News
TRANSCRIPT:
"So much of who we are comes from where we have been. Our experiences mold us into the people we are today. I would not be the person I am today and may not have chosen the paths I’ve taken without the people and places I have been blessed to encounter. Many of the people here in this room tonight have played a role in my standing before you now as the 174th President of Iowa Medical Society. This is an honor and privilege I do not take lightly.
Much of who I am was shaped by two people who are not here with us tonight. I am a third generation osteopathic physician. My grandfather was the son of Polish immigrants born in New York. He graduated medical school in Chicago during World War II, finished training and started his practice in rural Michigan recruited by a local factory. He had completed a surgical residency but had limitations in his scope of practice as a DO for a number of years. So much was different about the practice of medicine during those times beyond the difference in understanding of disease and treatment options. The cost of medical school tuition was a mere $500 per year. Less than 10% of Americans had private health insurance as we know it in the early 1940s. Many of my grandfather’s patients paid for their care by bartering.
His practice encompassed what we now think of as full scope family medicine with surgical privileges. His profession defined him. Everyone called him “Doc,” including my grandmother. To me, he was Grandpa Doc. His Normal Rockwell existence was most vividly portrayed at his retirement party. After nearly 50 years in practice, people travelled over a 100 miles to visit him, thank him and share stories of the generations of their family touched by him. I was in middle school at the time deep in the self-centered throws of adolescence. And even I was awestruck by the impact of my grandfather’s life of service— his calling.
My father’s education journey brought him to my grandfather’s alma mater for medical school in the late 1960s. He was drawn to rheumatology inspired by a dear cousin who had suffered from rheumatic disease during an era where most diseases were yet to be fully delineated let alone successfully treated. He was an academic rheumatologist whose clinical practice spanned from urban and suburban Chicago area to rural outreach clinics. His passion was clinical and pharmaceutical research, and teaching in all capacities. I have many vivid memories from my childhood that revolve around his career— rounding with him at hospitals on the weekends, the doctors lounges where I could always find the best treats, sometimes being pulled into the patient room with him to meet someone who has been hearing all about me and my brother for years, and many vacations centered around conferences where he was an invited speaker. As a child, I was given a glimpse of the sacrifices that a career in medicine meant. But I was also aware of the gratitude his patients, nurses, and trainees had for his compassion, time and enthusiasm for learning and teaching.
It is unclear to me exactly when I decided I wanted to follow in these giant footsteps. I suppose like many who enter “the generational family business” there was a part of me that didn’t really ever think twice. There were moments of guidance from both men on things to consider. There was not once ounce of pressure. If anything there were conversations about medicine changing. During the course of their careers, the science of medicine advanced immensely and the practice of medicine changed significantly. I didn’t fully understand their warnings at the time.
Once I had become steadfast in my desire to be a physician, it was clear to me that my motivation was to help others. How I would accomplish this was much less clear. I too followed my family footsteps to the same medical school in the late 1990s where I quickly became involved with student government as class president. This opened doors to a path toward organized medicine through the American Osteopathic Association - the AOA. I attended annual student lobby days in DC each year. Increasing roles in student leadership ultimately lead to being a voting student member of the AOA House of Delegates. Exposure to organized medicine and healthcare policy so early in my career was an absolute blessing; one I had not intentionally sought out but more or less stumbled upon. Having a voice on the floor during policy deliberation, and involvement on committees was truly eye opening. I learned that our oath to protect our patients did not start and stop at the bedside. This was not a lesson taught to my classmates. It was not in our curriculum. My classmates and I did not have the widespread use of the internet to gain information let alone algorithm-based social media to bring social & economic policies and constructs to our attention with little effort. Organized medicine introduced me to other student and physician leaders whose professional successes and challenges helped shape my views on changes needed in healthcare.
In hindsight, my love of pediatrics and critical care medicine seems like it was predetermined, but Pediatrics was not even on my radar entering clinical rotations. It was, however, my FIRST rotation. And it quickly became the standard to which I subconsciously compared every other field. Having had the fortune of my first impression of pediatrics being at a high-acuity community children’s hospital opened my eyes to the complexities of care for our most vulnerable population. I later returned there for residency. The place where I fell in love with the care of children and found my calling was only two miles from my high school. There were stretches of my training where I lived at home with my parents. The dinnertime discussions with Dad during those years were on a new level. I had rotated in his hospital throughout medical school — the same hospital where I rounded with him many years before. The wards, the clinics, even the doctor’s lounge, had new meaning but still felt like home. One of my favorite experiences was a two-week elective on his service. Like many young adults, I took for granted that unique opportunity to fully witness my father in his element. These are now some of my most cherished professional and personal memories. Here’s why:
Around the time I decided to apply for pediatric critical care fellowship, my dad was diagnosed with pancreatic cancer. The 14-month long battle taught me countless lessons personally and professionally. I was blessed to be training so close to home allowing me the opportunity of time with him. His sense of responsibility for his patients and trainees were unwavering during that time. That same hospital where he dedicated his career and where I grew up is where his battle with cancer ended.
