MSMA Council October 17, 2020 – 2:00 p.m.

via video conference

AGENDA

1. Approval of the minutes of the July 11, 2020, meeting

2. Remarks of the President – George Hruza, MD

3. Report of the Executive Committee – George Hruza, MD

4. Report of the Budget & Finance Committee – David Pohl, MD

5. Report of the Executive Vice President – Patrick Mills

6. Consent calendar:

a. Report of the Commission on Continuing Education

b. Actions and Recommendations on Resolutions from the 2020 Annual Meeting

c. Report of the MSMA Alliance

d. Report of the MSMA Insurance Agency

e. Report of the MSMA Delegation to the AMA

7. Report of the Missouri Physicians Health Program – Bill Woods, MD

8. Report of the Committee on Legislative Affairs – Ravi Johar, MD

9. Report of the Membership Committee – James DiRenna, Jr., DO

10. Reports of Councilors

11. Prerogatives of the Chair

MSMA COUNCIL via video conference

July 11, 2020 3:00 p.m.

Due to concerns over the COVID-19 pandemic, the scheduled gathering at the Lake of the Ozarks was canceled.

Presiding: George Hubbell, MD, Lake Ozark - Chair Present: George Hruza, MD, Chesterfield; Alex Hover, MD, Ozark; Lancer Gates, DO, Kansas City; James

DiRenna, Jr., DO, Kansas City; Brian Biggers, MD, Springfield; David Pohl, MD, Town & Country; Laurin Council, MD, St. Louis; Timothy Swearengin, DO, Springfield; Robert Corder, MD, St. Joseph; John Memken, MD, Hannibal; Elie Azrak, MD, St. Louis; Robert Brennan, Jr., MD, St. Louis; Inderjit Singh, MD, St. Louis; Christopher Swingle, DO, St. Louis; Kevin Weikart, MD, Lake St. Louis; Lisa Thomas, MD, Lake Ozark; David Kuhlmann, MD, Sedalia; Betty Drees, MD, Kansas City; Michael O’Dell, MD, Kansas City; Ellen Nichols, MD, Joplin; Lirong Zhu, MD, Clayton; Sharon Wallace, MD, Cape Girardeau; Peggy Barjenbruch, MD, Mexico; Sri Kolli, MD, Fenton; Sarah Florio, MD, Lee’s Summit; Jared Lammert, MD, Columbia; Priya Jain, UMKC; Tom Weigand, MD, St. Joseph; Sandra Ahlum, MD, Hannibal; Amy Zguta, MD, Columbia; Fariha Shafi, MD, Overland Park, KS; David Barbe, MD, Mountain Grove; Douglas Wallace, MD, Cape Girardeau; Hossein Behniaye, MD, Hannibal; Louis DelCampo, MD, Springfield; Frances Mei Hardin, MD, Columbia; Brette Harding, MD, Columbia; Sree Lanka, UMKC; Edmond Cabbabe, MD, St. Louis; James Conant, MD, St. Joseph; Joseph Corrado, MD, Mexico; Warren Lovinger, Jr., MD, Nevada; Charles Van Way III, MD, Kansas City; Ravi Johar, MD, Chesterfield; Diana Corzine, St. Joseph; Guests – David Nowak, St. Louis Metropolitan Medical Society; Sara Summers, Cape Girardeau County Area Medical Society; Staff – Patrick Mills, Jeff Howell, Benita Stennis, Liz Fleenor, Haley Wansing, Heidi Geisbuhler, Shantel Smith, Sarah Luebbert and Cheri Martin, Jefferson City.

Approval of Minutes: On motion, duly seconded, the minutes of the April 4, 2020, meeting were approved. Remarks of the President – George Hruza, MD, stated that this is an unusual year to be President, as his travel has been limited. He reported that as AAD President, he had traveled to four continents within the first few months of the year before travel was brought to a halt. He is optimistic that he will be able to travel in his role as MSMA President before his year is over. With MSMA’s support, Dr. Hruza has been working with the IMG section to promote federal visa legislation that would help bring IMG physicians to underserved areas in Missouri. Dr. Hruza thanked the Ad Hoc Committee on the Annual Convention – Drs. Betty Drees, George Hubbell, Brian Biggers, Ravi Johar, Lirong Zhu and Lauren Umstattd, and MSMA staff Jeff Howell and Benita Stennis - for their work in preparing a well-thought-out report. Compressing the annual meeting will hopefully result in increased attendance and cost savings. Report of the Executive Committee – Dr. Hruza reported that the Executive Committee had met earlier and there had been no votes taken at that meeting; however, there had been two issues voted on since the last Council meeting. Resolutions referred by the House of Delegates were sent to the Medical Economics Commission (numbers 2, 3, 4 and 9) and the Legislative Committee (numbers 5, 6, 7, 8, 10, 11 and 12). The Committee declined sending a letter to comment on DHSS proposed regulations which were then planned to be withdrawn and were later withdrawn.

The Committee received a report on MSMA’s reserves, which are fortunately doing better. They also received a report on membership and marketing efforts going forward. They discussed advocacy outreach, which will be accomplished with virtual advocacy meetings across the state and should be of help in recruiting members. They also discussed Medicaid expansion, which will be voted on August 4. MSMA is one of over 260 supporting organizations who joined the Missouri Chamber in coming out in favor of this a few weeks ago. MSMA’s support mirrors AMA policy, which believes that patients are better off when they have coverage. On motion, duly seconded, the report of the Executive Committee was approved. Report of the Budget and Finance Committee – David Pohl, MD, reported that the Committee had met via teleconference on June 29, 2020. Among the more noteworthy items in the budget are that dues revenues are slightly above budget, but still down 4.7% from last year. MSMA’s long-term reserves are down about 5% which is good considering the events of the past several months, along with the fact that we have drawn some funds from it. Expenses are close to our budgeted line items, with the exception of Council meetings, the annual convention, and AMA which are down due to virtual meetings. Several years ago, the Council directed the Committee to bring to the summer meeting its recommendations regarding dues amounts for the next year. The Committee recommends that the Council maintain the current dues structure for Active Members ($395) and Young Physician Members ($100, $200 and $300 in the first, second and third years of practice, respectively). They also recommend increasing Honor Member dues to $100 and Affiliate Member dues to $150. On motion, duly seconded, the Council voted to maintain the current dues structure for Active Members of $395 and Young Physician Members of $100, $200 and $300 in the first, second and third years of practice, respectively. There was discussion of the Honor Member and Affiliate Member dues structure. The Honor Member dues would increase from $25 to $100, mainly because many of the benefits that they enjoy exceed the $25 amount. The Committee does not believe that the $100 dues would be an imposition on the Honor Members. The Affiliate Member dues would increase from $25 to $150. Patrick Mills stated that this member category had been established 25 years ago in an attempt to foster relationships with medical group managers. The bulk of our requests are currently unlicensed assistant physician candidates who are not yet employed by MSMA members. On motion, duly seconded, the Honor Member dues will increase to $100, and the Affiliate Member dues will increase to $150. On motion, duly seconded, the report of the Budget and Finance Committee was approved. Report of Executive Vice President – Patrick Mills introduced MSMA’s newest staff member, Shantel Dooling, who will work on the lobbying team. Ms. Dooling offered remarks about her background and experience. Mr. Mills reported that Benita Stennis, who has served as Director of Scientific Affairs for many years, has taken on the new title of Director of Education and Operations. She will assist in HR duties, as well as other internal responsibilities. MSMA’s operations were impacted by COVID, as we worked remotely from mid-March to early May. CME has been affected, with many of the ACCME seminars being offered online. Liz Fleenor has been working with our editor, John Hagan III, MD, on Missouri Medicine, offering content on COVID. MSMA has signed on with Action PPE, which offers physicians a reliable source of personal protective equipment. A link to this vendor’s website is available on MSMA’s homepage.

