUD. It's a required part of the curriculum at Summit Pacific's family medicine residency, where Dr. Andrews serves as program director. "Physicians and other [prescribers] need to see what is at stake. And I think they are seeing it with the explosion of fentanyl deaths. They need to know that they are likely to save lives," she says.
</p>
<p>
Dr. Rudolf encourages all doctors to reflect on what prescribing buprenorphine means for their community. "To literally change someone's life with the right care intervention at the right time, it's a thrill," he says. "Any doctor who shies away from it is really missing a great opportunity to provide the kind of impactful care that I think most of us went into medicine to try to do."
</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 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 12:23:08 PM | 5/8/2023 11:59:25 AM | 5/8/2023 12:00:00 AM |
| doctors-making-a-difference-raj-sundar-md | Doctors Making a Difference: Raj Sundar, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/doctors-making-a-difference-raj-sundar-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="Doctor Making a Difference: Raj Sundar, MD logo" src="/images/Newsletters/Reports/2023/may-june/dmd-website-image-rsundar-645x425px.png" class="pull-right" /></div>
<h5>April 26, 2023</h5>
<h2>Doctors Making a Difference: Raj Sundar, MD</h2>
<p>
Through its first 15 episodes, guests on the podcast "Healthcare for Humans" cover topics ranging from the concept of food as medicine to the model minority myth to the meaning of "aloha." In the series, creator and host Raj Sundar, MD, a family physician at Kaiser Permanente's Burien Medical Center and community organizer, speaks with physicians and others from a wide range of backgrounds about how physicians can weave patients' cultural values into the care they provide. Dr. Sundar talks to <em>WSMA Reports</em> about the genesis of the podcast what he hopes physicians take away from these conversations.
</p>
<p>
<strong><em>WSMA Reports:</em> Where did the idea for the "Healthcare for Humans" podcast come from?</strong>
</p>
<p>
<em>Dr. Sundar:</em> The idea was born out of my personal experience of feeling stuck in caring for culturally diverse communities. This was particularly noticeable in immigrant and refugee communities, where there was a vast difference between my worldview and that of my patients. I tried to find ways to be a better caregiver but found that existing resources were focused on cultural competence, which was stereotypical and "othering." It conveyed the belief that my way of life was normal, while the patient's way was abnormal and needed to be studied.
</p>
<p>
As I have two kids (a 2 1/2-year-old and a 12-month-old), I listen to a lot of podcasts while doing chores. I found that the podcast was an excellent medium to capture voices and stories better and convey the nuances of culture by elevating community voices. After realizing this, I started the "Healthcare for Humans" podcast to give community members a voice and answer the question, "What does it mean to care for your community?" The podcast focuses on highlighting the diversity of cultures and values in the community and bridging the gap between caregivers and patients.
</p>
<p>
<strong>In the podcast intro, you say one of the goals is to help physicians learn to "care for the person in front of you, not just a body system." What does that mean to you?</strong>
</p>
<p>
Caring for the person, not just their body system, means treating patients like individuals with unique needs rather than just a collection of organs and symptoms. It's about recognizing that health care is more than treating diseases and conditions. It involves healing the person in front of you. Although the [biomedical] model is effective in many situations, we all witness daily how this can be inadequate in healing our patients and communities. We can lose sight of the person behind the illness, their needs, values, and preferences. To be healers, we need to be well versed in the history and culture of our communities as we are about diagnosis and treatment plans.
</p>
<p>
<strong>Why is it important to include that historical context?</strong>
</p>
<p>
Understanding the historical context of a patient's community can provide insight into the cultural, social, and economic factors that may impact their health outcomes. Historical events such as immigration patterns, discriminatory policies, and social movements can shape a community's experiences and contribute to current health inequities.
</p>
<p>
One important point is that cultural competence, the idea that health care professionals should learn about and master cultural practices and beliefs, is not the most effective paradigm for promoting health equity. Instead, we need to focus on cultural safety. Cultural safety is about creating an environment where patients feel safe, respected, and understood, regardless of their background or cultural identity. It's not just about learning specific cultural practices but also recognizing the historical and social contexts that have shaped a patient's experiences and tailoring care accordingly.
</p>
<p>
Lastly, understanding the historical context of a patient's community can help clinicians identify systemic issues and advocate for policy changes that address health disparities. This is critical to creating more equitable and just health care systems that better serve all communities.
</p>
<p>
<strong>What are some of the most surprising or meaningful things you've learned from guests on the podcast?</strong>
</p>
<p>
Each episode has many learnings I have not learned about in my medical education. Let's take the Pacific Islander community, for example. The foundation of our health care system is on one-on-one consultations. This traditional approach of educating individuals with diabetes may not work in Pacific Islander families where someone else prepares the food. Making dietary changes must involve the entire family to be effective. The respect and togetherness of the family are essential in making these changes. This value is not exclusive to Pacific Islander communities, but it's amplified in a culture that values family and community over individuality. How often do we see health systems make "family" visits a priority?
</p>
<p>
Another example is from the Native Hawaiian episode. We often focus on morbidity and mortality to "motivate" individuals and patients. "Hey, you should do this so you can live longer and healthier." But this idea of living longer as a selling point for health care doesn't resonate with families who face hardship and poverty. However, passing down knowledge and legacy to younger family members is a value that is important to many. Again, what does it mean to focus our care on families and how we care for each other because we have generational knowledge that we want to pass on and a legacy that we want to create? Do we talk about that at all in our conversations?
</p>
<p>
Lastly, in almost all episodes, there is a focus on bringing back practices that ancestors had to integrate into daily lives, shifting away from the toxic stress of capitalism to nurture relationships and recreate the village or town of health.
</p>
<p>
<strong>What do you hope physicians, or other listeners, take away from the podcast?</strong>
</p>
<p>
I want listeners to contemplate these questions: What does it take to build a healing relationship? What do you need to know about the person to care for them? What does it mean for you to learn about them and their community so you don't place the burden on the patient to educate you? I hope the podcast is one resource to help clinicians on this journey.
</p>
<p>
<strong>What topics would you like to cover that you haven't, yet? </strong>
</p>
<p>
I am currently working on a series of interviews that aim to amplify the voices of underrepresented communities, particularly the Latinx community, and their intersectional experiences. This series includes interviews with the Afro-Latinx community and DACA recipients. Additionally, I am collaborating with Safe Place International to shed light on the often-overlooked experiences of LGBTQ individuals in refugee populations. Lots more ideas and I'm happy to hear more from listeners at <a href="https://www.healthcareforhumans.org">healthcareforhumans.org</a>.
</p>
<p>
<em>This article was featured in the May/June 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 11:26:33 AM | 4/26/2023 10:37:31 AM | 4/26/2023 12:00:00 AM |
| a-call-to-climate-action | A Call to Climate Action | WSMA_Reports | Shared_Content/News/Latest_News/2023/a-call-to-climate-action | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/may-june/heartbeat-website-image-mzfy-badger-do-645x425px.png" class="pull-right" alt="WSMA Reports Heartbeat logo with Mary Badger, DO's name on it" /></div>
<h5>April 25, 2023</h5>
<h2>A Call to Climate Action</h2>
<p>
By Mary Badger, DO
</p>
<p>
My interest in the outdoors and sustainability started as far back as my time in the Girl Scouts, with its emphasis on community betterment, and those many days and weekends spent with friends or on my own hiking and backpacking, carefully and thoughtfully following the "leave no trace" ethic of good wilderness stewardship. These interests only grew as I became an adult, then a practicing (and now retired) physician, and rapidly expanded to include health as I saw firsthand the increased vulnerability of my older patients and my patients with chronic diseases to climate change.
