AOMA President's Blog

Concerns

2011-10-07T11:49:00.000-07:00

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

2011-09-19T13:25:00.000-07:00

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?

2011-02-23T15:17:00.003-07:00

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

2011-02-17T19:44:00.002-07:00

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

2011-02-14T14:30:00.001-07:00

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

2011-02-11T16:17:00.003-07:00

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?

2011-01-12T17:37:00.003-07:00

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.

Welcome to the AOMA President's Blog

2010-09-24T15:07:00.001-07:00

Arizona Osteopathic Medical Association President Kelli M. Ward, D.O., MPH, FACOFP was inaugurated as the 2010 - 2011 AOMA President on April 22, 2010.

Her acceptance speech is posted below:

Good afternoon, Delegates and Honored Guests. It is a privilege to accept the office of President of the Arizona Osteopathic Medical Association and continue to move forward with the work of our Immediate Past President, Dr. Lori Kemper, and our Past President squared, Dr. Chip Finch, both of whom have given me awfully big shoes to try to fill, but both of whom I know will be right here, serving AOMA and helping me steer our organization on the right track in this time of change. I look forward to working with our excellent staff – Mandy, Flannery, Tammy, and Teresa who maintain the continuity of the AOMA year after year.

I also want to take a special moment to say that I would not be here or have any success without the gifts that I have been blessed with. Not only was I lucky enough to be given the intelligence to make it through college and osteopathic school, God also blessed me with a wonderful family – my husband, Dr. Mike Ward is here with me today. Without him and our awesome children, Katie, Cameron, and Nick, there is no way I would have the strength, the courage, or the motivation to do all of the things that I do. My mom and step-dad and Mike’s parents also live just around the corner from us in Lake Havasu which also makes serving our profession a little easier – knowing that I have my family support system right there for all of us. Finally, my dad lives far away in Florida, but he is only a phone call or an email away and he is here this week to support me as I take the office of the president. He always told me that I could do anything. So, to my family – thank you for everything!

My friends in this great osteopathic profession – we are faced with something scary right now – change. Dr. Nichols talked to us yesterday about “Back to the Future” and I agree with her that there is really no difference in what we need to do in terms of caring for our patients. We need to continue to practice the D.O. way – teaching our patients that the body has the inherent ability to heal itself as long as there aren’t impedances to that healing process, talking to them about prevention, knowing them as PEOPLE, not as symptoms. Taking the time to grab a blanket for the child who is cold or get a cup of water for a husband who doesn’t want to leave his wife’s bedside. Going the extra mile to welcome a medical student or resident into the osteopathic family – not letting that part of our identity slip away even though we don’t have as many osteopathic hospitals anymore. These are the little things that set us apart. However, we will now be practicing medicine in a new era. We will need to change. We will need to grow. We will need to become resources for our patients and for our communities and for our elected officials.

Change can be very important because first of all it allows for new technology and new ways of doing tasks that can make the tasks more efficient and cost effective. As well, change can be uncomfortable, but can make someone stronger and more knowledgeable in the long run.
There are many definitions of “change.” These include:

to make the form, nature, content, future course, etc., of (something) different from what it is or from what it would be if left alone: to change one's opinion; to change the course of history.
to become different: Overnight the nation's mood changed.
variety or novelty: Let's try a new restaurant for a change.
coins of low denomination.

The change we are going to be talking about today is the first kind – changing the course of health care from what it is now because it is no longer being left alone. We have long discussed quality, cost, and access to health care. It has been “all talk and little action.” Action has now happened and there are many opinions about what will happen now that health care legislation has become law. One thing is inevitable – change is coming.

There's an old Chinese saying, "What makes one tired is not the high mountain far away, but the sand in one's shoes."
There was a recent worldwide survey of physician attitudes about their work. It will probably not surprise you that North American physicians are the most unhappy in the entire world. It's the constant "sand in our shoes." Each of us could write a book about what makes up that sand. It's lots more than payment issues. It's interference with our ability to make necessary decisions for our patients, fears about unfair medical liability cases, pressure on time spent with patients. All the things that hinder our power to heal, all the things that leave us drained and disheartened.

We need fundamental change in our health care system for ourselves, for our patients, for our nation. Right now annual health care costs exceed $2 trillion. That's 16 percent of our nation's GDP. Costs are estimated to reach $4 trillion and 20 percent of GDP in 10 years.

