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.
On Monday July 27, IMS submitted a joint letter to Governor Reynolds calling for an immediate, statewide public face mask order for all Iowans over two years of age. IMS was joined in this letter by leadership from 14 healthcare organizations representing more than 12,000 physicians, providers, and public health professions from across the state. Previously, the IMS Board of Directors met in an emergency meeting to discuss the need for such an order and voted unanimously to support IMS moving forward in leading Iowa’s healthcare community in this call for statewide action.
The letter reads as follows:
Dear Governor Reynolds:
The Iowa Medical Society and the coalition of healthcare organizations listed in this letter represent the unified voice of the more than 12,000 physicians, clinicians, providers, pharmacists, health care facilities, public health professionals, and providers-in-training across the state of Iowa. In these roles, we have a professional and ethical duty to protect the safety and well-being of our patients and our fellow Iowans. It is through this lens that we view the current challenges facing our state and our nation. We have been proud to work with your office and the Iowa Department of Public Health over the last several months as part of the evolving response to address the impact of the novel coronavirus (SARS-CoV-2) and the disease it causes (COVID-19). In that spirit of partnership, we write today to ask you to immediately move forward with the next critical step in our state’s response to this pandemic – a statewide public mask order for all Iowans over the age of two.
We had all hoped that our ongoing efforts to flatten the curve and mitigate the spread of COVID-19 would find our state in a position of community containment by this point in the year. That is, unfortunately, not the case. In the past week alone, we have seen the number of Iowans with active COVID-19 infections rise to 6,565 – a 64% increase from the 3,993 reported cases on June 20 when we were all optimistic that we were starting to see the downward trend stabilize. As new numbers of daily positive tests continue to be reported by the hundreds, and results from tests administered over the weekend are released, the number of infected Iowans is positioned to climb steadily closer to the previous peak active infection figure of 7,381 that was reported on May 6.
Through the course of this pandemic, we have seen the prevalence of infections shift away from older Iowans and those with pre-existing conditions, to the greatest number of infections now occurring among our younger, healthier populations. More than 48% of infections are currently among adults aged 18-40 and less than 23% of those testing positive report a pre-existing condition. It is also worth noting that it is not simply a case that these are infections among young people with mild symptoms. Hospitalizations due to COVID-19 continue to rise. More than 32% of those hospitalized are requiring intensive care treatment and to date, 829 Iowans have lost their lives.
At the same time, vulnerable populations continue to also be impacted in large numbers by this pandemic. Older Iowans, particularly those in a nursing facilities and other congregate living settings, continue to see steady infection rates in new facilities across the state. The rising rates of infection in many counties have kept long term care providers from easing COVID-19 restrictions, and allowing further access for family and friends to their loved ones. With over 441 deaths occurring in long term care settings in Iowa, taking aggressive steps to mitigate infection rates through statewide public mask order could directly impact the lives of vulnerable, older Iowans.
As you know, this pandemic is not simply impacting Iowa’s urban, more densely-populated communities. Iowa’s rural communities are facing similar rates of infection, with some counties’ daily positive rates exceeding both the statewide average and the infection rates of the most heavily-hit urban counties. The risks of these dramatically increasing infection rates overwhelming response efforts in rural communities is further amplified as rural providers operate with significantly fewer resources to manage acute illness than their urban counterparts.
The fight against COVID-19 has proven arduous and constant. While there is much we are still learning about this virus, there is much we do know and knowledge we do have about effective ways to fight this type of illness. We know the best way to fight virus spread is to prevent it. Guidance from public health experts and numerous research studies, including a recent University of Iowa College of Public Health study, are clear: consistent, widespread use of cloth masks in public settings will dramatically slow the spread of COVID-19 and save lives.
The Iowa Medical Society and this coalition of healthcare organizations strongly support use of all available policy mechanisms, including a statewide order, to ensure Iowans more widely adopt public use of masks for the duration of the pandemic. As data-driven organizations, we are confident in the University of Iowa research that shows that mandating face mask use in public is associated with a decline in the daily COVID-19 growth rate and an estimated 250,000-450,000 COVID-19 cases potentially avoided across the 15 states that had such mandates in place at the time of the study. Thirty states, under the leadership of both Democratic and Republican governors, have now enacted statewide protocols mandating masks in public places and areas in which social distancing cannot be guaranteed. It is imperative that Iowa join their ranks.
As you have noted many times, we each have a role to play in our state and our nation’s response to COVID-19. You have consistently called upon Iowans to do their part and remain vigilant in exercising the precautions necessary to slow the spread of the virus. Unfortunately, voluntary efforts have proven to not be enough. We have seen infection rates continue to climb. We have seen businesses forced to re-close due to positive infections among their staff. In addition, healthcare facilities and community businesses who have attempted to establish their own masking policies have faced backlash and enforcement challenges in the absence of a statewide policy.