MSMA has been conducting informational calls with Dr. Randall Williams, Director of Missouri DHSS. These calls had been taking place on Saturday mornings. #MaskUpMO is a social media campaign sponsored in part by MSMA. MSMA has sent a letter to Governor Parson, co-signed by the Missouri Nurses Association, asking him to consider a mask requirement. Membership and advocacy remain our priorities. Advocacy is not just about lobbying, as is evidenced in the PDF of many letters that have been sent. We continue to offer advocacy meetings by communicating directly with chief medical officers at hospitals since they employ about half of the physicians in the state. Members should be on the lookout for recruitment letters from Haley Wansing. This is a valuable recruitment and retention tool. Also in this mailing will be three fliers outlining the virtual advocacy efforts offered by our lobby team. Members are encouraged to promote these virtual meetings and try to include five young non-members. MSMA continues to work with Arizona and Wisconsin in developing an Association Health Plan. We have encountered some challenges, but are moving forward and hope to have the plan in place by January. MSMA has been called upon to respond to a 77-page subpoena, served to us by Johnson & Johnson and Janssen, who are named parties in the State of Missouri vs. Purdue Pharma et al lawsuit. The scope of the document request extends back to 1990. We are complying with the subpoena in the best fashion possible. MSMA Insurance Agency typically reports at the Executive Session, but that session was not held today. Lancer Gates, DO, offered the report. He stated that the Agency is having a very good year in spite of COVID, market changes and such. He expressed appreciation for Ronnie Staggs and all that he has done for the Agency during this time. There has been an increase in professional liability costs, due in part to the severity of claims. The Agency continues to work toward a January 1, 2021, launch of the Association Health Plan. Mr. Mills explained to new Council members that they are welcome to attend the Executive Session which is a way to have an off-the-record discussion of issues and no votes are taken. Consent Calendar –The following reports were made available to members electronically:

Report of the Commission on Continuing Education

Report of the Commission on Medical Economics

Actions and Recommendations from the 2020 Annual Convention

Report of the MSMA Alliance

Report of the MSMA Delegation to the AMA Dr. Hubbell stated that all of the reports had been read and found to be non-controversial. He invited members to extract any item that they would like to discuss further. There being no extractions, on motion, duly seconded, the Consent Calendar was approved. Report of the Membership Committee – James DiRenna, DO, reported that the Committee had met on July 1 by conference call. MSMA currently has 2,090 active members, which is down by 49 from last year. Total membership is 3,527, which is up 77 from this time last year. New websites have been created for promoting free membership to residents and students. There is also a new member-to-member forum, which utilizes slack.com. To access this forum, use “msmaworkspace.” For further information, please contact Haley Wansing. She can send an invitation to anyone who is interested. MSMA personnel and members have delivered lunch for COVID workers through our DocPlates program on a request basis. This has been very favorable in the last four months.

There are fliers on the Council meeting website encouraging MSMA leadership to host virtual advocacy meetings and invite five members under age forty to participate. Contact Shantel to get on the schedule. Haley will be sending packets of recruitment letters to be personally signed and returned to the MSMA office. Peer-to-peer outreach is a very effective method of recruiting members. Report of the Committee on Legislative Affairs – Ravi Johar, MD, reported that the Committee had met earlier in the day by videoconference. They discussed several housekeeping issues, including welcoming Shantel Smith as the newest member of the legislative team. The Committee received a report from Heidi Geisbuhler regarding COVID-19 issues at the state level. Mark your calendars for March 2, 2021. This is the date scheduled for MSMA’s White Coat Day at the Capitol. The Committee received a recap of the 2020 legislative session. The Legislative Review is now available online. To receive a printed copy for non-member recruitment, please contact Jeff Howell or Haley Wansing. An electronic PDF version is also available for recruitment efforts. Due to the cancellation of the 2020 annual meeting, all resolutions were referred to Council for review and approval. The Committee discussed five of these resolutions at its meeting, all of which were discussed with staff and authors. All received unanimous approval by the Legislative Committee. Dr. Johar read the five resolutions; members may extract any resolution for further discussion. Resolution #5 – Ensuring Affordable Insulin RESOLVED, that our Missouri State Medical Association support legislation capping out-of-pocket insulin costs at an affordable level for individuals and further encourage our American Medical Association to support similar legislation. Resolution #6 - Non-Medical Exemptions for Immunizations RESOLVED, that our Missouri State Medical Association support the elimination of non-medical (religious, philosophical, or personal) exemptions from mandated pediatric immunizations and, in the alternative, support stricter guidelines for religious exemptions to immunizations. Resolution #7 – Research and Recreational Marijuana RESOLVED, that the Missouri State Medical Association oppose the legalization of recreational marijuana in Missouri until further research can better clarify the risks and benefits. Resolution #8 – Decriminalization of HIV RESOLVED, that our Missouri State Medical Association support modernizing criminal penalties for HIV-positive persons who knowingly or recklessly expose another person to HIV. Resolution #10 – Medication-Assisted Treatment for Opioid Use Disorder in Correctional Facilities RESOLVED, that our Missouri State Medical Association support legislation that requires persons incarcerated in jails and prisons to be screened for opioid use disorder and make available MAT services and medications to inmates as recommended by a physician. There being no extractions, the resolutions were adopted by Council on motion, duly seconded. On motion, duly seconded, the Report of the Legislative Committee was approved. Report of the Ad Hoc Committee on the Annual Convention – Betty Drees, MD, presented the report. Dr. Hubbell thanked Dr. Drees and commended the Committee’s work. Dr. Drees thanked all who served on the Committee.

She directed members to the summary of recommendations, presented in table form in the Committee’s report. The highlights include:

Shortening the meeting to begin Friday evening and end Sunday morning;

Eliminating the Exhibit Hall and looking at other opportunities, such as product theaters

Transitioning to an electronic Delegate Handbook (keeping a smaller printed version on-site at the meeting)

Not charging CME fees, but charging a flat fee for non-members who attend

Keeping Reference Committees and House of Delegates essentially unchanged

Simplifying delegate apportionment (this will require a bylaws change and cannot be implemented at this time)

Moving Thursday Council meeting and dinner to Friday; allowing Alliance to fundraise for MSMF at the Council dinner

MSMA to pay for room and tax only on the Master Account, with attendees being responsible for incidentals

Eliminating specialty society participation beginning in 2021, and looking for other ways to include specialties

Reducing the number of ancillary meetings

Reducing CME sessions to four or five, and shortening them to 60 minutes

Continuing medical school receptions as they are self-paid, but changing the times to avoid competition with other activities

Maintaining all three current Presidential activities: 50-year pin and Past President reception, Presidential Inaugural and Presidential Reception

On motion, duly seconded, the Report of the Ad Hoc Committee on the Annual Convention was approved. Councilor Advisor Appointments – Dr. Hubbell announced the following appointments:

Commission on Medical Economics – David Kuhlmann, MD Commission on Continuing Education – Peggy Barjenbruch, MD Commission on Public Affairs – Lancer Gates, DO Physicians Health Committee – Lisa Thomas, MD

On motion, duly seconded, the appointments were approved. Reports of Councilors District 1 – Robert Corder, MD, reported that eight of thirteen medical student scholarship recipients had been honored at the Buchanan County Medical Society meeting. With the aid of the Missouri State Medical Foundation matching funds, Buchanan County is able to present thirteen $1,000 scholarships. District 2 – Hossein Behniaye, MD, reported that their new society president is John Memken, MD. In spite of issues with COVID-19, they have been able to grant two scholarships to nursing school graduates. District 3 – Elie Azrak, MD, reported that District 3 members will have the opportunity to hear from the Legislative Affairs team with an update on the 2020 session during a Zoom meeting on Wednesday, September 2, at 8:00 p.m. Inderjit Singh, MD, reported that there will be a CME conference titled “The Physician’s Role in a Time of Critical Change.” This was originally scheduled for May, and has been re-scheduled for Saturday morning, October 24, from 8:30 a.m. to 12:00 noon in the St. Luke’s Hospital Auditorium in Chesterfield. Christopher Swingle, DO, reported that Herluf Lund, MD, an MSMA member and District 3 Delegate, has been elected national president of the Aesthetic Society.