We are the most innovative, resilient, determined, self-reliant and creative nation in the world. Our health care system is, in many ways, the best of the best – in others it isn’t. It is hard to say if the new health care law will make it the best overall or not, but change is likely to come for all of us because of this new law.

We need to come together to deal with what is driving our national debate about health care and that is cost. It is no different in other countries. Even before the global financial meltdown, concerns about cost took center stage. And now, concerns about cost will be the all-consuming issue.
Our ability to care for patients is threatened by the uncertainty of the annual wrangling with Congress over Medicare fees. And what is the response by our critics? "Oh it's easy," they tell us. "Why don't you just work harder and see more patients?" I’m not so sure that can really be done – there are only so many hours in the day for physicians to see patients and see them with excellence. Individually, we don't think too much about it. On April 1, a 21% cut in Medicare reimbursement to physicians went into effect, but it was held off to see if Congress could “fix” it. As you know, this fix called the SGR was left out of the health care reform act because it would have shown that the health care bill would add too much to the deficit. Instead, for two weeks, physicians were not paid for their services by Medicare. In spite of this, we continued to see Medicare and Tricare patients, not knowing how much we would be paid for seeing them. A lot of people think that doctors are wealthy and we can take it, but I don’t know one other business that could sustain that kind of treatment.

Who should be making the decisions about appropriateness of care, about overuse or misuse? It is our professional responsibility. We will likely not be alone in these decisions, but we can't be left out.

I’m sure you remember this pivotal question during one of the presidential debates? "Is health care a right, a privilege or a responsibility?" Whatever we think individually, the broad population seems to be moving toward believing that health care is a right. The Declaration of Independence states that we as Americans have the right to life, liberty, property, and the pursuit of happiness. These are rights to actions, not rewards from other people. Under the American system, you have a right to health care if you can pay for it – if you can earn it by your own action and effort. No one has the right to the services of any professional individual or group simply because he wants them and desperately needs them.

But who will pay for this so called right? Who will define the parameters of this right to health care? Everyone can’t have everything and society should not have to and can’t afford to provide everything. Deciding these “rights” and “responsibilities” will take time, thought, and difficult decision making. Personal responsibility will have to be laid out. What will be expected from the individual and what will be expected from society?

Are we prepared to participate in the debate? Because the debate is going to happen. It is not just about us. But physicians and patients will have to live with the outcomes. That's why we have a big role to play. Doctors need to stand up and let their voices be heard.

We're in a time when our country is demanding change. Let's harness that energy for our patients and ourselves. For sure, this is for us - we have to remove the sand from our shoes. But it is for so much more than us.

As Hillel said so many centuries ago, "If I am not for me, who will be for me? If I am only for me, what am I?"

There are about 100 D.O.s in our House of Delegates and 650 in the AOMA. There are 2700 licensed osteopathic docs in the state and by 2020, we expect to have 95,400 D.O.s in the United States. We are diverse in our backgrounds, in our ideological beliefs, in our political views. The osteopathic profession and our patients are well served by this variety. Our House of Delegates is well served by our strong opinions and energetic debates. We have power and a voice that should be heard. Physicians need to take a stand. As the leader of the AOMA, I pledge to listen to YOU, my colleagues and constituents and to present your voice to our officials. I have to hear from you to know what you believe and what you want our organization to take a stand for or against. I want to lead by the people and for the people – not tell you what is right for you.

So let's be firm in our determination, flexible in our approaches, and grounded in the ethical principles that have been the foundation of our profession throughout history.

My goal for the coming year is for the AOMA to harness the political power of our members. We will use our lobbying staff, our PAC money, our media connections and our members to be a resource to our elected officials, to physicians practicing in Arizona, and to our patients. I want to help emerging states that surround us to grow their osteopathic presence as well – states like Utah where there are people who are ready to be pioneers for osteopathic medicine if they have guidance from our trailblazers. We can form alliances with them – connecting our experienced physicians with the people there who have drive and ambition to make things happen – the AOMA can be the catalyst for positive change. We stand on the forefront regarding changes that are happening in health care this year and into the future. We want to be at the table. We want don’t want to be victims of change – we want to make change happen.

Thank you for your support and confidence as we move forward into the future of medicine. I look forward to working with all of you this year.