His death at the beginning of my fellowship along with the birth of both of my children during fellowship solidified the coming years’ focus on family and career. My graduation occurred during a down-turned economy causing the majority of the hospitals to which I had initially applied to pause hiring. Pediatric Critical Care had been a field of significant growth throughout the country during my training as more hospitals were opening PICUs placing supply and demand in my favor. But this promise was not my experience. I had received my bachelors from University of Iowa and gladly considered the opportunity to return to Iowa. Our family of four moved to Des Moines to join what is now known as MercyOne Children’s Hospital Pediatric Intensive Care Unit staff. Coming from two large, extended families, moving hundreds of miles away from all things familiar with very young children was no small feat. We quickly fell in love with all the charms of life in Iowa. Almost 14 years later, we are immensely grateful for the happenstances that lead us here to a community that has helped us raise two truly awesome teenagers.
As the strain of the early years of parenthood and my career subsided, opportunities to become more engaged within my hospital and IMS surfaced. It has been my experience that saying yes to opportunities that were not necessarily on my radar have been some of the most fulfilling. My subspecialty historically, and unsurprisingly, has one of the highest burnout rates. To borrow from Sheryl Sandberg, leaning in and broadening my horizons past the number of patients on my census has paid off many times over for me. The timing of IMS leadership in my life was nothing short of amazing— reigniting my interest in advocacy and organized medicine.
The fellowship and knowledge I have gained from my fellow board members, I cannot possibly find enough adjectives to describe. I want to thank each of those with whom I’ve served. Your perspectives and impact will forever remain.
I joined the board roughly a year before the pandemic was declared. The impacts of the pandemic on healthcare are ones that we will be feeling for a long time. Iowa has been no stranger to the discussion of workforce issues and access to care long before COVID-19 became a household word. However, the pandemic has taken our workforce issues to a new level. The economic impacts we are facing are unprecedented. Although, the pandemic was officially declared over recently, those of us in healthcare will be tending to our wounds for years to come. And I believe the wounds in Iowa to be deeper still as one of the lowest- reimbursed states in the country. With reimbursement rates essentially unchanged over the last decade in stark contrast to inflation in supply chain mixed with cost of contract labor to staff our practices, the number of problems to be solved are piling up. Meanwhile, we are still desperately trying to provide the best care for our patients and communities. Do more with less. We have seen closures of hospitals and birthing centers in rural areas that arguably need MORE, not less, help. In fact, there are few hospitals in our state that are not financially struggling to make ends meet. This is not sustainable.
The closures of hospital-based services for children over the last 2 years impacted families around the country. Many of my efforts during the pandemic were focused on pediatric access to care in our state. Surge planning changed over time from our perspective. Thankfully, children were not the primary burden on our healthcare systems. Pediatric wards and ICUs were frequently utilized for adult care due to overwhelming need. As the economic weight became heavier, many places around the US chose to permanently convert pediatric wards and ICUs to adult services due to low patient volumes and significant disparity in reimbursement. Over 25% of the PICUs in the country closed months before the respiratory illness surge hit last fall. I am incredibly proud to have worked alongside my fellow Iowa children’s hospital leaders on a daily basis over the last two plus years in an attempt to improve access for Iowa’s sickest children. All three of our hospitals received children from our surrounding states where they had run out of PICU beds due to closures. Our collaboration was grassroots and unprecedented but born out of necessity. Although there is still much work to be done for our state to improve ease of access to higher level of care centers for patients of all ages, the groundwork has been laid. That alone is progress.
It is only human during times of stress to become focused on self-preservation, and those who were in the midst of their training years during the pandemic were forced to do just that. If you don’t have the pleasure to work with the phenomenal medical students, residents and fellows who are training in Iowa, or have had a new grad join your practice in the last few years, you may likely not have reflected on how this has impacted them. Practicing physicians… I challenge each of you to consider how different your knowledge and experiences would have been in your given fields if your clinical training was limited in the ways our current trainees experienced. At minimum, the learning curve would be steeper and perhaps your choice of field would have been completely different. Please remember this as these fine trainees recover from these extreme challenges. Their experiences are like none before. To our next generation of physicians, I want to commend each of you for taking on medicine as a career as I know how difficult the journey was for me. Mentorship is the hallmark of our profession and I hope we, as already-practicing physicians, rise to the unique challenges to meet your needs.