</p>
<p>
The 2022 Intergovernmental Panel on Climate Change impacts report states that climate and health care are inseparable, that addressing climate change is the greatest public health opportunity of the 21st century, and that failure to adequately address it could undo most of the progress in global health over the past century. Climate change is putting increased pressure on vulnerable systems, populations, and regions, compounding existing medical conditions and health disparities. A host of medical societies, including the WSMA, the American Medical Association, the American College of Physicians, the American Osteopathic Association, and the American College of Osteopathic Internists, have position papers on climate and health (ACOI, AMA, and ACP are members of the Medical Consortium on Climate and Health).
</p>
<p>
But what can we do as individual physicians?
</p>
<p>
Educate ourselves: Sixty percent of physicians cite lack of knowledge about climate as a reason they don't address climate-related health concerns with patients. There are free webinars available from the <a href="https://medsocietiesforclimatehealth.org/educate">Medical Consortium on Climate and Health</a>, <a href="https://www.hhs.gov/climate-change-health-equity-environmental-justice/climate-change-health-equity/actions/health-care-sector-pledge/webinar-series/index.html">Office of Climate Health Equity</a>, and <a href="https://www.publichealth.columbia.edu/research/centers/global-consortium-climate-health-education">Global Consortium on Health</a>. "Global Climate Change and Human Health, from Science to Practice," second edition by Lemery and Sorrenson, is a great resource. Several institutions now offer fellowships in climate and health.
</p>
<p>
Educate our trainees: Medical schools are implementing either required or voluntary lectures on climate and health, and residencies are including patient-specific climate discussions during rotations. According to colleagues in several climate groups, rumors are that the Accreditation Council for Graduate Medical Education may be considering adding climate to competencies in the future.
</p>
<p>
Educate our patients: Even though patients trust their physicians more than anyone else, when it comes to discussions on climate change, 40% of physicians report lack of time as a reason they don't do this. You can briefly review their individual risks as part of disease prevention strategies. To save time, give them printed information, available from the <a href="https://mygreendoctor.org/waiting-room-brochures/">My Green Doctor website</a>, which can be set up with your practice information and emailed or printed for patients in English or Spanish; from the <a href="https://climatehealthconnect.org/resources/posters/">Public Health Institute</a>; and from websites such as <a href="https://www.ready.gov/kit">ready.gov/kit</a>, for emergency preparedness, and <a href="https://www.airnow.gov/">airnow.gov</a>, for air quality.
</p>
<p>
Serve as an example: Use the Native American "seventh generation" principle, which says that in every decision, be it personal, governmental, or corporate, we must consider how it will affect our descendants seven generations into the future.
</p>
<p>
Reject, reuse, and recycle: The health care sector is responsible for about 10% of U.S. greenhouse gas emissions. We need to address this in our places of work. The U.S. government has provisions to help with this.
</p>
<p>
Finally, be sure that vulnerable populations are specifically included-visit the <a href="https://www.epa.gov/cira/social-vulnerability-report">U.S. Environmental Protection Agency website</a> for a social vulnerability report.
</p>
<p>
It's said that weather is what is happening where you are at a given moment and that climate is how you got there over time. I would add that climate change is adversely affecting that journey. Addressing climate change will help our patients' and our own health and the health of our planet. We must all do our part to "leave no trace." Please start now!
</p>
<p>
<em><strong>Mary Schaefer Badger, DO, FACOI, FAWM</strong>, is an emeritus member in Spokane and chair of the American College of Osteopathic Internists Committee on Climate and Health.</em>
</p>
<p>
<em>This article was featured in the May/June 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/11/2023 9:34:20 AM | 4/26/2023 10:36:40 AM | 4/25/2023 12:00:00 AM |
| death-comes-to-us-all-prepare-now | Death Comes to Us All: Prepare Now | WSMA_Reports | Shared_Content/News/Latest_News/2023/death-comes-to-us-all-prepare-now | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/march-april/cover-wsma-marapr-2023-645x425px.jpeg" class="pull-right" alt="cover of March/April 2023 issue of WSMA Reports" /></div>
<h5>March 17, 2023</h5>
<h2>Death Comes to Us All: Prepare Now</h2>
<p>
By Joanne Roberts, MD</p>
<p>
Having practiced palliative medicine most of my career before I retired in mid-2021, I have been involved in thousands of deaths and sat vigil with hundreds of families. I know a thing or two about the end of life. Or so I thought.
</p>
<p>In October 2021, I had a routine exam that included basic blood work. A few hours after the draw, the results dropped into MyChart: neutrophils 700; hemoglobin 9.2; platelets 108,000. A week later, a bone marrow biopsy showed 14% myeloblasts.</p>
<p>
"What do you think of the biopsy results?" asked Brian, my hematologist, letting me take the lead in recognizing this as a high-risk myelodysplastic syndrome. "I think I would have liked to have lived to be at least 80," I replied. He wisely let silence fill in the next few moments.
</p>
<p>
We know that from the moment we're born, we are dying. But as another patient with a terminal diagnosis said: "We all see the exit sign, but I see it more clearly than you do." Indeed, little in my life has focused my brain more than being within sight of my death.
</p>
<p>
Once I got through the first month of shock, every day of the last 17 months has been among the best of my life. I've intensified my meditation alone and in groups, reflected on my life, spent more time talking with friends and daughters, ridden my bike more than 7,000 miles, and, generally "gotten my affairs in order."
</p>
<p>
My biggest worry was for my young adult daughters. Both live far from me, so I set up a Zoom call to share the news of diagnosis, chemotherapy plan, and prognosis. When my older daughter, a nurse and my health care agent, blurted out, "Does this mean we'll get a bigger inheritance?" we all wept with laughter, and I breathed easier. I know from my practice that when families laugh together, grief is easier to bear.
</p>
<p>
For my friends, CaringBridge is a lifeline to scores of people I know and love around the world, and I've hired a doula to help me build a support team for my daughters, my friends, and me.
</p>
<p>
Working in palliative medicine for decades, I failed to appreciate the intensity and richness of life that exists between diagnosis and hospice. Part of that richness is the accomplishment of the "logistics" of the end of our lives. As we come up to the annual Healthcare Decisions Day this April, my plea to you is to focus on yourself-and your own mortality. Don't put it off. As they say on every flight, "Put your own mask on first." This year, tend to yourself first and your patients second.
</p>
<ul>
<li>Havetheconversationwithyourfamilyabout your values and the care you hope to have when you are struck by disease, frailty, or another cause of death that is daily closer.</li>
<li>Designate a health care agent, and make sure everyone in your family knows who that is.</li>
<li>Complete your will so your family won't suffer over your "stuff."</li>
<li>Decide what you want done with your body. It will help you all acknowledge that death comes to us all.</li>
<li>Write your obituary. It will help you clarify what is most important to you in the life you have.</li>
</ul>
<p>
Death is the most natural thing in the world, particularly among those of us over 50 or 60. It is the one event that we all share. Imagine yourself as having a year to live, and then live as if you do. I suspect you'll be surprised at what you and your loved ones-and your patients-will discover.
