It was an extremely busy week at the capitol as IMS’s top legislative priority – tort reform – was introduced and began moving through the House. Hundreds of physician, resident, and medical student advocates from across the state participated in Physician Week on the Hill and made their voice heard in the tort reform fight. We also saw our first IMS legislative priority make its way to the Governor’s desk for signature.
After months of behind-the-scenes and grassroots activity, our tort reform efforts entered a new chapter this week. On Monday, the House introduced HF 517, which will enact a $1 million hard cap on noneconomic damages. On Tuesday, a House subcommittee met to consider the legislation. IMS Board members Jessica Zuzga-Reed, DO, and Christi Taylor, MD, were joined by physician and administrative leaders from multiple systems, facilities, and clinics speaking in support of the bill that passed the subcommittee on a party-line 2-1 vote. On Thursday, the House Human Resources Committee took up and passed HF 517 also on a party-line vote. The bill now moves to the full House for consideration.
It is absolutely imperative that House members are hearing from their local physicians about the need for this legislation. If you haven’t already, please take a minute to contact your State Representative via the IMS Action Center to add your voice to the tort reform fight.
On Tuesday, the House took up and overwhelmingly passed SF 129 – a joint workforce priority of IMS and the Iowa Psychiatric Society to do the following:
Tuesday’s House vote marked final passage for this workforce priority, which is now on its way to the governor’s desk for signature.
We saw further efforts to erode Iowa’s strong vaccine policies this week with a lengthy Senate subcommittee hearing on SF 193 – the anti-vaccine omnibus bill – on Tuesday afternoon. This expansive legislation would do the following:
Tuesday’s subcommittee hearing, which stretched to nearly two hours, covered a host of topics from debunked theories about purported links to autism and SIDs, to the safety concerns about the new COVID-19 vaccines. Anti-vaccine advocates shared stories of difficulty finding care for their unvaccinated children and employment challenges after they themselves refused to get vaccinated and attempted to continue to work in healthcare settings.
IMS joined several provider, public health, and business advocates in testifying against the legislation, noting the numerous concerning implications of advancing this measure. Subcommittee members were split on the proposal with the bill ultimately advancing to full committee on a vote of 2-1.
After weeks of behind-the-scenes work, our tort reform efforts take center stage next week as Physician Week on the Hill kicks off a week of coordinated advocacy in support of a hard cap on noneconomic damages. If you haven’t already, register to join our live advocacy briefing and legislative address on Tuesday over the noon hour. This week saw action on several issues of interest:
IMS efforts to address physician workforce saw further progress this week as the House Human Resources unanimously passed SF 129 on Tuesday. This bill – a joint priority of IMS and the Iowa Psychiatric Society – will expand the Rural Physician Loan Repayment program to include OB/GYNs, to establish true geographic standards for qualifying rural communities, and to allow psychiatrists who practice in federally-designated mental health shortage areas to also qualify for loan repayment. The bill also allows new physicians to enter into part-time practice arrangements in exchange for a longer service commitment and still qualify for the maximum $200,000 in loan repayment under the program.
This same bill unanimously passed the Senate and a House subcommittee last year, before the 11 week COVID-19 shutdown of session halted its progress. This year’s bill is now eligible for consideration by the full House where it is expected to easily pass and make its way to the Governor’s desk for signature in the next few weeks.
This week saw further movement on efforts to advance anti-vaccine legislation at the capitol. On Tuesday, the Senate Human Resources Committee took up and passed on a party-line vote SF 125 to require the listing of infant vaccination records on medical examiner forms. This legislation creates a pathway for anti-vaccine advocates to obtain death records that will allow them to identify families who lost a young child. In other states where this measure has been enacted, the advocates then target these grieving families to spread misinformation about a purported link between immunizations and SIDS, and try to recruit families to publicly use their child’s death as an example of the dangers of vaccines.
IMS is working with AAP-IA and the Iowa Immunizes Coalition to oppose this legislation, which is now eligible for consideration by the full chamber. In the coming weeks, IMS and AAP-IA will be coordinating to present a webinar to educate legislators on the child death review process and how this legislation has been utilized to undermine vaccine confidence around the country.