The challenges faced over the last three years and over the coming years, in many ways, have amplified the problems that already existed in our healthcare systems. We must not overlook or forget some of the extreme things we encountered. Perhaps, you closed your practice and paid employees to remain at home all while trying to figure out how to pay the rent for your space. Perhaps you were the critical access physician who held up the morale of your emergency room while attempting to care for patients much higher in acuity than what you are designed to handle. Or you were the hospitalist, Intensivist or infectious disease specialist at a tertiary/ quaternary center who is trained to always take the patient and be of help but cannot as you drown in the weight of dying patients at a volume you’ve never imagined. The moral injuries we have sustained cannot be ignored. And yet, we are here persevering for our patients when our own reserves are low.
For me, self-preservation during this time caused me to question my purpose. What on Earth was I thinking going into medicine?!? I was at a personal low point when I was invited to Carver College of Medicine’s convocation ceremony last year on behalf of IMS to be one of a few physicians on stage. Almost exactly 25 years prior, I had been performing on the stage at the old Hancher Auditorium as a dance major. Sitting on the stage of the reborn Hancher, I found myself reflecting back on that young lady and her journey. Would she make different choices if she knew what I know now? That all changed the moment they began calling individual students’ names to be hooded. I was one of the first people to see the glimmer in the eyes and the overwhelming sense of accomplishment and hope on the faces of each student as they heard their names preceded by the word “doctor” for the first time. The ‘why’ for which I did this, the ‘why’ I’m STILL doing this became much more clear. The words of the oath taken had renewed meaning on a day that was almost exactly 20 years from the date I took it.
There is hope that the trials and tribulations we are facing will be behind us one day. Medicine and healthcare changed a lot over the last few years. As a Greek philosopher once said, “change is the only constant.” Over the lifespan of the three generations of doctors in my family, the science and art of medicine, delivery of medicine, oversight of medicine, and cost of care has changed immensely. Changes in workforce and demands of the evolving populations are not a new problem. The scope of practice changes for DO’s was born out of necessity during wartime when MD’s were sent overseas. As I stand here now, I feel it’s especially important to remember that it took physician advocacy to achieve that.
Our discussions of workforce shortages and potential solutions including scope of practice today are different, but these discussions need our voices to assure that any changes made are executed well and with a focus on patient care at the center. “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” Charles Darwin said that and I believe it to be true.
As I move into this new role, I want to assure you that IMS has, and will, continue to respond to changes needed to improve patient care, your practice of medicine, and uphold the sanctity of the patient-physician relationship. We are an ever-evolving profession and it is imperative for us each to lean in and speak up when possible for the sake of our patients. Medicine is deeply personal to each of us. I hope that you find reflecting on & sharing your personal stories with colleagues, legislators, and others will help renew for you WHY you took the leap and put in all the grueling years of work to do what we do.
I thank you all for your time and willingness to listen and I look forward to meeting as many of you as I possibly can through the coming year as we try our best learn how IMS can help you achieve what you need to serve your patients and communities.
IMS would not be the organization it is today without our staff. Steve, Phil, Kady, Sara, Heather, Mary, Lori, Sydney, Petra— thank you for all that you do to support the physicians of Iowa.
Lastly, I want to thank my dear friends and family who joined me here tonight. Your love, support and understanding over the years has carried me through some of the darkest days. To my phenomenal husband, Joe, and amazing children Jillian and Ian I cannot begin to thank you for being my rock and my home. Your sacrifices have been many. I am forever grateful. I love you to the moon and back."
Jessica Zuzga-Reed, DO, 174th President of the Iowa Medical Society keynote address - April 21, 2023 President's Inaugural Reception and Awards Ceremony
Iowa has become a target for trial attorneys from across America. Like a high-powered magnet, we are drawing high-paid lawyers to litigate in our state because they know the sky is the limit terms of jury awards – and they often face hard caps in their own backyard.
When a medical malpractice case is filed, the patient can sue for economic damages as well as noneconomic damages. To offset the potential for personal injury attorneys to seek millions of dollars in malpractice cases, 28 states have enacted caps on noneconomic damages – also known as tort reform. The monetary cap varies from state to state, as does how strictly the cap is enforced.
Iowa has no cap on total damages, and previous efforts to impose a "soft cap" for noneconomic damages have proven unimpactful. The soft cap is considered “soft” as it serves as a recommendation or guidance rather than a hard-stop limit to the amount of non-economic damages that can be awarded.
That is how an out-of-state trial attorney secured a $97.4 million medical malpractice verdict suit in Iowa City last March. More than $43 million was awarded for noneconomic damages. It is the largest malpractice judgment in Iowa history.
