UMA President’s Page

Week 31 - April 13th

This week started with a meeting of many of the stakeholders for health care reform. We met to discuss the unifying measures that could be undertaken by the various associations to assist in the efforts of the newly formed state wide task force on health care reform.

The executive board met this week and discussed a very involved and extensive agenda. Your executive board was instrumental in shaping up the next BOT meeting. We have many decisions to make at the next BOT meeting. I look forward to it in Springdale.

We finished off the week by providing some funds to our various Congressmen for their upcoming elections. These funds came from AMPAC and UMPAC, not from your membership dues. The funds will help to further engender the relationships we have with our Utah State Congressmen.

Week 30 - April 6th

This was a quieter week at the UMA. The staff continued to work on the upcoming spring conference. I met with UHIN to discuss some measures to be taken in reformatting their governance structure. These were preliminary discussions that will help guide our discussion at an upcoming UHIN retreat.

Week 29 - March 30th

We spent the week in Washington. We met with all of Utah’s Congressmen and Senators. The AMA prepared some messages for us to help spread to members of Congress. The first was the same old song and dance with a new twist. The Sustainable Growth Rate (SGR) equation has wreaked havoc on medicine. Each year we go to Washington to beg for a slight increase. This year Congress gave a 6 month extension to the “cliff” reduction in Medicare reimbursements. This was unique since most of the time they give us a year. We spent some of our time encouraging them to at least approve an 18 month extension but were cautioned that it may be anywhere from 6 to 18 months. We hope that the current Congress has the wisdom to extend the temporary fix until well into the next
administration.

The second message was new this year. A new bill has been introduced to allow for balance billing to Medicare patients. Currently those who do NOT participate in Medicare are still held to billing no more than 115% of Medicare to their recipients. This new bill would allow increased billing and more access to physicians that have chosen NOT to participate. Unfortunately those of us who must sign up for Medicare will be held to the current reimbursement schedule without the ability to balance bill.

Lastly, we discussed the deferment of student loan payments until after residency. This is another issue that appears to be destined for sunsetting at the end of June. Students, residents and new physicians are fearful of their ability to pay on student loans if they are not allowed to defer. There is a bill before Congress now that will continue the deferment of student loans. We felt it was necessary to continue the ability to defer in order to allow students, residents, and new physicians to pay off their student loans appropriately.

Week 27 - March 17th

I am just past the half way point of my year as President. What a great ride. I have enjoyed some great opportunities so far and look forward to many more.

This week I met with the Charted Value Exchange (CVE). This was the first meeting after being chartered by CMS. The group is now formulating a philosophy and outlining the parameters of the functions it will provide. These will mainly focus on dealing with Quality. The CVE is looking forward to becoming the leader in developing, analyzing and implementing quality measures for medicine. The group will also have an advisory function for the health reform process.

We also met with the UMA Financial Services board. UMAFS is growing and vibrant. This is a wonderful service provided to members of the UMA. If you have not had a chance to visit with one of our salaried, professional advisors I would recommend making an appointment.

Week 28 - March 23rd

This week I spent in preparation for the upcoming AMA Leadership Conference in Washington DC. We will be attending several meetings and will have a chance to meet with our Utah Congressmen. I will also be participating in creating an NPR message to be aired in Utah on the SGR. We spent about an hour this week working on making sure that the physician leaders from the western states were consistent in their message to the citizens of their respective states.

At the Utah Hospital Association (UHA) board meeting we had some great discussions. Chief among the upcoming issues will be dealing with what are called “Never Events.” These are hospital based events that could and should have been prevented. CMS is no longer going to reimburse for the never events. For physicians, there are many issues surrounding the “Never Events.” We need to find out how the lack of reimbursement to hospitals affects physicians. There are many questions. We need to know if the total episode of care is no longer reimbursable if a complication develops. Will a consultant be reimbursed to assist on an event? What input will physicians have in determining if the event was preventable? This will become a huge issue over the next few months.

Week 25 – March 3rd

This week marked the ending of the legislative session. It was a wild ending. The papers called it a mundane, unexciting year but for the medical association we worked hard. Michelle McComber and Val Bateman were there up until the final moments completing the work we had started this year. Senate bill 93 was one of the last 3 voted upon. It was questioned because of a time clock issue the next day but the issue was resolved and the bill stands as voted upon. We owe a debt of gratitude to Michelle and Val who have worked tirelessly for us this year as they always do.

Week 26 – March 10th

The session is over and now we return back to other work of the association. We met with the director of UHIN this week to discuss the ongoing details of the clinical healthcare information exchange module known as the CHIE. I am excited over the prospects of an interactive database that will assist physicians in providing better care to their patients. Utah is one of the first states to attempt this type of project on a statewide basis. Several communities have implemented similar programs with varying levels of success. This is a project that will continue to need the input and direction of physicians as we mold the concept into a functional product. The physician advisory committee of UHIN is that conduit for formation. We encourage UMA members to come to the meetings and provide input on the project.

