Kansas City Medicine - April 2015

APRIL 2015 JOURNAL OF THE KANSAS CITY MEDICAL SOCIETYPHYSICIANS IN LEADERSHIP ROLESWhat does it take?What are the rewards? kansas city medicine 1

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— january-april 2015 —Leadership Cover Feature 21 The Leadership Journey Four physicians share their insights on achieving senior leadership positions and its rewards: Melinda Estes, MD; Michael O’Dell, MD; Joshua Mammen, MD; Cori Mason, MDNews Commentary kcms Annual Meeting 20145 Note from the Editor 12 Kansas Patients to Receive 30 Meeting Highlights: Real-Time Estimates of Cost Share “Inspiring Health Together”5 Physicians Advocate for Missouri By Jim Denning, Editor, Kansas State Senator Tort Reform 34 Lifetime Achievement Awards Response by Joshua Mammen, MD, KCMS • Charles W. Van Way, III, MD5 KCMS Partnership to Provide Government Relations • William A. Reed, MD Exams to Children Entering Foster Care from the Dean’s Office Practice managementEditorially speaking 15 Brave New World of Graduate 36 Accountable Care Organizations Medical Education Accreditation May Increase Professional Liability6 Who You Gonna Trust? By John J. Dougherty, DO, Kansas City Risks By Charles W. Van Way III, MD University of Medicine and Biosciences By Tom McNeill, The Keane Insurance Group, Inc.Commentary 18 Great Expectations: 38 Is Strategy Driving Your Marketing What the Next Accreditation Plan8 Myths and Facts About System Will Mean for Graduate By Julie Amor, Amor Consulting E-Cigarettes Medical Education By Donald A. Potts, MD By Christine Sullivan, MD, University of on the cover: Missouri-Kansas City School of Medicine10 Advancing Life Sciences Cori Mason, MD, with physicians from An- for the Region esthesia Associates of Kansas City, from left, By Wayne Carter, Kansas City Life Sciences Brian Casement, MD; Christopher Dixon, MD; Institute Ryan Grindstaff, MD, PhD; Kevin Policky, MD; and Scott Henderson, MD. See her thoughts on leadership along with those of other physician leaders starting on page 21. kansas city medicine 3

(USPS 227-680) Editor Volume 109, Number 1 Charles W. Van Way, III, MD Official publication of the Kansas City Medical Society Contributing Editors www.metromedkc.org Nate Granger, MD, MBA John Sheldon, MD Kansas City Medicine (ISSN 0894-508x) is published five times a year by the Kansas City Medical Society. Contents of the Staff Angela Broderick-Bedell, CAE, Executive Director publication are protected copyright, and no part or portion may Stacy DeMeyer, Manager, Membership & Events be reproduced without permission of the publisher. Periodical Kate Gingras, Manager, Community & Technology postage paid at Kansas City, MO (USPS 227-680) and at other Send all advertising inquiries to: Angela Broderick-Bedell mailing offices. Subscription price to physicians, $10.00 per Phone: (816) 531-8432, Fax: (816) 531-8438 year; to all other persons, $50.00 per year. Postmaster: Please send address changes to Kansas City The Kansas City Medical Society in no way endorses opinions Medicine at the above address or statements contained in this publication except those that accurately reflect official action of the Society. Acceptance of ad- vertising in this publication in no way constitutes professional approval or endorsement of products or services which may be advertised. The Kansas City Medical Society reserves the right to reject any advertising material submitted for publication. All communication should be sent to: Kansas City Medical Society, 315 Nichols Road, Suite 250, Kansas City, MO 64112, Phone: (816) 531-8432, Fax: (816) 531-8438. Kansas City Medical Society Board of Directors Other Representatives (non-voting) James DiRenna, DO, MSMA Councilor Michael O’Dell, MD, President Josephine Doo, UMKC student Lancer Gates, DO, Past President Betty Drees, MD, MSMA Councilor Mark Flaherty, JD, Legal Counsel Rob Caffrey, MD, Treasurer Mike Haines, CPA, Financial Counsel Michelle Haines, MD, Secretary Rebecca Hierholzer, MD, AMA Alternate Delegate Stephen Salanski, MD, President-Elect Karen Highfill, Medical Group Management Association of Kansas City Thomas Allen, MD, St. Joseph & St. Mary’s Medical Centers Ashley Huppe, MD, KUMC Resident Anthony Fangman, MD, Saint Luke’s North Hospital Scott Kuennen, MD, Mid-America Coalition on Health Care Carole Freiberger-O’Keefe, DO, Saint Luke’s Hospital of Kansas City Corey Offut, MD, Truman Lakewood Family Medicine Resident Alan Forker, MD, John Locke Society John O. Stanley, MD, MSMA President-Elect John Gianino, MD, Truman Medical Centers Tony Sun, MD, Chair, Medical Directors Council John C. Hagan III, MD, Discover Vision Centers Marc Taormina, MD, MSMA Vice Councilor Rahul Kapur, MD, Kindred Hospital Kansas City Charles W. Van Way III, MD, AMA Alternate Delegate Scott Kujath, MD, North Kansas City Hospital Thomas Lovinger, MD, Saint Luke’s East Hospital Joshua Mammen, MD, University of Kansas Medical Center Jimmer Miller, MD, Olathe Medical Center Vernon Mills, MD, Kansas City Medical Society Scott Roethle, MD, Anesthesia Associates of Kansas City Keith Sale, MD, Kansas City Society of Ophthalmology & Otolaryngology Jon Schultz, MD, Truman Medical Centers Blake J. Williamson, MD, MS, At-Large Casey Willimann, MD, Liberty4 april 2015

Help@Hand: new KCMS partnership providing exams to children entering foster care note from the Editor Children brought into state custody in for seeing children within 24 hours of be- Jackson and Cass Counties need a com- ing brought into care cannot be accessed. Welcome to the new Kansas City Med- plete physical examination according to When appointment needs are filled, aicine. And yes, our new name goes right State of Missouri rules, and the standard follow-up text simply stating “exam needalong with our society’s new name, Kansas is that these exams are conducted within filled” will be sent to the group of physi-City Medical Society. It’s a new year, 24 hours after coming into care. It is often cians contacted.and we’re getting a new start. This issue, challenging for agencies to get this examJanuary-April, is a big issue, with a lot of for the child. Physicians/practices can offer theirmaterial from the past months, and full services on a volunteer basis, but thesereports of the annual meeting in October. The Kansas City Medical Society and children are also covered by Medicaid.Please don’t expect this large an issue in the Medical Group Management Associ-the future, but we do intend to expand the ation of Kansas City are partnering with The three organizations are developingjournal considerably. Cornerstones of Care to recruit physicians a system to document the success of the who will provide physical examinations initiative and to improve upon short- We will be back on a regular schedule for some children taken into foster care in comings that may be identified. Baselinethis year. You can look for future issues Jackson and Cass Counties. Help@hand is information will include the number ofof Kansas City Medicine in June, August, an initiative of the three organizations to physicians participating, the number ofOctober and December. better serve children the state takes into children served, the number of examina- custody. tion hours provided and of that time, how Next month, we will be introducing our much was donated.“theme” issues. Each issue, we will high- Volunteers will receive messages fromlight medical and scientific articles from Cornerstones through the Medical Soci- To volunteer your practice to see thesea local group, division, or department. In ety’s DocBook MD, a HIPAA-compliant children, or for more information, contactMay, we will feature five articles from the texting service, when the usual resources Jessica at [email protected], orDivision of Cardiothoracic Surgery, Kansas call the office at 816-531-8432.University Medical Center, University ofKansas School of Medicine. In addition, Physicians Advocate for Missouri Tort Reformof course, we’ll have medical society news,articles on the business of medicine,invited editorials and other contributions,and, of course, my “Editorially Speaking.”Yes, it’s time for me to sharpen my meta-phorical pen and analyze social, political,and scientific trends in today’s health careenvironment. I think of this as a combi-nation of writing and surgical dissection.With a bit of humor, of course. I hope tostimulate your interest and your thinking.We welcome your comments and feedbackon our publication.charles w. van way, iii, md Physicians from across Missouri spent the day of Feb. 24 at the Missouri Capitol lobbying for tort reform and other issues of importance. KCMS President Michael O’Dell, MD, led the Kansas CityEditor-in-Chief, Kansas City Medicine delegation. As of March 18, the tort reform bill (SB 239) has passed the Senate but must still go through committee and a final vote in the House. kansas city medicine 5

Editorially speaking Who You Gonna Trust? By Charles W. Van Way, III, MD, Editor, Kansas City Medicine“Reader, suppose you were an idiot. where that idea came from. Why in the one thing. People out in Wichita, Kan.And suppose you were a member of world should we trust them? or Peoria, Ill. or Los Angeles, Calif.Congress. But I repeat myself.” don’t have to come to D.C. to learn OK, I do remember my early high how things really work. They can just- mark twain journalist, around 1870 school civics classes. But I took them turn on the TV or the Internet. Truly, in Washington, D.C. Taking civics anyone over 18 who doesn’t know what“Remember that a government big in the D.C. area was probably very things are really like are just foolingenough to give you everything you different from taking it in, say, Topeka, themselves. And when people find outwant is also big enough to take away Kan. Sure, we learned all about how how things really work at the nationaleverything you have.” the government was supposed to work. level of government, and at the state But in D.C., even kids knew people in level, they begin to get cynical. Who- davy crockett, one-time member can blame them? As the 19th century of congress, around 1830 If we treat our patients German leader, Otto von Bismarck, with more respect famously said, “No one should watch We have a crisis of trust. Yes, we do. sausages or laws being made.” Now,Or at least, that’s what the pundits and today, and allow them the whole warts-and-all legislativethe talking heads tell us. They do have more say in their own process is all over evening television.reason. Polls say that less than 20% of care, doesn’t that speak Necessary though it may be, it’s messypeople approve of Congress. More than to more mutual trust and repulsive. And if the evening newshalf of Americans think the President overlooks any disgusting tidbit, some-tells untruths. Politicians use the IRS rather than less? body on the Internet will jump all overto go after their opponents. More than it. It’s small wonder that we don’t trustthat, lots of people don’t trust each oth- politics. My friends’ parents were often anyone inside the Beltway.er. Republicans don’t trust Democrats, politicians, bureaucrats, or lobbyists.and vice versa. Conservatives don’t It all looked a lot less idealistic than it Then, too, there are cycles in ourtrust the IRS. Liberals don’t trust Wall did in civics classes. Then, as now, it relationship with government. DuringStreet, except when they need cam- looked like a game. None of us be- World War II, people became used topaign contributions. Even then, they lieved the idealism. From the ninth very intrusive government. Conscrip-cash the checks rapidly, lest the donor grade on, we were skeptical about our tion was well-received. Price controls.go broke or get caught. government. On the other hand, folks Concentration camps (Yes, we did, for out in the rest of the country often Japanese-Americans, Quakers, and But … is it really a crisis? Have we believed in the idealized picture. You others). Taxes were high, and goodsbecome Greece? Actually, as evidenced know, the whole “Mr. Smith Goes to were rationed. After the war, in theby the two 19th century quotations Washington” thing. People actually 50’s, people didn’t want as much gov-above, the “crisis” is nothing new. believed that was the way it works. ernment. They were just fed up withWe’ve long been highly skeptical both the whole thing. Words describing theof politicians and government. The So what’s different today? Well, we government, such as “snafu” and “reddifference today is that we have some- have much better communications, for tape” had been coined during the war,how acquired the idea that it’s a Bad and were widely used. But then gov-Thing to mistrust politicians, bureau- ernment became popular again, thiscrats, and political zealots. I’m not sure time as an agent of change and reform.6 april 2015

