Meeting of April 7, 2019 – Kansas City
James DiRenna, DO, Gladstone, President, presided. George Hruza, MD, St. Louis, was elected President Elect. Alexander Hover, MD Springfield, was elected Chair, George Hubbell, MD, was elected Vice Chair. Brian Biggers, MD, Springfield, was elected Secretary. David Pohl, MD, St. Louis, was elected Treasurer.
Meeting of July 14, 2019 – Osage Beach
During the July 2019 Council Meeting in Osage Beach, Missouri, MSMA voted to support a campaign for the November 2020 ballot initiative regarding Medicaid expansion. Currently, a proposed statute and a proposed Constitutional amendment, both with the same language, have been filed with the Secretary of State. MSMA support would be given to whichever option emerges as viable. The Council also approved supporting Missouri Hospital Association’s subcontract with Iowa Healthcare Collaborative for the CMS Clinician Quality Improvement Collaboration.
Advocacy
The Council heard a review of legislative issues, including prior authorization reform, medication-assisted treatment, APRN, Physical Therapy, and other scope of practice issues, as well as public health issues such as homelessness and anti-vaccination.
Two resolutions were referred to the Committee on Legislative Affairs. Discussion on Resolution 1 regarding Chronic Traumatic Encephalopathy was tabled until October so staff can gather more information; Resolution 7 - Supporting Environmental Health Legislation, was adopted:
RESOLVED, that the Missouri State Medical Association support legislation that addresses the harm presented by environmental pollution, and seeks to improve air and water quality as it affects the health of Missouri patients.
Other actions from the Annual Convention resolutions can be found at www.msma.org/resolutionactions.
Participation in the 2019 Physician of the Day program was very much appreciated; the sign-up form and available dates for 2020 are now on the website. Physicians may also agree to have a student shadow them. MSMA encourages volunteers to bring along a nonmember colleague to the Capitol. White Coat Day for 2020 will be held on March 3. A sign-up form is also on the website.
MSMA has hosted several advocacy events, one in St. Louis and one in Kansas City, co-sponsored by St. Louis Metropolitan Medical Society and Kansas Medical Society. MSMA staff is happy to bring an advocacy event to you at your local medical society, medical staff, or at your home. MSMA can arrange to have your local state representative stop by. Contact MSMA for more information.
In addition to the weekly legislative updates that are provided during the legislative session, MSMA will now provide updates on the second and fourth Thursdays of the months outside of session. Please share this information with non-members.
A new communication tool, Phone2Action, will allow members to send a one-time text to sign up to be linked with their legislators, and will receive notifications when important issues are being addressed. They will then be able to provide input directly to their elected officials.
SHINE
There are changes in the ownership of KAMMCO Healthcare Solutions (KHS). KAMMCO is the professional liability insurance company sponsored by Kansas Medical Society. The insurance company has divested, and has sold KHS to Kansas Health Information Network, a 501c(3). The contractual relationships with KHS are unchanged, although they now have a new parent company. Department of Social Services budget includes $1 million, and SHINE (Show- Me Health Information Network) hopes to leverage that for the federal 90% match. It has already received $83,000 as the share of the Physicians Foundation grant, and hopes to use those funds to defray some of the upfront connection costs. The SHINE HIE connection fee is about $3,500, and EHR connection costs to HIEs are between $3,000 and $20,000.
CME
Identified topics for the 2020 Annual Convention, based on evaluation summaries and practice gaps, include state and national advocacy efforts, science of medical marijuana, e-cigarettes and vaping, and medicine/artificial intelligence. An ad hoc committee, chaired by Betty Drees, MD, will study the MSMA Annual Convention to find ways to streamline the programming, identify savings, increase efficiency, and find alternative means that maintain its purpose of governance, education, and camaraderie.
Missouri Physicians Health Program
Lisa Thomas, MD, Medical Director for MPHP, praised the success rate of the program. The rate of return to successful practice is high because the MPHP program is longer and more comprehensive than other programs of similar nature.
AMA Report
Edmond Cabbabe, MD, reported that the AMA delegation, including Drs. Jim DiRenna and George Hruza, as well as the student and resident representatives, attended the AMA Annual Meeting in Chicago in June. Dr. Cabbabe has completed his second year on the Council of Long-Range Planning and Development and encouraged application to the AMA Community Health Grants through the AMA Foundation. David Barbe, MD, has completed his leadership role with the AMA, and as Past President he will have a seat in the House of Delegates. He is now in line to be President-Elect of the World Medical Association. MSMA presented a resolution at the AMA meeting regarding the care of children of incarcerated parents. It was combined with a similar resolution, and was adopted.
