Meeting of March 30, 2017 – Kansas City
Warren Lovinger, MD, Nevada, President, presided. Joseph Corrado, MD, Mexico, was elected President Elect. James DiRenna, DO, Gladstone, was elected Chair. George Hruza, MD, St. Louis, was elected Vice Chair. Brian Biggers, MD, Springfield, was elected Secretary. David Pohl, MD, St. Louis, was elected Treasurer.
Meeting of July 16, 2017 – Lake of the Ozarks
The MSMA Council heard at its July 16 meeting at Lake of the Ozarks that the parties involved in the Anthem- Cigna and Aetna-Humana mergers have dropped their pursuit of appeals, so the federal court rulings blocking these mergers stand. MSMA, AMA, and a handful of other states have worked very hard on this issue, and it is a big victory for both organized medicine and patients.
In other advocacy efforts, Anthem has notified its Missouri members that beginning June 1, it will no longer cover emergency department services for conditions deemed not a true emergency. See front page article, above, for more explanation.
The Missouri Department of Health and Senior Services has announced that it will begin rigorously enforcing a law that requires an attending physician to report within 45 days any complications resulting from an abortion procedure. It has issued an official reporting form that includes about a dozen complications. Failure to comply subjects the physician to revocation of license and conviction of a Class A misdemeanor. This applies not only to the physician performing the abortion, but also to any physician treating any complication that arises from an abortion procedure.
MSMA and AMA are working to educate physicians on the federal Quality Payment Program (QPP) which is the current Medicaid physician payment system and what they need to do now in order to avoid payment penalties in 2019. More information, including a helpful instructional video, is on MSMA’s website.
MSMA staff reviewed the 2017 legislative session and gave an update on summer advocacy objectives. The Council also heard a review of the rules and regulations promulgated by the Department of Insurance, and are developing legislation for the 2018 legislative session. David Barbe, MD, AMA President, gave a national perspective on some federal issues.
MSMA President, Warren Lovinger, MD, reported on his travels to visit members throughout the state. He has visited 67 of the 114 counties in Missouri. He also represented MSMA at meetings of the Mid-Missouri Medical Society in Rolla and the Tri-County Medical Society in Washington. He attended the annual meetings of Arkansas, Oklahoma, and Iowa, and plans to attend annual meetings in Nebraska and Kansas.
Resolution #11 was referred to MSMA Council by the House of Delegates. The Council adopted the following substitute resolution:
“Resolved, that the Missouri State Medical Association continue to support Medicaid medical benefit coverage for the treatment of dental conditions that complicate or exacerbate systemic medical disease.”
2017 Resolution Actions
The Council reviewed the dispensation of the resolutions from the 2017 Annual Convention.
KaMMCO Health Solutions
Partnering with KaMMCO Health Solutions will allow MSMA to license a Health Information Exchange and clinical data analysis program to market to Missouri physicians and hospitals. This service will be a membership benefit with almost no financial risk to MSMA.
Membership
MSMA is ramping up for the 2018 renewal season, and has gained 207 new members for 2017. Ravi Johar, MD, Chair of the Membership Committee, asked that everyone reach out to the new members. MSMA’s Membership department has postcards available for contacting those new members. The committee heard an update on student activities, and brain-stormed ideas for engaging residents. More than 120 physicians have signed up for a “White Coat Night” at the ballpark in St. Louis on Friday, August 11, when the Cardinals play the Atlanta Braves.
Report of the Physicians Health
The retirement of Charles Sincox, MD, as Medical Director of the Missouri Physicians Health Program, was announced. Lisa Thomas, MD, Columbia, assumed that role on July 1, 2017. Many thanks to Dr. Sincox for his long years of service. Dr. Thomas emphasized how vital the program is, and how the range of issues has broadened over the years. She introduced the MPHP’s new gift acceptance policy, and encouraged physicians to consider including the program in their will, estate, and trust planning.