We had the civil rights movement, independence. That may well erode “big tent” political parties in the 1950’s,Medicare, and much else. But after that public trust in our profession. 60’s, and 70’s, to the more British/Eu-came Vietnam, and people became ropean system of ideologically definedcynical once again. We had prosperi- What will happen as health care parties. As anyone who follows Euro-ty during the 90’s, and things looked reform plays out? When the details of pean politics can attest, this producesgood. But then we had Iraq, and Af- care become set by national policy, we a lot of confrontation, and makesghanistan, and the Great Recession. So run the risk of losing the trust of our compromise more difficult. But we’venow we’re cynical again. And we will patients, and the public at large. The tried this before, and the Republicgo through this cycle again, and again. whole managed care debacle from 20 survives. Americans have a genius for years ago was a major blow to pub- innovation and compromise, and we But let’s get back to the central is- lic trust in us and in the health care will eventually make the system work.sue. Have we lost trust in one another? system. Although much of the damage And seeing Congress with approvalYou know, we as physicians are pretty has been repaired, we run the risk of ratings dipping toward single digitsmuch in a central position to judge repeating the same mistakes. For ex- may help to keep them honest. Or atthat question. Has there been a break- ample, are Accountable Care Organi- least, careful not to get caught.down? Do our patients trust us? Do we zations going to be the saving of us, ortrust our patients? I would submit that simply a repeat of managed care? We’ll We have enough to do without wor-little has changed. Sure, patients chal- find out, the hard way. rying unnecessarily that our mutuallenge us from their Internet research, ties are dissolving. They aren’t. Butor maybe from watching Dr. Oz. But Just as we and our patients still trust that’s not to say they cannot be weak-50 years ago, patients brought in copies one another, so goes much of Amer- ened. We as physicians depend uponof the Reader’s Digest. Actually, they ican society. We happily share our mutual trust as much or more thanstill do. The paternalistic style of med- thoughts and our private information anyone else. As we and our patientsical practice is strongly frowned upon with one another on line, trusting that navigate through the changes in healthtoday, but that’s a good thing. If we our friends and acquaintances will not care, maintaining the trust on whichtreat our patients with more respect to- misuse it. Online shopping and eBay our profession depends should be atday, and allow them more say in their both evidence a high degree of mutual the forefront of our minds, and theown care, doesn’t that speak to more trust. Given all that, it’s really hard to focus of our efforts.mutual trust rather than less? make the argument that we’ve become reluctant to trust anyone outside our Charles W. Van Way, III, MD, is editor of There are ongoing challenges. The families and acquaintances. Of course,Kansas City Star published a series by that doesn’t stop our national pundits Kansas City Medicine and is emeritus professorAlan Bavley deploring the increasing from making the case, but hey! Theyemployment of physicians by hospi- have to write about something, don’t of surgery at the University of Missouri-Kansastals.1 How’s that for irony? A paper that they? Journalism is all about believingsupports centralizing health care is six impossible things before breakfast, City. He can be reached at [email protected] over physicians becoming cen- as the White Queen told Alice.trally controlled. But it’s true that when REFERENCESphysicians become agents of a large It is unquestionably true, however, 1 Bavley, Alan. Kansas City Star, December 28-30,entity, be it government, for-profit, or that our legislators seem not to trustnot-for-profit, they lose some of their one another. Of course, they never did. 2013.independence. Or maybe a lot of their It’s more obvious today, because we’ve moved from the American model of kansas city medicine 7

Commentary Myths and Facts About E-Cigarettes and Vaping By Donald A. Potts, MD, UMKC School of Medicine Have you seen the ads for “vaping?” using microcircuits. The “electronic ly better than the two packs of coffinEvery strip mall in town, it seems has cigarette” term was used by lobbyists to nails you have been smoking”).a “vaping” store. What in the world is try to convince legislators these devicesgoing on? Well, vaping, or the use of were modern, and that the legislatures But wait. Is it really better to tradeso-called electronic cigarettes has been should bring state laws up-to-date. one addiction for another? Some of usin the news recently. What are they? have probably heard of someone whoBasically, they are devices to produce a The first “personal vaporizer” was was able to stop smoking complete-nicotine-rich vapor, which can be in- patented 50 years ago, but the pres- ly by switching to e-cigarettes. That ent devices date back only 10 years. would be wonderful. The data, howev-haled and absorbed. They are nicotine er, show that most people (over 70%)delivery devices. The tobacco com- Introduced in China, they have spread who use e-cigs also smoke regularpanies (who now produce the bulk of to the West. Opium in reverse, if you tobacco products.these devices), label them as a healthy like. They have been used in the U.S.alternative to conventional cigarettes. since about 2008, and have become What we do know about theseOther groups remind us because they widely used over the past 3-4 years. devices is they heat a liquid containingdeliver nicotine, it is still a potent ad- The truth is, we have very little experi- nicotine and also a vapor-producing,diction concern. ence with these devices. Understand- FDA approved (for food use) product, ably, physicians are hesitant to take a propylene glycol. Most also include The term “electronic cigarettes” definitive stand. We are being asked to various flavors. There are variations onor “e-cigarettes” is really a market- inquire of every patient about tobacco the original look-alike cigarettes, suching term. Initially, e-cigarettes used use. Patients turn to us for advice on as cigars, cigarillos, pens, hookahs,a simple electrical circuit to produce things like smoking. Most of us have but this is the basic operation. We alsotheir vapor, consisting of a battery, cautioned patients about the long term know, of the few decent studies thata heating element or a piezoelectric consequences of tobacco use. Indeed, have been performed, the vapor theycrystal, a switch and an LED. Now they some physicians may see these e-cigs produce has minute traces of metals,have advanced to sophisticated devices as a welcome alternative (“It’s certain- some carcinogens such as nitrosamine and formaldehyde, albeit in small amounts. We also know that users have noted airway irritation and decreased FEV1. Nicotine causes other physiological changes, including transient rise in blood pressure, heart rate, vasocon- striction of coronary arteries, adverse effects on lipids and increase in insulin resistance. Of course, given our short experience, we don’t know if there are long term effects from their use. And we won’t truly know for some time. In 2012, the FDA, specifically its Center for Tobacco Products (CTP), was given the responsibility to over-8 april 2015

see (most of) the tobacco products the treatment regimen—bupropion or include charges that the tobaccosold in this country. This was seen varenicline—about 19% are tobacco companies are hoping to “normalize”as almost carte blanche control, with free after a year. But they aren’t nic- smoking. These charges are supportedthe exception of eliminating tobacco otine-free, until they stop nicotine by the appearance of the e-cigarettes,completely. Unfortunately, it appears replacement. According to studies, and their marketing to young people.the agency has been quite sluggish in the most effective office-based treat- E-cigarette cartridges are marketedexercising this responsibility (trigger- ment regimen is combining drugs and with 7,000 available flavors. Theseing the suggestion the acronym stands nicotine replacement therapy with include chocolate milkshake, bubblefor Foot Dragging Authority), and only several sessions of effective counseling, gum, cinnamon, peach, strawberry,very recently announced its intentions, resulting in a success rate of 28-32%. candy cane, peanut butter. Let’s bewhich resulted in the mandated citizen In other words, one out of three. For honest. They aren’t marketing these toinput giving them lots to consider. those of us who feel our job is to cure 25 year olds. Tobacco companies are patients, that may not seem very suc- acutely aware of the statistics showing The World Health Organization cessful. But the Mayo Clinic’s eight day, that, of people smoking by age 18, overcame out with a statement August 26, very intensive, very expensive inpa- 80% will still be smoking into adult-2014 stating there is “need for stringent tient treatment program results in a hood.regulation” of e-cigarettes. France was “cure” rate less than 60%. This puts thethe first country to ban e-cigarettes. outpatient programs into perspective. A September 2014 article in theThe Health Minister Marisol Touraine It also underscores the addictive nature NEJM outlined “A Molecular Basisexplained, “This is no ordinary prod- of nicotine. for Nicotine as a Gateway Drug.” Theuct because it encourages mimicking premise here is that regular use ofand could promote taking up smok- In case you happened to have nicotine primes the brain and makesing.” Others who followed included read it, about two years ago, a highly it easier to become addicted to otherAustralia, Brazil, Canada, Mexico, respected local physician, writing for drugs, such as cocaine. This is accom-Panama, Singapore and Switzerland. a hospital newsletter, and based upon plished by means of global acetylationBeginning in 2016, all 28 European one patient’s experience, touted the in the striatum, leading to the releaseUnion countries will ban e-cigarette concept of using e-cigarettes to quit of dopamine. At least in mice.advertising. smoking, stating nicotine was innoc- uous and the body manufactured it So, what should you tell patients The FDA apparently does not plan anyway. These two statements are who ask you about switching to e-cig-to restrict any of the more than 7,000 unequivocally untrue. arettes to help them stop smoking??flavoring substances available for these Like any other advice you give them,e-cigs. Even if it decides to restrict In the October 10, 2014 Circula- you should point out the benefits andpackaging to simple plain paper tion, the American Heart Association the side effects, the unknowns associ-containers, the enforcement would came out with a policy statement: “If ated with their use. And make sure younot begin until at least two years after a patient has failed initial treatment, give them opportunity to ask questionsthe announcement. There is also no has been intolerant to or refused to they may have after you have advisedrestriction on advertising, at least in use conventional smoking cessation them. Lastly, warn them that they maytheir initial list of intended controls. medication, and wishes to use e-ciga- be trading tobacco addiction for nico- rettes as to aid quitting, it is reasonable tine addiction. Most tobacco treatment specialists to support the attempt.” This is a majoragree that the least effective way to diversion from the usual position of Donald A. Potts, MD, is associate professorquit using tobacco is just to quit “cold other agencies, which almost unani-turkey.” Only about 4% of people who mously recommend only FDA ap- emeritus at the UMKC School of Medicine and isattempt this are still abstinent after proved treatments for tobacco addic-12 months. Adding FDA approved tion. This is just one more thing that a Mayo Certified Tobacco Treatment Specialist.nicotine replacements—viz; patch- makes deciding what to tell patientses, lozenges, inhalers—increased the difficult. He can be reached at [email protected] to about 12%. If a prescriptiondrug for the purpose is included in Other concerns about e-cigarettes kansas city medicine 9