District 5 – Dr. Hubbell reported that Boone Hospital is leaving the BJC health system effective 12/31/20. Look for a press release soon on a new CEO for Boone Hospital. Lisa Thomas, MD, is running for state representative in the northern Camden and Miller county areas, with four opponents on the Republican side. Dr. Thomas expressed her appreciation for the support from MSMA and MMPAC. She also stated that Boone County is remaining very active with webinars. BCMS has had over 1,000 attendees on its first 14 webinars. Shantel will be sending an invitation to Council for the next webinar. Headlining the next webinar will be Lynelle Phillips, who is on the MPH faculty at the University of Missouri, and has been working as a contact tracer with the Boone County Health Department. Dr. DiRenna asked about the closure of Pinnacle Hospital in the Boonville area. Dr. Thomas responded that a Cooper County hospital had indeed closed, and she could provide further information. Pat Mills stated that the University of Missouri had opened a clinic in Boonville to replace that lost access. Dr. Joe Corrado reported that the Mexico hospital – SSM-Audrain – is trying to dissociate themselves from SSM in St. Louis and Jefferson City. They would prefer to be on their own. They have a letter of intent by a corporation called Noble, who they will be meeting with in the coming week. They are also considering a micro-hospital. District 6 – Warren Lovinger, MD, reported that the federal assistance has been helpful. District 7 – Dr. Drees reported that Mark Bernhardt, a prominent orthopedic surgeon and chair of Orthopedic Surgery at UMKC and Truman Medical Center, had passed away. Dr. Drees welcomed new Vice Councilor Fariha Shafi, MD, who is an internist in Kansas City and practices at Truman Medical Center. District 7 had its first webinar, with the topic of physician leadership during COVID-19. The next webinar will take place next Saturday on the topic of Medicaid expansion. An ad in the Kansas City Star will support the amendment, with over 350 physicians signing on. They plan to partner with MSMA on future webinars after the August 4 primary and before the November election, focusing on legislative affairs. The annual meeting will take place in October, probably as a virtual meeting, and will focus partnering with the community around health. This meeting will feature four area mayors. District 8 – Ellen Nichols, MD, reported that the first KCU-Joplin class has reached its fourth year. Alex Hover, MD, is pleased with the Greene County Medical Society and its response to COVID, and collaboration among city and county leaders, the health department and both health systems. He also noted that the GCMS Alliance is working on a way to have Family Physician Day in August with social distancing. District 9 – Lirong Zhu, MD, reported that David Barbe, MD 9th District Vice Councilor has resigned and nominated Nathaniel Barbe, DO to serve the remainder of his term. On motion, duly seconded, the appointment of Nathaniel Barbe, DO, as Vice Councilor for District 9 was approved. International Medical Graduate Section – Sri Kolli, MD, reported that MSMA has supported two visa bills that the IMG section supported. The first supports immigrant visas for use of IMGs to help with the COVID crisis. The second is longer-reaching and supports the use of IMGs to provide care in medically-underserved rural areas. She thanks MSMA for providing letters of support to the Missouri Congressional delegation. She intends to send this information to non-members of the IMG section of the local society, to show that MSMA support all physicians, everywhere in the state of Missouri. Resident and Fellow Section – Jared Lammert, MD, reported that July 1 begins the new academic year. One of the section’s goals is membership now that MSMA dues have been waived. He, along with Brette Harding, MD, and Frances Mei Hardin, MD, will use this opportunity to recruit more members. They have over 300 members so far, and hope to retain those members as they move to become attendings. They hosted a virtual advocacy meeting with Jeff Howell, who summarized the legislative session. In order to increase engagement, they will be using the Slack platform. Residents at MU participated in DocPlates, delivering food to the units at the University of Missouri Hospital who are providing care to coronavirus patients.

Women Physicians Section – Frances Mei Hardin, MD, reported that the section had had quarterly group calls with involvement from all levels of training within the WPS. They are making progress on social media. Medical Student Section – Priya Jain reported that student officers from each of the medical schools had met Thursday with Jeff Howell and Haley Wansing and discussed recruiting students. MSMA is helping to get out information, working with deans’ offices. Dr. Hubbell will speak at the UMC white coat ceremony. They are working on getting virtual advocacy meetings set up. SLU will host one on August 5, and hopefully other schools will follow suit. The section has also been advocating for Medicaid expansion, and is working to get students registered to vote, particularly those who are just coming to Missouri from other places. Prerogatives of the Chair – Dr. Hubbell recognized Edmond Cabbabe, MD, who reported that the assistant physician license has been adopted in four states – Missouri, Kansas, Arkansas and Utah; however, Medicare is not reimbursing for their services. Dr. Cabbabe has contacted Congresswoman Ann Wagner, the two Missouri Senators, and the Medicare medical director for Missouri about this issue, and encouraged them to bring up a bill in Congress and the Senate to support reimbursement for assistant physicians working under a licensed physician. He requests that MSMA send a letter to each Missouri legislator, and asks the Council to approve this action. Pat Mills pointed out the AMA had created policy opposing assistant physicians; a letter will be sent, but we should also consider bringing it up through the AMA House of Delegates. Dr. DiRenna suggested sending a copy of the letter to the Board of Healing Arts. Adjournment – On motion, duly seconded, the meeting was adjourned. Next Council Meeting - The next meeting will be held on Saturday, October 17, 2020, at the DoubleTree Hotel in Jefferson City.

Missouri State Medical Association2020: 8 mo actual vs budget

2021 Budget 2020

8/31/2020 2020 2021 YTD budget

YTD actual Budget Budget variance

Revenue

1 MSMA Member dues 816,830 800,000 700,000 16,830

2 MSMA Member Subscriptions 7,830 7,900 7,500 (70)

3 Annual Convention Exhibits - 25,000 - (25,000)

4 Annual Convention Sponsors 130,000 140,000 140,000 (10,000)

5 Advertising revenue 96,084 137,700 130,200 (41,617)

6 Royalty Income 22,634 30,200 24,450 (7,566)

7 Administrative Services 143,450 190,500 208,800 (47,050)

8 CME Income 122,950 154,500 150,300 (31,550)

9 Workshop

10 Insurance Reimbursement

11 Miscellaneous 1,006 1,820 970 (814)

12 MSMA IA interest payments 5,988 9,432 8,982 (3,444)

13 Investment income 2,022 623,122 602,070 (621,099)

Total Revenue 1,348,794 2,120,174 1,973,272 (771,380)

Expense

14 Salaries 607,525 932,500 840,000 (324,975)

15 Matching FICA and Medicare 50,493 71,336 64,260 (20,843)

16 FUTA & SUTA 588 1,300 1,300 (712)

17 Payroll Expenses 5,117 6,204 3,100 (1,087)

18 Insurance 109,279 157,956 168,800 (48,677)

19 Travel Advances & Expense 10,297 23,500 12,000 (13,203)

20 Pension Expense 237,500 237,500 232,500 -

21 Utilities Expense 9,294 15,000 15,000 (5,706)

22 Building Expense 2,133 30,000 30,000 (27,867)

23 Real Est/Personal Property Tax - 7,250 7,250 (7,250)

24 Money Management Fees 8,772 21,000 21,000 (12,228)

25 Credit Card Processing Fees 6,257 12,000 12,000 (5,743)

26 Office Supplies 3,591 8,000 8,000 (4,409)

27 Membership Development 8,779 47,500 42,600 (38,721)

28 Marketing 500 25,000 10,000 (24,500)

29 Equip Repair/Maintenance 564 7,500 5,900 (6,936)

30 Computer Expense 3,093 5,000 5,000 (1,907)

31 Postage / Shipping 2,071 6,500 7,500 (4,429)

32 Telephone / Fax / Internet / database 23,503 27,835 65,700 (4,332)

33 Dues and Professional Development 4,896 5,947 7,750 (1,051)

34 Misc. Expense - 1,000 1,000 (1,000)

35 SHINE / KHIN - 1,000 1,000 (1,000)

36 Assoc Health Plan 2,311 - 10,000 2,311

37 Continuing Medical Education 28,058 30,565 9,700 (2,507)

Missouri State Medical Association2020: 8 mo actual vs budget

2021 Budget 2020

8/31/2020 2020 2021 YTD budget

YTD actual Budget Budget variance

38 Journal Expense 35,938 54,300 50,800 (18,362)

39 Annual Convention 10,012 110,500 90,500 (100,488)

40 Council 6,107 64,000 43,000 (57,893)

41 AMA Expense 9,387 89,250 50,550 (79,863)

42 Sections 605 13,900 18,300 (13,295)

43 Legislative 12,205 17,885 12,300 (5,680)

44 Alliance 387 10,000 10,000 (9,614)

45 President & Officer Expense 9,391 20,000 16,000 (10,609)

46 Advocacy Expenses 713 5,000 5,000 (4,287)

47 Legal & Acctg Fees 30,299 24,500 35,000 5,799

48 Progress Notes 11,620 24,150 24,500 (12,530)

49 Student Awards 1,500 1,800 - (300)

50 Equipment Purchases 7,611 7,500 7,611

Total Expense 1,260,395 2,116,678 1,944,810 (856,283)