It is now apparent that stronger measures are necessary to better protect our fellow Iowans. Requiring public use of cloth masks represents an immediate opportunity to drastically reduce the spread of COVID- 19 in our state. A statewide order, appropriately structured to account for young children and other special health considerations, further enhances the state’s efforts to protect patient safety and safeguards our initial progress toward economy recovery.
The shutdowns of large swaths of Iowa’s economy, schools, and many non-urgent medical procedures earlier this year inconvenienced nearly every Iowan and rendered a significant blow to countless Iowa businesses, including many medical practices. While these measures were necessary at the time to slow the spread of the virus and preserve critical resources for front-line COVID-19 response efforts, we do not want to go backwards on our state’s recovery efforts. A statewide mask order is the surest way to ensure that our schools, businesses, and health care facilities are able to reopen and stay open, and that our medical practices are able to continue to offer a full array of care for Iowa patients.
Iowa’s healthcare community remains committed to doing all that we can to help respond to the ongoing pandemic. The time has come that mandatory public mask use must be a part of those efforts. We thank you for your ongoing leadership during this difficult chapter in our state’s history and look forward to continuing to partner with you and your administration in responding to the challenges of COVID-19.
Brian Privett, MD, President, Iowa Medical Society
James Bell, MD, President, Iowa Academy of Family Physicians
Daniel Wright, DO, President, American Academy of Pediatrics, Iowa Chapter
Stacey Marlow, MD, President, American College of Emergency Physicians, Iowa Chapter
Melinda Seering, MD, President, Iowa Society of Anesthesiologists
Tim Daley, MD, President, Iowa Academy of Ophthalmology
Kevin Locke, MD, President, Iowa Association of County Medical Examiners
Sakeer Hussain, MD, President, Iowa Oncology Society
Anne Gentil-Archer, ARNP, President, Iowa Nurse Practitioner Society
Stacy Crill, ARNP, President, Iowa Association of Nurse Practitioners
Natalie Weber, PA, President, Iowa Physician Assistants Society
Julie Thorson, Board Chair, Leading Age Iowa
Ron Kemp, Board Chair, Iowa Primary Care Association
Connie Connolly, RPh, President, Iowa Pharmacy Association
Lina Tucker Reinders, MPH, Executive Director, Iowa Public Health Association
By: Brooks Jackson, MD, MBA
It’s been said that the value of an organization’s leadership is overlooked during times of prosperity or stability and often amplified during times of turbulence or uncertainty.
While there is no single blueprint to navigating a crisis, the ability to make quick (not perfect) decisions and adapt to changing circumstances are desired leadership qualities. Gathering and using reliable information to guide decision-making, and having trusted teams and processes in place also are important considerations.
The key ingredient that binds all of these factors is effective communication.
Health care systems, like any business or organization, abhor a vacuum when it comes to communication, especially during times of crisis. When its leaders do not communicate clearly and consistently, the information vacuum is filled with speculation and rumor—by employees and stakeholders, by patients and families, and by the general public. And speculation and rumor can often be worse than reality itself.
I’ve been reminded of the value of communication as the COVID-19 crisis brought never-before-encountered challenges to the University of Iowa Health Care mission of medical education, research, and patient care, as well as our planning and response to this pandemic. Getting the word out has been central to our efforts to understanding and adapting to conditions that have changed on a weekly, and sometimes daily, basis.
We are not alone, of course. The coronavirus has impacted health systems and medical practices across the nation. And the coming weeks and months will be just as challenging as we work to define and establish a “new normal” for our providers, students and trainees, and patients.
Although the first COVID-19 cases in Iowa were reported in early March, our preparation began in late January as we communicated across our health system and with county and state public health officials, university leaders and the Board of Regents, and colleagues and at institutions around the country and world. Raising awareness about the emerging pandemic—and letting our employees know that we were already addressing the issue—helped set the stage for changes implemented in the weeks that followed.
For example, we issued an enterprise-wide email to all our employees the day we activated our emergency response system on March 10, with instructions on properly using and conserving PPE, and preparing for a potential surge of COVID-19 patients. Subsequent broadcasts over the following days and weeks shared other updates, like the admission of our first COVID-19 inpatient, social distancing and other safety measures, child care resources for our staff, and the implementation of protective face shields for employees, just to highlight a few. We also publicly shared our successful initiatives in setting up an influenza-like illness clinic, remdesivir clinical trials, in-house COVID-19 virus and antibody testing, and our COVID-19 convalescent plasma treatment program.
We revamped our organization’s internal news website to categorize coronavirus-related information for easy scanning and viewing. As we closed entrances, modified visitation policies, and established requirements for face coverings and social distancing, we shared our guidelines—and the rationale behind these decisions—internally and externally.
