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In 2016, the IMS Board of Directors approved the formation of an ad hoc task force to determine how IMS might best support physicians at risk of or currently experiencing professional burnout. Their recommendations, contained in the Steenblock Report, kicked off five years of statewide work to provide individual and organizational burnout and professional wellness resources to physicians and clinicians across our state. The COVID-19 pandemic has only worsened the strain on the healthcare community and is now leading to a concerning explosion of professional burnout. IMS is here to help.
Physician Wellness Resource Page
Following the adoption of the Steenblock Report in the summer of 2017, IMS launched the first of several resource pages, which have evolved over the years to meet the changing needs of the physician community. The current resource page includes an anonymous self-assessment tool to allow individuals to gauge their level of burnout in a secure and private manner. Since early in the pandemic, IMS has operated a second COVID-19 Wellness Page, which included a number of pandemic-specific tools to help support individuals and practices. Many of these resources have been migrated to the newly relaunched Physician Wellness Resource Page so all of our burnout and wellness resources are now available on a single site.
IMS Programming
In 2018, IMS hosted the first-ever statewide, multidisciplinary conference on professional burnout. Co-hosted by eleven provider and clinic administration organizations, this conference represented an acknowledgement that burnout impacts all members of the care team and successfully addressing the problem will require buy-in from administrative leadership. The program included sessions on recognizing burnout, critically evaluating clinical systems to improve the culture leading to burnout, and learning new techniques to respond to professional stress. In 2019, IMS partnered with the Iowa Pharmacy Association to bring these valuable resources to more Iowa communities, hosting a series of 13 local wellness programs that connected area clinicians with subject matter experts on burnout and professional wellness.
The COVID-19 pandemic forced a reimagining of our physician wellness programs, with IMS shifting to offering several virtual programs. Recently, IMS was able to resume its in-person programming in a local, small-group format. Working with leadership at a clinic in Northeast Iowa, IMS helped facilitate two evenings of extensive, peer-guided reflection and discussion. These allowed first their physicians and then their advanced practice providers to discuss their individual and collective experiences throughout the pandemic, opportunities for clinic-wide improvement, and new techniques to maintain professional wellness in the face of these ongoing challenges.
What’s Next
The ongoing strain COVID-19 has placed on Iowa physicians has renewed the Iowa Medical Society’s commitment to physician wellness. The IMS Programming Committee and staff are in the process of critically evaluating the resources, programming, and support we offer, with an eye toward identifying additional unmet needs. In 2022, IMS also hopes to build upon the success of our recent local self-evaluation events in Northeast Iowa by making similar opportunities available to more practices across our state. If you have ideas for how IMS can help support you or your clinic, we want to hear from you. Please contact Autumn McGill with IMS for more information on our physician wellness efforts or to share your ideas.
The COVID-19 pandemic has transformed telehealth utilization here in Iowa and around the country. Thanks to a significant influx of funding, an expansion of coverage, and an easing of long-standing regulatory barriers, more clinics in our state are providing a greater variety of telehealth services than ever before. In this week’s IMS Close-Up, we look at a new IMS project to help support and sustain these telehealth expansions, and how this new work builds upon years of IMS advocacy in this area.
The Telehealth Initiative
This past June, IMS received notification of selection to participate in the second cohort of The Telehealth Initiative (TTI), a program created in collaboration between The Physicians Foundation and the American Medical Association (AMA) to bolster implementation support at the state-level by equipping state medical societies with telehealth programming that can further support physicians and practices in implementation and optimal use of telehealth. Components of TTI participation include:
Through this initiative, IMS will be able to offer greater educational resources to all Iowa practices, as well as targeted technical assistance to a handful of practices looking to expand their telehealth offerings or considering making permanent some of the telehealth services they stood up during the pandemic. In partnership with the AMA, IMS will assess physicians’ experience with telehealth during the pandemic and work to identify additional barriers to sustainable utilization moving forward.
For more information on The Telehealth Initiative and how your clinic can take advantage of these resources and support, please contact Kady Reese with IMS.
Telehealth Advocacy
Support for expanded telehealth utilization has long been an advocacy priority for the Iowa Medical Society. In 2015, IMS worked in partnership with the Iowa Board of Medicine to stand up Iowa’s first telehealth practice standards, which were based in part upon guidelines from the AMA and other national experts. These board rules were intentionally designed to allow for an evolution of technology and utilization practices, while still ensuring minimum standards for appropriate telehealth services in our state. That same year, IMS successfully pushed for enactment of Medicaid coverage and payment parity to ensure that telehealth services provided to Medicaid patients were covered at the same rate as in-person services.