Alliance
Gill Waltman reported that she and Diana Corzine have been installed for a second term in their roles as President and President-Elect. The Alliance executive board met on May 29, with Fall Conference scheduled for October, Winter Board Meeting and Day at the Legislature to be held in conjunction with White Coat Day, and the Annual Meeting planned for April 3. The AMA Alliance Annual Meeting was held in Chicago in June, and Missouri had the largest representation. The AMA Alliance will be adding “vaping” to the list of issues to be addressed through their programs. The SLMMS Alliance received the 2019 AMA Alliance Health Awareness Promotion Award for its opioid awareness program at Loyola Academy in St. Louis.
Announcements
Council Chair Alexander Hover, MD, welcomed new Council members: Christopher Swingle, DO, District 3 Councilor; Michael Weaver, MD, First Vice President; Samantha Lund, AMA Student Delegate from Washington University; and Priya Jain, Medical Student Section Vice Councilor from UMKC. Councilor Advisors were appointed: David Kuhlmann, MD – Commission on Medical Economics; Peggy Barjenbruch, MD – Commission on Continuing Education; George Hubbell, MD – Commission on Public Affairs; Lisa Thomas, MD – Physicians Health Committee.
Councilor District Reports (Selected)
District 1
Robert Corder, MD, reported that Buchanan County Medical Society is focusing on issues that affect the health of the community, specifically human trafficking and the opioid epidemic. Dr. Corder participates in the Missouri ECHO program, which offers teleconference CME for free during the semi-monthly Opioid Use Disorder program offered by ECHO.
District 3
Christopher Swingle, DO, reported the 17th Annual Hippocrates Lecture will take place on September 17 at Spazio’s Westport in St. Louis. More information is available on the SLMMS website.
District 6
Warren Lovinger, MD, reported that Nevada Regional Medical Center, which is owned by the community, has been very close to being liquidated several times. The Sole Community Hospital program, along with a half-cent sales tax, will help NRMC to meet its required bond payments.
District 7
Lancer Gates, DO, announced that Marc Taormina, MD, has been appointed by Governor Parson to serve on the Missouri Board of Healing Arts. The Kansas City Medical Society Annual Meeting will be on Sept. 26. The guest speaker is Vanila Singh, MD, the Chief Medical Officer for the office of the Assistant Secretary of Health for the U.S. Dept. of Health and Human Services.
District 8
Matthew Stinson, MD, reported that Greene County Medical Society has been involved in the Tobacco 21 measure locally, and hopes that the measure will pass. Brian Curtis, MD, reported that the Joplin Medical School is in its third year; there should be nearly 120 students coming into the two hospitals, Freeman and Mercy, next year.
Organized Medical Staff Section
Peggy Barjenbruch, MD, reported that approximately 100 physicians attended the AMA OMSS in June in Chicago. Out of 12 business items, three prompted robust discussion: accountable care organizations, restrictive covenants, and limitations on physician access to hospital services based on case and monetary volumetrics. The section sent six resolutions to the House of Delegates, including one on ergonomic injuries.
Medical Student Section
Scott Berndt encouraged members to reach out to students to attend their meetings. He thanked the Council for its help with the resolution that the MSS put forth and got passed at the AMA Annual Meeting regarding care of children of incarcerated parents. MU is working on a Homeless Connect project. UMKC is continuing to work on advocacy and getting students signed up to vote. Washington University recently hosted a Pints and Policy event. KCUMB and SLU both have upcoming meetings.
Meeting of October 13, 2019 – Jefferson City
Demonstrating the value of membership through its upcoming advocacy efforts, MSMA announced its top priorities for medicine at the October Meeting in Jefferson City: making the credentialing process less of a headache, curbing vapor product usage by minors, and fighting the anti-vaccination movement.
Advocacy
Working on those three issues and many more begins with the 2020 legislative session on Wednesday, January 8. MSMA has held numerous statewide meetings to increase communication and advocacy this summer and fall, and has been meeting with lobbyists, discussing both old and new issues and anticipating an interesting year for public health. The October Legislative Report highlighted the importance of building relationships with elected officials before the legislative session convenes. Identify your state legislators and make contact with them. Phone2Action is a new tool to connect members to MSMA’s legislative text alert network. Visit www.msma.org/action to sign up.
