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Physicians Advancing Health Care

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a newsletter for the medical communityTulsa Medicine»

August 2017

For further information about the following meetings,email tcms@tcmsok.org or call 918-743-6184

August 1, NoonOSU 1st Year Student OrientationOSUAugust 10-11EXPLORE HealthcareSummit 2017Embassy Suites, NormanAugust 12, 8-3pmThe Joy of MedicineTCMS/Hillcrest CMERiver Spirit CasinoAugust 18, NoonOU 1st Year Student OrientationOU-TulsaAugust 19, 11amStudent-Resident SocialTulsa ZooSeptember 12, 5-8pmPLICO Evening RoundsTCMSSeptember 13, PLICO Rounds, 11am-1:45pmPLICO Evening Rounds 5-8pmTCMSSeptember 14, 6pmOB/GYN SocietyTCMSSeptember 21, 6pmTCMS Foundation Board MeetingTCMSSeptember 28, 5-8pmPLICO Evening RoundsTCMSOctober 12, 6pmOB/GYN SocietyTCMSOctober 25, 5-8pmPLICO Evening RoundsTCMS

PRESIDENT’S LETTER Michael Weisz, M.D.

In MemoriamDelbert O. Williams, Jr., MD

June 30, 2017

Dr. Peter Aran and I recently represented Tulsa County Medical Society at the Tulsa Regional Chamber Health Care Advocacy Task Force. Dr. John Schumann chairs the Task Force which brings together a diverse group of organizations and individuals with direct and indirect connections to health care.

The Task Force will meet again on August 7 and August 14 to vote on top state and federal priorities to present to the OneVoice Regional Legislative Summit scheduled in September. The meetings are held in the Saint Francis Health System Room at the Tulsa Regional Chamber and begin at 9:00 a.m. The meetings are open so if you are interested in attending contact Mona at TCMS, mona@tcmsok.org, to make a reservation.

There was a great dialogue at the meeting of both opportunities and challenges. It was interesting to hear different perspectives on important issues, including; the state budget/revenue failure, mental health/substance abuse, reimbursement, Medicaid expansion, health care reform, and population health. Also, of note was a discussion on the economic impact of physicians in the community.

The following is a list of 2017 OneVoice priorities that remain relevant:

Expand Insure Oklahoma: this issue was further discussed with OHCA CEO Becky Pasternik-Ikard on July 31st and a report will be presented to the Health Care Task Force on August 7. The group discussed the need for increased verbiage surrounding the economic impact of health care. There was additionally discussion of weighing in on the state’s Section 1332 waiver program, and looking at Nevada’s proposed buy-in program in reframing how this issue is discussed.

Behavioral Health Services: The chair noted the importance of this issue and maintaining some version of it on the task force’s slate. Richard Wansley of the Mental Health Association Oklahoma gave an update on the state mental health department’s funding, including budget cuts. He noted, however, that certain aspects of the statement may not be needed, including the reference to the Mark Costello Act. Additional discussion noted the prevalence of opioid addiction; the relevance of behavioral health issues to homelessness; the importance of noting the economic impact of health care and this issue; and the possibility of examining budget solutions as a whole.

FQHC Uncompensated Care Pool: Jim McCarthy with Community Health Connection and Susan Savage with Morton suggested this issue is secondary for FQHCs to larger Medicaid funding. They noted that there had been an erosion of funding for their facilities via the formula used to distribute uncompensated care money. It was also suggested that consideration be given to suggesting the uncompensated care fund be moved from the State Health Department to the Health Care Authority’s oversight.

Healthcare Workforce Expansion: There was discussion of the use of telehealth in the statement, and whether this should be reframed as support for virtual care. Richard Wansley with MHAOK suggested noting OSU’s Project ECHO initiative, and Eric Polak with OSU-CHS gave an overview of the program. There will be further discussion of the NP issue at the August 7th meeting.

Federal issues: The group did not have time to discuss federal issues in-depth. However, it was discussed that the task force will likely want to weigh in on federal health care reform and the Affordable Care Act’s replacement. This may include discussing mental health as defined as an essential service. Additionally, Richard Wansley with MHAOK noted that the federal mental health reform statement was largely accomplished by federal legislation late in 2016. However, a Parkside hospital representative, Eric Sachau, suggested that parity is still an issue that may need to remain on the slate of issues. New statements: Teresa Burkett with Conner & Winters suggested creating a new statement on Health Information Exchanges and the ability to share data across state lines.

