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This blog is written by Missouri Association of Osteopathic Physicians and Surgeons (MAOPS) team members, with special guest blog entries provided by members. To submit a guest blog entry, email contact@maops.org. Thank you!

 

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Top tags: advocacy  opioid crisis  PDMP  Physician Burnout  Self-care  Staying Focused 

Senate Bill 151

Posted By Administration , Tuesday, January 13, 2015

SPEAK Up for the Profession, Your Patients and Your Community

By Brian Bowles, MAOPS Executive Director

 

The increased payment to primary care physicians for Medicaid services, as provided by the Affordable Care Act, expired on Dec. 31, 2014, when the U.S. Congress failed to extend the increase. As of Jan. 1, 2015, physicians providing Medicaid services will be doing so at much reduced rates than the previous two years. One rural Missouri practice expects to lose $400,000 in 2015 alone due to Congress’ failure to act. While several states took it upon themselves to either partially or fully fund the increase for 2015, Missouri did not. Gov. Nixon asked for $20 million to help fund the increase. Yet, the legislature cut that back to $4 million, and the Governor line-item vetoed that from the budget.

Missouri Senate Bill 151, sponsored by Rep. David Sater (R-29), would increase reimbursement rates for physicians providing Medicaid primary care services to that of those providing services under the Medicare program, pending appropriations, for 2016. While this bill would not affect payment rates in 2015 (the Missouri budget is already set), it would be a positive step moving forward.

Senate Bill 151 offers a short-term solution to the issue of Medicaid reimbursement. While we will certainly advocate for this bill, we will also be presenting our message that a long-term solution must be found. We cannot continue to turn patients away from health care, and physicians and hospitals cannot continue to provide care for free (or worse).

Doctors, it is time to step up to the plate and help your cause. MAOPS membership is a start. Your financial support is needed and appreciated. How else can you help? First, you must take the time to advocate on the issue with your 1) Congressman, and 2) state legislators. MAOPS provides a simple way for you to do this through our MoGOAL online advocacy program. This tool allows you to compose a message and send it to your legislator with a few mouse clicks. Nothing could be easier… Except doing nothing, which is not an option! Try it now by visiting MAOPS Advocacy Center, clicking on Advocacy Campaigns set up in the “Actions” section, and composing a message.

But, I challenge you to take it one step further. Visit with your elected officials in person. I know this can be challenging, but I also know, from experience, that it has the greatest impact. If you have heard my rant before, I apologize, but here is the simple truth: If you choose not to be heard, you won’t be. You must share your stories of how this increased payment not only impacts you, but your patients. Does the increase let you see more Medicaid patients? How many more? Let your legislator know!

MAOPS offers an excellent venue for you to be heard. The D.O.c.-A-Day program provides you with a forum to visit with your legislator face-to-face at the Missouri State Capitol in Jefferson City. While MAOPS supports program participants, it’s up to each participant to do the talking – and legislators will listen! Legislators listen to Brad and I every day at the Capitol, so when they hear a new voice, they listen more intently (plus, Brad and I can’t vote for them!). I strongly encourage each of you to get involved and make your voices heard! To schedule a date to participate in the D.O.c.-A-Day program during the next three months, please contact me at your earliest convenience. Tuesdays and Wednesdays are by far the best days to come. Check out the “Look Who’s Coming” calendar to see open dates and/or when your district day will be held.

MAOPS is here to support you while you care for your patients. But we also need your help occasionally in advocating for the profession. Membership associations, like MAOPS, rely on the support of volunteers to meet our mission. So check your calendars, and SPEAK up for the profession, your patients and yourself! MAOPS is the voice of more than 3,000 osteopathic physicians and students in the Show-Me State. As a united front, there is no limit to what we can accomplish together.