On Thursday, the House Human Resources Committee discussed multiple bills to expand scope of practice for non-physician providers.
Among these was HSB 71, which would allow dentists to administer the COVID-19 and flu vaccines to patients of any age. As we told you a few weeks ago, this legislation is being brought forward by the Iowa Dental Board who argue that it will expand the number of eligible COVID-19 vaccine administrators and as a result speed the rollout of the vaccine. This is despite the Department of Public Health reporting that Iowa has a sufficient number of approved administrators and it is a lack of vaccine supply, not providers, that is the cause for the slow rollout.
IMS has had a number of conversations with legislators in recent weeks to educate them about the vaccine rollout process. We have also explained how critical is it to ensure that any provider of the COVID-19 vaccine be well-versed in utilizing the IRIS system to ensure that every dose of Iowa’s limited supply is accurately tracked and reported so as to not negatively impact our weekly statewide allocation from the federal government. Despite these concerns, the overriding belief that we will eventually get to the point where Iowa does not have a sufficient supply of providers to administer the COVID-19 vaccine in a timely manner, has motivated legislators to support the bill. HSB 71 passed out of committee nearly unanimously and now moves to the full chamber for consideration. A companion bill in the Senate has not been introduced.
The House Human Resources Committee on Thursday was also scheduled to consider a pair of bills to expand pharmacist scope of practice. HSB 91 would expand the pharmacist statewide protocols to allow pharmacists to administer pediatric immunizations and tobacco cessation products; oversee point-of-care testing and treatment for influenza, strep, and COVID-19; and to enter into a collaborative practice agreement with any practitioner with prescriptive authority, rather than just physicians. HSB 73 would build upon these expansions by allowing pharmacists to delegate any services permissible under the statewide protocols to be administered by pharmacy support staff.
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.
As of Friday, we’re now one month away from the first funnel deadline on March 5 – the date by which most policy bills must have passed a committee in their chamber of origin in order to remain viable for consideration this session. Over the next month, we’ll continue to see extensive committee and subcommittee work ahead of this deadline. This week that included:
In recent years, we have seen a concerning trend at the capitol with the anti-vaccine community becoming much better coordinated under the leadership of an organization known as Informed Choice Iowa (ICI) . With the help of a handful of vocal anti-vaccine legislators, these advocates successful pushed for the introduction of numerous anti-vaccine bills. Despite the ongoing pandemic and the central role that vaccines are going to play in helping end it, this trend has continued this session and taken on an additional focus as anti-vaccine advocates worry they may be required by their employer, their child’s school, or other entities to receive a COVID-19 vaccination. So far this session, we’ve seen the following anti-vaccine bills introduced:
While many of these bills are unlikely to even see a subcommittee hearing this session, the growing number and complexity of the bills is cause for concern. Informed Choice Iowa has begun engaging on additional bills outside of the traditional proposals to simply expand vaccine mandate exemptions and are pursuing less-obvious avenues of increasing vaccine hesitancy in the state.
This week, a Senate subcommittee considered SF 125 to require a listing of infant vaccination history on medical examiner investigation forms for individuals under the age of three. IMS joined public health officials, provider groups, health insurers, and a host of other opposing the bill. Several ICI members – including some who cited their personal education as healthcare personnel – spoke in support of the bill, which passed out of the subcommittee with support from two of the three members. The bill now moves to the full Senate Human Resources Committee where similar legislation passed last session. IMS will continue to work with the Iowa Immunizes Coalition and other vaccine advocates to halt this and any other anti-vaccine legislation that may gain momentum this session.
Last spring, as the state was imposing the first of a growing list of policy flexibilities to confront the COVID-19 pandemic, IMS worked with the Governor’s Office to secure a waiver on continuing education requirements for physicians and other health professions, as well as an extension of license renewal dates, to allow frontline providers to focus on pandemic response efforts. These waivers have subsequently been extended with each Public Health Disaster Emergency Proclamation. Physicians whose licensed expired in 2020 now have until June 30, 2021, to meet their CME requirements and renew their medical license. Physicians whose licenses expired in 2021 currently have until the expiration of the Public Health Disaster Emergency Proclamations to do so.