Commentary Advancing Life Sciences for the Region a look at the kansas city area life sciences institute By Wayne O. Carter, DVM, PhD, DACVIM, Kansas City Area Life Sciences Institute The Kansas City Area Life Sciences specific drug or device R & D work. plans and finalizing software and hard-Institute works to advance life sciences We are committed to advancing ware development. One such companyacross our service area which extends is Medicast, a concierge service forfrom Columbia, Mo. to Manhattan, technologies through the commercial- physician “House Calls.” Any physicianKan., and north to include St. Joseph, ization process into the marketplace. can sign up and set their own “On-Mo. Our efforts focus in four areas: Our work with the Sprint Accelerator, Call” schedule with a direct paymenteducation, research, collaboration and model.commercialization. Our collective efforts have created many SUCCESSES Our education efforts concentrate successes includingin P-20 STEM (Science, Technology, Since KCALSI was incorporated inEngineering and Mathematics) and increased inter- 2000, our collective efforts have creat-scientific symposia for health care pro- institutional scientific ed many successes including increasedfessionals. Among these in 2014 was a inter-institutional scientific collab-program on technology integration in collaboration, oration, development of the Animalhealth care. development of the Health Corridor, successfully compet- Animal Health Corridor, ing for the National Bio and Agro-De- The Institute has awarded over successfully competing fense Facility, expansion of regional$2.2 million in research grants to area for the National Bio wet laboratory incubation space, andscientists generating over $14 million and Agro-Defense progress in developing a workforcein follow-on federal and foundation Facility, expansion of better prepared in science and math.funding. regional wet laboratory incubation space, and We supported the University of We foster and promote collabora- progress in developing Kansas in their successful pursuit oftion across the region. As one exam- a workforce better NCI designation for their Cancer Cen-ple, we held a translational medicine prepared in science and ter and a Clinical Translational Sciencemeeting at Kansas State University Award, assisted the University of Mis-in April 2014 that included represen- math. souri and Kansas State University intatives from academia and industry. enhancing their presence in the KansasDiscussion topics ranged from cancer an exciting company accelerator in City area, and assisted our stakehold-research and diagnostics to zoonotic the KC Crossroads district, serves as ers in recruiting top-notch researchersdiseases and emerging threats that may one example of our commercialization to the region.be part of the research at the new $1.25 activities. Ten mobile health start-upbillion National Bio and Agro-Defense companies are polishing their business We conduct a triennial census toFacility under construction in Man- measure the life science industry in thehattan, Kan. We also foster regional greater KC region. In the three-yearnetwork development, including the period from 2009 to 2012, there was aMedical Device Network and BioRe- 17% increase in life science companies,search Central. The latter is a network a 21% increase in employment in lifeof over 90 contract research organiza- science companies and a 38% increasetions contracting with companies for in the most rapidly growing sector,10 april 2015

medical device companies. The census Kansas, Saint Luke’s Health System, KCALSI MISSIONis an example of several studies KCAL- University of Kansas Medical Center,SI has undertaken to expand research, and Kansas State University. In addi- To coordinate the regional life sciencesdevelopment, and commercialization tion, Blue Cross Blue Shield of Kansas initiative by:capabilities/capacity in the region. City, Bank of America, the Kauffman Foundation, Hall Family Foundation, * Fostering and solidifying relationshipsOUR REASON FOR SUCCESS and Sosland Foundation have also between the academic and private sector been instrumental in supporting our life sciences communities We rely significantly on our stake- efforts.holders, business/civic partners, and * Assisting scientific collaborative researchphilanthropic organizations for our Wayne O. Carter, DVM, PhD, DACVIM, is efforts through identification and qualifi-support. We are extremely appreciative president and CEO of the Kansas City Area Life cation of funding opportunities, proposalof their support including our found- Sciences Institute. He can be reached at wcarter@ review facilitation, resource allocation, anders—the Civic Council of Greater kclifesciences.org. maintaining accountabilityKansas City and the Kansas City AreaDevelopment Council—and our stake- * Raising awareness of the life sciences andholder institutions, including Truman the value it brings to people, the region andMedical Center, Children’s Mercy Hos- institutionspital and Clinics, the Universityof Missouri and the University of * Assisting in life sciences advocacy effortsMissouri-Kansas City, the Kansas City at the local, state, and national levelsUniversity of Medicine and Biosci-ences, MRIGlobal, the University of * Providing support to economic development and technology transfer & commercializa- tion organizations www.kclifesciences.orgPRIVATE BANKING | FIDUCIARY SERVICES | INVESTMENT MANAGEMENT | FINANCIAL PLANNING | SPECIALTY ASSET MANAGEMENT | INSURANCEJust As ImportantAs Healthy PatientsIs A Healthy Practice.We’re a partner with the industry experience and know-how to tailor a planthat meets your individual needs. For both your practice and your personal life.Give us a call, or better yet, let us come see you. www.bankofkansascity.com | 913.307.1800© 2015 Bank of Kansas City, a division of BOKF, NA. Member FDIC. Equal Housing Lender. Private Bank at Bank of Kansas City provides products and services through BOKF, NA and itsvarious affiliates and subsidiaries.Investments and insurance are not insured by the FDIC; are not deposits or other obligations of, and are not guaranteed by, any bank or bank affiliate. All investments are subject to risks,including possible loss of principal. Securities offered through BOSC, Inc. Member FINRA/SIPC. kansas city medicine 11

Legislative perspective Kansas Patients to Receive Real-Time Estimates of Cost Share information will help patients and physicians make more informed decisions By Jim Denning, Kansas State Senator The Kansas Legislature tackled the amount and is due at the time of ser- care industry. Since the late 1990s, thedesperate need for health care trans- vice. The deductible is the portion of Health Insurance Portability and Ac-parency head on with the 2014 passage medical expenses the patient is 100% countability Act (HIPAA) has adaptedof the Predetermination of Health responsible for up to a certain amount. a number of ASC standards which areCare Benefits Act (HB 2668). Start- Co-insurance is the cost share between now the bedrock of electronic trans-ing July 1, 2017, health plans will be the insurance company and the patient missions in the health care industry.required, before a treatment or proce- once the deductible is met. The most common transaction sets aredure is performed, to give the patient the electronic claims submission (837),and provider an estimate of coverage, Figure 1, below, shows a typical electronic remittance advice (835), andincluding the expected payment to the breakdown of a non-emergency med- the eligibility inquiry (270). The 837,provider and the patient’s cost share ical procedure. You can see that the 835, and 270 transaction sets are allincluding deductible, coinsurance and patient has become more financially included in HIPAA version 5010 andcopayment. responsible for non-catastrophic pro- are used daily by all medical providers cedures than the insurance company. and their staffs to process health care We have all received the surprise transactions.medical bill 30 days after we received fig. 1medical care. High deductible plans The insurance industry, medicaland high co-insurance plans now $270.40 providers, and clearinghouses (whichdominate both the private sector plans process and standardize transactionsand the Affordable Care Act (ACA) INSURANCE PAYS between health care entities) workedExchange plans. The need for cost with the ASC to develop a businesstransparency is a vital issue for phy- $67.60 transaction set to determine an esti-sicians, hospitals, other health care mate of patient out of pocket costs pri-providers and most important patients. PATIENT CO-INSURANCE or to the patient receiving the services. Patients are being coerced into $1,000.00 The two transaction sets devel-managing and paying a larger part of oped by ASC to electronically querytheir health care expenses. Provid- PATIENT DEDUCTIBLE to obtain patients predeterminationers are required to collect more out out of pocket expenses are known asof pocket expenses directly from the $1,338.00 837-P and 837-I. The “P” stands forpatient. Yet, neither the patient nor “professional” and the “I” stands forprovider can easily estimate the out of TOTAL COST “institutional.” The transaction setspocket costs until after the insurance were published in 2008 but did notcompany processes the claim. This can The Kansas Legislature wanted to get included in the release of HIPAAtake months. have a good policy solution that used 5010 in 2009. As a result, the insurance technology, did not require “reinvent- industry currently does not recognize A typical health care expense is ing the wheel,” and was integrated the predetermination of cost transac-made up of three components: 1) within practice management software tion sets.co-payment, 2) deductible, 3) co-in- systems. The legislature looked tosurance. The co-payment is a fixed the Accredited Standards Committee With the legislation contained in (ASC) for a solution. For over 30 years, the ASC has developed standards for the exchange of electronic business information including many standards developed specifically for the health12 april 2015

HB 2668, health insurance companies er-to-computer integrated technology and fewer complaints by patients ofdoing business in Kansas will add the solution. Figure 2 shows the transition not being informed of unexpectedly837-P and 837-I to the latest version from manual to automated process. large out of pocket expenses.of HIPAA and support and respond toall health care industry requests for the Knowing the out of pocket costs of This legislation is a giant step intransaction sets. non-emergency health care services is the right direction of simplifying the part of the informed decision process complex business side of health care In a nutshell, Kansas health care between a physician and patient. Real transactions. Hopefully it will serve asproviders will be electronically com- Time EOB will help prevent financial an impetus for Missouri and all statesmunicating with the insurance com- “sticker shock” and “buyer’s remorse” to adopt.pany’s adjudication databases to get by patients. Patients need to know thea non-binding estimate of patients financial obligation they will incur as State Sen. Jim Denning (R-Overland Park) hasnon-emergency out of pocket expenses well as being able to have time and represented the 8th district since 2013. He spon-in real time or overnight batch mode ability to satisfy it. Knowing what sored SB 251 which became HB 2668. Jim is the(submitting a large number of requests out of pocket expenses will be due retired CEO of Discover Vision Centers. He canafter office hours). The legislation has is important in the rapidly changing be reached at [email protected]. Thisbecome known as Real Time Explana- health care environment. Patients may article was co-published with Missouri Medicine.tion of Benefits, (Real Time EOB). The be purchasing health care for the firstlegislation will move the health care time and will be unfamiliar with their See Response on next page.industry from an inefficient, expensive, co-payment, deductible, and co-insur-time-consuming manual telephone call ance responsibilities. Physicians shouldprocess to a highly efficient comput- have an easier time with collectionsfig. 2 = Insurance Company Current Inefficient Manual Process Technology Solution Transaction by phone call, 30-60 minutes for each inquiry Electronic Transaction - real time or batch mode Physician’s Office Clearing House Physician’s Office kansas city medicine 13