</p>
<p>
<em>Joanne Roberts, MD, MHA, is an emeritus member now retired and living in Minnesota.</em>
</p>
<p>
<em>This article was featured in the March/April 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 11:26:32 AM | 3/10/2023 2:12:23 PM | 3/17/2023 12:00:00 AM |
| doctors-making-a-difference-naomi-busch-md | Doctors Making a Difference: Naomi Busch, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/doctors-making-a-difference-naomi-busch-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/march-april/dmd-website-image-nbusch-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Naomi Busch, MD graphic" /></div>
<h5>March 16, 2023</h5>
<h2>Doctors Making a Difference: Naomi Busch, MD</h2>
<p>
After 20 years of practicing primary care, including as the owner of Greenlake Primary Care, a private practice in Seattle, Naomi Busch, MD, drew on her interest caring for patients with eating disorders and began a new role as Washington state's director of medical services for The Emily Program, a network of eating disorder treatment centers in four states. Dr. Busch talks about her new role and what she hopes for the future of the program in Washington.
</p>
<p>
<strong><em>WSMA Reports:</em> What led you to leave your longtime primary care practice to work with The Emily Program?</strong>
</p>
<p>
<em>Dr. Busch:</em> I was excited to work in an integrative model with behavioral health, nutrition, and medical. It also offered me the opportunity to lead a team of physicians, PA-Cs, and ARNPs throughout the state and educate future clinicians. The number of people with eating disorders has increased substantially during and after COVID-19, and The Emily Program has grown to meet this need. I saw it as the next step for me in caring for patients and teaching others.
</p>
<p>
<strong>Were eating disorders an area of focus for you in your primary care practice? </strong>
</p>
<p>
No, The Emily Program first approached me in 2012 to consult with their partial- hospitalization program because of my reputation for providing weight- inclusive primary care. I was drawn to working in this field due to the lack of medical resources available and the possibility of providing specialized medical management. At the time, there was not even a chapter in UpToDate to reference. I spent the next several years attending conferences across the country learning everything I could. As The Emily Program grew to include a residential site, several partial-hospitalization programs in Washington, and locations in Lacey and Spokane, my knowledge grew and was needed in my new role.
</p>
<p>
<strong>What does that role entail?</strong>
</p>
<p>
I provide the medical leadership support for The Emily Program's eight partial- hospitalization programs with over 100 patients and one 16-bed adult residential program, as well as numerous intensive outpatient programs. I lead 10 clinicians (physicians, PA-Cs, and ARNPs), as well as provide consultation for outside primary care physicians. I work directly with Washington state site directors, dietitians, and psychiatric teams. I am part of the national leadership team and serve as a member of our state-based quality committee.
</p>
<p>
<strong>What are the biggest challenges you've faced in your new role, and what is the most fulfilling part?</strong>
</p>
<p>
Going from owning my own clinic to leading the medical for an organization was challenging because I am no longer the ultimate decision-maker. This is also the most fulfilling part of the job! I enjoy working on an interdisciplinary team and collaborating on best practice, policy, and how to meet the needs of our eating disorder patients. It was this community of clinicians, therapists, psychologists, and dietitians that drew me away from primary care and into the field of integrative behavioral health.
</p>
<p>
<strong>Are there any goals you're striving for with The Emily Program in Washington? </strong>
</p>
<p>
I would like to see an expansion of adolescent residential care in the state of Washington. Currently, there are only 26 residential beds for adolescents provided by other companies. I would also like to see an inpatient unit that specializes in eating disorders be developed in our state. Right now, any patient over the age of 18 requiring hospital-level care for eating disorders must leave the state to seek specialized treatment.
</p>
<p>
I am also passionate about educating our future physicians about eating disorders. 30 million people in the country will have an eating disorder in their lifetime. Until the opioid epidemic, anorexia and bulimia had the highest mortality of any other mental illness. I had to fight to learn about the medical impact of these diseases because of how they have been stigmatized. Recognition and management of these conditions should be part of routine curriculum for medical students and residents as they impact every specialty in medicine.
</p>
<p>
<em>This article was featured in the March/April 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 11:26:33 AM | 3/16/2023 10:16:59 AM | 3/16/2023 12:00:00 AM |
| ian-morrisons-crystal-ball | Ian Morrison's Crystal Ball | WSMA_Reports | Shared_Content/News/Latest_News/2023/ian-morrisons-crystal-ball | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/march-april/cover-wsma-marapr-2023-645x425px.jpeg" class="pull-right" alt="cover of March/April 2023 issue of WSMA Reports" /></div>
<h5>March 15, 2023</h5>
<h2>Ian Morrison's Crystal Ball</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<br />
<p>
Ian Morrison, PhD, author of "Leading Change in Health Care: Building a Viable System for Today and Tomorrow," likes to joke that he's in the "sweeping generalization business." Joking aside, the Scottish-born futurist bases his predictions on observations and data gleaned from nearly 40 years of working with physicians, health care organizations, and related nonprofits.
</p>
<p>
Morrison's training in health policy and health economics began in Canadian teaching hospitals, where he spent seven years as a researcher on economic studies. His work as a futurist began in 1985, when he joined the Institute for the Future in Palo Alto, California, serving as its president from 1990-1996.
</p>
<p>
During that time, Morrison worked on a project called Looking Ahead at American Healthcare for the Robert Wood Johnson Foundation and the Commonwealth Fund. It was then that he began a 30-year partnership with the Harris Poll and the Harvard School of Public Health focusing on public health, conducting annual surveys of doctors, employers, the public, and sometimes hospitals and state legislatures.
</p>
<p>
In his work today, Morrison helps public and private organizations plan for the longer-term future. "Much of what I talk about as a futurist is based on understanding derived from mining public and professional opinion on health care over a long period of time," he says.
</p>
<p>
Morrison is a featured speaker at the 2023 WSMA Leadership Development Conference in May (see insert in this issue). WSMA Reports asked him what major trends in health care and health care economics he thinks may affect physicians in 2023 and beyond. The conversation was edited for length and clarity.
</p>
<p>
<strong><em>WSMA Reports:</em> The overriding perception in the public is that health care is broken. What's the physician's role in fixing the system and fixing that perception?</strong>
</p>
<p>
<em>Dr. Morrison:</em> We know from surveys that people think the health care system in the U.S. is broken. But if you ask them detailed questions about their doctors, their insurance, they're relatively satisfied. They have a perception that the system is broken, but not necessarily that the care they receive is broken. They do have complaints, particularly for people with chronic conditions, about fragmentation and lack of coordination and difficulty accessing certain things.
</p>
<p>
There is this tension between the system and the experience of care that individuals receive, between the health of the population, where we clearly underperform for the money we're spending. It's crazy. We're five years behind in life expectancy now, behind the Spanish. We're going in the wrong direction in terms of life expectancy and have been for three years now. Yet, we spend literally twice to three times as much as the average European country.
</p>
<p>
There are a number of reasons we underperform. One is we've got the wrong priorities. We are way more invested in high-tech specialty care, and under-invested in primary care, relative to other countries. We lack universal coverage. Obamacare has put a dent in it, but we still have 20 million to 30 million people without coverage, particularly in the 11 states that didn't expand Medicaid.