The clinic involved in this suit has since filed for bankruptcy. This event, a direct result of the verdict, places into question the long-term obstetrical and gynecological care options for patients in the region. Iowa has one of the lowest number of Ob/Gyns per capita in the U.S
The fear of legal action over a poor decision has the potential to force physicians to practice defensively, and exorbitant verdicts like the one in Iowa City can have detrimental impacts on the healthcare system as a whole. We know physician recruits who have withdrawn a job application based on malpractice exposure.
Without question, patients who have been injured deserve fair restitution for their loss, but it must be balanced with the needs of the broader community to maintain access to healthcare by making sure we protect the financial viability of small providers. Tort reform will not take away a patient or family’s rights to a fair trial, trial by jury, or their right to litigate. And it will not limit appropriate compensation to concrete economic damages they may receive. However, it will place reasonable caps on noneconomic damages and bring a level of consistency and common sense to out-of-control damages and demands by trial attorneys.
We applaud Governor Reynolds for making this issue a legislative priority to ensure access to healthcare throughout Iowa. We are hopeful the Iowa legislature will enact tort reform this year to place reasonable caps on intangible noneconomic damages that cannot be quantified.
Scott M. Truhlar, MD, FACR, Radiology, Partner - Radiologic Medical Services PC, Iowa City and President - Iowa Medical Society
The Iowa Medical Society applauds Governor Reynolds' strong support of medical tort reform as one of her top legislative priorities. In order for Iowa to be a safe and accessible state for medical practice, we need to protect our physicians with a hard cap on non-economic damages.
Now is the time to contact your legislators and encourage them to support the governor’s priority of enacting reasonable caps on non-economic damages. In addition, please register to attend Physician Day on the Hill and use your voice to fight for Iowa's healthcare community.
To quote the Governor, "We can’t put this off another year; we need to get this done."
For more information, please visit the IMS Advocacy page on our website for more resources on how to support tort reform.
The Iowa Medical Society Board of Directors is pleased to announce Steven W. Churchill as the Society’s next Chief Executive Officer (CEO) effective October 10, 2022. Steven replaces Mike Flesher, who departed IMS in June to accept a new role as the CEO of the Wisconsin Medical Society and Dennis Tibben, who provided dedicated leadership as the Interim Executive Vice President & CEO of IMS from June to present.
After living abroad as Chief of Staff at the United States Embassy in Beijing, China, Churchill returned to Iowa last fall, where he had lived and worked for over 25 years. A graduate of Iowa State University, Mr. Churchill was elected to three terms in the Iowa House of Representatives and served as Vice President for Development and Alumni Relations at Des Moines University during his time in Iowa.
A nationally recognized leader with over two-decades of management experience and 14 years of leadership in the healthcare arena, Churchill previously served as the CEO of the Association for Healthcare Philanthropy in Washington, DC and as Executive Director of the American Medical Association Foundation in Chicago. His leadership experience in the public, private and nonprofit sectors were key factors in his selection to lead the Iowa Medical Society.
An experienced CEO, elected-official, and diplomat with a Master’s in Nonprofit Administration, Steven has a record of working closely with board members and staff to build trusting relationships and strategic partnerships to advance the mission and priorities for the organizations that he has led.
“We are excited to welcome Steve Churchill as the new CEO of the Iowa Medical Society. With broad experience in the healthcare arena, executive leadership in association management and deep ties to Iowa and its leaders – Steve knows his way around the statehouse and understands the issues facing physicians and the patients they serve,” said IMS President Scott Truhlar, MD.
“I am honored to be joining the Iowa Medical Society. As a young state legislator, I clearly recall the important role IMS played in shaping healthcare related policy for the benefit of all Iowans. The society has a long history and an unwavering commitment to representing the needs of physicians and the patients they serve. I am excited to put the skills I’ve learned as a leader across the country and the globe to work to advance the Iowa Medical Society’s mission to assure the highest quality health care in Iowa through its role as physician and patient advocate.” stated Churchill.
Steven will work with the Board, outgoing Interim Executive Vice President & CEO Dennis Tibben, and the IMS staff to ensure an effective and seamless transition.
The University of Iowa Prevention Research Center for Rural Health (UI PRC-RH) is conducting a study to understand clinic and provider-level barriers and facilitators to promoting COVID-19 vaccines for prenatal, postnatal and pediatric patients. They are recruiting participants for three separate research activities.
As part of our project designed to increase COVID-19 vaccinations in Iowa communities, we have identified a need to address concerns about vaccine safety and efficacy before, during, and after pregnancy. We need your input on strategies that would be successful for providers recommending vaccines.
Your response is confidential and will help us develop relevant training materials for health care providers promoting COVID-19 and other vaccinations across the state.