An FAQ flyer on medical marijuana is being developed by MSMA, and physicians are encouraged to submit any questions they or their patients have to Jeff Howell at jhowell@msma.org so that those issues can be incorporated.
The Missouri Health Insurance Innovation Task Force has been established to look into a Section 1332 waiver in the ACA and will put in legislation to launch a re-insurance program similar to what other states have done. MSMA member Rep. Jonathan Patterson, MD, is on the committee.
Five MSMA members on the state’s Opioid Prescriber Advisory Committee give MSMA great input into Medicaid opioid policies. An effort to expand the 12-month drawback period for HMO payments to physicians was turned back in the Governor’s Medicaid Fraud Task Force.
The Council discussed the possibility of creating a Missouri Healthcare Collaborative to jointly pursue shared interests, as Iowa and Kansas hospital and medical associations have done.
Events to sign up for:
Physician of the Day program www.msma.org/physician-of-the-day
March 3, 2020 - White Coat Day www.msma.org/white-coat-day
Annual Convention/CME
Programming is underway for the 162nd Annual Convention, April 3–5, 2020, Renaissance St. Louis Airport Hotel, reported Peggy Barjenbruch, MD. She said the CME Commission accredited Hannibal Regional Hospital for four years, and approved progress reports for North Kansas City and Lake Regional. The MSMA annual maintenance fee will increase due to an ACCME fee increase, and beginning in 2021, providers will pay the maintenance fee directly to the ACCME.
An ad hoc committee on the Annual Convention is reviewing possibilities for cost savings and ways to increase attendance among younger physicians. Other improvements include changes to the exhibit hall, CME, and registration fees. By 2022, the delegate handbook will be only available via MSMA’s website.
SHINE
SHINE is continuing with its existing policies and structures, and is working with MO HealthNet to determine how to distribute $10 million in federal matching funds, which are intended to assist clinics with connection fees to HIEs; these fees remain the largest challenge to signing up. SHINE is now owned by the Kansas Health Information Network, rather than KAMMCO.
MSMA Insurance Agency
Ronnie Staggs, Director, discussed the current market analysis, which showed that for the first time in many years, insurance companies are filing for rate increases across the board. Progress continues on the Association Health Plan. It was delayed due to a new ACA format allowing individual states to make more decisions on what they will allow for groups under 50.
Services Update
MSMA will continue administration services in 2020 for Boone County Medical Society, and the Missouri organizations of the American College of OBGYN, American College of Emergency Physicians, and American College of Physicians.
Missouri Physicians Health
Lisa Thomas, MD, Medical Director for the Missouri Physicians Health Program, reported that educational presentations will continue in 2020, and asked all physicians to support their physicians’ health program in their respective hospitals and practice settings. She reviewed the participation figures, which are mostly internal medicine and family practice physicians. Dr. Thomas also announced her candidacy for State Representative of House District 124 comprised of portions of Camden and Miller counties. She is a resident of Lake Ozark and has been involved in MSMA leadership since 2005. She is currently MSMA’s District 5 Councilor.
Actions and Recommendations
Resolution actions of the 2019 House of Delegates were approved and can be found at www.msma.org/resolution-actions.
Constitution and Bylaws
Two areas of the MSMA Constitution and Bylaws are to be updated through resolutions introduced at the January 2020 Council Meeting. First, the Women Physicians Section, established in April 2019, is crafting bylaws to amend MSMA’s Constitution and Bylaws. Secondly, the bylaws that address the allocation of councilor positions based on membership will be updated to keep the allocations unchanged.
Councilor District Reports (selected)
District 2
Councilor John Memken, MD, Hannibal, reported that Patricia Herner, MD, presented the American College of Surgeons “Stop the Bleed” program at a recent society meeting.
District 3
Councilor Inderjit Singh, MD, St. Louis, reported the annual Hippocrates lecture topic was “Healthcare in Crisis,” presented by Dr. Ed Weisbart in September. Following the lecture, participants discussed the pros and cons of a “Medicare for All” single-payer program. The partnership with the Midwest Health Initiative (MHI) and the St. Louis Business Health Coalition (BHC) continues to provide physician input for the Choosing Wisely initiative. A sub-group of four SLMMS physician members have joined with physicians from the MHI board to analyze areas of high cost and potential waste reduction in healthcare. Using payer-provided data, the physicians are identifying opportunities in the St. Louis market and will publish findings in 2020.
District 4
Councilor Kevin Weikart, MD, St. Charles, reported that St. Charles Lincoln County Medical Society will be awarding $7,500 for their medical student scholarship.