</p>
<p>
And we're enamored with technology. I'm a beneficiary, having just had quadruple bypass surgery, so I'm not knocking technology. But we're neglecting some of the basic preventive and primary care universality that exists in other systems.
</p>
<p>
<strong>How does that system tension filter down to physicians? What will this year and near future look like in trying to resolve that tension?</strong>
</p>
<p>
The cumulative effect of critiques of the health system is dispiriting to physicians. That's one of the reasons why the burnout numbers among physicians are at an all-time high. We've tracked physicians' satisfaction for decades, and it's never really been that a majority of doctors were dissatisfied. But there have been waves of dissatisfaction. And the COVID-19 pandemic has been a further punch to the gut for front-line physicians.
</p>
<p>
<strong>Are you seeing any indication as COVID-19 starts to wane, hopefully, that those burnout numbers are going to get better? Or that the pressure on physicians will ease?</strong>
</p>
<p>
From the best numbers I've seen, about 2% of doctors have left medicine for other careers. On the margin it may not sound like a big deal, but we were already in a physician shortage situation. The good news is that CEOs and leaders of health systems that I've talked to are extremely mindful that they've got situations of burnout with their physicians. The enlightened ones recognize they have to work with physicians to redesign care processes to bring back some of the joy and meaning of the work and get rid of some of the administrative hassles.
</p>
<p>
<strong>Washington state is often synonymous with technology. You've joked that over- reliance on technology in health care has created a "quantitative patient" and "cyberchondria." How is emerging patient- centered technology affecting physicians?</strong>
</p>
<p>
For years we've tracked through surveys the impact of electronic health records. What we've found is, if you hate your electronic health record, you hate your life. That's a big burden on physicians. I'm hopeful that we get more technological fixes to that problem, where people are not spending their entire time interacting with and entering data in Epic and other medical record systems.
</p>
<p>
The consumerism movement in health care has made patients more demanding of a job that's already hard to do. COVID-19 made the conditions for front-line health workers even more difficult. There are some technological improvements that can be made to enable consumers to interact with doctors. But now we've got to get it right.
</p>
<p>
I'll give you a classic example. My friend, Bob Watcher, MD, chair of the department of medicine at the University of California, San Francisco, shared data a couple of years ago that showed during the height of the pandemic there was a five-fold increase in interactions through Epic on MyChart between patients and physicians. All of that is unpaid, right? Basically, now, in the name of consumerism, we have digital front doors to manage. Another example: After I had surgery at Stanford last year, I emailed my wonderful surgeon through MyChart. She got back to me at 10:50 p.m. on a Saturday night. That's ridiculous.
</p>
<p>
We're overwhelming doctors with digital inquiries in the guise of responsiveness to consumers. But it's a burden on physicians. We have to engineer that particular problem using technology and AI, so that consumers get what they want-which is instantaneous reassurance-but you're not burdening caregivers 24/7. They can have a work-life balance.
</p>
<p>
<strong>What trends are you seeing in health care economics that will impact physicians and physician practices?</strong>
</p>
<p>
Let's start with the basics of how American health care is financed. Right now, it's an elaborate cross-subsidy game, where self-insured employers are charged three times what it costs to deliver the service to make up for the perceived underfunding of Medicare and Medicaid. I say "perceived underfunding " because, in my opinion, when people say Medicare doesn't cover the cost of care, I always rephrase that as Medicare doesn't meet the income expectations of those delivering the care.
</p>
<p>
This raises an important question: Are employers going to continue writing that check? I've been working closely with the Purchaser Business Group on Health. It represents Apple, Disney, Boeing, Walmart, and other large entities that purchase tens of billions of dollars, if not hundreds of billions, in health care [the Washington State Health Care Authority and the Washington State Health Benefit Exchange are also members]. And they are more activated now [to lower costs] than they've been in a long time.
</p>
<p>
They're now flexing their muscle demanding what they call an "advanced primary care" model as the standard. This model uses a lot more selective contracting and narrow high-performance networks.
</p>
<p>
Many of them had been getting 7% rate increases-that's the number I'm hearing employers are being asked to pay in their latest round of negotiations with hospital health systems and physician groups. Up until the recent layoffs, many of these companies were in a war for talent, so they didn't push back. Now that we're seeing Microsoft lay off 10,000 employees, Salesforce lay off 7,000, and Amazon lay off 18,000, I think you're going to see the pushback from employers getting more severe in 2023-24.
</p>
<p>
The other driving force is that is doctors in America are increasingly employed by large health systems or by private- equity-controlled entities. That means they're in somebody else's EBIT-earnings before interest in taxes. One of the key investments that has been made by health systems is to subsidize those physicians to the tune of $200,000 to $300,000 per doctor. They are subsidizing most employed physicians over and above what they're billing. And that's a burden on the system. 2022 ended up being the worst year financially of the COVID-19 cycle for hospitals and health systems because of the tremendous costs in staffing, supply chain issues, and CARES Act money running out.
</p>
<p>
Everybody I've talked to has said they are losing money and it's going to continue through 2023. And the labor shortage is still a big issue. How we resolve that depends on how we organize care.
</p>
<p>
The future is about reengineering care processes so it's team-based. We need people practicing at the absolute top of their license. We need to have surgeons and specialists spend their time doing what they were trained to do. That's actually the story from other countries.
</p>
<p>
When I first came down here from Canada, I teased friends at Stanford that most American specialists are amateurs because they don't practice their subspecialty all of the time. Whereas in Canada, there's so few of these subspecialists that they do nothing but that subspecialty.
</p>
<p>
In terms of where we're headed, enlightened systems are going to lead the charge of clinical redesign of care. And doctors need to be actively engaged and involved in that, particularly the ones employed in these larger systems.
</p>
<p>
As for the future of independent solo practice, they need support to survive independently. They have to be engaged with value-based care systems one way or another.
</p>
<p>
The numbers I've seen that the Physician Foundation put together show a significant uptick in doctors being swept into health systems and private equity- controlled systems during COVID-19. I don't think that's going back in the bottle. I don't think solo, independent fee-for- service practice makes a late-breaking comeback in the fourth quarter. I think it's a relentless grinding of physicians to become part of larger entities.
</p>
<p>
<strong>What should physicians know about advanced primary care and what it means to physicians and health care?</strong>
</p>
<p>
Advanced primary care includes focusing on capitation, or some form of incentive to coordinate care and integrate social determinants of health, like food security, into care. The intent, going back to international comparisons, is to do a better job on the front end so that you negate demand on the back end.
</p>
<p>
The problem is, the facts on the ground are that very few dollars are capitated, particularly in the commercial market where the money is. And that's why Purchaser Business Group on Health initiatives are important to try. If they make meaningful progress with their members toward promulgating value- based care, then that's a huge pivot point.
</p>
<p>
Where we're seeing the managed care movement is in Medicare and Medicaid. Medicare is now a majority Medicare Advantage. And that is the default policy of Congress to essentially delegate the rationing decision to private entities and not be on the hook for the micromanagement to the same extent of Medicare coverage and costs.
</p>
<p>
And every state is flipping over, if they haven't done so, from fee-for-service Medicaid to managed Medicaid. I'm on the board of the Martin Luther King Hospital in Los Angeles, which is a safety net hospital, 97% non-commercial. The only way that math works for us is we have special deals from government to make up the funding.
</p>
<p>
The fact that Washington state has a very important set of initiatives to promulgate value-based care across multiple payers, including Medicaid and state employers, I would say it's further ahead than almost any state in the journey to value-based care.