Legislative perspective Response to Kansas “Real-Time EOB” Article By Joshua Mammen, MD, FACS, University of Kansas Medical Center In the recent past, patients had largely been insulated to service. In that manner, patients can more truly becomefrom medical charges. Over the last few years, the burden informed partners in their medical care. As physicians, thisof medical expenses has shifted more to patients. As physi- is a development that we should embrace as we work withcians, we have largely remained ignorant of the true cost of our patients to make decisions that best serve their medicalmedical care that is shouldered by physicians, largely due needs.to the vagaries of individual insurance plans and possiblydue to a lack of interest. In an era of increasing health care Joshua Mammen, MD, FACS, is an assistant professor of surgery andtransparency and the shifting of costs to patients, compla- molecular & integrative physiology and vice chair of research in the Depart-cency is no longer an option. ment of Surgery at the University of Kansas Medical Center. He is a mem- ber of the KCMS Board of Directors and is chair of government relations. The Kansas Legislature recently passed Sen. Jim Den-ning’s proposal in HB 2668 that mandated insurers providereal time information about the cost of medical care prior Congratulations to Kindred LTAC Hospital on our Partnership Partners of the Metropolitan Medical Society of TWO LOCATIONS Greater Kansas City embrace our core values of Kindred Hospital physician leadership, solid business practices, 8701 Troost Ave Kindred Hospital Northland innovation and quality patient care. 500 NW 68th Street kindredhospitalkc.com14 april 2015

from the Deans’ OfficeA Brave New World ofGraduate Medical Education AccreditationBy John J. Dougherty, DO, Kansas City University of Medicine and Biosciences“All that happens means something; common program requirements relat- The ongoing assessment and assurance ed to residency and fellowship eligi- of milestone accomplishment by thenothing you do is ever insignificant.” bility. These modifications were made resident-in-training then provides a— aldous huxley, crome yellow in response to the Medicare Payment common report card, by which fellow- Advisory Committee (MedPAC) 2010 ship programs can assess preparedness In the Osteopathic community, a report to Congress, recommending and abilities. AOA accredited pro-historical event occurred July 19, 2014 a performance-based GME funding grams do assess the same competen-in Chicago at the American Osteo- structure with payments contingent on cies, with the Osteopathic philosophypathic Association (AOA) House of educational outcomes.4 of “holistic” patient care integratedDelegates. It was on this date that the throughout the competencies, but aregoverning body for the profession, As part of a strategy to measure not part of the NAS and are unablewith representation from every state these competency-based outcomes provide a compatible progress report.and specialty college, met to approve aresolution granting the AOA Board of In another strategy to This provision within the NextTrustees authority to proceed in good help mitigate program Accreditation System therefore limit-faith towards a single accreditation sys- loses, many institutions ed access to ACGME training to onlytem for Graduate Medical Education those residents who had trained in(GME).1 The approval comes after an embedded AOA- programs utilizing the NAS (or theannouncement in February that the accredited residencies Canadian equivalent, CanMEDS). AsAmerican Association of Colleges of into current ACGME a result, graduates of AOA-accredit-Osteopathic Medicine (AACOM), the residencies, called dual ed residencies would be unable to beAOA, and the Accreditation Coun- accepted into ACGME subspecialtycil for Graduate Medical Education programs. fellowships or even to transfer into(ACGME) reached an agreement ACGME residency programs if theyto work together to prepare future and accomplish the reporting require- had performed an AOA accreditedgenerations of physicians and that this ments, ACGME developed the Next primary residency.4 This change wouldcollaboration would be integrated into Accreditation System (NAS). The goal impact all ACGME training programsthe governance and operations of the of the system is to improve trainee out- nationwide. It would, in essence, haveACGME.6 comes in the six defined competencies. an effect on only a small percentage of NAS is the result of the “Outcomes osteopathic medical school graduates, This resolution was made after Project,” focused on data acquisition specifically those who trained in AOAconsiderable debate by all parties in- and creating a national database that accredited programs and were seekingcluding a strong voice from the future includes program characteristics, ACGME fellowships. Roughly 60% ofof the profession, our medical students performance parameters, and resident DO graduates already train in ACGMEand residents. The deliberations on achievement of defined milestones.5 programs.2 Osteopathic medicines’seeking an affirmation from the profes- accreditation process is similar to thatsion to proceed on an agreement began of the ACGME, but with a smallerin October 2011 with the ACGME’s number of programs and therefore atannouncement of modifications to its times, quicker to navigate, particularly kansas city medicine 15

as it relates to new program approval. In 1997-1998 the AOA instituted a this history in mind it was with a fair Historically, DO graduates trained new layer of local support and over- amount of trepidation that the Osteo- sight called an Osteopathic Postgrad- pathic community entered discussionsin “Osteopathic Hospitals” which were uate Training Institute (OPTI) with a about the changes necessary to alignoften community based facilities with required member being one of the Col- with the NAS milestones and thereforea robust graduate medical training leges of Osteopathic Medicine (COM). keep the pathway open for those whoatmosphere, accredited through the As many remaining Osteopathic pro- choose to pursue these opportunitiesAOA. Through the later 1980s and grams are based in stand-alone com- afforded by participation. Reservations1990s many of these training institu- munity hospitals, this format provides include that existing AOA accreditedtions were acquired by larger systems a shared academic infrastructure for a residency programs will be lost eitherand integrated or closed. Kansas City consortium of programs spread across due to an inability to meet additionalwas home at one time to three such fa- many facilities which are then “based” financial requirements of ACGMEcilities: University Hospital, Park Lane through the COM. The OPTI can pro- accreditation that are not required byMedical Center and Lakeside Hospi- vide economies of scale that otherwise the AOA, or fall below the minimumtal. All are now closed, for a variety trainee cohort in the current standardsof reasons. With the closure of these Continuing the as the populations they serve cannothospitals came the loss of many of the development of support the volumes required for larg-profession’s training programs. Since primary care training er resident counts.those times, a concerted effort has opportunities in areasbeen made to initiate new programs in of need will ensure Other challenges include, as writtenhospitals that were eligible for reim- retention of future currently, existing Program Directorsbursement through the CMS funding physicians to practice in who are certified through the AOAmechanism. These efforts were partic- underserved areas. and not ABMS, would not be eligibleularly successful in the Midwest and to remain in their position. ABMSWestern part of the U.S. where growth would make training programs in certifying boards do not measure theopportunities were greater as 60% of those environments cost prohibitive. “Osteopathic Principles” that are wo-all training programs are currently in In another strategy to help mitigate ven thorough the common core com-the East and Northeast and the hos- program loses, many institutions petencies and therefore the uniquenesspitals there were more likely to have embedded AOA-accredited residen- of the profession would be lost if notexisting programs.2 cies into current ACGME residencies, measured by AOA boards. There is an called dual programs. Although these effort to have both AOA and ACGME A challenge to that growth came programs incurred double the cost and boards recognized as fundamentallywhen the Balanced Budget Amend- paperwork to maintain both AOA and equal outcomes measures for resi-ment of 1997 placed a restrictive cap- ACGME accreditation requirements, dents-in-training. The final point ofitation, or CAP, on hospitals limiting they enabled osteopathic residency emphasis in the profession has be-their reimbursement to the number standards to reflect ACGME residency come to ensure efforts are directed atof trainees that were in the employ of standards.2 maintaining current GME positions,the hospital at midnight December particularly primary care positions.31, 1997. The timing could not have Needless to say, being nimble and Continuing the development of prima-been worse for Osteopathic training creative over the last 25 years has been ry care training opportunities in areasprograms, as many programs were in a positive factor in preserving Osteo- of need will ensure retention of futuretransition at the same time, working to pathic-focused GME positions. With physicians to practice in underservedmove to alternate hospitals but unable areas.4to do so as the funding was now re-stricted. Lost with those closed hospi- The resolution passed had a focustals, was the academic infrastructure on and reflects these concerns. Thethat had existed in those programs, “Resolves” also includes that the AOAmany since the 1930s. An alternate will monitor the progress of the tran-support mechanism was needed. sition to a single GME accreditation16 april 2015

system, emphasize osteopathic princi- Medicine governing body, AACOM REFERENCESples and educational opportunities and strongly supports the process and 1. AOA House of Delegates. (2014, July 19). Res. No. H-800.to be cognizant for the emergence of believes the public will benefit fromany unintended consequences during a single standardized system that Single Graduate Medical Education Accreditation Systemimplementation. The AOA will seek to evaluates the effectiveness of GME Chicago, Ill: Special Reference Committee for ACGME.create an exception category to allow programs for producing competentthe institutions and programs, on a physicians.6, 3 The ultimate goal, when 2. Connett, D. A. (2014, July). Effect of the Single Accreditationcase by case basis, up to a one year fully implemented in July 2020, will System. J Am Osteopath Assoc, 114, 524-526.extension for those that experience be for the new system to allow grad-challenges with meeting additional uates of osteopathic and allopathic 3. Hahn, M. B. (2014, July 21). Message from the President:financial impact due to a change in the medical schools to complete their Landmark Decision for GME. Kansas City, Missouri.standards. Finally, the AOA will ad- residency and/or fellowship educationvocate for an extension of the closure in ACGME-accredited programs and 4. Kelley, C. S. (2014, July ). Impact of the Single Accreditationdate for AOA accreditation beyond demonstrate achievement of common Agreement on GME Governance and the Physician Workforce. JJuly 1, 2020, where appropriate for milestones and competencies.3 Am Osteopath Assoc (114), 518-523.individual programs on a case by casebasis.1 Overtures from the ACGME John J. Dougherty, DO, FACOFP, FAOASM, 5. Nasca, T. J., Weiss, K. B., Bagian, J. P., & Brigham, T. P. (2014,leadership have been that these points January). The Accreditation System After the “Next Accreditationare open for ongoing discussions as the FAODME, FILM, is senior associate dean of System.” Academic Medicine, 27–29.details of the merger are made final. clinical affairs and graduate medical education 6. Shannon, S. (2014 , July 19). Single ACGME Accreditation As the Colleges of Osteopathic System Passes at AOA House of Delegates Meeting . Chicago, Ill. at the Kansas City University of Medicine and Biosciences. He can be reached at jdougherty@ kcumb.edu.More than just a broker... Now more thaN ever you The Keane Group Need resources! is a physician’s resource. 33 Over3303insurance3carriers 33 Medefense3&3eMd3cOverage3 fOr3hIPaa breaches and data3lOss 3 LumP sum dIsabILIty insurance -3 guaranteed3issue3up3tO3$3M -3 designed3fOr3physicians 33 hipaa3risk3and3security33 comPLIaNce 33 huMan3resOurces3guidance3 with3thINkhr 33 hipaa3cOMpliant,3secure3 textINg soLutIoN kansas city medicine 17