Dr. Barbe reported that Bob Bondurant, the MPHP Executive Director, has connected with the Federation of State Physician Health Programs, and will participate in a forum or seminar at the AMA’s Interim Meeting in November.
Continuing Education
In 2016 and 2017, the MSMA offered ABIM MOC Points for CME General Sessions during MSMA’s Annual Convention. The number of physicians who received ABIM MOC doubled in 2017. In 2018, ABIM MOC points will again offered for the General Sessions. The MSMA’s 2018 Annual Convention will be held March 23–25 at the St. Louis Renaissance Airport Hotel.
Accreditation/Activity Review/Progress Report decisions included accreditations for both the Kansas City Southwest Clinical Society and the Missouri Baptist Medical Center.
The MSMA Insurance Conference is Thursday, July 20, at the St. Louis Renaissance Airport Hotel.
AMA
Edmond Cabbabe, MD, Chair of the Missouri Delegation to the AMA, reported Dr. Barbe is AMA President; David Fleming, MD, has been appointed to the AMA Council on Ethical and Judicial Affairs; Dr. Cabbabe has finished his third three-year term at the AMA Foundation, and has started a four-year appointment on the AMA Council on Long Range Planning and Development; and Jerry Kennett, MD, is on the AMA Council on Legislation. At the annual meeting, Rebecca Hierholzer, MD, chaired a reference committee, and Elie Azrak, MD, served as a reference committee member.
Dr. Barbe commented on the status of health care reform. He also encouraged members to sign up for “AMA Morning Rounds,” a daily email push of information that is a synopsis of the day’s activities. “Weekend Edition” is a members-only subscription, which summarizes the week’s activities.
Alliance
Donna Corrado provided the report on behalf of MSMA Alliance President Marsha Conant, who has been traveling to various counties in Missouri. Barbara Hover has been appointed to the AMA Opioid Task Force and has helped coordinate an informational packet, as well as a DVD in which Missouri Alliance member Kelly O’Leary tells the story of losing her son to an opioid overdose. Mrs. Corrado and Mrs. O’Leary are now offering a 20-minute program for county groups discussing the opioid epidemic and the science of addiction. The Alliance Fall Conference will be October 4–5 in St. Joseph.
Announcements
Dr. Thomas will take the 5th District Councilor seat vacated by MSMA President Elect Joseph Corrado, MD.
Clark Andelin, MD, will take the 5th District Vice- Councilor seat vacated by Dr. Thomas.
Brian Curtis, MD, will take the 8th District Vice- Councilor seat vacated by the resignation of Ellen Nichols, MD.
Dr. Lovinger will take the AMA Delegate seat vacated by the retirement of Ted Groshong, MD.
Dr. Corrado will take the AMA Alternate Delegate seat vacated by the retirement of Nathaniel Murdock, MD.
Councilor District Reports (Selected)
The St. Louis Metropolitan Medical Society Physician Leadership Institute will begin September 16, and run through November 11, offering 21 CME credits. SLMMS and MSMA members receive a discount to participate. The annual Hippocrates Lecture is Wednesday, October 4, in St. Louis. There will be a cocktail hour, followed by dinner and a presentation by Dr. Barbe: “How the AMA Affects Everyday Practice – What Have You Done For Me Lately?” Contact the SLMMS office for more information on any of these programs.
Boone County Medical Society is inviting Cole County physicians to join. Work continues on local membership of residents and fellows, as well. An annual football tailgate will be held this fall in conjunction with the Alliance.
District #8 has been active producing CME programs on sports medicine, field management of heatstroke, and HPV prevention through vaccination and managing HPV. The Greene County Alliance sponsored Dr. Samantha Meltzer-Brody, a psychiatrist from North Carolina, dealing with physician burn-out.
Greene County Medical Society supports the adoption of the St. Louis County prescription drug monitoring program in Greene County and the city of Springfield.
In District #9, Lirong Zhu, MD, reported that the Mid-Missouri Medical Society has been re-activated, with Dr. Lovinger attending the May meeting.