</p>
<p>
<strong>What does all this mean for physicians this year and the years to come?</strong>
</p>
<p>
I'm reminded when I started in health care in the U.S. of a great line a GI specialist once said of being a doctor: It's still going to be better to be a doctor than anyone else, unless you're seven feet tall and have a terrific hook shot.
</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 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 11:26:33 AM | 4/27/2023 12:25:31 PM | 3/15/2023 12:00:00 AM |
| member-profile-kristin-conn-md | Member Profile: Kristin Conn, MD | WSMA_Reports | Shared_Content/News/Latest_News/2023/member-profile-kristin-conn-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/march-april/member-spotlight-website-image-kconn-645x425px.png" class="pull-right" alt="Kristin Conn, MD Member Profile graphic" /></div>
<h5>March 13, 2023</h5>
<h2> Member Profile:
Kristin Conn, MD</h2>
<p>
<strong>Works at: </strong>Washington Permanente Medical Group, Kaiser Permanente Washington.
</p>
<p>
<strong>How long in practice:</strong> 23 years.
</p>
<p>
<strong>Specialty:</strong> Family medicine.
</p>
<p>
<strong>Why WSMA: </strong>The WSMA is responsive to the concerns of clinicians in Washington, and one of my concerns is health equity. I was excited to have the opportunity to join WSMA's Diversity, Equity, and Inclusion Committee last year. The committee reviews existing and proposed policies, identifying when equity issues are present and notifying the policy sponsors or WSMA staff. The insights and perspectives of committee members contribute to thoughtful discussions about unintended consequences of policy as well as opportunities to address inequities. WSMA staff, leadership, and those of us on the committee are committed to ensuring that policy empowers and equips doctors to provide the best care to all people across a wide range of individual and community attributes, but most especially where additional barriers exist.
</p>
<p>
<strong>Proud moment in medicine:</strong> Medical care is a team effort, and my proudest moments are team successes. Several years ago, our large primary care clinic successfully integrated mental health and substance use disorder screening into our standard work, taking another step toward delivering whole-person care. It's hard to appreciate what a big adaptive change that was. Ten years on, we know what a difference it's made to the lives of so many of our patients. I hope as social health screening gains traction, we'll be thinking about that in the same way in years to come.
</p>
<p>
<strong>Top concern in health care: </strong>I'm concerned about the continued impacts of the pandemic on doctors and medical practices-specifically, physicians leaving medicine or cutting back at a time when their skills and knowledge are solid. Medicine is reckoning with disparities and variation in outcomes and health by place, race, and other factors. There is an opportunity to work collectively and align incentives, policies, and processes. The time to act to advance health equity is now. Good work is happening in Washington but there are so many headwinds to push through.
</p>
<p>
<strong>If I weren't a doctor, I'd be:</strong> Working with a community-based organization to improve conditions, well-being, and a better future for children and families. There is so much need and so much opportunity. For the sake of balance, I'd also consider making specialty ice cream. Though it's been decades, I loved my college jobs in ice cream shops. Ice cream really does make people happy.
</p>
<p>
<strong>Best advice I've received: </strong>From my co-chief resident many years ago: "Don't sweat it alone." I tend to be an internal processor, which I recently heard in a presentation can be more common for people from cultures that are focused on the collective instead of the individual. If there's something that's difficult that I'm working through, it's helpful to get it out in the open and invite input and guidance from others. The wisdom of the group is much more than that of any one individual.
</p>
<p>
<strong>Recommended reading: </strong>We had two copies of "Washington Black" by Esi Edugyan when my teenage son was reading it, so I read it too. What an incredible story about the life of an 11-year-old boy, a slave on a Barbados sugar plantation. I'm finishing up Michelle Zauner's beautiful memoir, "Crying in H Mart," which is about the loss of her mother and growing up as a Korean American in Oregon.
</p>
<p>
<em>This article was featured in the March/April 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 11:26:33 AM | 3/15/2023 12:15:39 PM | 3/13/2023 12:00:00 AM |
| peering-into-the-future | Peering Into the Future | WSMA_Reports | Shared_Content/News/Latest_News/2023/peering-into-the-future | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/march-april/cover-wsma-marapr-2023-645x425px.jpeg" class="pull-right" alt="cover of March/April 2023 issue of WSMA Reports" /></div>
<h5>March 13, 2023</h5>
<h2>Peering Into the Future</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<br />
<p>
WSMA Reports spoke with several prominent physician leaders representing a cross- section of medicine to get their thoughts during a transitional, or as some would say, transformative, time in health care.
</p>
<p>
One theme was consistent among the physicians interviewed for this article: Staffing shortages will be a major issue this year. “All of health care is challenged by staffing issues,†says John Pryor, MD, president and board chair of Proliance Surgeons. “It affects every aspect of care.
It’s optimistic to think we’ll climb our way out of that soon.â€
</p>
<p>
The rest of the answers from these physician leaders provide insights into the range of opportunities and concerns facing health care this year and beyond. Together, those responses paint a picture of a changing landscape as it responds to the trends that are reshaping the profession in Washington.
</p>
<h3>Leadership: Supporting and mobilizing the workforce</h3>
<p>
The issue of health care workforce shortages is a consistent problem for practices across the state that will remain an issue now and beyond, says Donna Smith, MD, president of Franciscan Medical Group and senior vice president of Virginia Mason Franciscan Health.
</p>
<p>
The challenge for leaders, she says, is how to support physicians and other health care personnel in the face of ongoing staffing shortfalls. Doing so is critical to avoid burnout and all the attendant problems that follow in its wake.
</p>
<p>
“We’re going to need to support the people we work with and really figure out ways to engage as physicians and leaders on how to give the best care possible by improving the process of care,†she says. “We have teams of highly motivated and skilled people, but we need to help people stay highly motivated and skilled.â€
</p>
<p>
In some ways, that support may seem, in Dr. Smith’s words, “soft and squishy.â€
</p>
<p>
“It’s about appreciating people and the work we do together to care for other human beings,†she says. “We can all tap into that compassion. That will help people sustain their energy, particularly if they are doing that with a smart team.â€
</p>
<p>
But in other ways, the support is an important reminder as to why physicians chose the profession in the first place. “More people go into health care because they really want to have an impact and really want to do meaningful work that helps other human beings,†says Dr. Smith.
</p>
<p>
Practical changes, such as process improvements, will provide more tangible support. For example, Dr. Smith points to advances in technology as offering ways to facilitate smoother interactions between patients and physicians.
</p>
<p>
The other issue that Dr. Smith sees ahead for this year and future years is the role physician leaders will need to play in addressing social determinants of health outside of the health care system.
</p>
<p>
“Physician leadership will have to step in and influence the conversation in other sectors, whether its policy or funding, in areas that are normally outside of health care but that can absolutely impact disparities in health,†she says. “We can impact the disparities influencing our systems, but we need to step into other conversations to influence the other areas of social determinants of health.â€
</p>
<p>
Dr. Smith says that broadening the conversation beyond leaders’ immediate systems is necessary because the problems extend far beyond the clinics’ doors. “It’s about looking for opportunity to connect the dots in the communities and influence the systems that support the health of the community and not take it all on in health care,†she says.