 




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What Physicians Need to Know about Open Payments

Posted By Administration, Wednesday, December 10, 2014

Why It’s Time to Time to Take a Closer Look at the Physician Payment Sunshine Act

By Brian Bowles, MAOPS Executive Director

 

By now, you’ve likely heard a lot about how the Affordable Care Act, which implemented the Physician Payment Sunshine Act (i.e., Open Payments), now requires certain industries to report payments and transfers of value to physicians. While there is no mandate on physicians to do anything differently, it does have implications physicians need to be aware of.

What You Should Know:

  • Transfers of Value Will be Reported and Published – Stipends, giveaways, dinners, etc., from pharmaceutical companies, durable medical equipment companies and other similar industries must be reported to the Centers for Medicare and Medicaid Services (CMS), and CMS will then publish the information. Companies even have to report copies of articles they leave for you! Also, say a pharmaceutical company wants to entice you to come to work for them to do research. Under the Sunshine Act, the dinner they buy for you during the interview has to be reported, as does the hotel and airfare they offer to get you to the interview.
  • Physician Responsibility – As a physician, you don’t need to stop seeing pharmaceutical representatives. However, please keep in mind that information about any transfers of value will be accessible. In my opinion, very few people will actually look at this data, and even fewer will care.
  • Data Reports – To monitor the data that industries are reporting about you, click here to register. By registering, you’ll be able to review what has been reported about you, as well as appeal any data you don’t agree with.
  • Tracking – Consider downloading a tracking app or creating your own method of tracking to monitor what you have received from industries so you can appeal erroneously reported information. During the first reporting period, which was only six months long, more than $3.5 billion was reported. Industry officials believe much of this was misreported, primarily by over-reporting to make sure they were in compliance with the law.

As for additional impacts the law might have on industry-physician relationships, some hospitals and employers might prohibit physicians from seeing vendors. Vendors are already cutting back on office visits and pharmaceutical companies are spending more on direct marketing tactics.

One aspect of the original law that did not make it into the final law is that of exhibitions, like the one held at the Missouri Osteopathic Annual Convention (MOAC). Originally, vendors would have had to report a certain value for their “exhibit fee” for each attendee at the conference. Due to advocacy by organizations like MAOPS, the American Osteopathic Association and other national associations, this piece of the law was deleted. Therefore, exhibit halls, like the one at MOAC, are about the only venue left where industry representatives and physicians can network and discuss new innovations and products without government intervention and without report of any transfers of value occurring. The 117th MOAC will be held April 29 through May 2, 2015, in Branson, Mo., and it has one of the largest exhibit halls of its type in the nation. I hope you all will take advantage of it this year!

To learn more about Open Payments or any of the points referenced in this blog post, contact me at (573) 634-3415, or visit the quick links below.

Quick Links:

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Lessons Learned at the AOA's Leadership Conference

Posted By Administration, Wednesday, November 26, 2014

AOA Advocacy for Healthy Partnerships Conference Recap

By Michael Brown, D.O.

 

This past weekend, it was my pleasure to attend the American Osteopathic Association’s (AOA) Advocacy for Health Partnerships conference on behalf of MAOPS.  This conference is designed by the AOA as a weekend of training and sharing of ideas that give strength to the many state and affiliate organizations within the AOA.  I was proud to see that in many instances our state has played a large impact on this meeting as many of the ideas and speakers originated from things that MAOPS has already started implementing.

One of the highlights for me this weekend was an address from the authors of the book “The Road to Relevance,” which members of MAOPS Board of Trustees are familiar with.  Harrison Coerver and Mary Byers spoke to us about the importance of focus, and in my own words, “eliminating the fat” from organizations to make them more valuable to their members.  They brought with them examples of how programs in associations tend to grow and bloat with very little return. However, out of fear of hurting a few members who may have championed those programs at one time, the organization as a whole is bogged down in inefficiency. MAOPS, I am proud to say, has been a leader in implementing positive focus within the organization.