In 2017, a group of IMS member physicians and medical students submitted a request to the Policy Forum for IMS to pursue commercial telehealth parity legislation the following year. This policy request resulted in a successful 2018 legislative push to enact commercial coverage parity to further extend the policy underpinnings to support greater telehealth utilization. This also marked the beginning of a multi-year push for commercial telehealth payment parity to extend the same payment equity now in place under the Medicaid program.
In 2019, IMS partnered with the Iowa Association of School Boards to craft legislation to enact a regulatory framework to allow for an expansion of behavioral health services delivered via telehealth in a school-based setting. This nontraditional service delivery model represents a larger commitment to creatively approaching both Iowa’s provider workforce shortage and broadband access problems. By building upon the ICN fiber optic network that is connected to every Iowa school and ensuring appropriate safeguards to utilization, this legislation, which took effect in 2020, further expanded the number of sites in rural Iowa that are now able to offer pediatric behavioral health services.
With the onset of COVID-19, IMS worked closely with the Governor’s Office to successfully push for the inclusion of numerous telehealth expansion and flexibility measures, including enactment of temporary full commercial payment parity. IMS also worked with Iowa’s Congressional Delegation and our federal agency partners to push for telehealth policy flexibilities including coverage for audio-only telehealth services and an easing of site restrictions, as well as an expansion of covered services. As Iowa practices demonstrated the true possibility of expanded telehealth services, we also built the case for making permanent several of these temporary measures. This has included two successive years of CMS expansions of permanent telehealth coverage options as part of the Physician Fee Schedule payment rule and legislative action earlier this year to enact full commercial payment parity for behavioral health services delivered via telehealth.
Our advocacy work in support of greater telehealth utilization is not done. IMS is working now with the Iowa Board of Medicine to update their telehealth practice standards to recognize the important role audio-only telehealth can play as a service delivery option. We continue to pursue commercial payment parity for physical health services and we continue to explore options to make permanent the temporary policies and flexibilities that have proven so critical during the pandemic. In addition, IMS is working closely with our federal partners to ensure the billion in new funding to support telehealth infrastructure is awarded in such a manner so as to maximize its impact on telehealth access across our state.
For more information IMS advocacy efforts in support of telehealth, please contact Dennis Tibben with IMS.
The physician leaders of the Iowa Medical Society drive everything we do as an organization. Engagement with organized medicine helps develop both personal and professional leadership skills and IMS offers a host of options to do so. Opportunities extend beyond simply serving on the IMS Board of Directors to also include service as an Iowa representative to the AMA House of Delegates, service on two IMS-affiliated boards, and service on one of nine IMS standing committees.
IMS Elected & Appointed Leadership Roles
IMS Standing Committees
Each of the IMS standing committees focuses on a different aspect of the work of the organization. Appointments and reappointments are made annually by the new IMS President, with meeting frequency and timing varying by committee. For more information about the individual committees, please visit the
IMS Leadership Development Committee
At its September 2021 meeting, the IMS Board of Directors voted to recommend the formation of a new standing IMS Leadership Development Committee. This group is intended in part to replace the IMS Nominating Committee, which annually slates candidates for the elected leadership positions of the organization. It is also charged with providing an ongoing, holistic review of IMS leadership recruitment and selection processes, as well as providing additional opportunities for greater member engagement at every level of the organization.
Committee membership will consist of a representative of each of the nine standing IMS committees, confirmed by the IMS Board of Directors, and the IMS President-Elect as committee chair. Initial appointments to the new Leadership Development Committee will be confirmed at the December Board of Directors meeting. Because transitioning from the Nominating Committee to the Leadership Development Committee will require amending the IMS Bylaws, the Board of Directors voted in September to recommend these bylaws amendments at a special Policy Forum meeting, which will be held in conjunction with the December board meeting to ensure the new committee is seated in time to help slate candidates for the 2022 IMS leadership elections.
Initial 2022 Legislative Priorities
At their September 17 meeting, the IMS Board of Directors voted to approve recommendations from the Committee on Legislation for our initial 2022 Legislative Agenda. These priorities are as follows:
Medical Liability Reform
Combatting Vaccine Hesitancy
Expanding Physician Workforce
Protecting Safe Medical Care
Reducing Administrative Burden
Strengthening Medicaid
Read the full Initial 2022 Legislative Priorities
These priorities represent the top focus areas for the organization as we prepare for the next legislative session, however, this is by no means an exhaustive list. Each session, IMS engages on hundreds of pieces of legislation to ensure the voice of Iowa physicians is a part of the policy discussions that impact medical practice in our state.