</p>
<h3>Value-based care: Slowly but surely, it’s coming to Washington </h3>
<p>
Value-based health care has been on the horizon for more than a decade. A survey of U.S. physicians in 2014 predicted that half of compensation in 10 years’ time would be value- based. “It’s obvious we’re way short of that forecast,†acknowledges Imelda Dacones, MD, president of the Washington Optum Care market, which includes The Everett Clinic, The Polyclinic, and the Optum Care Network of Washington.
</p>
<p>
Still, looking ahead into the year, says Dr. Dacones, it’s simply a matter of time. “I believe it’s a given that more will move to value,†she notes. “For us in Optum Health, it’s mission critical to move more to value-based care.â€
</p>
<p>
For the most part, the framework is already in place in many places. “Large health systems more or less have the infrastructure set up already,†says Dr. Dacones. “The opportunity for the state of Washington now is how do we as a community of caregivers, as an ecosystem of care and stakeholders— practices, hospitals, purchasers, legislators, and payers—support each other and our patients in our journey from fee-for-service to value, addressing health equity and disparities and the total cost of care moving forward.â€
</p>
<p>
Dr. Dacones believes that the pandemic has only accelerated the movement toward value-based care. “If you think about practices whose business model was purely fee-for- service, they had no volume during the shutdown,†she says. “Practices consolidated or closed shop because they couldn’t survive. I think practices now see the resiliency that the value- based model offers.â€
</p>
<p>
The per member, per month payment model of value-based care provides practices with a sustainable business model. “It gives you the ability to invest in resources and technology to keep access and care open to patients, to keep them well. Resources that you otherwise won’t have if it’s just fee-for- service,†says Dr. Dacones.
</p>
<p>
This year, Dr. Dacones expects to see hospital systems step up their participation in value. “It’s no secret that Providence’s CEO declared that one of his priorities is to get more into value-based care,†she notes. “I think more hospital executives are pointing to that, and for 2023 we will see more and more movement in that direction.â€
</p>
<p>
However, it’s not just large practices. For value-based care to thrive, it will have to take root throughout the entire system. Dr. Dacones says it is incumbent to ensure that independent practices have the support they need to make the transition. “I see that as an evergreen opportunity to really support independent practices, small, medium, and large group practices, to do value-based care. That’s what Optum Care Network is all about: a physician- and practice-enabling partner for value-based care with a suite of services so more can participate and do well in value.â€
</p>
<p>
All in all, this year represents what Dr. Dacones calls “another growth year in Washington’s journey toward value.â€
</p>
<p>
“For physicians, value-based care or not, with the learnings from the pandemic and workforce shortage, it’s really blowing up our own mental models of care and re-imagining and re-engineering what it needs to be and look like in the 21st century,†she says. “We have to lead that change, and not just manage it, if we are to achieve the quadruple aim.â€
</p>
<h3>Telehealth: The future is even more virtual</h3>
<p>
When Michael Vaughan, MD, a nephro- logist with Kaiser Permanente and executive medical director of operations at Washington Permanente Medical Group, looks at the trends for telehealth this year, he sees the sector becoming more sophisticated in how it meets patients’ needs.
</p>
<p>
“When I talk about the direction telehealth is going, I think about taking what we’re doing and advancing it to a much higher level,†he says.
</p>
<p>
The pandemic certainly turbocharged the emerging trend toward telehealth, as practices found virtual visits a necessary alternative to in-person visits. “The time we had in the pandemic helped catalyze our efforts and helped align a lot of state and governmental regulations around the use of telehealth,†says Dr. Vaughan.
</p>
<p>
Now telehealth is poised to move well beyond phone visits and video visits to more complex technology meant to address patient needs. At Kaiser Permanente, that already includes on- demand virtual visits where patients can talk to physicians. “We are able to meet about 60% of our primary care patient needs through virtual services; 20% of those visits are now on-demand virtual care visits, like online chatting with a physician. The demand for that service has doubled in the past year,†says Dr. Vaughan. (Kaiser Permanente is providing close to 250,000 on- demand virtual visits, including phone, video, and online chatting, per year.)
</p>
<p>
The advantage of the advances in telehealth is that, as Dr. Vaughan puts it, “we meet members where they want to be met.†Much as the work- from-home requirements during the pandemic changed the way people view the work office, so too did the pandemic change how people view the need for a visit to a doctor’s office.
</p>
<p>
“The reality is many people don’t want to come in because it isn’t convenient for them,†says Dr. Vaughan.
</p>
<p>
The opportunity is how to move telehealth to the next level. Washington Permanente is looking for ways to integrate telehealth into care for patients with more complex medical conditions. “We can arrange to integrate the primary care physician and the specialist, so it’s not just the front-line physician,†says Dr. Vaughan. “We can interact with specialty teams to get the information the physician really needs to help them address the needs of patients at hand. Whomever is interacting with the patient on the virtual interface can tap into that live to make sure the patient is getting the care they need, so it’s a high-quality visit.â€
</p>
<p>
For all its advances, telehealth is not a replacement for the work that’s being done, but rather a tool to do it in a new way. “We think our digital health services complement all the other things we are able to do,†says Dr. Vaughan. “Our vision of this is that we really see ourselves as having a very different opportunity to provide value to our patients.â€
</p>
<h3>Independent networks: The consolidation continues</h3>
<p>
The past several decades have seen tremendous consolidation among physician practices throughout the country. We continue to see the effects of this consolidation, specifically reshaping the role of physicians in health care, says Rodney Anderson, MD, president and CEO of Family Care Network, one of the largest independent, physician-owned primary care organizations in Washington.
</p>
<p>
“It’s certainly changing our industry, particularly the influence physicians have in shaping the future of health care,†says Dr. Anderson. He sees two primary issues that will play out in the coming year and beyond as the profession grapples with the impact of consolidation.
</p>
<p>
“The first key issue is how each individual health care organization chooses to balance patient care against financial metrics,†Dr. Anderson says. “I continue to worry that health care organizations will prioritize profits over patients.â€
</p>
<p>
The other is how physicians fit into the changed landscape. “What role do physicians play in defining the future of health care if they are being pushed to the sidelines?†asks Dr. Anderson. “When you put physicians in leadership roles, they prioritize patient care.†As more and more physicians are moved out of key leadership and decision- making roles, Dr. Anderson says that he is worried that the mission of health care “is being distorted.†Not surprisingly, Dr. Anderson strongly encourages physicians to “continually push for more influence, authority, and leadership opportunities, particularly in larger health care entities.â€
</p>
<p>
Dr. Anderson acknowledges that the ongoing financial pressures that practices and smaller community hospitals face add to the incentives to join forces with a larger system. “The ripple effects of the pandemic only added to these financial pressures and have left many smaller health care entities looking for a way to keep their doors open,†he says. “Even though we work hard to provide high-quality, cost-effective care while being good stewards of our financial resources, the fact remains that health care is expensive to provide and requires adequate reimbursement from both the government and insurance companies.â€
</p>
<p>
Compounding the problem is the issue that all physicians are facing: staffing.
</p>
<p>
“It’s all levels, from front-desk employees to nursing staff to physicians themselves,†says Dr. Anderson. “How do organizations grapple with it today?â€
</p>
<p>
The concern Dr. Anderson has is that the search for efficiencies will come at the expense of the patient-physician relationship. “Do you lose that individual, personal touch that makes health care special?†he asks. “Do you sacrifice that sacred doctor-patient relationship in the name of efficiency?â€
</p>
<p>
One thing Dr. Anderson is sure of is that the challenges and opportunities will last well beyond 2023. “Health care continues to evolve rapidly, and the question of how organizations and individual physicians are going to adapt will go on for many years ahead,†he says.