Organized Medical Staff Section
Peggy Barjenbruch, MD, reported on educational sessions presented during the AMA-OMSS meeting, which included emerging issues in medical staff affairs, individualizing by-laws, physician burn-out in relation to data entry, social media, and the liability involved in texting patients.
Medical Student Section
Efforts to improve recruitment include greater coordination among the chapters, more idea-sharing, and joint events. The focus of the 2017 Lobby Day was a PDMP, and 40–50 students came to discuss the issue with their representatives. The students are excited about promoting the physician mentorship program, and more than 75 physicians are already signed up to be mentors. MSMA will soon send out the first round of sign-ups. The students thank those participating in the program.
Meeting of October 15, 2017 – Jefferson City
The MSMA Council learned about the Show-Me Health Information Network of Missouri (SHINE), a statewide health information exchange set up in partnership with KaMMCO Health Solutions to develop a statewide health information network led by the physician community during the October Council Meeting held in Jefferson City. See complete article, above.
Advocacy
The Council discussed the ongoing battle with Anthem over a new policy that denies coverage for emergency department services if, after the fact, Anthem decides the services were not for a true emergency. This policy appears to violate the “prudent layperson” standard contained in both state and federal law. In recent weeks, Anthem has announced two additional policies that are causing concern. Effective November 15, Anthem will begin denying coverage for emergency department imaging services if it decides later that there was not a bona fide emergency. And Anthem is now denying certain out-patient imaging services provided in hospital-owned facilities, and using aggressive prior authorization to push patients to independent imaging facilities. MSMA has partnered with the Missouri Hospital Association, MAOPS, and Missouri College of Emergency Physicians to work on these issues, and is preparing remedial legislation for when the General Assembly reconvenes in January.
The Council heard an update on the activity with the Affordable Care Act. At the state level, issues include advance nurse practitioners scope of practice and licensure, comprehensive insurance packages, tanning bed prohibition for minors, and tort reform. Dates and sign –up processes for MSMA Physician of the Day program are on the MSMA website.
MSMA President, Warren Lovinger, Jr., MD, reported he has visited physicians in all 114 Missouri counties, the City of St. Louis, and several rural and urban hospitals, and learned of the financial challenges that they are facing. Dr. Lovinger also offered his thanks to societies in Lake Ozark, Washington, Hannibal, and Rolla. In West Central, he and Mrs. Lovinger hosted a barbecue at their home.
MSMA is educating physicians as to what they need to do in 2017 to avoid penalties in 2019 for the Medicare Quality Payment Program. Educational information/videos are on the MSMA website.
Membership
MSMA members are now renewing for 2018, with over 1,700 members already joined, including active physicians, residents, and students. The new MSMA Student Mentorship Program has more than 85 members signed up to be mentors, with the first wave of student/physician match-up underway. Dr. Lovinger applauded the enthusiasm of the new MSMA Resident and Fellow Section leaders, and introduced Joanne Loethen, MD, who is spearheading the resident membership effort. He also introduced Mr. Alex Goodson and Ms. Shannon Tai, Medical Student Section leaders, and thanked them for their excellent work.
Continuing Education
Betty Drees, MD, reported that planning for the CME portion of the Annual Convention is nearly complete. General session topics include Ethics/Palliative Care, Immunotherapy for Arthritis, Practice Management, Heart Failure Medications, and Finding Fulfillment as a Health Professional.
Physicians Health Committee
Lisa Thomas, MD, MPHP Medical Director, reported that the donor-dependent and highly regarded MPHP continues to assist physicians at all levels, and is considered to be a model program throughout the country.
Dr. Thomas reminded members that there are resources available for physicians who are impaired. Initial assessments, treatment referrals, and referrals to attorneys are provided by MPHP. Future developments utilizing teleconferencing to minimize travel, accomplishing initial assessments more quickly, and follow-up.