Net Income 88,399 3,496 28,463 84,903

MSMA Legislative Updates June 17 – IMG section June 29 – RFS July 30 – Wash U medical students August 5 – SLU medical students August 5 – CGMS August 25 – BCMS August 25 – District 1 September 1 – District 2 September 2 – District 3/SLMMS September 3 – District 4 September 15 – District 9 September 17 – UMKC family medicine residents September 17 – District 10 September 22 – KCU medical students September 22 – District 6 September 24 – District 7 September 29 – District 8 October 1 – District 5 October 2 – Missouri Dermatological Society October 8 – YPS October 8 – SLU Dermatology Residents Grand Rounds November TBD – WPS

September 22, 2020 The Honorable Frank Pallone The Honorable Greg Walden Chairman Ranking Member House Energy and Commerce Committee House Energy and Commerce Committee Washington, DC 20515 Washington, DC 20515 The Honorable Richie Neal The Honorable Kevin Brady Chairman Ranking Member House Ways and Means Committee House Ways and Means Committee Washington, DC 20515 Washington, DC 20515 The Honorable Chuck Grassley The Honorable Ron Wyden Chairman Ranking Member Senate Finance committee Senate Finance Committee Washington, DC 20510 Washington, DC 20510 Dear Committee Leaders: The undersigned medical professional organizations write to you with an urgent request that impacts the quality of care that our nation’s patients receive. H.R. 884 / S. 2772, the “Medicare Mental Health Access Act,” would change the definition of “physician” under the Medicare program to include clinical psychologists. This proposal jeopardizes the safety of patients in the Medicare program and would create silos in the delivery of appropriate mental and physical health care. Moreover, this legislation runs counter to efforts to coordinate and integrate the delivery of care to patients with mental illnesses and co-occurring health conditions. As such, the undersigned organizations strongly urge you to oppose H.R. 884 / S. 2772. As indicated by the Centers for Medicare and Medicaid Services (CMS) in its Medicare Policy Benefit Manual, Medicare defines “physicians” as providers who medically diagnose patients, prescribe and manage medication, and supervise other medical staff. In addition, the Policy Benefit Manual (160.E) specifically states that clinical psychologists must consult with a patient’s attending or primary care physician during the course of providing psychological care. However, H.R. 884 / S. 2772 would change these policies and allow clinical psychologists to be regarded as physicians and treat patients without supervision throughout in-patient settings, including partial hospitalization settings. Expanding the term “physician” to include clinical psychologists under the Medicare Program, thereby removing the team-based care approach and improperly expanding psychologists' scope of practice, would have far reaching and negative impacts on patients seeking psychiatric care. Physicians complete four years of medical school plus three to seven years of residency, including 10,000-16,000 hours of clinical training. Our colleague psychologists are an essential part of a physician led patient care team, however, they lack the requisite medical education, medication management training, and clinical training that is critical in determining differential diagnosis and do not fit the definition of a physician. Medicare patients in partial hospital programs or in-patient settings with acute and serious mental illness often have multiple complex medical problems typically requiring several different medications to treat

underlying illnesses. Moreover, these patients often have chronic comorbidities ranging from severe depression to diabetes, hypertension, and cardiovascular disease. Psychologists are not trained to treat acute mental illness requiring medication management or co-occurring physical illnesses. Given the complexity of this patient population, it is essential that we retain collaborative guardrails that require psychologists to consult physicians who have the education and training to effectively manage the entire treatment plan, including both physical and mental health services. However, the passage of H.R. 884/ S. 2772 would put patient safety at risk by allowing psychologists to offer services which they are not trained to perform. Furthermore, H.R. 884 / S. 2772 would not expand access to mental health and substance use disorder services under the Medicare program. In-patient care, including partial hospitalization, requires physician supervision for a reason. Treatment in these settings is for acute mental illness and the overall treatment of physical conditions that requires advanced medical training. Therefore, if psychologists were allowed to manage these patients, they would not receive the full array of medically necessary services they require from an in-patient setting and thus, access to the care that these patients truly need would be curtailed, not expanded. Likewise, this legislation is unnecessary as the Medicare program already recognizes and allows psychologists to provide and bill for the services they are trained to perform and thus, will not actually increase the net number of mental health care providers in the community or the number of services that can be competently performed for patients. Enacting this legislation would decrease the overall access and quality of care received by Medicare patients by inappropriately allowing psychologists to provide services well beyond their education and training. We urge the Committees to oppose H.R. 884 / S. 2772. Sincerely,

American Medical Association American Psychiatric Association

AMDA - The Society for Post-Acute and Long-Term Medicine American Academy of Dermatology Association

American Academy of Emergency Medicine American Academy of Facial Plastic and Reconstructive Surgery

American Academy of Family Physicians American Academy of Ophthalmology

American Academy of Otolaryngic Allergy American Academy of Otolaryngology- Head and Neck Surgery

American Academy of Physical Medicine and Rehabilitation American Association of Child & Adolescent Psychiatry

American Association of Clinical Urologists, Inc. American Association of Hip and Knee Surgeons American Association of Neurological Surgeons American Association of Orthopaedic Surgeons

American College of Allergy, Asthma and Immunology American College of Emergency Physicians

American College of Medical Genetics and Genomics American College of Osteopathic Internists

American College of physicians American Medical Women’s Association

American Orthopaedic Foot & Ankle Society American Osteopathic Association

American Society for Clinical Pathology American Society for Dermatologic Surgery Association

American Society of Addiction Medicine American Society of Anesthesiologists

American Society of Cataract and Refractive Surgery American Society of Plastic Surgeons Association of Academic Physiatrists

College of American Pathologists Congress of Neurological Surgeons

National Association of Medical Examiners North American Neuro-Ophthalmology Society

Society of American Gastrointestinal Endoscopic Surgeons Society of Interventional Radiologists

Spine Intervention Society

Medical Association of the State of Alabama Alaska State Medical Association

Arizona Medical Association Arkansas Medical Society

California Medical Association Colorado Medical Society

Connecticut State Medical Society Medical Society of Delaware

Medical Society of the District of Columbia Florida Medical Association Inc Medical Association of Georgia

Hawaii Medical Association Idaho Medical Association

Illinois State Medical Society Indiana State Medical Association

Iowa Medical Society Kansas Medical Society

Kentucky Medical Association Louisiana State Medical Society

Maine Medical Association MedChi, The Maryland State Medical Society

Massachusetts Medical Society Michigan State Medical Society Minnesota Medical Association

Mississippi State Medical Association Missouri State Medical Association

Montana Medical Association Nebraska Medical Association

Nevada State Medical Association New Hampshire Medical Society Medical Society of New Jersey New Mexico Medical Society

Medical Society of the State of New York North Dakota Medical Association

Ohio State Medical Association Oklahoma State Medical Association

Oregon Medical Association Pennsylvania Medical Society

Rhode Island Medical Society South Carolina Medical Association

South Dakota State Medical Association Tennessee Medical Association

Texas Medical Association Utah Medical Association Vermont Medical Society

Medical Society of Virginia Washington State Medical Association

West Virginia State Medical Association Wisconsin Medical Society Wyoming Medical Society

July 21, 2020 The Honorable Senator Roy Blunt The Honorable Senator Joshua Hawley The Honorable Representative Ann Wagner The Honorable Representative Emanuel Cleaver II The Honorable Representative Billy Long The Honorable Representative Jason Smith The Honorable Representative Lacy Clay, Jr. The Honorable Representative Blaine Luetkemeyer The Honorable Representative Sam Graves The Honorable Representative Vicky Hartzler

On behalf of Missouri’s physicians and surgeons, the Missouri State Medical Association (MSMA) asks you to review the lack of Medicare reimbursement for Assistant Physicians. Missouri is one of four states that license Assistant Physicians. An Assistant Physician is a medical school graduate (MD or DO) and has completed Step 2 of the United States Medical Licensing Examination but has not entered a medical residency program. In Missouri, Assistant Physicians are required to work in collaborative practice arrangements with a supervising physician.