Take the Survey
Or copy and paste the URL below into your internet browser:
https://uiowa.qualtrics.com/jfe/form/SV_3BHsX9I4SwFj0vI
The survey will take approximately 10 minutes to complete. The survey is completely voluntary, and you can end your participation at any time by closing out of the web browser.
https://uiowa.qualtrics.com/jfe/form/SV_73NwOpNKXCEnvVk
As part of our project designed to increase COVID-19 vaccinations among rural Iowa children, we identified a need to address community concerns about safety and efficacy for all pediatric vaccines. We would like to learn how you communicate with parents of young children about vaccines and how the COVID-19 pandemic has impacted attitudes about vaccines.
The interview would take 30 minutes of your time and would be conducted over the phone with a member of our research team. Your discussion will remain confidential and will help us to develop a COVID-19 vaccine communication training for health care providers across the state.
We would like to schedule an interview with you within the next two weeks. Please use this link to see available time slots and reserve a time for your interview: schedule interview here.
Or by copying and pasting the URL below into your internet browser: https://outlook.office365.com/owa/calendar/UIPreventionResearchCenterforRuralHealth@iowa.onmicrosoft.com/bookings/s/3FSwsykUJEm-lv-8Kx2fYQ2
After you select a time, you will receive a confirmation email and calendar invite for the interview (please check your spam folder). At the start of your appointment, a member of the research team will call the phone number you provided.
Questions?
If you have any questions about this study or have further input, please reach out to Nicole Gauthreaux at nicole-gauthreaux@uiowa.edu or call (319) 467-4251.
Over the final few months of my IMS Presidency, I’ve spent considerable time reflecting. Reflecting on the impact I’ve hopefully made during my time as your president and the path for me to continue my journey as a physician & patient advocate moving forward. I’ve thought of the reasons I became a physician – my compassionate spirit, love of science, dedication to lifelong learning, and most important serving those who need us the most.
As I come to the end of my term as IMS President, I would like to share some successes and challenges your Iowa Medical Society has encountered over the last year, many of which intersect with those same reasons why I became a physician.
As I hope you know, the Iowa Medical Society is fighting for you – our members – and of course our patients! We fight every day for Iowa physicians who are in the trenches – to each of you who pour your heart and soul into your practice, and give each and every patient high-quality care, straight from the heart.
It amazes me every day, how Iowa physicians continue to do the work they do. Especially when reimbursements are falling, prior authorizations eat up more and more of your time, and quality improvement initiatives and the EMR fill your evenings and weekends with data entry.
Out of state lawyers circle you, awaiting your every mistake. And inflation and worker shortages make it more difficult than ever to keep your doors open for business. But while you are busy doing the doctoring, your medical society is busy fighting for you to keep doing what you’re doing – taking care of patients! I hope we also remember that our medical society fights for the Iowans most in need.
We have made strengthening access to rural healthcare in Iowa a top priority. IMS led the development of Iowa’s first-ever statewide provider workforce strategic action plan, convening representatives of more than 35 organizations spanning the breadth of healthcare professions, academia, patient advocates, the payor community, and the business community.
We will continue to work with these stakeholders to find actionable solutions to the current access concerns in rural Iowa because we know that patients in small towns deserve the same high-quality care that their urban neighbors receive, just as the physicians who care for them deserve the same reimbursement as physicians in non-rural practice settings. We also continue to advocate on the federal level for a much-needed update to the Medicare Geographic Practice Cost Index. Your Iowa Medical Society is more devoted than ever to assuring access to quality care throughout our rural state.
IMS has also never had such an overt organizational dedication to diversity, equity, and inclusion. With the creation of our Diversity, Equity, and Inclusion Committee, we have begun to lay the groundwork for a medical society that welcomes members from all backgrounds and promotes policies that work toward justice and fairness for all. This applies to our members, our leaders and staff, and to the patients we serve. We are all learning about the many ways an overt commitment to these principles can transform what we do and I’m excited that we can all learn and grow together.
And lastly, our Society has always and will always fight for Iowa’s children – our most precious resource! At IMS, we are lucky enough to count a high proportion of Iowa’s pediatricians as members. Our close work with the Iowa Chapter-American Academy of Pediatrics, and others who care for tiny Iowans has created numerous opportunities for collaboration and helped to strengthen our pediatric efforts.
Together, we have advocated for strong pediatric vaccine policy. We created a first of its kind in the state COVID-19 vaccine ECHO-model education series to ensure that Iowa’s providers were equipped with the latest science and clinical recommendations as pediatric vaccines were authorized. We have provided technical assistance for clinical quality improvements through our leadership of the 5-2-1-0 Healthy Choices Count Initiative. And we are continuing to work toward strengthening our Medicaid program, with the knowledge that children make up over half of all Medicaid members in Iowa. Believe me when I say that IMS stands with children!