AMA Report
The Missouri Delegation to the AMA will hear a number of resolutions during the Interim AMA Meeting this month. Missouri will be well represented as the President of the AMA is MSMA’s own David Barbe, MD, from Mountain Grove. Jerry Kennett, MD, serves as a member of the AMA Council on Legislation. Ed Cabbabe, MD, is a member of the AMA Council on Long-Range Planning and Development.
Councilor District Reports (selected)
AMA President Dr. Barbe was the guest speaker at the St. Louis Metropolitan Medical Society (SLMMS) Hippocrates Lecture on the topic “AMA – What Have You Done for Me Lately?” SLMMS wrote a letter to the St. Louis Post-Dispatch regarding the imaging issue with Anthem and the inappropriateness of the approach. In response to the opioid epidemic, SLMMS is joining with Clayton Behavioral Partners to present an opioid crisis symposium for practicing physicians early next year. It will be a half-day workshop focused on physician education and response to patients with opioid issues, and will promote St. Louis County’s PDMP.
The Joplin medical school has opened with 162 medical students, and there has been a dean change. A Greene County presentation on physician burn-out was well received and attracted several new members. Dr. Barbe will speak to community physicians at the Jordan Valley Community Health Center regarding the opioid crisis.
Cape Girardeau County reported that it is developing a lecture series and applauded a recent successful campaign, which raised $16,000 for the American Cancer Society.
In Medical Student Section news, Mizzou recently hosted a residency panel for undergraduates in coordination with Boone County Medical Society. They received a small grant for the free clinic that they run at Mizzou. They also have an upcoming event, “Pints and Politics,” that will focus on the opioid epidemic. Statewide, most schools of medicine have had their recruitment meetings; UMKC has been raising awareness about DACA; SLU has scheduled a roundtable discussion regarding DACA, to include a letter-writing campaign; and will also hold a resolution-writing workshop.
Alliance
The Council received the Alliance Holiday Sharing Card, which collects funds for the Missouri State Medical Foundation. In addition to representation at the North Central Alliance meeting in Novi, Michigan, the Missouri Alliance met for its Fall Conference in St. Joseph in October.
Meeting of January 14, 2018 – Jefferson City
The Council heard an overview on the new KaMMCO Health Solutions, dba SHINE (Show-Me Health Information Network), program, during MSMA’s January 14, 2018, Council Meeting in Jefferson City.
The program is completely physician-directed; MSMA will have full control over data usage policies; and it will be a state-wide, MSMA effort. The SHINE program brings new capabilities in analytical reporting. There is a significant differential in member/non-member pricing, so it should provide an incentive for membership. A KaMMCO employee, Jonathan Smith, will start work in February, live in Kansas City, and travel statewide to promote SHINE.
Alexander Hover, MD, SHINE Technical Advisory Committee chair, stated the committee has continued to review the functionalities to be certain that this product is something that can be promoted to individual physicians and small practices. The additional clinical information that is brought by integration with EMRs is very helpful with the daily business of physicians (e.g. – immunization review). Another benefit is population analytics, and the ability to meet federal MIPS reporting requirements, as well as insurance contract requirements. This product is much more than simply a health information exchange. Implementing SHINE may bring a stronger relationship between MSMA and Missouri Hospital Association (MHA), as it has between KMS and KHA. Dr. Hover named the other members of the transition committee: Drs. Jim Schell, John Stanley, Charles Van Way, and Sharon Wallace.
Dr. Van Way shared his experience with the product and pointed out some of the ways in which care can be enhanced by utilizing the product, particularly avoiding duplication of efforts and ensuring that patients are receiving the necessary studies, tests, and procedures. Dr. Hover stated that the ability to access information necessary for quality reporting is a big selling point for the product, and it is not limited to those who are part of a big organization.