As the state begins to plan for the end of the pandemic, legislators are looking at ways to ease the winddown of these policy flexibilities, without imposing a substantial immediate burden on those who have been given flexibilities under the proclamations. Last week, a House subcommittee took up and passed HF 133, which provides six months after the expiration of the Public Health Disaster Emergency Proclamations to complete continuing education requirements imposed by professional licensing boards. This week, a Senate subcommittee considered and passed SF 163, which requires professional licensing boards to extend continuing education deadlines for individual licensees who experience a medical or financial hardship. Both bills now move to full committee in their respective chambers with subcommittee members indicating that they may bring forward amendments to further expand the flexibilities for licensees.
On Wednesday, a Senate subcommittee met to consider SSB 1046, which would create a new system for regulating professional licensure, registration, and certification in the State of Iowa. Highlights of the bill, which would impact all professional licenses not just those in healthcare, include:
It was another busy week at the capitol. Subcommittees and committees are working at a more rapid pace than this point in session most years, which also means the first substantive debate by the full chambers also occurred this week. Several issues of interest to the medical committee saw movement:
Our top legislative priority has seen a lot of activity during the first few weeks of session. Again this year, IMS has assembled a large coalition of provider, facility, insurer, and business groups working collectively in support of a hard cap on noneconomic damages. IMS has been meeting with legislative leadership and key members to discuss strategy, and has been coordinating coalition contacts with key undecided House members who will determine whether legislation like the bill that passed the Senate will ultimately see final passage this session. These efforts have been aided by numerous local meetings between target legislators and physicians in their area. These on-the-ground perspectives have been invaluable in helping to inform legislators about the extent of this problem and the local support for action to fix it. If you are interested in becoming move involved in the tort reform fight, please contact Andy Conlin, IMS Grassroots Coordinator, to learn how you can help.
Scope of Practice
This week saw action on several scope of practice proposals, with various provider groups pointing to the ongoing COVID-19 pandemic as the impetus for allowing their profession to provide more medical services.
Pharmacists (HSB 73; HSB 91; HSB 121)
In a trio of subcommittee hearings this week, legislators considered legislation that would impact pharmacist scope of practice. On Tuesday, a subcommittee considered HSB 91, which would amend the statewide protocols statute to allow pharmacists to administer point-of-care testing and treatment for influenza, strep, and COVID-19; administer pediatric immunizations; and enter into collaborative practice agreements with any prescribing profession. Despite objections from the medical community, the bill unanimously passed out of subcommittee and now moves to the House Human Resources Committee for consideration.
Wednesday saw subcommittee action on HSB 121, which allows pharmacists to dispense hormonal birth control pursuant to a statewide standing order under the oversight of the state Medical Director within the Department of Public Health. This proposal, which is being put forward by the governor, limited dispensing to patients over age 18, limits dispensing to no more than a one-year supply, and requires pharmacists to provide patients with information about the importance of receiving an annual exam from a medical provider. The bill unanimously passed out of subcommittee and now moves to the House Human Resources Committee for consideration.
On Thursday, a House subcommittee considered HSB 73, which makes numerous technical changes to pharmacist practices. Of concern to the medical community, the legislation would allow pharmacists to delegate services and medications ordered or administered via the statewide protocols to pharmacy support staff. The bill passed out of subcommittee and now moves to the House Human Resources Committee for consideration.
Dentists (HSB 71)
Also on Tuesday, a House subcommittee took up consideration of HSB 71, allowing dentists to administer the influenza and COVID-19 vaccines to patients of any age. Discussion of the bill largely centered on the COVID-19 vaccine sections, with proponents arguing more providers are necessary to speed vaccine administration across our state. IMS spoke in opposition to the legislation, noting that more than 2,400 provider entities representing thousands of individual providers have already been approved to administer the COVID-19 vaccine. The vast majority of these entities are not yet administering the vaccine due in large part to the limited doses available to the state.
