Iowa Medicine article published: 10-1-2020
Michelle Dekker, CAE, CMP, Director of Membership & Strategic Alliances at IMS
For the Iowa Medical Society, the last quarter of the year is when we begin our process for renewing group and individuals dues for the following year. Earlier this year, the Iowa Medical Society upgraded its membership database platform, giving a new look and usability to the IMS website. As a result, we are excited to offer a few different options for dues renewals this year, allowing you to chose what works best for you.
OPTION 1: Annual Dues
Like we have in the past, IMS will offer the option to pay dues at one time for the following year. We will provide this through online availability and via mailed dues statements, beginning to arrive in November. A new, exciting feature we can now offer is automatic renewal annually. If you would prefer to enter your payment for 2021 and then have it continually renew for the following years on January 1, this option is for you!
OPTION 2: Monthly Dues
The new monthly dues options allows members to pay for dues on a month-to-month basis. This is an automatic renewal that will charge to your credit card and can be set up online.
OPTION 3: Group Membership
Did you know that any group of two or more can receive discounts on membership dues when all your physicians are members of IMS? If you are interested in group membership, please contact firstname.lastname@example.org.
IMS members and potential members will begin receiving information about the 2021 dues campaign soon. To make sure you are receiving the latest information from IMS, be sure to:
1.) Sign into your account at iowamedical.org.
If you are logging in for the first time, you’ll need to reset your password by hitting the “forgot password” button. You will then receive a link to log in. Be sure to check your spam/junk folder if you aren’t seeing the email. If you have questions or need assistance, please contact Cody Campbell on IMS Staff to assist you: email@example.com.
2.) Update your contact information so we can get the most up to date information to you!
Once you are logged in, click on your name in the upper right hand corner.
Then click the “edit profile” button.
THANK YOU FOR YOUR MEMBERSHIP IN IMS!
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.
Iowa physicians are on the forefront of our state’s response to the COVID-19 pandemic. It is incredibly disappointing to see comments attributed to Senator Ernst implying that the Iowa medical community is doing anything other than continuing to uphold its long track record of providing the highest quality of care and rising to the evolving challenges of the pandemic with the greatest of integrity.
The Iowa Medical Society stands firmly behind Iowa physicians and clinicians. We will continue to ensure the concerns of our healthcare community are at the forefront as we work to educate policymakers. Now is not the time to spread mistruths and distrust. We must work together to keep Iowans safe and healthy.
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.
This week, IMS efforts to streamline the Medicaid managed care system took another step forward with implementation of a set of universal prior authorization applications that can be utilized for both MCOs and the fee-for-service program. The result of a 2019 IMS-authored legislative directive, these universal forms are intended to address an aspect of the administrative burden many practices have reported since the state transitioned to managed care.
The state is taking a phased implementation approach to allow practices time to transition to the universal applications. Until October 1, practices may continue to utilize the MCO-specific applications; they may also begin utilizing the new universal application forms. After October 1, practices must have transitioned to the new universal forms for all Medicaid prior authorizations.
More information on the new forms is included in a new Informational Letter which was released this week. IMS continues to work on additional steps to address issues within the Medicaid managed care system. For individual assistance with Medicaid issues or more information on these efforts, please contact Dennis Tibben with the IMS Center for Physician Advocacy.
In 2017, IMS pursued a package of medical liability reforms, which included strengthened expert witness standards, a Certificate of Merit requirement in all cases, expanded CANDOR early disclosure protections, and a hard cap on noneconomic damages. Republicans controlled both chambers of the legislature and the Governor’s Office for the first time in nearly 30 years so traditional tort reform was politically viable. The bill easily cleared the Senate and then it went to the Iowa House where Republicans held a 57-seat majority. After months of work and tireless efforts of House leadership, we were unable to persuade a handful of holdout members to support the hard cap. The bill passed, but the hard cap became a soft cap, which only protects against frivolous lawsuits.
In the three years that followed, trial attorneys employed a host of new techniques to exploit Iowa’s soft cap – playing to juries’ emotions and driving up judgements to force higher settlements from practices and providers. Unfortunately, these tactics work. In just five cases, juries awarded a record $85 million in damages, with 75% of these awards coming in the form of noneconomic damage awards.