Our experts in hospital epidemiology, transfusion medicine, infectious diseases, virology, internal medicine, and other specialties have fielded requests from multiple news media outlets, including national news organizations. Our chief medical officer has cleared time on her schedule to participate in weekly news briefings with county emergency management officials and answer COVID-19 questions from the public via Facebook Live. Similarly, two of our Spanish-speaking faculty have participated in Facebook Q&A sessions developed specifically for the Latinx population.
Internally, we’ve distributed weekly video messages to thank our employees for their commitment and service. We also have livestreamed two Q&A forums on COVID-19 each week—one related to patient care, and one focused on our research enterprise and medical education efforts. I’ve had the opportunity to lead the Carver College of Medicine forum, and it’s been gratifying to see the level of interest from our employees, based on the questions and comments submitted before and during the sessions. For the collegiate forums, we’ve included guest panelists who cover topics such as pediatric care and COVID-19 and the impact of our hospitalist-led Home Treatment Team, which monitors COVID-19 patients who are recovering at home.
While we don’t always have immediate answers, our employees seem to appreciate the opportunity to hear from and engage with leadership on a more regular basis. This was especially clear when we held a series of town hall sessions in late May to outline the financial implications of COVID-19 on UI Health Care. Sharing “bad” news is never easy, but admitting that we are working through problems—and promising to share more details as they become available—is better than waiting for all the answers before saying anything.
In times like these, when difficult questions and mounting challenges are a matter of course, ongoing communication is not just prudent. It’s necessary as we continue to care for COVID-19 patients while reassuring non-COVID patients that we can continue to provide a safe environment for their routine and emergent medical care, including those treatments and procedures that were postponed.
Two things I have learned over the past several months: First, collaboration truly is a hallmark of this university and our academic health system. I continue to be impressed by our people, who remain willing and eager to find solutions and get things done.
Second, strategic communication will guide many of our initiatives moving forward. This is not to say that we failed to communicate with our staff and the public before COVID-19, but the pandemic has underscored the importance of clarity and consistency. The first message people hear tends to be the message most believed, so slowing the rumor mill often means countering first perceptions. There’s room for improvement in any health care organization, but those that embrace traditional and non-traditional channels to reach employees, patients, and families will fare better in maintaining the public’s trust in a post-COVID-19 world.
Hard Cap on Noneconomic Damages
The most disappointing outcome of the 2020 session was the failure of the Iowa House to pass a hard cap on noneconomic damages. In 2017, House Republicans failed to garner sufficient votes to pass a hard cap as part of the broader tort reform package that was enacted this year. Heading into this session, we knew that the House would again be the linchpin to passage of this reform, which is absolutely critical to turning the tide on the recent string of high-dollar judgements against Iowa physicians and facilities.
IMS invested nearly $250,000 in this fight – bringing on additional contract staff dedicated solely to this work, dramatically expanding our physician engagement efforts across the state and in targeted House districts, and implementing new communications tools and outreach techniques to allow for rapid engagement at critical times in the legislative process. Despite these extensive efforts and the largest coordinated lobbying campaign in IMS history, we were unable to win over the last few House Republican holdouts who were unwilling to support a hard cap at any level.
IMS remains committed to passage of a hard cap on noneconomic damages. It is now apparent that the only path to passage of this reform is for the House Republicans to increase their majority to the point that those holdout members’ votes can be overcome by the larger legislative caucus. To help support this, the Iowa Medical Political Action Committee (IMPAC) is relaunching the $100,000 Tort Reform Challenge and committing the remainder of 2020 to raising the resources necessary to help make this happen. Watch for additional updates from IMS on how you can help.
COVID-19 Liability Protections
The COVID-19 pandemic challenged Iowa’s healthcare system in ways many never expected possible. The wholesale collapse of the traditional medical supply chain and the sheer number of unknowns surrounding the novel coronavirus SARS-CoV-2, forced practices to improvise and adapt to the evolving situation. While these actions were absolutely critical to ensuring our healthcare system did not collapse, they also resulted in a number of liability exposure concerns.
During the legislative shutdown, IMS worked with the Governor’s Office and the Iowa Department of Public Health to enact a series of short-term blanket liability protections to help. When the pandemic forced the suspension of elective and non-urgent medical procedures, we secured protections against future litigation as a result of delayed care. When these statewide bans were partially lifted, we secured another set of blanket protections to allow practices to reopen and resume services, as their local circumstances warranted, without risking future litigation as a result of doing so.
As additional situations and liability concerns continued to come to light, it became apparent that the only way to truly protect Iowa physicians would be legislative action to enact blanket liability protections for all medical decisions made during the pandemic. Working with legislative leadership, we successfully passed language to codify the protections from the emergency orders and expand it to include all medical actions, except those that constitute intentional harm. A summary of these protections, which are retroactive to January 1, 2020, and extend for the duration of the COVID-19, is available on the IMS website. These short-term protections will be absolutely critical to helping protect Iowa practices as they work to rebuild.
The Iowa Medical Society is a 501(c)6 non-profit organization. 515 E Locust St. Ste. 400 50309