</p>
<h3>Specialties: More surgeries in outpatient settings</h3>
<p>
One trend that has been occurring over the past several years is only going to continue in 2023, according to Dr. Pryor, who is an orthopedic surgeon. That trend is the increasing reliance upon outpatient settings for surgeries, both at ambulatory surgical centers and at hospital-based outpatient departments.
</p>
<p>
“I’m pretty confident that 2023 will continue to see the migration of more and more of our surgeries to an outpatient setting,†says Dr. Pryor. “That is certainly a trend we’ve seen, particularly with spine surgery and joint replacement surgeries.â€
</p>
<p>
As an independent group across Western Washington with approximately 220 doctors in all types of surgical subspecialities, Proliance is a bellwether for the shift in how surgeries are being performed. Dr. Pryor says that the ongoing trend is the result of several factors coming together. “There is the evolution of technique to a less invasive technique,†he notes. “Regulatory and payer policies have recognized the safety, quality, and value of those settings, as well.â€
</p>
<p>
Indeed, the cost savings associated with transferring surgeries to an outpatient setting have been an important driver of the change. Last year, the Centers for Medicare and Medicaid Services eliminated 250 musculoskeletal surgeries from a list of surgeries for Medicare beneficiaries that needed to be performed on an inpatient-only basis. At the beginning of this year, the agency added another 1,500 surgeries to that list.
</p>
<p>
Another development that Dr. Pryor hopes to see in the coming year is a return to the kind of patient-physician relationship that was interrupted because of the pandemic, “as we return, just like our social lives, to more in- person interactions.†Time with patients and their families, which was a casualty of pandemic protocols, says Dr. Pryor, is “the softer side of medicine, but it’s very real to patient experience.â€
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the March/April 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 11:26:33 AM | 3/10/2023 2:35:31 PM | 3/13/2023 12:00:00 AM |
| breaking-through-the-red-tape | Breaking Through the Red Tape | WSMA_Reports | Shared_Content/News/Latest_News/2023/breaking-through-the-red-tape | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="January/February 2023 issue of WSMA Reports" src="/images/Newsletters/Reports/2023/january-february/wsma-jan-feb-2023-final-lr-cover-645x425px.jpeg" class="pull-right" /></div>
<h5>February 2, 2023</h5>
<h2>Breaking Through the Red Tape</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
Fixing prior authorization will take time, starting with this year's legislative session. BY JOHN GALLAGHER Imagine a process that delayed needed care, relied on outdated technology, and drove up costs for physician practices and patients, yet in the vast majority of cases led to no change in the course of treatment. As it turns out, you don't have to imagine. That process exists: prior authorization. From the administrative burden it places on physicians to the harm it causes to patients, prior authorization has transformed from a process ostensibly established to reduce overuse of resources into one that diverts an enormous amount of time and resources better spent on patient care.
"In the past 15 years, it's been getting worse and worse," says Katina Rue, DO, a family physician in Kennewick and president of WSMA. "Maybe there was a good reason when it began, but now it's snowballed into a giant entity. Physician practices are having to hire additional staff, retrain current staff, and pull physicians from patient care to deal with it."
</p>
<p>
Indeed, a 2021 physician survey by the American Medical Association documented just how extreme the burden of prior authorization is on both physicians and patients. On average, the 1,000 physicians surveyed completed 41 prior authorizations every week, spending an average of two days on the process. Forty percent of physicians have staff who exclusively complete prior authorizations. Fully 88% of the physicians said that prior authorizations represented a high or extremely high burden.
</p>
<p>
The 2021 survey underscores that the problem of prior authorizations is only getting worse. An AMA survey from 2017 found doctors completing four fewer prior authorizations a week and just over one-third of them with staff fully dedicated to the process.
</p>
<p>
Recognizing the concerns of its members, the WSMA is making prior authorization reform its top priority in the 2023 Washington state legislative session. But reforming prior authorization won't be easy and it won't happen overnight.
</p>
<p>
"This is going to be an ongoing priority," said Sean Graham, WSMA's director of government affairs. "We're in it for the long haul. We're committed to engage on this issue until we see meaningful improvement."
</p>
<h3>Opaque processes and antiquated technology</h3>
<p>
Every physician has stories to tell about how prior authorizations make caring for patients unnecessarily hard. To begin with, it's impossible to tell what will require prior authorization. Each carrier has its own rules and formularies, with the formularies sometimes changing at the start of the year. Physicians don't know what will require prior authorization until the insurance company rejects a prescription or request for a procedure, frustrating both physician and patient.
</p>
<p>
For specialists, prior authorization is pretty much a given. Amish Dave, MD, a rheumatologist at Virginia Mason Franciscan Health, says that in his specialty, "most of our medications are biologics that are super expensive and almost all require prior authorization, not dissimilar to what oncologists and other specialists deal with." At this point, Dr. Dave says, even inexpensive medications are routinely subjected to prior authorization.
</p>
<p>
Once a request is denied, the effort to get approval begins. The process is onerous enough, but it relies on outdated technology. At a time when medical systems are dependent upon electronic health records, prior authorization systems are dependent on fax machines.
</p>
<p>
"It's bizarre that we're living in the 21st century and relying on faxes and hoping that they get it," says Dr. Dave.
</p>
<p>
Because faxes can't be tracked the way an electronic exchange can, missed faxes and their attendant delays are all too common. "I can't tell you how many times faxes don't arrive for whatever reason," says Clinton Hauxwell, MD, a family physician at MultiCare in Spokane.
</p>
<p>
The plans have a "peer-to-peer" process that, at least in theory, can match physicians with a knowledgeable colleague who can evaluate their case. However, the "peer-to-peer" part often fails to live up to its billing.
</p>
<p>
"It's frequently somebody who knows less about the study than I do," says Dr. Hauxwell. "Not to say anything about the person on the other end of the line, but they're just reading the script."
</p>
<p>
Dr. Dave says that his prior authorization questions about rheumatology cases are rarely handled by a rheumatologist. "I have had people with ANCA [anti-neutrophil cytoplasmic autoantibody] vasculitis, where they literally have an organ-threatening disease and I want to get them on rituximab," he says. "Instead of getting a peer, I get a pharmacist or a pediatric occupational medicine doctor who deals with disability cases and knows something about seminal trials. It's demeaning because you are talking to someone who has the power to deny the medicine you've been waiting weeks for, and then you talk to someone who is not even a peer."
</p>
<p>
Indeed, prior authorization now treats every physician with the same level of suspicion, even if most physicians have their requests routinely approved. Essentially, health plans are casting the widest possible net to catch a few outliers.
</p>
<p>
"My experience with prior authorization for imaging studies that require peer- to-peer review is that they always get approved because it's appropriate order," says Dr. Hauxwell. "But the time I and my staff spend is inordinate."
</p>
<h3>Risking patient safety and access to care while contributing to burnout</h3>
<p>
The waste of time and resources is just part of the problem with the current prior authorization system. The bigger one is the impact it has on patients and physicians.