The Board of Trustees met this week. They were updated on our successes and concerns from the legislative session. The full report will be coming in the next UMA Bulletin. The board discussed many other issues they will be working on. In addition, Dr. Cowley shared the format and agenda for the spring meeting in Springdale. He and Mark Fotheringham have done a great job in preparing this meeting. I look forward to seeing everyone in Springdale this year. Visit www.utahmed.org for details.

Week 23 - February 18th

This week was a pivotal week. We met with Secretary Leavitt and many community leaders to discuss the newly chartered value exchange (CVE). Secretary Leavitt outlined his vision of a new health care system that will span the USA. He is working hard to put the needed pieces in place prior to the end of his term. He has committed to create a national organization and leadership that will be private and outside of government control to help in evaluating, guiding and implementing his system of CVE’s across the country.

We also met with our state’s US Attorney, Mr. Brett Tolman. There has been a lot of media hype about physicians prescribing narcotics inappropriately. A story was run where it was implied that the US Attorney’s office was going after physicians. We were reassured that they are only going after physicians who have been involved in obvious illegal activities. We offered our assistance in making sure they target only physicians whose practices endanger our patients in Utah. We look forward to a good working relationship to improve the healthcare of our patients.

Lastly, I finished the week with a meeting at the Department of Health. The Practicing Physician committee meets to evaluate and advise Medicaid on actions and implementations. We have some hard working physicians, including Chairman Thomas Jones MD, who are trying to make sure Medicaid is appropriately paying Utah physicians. If you have any grievances or issues that need to be brought to the attention of Medicaid this is a great forum.

Week 24 - February 25th

This is the final full week of the legislative session. We have been involved in brokering many deals to ensure that legislation passed this year will assist physicians and protect patients. Michelle McComber has been leading the team and doing a wonderful job.

The UMA Executive committee met this week and addressed many of the legislative issues. We have also begun discussions on how medicine is going to change with health care reform. Many physicians are already concerned about how they will maintain their current practices or be able to expand under the new reforms. This is going to be an interesting couple of years to come.

The UHIN Physician Committee was solidified this week. There will be 9 members. The meetings will be open to any willing participants. This committee will be essential in creating the basic clinical approach to the building of the Clinical Health Information Exchange. Dr. Kerry Stratford will be the first chair.

Week 21 - February 4th

February 4th started a brisk couple of weeks at the Legislature. Michelle McComber was there full time for us, along with Val Bateman. I was there for testimony on several occasions. On Monday I testified in front of the Health and Human Services Appropriations Meeting. It was a long 3 hour meeting during which I offered testimony for 2 minutes. It seemed to be effective in that we had our Medicaid increases moved to the 5th and 6th spot on the priority list for funding. The combined total would be a 12.5% increase. This is the first part of a negotiated 30% increase over 3 years plus inflationary increases of 2.5% per year. We also had our EMR project funded to completion this year at which point we will have been able to help nearly 80% of physicians in Utah connect to an EMR. This makes Utah the most progressive state in EMR adoption and implementation.

This same week we enjoyed a very successful Doctor’s Day at the Legislature. We had more physicians attend than ever before. I was very proud to see many physicians who had used the morning to contact their legislators and encourage them to support our initiatives this year. This service is invaluable to the organization and physicians in Utah. That same afternoon we attended the final appropriations meeting to help secure our priorities.

Thursday was spent meeting with the Licensed Direct Entry Midwives (LDEMs). We had a long meeting to help address the specifics of SB93 that would modify their act to define “normal birth” and specify safety parameters for these individuals. It was a long meeting. Much progress was made. We agreed to put together alternative plans for the modification of SB93 that each organization could agree upon.

In addition to the legislature physicians met to finalize our support and participation in the Salt Lake City Marathon. We are excited to once again sponsor this event and encourage our physicians to participate. Our Healthy Lifestyles Committee is very supportive.

This week ended with a presentation to the Utah Chapter of the American College of Emergency Physicians. We met in Park City for our Winter Symposium. I was lucky to be on the agenda with the National President-Elect of ACEP. I was able to share what the UMA is doing for the physicians of Utah and encourage their participation, membership, and financial support.

Week 22 - February 11th

February 11th started the week with a meeting with the DOPL chief Mr. Stanley. Following that meeting was the second meeting with the LDEMs as proposed the week before. This was a longer meeting. But at the end of the day the physicians still felt that delivering breaches, twins, and VBAC’s at home was not safe. The bill will be going forward.