Advocacy
In other advocacy efforts, the Council was directed to copies of several letters that have been sent in an effort to oppose Anthem’s policy of retrospectively denying emergency room services claims. A letter was also sent by Senator Claire McCaskill to Joe Swedish, the Chairman, President and CEO of Anthem, wherein she requests specific items of information, including internal emails among senior management regarding their emergency department policies. MSMA, partnering with MHA, MAOPS, and MoCEP, has met with the Attorney General’s Chief of Staff and Chief Counsel for Consumer Affairs, as well as the Director of the Department of Insurance (DOI), to discuss the Anthem emergency services claim denial issue. MSMA encourages anyone who knows of a patient who has been adversely affected by Anthem’s policy to call MSMA, and they will be instructed on how to file a complaint on the DOI’s website. There was discussion regarding whether the patient would be billed for the non-covered services, or the hospital would simply not be paid for those services. The latter would result in fewer complaints, as the patient may not know if the hospital did not get paid. Jeff Howell, MSMA Director of Governmental Affairs, stated that the hospital would have to bill the patient for the services. Peggy Barjenbruch, MD, stated that the patients know about this, as she has had patients come into her office with chest pain instead of going to the ER, for fear of the emergency services claim being denied.
The Council was referred to an example of an AMA sign-on letter, this one addressing the Prescription Drug Benefit Management Model Act. AMA has initiated the effort at the federal level, and then provided the letters to states and specialty societies.
An update on this year’s legislative priorities was shared: workers’ compensation fee schedules, Medicaid managed care expansion, APRNs, reeling in Anthem’s ED denials and their modifier-25 clinical edits. The PDMP will be addressed again, as well as many other items. MSMA is part of a coalition with other groups, working on issues like tanning beds. The Council was encouraged to sign up for Physician of the Day and bring a friend along when serving.
A handout on the Missouri Medicaid ER Utilization Reduction Project reviewed what has happened in Washington with a software vendor that is trying to have early intervention with the “frequent flyers” of emergency rooms. MSMA is involved, so that Missouri Medicaid monies can be spent in the most appropriate fashion.
The Opioid Summit on March 2 in St. Louis is supported by MSMA, in addition to promoting a PDMP in every county in the state.
Warren Lovinger, Jr., MD, President, reported that he and his wife, Marilyn, have visited all 114 counties in Missouri and the City of St. Louis. He has also visited several component society meetings recently, including St. Charles, Pettis County, St. Joseph and the historic “Kansas Connection.” They are looking forward to visiting Boone County, Greene County and St. Louis in the upcoming weeks, and thank all of the physicians who have shown them hospitality.
Assistant Physicians
Jim DiRenna, DO, spoke about the inception of the Assistant Physician licensing program in Missouri. Dr. Lovinger introduced Drs. Amanda Turner and Elizabeth Mukherjee of Nevada. Dr. Turner, of Nevada Medical Clinic, is sponsoring Dr. Mukherjee as an Assistant Physician. Each physician shared her perspective, along with details of how they are making the program work.
Membership
The Membership Committee reported that MSMA is developing marketing materials based on awareness, recruitment, and retention. MSMA is becoming more active in social media, with a YouTube channel featuring Dr. Lovinger as well as Facebook, LinkedIn, Instagram, Twitter, and the MSMA website.
AMA Report
Edmond Cabbabe, MD, reported that the AMA delegation, including Drs. Lovinger and Joe Corrado attended the interim meeting in Hawaii in November. AMA representatives were David Barbe, MD, AMA President; Jerry Kennett, MD, Council on Legislative Affairs; and Dr. Cabbabe, Council on Long-Range Planning and Development. Thank you to Drs. Lent Johnson and Ted Groshong for their past service on the delegation. Thanks also to Drs. Nathaniel Murdock and William Huffaker, who have also retired from the delegation. Dr. Barbe responded to several questions regarding AMA’s position on different issues. He encouraged members to join the AMA and to contact their specialty representatives and delegates if they have concerns or questions.