District 5
Councilor George Hubbell, MD, Lake Ozark, reported that Boone Hospital in Columbia will no longer be a subsidiary of BJC, but instead will be managed by itself as a county hospital, led by long-time MSMA member Jerry Kennett, MD. The University of Missouri is in the process of buying out SSM-St. Mary’s in Jefferson City and Mexico. MU is expanding its family practice residency to include Bothwell Hospital in Sedalia. Amy Zguta, MD, Columbia, will become the District 5 Vice Councilor, due to the relocation of Clark Andelin, MD, Mexico. Boone County Medical Society held two events: a residency forum for directors and third-year medical students and an educational forum on medical marijuana.
District 6
Vice Councilor Amanda Turner, MD, Nevada, expressed her appreciation for Dr. Lovinger’s efforts to effect the passing of a sales tax to keep the Nevada, Mo., hospital from closing. Dr. Turner thanked MSMA for its presentation on advocacy and communication at the West Central Society’s meeting in August.
District 8
Vice Councilor Brian Curtis, MD, Joplin, reported the medical school in Joplin is now in its third year, so the original students are now in their third-year rotations.
District 9
Vice Councilor Omofolarin Fasuyi, MD, Rolla, thanked MSMA for its advocacy presentation and expressed his appreciation for the opportunity to serve on the MSMA Council as he will be moving to Georgia to continue his practice.
District 10
Councilor Sharon Wallace, MD, Cape Girardeau, has reached out to St. Francis Medical Center to address credentialing and contracting issues. St. Francis, along with Southeast Hospital, is the ACO for 16,000 people.
Sections
Medical Student Priya Jain, UMKC, encouraged members to reach out to the medical schools and be involved in their meetings. Mizzou and Washington U have had Pints and Policy meetings. KCU and UMKC had a combined meeting in which the AMA government relations staff addressed the students.
The Council accepted Jared Lammert, MD, to fill a vacancy for the Resident and Fellows Section Vice Councilor position, and accepted Joanne Loethen, MD, as Councilor, and Frances Mei Hardin, MD, as Vice Councilor, for the Women Physicians Section. Dr. Loethen reported the WPS has held two organizational meetings to create vision and goals.
AMA Report
Elie Azrak, MD, reported the AMA delegation is preparing for the 2019 AMA Interim meeting in San Diego, November 15–19. Resolutions and reports are on the website and can be viewed and commented upon ahead of the meeting. Dr. Loethen is running for an open delegate seat in the AMA Resident and Fellows Section, and Dr. Azrak has submitted his name for appointment to an open seat on the AMPAC board. The delegation chair, Edmond Cabbabe, MD, continues to serve on the AMA’s Council for Long-Range Planning and Development.
Dr. Cabbabe reminded members that the AMA has many monetary awards. There is also the annual grant from the Missouri Honor Fund for a free, physician-led clinic. Go to the AMA Foundation website to nominate or apply.
Missouri for many years was part of the four-state Heart of America caucus at the AMA. Oklahoma and Arkansas decided to join the Southeast Caucus. Missouri remains aligned with Kansas.
Alliance
Diana Corzine, MSMAA President-elect, encouraged participation in the Alliance’s Holiday Sharing card campaign. The deadline to contribute is November 22. She announced the Foundation Fundraiser, the “Alliance Celebrates 50 Years of James Bond,” is scheduled for Friday, April 3.
Meeting of January 11, 2020 – Jefferson City
The MSMA Council met via conference call for its January 11, 2020, Meeting due to inclement weather. Below are the highlights.
Advocacy
Ravi Johar, MD, reported that MSMA staff have read 1,500 bills and are following 400 bills that affect healthcare. He encouraged members to sign up for Physician of the Day, and to consider allowing a medical student to shadow. White Coat Day at the Capitol will be March 3, 2020. Phone2Action is a good tool for physicians to connect with legislators. Currently, there are 120 physicians signed up.
The Council approved that Resolution #1, which addresses the issue of tackle football below high school age, not be adopted. Members were also updated on the E/M coding revision and Texas v. Azar challenge to the ACA.
Other updates included marketing efforts, membership outreach, Medicaid expansion, and a healthcare collaboration with Missouri Hospital Association.
James DiRenna, Jr., DO, MSMA President, reported on his travels throughout the state, as well as other states. He encouraged members to keep in touch with their legislators. MSMA’s Annual Legislative Award be presented to Representative Robert Ross and Senator Bill White. The MSMA Constitution and Bylaws will be changed to reflect the addition of the Women Physicians Section, which was added at the 2019 Annual Convention.