Legislators expressed some reservations about the proposal, but did move the bill out of subcommittee and to the full House Human Resources Committee for consideration. IMS is continuing conversations with the full committee and members of the Senate to work to halt the legislation in its current form.
IMS was approached this week by representatives of the Iowa Podiatric Medical Society (IPMS) to discuss their pending proposal to allow podiatrists to administer all CDC recommended immunizations. IPMS has asked legislators in both chambers to introduce legislation to grant this authority. We have not yet seen the legislative language, but the IPMS representative indicated they had not included any limitations on administration to pediatric, elderly, or high-risk populations. Conversations continue on this newest proposed scope expansion.
Two of the telehealth bills we told you about last week saw movement at the capitol this week. HF 89, which would require commercial insurers to reimburse for behavioral health services at 100% on in-person rates, passed its subcommittee last week and on Tuesday passed the House Human Resources Committee. The bill now moves to the full chamber for consideration.
On Tuesday, a House subcommittee met to consider HF 88, which would permanently recognize audio-only as a permissible form of telehealth in the state of Iowa. The original bill included a requirement that providers of audio-only telehealth services must meet all in-person standards of care. IMS worked with the subcommittee and stakeholders to craft amendment language to replace this requirement with a directive that the individual licensing boards adopt rules to guide licensees in determining clinically appropriate services to provide via audio-only telehealth. The legislation with amendment passed the subcommittee and now moves to the House Human Resources Committee for consideration.
Also last week, we told you that Wellmark has developed a new proposal for a long-term telehealth payment model, which is under consideration by the Committee on Legislation. As those deliberations continue, we want to hear the broader membership’s thoughts on the proposal. Wellmark has shared a summary document with IMS and other stakeholders outlining the framework for this new model, which would begin after the pandemic ends. Under the structure proposed by Wellmark, they would raise their base telehealth payment rates from 50% of in-person rates for physical health services and 75% of in-person rates for behavioral health services, to 70% of in-person care for physical health and 85% of in-person rates for behavioral health services. Providers who meet certain service criteria outlined in the overview document would then qualify for a further increase in payment rates, up to 95% of in-person rates.
As the model advances through the baseline and intermediary phases to the advanced criteria, baseline rates would remain the same but maximum payment rates would drop to 90% of in-person rates and stay at these levels long-term. Among the criteria for the advanced phase of the model is that providers be enrolled in a risk-sharing agreement such as an ACO model with Wellmark. In conversations with Wellmark this week, IMS noted that under this risk-sharing arrangement, providers would already be accepting a reduced global payment as they seek to more comprehensively manage patient utilization. We suggested modifying the maximum payment rate under the final long-term phase to 100% of in-person rates for those practices in a risk-sharing agreement, recognizing that Wellmark’s global spending to these providers is already expected to be reduced as part of that agreement. The Wellmark representatives expressed an openness to discussing this change further with stakeholders.
As we wrap up the second week of session, the legislature has begun to settle into a new rhythm with hybrid virtual and in-person subcommittee and committee meetings beginning to meet frequently to complete their work. Discussions continue behind the scenes on our tort reform efforts and a number of bills of interest to the medical community have begun to move through the legislative process.
This week saw action on IMS priority legislation SSB 1042 and companion bill HSB 92. These bills would expand the popular Rural Physician Loan Repayment Program, which provides up to $200,000 in loan repayment for a physician who agrees to practice in a rural area, and add additional flexibility to program requirements. The legislation would make the following changes:
This joint effort by IMS, the Iowa Academy of Family Physicians, and the Iowa Psychiatric Society, passed out of subcommittee and committee in the Senate this week and is now eligible for consideration by the full Senate. The House companion was introduced this week and is expected to have a subcommittee hearing soon.
This week saw the introduction of a new scope of practice proposal for the state of Iowa. HSB 71, which is being proposed by the Iowa Dental Board (IDB), would allow dentists to administer the influenza and COVID-19 vaccines. Over the summer and fall, proponents for the bill engaged with IMS as they developed this proposal. At IMS’ request, the bill was narrowed to remove dental administration of the HPV vaccine and restrict dentists’ ability to delegate administration to dental support staff.