A reflection on the last year must also include our ongoing legislative push for medical liability reform. The recent record judgement handed down here in Iowa City brings renewed urgency to our efforts at the capitol. We continue to work on educating the handful of holdout votes in the Iowa House about the importance of enacting a $1 million hard cap on noneconomic damages. We are thankful to have the strong support of the Governor and legislative leadership, but we still have work to do.
As we look to the future, there is no doubt that our Iowa Medical Society will continue to be front and center advocating for and advancing medical practice in Iowa. We will continue to meet the challenges presented to our physicians, our practices, and our patients. Under the dedicated leadership of your new president, Scott Truhlar, led by a talented and dedicated Board of Directors and so many physicians lending their time and their talent on our 11 IMS standing committees, and supported by the capable IMS staff, I am confident that your Iowa Medical Society will continue to be bold and relevant in the year ahead and for many years to come.
It has been my honor to serve as the 172nd President of our Iowa Medical Society and I thank you for this incredible opportunity!
Tiffani Milless, MD
IMS federal advocacy is closely linked with that of the AMA, which retains an army of federal staff to advocate on behalf of American physicians. There are times, however, where Iowa physicians may disagree with an AMA position or an issue uniquely impacts the practice of medicine in our state. In those moments, it is critical that Iowa physicians have established relationships with Iowa’s Congressional Delegation and federal Executive Branch Agencies.
In 2018, the IMS Board of Directors recognized the importance of establishing a broader, more sustained federal presence with the formation of the IMS Federal Policy Council. Comprised of the eight members of the Iowa AMA Delegation, this group draws upon the federal experience and close working relationships its members have honed after years of participating in federal policy discussions at the AMA House of Delegates.
This group meets once a year in conjunction with the AMA’s fall Interim Meeting to formalize recommendations to the IMS Board of Directors for federal policy priorities for the coming year. The group also consults on an ad hoc basis throughout the year as issues arise to help guide IMS federal advocacy efforts. In February of each year, a group of IMS physician leaders and staff travel to Washington, DC, to participate in the AMA’s National Advocacy Conference. This annual event is an opportunity for Iowa physicians to carry the IMS Federal Priorities to members of our congressional delegation and to learn the latest updates from the AMA’s federal advocacy staff.
The IMS Federal Policy Council met on November 14 to formalize recommendations for the 2022 IMS Federal Policy Priorities. These recommendations will now go to the IMS Board of Directors for approval at their December 16 meeting.
Issue
Description
Responding to
COVID-19
The COVID-19 pandemic continues to challenge Iowa practices. Federal action provided much-needed financial support to help offset reduced clinic volume and mandatory clinic shutdowns, and to ensure regulatory flexibilities to help physicians adapt to the changing practice environment. With the pandemic still unfolding, practices continue to need flexibility to appropriately respond. In 2022, IMS will work with our federal partners to critically evaluate temporary policy flexibilities to determine where it is appropriate to make temporary policies permanent. Recognizing the ongoing financial strain practices have sustained as a result of the pandemic, IMS will push our federal partners to forgive provider payment advances and for additional time to repay payment advances where forgiveness is not possible.
Addressing Medicare Payment Geographic Disparity
For nearly 30 years, IMS has fought to correct the geographic disparity in Medicare payment rates as a result of the geographic practice cost index (GPCI) calculations. The temporary 1.0 Physician Wage GPCI floor, which expires December 31, 2023, protects physicians in rural states like Iowa from inappropriate payment adjustments that would further reduce payments to Iowa practices by more than $69 million a year. In 2022, IMS will continue to pursue a long-term solution to this problem including addressing the flawed data sources used in these calculations, making permanent the protections of the GPCI floors, and thinking creatively about new payment models that accurately reimburse for the quality of care delivered to Medicare members.
Expanding Physician Workforce
Over the past year and a half, IMS has led a large coalition of stakeholders who helped author the Iowa Rural Healthcare Workforce Strategic Action Plan – our state’s first-ever comprehensive, coordinated strategic plan to address the provider workforce shortage. In 2022, IMS will push for federal action to implement the policy elements of this action plan. These include expansion of recruitment initiatives like the Conrad 30 program, which waives the Visa waiting period for international students who attend an American medical school and agree to practice in workforce shortage areas. This also includes addressing the limitations on funding for graduate medical education (GME) to help increase the availability of sustainable residency positions in our state.
Increasing Rural Access to Case
The rapid, widespread expansion of telehealth services during the COVID-19 pandemic has helped increase access to care and demonstrated the potential for greater technological solutions to rural access and workforce shortage concerns. Temporary measures, including coverage for audio-only telehealth and easing of site restrictions during the public health emergency (PHE) helped unleash the rapid expansion of telehealth services. In 2022, IMS will continue pushing to make permanent those temporary measures that have proven so critical during the PHE and for congressional action to ensure telehealth payment parity for ERISA-governed commercial insurance plans. IMS will work with our federal partners to ensure strategic allocation of newly-authorized funding to sustain broadband expansions, which will help foster greater telehealth utilization, and support improvements to other rural infrastructure including EHR upgrades to improve integration and functionality.