</p>
<p>
"My biggest concern is that due to its ever-increasing reach, it is actually now a patient safety issue," said Carrie Horwitch, MD, an internist at Virginia Mason Franciscan Health. "It is causing harm to patients by delaying care or even perhaps denying appropriate care."
</p>
<p>
The AMA physician survey bears that observation out. Over a third of physicians reported that prior authorization led to a severe adverse event for a patient, while 24% indicated prior authorization led to a patient's hospitalization.
</p>
<p>
As a primary care physician with a large HIV practice, Dr. Horwitch regularly runs into the prior authorization wall when she prescribes antiretrovirals for patients. "They are considered a specialty medication," she notes. "They are more expensive and typically a higher tier. I have experienced delays in getting approval when I need to start someone on medication or perhaps need to change someone to an antiretroviral that is better or safer for them. These are medications that shouldn't be delayed because they lead to better outcomes and reduced transmission."
</p>
<p>
The problem is hardly confined to just HIV medications. "The other big area that many, many physicians and allied health professionals face with patients is diabetes," Dr. Horwitch says. "I think everyone has run into delayed or denied care, which could include insulin or the type we want to prescribe, or the new medications, which evidence shows may be better or safer for patients with multiple comorbidities than some of the older medications."
</p>
<p>
Prior authorization denials hit some types of patients harder than others. A 2021 report on prior authorization from the Washington state Office of the Insurance Commissioner found that carriers reported a lower number of requests, approval rates, and response times for mental health-related codes.
</p>
<p>
One frequent frustration is the tiering system for drugs. Sometimes patients fail on the first treatment, but instead of their physician being able to move them to a medication with a different method of action, they are denied access to that medication until they try another medication like the first failed treatment.
</p>
<p>
"We know it didn't work for that first drug, and then they make someone suffer for no reason because you want them to try a cheaper medicine first," says Dr. Dave. Instead, the patient bears the financial cost of the failed second treatment, as well as the additional physical cost of the failed therapy before being able to get the right medication.
</p>
<p>
Dr. Dave brings a unique perspective on prior authorization because for six years he used to do prior authorizations for a small pharmacy benefit management company. "There is a real role for prior authorization, and I understand that perspective," he says. Yet what he saw was that inappropriate use was a problem "less than 10% of the time," far smaller than the current prior authorization apparatus would justify.
</p>
<p>
If anything, Dr. Dave says, physicians are trying to do right by their patients. "Most of the time, physicians are not trying to prescribe the wrong drug for their patients," he says. "They are not trying to prescribe something inferior or less effective just because it's cheaper."
</p>
<p>
The constant battle just to do the right thing inevitably takes a toll on physicians. Jack Resneck Jr., MD, president of the AMA, has said that prior authorization is high on the list of what he calls "hassle factors" contributing to physician burnout.
</p>
<p>
Dr. Dave agrees and points out that the burnout affects the relationship with patients. "One thing that is driving burnout for physicians is not just the increase in paperwork, but how the therapeutic alliance between patients and physicians is affected by these things," he says. "People think we are responsible for the delay in getting their treatment."
</p>
<p>
Burnout only contributes to the physician shortage, particularly in primary care. Yet the remaining physicians find more and more of their time consumed by prior authorization requirements.
</p>
<p>
"Now with physicians spending a large amount of time on prior authorizations instead of direct patient care, it's very directly impacting the access to patient care in Washington state," says Dr. Hauxwell. "It's time I could use to take care of patients. It adversely impacts patients' ability to have access to me, when I'm in a state that already has primary care access challenges."
</p>
<h3>Taking steps toward reform</h3>
<p>
Starting to tackle the many problems of prior authorization won't be easy. However, heading into legislative session, the WSMA is able to build on past successes, including a series of rulemakings from the insurance commissioner's office in 2015 and 2016, as well as legislation from 2020 that led to some reporting requirements on prior authorization practices.
</p>
<p>
"We're making this our top priority for the 2023 legislative session," says WSMA's Graham. "We are looking to standardize prior authorization as broadly as we can at the state level. We are looking to reduce the administrative burden and expedite access to care for patients who need health care services."
</p>
<p>
The WSMA is modeling its proposed legislation in part on a measure that was successfully passed last April in Michigan. Among the major components of the measure:
</p>
<ul>
<li>Standardizingpriorauthorization requirements across state-regulated insurance carriers, mandating that insurance carriers utilize electronic portals, approve standard prior authorization requests within 48 hours, and approve expedited prior authorization requests within 24 hours.</li>
<li>Promotingtransparencybyrequiring insurance carriers to post their prior authorization requirements and all relevant evidence and criteria online, as well as making it available to patients and physicians upon request.</li>
<li>Ensuring insurance carriers are making informed decisions on prior authorization by requiring determinations to be made by a physician or physician assistant in the same specialty as the ordering physician or physician assistant.</li>
<li>Prohibiting the use of prior authorizations for those services that are routinely approved at high rates, building on legislation the WSMA spearheaded in 2020 to compel annual reporting on insurance carriers' prior authorization practices.</li>
</ul>
<p>
The Michigan legislation was the result of a three-year campaign. "We're hopeful that it won't take three years, but if that's what it takes, we're going to do it," says Graham.
</p>
<p>
However, there is only so much that some legislation will be able to do. One major exception to any state-level reform that passes will be self-insured plans, which most large employers carry. Under the federal Employee Retirement Income Security Act, or ERISA, self- insured plans would be exempt from any changes to prior authorization requirements enacted in legislation.
</p>
<p>
Efforts are also underway at the federal level to reform prior authorization. Last September, the House of Representatives passed a measure that would institute a number of changes for Medicare Advantage plans. The bill would establish an electronic process for prior authorization, forcing plans to move away from the antiquated fax and paper systems that many still require. The measure would also require Medicare Advantage plans to provide data to the Centers for Medicare and Medicaid Services on how frequently they require prior authorizations, as well as their rates of denials and approvals.
</p>
<p>
In an era of intense political polarization, the measure had broad bipartisan support, with 326 votes in favor of passage. "I think our legislation is a straightforward fix that will make a huge difference for patients and for [physicians]," Rep. Suzan DelBene (D-Medina), the bill's sponsor, told the AMA. Even DelBene's family hasn't been spared the problem. A parent of a family member had to cancel scheduled surgery because they were unable to receive prior authorization in time.
</p>
<p>
The WSMA has been actively supporting the federal effort, as well. Any reform that impacts Medicare could have wide-reaching implications.
</p>
<p>
"There's a saying-as Medicare goes, so goes the world," says Jeb Shepard, WSMA's director of policy. "Traditional Medicare doesn't typically require prior authorization. What is really compelling here is that these are Medicare Advantage plans, so they are insurance carriers. The hope is that these potential new requirements on Medicare Advantage plans would be adopted by the broader carrier market, including those self- insured ERISA plans. That is simply a hope at the moment, and time will tell."
</p>
<p>
Still, the momentum is moving toward change.
</p>
<p>
"This legislation is the first step," Dr. Rue says of the Washington state measure. "This is a long process. It's going to be a stepwise approach that takes many years. The insurance companies have held the narrative for a long time. Now it's going to take physicians working with patient groups and others to help move this forward. Hopefully, right now health care is in a space where we're trusted by legislators and the public."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the January/February 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/10/2023 11:26:32 AM | 2/2/2023 10:11:41 AM | 2/2/2023 12:00:00 AM |