IMS Legislative Planning
Early each fall, the IMS Committee on Legislation meets to establish recommendation to the Board of Directors for the organization’s Legislative Agenda for the coming year. Ideas for these priorities come from a host of source. A member might submit a legislative request through the Policy Forum process, staff flag trends in issues that they hear from member contacts throughout the year, and partner organizations regularly contact IMS to request that we partner to work on a legislative idea.
Regardless of its source, an idea for legislative action follows the same path. Staff review the issues and work to identify potential legislative and non-legislative solutions, including legislation that has been proposed in other states to address the problem. This information is then shared with the IMS Committee on Legislation – a diverse group of physicians from various specialties, practice settings, and areas of the state, as well as representatives from both medical schools. This group finalizes the recommended priorities to the IMS Board of Directors for approval at their September meeting.
Once approved, these initial priorities are shared with the membership, the impacted IMS standing committees that meet throughout the fall, and other key IMS partners for feedback and additional insights. This input is brought back to the Committee on Legislation when it reconvenes in late fall to determine if any refinements or additions should be made to the IMS Legislative Agenda. If adjustments or additional priorities are recommended, these are approved by the IMS Board of Directors at its December meeting.
For more information on the IMS legislative priority development process, to share your thoughts on the initial 2022 Legislative Agenda, or to get more involved in this work, please contact Dennis Tibben with the IMS center for Physician Advocacy.
Through a contract with the Iowa Department of Public Health (IDPH), IMS has worked over the past year to lead a multi-disciplinary workforce project team that included the Iowa Hospital Association, the Iowa Pharmacy Association, and the Iowa Primary Care Association. This group has collaborated to establish a comprehensive statewide strategy to address the workforce barriers in Iowa. This initiative brought together healthcare leaders and stakeholders from the business, payer, and educational communities. It built upon the work initiated in 2018 with the formation of the IMS Physician Workforce Committee and the fall 2019 Physician Workforce Stakeholder Meeting that included many of these same stakeholder groups meeting for the first time across industries for a frank and comprehensive discussion about our state’s provider workforce needs at all levels.
Over the past year, the project team has conducted a series of townhall-style focus groups and surveys to identify needs, barriers, and opportunities, which helped to inform a stakeholder task force that jointly crafted the Iowa Rural Healthcare Workforce Strategic Action Plan – Iowa’s first-ever comprehensive, statewide provider workforce strategic plan. This report has been submitted to IDPH and IMS has been tapped to lead year two of this work, which now pivots to implementation of the recommendations included in the plan.
This week’s full FDA approval of the Pfizer-BioNTech COVID-19 vaccine marks another milestone in the fight to end the pandemic, but nearly half of all Iowans remain unvaccinated and many remain deeply skeptical of the vaccines. In the face of this persistent vaccine hesitancy and confusion over the evolving public health guidance regarding COVID-19, more and more patients are looking for a trusted, local authority for information. Iowa physicians are well-versed in breaking down complex medical conditions and helping their patients make the best care decisions for their individual circumstances, but how do we reach those who are deeply skeptical of the safety, efficacy, or even the need for a COVID-19 vaccine? How do you explain the relatively new Emergency Use Authorization (EUA) process or know which authoritative source to seek out when there is often conflicting guidance from state, federal, and international sources? IMS is here to help.
IMS has launched a new vaccine confidence initiative aimed at better equipping Iowa physicians to be the trusted local messengers to help their communities navigate the questions and skepticism around the COVID-19 vaccines. This new project is being built in conjunction with state and federal public health experts to ensure that every Iowa physician has the tools necessary to best advise their patients on COVID-19 vaccinations. These resources will include:
In addition to these more traditional resources, IMS will be standing up one of the country’s first Vaccine ECHO Projects – a hub and spoke model of virtual grand rounds that will regularly connect physicians from across the state to share best practices and what’s working in their local communities. First established nearly twenty years ago by the University of New Mexico School of Medicine, Project ECHO utilizes technology to connect providers with subject matter experts and each other in a virtual “community of practice” to learn from each other and foster greater professional collaboration. Based upon New Mexico’s success in the treatment of hepatitis C, the ECHO model has been expanded and replicated for the treatment and management of a host of medical conditions. Now, IMS is leading the way in utilizing this innovative model to better equip Iowa physicians to build confidence in the COVID-19 vaccine.