Currently, Assistant Physicians in Missouri experience difficulty gaining employment due to a lack of reimbursement for Medicare services. These physicians can help alleviate the existing shortage of healthcare professionals. MSMA requests that CMS recognize Assistant Physicians as Medicare providers for the purpose of reimbursement. Thank you for your consideration on this matter. Sincerely, Patrick Mills Executive Vice President Missouri State Medical Association

The Honorable Roy Blunt The Honorable Patty Murray

Chairman Ranking Member

Senate Appropriations Subcommittee on Senate Appropriations Subcommittee on

Labor, HHS, Education, and Related Agencies Labor, HHS, Education, and Related Agencies

United States Senate United States Senate

Washington, DC 20510 Washington, DC 20510

The Honorable Rosa DeLauro The Honorable Tom Cole

Chairwoman Ranking Member

House Appropriations Subcommittee on House Appropriations Subcommittee on

Labor, HHS, Education, and Related Agencies Labor, HHS, Education, and Related Agencies

U.S. House of Representatives U.S. House of Representatives Washington, DC 205105 Washington, DC 20515

Dear Members of Congress:

As state medical societies invested in the professional development of America’s healthcare

workforce, we write to encourage you to prioritize the education of healthcare professionals at it

relates to COVID-19. Treatment and care for COVID-19 patients is rapidly changing and can be

expected to evolve over the coming months and years. Therefore, in order to support the vital

education of the nation’s physician workforce, we urge you to appropriate $100,000,000 for Public

Health Workforce Development under the Health Resources and Services Administration (HRSA) in

fiscal year (FY) 2021 to facilitate continuing medical education (CME) initiatives related to COVID-

19.

In nearly every state across the country, state medical societies maintain primary responsibility for

physician licensure, including facilitating and enforcing minimum requirements for continuing

education. These courses are vital in a physician’s career-long educational process, as doctors rely

on CME to improve their ability to diagnose, treat, and care for patients. Moreover, CME courses

reliably improve health professionals’ knowledge and competence, and academic studies

consistently show that physicians who participate in CME are more likely to provide “evidence-

based care” than nonparticipants, resulting in improved patient outcomes.

Since the threat of the novel coronavirus emerged, our societies have dedicated significant

resources to supporting our members in combatting the pandemic and have provided them with

valuable information on the virus. Based on the urgent need, we have held countless webinars,

created educational courses and have distributed CDC guidance to our members since early

February 2020. However, the total cost of educating America’s providers on the impact of COVID-

19 on their practice is expected to be in the hundreds-of-millions of dollars at least — a sum that

simply cannot be absorbed by traditional funders of CME.

Among the specific areas of consideration where additional education is necessary:

• Telemedicine — The currently available education for telemedicine is not state specific

and for the most part needs to be updated. Additional funding could be utilized to develop

state-specific telemedicine education including liability, licensure consideration, proper

techniques and considerations, billing, and coding.

• Infection Control — Large hospitals and facilities have infectious disease service.

Ambulatory practices lack this service and would benefit from learning the proper use of

personal protection equipment (PPE), how to disinfect exam rooms, and how to provide

staff training.

• Disease Diagnosis — The need to diagnose COVID-19 will continue as practices reopen. In

addition to learning how to use testing kits, there are other studies which should be done to

determine whether patients can go home or need to be hospitalized. This is no small issue,

as some patients deteriorate rapidly. Guidance on these decisions will be needed.

• Disease Prevention and Management — The field of COVID-19 prevention and

management is evolving rapidly. The importance of clinicians staying current on the status

of vaccines cannot be understated, as when a vaccine is available, it will slow the spread of

the virus. Until such time, clinicians need information on evidence-based management of

COVID-19, including symptomatic treatment and antivirals.

The deadly impact of COVID-19 will only worsen if physicians are not trained to treat patients with

acute COVID-19 while the pandemic continues and are unprepared to address the myriad of chronic

health consequences many patients may face after they recover from the acute infection. As such,

we ask you to support America’s physician workforce by providing funding to facilitate CME

initiatives related to COVID-19.

Sincerely,

Patrick Mills

Executive Vice President

September 10, 2020

Randall Williams, MD

Director, Missouri Department of Health & Senior Services

PO Box 570

912 Wildwood

Jefferson City, MO 65102

Dear Dr. Williams,

Upon review of the U.S. Department of Health & Human Services guidance issued September 3 regarding

pharmacist administration of the COVID-19 vaccine, the Missouri State Medical Association would like to

share our concerns regarding the safety of this guidance. While allowing pharmacists to order and administer

COVID-19 vaccines may indeed expand access to the vaccine, the physicians who make up our organization

have many concerns about the implications of allowing pharmacists to administer this new medical product.

Our first concern centers around the recentness of the vaccine’s development. While reactions to medications

and vaccines are rare, they can and do occur. At this point in time, the possible side effects from a COVID-19

vaccine have yet to be established. To ensure the highest standard of patient safety, we suggest patients receive

the vaccine from a health care team that includes an available physician in case of a negative reaction.

Storage of the vaccine is also a concern. It is being reported that the vaccine will require cold storage before the

vaccine is administered. While some pharmacies are well-equipped to handle such storage requirements, others

are not.

The most recent information from vaccine developers indicates that the vaccine will require two doses.

Allowing pharmacists to offer the vaccine will make patient adherence and tracking extremely difficult. This

will likely result in two possible outcomes: either patients will wait longer than they should to receive the

second dose, or they will simply not receive the second dose at all.

Ultimately, our greatest concern as physicians is our patients’ wellbeing. To guarantee the safest environment

for patients to receive the COVID-19 vaccine, physician-led healthcare teams should be responsible for

administering vaccines when they are released to the public.

Thank you for your consideration.

Sincerely,

George J. Hruza, MD, MBA, FAAD, FACMS

President

July XX, 2020 The Honorable Nancy Pelosi The Honorable Mitch McConnell Speaker of the House of Representatives Senate Majority Leader U.S. Capitol Building, H-222 U.S. Capitol Building, S-230 Washington, DC 20515 Washington, DC 20510 The Honorable Kevin McCarthy The Honorable Charles Schumer House Republican Leader Senate Democratic Leader U.S. Capitol Building, H-204 U.S. Capitol Building, S-221 Washington, DC 20515 Washington, DC 20510 Dear Speaker Pelosi, Leader McConnell, Leader McCarthy, and Leader Schumer: The undersigned state and national medical societies, representing hundreds of thousands of frontline physicians, thank you for your continued efforts to respond to the COVID-19 pandemic. As you know, this public health crisis is stressing physician practices more than any time in our country’s history. Unfortunately, despite the fragility of physician practices, some see an opportunity to include surprise medical billing provisions in the next COVID-19 relief package. America’s physicians strongly agree that it is critical to protect patients from surprise medical bills, and we firmly believe that a thoughtful, measured federal solution is possible to achieve. However, now is not the time to adopt divisive surprise billing legislation. It is important to note that physicians who have received emergency funding cannot balance-bill coronavirus patients, thus helping ensure that patients do not receive a surprise medical bill during the pandemic. Furthermore, the medical community remains committed to working with Congress to seek a broader solution that protects patients from unanticipated medical bills when their insurer fails to provide them with an adequate network of physicians. At the same time, it is imperative that any solution should facilitate a process to quickly, efficiently, and fairly resolve physician and health plan billing disputes. As conversations regarding a final compromise solution continue, physicians strongly believe that the following provisions are essential to any surprise medical billing legislative solution to ensure patients’ continued access to quality care:

Patients must be protected and should only be responsible for their in-network cost-sharing amounts, including deductibles, when receiving unanticipated medical care.