Another speaker, who I believe provided useful insight to MAOPS, was Don Neal of 360 Live Media. Mr. Neal has been consulting with the AOA on their annual OMED conference.  He described how experience is everything in today’s economy.  Think of Starbucks and Apple and how consumers are willing to pay more for the experience.  He emphasized that your conferences had to offer something that members cannot get in any other way.  While some may consider it controversial, this means that CME should not be the central focus of your conference, but emphasizing your brand should be.  Don’t worry, there should still be high quality CME, but in a competitive world of podcasts and webinars, CME can’t be the only thing that drives members to your events.  The gold standard for our events should be that they are “transformative.” In other words, we want our members to walk out of MAOPS-sponsored events different than they were before arriving.

Two last items of note.  The first is special recognition to MAOPS Director of Communications and Membership Holly Koofer-Thompson, who presented on how we can use social media to reinforce our brand.  She did an excellent job.  The last is that we still have a lot of work to do in our state when it comes to establishing a statewide prescription drug monitoring system.  One of the pictures attached shows one lone state in the nation standing out above the rest for not having any program or goals to implement one.  So take home from this conference that it’s time to roll up our sleeves and get to work!

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Can You Afford NOT to Count?

Posted By Administration, Monday, November 17, 2014

Your Voice and Vote CAN Make A Difference

By Brian Bowles, MAOPS Executive Director

 

Do you ever feel like you have no say in the political process? That no matter what you do, politicians will ignore you? If so, I think you join a majority of Americans. This is evident in U.S. News report that shows that only 32.3 percent of eligible voters showed up at the polls in our recent November election. In 2010 that number was 45.7 percent!

But do we truly NOT have a voice? Are we truly not heard? I am involved with this process every day and can say with certainty that the reason you are not heard is because you don’t speak up! I have seen legislators with no opinion on an issue develop a strong one with the help of physician members participating in MAOPS D.O.c.-A-Day program. I have been called by legislators seeking information on an issue, because they know we represent many of their constituents. And most importantly, I have seen our members realize they can make a difference if they make the choice to actively engage in advocacy.

So, how do you make sure YOU count?

  • Vote – If you don’t cast a ballot, you’re giving away a right that many have fought and died for us to have. MAOPS can’t tell you how to vote, but we can provide you with information to help you make an informed decision. Just check out our 2014 Legislative Scorecard!
  • Advocate – Contact your legislators and ask them their opinion on issues that matter to you the most. If they don’t have an opinion, inform them so they can develop one. I would venture to say it is even more important for you to do this if the person in office is not the one you voted for. MAOPS has two grassroots programs to assist you in advocating for yourself – D.O.c.-A-Day and MoGOAL. D.O.c.-A-Day fosters face-to-face interaction with your legislators with the help of MAOPS staff. MoGOAL is an online tool allowing you to contact your legislators quickly and easily via email. Use these resources to do your part!
  • Support – No one likes giving money to politicians. But, if we get good ones in office that support our beliefs, we want to keep them there. Consider a donation to those candidates who share your ideals. MOPAC allows you to support candidates who support medicine. Consider making an annual donation to help keep the program strong.
  • Participate – The larger the coalition, the greater the impact. Individuals can make a difference, but organizations like MAOPS best serve their members because we can claim to represent close to 3,000 osteopathic physicians and students in the state of Missouri. One of the best ways to ensure that you count is to join organizations like MAOPS that share your ideals and vision. Your dues support the efforts of these organizations and help them build a unified voice.

So, while we often get frustrated with our politicians and the decisions they make, and while we can never be certain that we have voted for the best person to represent us, one certainty is that in order to count, you have to make a conscious decision to do so. If you want to not count, then don’t do anything. This is your choice. However, if you choose not to count, then you can’t complain when those elected by people who chose to count do things you disagree with.

MAOPS offers you many ways to help ensure that you count. Use them!

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PDMP

Posted By Administration, Tuesday, October 28, 2014

Prescription Drug Monitoring... Are You Willing to Go the Extra Mile?