IMS has hired a dedicated project manager with a background in public health and clinical care delivery to help lead this work. In the coming weeks and months, we will begin rolling out additional patient and provider resources, including live and on-demand trainings on skills such as motivational interviewing. The first of these resources – a quick guide on talking with patients about COVID-19, as well as a patient guide to understanding the COVID-19 vaccines and the EUA process – have been posted to the IMS Patient Resource Page. For more information on this project, please contact Kady Reese with IMS.
August 19, 2021
As the COVID-19 pandemic continues to impact our communities, the impending start of the 2021-2022 school year necessitates continued COVID-conscious planning by parents and students.
Over the summer, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) issued updated guidance on face mask usage, including the recommendation for universal indoor masking by all students (age 2 and older), staff, teachers, and visitors to K-12 schools, regardless of vaccination status.
This guidance for universal indoor masking regardless of vaccination status was made in response to evolving understanding of the COVID-19 Delta variant. The Delta variant is significantly more infectious than previous strains of the virus, as contagious as the chicken pox. Delta may also carry with it greater risk for serious illness and potential hospitalization. The increased risk of infection, coupled with the current absence of an authorized COVID-19 vaccine for children under 12 years of age, warrants a return to more stringent COVID precautions.
As we await authorization for vaccination for individuals under age 12, masking by all individuals in all public indoor spaces, including school-based settings, is our best defense to protect our children against COVID-19 and emerging variants.
Vaccinated Individuals, Adults and Students Age 12+
While currently available COVID-19 vaccines have demonstrated strong effectiveness in preventing severe illness and hospitalization, we are learning more about the strength of defense against mild and non-symptomatic infection and transmission. Based on the information available and to best protect those who are currently unable to receive vaccination, vaccinated individuals should resume masking in all indoor public spaces, including school and child care settings.
Unvaccinated Individuals, Adults and Students under Age 12
Currently, there are no COVID-19 vaccines approved to protect children under the age of 12. While many infections among children may have been asymptomatic or have resulted in less severe illness with previous COVID variants, the Delta variant may potentially carry a higher risk of symptomatic infection and potential severe illness.
Until there is a vaccine available for all age groups, continued masking is critical to protect children under age 12 and vulnerable individuals who are otherwise unable to receive vaccination. Any unvaccinated person over the age of 2 should wear a mask in all indoor settings outside of your own home, including school and child care settings.
Persons with Previous COVID Infection
While prior COVID-19 infection does provide a level of natural immunity against COVID, current studies indicate this immunity is shorter-lived than immunity from vaccination. Vaccination among those who have also previously had COVID-19 strengthens and prolongs any existing immunity. Vaccination is appropriate and encouraged for persons who have had COVID-19. As with vaccinated individuals, wearing of face masks is the best practice to both protect yourself and those around you.
As we continue to navigate this pandemic and prepare for approval of COVID-19 vaccinations for children under the age of 12, it is understandable that parents and families have questions. Iowa’s physician community stands ready to help you make sense of it all. If you or a family member have not yet received your vaccination, speak with your family’s care provider about your individual health circumstances, the COVID-19 vaccines, and how best to keep your family safe.
In recent weeks, the Centers for Disease Control and Prevention (CDC) and the Iowa Department of Public Health (IDPH) have issued updated guidance on face mask usage. In recent days, the Iowa Legislature has enacted a new statutory ban on local municipalities and school districts enacting their own mask usage mandates.
These rapidly changing guidelines, coupled with the fatigue of a global pandemic now entering its fifteenth month, have left many Iowans understandably confused and frustrated about how best to protect themselves and their families from COVID-19. Iowa’s physician community understands your confusion and frustration, and stands ready to help you make sense of it all.
It is important to remember that while the local mandates are no longer in place, this new law does not prohibit individual mask use and still allows for private businesses to make their own decisions. If you are not yet fully vaccinated, masking in public settings, including schools, is one of the most effective ways to protect yourself and your family until the majority of Iowans are vaccinated.
Fully Vaccinated Individuals
Protecting you and your family starts with getting vaccinated as soon as possible, if you are eligible and able. Vaccine supply is now plentiful, widely available across the state, and approved down to age 12. Once you are fully vaccinated, the CDC and IDPH advise that a mask is no longer necessary in most settings to help protect you from COVID-19. Of note, in healthcare settings, masks are still recommended.