IMS entered the session committed to stemming the tide of high-dollar awards. Armed with the facts of these recent cases and supported by additional contract staff working exclusively on tort reform efforts, we got to work. IMS assembled a coalition of more than 30 organizations, represented by more than 50 lobbyists – the largest, most extensive advocacy coalition in our organization’s history. Our coalition divided the House Republican caucus to ensure a rotating cast of lobbyists was speaking with individual members each week to keep the pressure up for passage of the hard cap. Outside the building, our staff crisscrossed the state to educate local physicians on the issue and get them signed up to help with the fight. Our Grassroots Coordinator lined up local physicians in targeted House districts to engage those key House votes in a discussion of the importance of a hard cap to their local community. House Republicans now hold a 53-seat majority so the margin for error was razor thin.
After the Senate passed the hard cap 30-20, with two Republicans joining the Democrats to vote against the bill, our final hurdle to passage was the House. When the original House bill failed to make it out of the Judiciary Committee, we worked with House Leadership to get the Senate bill assigned to a more favorable committee – House Commerce. Then COVID-19 forced an eleven-week suspension of session. During this time, we continued conversations with legislators and near the end of the suspension we asked local physicians to again reach out to their local House targets to confirm whether they continued to continued to have reservations about the hard cap. Local physicians confirmed what House leadership later would – at least five House Republicans were still firmly opposed to a hard cap and a handful of others refused to take a position on the issue. Shortly after session resumed, House Leadership informed our coalition that they did not have the votes to pass a hard cap and the language would be stripped from the legislation.
Frequently Asked Questions About Tort Reform
Is tort reform dead?
A hard cap will not become law this year, but the effort is not dead. With House Republicans only holding a narrow margin, a handful of them can derail tort reform efforts. The only viable path to passage of a hard cap now is to elect more people who support tort reform to the Iowa House to overcome the handful of House Republicans who oppose this reform. This will take financial resources. IMPAC has relaunched the $100,000 Tort Reform Challenge to raise money for political contributions to pro-tort reform legislative candidates. 100% of funds raised through this campaign with be used for direct candidate contributions in support of tort reform.
What about passing tort reform with Democratic votes?
Tort reform, and specifically a hard cap on noneconomic damages, has been a highly partisan issue for many years. During the years that Democrats controlled legislative chambers or the Governor’s Office, IMS tried to convince them of the merits of these reforms, which still maintain a means for just compensation of patients with a legitimate injury. The Democrats consistently rejected these arguments and refused to support a hard cap. We saw in 2017 and again this session that when given the chance to vote for a hard cap, not a single Democrat cast their vote for the legislation and in fact some Republicans didn’t even vote for the bill. The most realistic path to passage of a hard cap is with Republican votes.
Was the 2020 effort a waste of time and money given the political dynamics of the House?
Not at all. In 2017, many argued that a hard cap was a solution in search of a problem. Iowa has a long history of reasonable jury awards. IMS felt it best to pursue a hard cap before the liability climate became a problem, but legislators disagreed. Unfortunately, we no longer have that track record of reasonable jury awards. Given the recent spike in high-dollar jury awards and the new tactics being employed by trial attorneys, there is a clear trend threatening medical practice in our state. These new facts necessitated revisiting the issue with legislators and in fact, many who had expressed reservations in 2017 acknowledged this session that it has become a problem. The House Republican caucus also had 14 new members this year who were not there in 2017. This provided an opportunity to educate new legislators and the issue too important to not pursue.
Is IMS still committed to tort reform?
Absolutely. As we’ve mentioned, we know of several additional high-dollar suits that are working their way through the legal system. The trial attorney behind several of the recent high-dollar suits has also begun teaching continuing education courses to share his questionable techniques with his peers. We expect to see more high-dollar judgements and greater pressure to reach a high-dollar settlement to avoid a costlier jury decision. This is unacceptable and unsustainable. IMS is committed to pursuing every avenue to passing a hard cap on noneconomic damages. Right now, that requires a political focus to prepare for the elections this fall.
Does giving money to political campaigns really matter?
Yes. Like it or not, politics impact the practice of medicine and money drives politics. Political campaigns require funds to pay for polling, yard signs, campaign literature, and get out the vote efforts. The Iowa Medical Political Action Committee (IMPAC) provides financial support to political candidates who are supportive of pro-medicine issues. This year, our focus is exclusively on supporting candidates who support a hard cap on noneconomic damages. Here in Iowa, political contributions to candidates must come from individuals. IMPAC bundles individual contributions from Iowa physicians to have a more substantial impact on political campaigns.
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