My second day at the Legislature was the day of the fateful February 13th snow storm. The Utah Society of Anesthesiologists has been working on a proposal to investigate the licensure and use of Anesthesia Assistants. The UMA has been assisting them with the language and verbiage of the bill. This day an emergency meeting was called by the CRNA organization with Representative Stephen Clark who will be the sponsor. The UANA had been discussing their concerns throughout the day with the representative and he felt that a meeting with the interested parties would be important. We drove up in the snow to the meeting, discussed the issues and set up a working group to address the specifics of the bill. The ride home took over 6 hours through all of the
accidents, snow, and closure of SR92. It was an interesting day.

I am always appreciative of the women and men that work so hard to assist us at the UMA to address bills that affect the safety and rights of our physicians and patients.

The legislative session has begun and the politics of the season are in full bloom. Michelle and Val are on the Hill full time protecting the interests of physicians and their patients.

While the legislature was ramping up, we took care of other business at the UMA. I met with the UMA Bulletin Editorial Board which discussed the topics and themes for the coming year. We are interested in a design that stimulates physicians to read and react to our environment in medicine. We look forward to some great new ideas that will be incorporated into the Bulletin.

Our legislative committee met that night to work through the myriad of bills concerning healthcare this year. They prioritized the bills that we had and prepared their report for the board.

I spent the day of the 23rd meeting with representatives of UHIN to discuss our further involvement in the CHIE (Clinical Healthcare Information Exchange). They would like to formalize the physician committee and input during the development and implementation phase of the project. Following that meeting was the UMA Executive Committee meeting during which we discussed many of the issues facing UMA. The night finished out with a meeting of the specialty society presidents. We shared ideas and concerns from each point of view. It was a great exchange of ideas that I believe helped to further connect the physician community.

The next day I spent at the Utah Hospital Association’s legislative reception. The next day was the UHA Board meeting. It is very important for us to have representation on the UHA Board to help maintain our symbiotic relationship.

During this past week we had several meetings to assist the anesthesiologists in their battle to keep the state from opting out of the CRNA provisions of Medicare. We met with representatives of the UHA, Rural Hospitals, Administrators, CRNA’s and Anesthesiologists. We were able to develop an action plan to help each faction of the ad hoc committee to feel comfortable with the current balance we have in the practice and delivery of anesthesia care today in Utah.

Later that same day (Jan. 30th) we held our UMA Board meeting and then went to the Joseph Smith Memorial Building for our annual Legislative Reception. We had a great turn out with almost half of the legislature reserving a spot at the reception. Your physician representatives did a wonderful job of explaining UMA positions and making sure that all the legislators were busy talking about issues.

I started this week in meetings to prepare to discuss the ever-changing Health Care Reform bill. This culminated in a discussion with Representative Clark who is running the bill. At this point most of the items we had hoped to include in legislation have been shifted to a list of items that must be discussed in a committee that will be formed for the purpose of addressing Health Care Reform. We were re-assured that the UMA would have a seat on this committee to make sure that physicians have a voice in the inevitable changes in health care that will come.

Tuesday night Dr. Cowley and I accompanied Michelle McComber to the Republican Caucus Reception. We spent a couple of hours talking with representatives and senators on various health care related bills that will be address separately from the main bill being presented by Representative Clark. I believe it was a productive night.

Thursday was a very long day. I started with a hearing on Naturopathic Physician Formulary changes where I gave testimony on several important changes to make sure that the formulary matches their training and expertise. Then we met with Lieutenant Governor Herbert discussing the issues regarding CRNAs “Opting Out” of 42 CFR 482.52 (a)(4) which describes the need for the availability of a physician, and the medical issues of a patient receiving anesthesia from CRNA’s. My day finished with a meeting at HealthInsight with the Utah Partnership for Value Driven Health Care. This group is still in the application process to become the Utah Value Exchange under CMS. We have been an integral part of the process and look forward to our continued participation.

Saturday night the UMA participated in the “Democratic Gala” event. We have always been believers in working with both sides of the isle to bridge issues concerning medicine that affect us all.

We had only a few meetings sparsely spread among the holidays to address upcoming legislation. Many of the bills we have interacted with legislators on are “Protected” but they have shared their content with the UMA. It is nice to know that we are well respected and people want to know our opinion prior to releasing their bills.

We are working on several other issues as well. Blue Cross Blue Shield met with us to share with us their launch of a new program that will rate physicians based on customer satisfaction. This was only a meeting to explain the program and not to get our opinion. Many of you have probably already received your provider packet that explains the program. You should be able to access information on the Blue Cross Blue Shield website as well. Let us know of any concerns you might have about this program.

The UMA continues to be supportive of good health practices. We are working with a committee of physicians to enhance our support of the Salt Lake Marathon. We are also considering ways to expand our influence to other venues and events. This will prove to be an exciting year. I plan on participating as much as possible so I can keep my new year’s resolutions.