Partially-Vaccinated Individuals
Full protection from COVID-19 occurs approximately two weeks following the completion of your vaccination series. If you have received the Pfizer/BioNTech or Moderna vaccines, this means a two-dose series. Between these two doses, you are not yet fully protected. You should continue to wear a mask in public settings. Similarly for the two weeks after receiving these or the single-dose Johnson & Johnson/Janssen vaccine, you should continue to wear a mask in public settings.
Children
On May 10th, the Pfizer vaccine was approved for use in 12-15 year-olds. Currently, there are no COVID-19 vaccines approved to protect children under the age of 12. While infections among most children are less severe, some have seen severe complications. Children with even a mild infection are still able to transmit the disease to more vulnerable populations. We are also still learning about the long-term side effects of even mild infection. Until vaccines are approved for them, children ages 2-11 should wear a mask in public indoor spaces to protect themselves and those around them. The CDC continues to recommend children wear masks in school unless fully protected by vaccination- two weeks after their second dose is received.
A return to a more normal daily routine is on the horizon. For many of us who are now fully vaccinated, this return has already begun to occur. Adapting to the final phases of the COVID-19 pandemic can be stressful and confusing. As we move together toward a more normal tomorrow, we must exercise grace and understanding for the individual, small business, or family who is navigating mask usage in the manner that makes sense for their unique circumstances. Continue to look to your local physician as a trusted source to help make sense of evolving public health guidance, and encourage your friends and neighbors to join you in becoming vaccinated.
Together, we will emerge stronger from this pandemic.
It has been a long year as our state and our nation has worked to respond to the COVID-19 pandemic. Our healthcare community has faced dangerous supply shortages, worked long hours, and continuously adapted to ensure that Iowans have access to safe, quality care. Nearly 300,000 Iowans have become sick and sadly, more than 5,000 Iowans have lost their lives to this disease.
Fortunately, hope is on the horizon. While the rollout of the COVID-19 vaccine has not been as smooth or as quick as any of us would have liked, more than 300,000 Iowans have now received at least one dose of the vaccine and a third COVID-19 vaccine is now under consideration for federal authorization. At the same time, our state’s positivity rate has dropped substantially since its peak in November and the number of Iowans hospitalized with the disease is also on the decline.
These achievements should be celebrated, but it is also absolutely critical that Iowans not let their guard down now, even with the recent lifting of COVID-19-related public health state orders. It is likely going to be several months before COVID-19 vaccines are readily available and new, more highly infectious variants of the disease have begun to be detected in our state. The great achievements our state has made in the fight against the pandemic are a direct result of greater observance of the basic COVID-19 safety measures:
1. Wear a well-fitting facemask over your mouth and nose whenever you are in public, or in close contact with anyone outside your immediate household.
2. Avoid large gatherings and maintain at least six feet of social distance with those outside your immediate household.
3. Wash your hands with soap and water frequently and for at least twenty seconds especially when you are in public or have just blown your nose, coughed, or sneezed. If soap and water are not available, use hand sanitizer that contains at least 70% alcohol.
4. Monitor your daily health and be alert to COVID-19 symptoms including a fever, cough, or shortness of breath. If you experience symptoms, stay home and call your doctor immediately.
We must all continue to do the right thing and work together to keep ourselves and our communities safe. Failing to do so will result in another deadly spike in infections, which will further divert resources from rollout of the COVID-19 vaccines. Now is the time to double-down on the Iowan commitment to caring for our neighbors and working together to help end this pandemic.
The IMS Board of Directors has voted to implement a series of reforms to strengthen the Policy Forum model for organizational policy development. The reforms, contained in the Vista-Wayne Report, were discussed and approved at the recent IMS September Board meeting. They include the following measures intended to further increase member engagement opportunities:
This starts with the creation of an IMS members-only Facebook group for greater peer-to-peer interactions throughout the year under the guidance of a handful of member moderators who will be tasked with helping to identify emerging trends and encouraging engaged members to bring their ideas to the Policy Forum process.
Staff have also been tasked with formulating a model for allowing for anonymous PRS submissions, which will help to facilitate member deliberations on sensitive subjects while protecting members from potential negative repercussions from outside forces for simply voicing their thoughts among their peers.
Staff will be convening stakeholder discussions to develop clearer models to implement these final two reforms, with the IMS Board of Directors further deliberating both measures at its December meeting. Implementation of the other reforms is already underway with the intention of having all reforms ready in time for Policy Forum 21-1 next April. For more information about these reforms, please view the Vista-Wayne Report or contact Dennis Tibben with the IMS Center for Physician Advocacy.
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