By Brian Bowles, MAOPS Executive Director

 

MAOPS has supported a prescription drug monitoring plan (PDMP) in Missouri for the last four legislative sessions. As most are aware, Missouri remains the only state without a PDMP. What many may not be aware of is that some states that have them lack the funds to maintain them, rendering the programs ineffective. Missouri might receive the bad press associated with not having what many feel is an essential program, but is it any worse than having a program that cannot be funded?

Five years ago, MAOPS opposed a state mandated PDMP. Members from around the state were beginning to contact the Central Office asking, “Why?” Prescription drug abuse was rampant, and patients were doctor shopping. Shouldn’t we support something that would prevent this? We conducted a survey, and the majority of members said they wanted a PDMP. The Legislative Committee, Board of Trustees and House of Delegates considered member input and voted unanimously to support a PDMP.

Since that time, a PDMP has been proposed by the state legislature annually. Each year, it has been defeated. Ironically, two primary opponents of such a program are physicians – Sen. Rob Schaaf, M.D, and Rep. Keith Frederick, D.O. Both cite civil liberties as their reasons for opposing such a bill. Do we want the government to have such easy access to our (that’s you and me!) prescription history? Could they use that information negatively at some time? Could such a system be breached? These are solid arguments in opposition of a PDMP, especially in light of several similar security breaches in the recent past. In fact, these are the exact reasons MAOPS opposed a PDMP in the past.

At a recent symposium I attended, Dr. Schaaf had an interesting question that I think we need to answer as an organization and a profession: “If we had a PDMP, would you be willing to be mandated to report your prescribing of controlled substances?” Typically, MAOPS and other like organizations advocate against further burdens on physician time. However, if our organization advocates for a prescription drug monitoring program, yet also doesn’t want our members accountable for reporting, does that make us somewhat hypocritical? I ask for your feedback on this important issue.

 

Please take this brief three question survey, and let us know your thoughts on this important issue. MAOPS Legislative Committee and Board of Trustees will use the results to develop further policy.

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Medicaid Pay Parity Call to Action

Posted By Administration, Friday, October 17, 2014
Updated: Wednesday, October 15, 2014

You Can Lead a Horse to Water, But...

 By Brian Bowles, MAOPS Executive Director

 

Last month, the American Osteopathic Association (AOA) challenged its more than 60,000 members to reach out to Congress and ask them to extend the Medicaid pay parity for primary care physicians. The current payment parity law is set to expire at the end of this year. Without an extension, the increased payments that certain primary care physicians receive for Medicaid patients will end. This is something that MAOPS was highly involved in two years ago when MoHealthNet issued its rules, and they discriminated against non-ABMS certified osteopathic physicians. In order to get this changed, the AOA advocated at the national level to get the Affordable Care Act changed to include all board-certified physicians. This allowed MAOPS to advocate at the state level to have MoHealthNet change its rules so that non-ABMS certified physicians could take advantage of the increased payments without jumping through additional hoops.

Since that payment increase is set to expire, the AOA encouraged members to advocate for themselves to keep the payment increase in effect. Here’s the good newsMore than 1,000 osteopathic physicians took the time to send an email to their congressmen with a request keep the payment increase intact. However, the not so great news is that only 1,000 out of approximately 60,000 osteopathic physicians took the time to advocate for themselves on this issue.

Each time I come into contact with a member, I tell them that contrary to popular belief, they can have an impact by individually advocating for the profession. Establishing a personal relationship with your state legislators, using MAOPS online advocacy tools and participating in MAOPS D.O.c.-A-Day program are ways that you can have your voice be heard. Legislators do not understand all the issues they face. It is up to you, the constituent, to keep them informed about the issues you face and the issues they are deciding on. If you don’t, you force them to make uninformed, or partially informed, decisions. Or worse, decisions based on information given to them by those who don’t have your best interests at heart.