from the Dean’s Office GREAT EXPECTATIONS: What the Next Accreditation System will mean for Graduate Medical Education By Christine Sullivan, MD, FACEP, University of Missouri-Kansas City School of Medicine The Accreditation Council for during training.2 While great strides in not only in patient care, proceduralGraduate Medical Education (AC- the educational experience for train- skills and medical knowledge, but alsoGME) has implemented the Next ees was made, program requirements how to successfully navigate hospitalAccreditation System (NAS), changing became burdensome and often did not and health care organizations. To thatwhich reflects changes to the pro- keep pace with changes in the health end, a large part of the reasoning forcess and requirements for Graduate care system.2 The need to modify changing the current accreditationMedical Education (GME) programs. current training is due to concerns that process will be to shift the focus to theIn July 2013, seven programs began clinical learning environment, i.e., theworking within this system: internal One of the most participating sites for the residencymedicine, emergency medicine, pedi- significant changes programs, to ensure that these hos-atrics, diagnostic radiology, neurolog- pitals are actively engaging residentsical surgery, orthopaedic surgery, and for GME is the in quality and safety initiatives. Inurology (including subspecialties). For implementation of preparing for change, the ACGME hasall other programs, implementation specialty milestones as visited more than 100 teaching hospi-began in the current academic year on a measure of specific tals. The results of this extensive surveyJuly 1, 2014.1 How will these changes achievements that indicated a lack of resident involve-affect graduate medical training? How residents develop ment in the systems-based processes ofwill the NAS enhance the educational throughout the course of these institutions.5 So, to better prepareexperience for physician learners? And residents for “real life” practice andfinally, what will the NAS mean to the their training. challenges beyond training, GME pro-future workforce of physicians? By un- grams will need to adapt the learningderstanding the rationale for change, residents must be qualified to provide experience in cooperation with theirwhat the specific changes to the safe, high-quality evidence-based care clinical practice training sites.current accreditation system are, and in an integrated delivery system thatthe expected outcomes for the NAS, is team based.3 To better focus on care PROGRAM AND ACCREDITATIONwe as current physicians can draw an that is patient-centered, safe, efficient, CHANGESinformed conclusion regarding actual effective, and equitable, the healthbenefits as we begin to work with grad- care system structure and information One of the most significant chang-uates from this new training system. technology will need to be increas- es for GME is the implementation of ingly emphasized in teaching skills specialty milestones as a measure ofRATIONALE FOR CHANGE for residents as they learn to develop specific achievements that residents evidence-based practices while work- develop throughout the course of their Since the ACGME was established ing as a member and leader of inter- training. The milestones are specialtyin 1981, the organization has em- disciplinary teams.4 It is crucial that specific and reflect a progression ofphasized specialty program structure training provides residents the skill set skills within the six core competencieswhile requiring programs to improve that are considered as essential to thethe formal education and evalua- practice of that discipline. The edu-tion feedback standards for residents cational landmarks for each specialty18 april 2015

and sub-specialty have been developed accreditation, the ACGME has moved REFERENCESwith the collaboration of the American towards an annual surveillance of pro- 1. Accreditation Council for Graduate Medical Education. PottsBoard of Medical Specialties (ABMS) grams. Residency review committeesfor the specific specialty, as well as will examine programs’ milestone res- JR III. Implementing the Next Accreditation System, 2013.with review committees, program-di- ident data, faculty and resident annual https://www.acgme.org/acgmeweb/Portals/0/PFAssets/rector and resident organizations, and surveys, ABMS graduate performance Nov4NASImpPhaseII.pdf. Accessed: February 25, 2015.specialty societies.2 Programs will be on certifying exams, and case proce-charged with determining the pro- dural log data for trends.2 A self-study 2. Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GMEgression “level” of each resident every by the program to highlight educa- accreditation system — rationale and benefits. NEJM. 2012six months throughout their training. tional outcomes rather than focusing Mar 15; 366(11):1051-6.Levels for each milestone are rated on requirement details will proceed afrom “1” (skills expected of an entering 10-year site visit for programs that are 3. Ensuring an effective physician workforce for the United States:resident) to “5” (skills of a seasoned functioning satisfactorily.2 Additional- recommendations for reforming graduate medical education tophysician which residents can as- ly, Clinical Learning Environment Re- meet the needs of the public: conference summary. New York:pire to and few residents will achieve views (CLER) have been implemented Josiah Macy Jr. Foundation, September 2011. Available at:during training) with “4” being skills to provide feedback to sponsoring http://macyfoundation.org/docs/macy_pubs/JMF_GME_expected for a resident to achieve by institutions regarding the effectiveness Conference2_Monograph%282%29.pdf Accessed: Februarycompletion of training.6 Therefore, the of resident engagement in the areas of: 25, 2015.development of evaluation methods patient safety, quality improvement,for residents that match performance care transitions, supervision of learn- 4. Crossing the quality chasm: a new health system for theto the milestones is critical. As an ers, duty hours and fatigue manage-example, emergency medicine has 23 ment/mitigation, and professionalism.9 21st century. Institute of Medicine. March 2001. Availablemilestones. While some of the mile- at: https://www.iom.edu/Reports/2001/Crossing-the-stones reflect critical practice skills OUTCOMES AND CONCLUSIONS Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx(emergency stabilization, multitasking, Accessed: February 25, 2015.and airway management), they also The ultimate goal of the NAS isincorporate team management, prac- to improve the safety and quality of 5. Nasca TJ, Weiss KB, Bagian JP. Improving clinical learningtice-based performance improvement patient care while at the same time environments for tomorrow’s physicians. NEJM. 2014 March(evidence-based practice), patient advancing the quality of graduate 13; 370(11):991993.safety, technology, and systems-based medical education.9 Training programsmanagement (coordinating system will need to adapt their current learner 6. Beeson MS, Carter WA, Christopher TA, Heidt JW, et al. Emer-resources to improve care).7 Trainees assessments and curricula to meet gency medicine milestones. Accreditation Council for Graduatewill be able to see the specific skills milestone expectations. Sponsoring Medical Education and the American Board of Emergencythat they are performing well and institutions will need to work toward Medicine. 2012. Available at: http://acgme.org/acgmeweb/those that they need to focus on, while more actively involving residents and Portals/0/PDFs/Milestones/EmergencyMedicineMilestones.programs will be able to develop per- fellows in quality and safety programs pdf. Accessed: February 25, 2015.formance improvement plans to assist and initiatives. And finally, sponsoringresidents in the progression of the institutions, clinical practice sites, and 7. Beeson MS, Carter WA, Christopher TA, Heidt JW, et al. Emer-milestones. While the milestones can GME programs will need to embrace a gency medicine milestones. JGME. March 2013 Supplement:serve as a foundation to enhance the model of continuous quality improve- 5-13.educational experience for residents, ment.10 Perhaps that will be the aspira-the ultimate goal is to ensure that grad- tional Level 5 milestone for the NAS. 8. Philibert I, Brigham T, Edgar L, Swing S. Organization of theuates have attained the knowledge and educational milestones for use in the assessment of education-skills to practice unsupervised in their Christine Sullivan, MD, FACEP, is associate al outcomes. JGME. March 2014: 177-182.specialty.8 dean for graduate medical education, designated 9. Weiss KB, Wagner R, Bagian JP, Newton RC, et al. Advances Instead of a “spot check” of pro- in the ACGME clinical learning environment review (CLER)grams every 4 to 5 years to determine institutional official, and associate professor Program. JGME. December 2013: 718-721. of emergency medicine at the University of 10. CLER pathways to excellence. Clinical Learning Environment Review (CLER). Accreditation Council for Graduate Medical Missouri-Kansas City School of Medicine and Education. 2014. Available at: http://www.acgme.org/ acgmeweb/Portals/0/PDFs/CLER/CLER_Brochure.pdf. Truman Medical Center. Accessed: February 25, 2015. kansas city medicine 19

Meet Your Professional Home: Kansas City Medical Society Just as the “medical home” serves patients, your Kansas City Medical Society is a Professional Home that provides youas a physician with the tools and resources to become better, to network, to make your practice perform at a higher level, aplace where you feel at home. Among the resources we offer:For your career: For your profession:• Your own website and domain name (DrSmith.com) • Economic Impact Study showing the value of physicians• Promotional opportunities to build your community • Lobbying and policy advocacy to advance physician connections and personal brand interests• Quick, easy-to-digest information and answers to complex • Neutral place for developing inter-specialty relationships questions For your group:• Enhanced online directory and search capabilities • Physician recruitment and placement services • Marketing supportFor your patients: • Use of our Plaza office for events• Volunteer opportunities with “Help@Hand” • Features on you and your partners/colleagues in print• Enhanced online directory and search capabilities• 2015 Leadership Initiative media, on website and in electronic media • Opportunities to showcase your practice and/or facility by hosting our local events kansas city medical society would like to welcome our newest partner Encompass Medical Group Thank you for your support of our physician community. Encompass Medical Group is comprised of 51 physicians at nine locations, and all are active members of Kansas City Medical Society. encompassmed.com20 april 2015

LEADershipTHE LEADERSHIP JOURNEY - How did they achieve senior leadership positions?four physicians share their insights - What rewards do they gain from leadership? - What advice do they offer to physicians aspiring for leadership?Today’s health care environment offers many opportu-nities for physicians to get involved in leadership roles, important contribution the physician brings to leader-whether it be in a health system, in a practice group, or ship. Physicians are the voice for their patients and theirin community health advocacy. Leadership can take the concerns, and they offer the decision-making perspec-form of being a CEO, medical director or department tive of diagnosing problems, prescribing treatment andhead, or in the community as a board member or legis- evaluating results. These four physicians have chosen tolative advocate. Leadership today is not just top-down; it take the next step into leadership.also involves collaborative leadership requiring the abili-ty to work together in a team. These four leaders note the kansas city medicine 21

MELINDA ESTES President and CEO, Saint Luke’s Health SystemMelinda Estes, MD, has been president and I believe all physicians are leaders. You arechief executive officer of Saint Luke’s Health leaders for your patients, leaders in yourSystem since September 2011. Board certi- practice, leaders when you participate in yourfied in neurology and neuropathology, Dr. societies.Estes also holds an MBA from Case WesternReserve University. Prior to joining Saint Why is it important for Saint Luke’s Health One of the most popular tracks inLuke’s, she served as president and chief ex- System to have good physician leaders? medical education is the MD/MBAecutive officer of Fletcher Allen Health Care in track. When I got my MBA back inBurlington, Vt. Her other executive positions I believe all physicians are leaders. 1995, I was the only physician in myhave included: chief executive officer and You are leaders for your patients, class and very few physicians were pur-chair of the board of governors of Cleveland you are leaders in your practice, you suing any kind of business education,Clinic Florida, executive director of business are leaders when you participate in but today it is not uncommon to seedevelopment at The Cleveland Clinic Foun- your societies. But I think taking on that combo. Today, people talk aboutdation, chief medical officer at the Cleveland administrative roles is important medical knowledge turning over everyClinic Florida, and executive vice president because physicians, along with nurses seven years as opposed to just a fewand chief of staff for the MetroHealth System and allied health professionals, are years ago it was every 20 years. So, ifin Cleveland. really the line workers of health care. you think about that, just the demand We are the ones who understand the to keep up with the change in knowl- inner workings of delivering care and edge, I think makes it very difficult for doing that in a clinically effective and physicians often to wear two hats. high-quality way. This is particularly true for Saint Luke’s because we are How does Saint Luke’s provide opportuni- a large, diverse health system with ties for aspiring physician leaders? multiple settings of care, and we have physicians working in all those settings At Saint Luke’s, we are very interested of care. We really need them to step in identifying young and mid-career up and be leaders so strategies of the physicians who have an interest and organization can move forward. potential to take on more formal roles. You consciously have to reach out and What is it about the current medical edu- identify people and ask them to partic- cation system that doesn’t prepare doctors ipate on a committee. for administrative roles? Is there anything in your medical training that helped you I have found it to be very appealing to become an administrator? physicians to serve on something that has a finite life span. For instance, our22 april 2015

