Concerns

AOMA's President Jan D. Zieren, D.O., MPH, FACOFP, dist. updates the AOMA membership on her president's message from her inauguration (see original text here).

We continue to sail through the Healthcare waters having just entered the Sea of Concerns.  Certainly there is plenty to be concerned about – our physicians (licensing, certification, viable practices, retirement options); our patients (jobs, finances, insurance, health or illness); our profession (training sites, numbers, profession choices, residencies); our state and national healthcare situations.

Physicians are stressing with so many current changes and those looming on the horizon. The direction of certification is toward “continuous” in which cycles of training and testing over several years involving different disease categories instead of a crash course and testing over all the topics once every so many years.  The question is “will licensing pick up on this and utilize the continuous certification as a maintenance of licensure criterion?”  How many physicians have viable practices or have needed to become employees of a large group?  Are physicians able to become a Medical Home and provide complete care to their patients? What percentages of physicians or groups are now utilizing electronic medical records? How many physicians have retired from these stressors or changes in practice style?

Patients are not finding this any easier either.  Insurance costs are usually very high or the deductible is instead.  Seniors are often viciously hunting for the “best deal” with meds included if possible.  Some patients have lost their jobs, thus their access to health care insurance, or worse, enough income to pay for the home and/or car.  There are amazing patients working two or three jobs, or also attending college and yet find time for eating and sleeping.  And the decisions they must make… to see their physician or hit the urgent care/emergency room for a problem – whether great or small – depending on the availability of the physician in the office or their financial/insurance situation.

AOMA has committees and staff addressing the profession’s concerns for our members.  Addressing scope of practice issues; providing CME opportunities; lobbying for issues at the legislature; representing our organization in community interests such as Arizona Health-e connection, Health Services Advisory Group and Medicare’s Quality Improvement Organization.

As if just running a practice were not enough – these concerns have impacted so much and so many.  Give the office or your Delegates to AOMA any input or information to assist us through this journey.

Note: You can find your district and Delegates by visiting the House of Delegates page on the AOMA website.

Crisis

AOMA's President Jan D. Zieren, D.O., MPH, FACOFP, dist. updates the AOMA membership on her president's message from her inauguration (see original text here).


As promised, the USS AOMA is afloat and sailing the seven Cs.  The first sea we are crossing is CRISIS.  The Chinese pictograph for crisis is made up of two characters, one standing for opportunity, the other for danger. There are often two sides to the issues and concerns of this healthcare crisis.  Many see the “danger” in what appears to be coming down the path.  Others are optimistically seeing opportunities to what may be.  Both sides are aware of the challenges in sailing through reform ahead.

The physician-patient relationship is such a key to quality healthcare.  With the significant potential of newly insured patients there will be a need for more primary care providers, the logical entry point to the system. Several years of discussion, planning and encouragement to implement Medical Home status by primary care physicians stemmed from this very premise.  Health plans appreciate that physicians are a key to the care of their members and send alerts and clinical insights to the physicians to assist in keeping tabs on their members (the physicians’ patients).  Now physicians and health plans as well as facilities are building up accountable care organizations with hopes of improving care, saving money and providing useful information to the physicians.

Preserving the physician-patient relationship seems tantamount to other components of this reform storm.  With a projected serious increase in numbers of insured members in America, how much of a shortage of physicians will there be?  If we wish to continue the idea of physicians and patients in a relationship for health care, the potential need could escalate to over 45,000 more physicians needed in 2014!  There are physicians who may choose to retire early. One estimate found suggested 33% of physicians practicing today will retire over the next 10 years.  Most students are not choosing primary care specialties for their residency training.  Some practice trends have physicians working part time, opening medical spas, shifting into administration or even limiting themselves to VIP practices – all of which further reduce access to primary care for patients.

Health plans have been primarily concerned with corporations and businesses to supply programs to members.  A much lesser percentage of individuals have sought personal care packages from the health plans.  Will that ratio change dramatically with reform?  What impact could that have on this “quality” of physician-patient relationships?

Legislation to raise the debt ceiling and cut deficits most certainly will crunch into Medicare reimbursements for physicians.  Physicians are demanding a permanent fix to the SGR and it was left out of the deal.  If there are already physicians dropping as Medicare providers and future serious SGR cuts loom, how many more will have tough decisions as to whether they will continue providing for Medicare patients.  This would reduce access for Medicare patients to physicians and at a time of projected Baby Boomer influx to Medicare.

The officers of the USS AOMA continue to serve and maintain watch on the winds of the reform storm and are available for questions, conversation and informative updates.  We will hit the port of Tucson November 12-13, 2011 for the Fall Seminar.  Come aboard!

Unprofessional Conduct?

So, there are protests in many states and "physicians" are out giving "doctor's notes" to excuse the protesters from work. My personal opinion is that this is unethical behavior that reflects poorly on all physicians, not simply on those participating. The people don't have a doctor-patient relationship, there are inadequate or no medical records, it does not appear that histories and physicals are being completed - this is quite simply fraudulent. It calls into question all encounters that these "physicians" have especially when related to issues such as worker's compensation, disability, insurance claims, etc. If they are willing to lie in one instance to support their political beliefs then it is not a leap to believe they would help out "the little guy" against the "wealthy corporations" when they request time off work for an "injury" or "disability" that may or may not be there. They are calling the medical ethics of the entire profession into question. From the perspective of one who takes these issues very seriously, I find this to be unethical activity and unprofessional conduct and I think our medical boards should discipline the offenders as such. Let me know what you think!