To keep patients out-of-the-middle of any payment disputes between health plans and providers, provide physicians with direct payment/assignment of benefits from the insurer.

Following the delivery of out-of-network medical care, a reasonable payment should be paid to providers. A benchmark payment rate set at median or mean in-network contract rates or some percentage of Medicare is insufficient because it fails to recognize nuances in individual patient care, will increase health care costs by accelerating consolidation in the health care market, jeopardizes the emergency care safety net and restricts patient access to in-network physicians.

If the provider determines that the insurer’s payment is not reasonable, there must be a fair, accessible and equitable independent dispute resolution (IDR) process to resolve payment disputes. An accessible IDR process must not be restricted to claims above a specific dollar amount/threshold. Providers should also not be limited to accessing the IDR process only after a “cooling off” period. To maximize administrative efficiency, providers should be allowed to “batch” claims for the same or similar service under the same insurance provider. Additionally, this baseball-style dispute resolution process should incorporate a set of dispute resolution guidelines that allow for equal weight to be given to the following elements to ensure a balanced and fully informed decision:

Rates for comparable services in the same geographic region considered reasonable based on commercial insurance rates from an independent and transparent database of all commercial payer claims data;

Any previous contracting history; Demonstration of good-faith efforts (or lack thereof) made by either party (i.e. the out-of-

network provider or the health plan) to enter into network contracts; Market share held by the out-of-network health care provider or the health plan; Level of training, education, experience, outcomes, and quality metrics of the physician

providing the service; Complexity of the services rendered; Individual patient characteristics; and Any additional relevant factors contributed by either party.

Any payment rate base year should be no later than 2018 and should include an appropriate mechanism to ensure that future payments keep pace with inflation.

To prevent surprise medical bills from occurring in the first place, health plans should be held

accountable for provider networks that are appropriate to meet patients’ medical needs — including ensuring access to specialists and subspecialists on a timely basis, including in a facility. Health plans must also ensure that that provider directories are up-to-date and accurate. However, patients must be allowed to access elective out-of-network care when they so choose.

We thank you for your ongoing efforts to provide the resources physicians need to respond to the COVID-19 pandemic. The coronavirus has placed an extraordinary strain on our country’s physicians and hospitals, and it is, therefore, imperative that Congress refrain from actions that will further disrupt the health care system. Like you, we strongly agree that patients must be protected from surprise medical bills, and we reaffirm our commitment to devise a balanced approach. However, the complexity and multifaceted nature of the issues pertaining to surprise medical bills warrants due consideration from Congress. Any final proposal to address unanticipated medical bills should be addressed separately from any forthcoming COVID-19 relief legislation. We thank you for your consideration.

Sincerely,

Cheri Martin

Text Box

#5

Cheri Martin

Text Box

#5

Actions of the Commission on Continuing Education

Actions from the October 13, 2020 Conference Call Attendees: Inderjit Singh, MD-Chair, Ted Groshong, MD, Purvi Parikh, MD, Joan Shaffer, MD, Paul Trentham MD, Doug Wallace, MD, and Benita Stennis, Staff Commission Roster Commission members were given a current member roster and encouraged to contact staff with updates. Annual Convention 2021 Planning: The MSMA’s 2021 Annual Convention will be held Saturday, April 10, 2021 - Sunday, April 11, 2021 at the Westin Crown Center. All General Sessions will be one hour. General Session Schedule Saturday, April 10, 2021 11:00a-Noon Noon-1:00p 1:00p-2:00p 2:00p-3:00p 3:00p-4:00p Potential Topics and Speakers (Confirmation Pending):

1. Coronavirus: Public Health Response-Rex Archer, MD *Parikh 2. Legislative Update-MSMA Lobbyists *Groshong 3. High Value Care in Hospitalized Patients-S. Hasan Naqvi, MD *I. Singh 4. Health Care Disparities-Karen Maddox, MD *Shaffer 5. Stop the Bleed-Laurie Punch, MD *Wallace

*Commission members volunteered to review MOC test questions and presentation slide reviews. Commission members suggested having a panel of speakers for the Coronavirus presentation. Commission members will work with staff to identify panelists to discuss immunizations for the virus and infectious diseases. Provider Updates: Accreditation Decision: Dr. Doug Wallace and Benita Stennis conducted Boone Hospital Center’s accreditation interview on September 24, 2020. Dr. Wallace briefly summarized the survey team’s report. Motion: Boone Health Center should be placed on probation for two years, and if the probationary progress report is accepted, the provider will receive the additional two years of a standard four-year accreditation. Motion Made By: Ted Groshong, MD

Seconded By: Joan Shaffer, MD Vote: Unanimously Approved 2020 Reaccreditations: Staff continues to work with the remaining accredited providers due for reaccreditation in 2020. The CME coordinators from all three facilities were furloughed. Each provider was granted an eight-month extension, and MSMA staff is on target for completing the reaccreditations prior to the extensions expiring. Progress Report Rendered Since July: Electronic Vote Mercy Hospital Springfield –Progress Report approved via electronic vote on August 10, 2020. Provider Accreditation Withdrawal Mercy Hospital South has informed the MSMA that it will no longer offer CME after December 31, 2020. In January of 2021, MSMA will have twenty-two accredited providers statewide. 2021 Annual Maintenance Fee/2020 Annual Report MSMA staff sent the Annual Report correspondence and Annual Maintenance Fee invoice to providers the week of October 5, 2020. MSMA providers will be invoiced $2500 by the MSMA and the ACCME will directly invoice and collect their Annual Maintenance fee (based on its tiered fee structure) from MSMA accredited providers. 2020 ACCME SMS Meeting (Chicago IL): The ACCME SMS Meeting will be held December 9-10, 2020. The ACCME has announced the meeting will be hosted virtually. If members are interested in attending, please let MSMA staff know. Future Conference Call Dates @ 5:30 Tuesday, December 15, 2020 Tuesday, March 9, 2021 Tuesday, June 22, 2021 Tuesday, September 21, 2021 Adjournment: Dr. Singh adjourned the meeting.