For more information on IMS federal advocacy efforts, please contact Dennis Tibben with the IMS Center for Physician Advocacy.
The Iowa Medical Society Foundation (IMSF) is the giving arm of the Iowa Medical Society (IMS). The foundation is a voluntarily organization that uses contributions from physicians and friends of medicine to carry out its mission to inspire, facilitate, and expand the educational and philanthropic endeavors of IMS – ultimately supporting more than 6,000 physicians, residents, and medical students throughout the state.
Through support of the IMSF, Iowa physicians have access to a variety of professional development and leadership opportunities, such as the Physician Business Leadership Certificate Program, a collaborative program designed to help physicians gain knowledge, skills, and tools to become successful leaders in today’s complex healthcare environment. In addition to supporting the program as a whole, IMSF provides direct scholarships for a number of physician participants each year.
IMSF is also a key sponsor of IMS’ expansive offering of education events, conferences, trainings, and meetings. The robust burnout and physician wellness programming, inclusive of the Awareness and Professional Residency programming with Tammy Rogers, the Recognize, Recover, Rebuild programming with Dr. Charles Keller, and the Crucial Conversations FOCUSED workshop, are made possible through IMSF support. Continued support will be crucial to the next generations of educational programming from CANDOR to diversity, equity, and inclusion
As Iowa physicians have responded to the COVID-19 pandemic, navigating the complex and rapidly-evolving public health emergency, the IMSF has been there to help stand up real-time resources - launching business resources for clinics facing temporary closure and staff layoff, preparing public health communications and clinical guidance resources, and the weekly then monthly COVID-19 Quick Connect webinars to keep Iowa physicians in the know with the latest information as it was known.
Supporting the next generations of physicians is a core function and goal of the foundation. Each year, IMSF purchases the white coats worn by incoming medical students and awards a number of scholarships to Iowa students attending medical school at Des Moines University College of Osteopathic Medicine and the University of Iowa Carver College of Medicine. These scholarships provide funding support to Iowa medical students throughout their medical education experiences both here at home and globally through international health study rotations.
IMSF and the incredible work it supports is made possible through the generosity of physician partners, just like you, who want to invest in the future of their profession and in their peers. The need and desire to lift each other up and to champion physicians has never been greater than after enduring two years of pandemic, political, and personal pressures. Recent data shows that people are highly motivated to give in 2021, and are giving more in response to needs in their community and for causes they care about.
This year, IMSF is participating in GivingTuesday, a global day of generosity that will take place on November 30, 2021. If you support the work of IMSF, please consider contributing to IMSF. All donations to IMSF are tax-deductible and are made easy through our online donation page.
Donate today. Support tomorrow.
For more information on IMSF contributions or to get involved, contact Kady Reese at IMS.
Established in 2014, the IMS Policy Forum replaced the IMS House of Delegates as the primary policy-setting body for the Iowa Medical Society. This model is designed to ensure a more transparent and inclusive model for IMS members to call for organizational action. This model offers multiple opportunities for members to provide input in-person during live Policy Forum meetings; electronically via online discussion boards or submitted video testimony; and anonymously via secure email submissions.
Since transitioning to the Policy Forum model, IMS has seen record member engagement and members have seen results. In 2018, the governor signed into law telehealth commercial coverage parity legislation, which was a direct result of PRS 17-2-04 – a Policy Forum submission from a group of University of Iowa medical students and physicians calling for such action.
Policy Request Statements (PRS) are the formal requests submitted for consideration during the Policy Forum process. A PRS may seek to do any of the following:
A PRS may be submitted at any time throughout the year, however, it will only be considered during the official Policy Forum periods each spring and fall. A sample PRS is available to guide authors in development of their requests. Staff and Board Liaisons are also available to assist in developing the strongest possible request for consideration.
The official “Call for Action” period begins seven weeks prior to each scheduled Policy Forum meeting and lasts for two weeks. During this time, members are invited to submit their ideas for a Policy Request Statement. Individuals interested submitting an idea should contact staff to begin the process. The Policy Forum Speaker will assign a Board Liaison to each PRS author, based upon the content of the request and individual board members’ areas of expertise. Board Liaisons and staff will work with the PRS author during this phase to develop the strongest Policy Request Statement possible.
The second phase is the Testimony Forum, which begins five weeks prior to each scheduled Policy Forum meeting. PRSs received during the Call for Action period are published on a secure page of the IMS website. Members have two weeks from the opening of the Testimony Forum phase to contribute testimony via members-only discussions on the IMS website or submit feedback privately via email. Members may also submit video testimony to be shared on the Testimony Forum discussion boards or at the Policy Forum meeting.