D.O. Day Successful

We had a successful day at the legislature on Tuesday, February 15. Twenty osteopathic physicians, 27 osteopathic medical students, and two supporters of the D.O. profession gathered at the State Capitol for an exciting day of legislative visits (31 in all) and networking with fellow physicians and our elected representatives. We shared information about health information exchange and offered our health expertise to the legislators should they have questions in the future. We made personal connections that should be meaningful. Dr. Jim Dearing served as "Doctor of the Day." Senator Bartos, chair of the Senate Health Committee, took time out of her day to address attendees and answer questions. We also met with Beth Kohler Lazar, the Governor's Deputy Director for Health Policy, in the Governor's tower. She spoke with us about AZ's plans during the emerging changes in health care and also had a question and answer session with participants. as usual, our wonderful AOMA staff put together a fantastic event.

Remember that being involved in the legislative process gives osteopathic physicians a seat at the health policy table.

Obama's 2012 Budget Would Create $62 Billion in Medicare Savings

On Monday, President Obama released a $3.7 trillion budget proposal for 2012 that includes changes in health care spending, Politico reports.

The administration estimates that the proposal would reduce the federal deficit by $1.1 trillion over the next 10 years.

It also would create $62 billion in Medicare savings over 10 years (Rogers, Politico, 2/14). The Hill's "Healthwatch" reports that the savings would result from tighter restrictions on Medicare and Medicaid payments and expanded use of generic drugs in federal health programs.

The savings would be used to delay for two years a scheduled 25% cut to Medicare's physician reimbursement rate -- called for by the sustainable growth rate formula -- according to the proposal (Pecquet, "Healthwatch," The Hill, 2/13).

OSTEOPATHIC PHYSICIANS FOCUSED ON SOLVING FAMILY PHYSICIAN SHORTAGE

Doctors Kelli Ward & Jan Zieren work on solving challenge Universal coverage and multiple initiatives to improve health care delivery currently do not address the primary care workforce crisis

PHOENIX— Resolving America’s primary care physician shortage will require multiple solutions that boost programs to help medical students repay their education debt, narrow the payment gap between primary care physicians and subspecialists, change medical school admissions procedures and ensure the survival of primary care training programs. Universal coverage and multiple initiatives to improve health care delivery are crucial components of health care reform. However, addressing the primary care workforce crisis for the underserved is the missing link. According to Osteopathic Physicians Jan Zieren, D.O. and Kelli Ward, D.O., this vital issue can be resolved by creating primary care teaching health centers in an established patient-centered medical home practice environment. Residents would receive their final year of training in these centers, and then have the incentive of National Health Service Corps debt repayment if they subsequently practice in an underserved area. Doctors Ward and Zieren, members of the Arizona Osteopathic Medical Association (AOMA), have collaborated on possible solutions to this challenge and are available for interviews. For additional media information, to set interviews, etc., please contact Carole V. Bartholomeaux, Publicist, 602 404 8018 or Carole@b-pr.com.

“With the first of the baby boomers turning 65 this year the need for primary care physicians will continue to grow the next 18 years. That is why it is so vital to rebuild the ‘infrastructure’ of primary care health providers now,” Dr. Zieren stated. “At least 65 million people in the United States today reside in areas with a shortage of primary care health professionals.”

“A progressively decreasing number of doctors provide primary care for uninsured patients, as well as those on Medicare, Medicaid, and the Children's Health Insurance Plan,” Dr. Ward added. “This has further exacerbated limited access and often leads to more frequent, less effective, and more expensive care in emergency rooms.”

Solutions discussed by Doctors Ward and Zieren could:

• Create more opportunities for students and young physicians to trade debt for service, through effective programs such as the National Health Service Corps.
• Reduce or resolve disparities in physician income.
• Admit a greater proportion of students to medical school who are more likely to choose primary care, rural practice, and care of the underserved.
• Study the degree to which educational debt prevents middle class and poor students from applying to medical school and potential policies to reduce such barriers.
• Substantially shift training of medical students and residents to community, rural and underserved settings.
• Support primary care departments and residency programs and their roles in teaching and mentoring trainees.

A Fellow of the American College of Osteopathic Family Physicians (ACOFP), Kelli M. Ward, DO, MPH, FACOFP is a board-certified family physician. She serves as the Director of Medical Education at Kingman Regional Medical Center in Kingman, AZ, while maintaining a private practice in Lake Havasu City, AZ. She is a faculty member of Midwestern University/Arizona College of Osteopathic Medicine in Glendale and AT Still-SOMA in Mesa. Honored for her work, Dr. Ward was named Young Family Physician of the Year in 2008 by the ACOFP and Physician of the Year in 2007 by the AOMA. She currently serves as president of the AZ Osteopathic Association and as a member of the AZ Regulatory Board of Physicians Assistants.

Jan D. Zieren, DO, MPH, FACOFP was elected president of the ACOFP for 2009-2010 beginning with the March 2009 ACOFP Annual Convention & Exhibition in Washington, DC. Dr. Zieren, a board certified family practitioner who was designated a Fellow of ACOFP in 1993, has extensive experience in medical leadership, regulation and policy development. Her accomplishments can be summed up in two words – committed leadership. President-elect of the AOMA Board, Dr. Zieren is a former member of the Arizona Board of Osteopathic Examiners, the state agency that regulates osteopathic physicians.

Doctors Ward and Zieren will continue to keep the public updated on this crisis through a series of news releases and white papers.

For additional media information, to set interviews, etc., please contact Carole V. Bartholomeaux, 602 404 8018 or Carole@b-pr.com

Noticed any changes?

Well, on 1/1/11 some parts of the health reform law went into effect. I'd like to hear from you to know if you've seen any effect in your practice, if patients have discussed health care reform with you, or if you've made any changes to the way you are practicing medicine.