2020

Actions on Resolutions from the Annual Meeting

RES # SUBJECT HOUSE ACTION RECOMMENDED COUNCIL ACTION CURRENT STATUS

1 MSMA Women Physicians Section Adopted NA Constitution & Bylaws updated

2Eliminating Barriers in Rural Communities

for Cardiac RehabilitationReferred

Med Econ Commission substitute

resolution adoptedCompose letter to CMS

3 Gender Equity in Healthcare Referred adoptedCompose letter to healthcare

organizations

4

Minimum Standards for Parental Leave

during Graduate Medical Education

Training

Referred adopted Compose letter to AMA

5 Ensuring Affordable Insulin Referred adoptedAdded to MSMA policies; will be carried

out in 2021

6Non-medical Exemptions for

ImmunizationsReferred

Legislative Committee substitute

resolution adopted

Added to MSMA policies; will be carried

out in 2021

7 Research and Recreational Marijuana ReferredLegislative Committee substitute

resolution adoptedAdded to MSMA policies

8 Decriminalization of HIV ReferredLegislative Committee substitute

resolution adoptedAdded to MSMA policies

9Early Entry Pathway to ABIM Initial

Certification ExaminationReferred not adopted

10Medication-Assisted Treatment for Opioid

Use Disorder in Correctional FacilitiesReferred

Legislative Committee substitute

resolution adopted

Added to MSMA policies; will be carried

out in 2021

11 Surprise Billing Referred Legislative Committee

12Ensuring Network Adequacy for MO

HealthNet PatientsReferred Legislative Committee

Updated 8/10/2020

MSMA COUNCIL REPORT, October 1, 2020 Diana Corzine, 2020-21 MSMAA President A summary of our activities follows: We had a virtual Leadership and Business meeting August 14, 2020. We discussed the upcoming Fall Conference. The plan at that time was to meet for Fall Conference at The Elms Hotel in Excelsior Springs. Several members said they plan to attend, and a few declined for health and other reasons. However, after Sana Saleh and I reviewed the possibilities, I decided we would not meet in person after all. The virtual meeting will be October 6, 2020, starting at 10:00 a.m. and ending at 3:00 p.m. We will have Dr. Robert Corder and Dr. Jim Reynolds speaking in the morning and have our board meeting from 1:00-3:00 p.m. At this point, I am planning on us taking a lunch break from Noon to 1:00 p.m. with the Zoom going to allow socialization. Before Covid-19 we decided that the Stop the Bleed program was to be our health project and were going to have all attendees join in. Now, of course at this point, it is also virtual. 2020-2021 AMA Alliance President Sue Ann Greco and MSMAA Immediate Past-President Gillian Waltman presented an overview of the lifesaving Stop the Bleed Program as compiled by the American College of Surgeons. Mrs. Greco and Mrs. Waltman also reviewed the important points necessary to have our State or County Alliances present this program in the future. STB courses may be taught by an EMR, EMT, RN, physician, or paramedic

who has successfully completed a Bleeding Control Basic Course. State or County Alliance should appoint an instructor who will take the

Bleeding Control Basic Course and register to be a Stop the Bleed instructor.

There are a few sites which routinely offer the Bleeding Control Basic Course, but because of Covid-19 those are currently suspended.

The AMAA changed Physician Family Day proceedings this year thanks to Covid-19. Since families and Medical Societies cannot meet in-person, they were invited to submit a Video Salute to the AMAA by August 22. This video was to

honor physicians’ dedication and service to the medical profession. The video was to premier on the AMAA website August 28 at midnight. We will be busy attending virtual meetings this month, and probably more: The North Central States Regional Meeting will be virtual on Saturday, October 3rd from 10:00 a.m. to 1:30 p.m. The AMAA will hold a virtual Zoom meeting for State and County leaders at 11:00 a.m. on the first Thursday of this month and virtual meetings for all members on the third Thursday.

MSMA Insurance Agency Report to Council October 17, 2020 Your Agency has been working to adjust to our new normal when it comes to doing business in a pandemic. For the safety of our staff we have been working with rotating shifts and limiting our travel while trying to maintain the same level of service that are customers have come to expect. On the business side we are having a good revenue year with retention of current clients being a high priority. The Association Health Plan (AHP) continues to make progress with the hopes of being available at the first part of next year. Please keep us in mind if we can be of service to you or any of your peers. Ronnie Staggs 573-635-0320 rstaggs@msma.biz

TO: MSMA Council FROM: Ed Cabbabe, MD

Chair, Missouri AMA Delegation RE: AMA Report to Council DATE: 10/17/20 Your AMA delegation is preparing for the 2020 AMA Interim meeting in November. This will be a virtual meeting of the House of Delegates. AMA members can view and comment on resolutions and reports before the AMA House of Delegates in advance of the meeting by visiting the AMA website. Elie Azrak, MD, has been appointed to the AMPAC Board of Directors. Jerry Kennett, MD, was recently elected the AMA Foundation Board of Directors. Look for a recap of the Interim meeting in Missouri Medicine. Thanks to Dr. Van Way for authoring those updates for the delegation.

September 1, 2020 Elie C. Azrak, MD 13345 Buckland Hall Road St. Louis, MO 63131 Dear Dr. Azrak: On behalf of the American Medical Association Board of Trustees, it is my pleasure to announce your appointment to the Board of Directors of the American Medical Association Political Action Committee (AMPAC). Your two-year term of service on the AMPAC Board will begin December 1, 2020 and end on November 30, 2022. You will be eligible to serve three additional two-year terms, for a maximum tenure of eight years. Kevin Walker, Executive Director of AMPAC, has been notified of the action taken by the Board and will be in contact with you to advise you of the meeting schedule and the duties in connection with membership of the AMPAC Board. Congratulations on your appointment. Sincerely,

James L. Madara, MD cc: Lyle Thorstenson, MD

Todd Askew Kevin L. Walker Missouri State Medical Association

Missouri Physicians Health Program PHF Board of Directors

COUNCIL REPORT 3rd Quarter 2020

July 1 to September 30, 2020

1023 Executive Parkway, Suite 16 St. Louis, MO 63141

800-958-7124

Current Geographic Distribution (current participants 2019) 2020 Participants

Specialties (current participants)

Saint Louis 32 2020 New Participants 20 Anesthesiology 7Kansas City 16 Note: 2019 total new participants was 28 Cardiology 3Springfield 3 Participants Released Cardiothoracic Surgery 0Columbia 17 Successful Completion 21 Dermatologist 0Joplin 4 Administrative Release 5 Emergency Medicine 6Poplar Bluff/CapeGirardeau 6 Deceased 1 Family Practice 14Other 8 Hospitalist 1

Internal Medicine 13Medical Students 5Orthopedics 4

Total 86 TYPE OF CONTRACT Neurosurgery/Neurology 2Recovery 76 OB/GYN 5

Oncology 5Mental Health 7 Optometry with MD 0

Otolaryngology/Otology 1Mental Health/Recovery 3 Pathology 0

Pediatrics/neonatal/oncol 3Plastic Surgery 0Proctology 1Psychiatry 3

Referrals for this quarter 15 Pulmonary Critical Care 1Total for year 29 Radiology 5

Potential participants in Residents 4treatment or in process of signing Rheumatology 0agreement with MPHP 11 Surgery 3

Urology 0

Total 86

9%7%

5%

20%

3% 19%

37%

Saint Louis Kansas CitySpringfield ColumbiaJoplin Poplar Bluff/CapeGirardeauOther

Physicians Health Program Statistics 3rd Quarter 2020 - July 1, 2020- September 30, 2020

Sponsored by the Missouri State Medical Association

Supplementary-Revenue Information 3rd Quarter (Sept 30, 2020)

Annual Budget YTD 2020 Contributions $325,000 $145,467 Participant Fees $240,000 $172,932 TOTAL INCOME $565,000 $318,399

1023 Executive Parkway, Suite 16 St. Louis, MO 63141

Tel: 800-958-7124 Fax: 314-569-9444

www.themphp.org info@themphp.org _______________________________________________________________________________________________________________________

GET INVOLVED TODAY! MSMA is now accepting volunteers for Physician of the Day for the upcoming

2021 legislative session!

As Physician of the Day you will come to the state capitol to help legislators and their staff with minor aches and sniffles on a Tuesday, Wednesday or Thursday during the legislative session. During your time, MSMA volunteers almost always get to meet their local legislators and get introduced in the House or Senate chambers. It’s a great experience and a great service to our legislators. All specialties are welcome and encouraged to serve! Volunteer today! Days will start filling up quickly. Don’t miss your opportunity to be the medical voice in the state capitol.

VOLUNTEER HERE!