strategic planning has involved many On the other hand, those people who Being a physician and an administrator isphysicians on the steering committee. are involved in clinical care—phy- sort of left brain, right brain thing. HowBy serving on committees, you learn sicians, in particular—do need to does a physician learn to use both sides ofa whole host of things, plus you have understand, and be realistic, and be the brain?an opportunity to see how that work helpful to us as we look at the need tofits into the larger and broader picture generate a margin. What we put on the We talk an awful lot about the scienceof the organization, which was really bottom line enables us to reinvest, and of medicine, and we should, but med-important for me. Every committee I reinvesting gives our clinical providers icine is an art as well. And you lookhave served on had a different chair facilities, it gives them technology, it’s at the number of physicians who arewith a different style. Some people programmatic, it helps us take better musicians, it’s a high percentage, thewould come in, and the chair would care of patients, so it really is a contin- number of physicians who are artists.do all the talking. Other people did uous circle. There is an awful lot of right brain thatbrainstorming. I don’t think we are goes into that really good physicianborn with a leadership style. You have How can physicians promote wellness in who can tap into that creative side.to develop it. the community and make time to do so? What we are trying to do at SaintDo we have enough physician leaders We all understand the post-acute Luke’s is actually beginning to struc-today? If not, what can we do to build the continuum of care. What we have less ture a leadership course for our phy-ranks? experience and a little more difficulty sicians to say—if you have an inter- thinking about is this continuum that est, come and spend some time oneIf you look around the country, for happens before you get to the hospi- Saturday morning a month— to learnmy job, to lead a hospital, everybody tal. So whether it’s the doctor’s office, what’s a balance sheet, what’s the P &wants a physician, and that is where we whether it’s the fitness center, whether L, what does branding mean, what areclearly do not have enough physician it’s the employer sponsored “wear your crucial conversations. And then, prettyleadership—physicians who have said, Fitbit” contest, or whether it’s get out quickly, there are people who raise“I am going to have an administrative and play for kids for 30 minutes a day, their hand and say, “I’d like to do somecareer.” That requires a real different we haven’t been trained to think that more of this.”mindset to say, “Maybe I’ll start out as is health care, and we are being askeda vice president for medical affairs, and today to think that is health care.then I’ll move into being a chief qualityofficer, and then I’ll move into being Having said that, if you think abouta chief physician executive, and then what physicians do—they listen to thepotentially I’ll be a CEO.” I was sort patient’s complaint, they confirm withof fortunate. I started down the path a physical exam what’s going on, theybefore anyone knew it was a path. come up with a differential diagnosis, and then get some tests, they treat,How can you keep the medical voice and then they measure that—a plan-through physician leaders to make sure ning process does just that. So I thinkdiscussions don’t go too far toward the physicians are really uniquely qualifiedbottom line as opposed to best practices to be able to insert themselves into amedically? planning process.I really do believe that in these times The time question is a tough one. Allof turmoil, that if we focus on why we of us know that sometimes it’s thechose a career in health care, which busiest people who seem to do thewas to take the absolute best care of most. I think it’s a matter of saying thispatients that we possibly can, that ev- is important to me, and I will make theerything else will fall into place. time to do it. kansas city medicine 23

MICHAEL O’DELL, MD Department Chair, University of Missouri-Kansas City Associate Chief Medical Officer, Truman Medical CentersMichael O’Dell, MD, is a professor and chair One of the tricks to saying “no” is to beof the Department of Community and Family very clear about what you are sayingMedicine at the University of Missouri-Kansas “yes” to.City School of Medicine. He is also associatechief medical officer at Truman Medical Cen- What has driven you to take leadership As more physicians are becoming em-ters, serving primarily at the Lakewood Cam- roles? ployed, how can they make sure the medi-pus in eastern Jackson County. A graduate of cal voice is heard in a big system?Kansas State University and the University I think it’s important, and I’m goingof Kansas Medical Center, Dr. O’Dell is also to quote Saul Alinsky—if you are not If you are being asked to do things that2015 president of the Kansas City Medical part of the solution, you are part of aren’t in the best interest of your pa-Society. He previously served as chief quali- the problem. And Gandhi—you have tients, you have an obligation to raisety officer and director of the family medicine to be the change you want to see in your hand and say, “Can’t go there.”residency program at North Mississippi Med- the world. There are lots of things thatical Center. A retired U.S. Navy captain, Dr. need to change, and I want to play a One of the tricks to saying “no” is to beO’Dell deployed during the first Gulf War and role in helping that change occur. very clear about what you are sayingearned the Meritorious Service Medal. “yes” to. Every decision to say “no” is What is that you like about taking leader- usually after you have said “yes” to a ship positions? variety of other things. So while you are saying “no” to more CAT scans One of the real highs in life is having or whatever else might not be in the a group of people that you are fond of patient’s best interest, you need to working together and actually accom- be reminding those who are making plishing something that you weren’t that request—they are usually very sure was going to happen. I have seen well-intentioned souls—and here is that on sports teams, in the military, in what I’m saying “yes” to: “I’m saying major institutions, and in departments ‘yes’ to higher patient satisfaction. I’m I’ve worked in. One reason I’m fond of saying ‘yes’ to higher revenue for the “I think I can, I think I can”—the little system. I’m saying ‘yes’ to a variety train that actually did climb the hill— of other things while I’m saying ‘no’ is because you can think of it as the to the specific request that you are wheels, the engines and all the compo- making.” Otherwise you come off as a nents of the little train working togeth- curmudgeon, which docs have done er to get up the hill. A high-function- on occasion. ing team is a thing of joy.24 april 2015

How can physicians get involved with com- deliver the outcomes that should’ve a matter of saying, “Yes, I’m willing tomunity activities that talk about wellness? occurred. The need for that surgery help on that.” should’ve been mitigated long beforeMost of us have to understand that the patient ended up on that operatinggiving antibiotics and prescribing room table. It doesn’t diminish theantihistamines—any of the variety of work the cardiothoracic surgeon isthings that we do—are important, but going to do, but the system as a wholenot sufficient to improve the health will view it as a failure.of the community. And at some pointyou have to say, I need to get engaged What are the attributes of a good physicianin some of these community activities leader?as well. A good physician leader in many waysPhysician expertise on planning com- is going to have to take off the hat hemittees gets overestimated on occa- has learned as a physician of givingsion. I have no idea how many inches those orders and is going to have tothick a bicycle path needs to be. We begin asking the questions that helpneed to realize when it is best to listen other people come to the answers thatand let other experts weigh in. the system needs.How can mid-career physicians redirect That is something physicians are goodthemselves to learn how to work in this at: asking the right questions andnew world order of health reform that coming to the appropriate diagnosis,emphasizes collaboration more than the and moving forward on things. Butcaptain-of-the-ship model? we have not had to do it on the or- ganizational level before, so there isIt makes very little sense, to anybody some statesmanship and diplomacywho looks at it carefully, to have a involved. Physicians aren’t necessarilyfee-for-service system when you are used to behaving in that role. They aretrying to achieve high-quality health more used to, “This is the answer, let’soutcomes. So it really becomes very move on.” There’s going to have to beimportant to say, how does this help a lot more listening, a lot more carefulpatients and how do we move forward questioning.with helping the patient? And that’sa conversation that I think resonates What tips would you have for a physicianeven when someone is having to face who wants to become a leader?some fairly bitter choices about reduc-ing income, about reducing control, The first tip is that it’s all about theand in some cases, even fairly gut level, patient. As long as we focus on that,you know, what’s my value in this we are going to be operating in a zonesystem? of comfort, and frankly, in a zone of expertise as well. But in terms of read-My hat is off to people who spent years ing and tips, I’m a huge fan of servantand years becoming, say, cardiothorac- leadership, and Jim Hunter is some-ic surgeons. In the health care system body I have worked with for almost aof the future, sending a patient to the decade now. Jim has a couple bookscardiothoracic surgeon will likely be out that are well worth reading. Butviewed as a failure of the system to half of leadership is being there, so it is kansas city medicine 25

JOSHUA MAMMEN, MD Associate Professor and Vice-Chair, Department of Surgery, University of KansasJoshua Mammen, MD, serves as an associate Leadership does not mean you are theprofessor of surgery and molecular and inte- person that necessarily gets to be the onlygrative physiology at the University of Kansas voice that’s heard, but you can certainlyMedical Center. He also is vice chair of the facilitate others to have a voice or guideDepartment of Surgery. A native of Kaplan, the direction in concert with others.La., Dr. Mammen earned his undergraduateand medical degrees at Boston University. What has driven you to take leadership have in terms of the care they are ableHe completed his general surgery residency roles? to provide patients.at the University of Cincinnati, then serveda clinical fellowship in surgical oncology at I grew up around the time when C. What do you like about leadership roles?the University of Texas M.D. Anderson Cancer Everett Koop was the surgeon general.Center. He also completed a PhD in Molec- He was a pediatric surgeon, but his By the very nature of the profession,ular and Cellular Physiology, an MBA with greatest impact is probably not from physicians have to be leaders in myri-concentrations in Marketing and Manage- the innumerable surgeries that he did, ads of situations. Leadership does notment, and a Master’s in Education all from but his advocacy on issues like cig- mean you are the person that neces-the University of Cincinnati. He is certified arette smoking. That’s where he has sarily gets to be the only voice that’sby the American Board of Surgery, a Fellow saved the most lives. heard, but you can certainly facilitateof the American College of Surgeons, and a others to have a voice or guide the di-member of the Society for Surgical Oncology. For me, my roles in advocacy and rection in concert with others. Some ofA member of the Kansas City Medical Society physician leadership have been in the most important leadership roles Iboard of directors, Dr. Mammen is also Kan- trying to educate individuals about the play don’t have a title. I’m a surgeon insas state chair for the Commission on Cancer, dangers of ultraviolet light exposure, in the operating room working with mythe chair of KUMC’s Cancer Committee, and particular self-induced ultraviolet light colleagues—anesthesiologists, nurses,chair of the Kansas Cancer Partnership Early exposure by sunlamp devices. technicians—and I have a leadershipDiagnosis and Detection Committee. role to play there. My leadership role My other leadership roles arise from might be collaborative, but sometimes the simple reality that health care is there is a time, if something is essen- changing rapidly. Often when chang- tial to the care of my patient, where I es happen, it does not happen in a have to take a different role in terms of thoughtful manner with patients’ leadership. care as the priority. Physicians have a unique perspective. They see patients Are there any resources you have relied on a daily basis, and they realize how upon to become a leader, books or any- change, even small alterations, can thing like that?26 april 2015