The IMS Committee on Legislation discussed the proposal at length and recommended further narrowing the bill to remove administration of the COVID-19 vaccine and limit administration of the flu vaccine to not include children or elderly adults. IMS also requested patient notifications if the dentist administering the vaccine does not accept medical insurance, which is the case with the vast majority of community dentists, as this would result in patients having to pay cash for immunizations that are covered at no patient expense under many medical insurance plans. These recommendations were rejected. In conversations with legislators this week, there are a number of concerns with the current proposal, primarily with the authority for dentists to administer the new COVID-19 vaccines. The bill’s future is uncertain.
Several pieces of legislation were introduced this week pertaining to telehealth coverage and payment policy. As the medical community knows well, telehealth utilization has expanded dramatically over the past, in large part due to the easing of coverage restrictions and expansion of commercial payment parity to ensure that telehealth services are reimbursed at the same rate as in-person services. In preparation for the end of many of these temporary measures, likely in the latter half of 2021, policymakers are focused on updating policy and ensuring sustainable payment rates long-term.
Legislation introduced this week included the following:
Following the dramatic increase in telehealth utilization during the first months of the pandemic, Wellmark retained an outside consultant to develop a new telehealth payment model, which they are proposing as a non-legislative alternative to the bills being put forward. Wellmark has also announced that it will extend 100% telehealth payment parity until at least June 30,2021, to ensure full parity during the pandemic. The IMS Committee on Legislation is currently evaluating the details of the long-term Wellmark proposal. Discussions on this proposal and these pieces of legislation will continue in the coming weeks.
On Tuesday evening, Governor Reynolds broke with long-standing tradition and delivered an evening Condition of the State Address, which was carried live across the state. She used her annual address to thank healthcare workers, including IMS President-Elect Tiffani Milless, MD, and Secretary/Treasurer Jessica Zuzga-Reed, MD, who were invited to attend the address as guests of the governor.
The Condition of the State Address and the accompanying release of the governor’s budget recommendations are Governor Reynold’s opportunity to outline her policy and budget priorities for the session. Of interest to the medical community, these included the following:
Governor Reynolds renewed her long-standing support for tort reform efforts, highlighting in her policy priorities the need for passage of a hard cap on noneconomic damages this session. She noted the alarming, ongoing trend of high-dollar malpractice claims and the long-term implications limitless claims will have on the state’s ability to maintain healthcare access. Over the past year, IMS has been working with the Governor’s Office and legislative leadership to expand support for passage of this critical reform this session and partner on educating new members about the need for this reform.
One of the governor’s biggest proposals of the evening was a three-year, $450 million push to expand statewide access to affordable, reliable broadband. The governor noted that despite recent efforts to expand availability, a third of Iowa counties are still classified as broadband deserts and statewide broadband speeds are ranked second slowest in the nation. The COVID-19 pandemic has brought renewed focus to the implications of limited broadband access, including the ability to further expand comprehensive telehealth services across the state. In her address, the governor highlighted last year’s IMS-authored legislation, which established a regulatory framework for the provision of behavioral health services via telehealth in a school-based setting, as just one example of the potential for telehealth to expand access to care.
In her address, the governor applauded how the healthcare system came together to work in a regional manner across systems and clinics responding to the COVID-19 pandemic. In her budget and policy priorities, she proposed utilizing this as a model for rethinking care delivery long-term. The governor is proposing $1 million in FY 2022 to pilot two Health Care Centers of Excellence to test regional care delivery models with the goal of better integrating care delivery, especially for rural communities. The two communities to host these centers would be required to match the state’s $500,000 grants and include in their proposals a five-year sustainability plan. Additional details on this proposal are expected to be released soon.
Governor Reynolds is also proposing increased funding for the state’s mental health systems as a priority focus this session. The state continues to move forward with the Complex Needs behavioral health reforms and the establishment of a Children’s Mental Health System, which were enacted by the legislature in 2018 and 2019 respectively. The governor is proposing to build upon the $40 million in CARES Act funding she allocated to support these reforms and this new system in the current fiscal year, with an additional $15 million in new state funding in FY 2022 and an additional $15 million in new state funding in FY 2023.