Annual Convention and CME
The Actions and Resolutions from the 2019 Annual Convention can be found online at msma. org/annual-convention. Peggy Barjenbruch, MD, outlined general session topics for the upcoming Annual Convention including Vaping, Science of CBD, Stop the Bleed, Artificial Intelligence, and Missouri Medicaid. The report also reviewed recent accreditation decisions. Betty Drees, MD, reported on the restructuring of the Annual Convention. A proposal will be presented at the July MSMA Council meeting.
MSMA Insurance Agency
George Hubbell, MD, reported that the agency continues to meet member needs, urged them to utilize the agency for any insurance coverage, and encourage their colleagues to do likewise. The Council also discussed the status of MPM-PPIA/Physician Standard Insurance Company.
Physicians Health Program
Bill Woods, MD, offered the report as Chair of the Physicians Health Committee. Due to the resignation of Executive Director Bob Bondurant as of December 31, 2019, Acting Executive Director Mary Fahey has been named Bob’s replacement. The organization chart has been changed so that the Physicians Health Committee will oversee the operations of the MPHP; the finances will be overseen by the MSMA EVP, both will report to the Physicians Health Foundation board.
Dr. Woods outlined the Safe Haven system that is used in some states, which would allow those seeking voluntary help from MPHP from reporting this to the Board of Healing Arts, as long as they are actively involved in the program. MPHP staff will research the issue and come up with recommendations to be presented at the next Council and the Physicians Health Foundation board.
Membership
Joseph Corrado, MD, reported that the Committee had met on January 7 via conference call. He reviewed current membership numbers, the results of the Councilor-signed recruitment letters, recent advocacy events, and other marketing strategies. Staff will be connecting with hospital Chief Medical Officers. He encouraged everyone to sign up for the Advocacy App Phone2Action.
Publications
The Council gave its approval of Missouri Medicine’s 52-member Editorial Board to serve in 2020. The Editorial Board provides peer-review and submits articles to the Journal.
Alliance
Gill Waltman reported on the fall conference in Hannibal in October. She thanked all who contributed to the 2019 Alliance Holiday Sharing Card, which raised over $3,200. Sue Ann Greco, St. Louis, will be installed as AMA Alliance President next June.
AMA Report
Elie Azrak, MD, reported that the delegation represented Missouri at the AMA interim meeting in San Diego in November. A resolution put forth at the 2018 MSMA Annual Convention resulted in a change in AMA policy, which addressed the inclusion of health system science subjects in medical curricula and LCME accreditation. AMA members are encouraged to read and comment on resolutions, which can be accessed online.
Councilor District Reports – Selected
District 3
I.J. Singh, MD, reported that the St. Louis Metropolitan Medical Society will install Jason Skyles, MD, as the 2020 SLMMS President. Four physicians were presented with awards, including Sam Page, MD, who received the Schlueter Award and Bill Huffaker, MD, who received the President’s Award. Dr. Singh also offered an update on the Choosing Wisely program.
District 5
Lisa Thomas, MD, reported that the Boone County Medical Society had a successful residency forum in October. They will be offering a second session on financial, legal and insurance issues for medical students and residents. BCMS held its annual installation of officers and gala on February 1. The BCMS Alliance has been reorganized under the direction of Mary Katherine Heimburger and Donna Corrado, and will be renamed as Central Missouri Medical Alliance. The BCMS board approved a contribution to the MPHP in 2019.
District 8
Matt Stinson, MD, reported that the Greene County Medical Society held a medical marijuana discussion led by Lyndall Fraker of DHSS. Kayce Morton, DO, will be taking over the GCMS presidency. Dr. Hover expressed his appreciation for the social and recruiting events hosted by the Alliance.
District 9
Lirong Zhu, MD, reported that David Barbe, MD, had been named the President-Elect of the World Medical Association. She stated that new members had joined at Mercy Clinic-Rolla and Phelps Health, and they anticipate more new members in the coming months. They are seeking to fill the vacancy of Vice Councilor-District 9.
Women Physicians Section
Joanne Loethen, MD, reported that they have had three conference call meetings since inception of the new section. They will have an information mixer on Friday, April 3, in St. Louis during the Annual Convention. They are looking at having networking events across the state in 2020.
Medical Student Section
Scott Berndt reported that two legislative bills are proceeding in support of the resolution that the MSMA Council passed at AC 2019 regarding adverse events suffered by children of incarcerated parents, which was sponsored by the MSS.