What has allowed me to develop my Your leadership work has included advoca- You have been a physician for moreleadership skills the most is showing cy and testimony before the Kansas Legisla- than 15 years, so you are not new to theup. This is really underestimated. You ture. How did that come about? profession, but you are still relatively earlyhave to actually show up, whether in your career. How can physicians of yourthat’s a staff meeting or it’s at a local I am the Kansas state chair for the age and experience adapt to the emergingmedical society meeting or whatev- Commission on Cancer. It is a national model, where leadership is going to meaner opportunity there is. That’s hard organization which encompasses many more collaboration?sometimes since it is time away from different medical societies. I testifiedmy family. in that capacity on a proposed ban on In isolation, a physician has very lim- tanning beds for minors. Unfortunate- ited opportunity to really help his orThe Department of Surgery at KU has ly, the ban did not pass this year. It’s her patients. It requires a collaborativebeen tremendously generous as well as only a matter of time, and hopefully effort. That may be a medical society,the hospital. I went through the leader- we will be able to make some progress. it may be a committee at a hospital, itship training course put on by the KU Freedom is very important, and I cer- may be a national organization, butSchool of Medicine. Additionally, my tainly understand the concerns about rarely are you able to accomplish whatchair sent me to the American College this infringing on freedom. However, it you really need to do to improve yourof Surgeons “Surgeons as Leaders” is a simple question similar to wheth- patients’ health just as an individual.workshop in Chicago in addition to er we should allow kids to smoke or We have to engage a team. It could bethe Harvard course for Leadership De- should we have car seats for kids. me discussing the operation with myvelopment for Physicians in Academic team prior to starting it, to make sureHealth Centers. These are all oppor- In this era of consolidation in health care, everyone is on the same page. Workingtunities that have helped to enhance how can physicians speak up and ensure more broadly as a leader, working withmy leadership skills, but having actual administrators hear the medical voice? those larger groups is important.opportunities to lead is where I learnthe most. We as physicians have to realize that Do you think your generation might be some of these benefits are not going more open to collaboration than olderDo you think it’s important for physicians to be short-term gains. That is hard physicians? sometimes. When I do a surgery to re-to take a leadership role in promoting move a cancer, the results are immedi- The image of a physician as a lone indi- ate, but some changes we may advocate vidual is really not common among mywellness in the community? for may take quite some time. generation and largely is not present anymore in medicine as a whole. ThatI do think it is important. The biggest Can you give some examples? being said, one of the things we needgains we have had in terms of health to preserve from the previous era is ancare in the last century, for example, I helped put together a new surgi- emphasis on personal responsibility.have been secondary to improved san- cal checklist, like pilots do prior to It is easy for the pendulum to swingitation. Those have very real implica- starting an airplane, to review prior to the opposite extreme, when it’s alltions to our patients, and, again, since to the beginning of an operation. That about the team or the system thatphysicians often see the consequences revision has been going on for the made the mistake and the individualof destructive behaviors or outside last two years. It’s probably going to does not have any responsibility orinfluences, they can provide a unique get started in the next couple months. opportunity for initiative. So I do thinkperspective that can really help guide And the tanning bed legislation—cer- there should be that balance, that youpolicies by having those very real sto- tainly everyone I have spoken to in still have a responsibility to your pa-ries about their patients. For example, the legislative arena has not been at all tients, they still do have a relationshipa patient may say, “I would love to surprised that it failed in its first year, with you, as an individual.walk five miles a day, but you know, and suggests that most legislation is athe reality is, I don’t have any sidewalks three- or four-year project.where I am.” Or, “I’d like to bike towork but I can’t do it safely.” kansas city medicine 27

CORI MASON, MD Medical Director, South Kansas City SurgicenterAnesthesiologist Cori Mason, MD, recently I don’t like just talking about things.took over as medical director of the South I like taking action. If something isKansas City Surgicenter in Overland Park. Dr. wrong, what are we going to do, what’sMason got her start in leadership at Overland important ? So, having the opportunity toPark Regional Medical Center through her make decisions and seeing results is verywork as a physician with Anesthesia Associ- gratifying.ates of Kansas City. Her leadership positionsthere included serving as president of the What have you enjoyed the most about the I didn’t seek it. To be honest, I wasmedical staff and in other officer positions on leadership positions you have had so far? asked. I spent a couple years on athe executive committee. A native of Gardner, quality performance improvementKan., she obtained her medical degree from I enjoy the camaraderie with the other committee—that was basically like athe University of Kansas School of Medicine physicians. Obviously, I haven’t been peer review committee—where phy-and completed her residency at the Univer- practicing for 20 or 30 years like some sicians from all different departmentssity of Kansas Medical Center. She is certified of my colleagues, but I do think there came together and looked at cases thatby the American Board of Anesthesiology. used to be more of a culture of physi- maybe didn’t go so well. It was throughShe balances her leadership responsibilities cians doing things socially outside of that committee that other physicianswith her family including husband Jeff and work than there is now. Everyone is so discovered anesthesiologists werethree children ages 5, 7 and 9. busy. Physicians want to take part in involved in all parts of the hospital. We family activities very much. So this is a are there 24 hours a day. There is never time to set aside, you get to have some not an anesthesiologist at Overland social engagement, but also take part Park Regional. in making important decisions. I don’t like just talking about things. I Through this committee it was recog- like taking some action. If something is nized how important the anesthesiolo- wrong, what are we doing to do, what’s gists are. We are not just off in a corner important? So, having that opportunity in the operating room. We are really all of making decisions and seeing results over the hospital. The hospital and the is very gratifying. other physicians said, “Hey, these folks have a good grasp of what is going on What led you to become active on the in the hospital.” medical executive committee at Overland Park Regional? So I had been on that committee for a28 april 2015

couple of years, and then I became a If I have a day off, I will volunteer at can coordinate care quicker, and getmember-at-large of the medical exec- the kids’ school. I also love to cook, more accurate information. It is easierutive committee. I did that for a year, and I very much value being able to when you have developed relationsand I became department chair for a make things that are nutritious and with folks. When they are calling, theycouple years—I did that simultaneous- homemade. And so when I’m off work, know the face, you have had conversa-ly with being secretary-treasurer of the those are the things I focus on. tions before.executive board. How does becoming a leader help in What would your advice be to someoneWhat is it about leadership that you have becoming a better team player across who is looking to take the leap into leader-liked? Has it helped you in your practice of disciplines? ship, but is reluctant?medicine? There is a huge disconnect in physician Look to those people who are alreadyI don’t know if it has helped me in my communication amongst departments. in leadership roles. It is always good topractice of medicine. But there is a Instead of a surgeon calling and saying, have mentors and role models, and ifresponsibility for people who get along you can find great people to work with,well with others to take that role when that certainly helped me as I took onable, when asked. these leadership roles. Any leadership post you take, you are going to needIt was also good for my department some background, and so it is incredi-because we were recognized for the bly important to take advantage of theimportant role we play. We don’t just experience of others. Also, it is easiersit back and give people medicine all to start with a leadership role withinday. We are actually very involved your department and kind of go fromin patient care while they are in the there.hospital, so it was good recognition formy specialty.How did you decide to take on leadershipconsidering your family responsibilities?It was really hard. My husband and I “Hey, I have a patient with this prob-had to decide this is important for our lem, can you come do a consultationfamily. There is a certain amount of job for pain management?” Or, “I needsecurity when you are in a leadership to do a C-section at 2 o’clock in therole. And what ended up happen- morning because of this.” Instead, it’s aing—he was in a role to advance in his nurse that calls you and says, “We needcompany, and he took a step back—he this.”took a big step back. We couldn’t havehim working 80 hours a week, which Tell me why, how urgent it is, what’sis what he was doing previously, with the situation. There are a few physi-me working 50-plus hours along with cians, but not very many, who will callevening meetings and such. So he cut directly. There are different reasonsback to what for him is part-time, why that is. But I do think it is very im-which is about 30 to 40 hours a week, portant to have those conversations, sowhich was much more doable. everybody is on the same page and youDo you have any time for interests outsideof medicine and family? kansas city medicine 29

HEALTH INSPIRING HEALTH TOGETHER 2014 INSPIRING the annual meeting of the HEALTH metropolitan medical society of greater kansas city TOGETHER Kansas City Medical Society members and guests celebrated the accomplishments of the past year and recognized outstanding achievement and support at the 2014 Annual Meeting. The event was held at Sporting Park, home of the Sporting Kansas City pro soccer team. Carrying the theme of “Inspiring Health Together,” 2014 KCMS President Lancer Gates, DO, and Executive Director Angela Bedell offered thoughts on the Medical Society’s inspiring year. Two guest speakers told their inspiring stories. Dick Brown, chair of the board of the Stowers Institute for Medical Research, discussed the institute’s work. Mindy Corporon, whose father Bill Corporan, MD, and 14-year-old son were killed in the April 2014 Jewish Community Center shooting, shared recollections of her father’s career as a physician. Lifetime Achievement Awards were presented to Charles W. Van Way III, MD, and William A. Reed, MD (see separate articles following these photos). The Friend of Medicine Award was presented to Brian Burns, senior vice president, integrated health services, and chief health services executive of Blue Cross Blue Shield Kansas City. Members and guests had the opportunity to tour Sporting Park and mingle with Sporting KC players. Event sponsors were Keane Insurance Group and Tesla, which had one of their high-tech electric luxury vehicles on display. The Lee’s Summit High School Drum Line entertained.Top: 2014 KCMS President Lancer Gates, DO. Above: 2015 KCMSPresident Michael O’Dell, MD.30 april 2015

the annual meeting HEALTH of the metropolitan medical society INSPIRING HEALTH TOGETHER of greater kansas city 2014Guest speaker Dick Brown of the Stowers Institute. Ravi Govila, MD, Blue Cross Blue Shield chief medical officer, accepts the Friend of Medicine Award for Brian Burns.KCMS Executive Director Angela Bedell. Guest speaker Mindy Corporon shared recollections of her late father, Bill Corporon, MD, killed in the Jewish Community Center shooting.Donna and Mark Freidell, MD, of the University of Missouri- Gregg Laiben, MD, of Blue Cross Blue Shield; and Tony Sun, MD,Kansas City and Patti Grozanich, both of UnitedHealthcare. kansas city medicine 31

HEALTH the annual meeting of the metropolitan medical societyINSPIRING HEALTH TOGETHER of greater kansas city 2014KCMS staff. Attendees listen to the program.KCMS Past President Jeffrey Kramer, MD, and his wife. Lee’s Summit High School Drum Line. Members holding leadership positions in the Missouri State Medical Associa- KCMS Past President John Gianino, MD, and his daughter. tion: KCMS 2014 President Lancer Gates, MD; James DiRenna, DO; MSMA President-Elect John Stanley, MD; Betty Drees, MD; MSMA President Jeffrey Copeland, MD, of St. Peters; Rebecca Hierholzer, MD.32 april 2015

the annual meeting HEALTH of the metropolitan medical society INSPIRING HEALTH TOGETHER of greater kansas city 2014Tesla was among the event sponsors. Sporting KC players mingled with guests.James McDonald, MD, of Clay Platte Family Medicine, and his children. Michelle Haines, MD, and Katrina Schulze.Mangesh Oza, MD, surgeon and medical staff president, North Kansas City From North Kansas City Hospital, Gary Carter, MD, chief medical officer, andHospital, and his wife. Peggy Schmitt, president and CEO. kansas city medicine 33