September 2020

MSMA Membership

Actives 2015 2016 2017 2018 2019 2020 2021 Honor 2015 2016 2017 2018 2019 2020 2021

September 398 410 148 278 211 405 438 September 212 135 97 99 182 117

October 960 975 780 828 792 711 October 294 225 235 238 250

November 1364 1456 1066 1280 1145 1150 November 322 334 291 309 304 292

December 1936 1756 1526 1609 1536 1559 December 401 376 359 347 342 324

January 2345 1995 1855 1892 1727 1822 January 430 398 375 369 350 342

February 2529 2229 1954 2101 1953 1923 February 455 445 387 383 362 353

March 2641 2386 2223 2195 2052 2027 March 465 448 397 395 365 356

April 2709 2489 2359 2238 2078 2062 April 467 449 403 398 367 357

May 2761 2528 2400 2262 2116 2080 May 485 450 404 400 369 357

June 2849 2602 2441 2269 2139 2090 June 475 450 406 402 369 357

July 2919 2685 2523 2349 2201 2091 July 475 452 408 401 369 357

August 2938 2692 2530 2381 2226 2091 August 476 455 408 403 369 358

variance ‐258 ‐246 ‐162 ‐149 ‐155 ‐135 ‐1653 variance ‐21 ‐47 ‐5 ‐34 ‐11 ‐241

variance ‐8.1% ‐8.4% ‐6.0% ‐5.9% ‐6.5% ‐6.1% ‐79.1% variance ‐4.4% ‐10.3% ‐1.2% ‐8.4% ‐3.0% ‐67.3%

Residents  2015 2016 2017 2018 2019 2020 2021 Students 2015 2016 2017 2018 2019 2020 2021

September 6 2 142 45 46 41 335 September 798 896 1017 679 644 646 1646

October 44 39 81 93 46 56 October 910 962 982 694 692 673

November 50 85 93 96 86 93 November 994 945 978 771 701 677

December 51 84 98 99 90 95 December 1021 947 975 780 701 683

January 42 84 101 100 92 100 January 1042 949 962 794 709 689

February 44 85 107 100 100 105 February 1041 954 960 808 716 695

March 47 86 111 100 103 106 March 1054 958 958 818 727 698

April 86 86 115 103 103 168 April 1056 963 957 823 738 736

May 87 93 117 106 105 238 May 1056 959 930 826 739 748

June 87 93 118 108 105 326 June 1056 959 930 829 739 754

July 88 104 129 112 113 320 July 1053 986 892 835 740 775

August 95 130 169 112 115 322 August 1048 916 724 835 740 1547

variance 40 35 39 ‐57 3 207 13 variance 29 ‐132 ‐192 111 ‐95 807 99

variance 72.7% 36.8% 30.0% ‐33.7% 2.7% 180.0% 4.0% variance 2.8% ‐12.6% ‐21.0% 15.3% ‐11.4% 109.1% 6.4%

ALL 2015 2016 2017 2018 2019 2020 2021

September 1202 1520 1442 1099 1000 1274 2536 Comparison to same time prior year

October 1914 2270 2068 1850 1768 1690 2020 2021 change

November 2730 2820 2428 2456 2236 2212 Actives 405 438 33 8.1%

December 3409 3163 2958 2835 2669 2661 Retired 182 117 ‐65 ‐35.7%

January 3859 3426 3293 3155 2878 2953 Residents 41 335 294 717.1%

February 4069 3713 3408 3392 3131 3076 Students 646 1646 1000 154.8%

March 4207 3878 3689 3508 3247 3187 ALL 1274 2536 1262

April 4318 3987 3834 3562 3286 3323

May 4389 4030 3851 3594 3329 3423

June 4467 4104 3895 3608 3352 3527

July 4535 4227 3952 3697 3423 3543

August 4557 4193 3831 3731 3450 4318variance ‐189 ‐364 ‐362 ‐100 ‐281 868 ‐1782

variance ‐3.9% ‐8.0% ‐8.6% ‐2.6% ‐7.5% 25.2% ‐41.3%

MSMA Membership Committee September 16, 2020, Conference Call Minutes

Committee members present: James DiRenna, DO, Chair; Alexander Hover, MD; Lancer Gates, DO; Laurin Council, MD; Ramona Behshad, MD; and David Kuhlmann, MD MSMA staff present: Liz Fleenor, Jeff Howell, Patrick Mills, Benita Stennis, and Haley Wansing James DiRenna, DO, called the meeting to order at 6:00 p.m. Upon a motion, the July 1, 2020, Meeting Minutes were approved. As of Aug. 31, MSMA has 2,091 active members and 358 retired members. The first 2021 membership renewal billing mailed Sept. 4, preceded by a renewal email to membership. 700 postcards have been sent to newly licensed physicians in Missouri since April 2020. A half-price prospect mailing was not sent this year. Unpaid members continued to receive MSMA communications during the legislative session. Analysis of MSMA’s young physician members shows, since 2015, 158 young physicians joined MSMA in their first, second, or third year of practice. 104 are still MSMA members and 48 are now renewing their memberships as active members. We have 322 resident members, nearly triple since Council eliminated dues for residents in April 2020. We have 1,547 student members. Student enrollment rates are SLU – 98%, UMC – 50%, UMKC – 21%, Wash U – 18%, KCU – 15%, and ATSU – 11%. Dues ROI through influencer marketing by leadership totals $35,632 from direct mail since Oct. 2019 and $17,775 from email outreach since Feb. 2020. This month MSMA leadership is signing 3,582 letters to prospects, 720 to include a 2020 Legislative Review, as well as 230 letters thanking new members for joining. Leadership has helped supply missing email addresses for current MSMA members. Letters to CMOs were mailed by Drs. Azrak, Cabbabe, Gates, and Hruza in June and July. MSMA has a 12-month lease with Redi-Data for 11,158 physician email addresses. The committee reviewed MSMA letters and the new Legislative Timeline while discussing MSMA communications to nonmembers, specifically younger audiences and employed physicians. A virus/vaccine panel discussion may generate interest. To promote free membership to residents, Grand Rounds is an avenue MSMA will explore. In addition to enhancing our digital communications and MSMA visibility, staff is researching Association Management Software. To assist Missouri physicians with obtaining necessary PPE and as an added-value member benefit, MSMA has partnered with Action PPE. MSMA Virtual Advocacy Meetings by District take place through Oct. 1 and will be reframed in 2021. The call adjourned at 6:45 pm.

Oct. 2019 - Sept. 2020

MSMA LeaderNew/re-joined members

from letters

Dr. Ahlum 3Dr. Azrak 2Dr. Barbe, D. 6Dr. Barjenbruch 2Dr. Biggers 2Dr. Brennan 2Dr. Cabbabe 2 21 *Dr. Conant 4Dr. Corder 1Dr. Corrado 2Dr. Curtis 2Dr. DelCampo 2Dr. DiRenna 4Dr. Drees 2Dr. Fasuyi 5Dr. Gates 4Dr. Hardin 1Dr. Hierholzer 1Dr. Hover 2 2 Dr. Hruza 5 Dr. Hubbell 2 6 Dr. Kolli 2Dr. Kuhlmann 3 Dr. Lammert 2Dr. Loethen 2Dr. Lovinger 1 Dr. O'Dell 5Dr. Ratcliff 4 Dr. Singh 1Dr. Stinson 2Dr. Swearengin 1Dr. Swingle 1 2 Dr. Taormina 2Dr. Thomas 4Dr. Turner 2Dr. Van Way 8 4 Dr. Wallace, D. 5Dr. Wallace, S. 3Dr. Weaver 1Dr. Weigand 3Dr. Weikart 4Dr. Zguta 1 3 Dr. Zhu 2

102 51

$35,631.79 ROI on Letters since 10/2019 $17,775.00 ROI on Emails since 2/2020

* 16 emails sent by Haley, subject: "A Message from Dr. Cabbabe"

MSMA Influencer Marketing Report

Renewed members from

emails

Feb. 2020 - Sept. 2020

Location

January 16, 2021 Video conference

April 9, 2021 & April 11, 2021 Westin Kansas City at Crown Center

July 17, 2021 Video conference

October 16, 2021 & October 17, 2021 DoubleTree Hotel, Jefferson City

January 22, 2022 Video conference

February 24, 2021 Deadline for Resolutions - 5:00 p.m.

April 10, 2021 - April 11, 2021 Westin Kansas City at Crown Center

Date

FUTURE COUNCIL MEETINGS

FUTURE ANNUAL CONVENTION DATES

Please reply promptly when you receive meeting notices. If we are meeting in person, please indicate your hotel room preference and how many meals we should plan for. If your plans change and you cannot attend, please let us know so that we can adjust our numbers to avoid unnecessary charges.

Ways to reply:

Email - cmartin@msma.orgPhone - 573/636-5151