MAOPS works hard to try and ensure that your voice is heard at the state Capitol, at the AOA and even locally at the regulatory level. But, we cannot be nearly as effective without your help. Legislators want to hear from YOU, and nothing has a greater impact than when they do hear from YOU. The more they hear, the better. Think of the impact that 60,000 unified D.O. voices would have had rather than 1,000. Do the 1,000 voices make an impact? Sure! But not that of 60,000 or even 20,000. Click here to view a breakdown of state participation.

The General Assembly convenes in January, and MAOPS will be present daily looking out for you. But, we need your help. This is a team effort, and you are an integral part of that team. Respond to our Calls to Action, and use our online advocacy program, MoGOAL, when asked. Contact me, and commit to ONE day at the Capitol with our knowledgeable and dedicated MAOPS advocacy team, so you can speak directly to your legislators and key decision makers. And just as importantly, recruit your colleagues to join MAOPS and support the team!

Together, we can secure a strong future for the profession and your patients. Separately, we leave the future in the hands of those who may or may not understand the impact of the decisions they will be making. MAOPS can lead you to the right people, at the right times, but it’s ultimately up to you to metaphorically “drink the water” and participate in the process. Thank you for your dedication to the osteopathic profession. There is strength in numbers. Working as a united front, we can and will see results that benefit all osteopathic physicians.

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Call to Action

Posted By Administration, Monday, October 13, 2014

MAOPS President Assembles Medicaid Expansion/Reform Task Force

 By Lee Parks, D.O., MAOPS President

 

As President of MAOPS, I believe it’s time for us to come forward with a position on Medicaid. I am asking for volunteers to serve on a new task force I am creating to address Medicaid Expansion/Reform here in Missouri. This is an issue that we can no longer ignore as a professional physician society. It is not going to go away, and if we don’t provide guidance to legislators, we are asking them to make the decision for us. I, for one, would rather have a voice, and I hope you agree.

I am looking for a diverse group of up to six physicians representing various parts of the state, different specialties, practice situations and political affiliations to fill the task force. Members of the task force must pledge to look at data with an open mind and respect for the opinions of our membership as a whole. I am asking MAOPS members to submit their thoughts in the “Comments” section of the Association Blog, along with any statistical data or other research from reputable sources relevant to this discussion. The timeline will be short, as I would like to have this ready for the next legislative session starting in January. If you are interested in serving on this important committee please submit the short application by November 1.

MAOPS also needs the input of membership to formulate a position on Medicaid reform/expansion. Legislators are asking our Legislative Liaison (Brad Bates) for this information. MAOPS needs to give our elected representatives in Jefferson City some of the guidance they are beginning to request on Medicaid reform/expansion. As a respected voice of organized medicine, we need to speak up for ourselves and our patients, giving our legislators OUR vision of the future of Medicaid. This vision needs to be fair, economical and efficient, and it needs to come from our vast experience with the limitations of the current system.

It is no longer enough to say that there are a certain number of people who cannot get access to care or that the state cannot afford to add to the roles of recipients because it is already spending too much money. The truth is that there ARE a lot of people who are having trouble getting care, there IS a problem with getting physicians to take this low-paying insurance, and meanwhile, the care received is fragmented and ineffective.

We pay for this in different ways. In the United States, the prison system is the biggest provider of mental health care, as people with various kinds of mental illnesses are not diagnosed and/or treated until their illness brings them to the attention of law enforcement. Additionally, instead of teaching people what a healthy diet looks like, we render catastrophic care for cardiovascular disease. We have worse statistics around prenatal care than Cuba and Romania! Our ERs are full of people with bad teeth, untreated mental disorders and people seeking pain relief in dysfunctional ways.

At the same time, Missouri graduates more than 500 physicians a year, with the majority coming from osteopathic programs. These physicians, from private osteopathic education programs with high debt loads, mostly leave the state to practice in their home states or where the residency of their choice may be located. Statistics show that physicians tend to find practice locations near where they did their postgraduate training. Missouri could facilitate some of the community-based training programs that put young physicians into the kind of setting where they will eventually practice primary care.