Councilor District Reports (Selected)
Robert Corder, MD, reported that Mosaic has pulled out of North Kansas City, and will focus now on their regional area. Buchanan County Medical Society revised their bylaws last year, primarily to allow them to use their money for community action. Sandra Ahlum, MD, reported that Hannibal Clinic, a private physician group, has sold all its shares to Blessing Hospital from Quincy. Physicians will still work at Hannibal Regional Hospital, and patients will not see any difference. They are very excited about the collaboration and new ownership.
Elie Azrak, MD, reported that the St. Louis Metropolitan Medical Society (SLMMS) is conducting a CME event regarding the opioid epidemic featuring an all-physician discussion panel on April 21 at St. Luke’s in St. Louis. Lancer Gates, DO, reported that in Kansas City, a new clinically-integrated network has started as of January 1, 2018; it is a consolidation of the Shawnee Mission Medical Center, the University of Kansas Hospital, and the North Kansas City Hospital, combined with the Kansas City Metropolitan Physicians Association, which is an independent physician organization. The four organizations have come together for a Medicare shared savings program ACO. They have also made a deal with Blue Cross Blue Shield of Kansas City for a quality program that includes several measures, namely, decreased emergency department utilization, decreased readmissions, and colorectal screenings.
Dr. Hover reported that Dr. Barbe will be speaking on physician burnout, and there will be a night at the museum event in Springfield. Brian Curtis, MD, reported that the new Joplin medical school that started in July has 162 students enrolled. Representative Bill White, spouse of Ellen Nichols, MD, is running for a state Senate position (District #32), and is a good advocate for physicians’ needs.
Organized Medical Staff Section
Dr. Barjenbruch reported that the OMSS has asked the AMA to urge all accrediting bodies to include the hospital medical staff in the accreditation process. They are working to change the nomenclature of “physician burnout,” feeling that the term indicates that the problem is with the physician, when the problem is demoralization due to outside pressures. They also discussed hospital disaster plans, which no longer include physicians since becoming a system; they will push for involvement of physicians in hospital disaster plans. She encouraged members, particularly those from Kansas City, to join OMSS to further this effort. Lancer Gates, DO, spoke of a drill that was held in North Kansas City, with participation required. Dr. Corrado spoke of the “Stop the Bleed” program, a disaster response program in which the American College of Surgeons is very involved.
International Medical Graduate Section
Sri Kolli, MD, introduced Angeline Stanislaus, MD, the Chief Medical Officer for Adults of the Missouri Department of Mental Health. She encouraged members to contact her with any needs they may have in their counties, as the Department of Mental Health has many resources.
Medical Student Section
Shivani Singh reported that they are hosting naloxone trainings at medical schools across the state. They are also having student meetings across the state to discuss policy and regulations, and holding MSS Lobby Day on March 13. She thanked all physicians who have volunteered to be part of the mentoring program.
Appointments and Introductions
Brian Biggers, MD, will fill an open spot on the board of the MSMA Insurance Agency. Dr. Lovinger introduced new MSMA staff members Heidi Geisbuhler– Director of Legislative Affairs and Stephen Foutes– Director of Marketing, and Sarah Luebbert is now Director of Medical Specialty Societies. Ravi Johar, MD, was introduced as the Medical Director of United Health Care.
Reports
The Council heard reports from the Commission on Continuing Education, Missouri Physicians Health Program, Publications Committee, and Actions and Recommendations on 2017 Resolutions.
Alliance
County Alliances celebrated with holiday luncheons, “Student Santas,” and adopting families. The Alliance recognized Barbara Hover for having articles published in Alliance in Motion and Physician Family magazines. The Alliance will have Advocacy Day at the Capitol on February 20 and 21, and planning the Alliance Annual Meeting on March 23 and 24 in St. Louis.
Gill Waltman gave an update on fundraisers to benefit the MSMA Alliance Scholarship fund and the MSMF. There will be two evening events during Annual Convention: a women’s clothing direct-sale event on Thursday evening and a fundraiser dinner with the theme “Come Fly with Me” on Friday night.