If you don’t have time to attend the Task Force meetings but would like to receive a copy of the minutes, please let Mona know.

August is a busy month for TCMS and OSMA, see the meeting schedule on the right and let us know if you can join us for any of the upcoming events.

2017 LEGISLATIVE OVERVIEW

Budget Deal Avoids Drastic Medicaid CutsA state budget that minimizes cuts to the Oklahoma Health Care Authority (OHCA) passed the House and Senate and was signed by the governor, marking the end to a tumultuous legislative session. OHCA’s funding will increase about $36 million. Unfortunately, that still leaves it about $33 million short of funding needed for current services and reimbursement. The Health Care Authority now says, if this budget holds, they believe they can get through the next year without further provider rate cuts.

A $1.50 cigarette fee, advocated for by OSMA, provides a significant portion of the funding needed. Since it is a revenue-raising measure passed within the last five days of the legislative session, its constitutionality has already been challenged. State law prohibits such action late in the session. No matter what lies ahead, increasing the cost of cigarettes to fund healthcare has to be part of solving this shortage,” said Kevin Taubman, M.D., president. “Healthcare to the 20 percent of our state’s citizens who rely on this for basic healthcare services must be protected,” “Taubman called the passage of an increase in the cigarette fee a ‘home run’ for Oklahomans’ health. The price for cigarettes is the single largest predictor of the likelihood of minors to take up the tobacco habit. Very simply, it will save lives.” Citing Oklahoma’s cigarette pricing in comparison to other states, Taubman said he believes further increases should be considered and we will advocate for that. “We need to expand this to smokeless tobacco as well, he added.”

The Big Tobacco industry filed suit against the new law, alleging it violates a state constitutional provision which prohibits passage of revenue-raising measures in the last five days of the session. However, prior court precedent has held that such measures may be permissible if the fee in question has proven public benefit and the funds raised are ancillary to the purpose of the bill.

OSMA filed an amicus brief with the Oklahoma Supreme Court in July in support of the $1.50 tobacco fee passed by the legislature during the last days of session. OSMA was joined in the filing by the Campaign for Tobacco-Free Kids, American Cancer Society Cancer Action Network and the American Lung Association of Oklahoma. The Supreme Court is scheduled to hear arguments on the case on August 8.

Nurse Practitioner Bill Not HeardHB 1013, the measure that would have given nurse practitioners full independent practice and prescriptive authority, was not heard in the Senate Health and Human Services Committee. After not meeting the legislative deadline for bills to be out of committee, the bill is now dead for this year. We are grateful to Sen. Ervin Yen, MD and Senate leadership for preventing the bill from advancing and working to protect patient safety. However, while this was an important victory, this is certainly not the time to rest on our laurels. We must keep up the drumbeat about this issue and why it is not in the best interest of Oklahoma patients. The bill will carry over to next session and could be considered then. Proactive efforts are underway now to develop strategies to address this issue before the 2018 legislative session.

Tanning Bill Signed Into LawAfter going through one of the more convoluted legislative processes we’ve ever seen, a measure that will protect Oklahoma’s youth from the dangers of skin cancers was finally signed into law. SB 765 by Sen. Ervin Yen, MD and Rep. Katie Henke will prohibit minors from being allowed into tanning booths. The bill originally failed in the Senate, but Dr. Yen was able to have the bill reconsidered and it passed. In the House, the bill was assigned to two different committees and was never heard, but was brought to the House floor via an obscure rule allowing committee members to sign it out without a hearing. It passed the House April 25 and was signed by Governor Mary Fallin. TCMS is very grateful for its member dermatologists who have worked so diligently on this issue for several years. We would also like to congratulate the TCMS/OSMA Medical Student Section, which adopted this as their legislative issue for the year, and our partners at the American Cancer Society for all of their hard work.

Administrative Rules Bill VetoedAs long-time OSMA members know, many of our most heated scope of practice battles over the years started not at the Legislature, but with a licensing board drafting a new rule expanding what their licensees could do. And there was little that could be done, short of getting the Legislature to vote to reject the rule. HB 1552 was our effort this year to rein in overactive licensure boards by requiring their rules to be approved—rather than disapproved—by the Legislature. The bill passed both chambers of the Legislature by significant margins but was vetoed by Governor Fallin, claiming it would diminish the role of the executive branch in the rulemaking process. We have already had discussions with the bill authors and will continue working on this issue

TCMS Immediate Past President, Peter Aran, M.D., has recently been selected to represent the American Medical Association (AMA) on the Accreditation Review Committee of the ACCME. He will begin serving in February. Dr. Aran is a gastroenterologist and longtime physician executive and hospital board member. Currently, he is medical director of population health management for Blue Cross Blue Shield of Oklahoma.