Missouri is also the home to what is arguably one of the most successful Accountable Care Organizations (ACOs) in the country – the Mosaic system of Kansas City. Mosaic has demonstrated sufficient cost savings/patient satisfaction with team-based care in a medical home model to receive a substantial financial reward in the past year from the federal government. If I understand the system correctly, each physician heads up a miniature team comprised of a nurse practitioner, a mental health counselor and a case manager. Each team member works at the top of his/her license to give patients the medical home envisioned.

Crider Center, where I work, is an FQHC growing out of an older community mental health organization. (We recently merged with Pathways, which is another organization that has provided mental health care for a large portion of rural Missouri for many years.) With the kind of care we are able to provide to our challenged patients in this model, we see substantial changes in health, ER use and general level of functioning once they realize we are here for the long haul. We are also able to address very longstanding issues of chronic pain, drug abuse and the most debilitating of the dental problems (usually with United Way money), while working on changing lifestyle problems. We work under a confusing patchwork of funding through the Department of Mental Health, Medicaid and so on, to achieve our results. And, we work in the local school systems providing mental health services (50 percent of mental illness will be diagnosable by age 14).

My point is this: There are good things happening in Missouri that could be replicated, and there are a lot of places where change needs to occur. The state government can be a player in making that happen, but our legislators are not medical people for the most part. WE are the ones in the exam rooms, ERs, nursing homes and radiology suites. WE are in a position to tell them how to spend the money more wisely and what will really make a difference to their constituents. WE are the ones who can tell decision makers why it’s hard to find a specialist to take a patient, how much it would help a chronic pain patient to get a couple weeks of physical therapy or OMT instead of a script for Vicodin or how severe the mental health crisis is over the entire state. WE also need to be leaders, because whatever the solutions that are proposed, WE, as citizens of Missouri, will be impacted financially even if we never see a Medicaid patient.

Help MAOPS develop our policy on Medicaid expansion/reform by taking a few minutes and responding to this blog with your ideas on what a successful plan would contain. You can log in and respond directly to this blog or email your comments to our Executive Director Brian Bowles, and he will ensure they are considered by the task force. This is your opportunity to have a voice regarding the future of healthcare in Missouri. Please take advantage of it!

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Time Away Sparks Question…

Posted By Administration, Tuesday, September 30, 2014

Medical Marijuana in Missouri – Nip in the Bud Now or Investigate Further?

By Brian Bowles, MAOPS Executive Director 


I recently spent a week in Colorado with my family. It really hit home how insulated we are here in the Midwest. We hear and joke about the marijuana laws in Washington and Colorado (each has legalized medical and recreational marijuana), but we don’t really see the impact of those laws or understand how similar laws here in our state (or surrounding states) would impact us.

Our first reality check occurred as we drove down the highway from Glenwood Springs to Aspen. A corner house was being painted with a fresh coat of what I can only describe as “marijuana green” paint. In front of the house was sign that read “Green Medicine Wellness” (see photo). The house was home to a medical marijuana dispensary. I am not sure if this was actually a physician’s office or not, but I was further amused by their use of a neon green cross in the window, similar to the “Red Cross” logo, only green. There was an obvious intent to promote this as a “medical” institution.

What was really disconcerting was the temporary banner that had been placed in the front yard of the home by the time we returned through Glenwood Springs. It read, “Recreational Marijuana Now Open to All 21+.” Colorado legalized recreational marijuana last year. This gets to the heart of the issue regardless of your feelings on the efficacy of medical marijuana. Is legalization of medical marijuana simply a gateway to future legislation to legalize recreational marijuana? Is this really what we want here in Missouri?

It’s easy to think that we are protected here in good ole conservative Missouri. But the march is on to legalize pot in the state. No less than six bills were filed in our state legislature last session to either legalize marijuana (medical and recreational) or reduce penalties for possession. A hearing on medical marijuana featured impassioned testimony from many, including parents with children with seizure disorders whom they claimed were only helped by marijuana. And yes, even one child was there to illustrate his seizures.