The governor is also proposing to increase funding for the state’s medical residency grant program as part of statewide efforts to address physician workforce needs. She’s proposing an additional $200,000 for the Psychiatry Residency Training Program, which would fund additional residency slots and bring the annual funding for this program to $600,000. The governor is also proposing a status quo $1.4 million appropriation for the Rural Physician Loan Repayment Program in each of the next two fiscal years. IMS is working with the Iowa Psychiatric Society and the Iowa Academy of Family Physicians to push for increased funding for this popular program, which provides up to $200,000 in loan repayment to new physicians who agree in a rural area for five years following the completion of their residency.
The Governor’s FY 22-23 budget book and a summary of her 2021 policy priorities is available online. A summary of the Governor's health care policy priorities is available here.
While attempts to pass a hard cap during the 2020 Legislative Session were unsuccessful, IMS has not stopped working toward that goal. Over the past year, we have continued to educate legislators, successfully pushed to expand the pro-tort reform majority in the Iowa House, collected new data and additional examples of the implications of the current liability climate, and activated additional local physicians to contact targeted legislators. Behind the scenes, IMS has been brought on additional staff to support our efforts and developed detailed plans to maximize our chances for success in this uphill legislative battle. IMS has further grown the coalition of advocacy organizations who will be joining our efforts this session and developed extensive resources to equip physicians to advocate on this issue. IMS is all in on tort reform in 2021.
Hundreds of physicians have advocated for tort reform over the past year and reengaged in the lead up to the 2021 Legislative Session. We continue to hear questions about how an individual physician can help. There are so many ways to get involved, but where to start? This checklist is your one-stop resource to prepare to make your voice heard this legislative session and there are several steps you can take RIGHT NOW to do so.
Once you’ve prepared yourself for the tort reform fight, we need your help to recruit others. Iowa physicians have fought for more than 40 years to pass a hard cap on noneconomic damages. This session, we are closer than ever to finally achieving this goal, but the path is not easy and success is far from certain. We need your help to educate your peers about this problem and recruit more physicians, residents, and medical students to joint the fight that impacts us all.
This week, hundreds of providers across the state received their first doses of the new Pfizer-BioNTech COVID-19 vaccine. With thousands of additional doses now arriving weekly and the Moderna vaccine candidate likely receiving FDA approval within days, attention is now increasingly turning to those who have expressed reluctance to receiving the new vaccines. Recent national polling shows a steady increase in the number of individuals willing to receive a COVID-19 vaccine, but vaccine hesitancy both among general public and some provider groups remains at alarming levels. More must be done to ensure Iowans feel confident receiving a vaccine when it becomes available to them. This week, IMS is rolling out a new campaign intended to help build confidence in the new vaccines.
Physicians on the Frontlines
These efforts begin with you! IMS is compiling photos of Iowa physicians who are stepping up to receive their COVID-19 vaccines. These photos will be shared on social media and on the Physicians on the Frontlines website to spotlight local physicians who trust the safety and efficacy of the new vaccines. By showcasing physicians who patients know and trust, we can help to dispel myths about the vaccine and concerns that the development process was rushed. Please snap a quick photo as you receive your COVID-19 vaccination and submit it to IMS. We’ll make sure to share your photos statewide and showcase your leadership in helping to bring an end to the pandemic.
COVID-19 Vaccine Resources
Iowa Medicine article published: 10-1-2020
Brian Privett, MD, IMS President
“We need more physicians to say yes when asked to be involved (in organized medicine) and to follow through with that commitment.” This was the parting advice of my program director, Tom Oetting, MD, at the end of my residency at the University of Iowa. I took the advice to heart. After my first year in practice, I was asked to serve as the president of the Iowa Academy of Ophthalmology (IAO), and I said yes.
During my time on the IAO Board, we worked with the Iowa Department of Public Health to institute a vision screening program in Iowa for children and worked to prevent the practice of surgery by non-surgeons. It was during this time that I was introduced to the Iowa Medical Society and the work they do for all physicians in Iowa.