The final phase is the Policy Forum meeting. At the meeting, all PRSs and accompanying Testimony Forum comments are considered by the Policy Forum. All IMS members are invited to attend the Policy Forum to engage in discussion and offer testimony, either live or via video, regarding the PRSs under consideration. Authors are invited to present their PRS to the Policy Forum members either live or via video, and answer members’ questions about their request. Following the Public portion of this meeting, the Policy Forum members will convene in closed session to deliberate on each PRS and take action. PRS authors are notified of the Policy Forum’s decision following the meeting.
While Policy Forums must be held at least once a year, they are regularly scheduled to be held once in the spring in conjunction with the Presidential Installation and again in the Fall. In addition, special sessions of the Policy Forum may be called as needed.
The Policy Forum may take the following actions with a Policy Request Statement:
Recognizing the sensitive nature of some Policy Request Statements and the possibility that a member may not feel comfortable publicly raising an issue for consideration, in 2020 the IMS Board of Directors approved the development of an anonymous Policy Forum submission process. PRS authors wishing to anonymously submit an issue for consideration may select to have an IMS Board member or an IMS staff member serve as their public proxy during the Policy Forum process. Based upon the member’s preference, the Policy Forum Speaker will assign a board member or staff member to work privately with the author to develop his or her PRS. Staff proxies will coordinate with the Board Liaison assigned to that Policy Request Statement. Board proxies will also serve as the PRS Board Liaison.
In 2020, the IMS Board of Directors approved the designation of Board Liaisons to work with PRS authors throughout the Policy Forum process. Board Liaisons are assigned by the Policy Forum Speaker, based individual board members’ areas of expertise and the subject of the individual PRS. The Board Liaison will work with the PRS author to craft the strongest possible request, answer questions about the process, and advocate on the author’s behalf during the Policy Forum’s consideration.
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To learn more about the Policy Forum process and submit your ideas for organizational action by visiting the Policy Forum page on the IMS website.
Combatting the growing opioid epidemic has long been a priority of the Iowa Medical Society (IMS). From working to pass the legislation that improved access to naloxone in 2015, the enactment of the Good Samaritan Law protections in overdose situations in 2017, expediting Prescription Drug Monitoring Program (PDMP) dispensed medication reporting and enhancing usability of the PDMP, championing the removal of regulatory burdens to ensure continued access to treatment for incarcerated persons following release, through leading the charge which eliminated Medicaid prior authorization barriers to Medication Assisted Therapy (MAT) in 2019, IMS is committed to ensuring access to prevention and treatment services for all Iowans.
The IMS commitment goes beyond policy and legislative charges. In 2019, IMS hosted an Opioid Summit in Dubuque. This educational event, held in partnership with the Iowa Behavioral Health Association (IBHA), provided a much-needed training opportunity for healthcare providers in an area especially hard hit by opioid use disorder (OUD). IMS has also hosted training events tailored to prevention through education on appropriate prescribing of opioids as recommended by the Centers for Disease Control and Prevention (CDC).
Contrary to common misconceptions, the opioid epidemic of misuse, abuse, and addiction is not simply a “big city problem”. The opioid dilemma in Iowa has unique application as a rural state with eight of the top 10 counties most vulnerable to opioid overdoses rural counties – a situation that has only been exacerbated by the effects of the COVID-19 pandemic.1
Since 2019, IMS has served as a lead consortium member as part of a targeted effort to address OUD in our rural communities. The Rural Communities Opioid Response Program (RCORP) is a multi-year Health Resources and Services Administration (HRSA) initiative aimed at reducing the morbidity and mortality of substance use disorder (SUD), including OUD in high-risk rural communities. Helmed by the Iowa Healthcare Collaborative, a long-time IMS partner, the RCORP initiative utilizes a multi-stakeholder approach to collectively address OUD through evidence-based best practices from prevention through treatment and recovery.
In this work, IMS leads the physician engagement and education efforts to amplify local community readiness to address opioid use/misuse. From this effort, IMS has and will continue to provide:
Through these efforts and more, IMS is equipping healthcare providers with the knowledge, tools, and support they need to address opioid addiction and care for patients who use opioids – from prevention and appropriate prescribing to treatment and long-term recovery.
For more information about IMS’ opioid initiatives, please contact Kady Reese, kreese@iowamedical.org.
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1 Iowa Department of Public Health. Bureau of HIV, STD, and Hepatitis. Iowa County-level Vulnerability Assessments for Risk of Opioid Overdoses and Rapid Dissemination of HIV and Hepatitis C. December 2019.
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