You would think that the hearing would also be loaded with opponents of this as well. But guess what? Only one testified in opposition to the bill – MAOPS! Why is MAOPS opposed to legalization of medical marijuana? One – a scarcity of evidence to show its efficacy. Two – skepticism as to the real intent of those promoting its legalization. There are just too many questions left unanswered to support legalization at this time. Do we want to be walking down the street and have our children exposed to “Cannabis Boutiques” such as those my family passed in Aspen at the base of the ski slopes?

Regardless of personal views on legalization of marijuana, either recreational or medical, everyone needs to be aware of the issue and its potential consequences. Take a look at the picture shown in this blog post illustrating the fine line between medicine and “green wellness.” This line will continue to get blurrier as more states legalize marijuana.

What are your thoughts on medical and recreational marijuana? Let us know! More importantly, ask where your legislators stand on the issue. You would be surprised who supports and who does not support medical and/or recreational marijuana.

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Understanding the Regulatory Process

Posted By Administration, Friday, September 19, 2014

The Devil Is In the Details

By Brian Bowles, MAOPS Executive Director

 

The saying, “The devil is in the details,” is especially true in the regulatory process. This process is often a misunderstood component of lawmaking, because either we forget about it or we don’t know enough about it.

When the legislature passes a law, it often stipulates that the rules will be promulgated by a specific regulatory board. This could be the Board of Healing Arts, the Board of Nursing or any of the scores of others that exist. These regulatory bodies are usually appointed by the governor, and meetings occur largely unpublicized. This is where a good law can become a bad one or vice versa! Possibly one of the most well-known regulatory bodies, at least to our outdoors-oriented members, is the Missouri Department of Conservation (MDC). On an annual basis, MDC proposes rules on a host of different topics, like deer harvest limits or the quantity of crappie one can keep.  

Not only does the Missouri Association of Osteopathic Physicians and Surgeons (MAOPS) keep a close watch on the regulatory process involving healthcare issues, but MAOPS also frequently participates in regulatory meetings, including the Board of Healing Arts (the regulatory body responsible for licensing physicians).

MAOPS lobbyist Brad Bates and I recently sat in on deliberations between the Board of Healing Arts and the Board of Nursing, as they jointly promulgated rules for House Bill 315, which passed in 2013. This bill established the ability for physicians and collaborating nurse practitioners to use telemedicine for follow-up visits. Current law requires that the collaborating physician (or other physician designated in the collaborative agreement) examine and evaluate the patient and approve or formulate a plan of treatment for new or significantly changed conditions no more than two weeks after the patient has been seen by the collaborating APRN. The law tasked the Board of Healing Arts and the Board of Nursing to jointly promulgate rules for implementation of the telemedicine component. The two boards had previously been unable to agree on the rules. Rep. Kathy Swan (Cape Girardeau) and Sen. Jay Wasson (Nixa) were present, and they warned the groups that if agreement could not be reached at the meeting, the legislature would determine the rules for them, noting that would likely be something both parties would not want to happen.

As background, a Board of Healing Arts task force met in the summer of 2013 to work on the rules and MAOPS was present for those discussions. During this time, the Board felt strongly that telemedicine should use the best technology available in order to treat and protect patients. The Board of Healing Arts supported live, interactive video as alternative to an onsite visit. However, the Board of Nursing disagreed, and supported conducting follow-up visits via telephone, email or eliminating follow-up visits completely.

During deliberations, the major sticking point seemed to be the requirement of having a two-week follow-up visit with a physician for patients with newly diagnosed conditions. The Board of Nursing supported the elimination of that rule. The issue, though, was that the two-week follow-up component was not the one that was supposed to be debated during the promulgation of these rules. The nurses were trying to use the new law as a way to eliminate an aspect of the law with which they did not agree. The nurses lost focus on the main objective, which should’ve been on examining how telemedicine should be used in the collaborative arrangement between a physician, APRN and patient. Board of Healing Arts member David Tannehill, D.O., said as much when he stated that “the two week follow-up requirement was irrelevant to the conversation.” He noted that the two groups needed to focus on their original charge of determining how telemedicine would be used.