Ophthalmology is a relatively small specialty. When our specialty’s concerns are amplified by the state medical society, our voice is much stronger. This is the basic principle of organized medicine. Individual physicians’ voices and ability to create change are amplified when we speak with a unified voice. One of my partners, Steve Jacobs, MD, was an IMS board member. When his term was up in 2013, he encouraged me to run for the board, and I said yes. My time on the IMS Board of Directors has been and always will be a highlight of my career. Over the past seven years, IMS has achieved a lot. We helped make incremental improvements to Medicaid and have been a sounding board between physicians and the state on the multiple problems with the managed care organizations.
We continue to pass temporary fixes to the unfair Geographic Practice Cost Index which punishes physicians in rural states like Iowa and, left unchecked, would result in more than $20 million in Medicare rate cuts to Iowa physicians each year. We passed CANDOR legislation which continues to improve the malpractice environment in Iowa along with a certificate of merit to cut down on frivolous lawsuits.
Working with our psychiatry partners, we helped pass and strengthen two mental health reform bills – first for adult patients with complex needs and then to establish the first-ever comprehensive Children’s Mental Health System in Iowa. In conjunction with our family medicine partners, we helped establish and fund the Rural Physician Loan Repayment Program to recruit more physicians to rural communities. IMS secured passage of telehealth payment and coverage parity for Medicaid, and telehealth coverage parity for commercial carriers to help facilitate greater expansion of these critical new tools in care delivery. We also continue to push back on the ever-increasing number of scope of practice expansions put forward each year. Recently, we have retooled our resources to help practices with COVID-19 and pass physician concerns regarding COVID-19 on to state and federal officials.
I was asked to attend AMA meetings as a representative of IMS, and I said yes. I have experienced the power of this organization speaking for the entire country. One recent example of how organized medicine made a difference was regarding the closure of Hahnemann University Hospital in Philadelphia which was the primary teaching hospital for Drexel University. This left 571 residents and fellows stranded without a job and without medical liability tail coverage.
The AMA stepped in and provided the legal services to broker a $9.3 million-dollar settlement for long-tail insurance for 1,500 residents, fellows, and alumni. The state and county medical society also helped place residents and fellows in difference programs across the state. Because Hahnemann was a corporate entity, this type of advocacy for these displaced trainees would have not been possible without the support of organized medicine.
I was nominated to run for the IMS Executive Committee and serve as the 171st IMS President, and I said yes. Sometimes people have asked me why I got involved in organized medicine so early in my career and my answer is, “how could I not?”. Too many decisions at the state and federal level affect how we practice and how we provide for our patients. If physicians’ voices are not heard, others will make these decisions for us. If anything, younger physicians and students should advocate more for themselves as the decisions that are made now will have a greater impact on their career than a physician who is closer to retirement.
The IMS Board has been an extremely welcoming group for me despite my younger age and we encourage younger physicians to speak up and be involved early in your career. I can attest that your life only gets busier if you have a family and raise kids. There is no better time to become involved than the present.
A side benefit of being involved in organized medicine has been the relationships I have made over the years. Working with my specialty society, I was able to meet a number of my ophthalmology colleagues across the state. As a person new to Iowa, my wife and I have made many friendships through our involvement with the Linn County Medical Society. We have also made many lifelong friends through my involvement on the IMS Board. These friendships outside of my practice are extremely valuable and well worth the time I have given up in my practice.
I believe saying yes also helps with physician burnout. Many of our IMS members have taken part in our burnout programming across the state and found them to be useful. One way to combat burnout is to become involved in organized medicine. One reason physicians experience burnout is that we have all these expectations about what a career in medicine should be, but in our daily practice these expectations are not met.
By advocating for yourself and your patients, you can help take back control of your practice, or at least make your voice heard. There is healing in knowing you did everything in your power to help your patients, your colleagues, your care team, and yourself. It is also helpful to learn that many of the burdens and frustrations you have in practice are shared by many of your colleagues.
No matter what career stage you are in, I encourage you to advocate for your patients and your profession. I hope when you are asked to participate in organized medicine, you will say yes.
The Iowa Medical Society is a 501(c)6 non-profit organization. 515 E Locust St. Ste. 400 50309