Nationally, he has led the AMA’s section on medical schools/academic physicians, the organized medical staff section and numerous education committees. Congratulations Dr. Aran.

SAVE THE DATEMarch 18-23, 2018

TCMS CME CRUISEDeparting from Fort Lauderdale. Ports of call include Nassau, Charlotte Amalie, St. Thomas,

Basseterre, St. Kitts & Nevis.

For more information contact

mona@tcmsok.org or 918.743.6184

The OSU Center for Health Sciences is expanding its Project ECHO (Extension for Community Healthcare Outcomes)

service lines, allowing better patient care in Oklahoma.

Developed by the University of New Mexico Health Sciences Center, Project ECHO increases access to specialty care to rural and underserved communities.

The heart of the ECHO model is its hub-and-spoke knowledge sharing network, led by expert medical teams who use multi-point videoconferencing to conduct virtual clinics with community providers. This allows primary care doctors, nurses and other clinicians to learn to provide excellent specialty care to patients in their own communities.

Through weekly videoconferences, Project ECHO trains and mentors primary care providers to care for patients with complex conditions. The Project ECHO model is based on the principle of sharing medical knowledge with primary care providers on a continued basis until the primary care providers develop the necessary specialty knowledge to care for their patients.

OSU-CHS currently offers the following service lines:

Obesity Medicine ECHO provides support on best practices and evidence-based care for children and families struggling with overweight and obesity. There are educational components on prevention and assessment. They advise on screening and diagnosis for common morbid conditions.

Addiction Medicine ECHO is designed to expand expertise in treating substance use disorders in the primary care setting. Increase knowledge of up-to-date evidence-based substance use care.

Psychiatry ECHO allows primary care physicians to speak with psychiatric specialists to make recommendations on treatment.

HIV/Viral Disorders ECHO is scheduled to begin in September.

With our Project ECHO services lines, OSU-CHS is expanding our healthcare delivery reach to underserved communities in Tulsa and to rural communities in Oklahoma. Project ECHO enables OSU-CHS to bring the care to the patient instead of having the patient come to an OSU-CHS clinic.

In addition to the medical information, those participating physicians may receive free CME credits for their efforts.

OSU-CHS is fortunate to have tremendous leadership in place at all levels -- institutional, university and regent. President Kayse Shrum, D.O. has worked to build trust amongst all the key decision-makers within the OSU system. She has championed the Project ECHO at OSU, securing the support of President Burns Hargis and of the OSU/A&M Board of Regents. The leadership within the OSU system recognizes the potential of Project ECHO to transform the delivery of health care in rural and underserved areas of Oklahoma. At present, OSU-CHS is the only academic health center in Oklahoma that has launched Project ECHO. President Shrum believes that the healthcare challenges that we face in Oklahoma such as mental health and opioid addiction are too significant to ignore. Given our institutional assets (clinical care capacity, knowledge distribution network, and cooperative extension offices), OSU-CHS is uniquely positioned to address these challenges through the Project ECHO model. Primary care providers such as physicians, physician assistants, nurse practitioners and nurses, can participate into the Project ECHO program free of charge. Financial support of Project ECHO service lines in addiction medicine and psychiatry is made possible through the support and generosity of the Anne and Henry Zarrow Foundation. OSU-CHS also received financial support for Project ECHO from Jack Allen, Jr. and from the Telligen Community Initiative.

For more information about Project ECHO contact Tara Jackson, tara.m.jackson@okstate.edu, 918-561-1460 or visit www.echo.okstate.edu

Benefits of ECHO

By participating in the OSU-CHS TeleECHO Clinics, primary care provides will:

• Obtain knowledge from specialists• Obtain CME credit for participation• Advance knowledge to improve patient care• Engage with an expert team and collaborate with the ECHO community• Be able to provide psychiatric care in your own communities instead of referring long distances for specialized care

Tulsa County Medical Society5315 South Lewis AvenueTulsa OK 74105-6539

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