The Board of Healing Arts continued to hold firm in their position on live, interactive video, and that the two week follow-up deadline was essential. The Board of Nursing capitulated, and by the end of the day, agreement was reached on the rules for House Bill 315.

What does this mean moving forward?

  • Telemedicine can now be used to conduct the follow-up visits mandated in current law.
  • It should be much easier for the physician, the APRN and the patient, because technology can be used to determine what is best for the patient.

The way I see it, feedback could now be immediate, as an APRN could video conference with a collaborating physician to provide expertise for patients. Of course, patient consent must be obtained before telemedicine services commence. Yet, I imagine most patients will gladly consent rather than having to wait or travel.

By law, the proposed rule must be published in the Missouri Register for a 30-day comment period. Both the Board of Healing Arts and the Board of Nursing will take comments under consideration before finalizing the rule. I expect that the nursing association will have plenty to say about this topic. MAOPS, on the other hand, is pleased that the rules agreed upon by the two boards actually match the spirit of the original law.

 

As I alluded to in my comments at the meeting, it’s discouraging when we support a bill that we feel is mutually beneficial to the collaborative arrangement and the patient, only to have to sit through more than an entire year of meetings, because the nurses are using the opportunity to try and gain additional scope of practice. However, by keeping an eye on this important process, MAOPS is helping to ensure that “any devil in the details” is as physician and patient friendly as possible.

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Healthcare in Aisle Eight?

Posted By Holly A. Koofer-Thompson, Friday, August 29, 2014

Walmart Opens Clinics Catering to Need for Mass Medical Care

Walmart has dubbed itself as the retailer that can “save people money so they can live better.” The saving part is evident in their price match guarantees, rollbacks and discounted goods ranging from groceries to household plants and everything in between. But, something new has been added to their repertoire  – healthcare. In April, the nation’s largest retailer – that brought in approximately $473 billion in fiscal year 2014 and employs more than 2 million associates worldwide – opened six care clinics, with six more planned by the end of the year.

 

According to an article posted in Medical Economics on Aug. 14, “with 4,200 stores across the United States, the retail giant is poised to capitalize on growing opportunities resulting from the Affordable Care Act and fill a need in Medically Underserved Areas (MUAs).”

 

If Walmart is getting into the business of providing healthcare to the masses, the question should be raised: Would doctors be willing to work for the big box retailer?

 

Kevin Hubbard, D.O., FACOI, of Kansas City, a professor and chair of internal medicine at Kansas City University of Medicine and Biosciences - College of Osteopathic Medicine, shared his thoughts on the topic:

 

“If Walmart offered to pay off student debt as a requisite for a physician joining up for a 4-8 year commitment after completing a residency, how many graduating medical students would take the offer? Remember, this represents guaranteed employment and loan forgiveness!

 

Would the federal government be willing to extend itself to a graduate who is willing to work at a Walmart located in a medically underserved area? How would Walmart choose to restructure its clinics to suit the needs of the Patient-Centered Medical Home? Think of a team of people (physician, physician extender, social worker, dietician, etc.) all employed by a Walmart partnering with patients to help them make better choices regarding preventative services, food/meal selections, exercise options, etc.

 

Back to the question, would doctors be willing to work for Walmart, after careful consideration, I think Walmart could potentially be in a position to be an impact player in many Missouri communities. Whether that's a good or a bad thing has yet to be seen. Although it feels bad to me at this point, I can also see where they have the opportunity to be a contributor!”

 

Do you agree with Dr. Hubbard? Share your point of view in the comment section below! If you’re currently a medical student, did you ever envision yourself working at Walmart after medical school?

 

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