Accomplishments of Charles W. Van Way III, MD, Span Surgery, Nutrition, Training and Medical Publications More than four decades ago, KCMS spanned half a century. Like his father, professor at the University of Missouri–Lifetime Achievement honoree Charles Dr. Van Way also had a long Army ca- Kansas City School of Medicine.W. Van Way, III, MD, was finishing a reer in the reserves and on active duty.clinical pharmacology research fel- In 2008, he became director of thelowship, having taken time out of his Through the years, his clinical Shock/Trauma Research Center atsurgical training. It was then that the practice has included general surgery, UMKC, and was the Sosland/Missourichair of surgery at Vanderbilt University vascular surgery, thoracic surgery and Endowed Chair of Trauma Services.beckoned him for a conversation. surgical critical care. After retiring from active practice in 2014, he remains Emeritus Professor The chair, H. William Scott, MD, Serving as chief of surgery at Den- of Surgery and continues to direct theinquired about Dr. Van Way’s interest in ver General Hospital was a highlight of research center.helping to establish a clinical nutrition his career, Dr. Van Way said. He was 39program for Vanderbilt Hospital. years old at the time of his appointment, Dr. Van Way’s time in Kansas City has and looking back, Dr. Van Way said he coincided with some of the highlights Dr. Van Way was reluctant because he was too young for the post. that he identified in his military career,was just resuming his surgical residency. including graduating from the U.S.But it quickly dawned on Dr. Van Way But it was in that position, he said, Army War College in 1997. He did histhat Scott had already decided he was that he put the finishing touches on coursework mainly through correspon-the man for the job. his education as a trauma surgeon and dence classes, though he did spend two where he learned to manage doctors. summers on the campus in Carlisle, Pa. “All I could do was either be gracefulabout or not be graceful about it,” Dr. “Managing a department is a difficult Dr. Van Way has also written moreVan Way said. “And in programs in the task,” Dr. Van Way said, “and I was sort than 400 papers, chapters, editorials, andold school, when the boss asked you to of thrown into it. I was six years out of other works, including contributionsdo something, you really needed to be residency—four years out of the Army— to the Journal of Parenteral and Enteralgraceful about it.” but I had a great time.” Nutrition, and other publications. He has served as editor of Kansas City Medicine And that, Dr. Van Way said, was his Dr. Van Way’s time at Denver General for more than 20 years.first step toward becoming a nationally came during the nearly decade and a halfrecognized expert on nutrition support. he spent on the faculty of the University In organized medicine, he has served of Colorado School of Medicine. as president of the Kansas City Medical The son of a career Army officer, Dr. Society, the Missouri State Medical As-Van Way was born at Fort Jay, N.Y., an It was from there, in 1988, that Dr. sociation and the American Society forinstallation located on Governors Island, Van Way came to Kansas City when Parenteral and Enteral Nutrition.which sits off the southern tip of Man- Saint Luke’s Hospital recruited him tohattan. become program director of the General continued on page 37 Surgery Residency program. Now 75, his medical career has At the same time, he became a34 april 2015

Heart-Surgery Pioneer William A. Reed, MD, Built Success Around Optimism and Hope Lifetime Achievement Award hon- discharge from the Navy after World was medical director of the Cardiovascu-oree William A. Reed, MD, pioneered War II, and an unexplained affinity for lar Surgery Program for three decades.open-heart surgery in the Kansas City horses that brought one of his thorough-area and developed other innovations in breds to near victory in the 2002 Ken- He returned to KU in 2000 to restartheart surgery. His legacy continues at the tucky Derby. the heart program.Dr. William A. and Mary J. Reed Cardio-vascular Surgery Center at the University Yet one thread runs largely unmen- He performed more than 10,000of Kansas Hospital. tioned through his lifetime of achieve- heart procedures in his career and ment: optimism. authored or co-authored 90 published Though he is nearly 90 years old and articles.several years removed from the operat- Or, as Dr. Reed put it in the titleing room, admirers have continued to of his new memoir, it is “The Pulse of Though retired from surgery, Dr.marvel at the dexterity he demonstrated Hope.” It is the essence of his story, he Reed still serves as chair of the Depart-as an acclaimed heart surgeon. They said. ment of Cardiovascular Diseases at KUhave noted his piety and dedication to Med. And, patients at the University ofhis wife, Mary, and their three sons. “If you take away hope,” Dr. Reed Kansas Hospital now receive care at the said, “you take away life.” Dr. William A. and Mary J. Reed Cardio- Patients and colleagues alike have re- vascular Surgery Center.flected on Dr. Reed’s love of poetry—ru- Dr. Reed said he saw it in the operat-minating on whether his affinity for the ing room, when a patient would sudden- Dr. Reed once told a Kansas City Starlikes of Robert Frost made him a better a ly rally from what appeared to be certain reporter that his attachment to horsessurgeon, or whether his profession made death. might’ve begun during the Depression,him a better poet. when he and his brothers took a Welsh “I don’t know if it was the prayer I pony named Queeny to the largest park Observers have also noted the said for the patient at that moment,” he in their hometown of Kokomo, Ind., toperseverance that led Dr. Reed to teach said. “But I know that it happens. So to sell rides.himself algebra and then attend college me, there is no situation that is hopeless,preparatory classes while working three really, it’s the way you manage to get out Back then, in 2006, The Star reportedjobs to finance his medical education in of or into maintaining that feeling of that he owned 38 horses, boarded at hisIndiana. some optimism.” farm south of Martin City, Mo., and at sites in Kentucky and Texas. Dr. Reed himself has reflected on the Dr. Reed arrived in Kansas City as aindignities of an impoverished child- newlywed in 1954, preparing to start his In that Kentucky Derby a dozen yearshood in Indiana during the Depression, internship at the University of Kansas ago, it was Perfect Drift—a horse thatthe nearly religious (and improbable) Medical Center. He became a professor Dr. Reed bred—that finished third in thecalling to medicine that struck him upon and head of heart surgery at KU. race. He later joined the staff at Saint Luke’s Dr. Reed has talked often about a Hospital in Kansas City, Mo., where he continued on page 37 kansas city medicine 35

Practice management Accountable Care Organizations May Increase Medical Professional Liability By Tom McNeill, The Keane Insurance Group, Inc. The main goals of the Affordable Insurance industry experts agree that that ACOs will have a higher risk ofCare Act (ACA) are to reduce the over- the factors that make ACOs desirable malpractice suits because, by de-all costs of health care in the U.S. and are the very same factors that create sign, they claim and publicize betterto improve access and quality of care additional exposure to risk. Informa- health care for the patients they serve.for a larger number of individuals. One tion sharing, higher standards of care, Evidence-based medicine, which isof the ways the ACA seeks to achieve and fewer tests are characteristics of an the term for the kind of care ACOsthese goals is through Accountable ACO that could lead to liability for in- provide, requires providers to put theCare Organizations (ACO). ACOs dividual physicians as well as the ACO proof of quality care in writing. One ofare designed to make care better and as an entity. In addition, the method the regulations set out by CMS re-more efficient, but they also introduce chosen for insuring the physicians quires that an ACO “Shall demonstratenew risks that need to be addressed by within the system could have signifi- to the Secretary that it meets pa-those forming them. cant problems. tient-centeredness criteria specified by the Secretary, such as the use of patient An ACO is formed by a group Under the CMS guidelines the pri- and caregiver assessments or the use ofof physicians, hospitals, and other mary care physicians are encouraged individualized care plans.”providers voluntarily joining togeth- to share patient health informationer to coordinate quality patient care. with the specialists, the hospitals, and Physicians may have to defendAccording to the Centers for Medicare everyone involved with EMR systems themselves not only on the basis of theand Medicaid Services (CMS), there in order to integrate and coordinate prevailing standards of care but on theare financial incentives in the form of the best care. Obviously this is a good basis of the individualized care plans.higher Medicare reimbursements for thing for patients, but it creates the In some cases these plans may requireACOs that can show reduced costs and risk of data breaches of Private Health additional duties of the physician, theprove a high standard of care. Like- Information (PHI). As good as the performance of which, or lack thereof,wise, private health insurance com- new EMR systems are there can still be could be brought into a lawsuit. Ofpanies provide similar incentives to problems, and they are always subject course, this is yet to be seen becauseACOs that achieve these benchmarks. to human error. Penalties for HIPAA the ACO model is still in its infancy,The idea is that physician led ACOs and HITECH violations can be as high but physician leaders should be awarethat are primary care centered can as $1.5 million so this is an area of of the issue and consult with riskcollaborate to deliver better care and serious risk for ACOs. The solution is management experts in the medicalsave money by keeping patients out of for each physician and the entity to get malpractice insurance industry tothe hospital, eliminating unnecessary protection with a cyber liability policy minimize the potential liability.tests, and streamlining communica- that also covers regulatory violations.tion within the system. It’s estimated Most professional liability insurance Another potential liability riskthat there are currently over 300 active policies have a small amount of cover- comes out of the requirement by CMSACOs operating around the country age but it is typically not enough. that physicians reduce costs and wherewith hundreds more in forming or they are able to do so the ACO willplanning stages. Along with cyber and regulatory share in the savings. But the other side liability, the ACO’s higher standard of the incentive is that CMS, utilizing While the ACO model appears to of patient care may also pose a new a carrot and stick approach, is alsobe living up to the proposed expecta- risk. Medical malpractice insurance able to penalize ACOs if they are nottions it is not without its challenges. companies and defense attorneys fear managing costs. This could increase36 april 2015

physicians’ malpractice risk if they are other risk with the self-insured model at reasonable rates. It would still giveordering fewer “unnecessary” tests in has to do with the financial viability of the ACO control of the coverage with-order to keep costs down and avoid the ACO itself. If for some reason the out risking its assets.penalties. “Failure to Diagnose” claims ACO isn’t profitable and is dismantledmay be a target for plaintiff ’s attorneys. the physicians and other providers With the formation of more andThe professional liability insurance could be left without any insurance more ACOs around the country wecompanies and defense attorneys are protection at all. This may seem far- will hopefully see the results of im-keeping a close eye on this situation. fetched, but it is a possibility. proved health care for all Americans as well as the reduced costs. However, There are innovative and creative On the other hand, letting phy- along with those rewards come theways to insure an ACO and its mem- sicians keep their own medical pro- risks of new liability exposures forber parties. But, because this is a new fessional liability insurance doesn’t those involved.concept the insurance options are still make much sense either in light ofbeing developed. Some ACO founders the potential vicarious liability for Tom McNeill is a health-care specialist with thehave chosen to use a self-insured mod- other physicians in the system and Keane Insurance Group. He has over 30 years’el because it can potentially be a profit the entity when there will be many experience in the health-care industry includ-center. However, this arrangement people involved in care for the same ing serving in hospital and physician practicecreates multiple challenges for the patient. One of the best solutions is management, and most recently as COO of thephysicians. First, typically if a doctor to use the buying power of the large Missouri State Medical Association Insuranceis being put into a self-insured plan group involved in the ACO and put all Agency. Physicians look to Tom for resourceshe or she will need to purchase Tail the members on one policy through such as medical professional liability insuranceCoverage from the previous insurance an A-rated private insurance compa- through NORCAL Mutual Insurance Compa-company to protect against prior acts ny. This arrangement would avoid the ny, physician disability insurance, cyber andclaims that may arise. Tail Coverage need to purchase a Tail Policy because regulatory liability coverage, and HR guidance.can be quite expensive, putting another a private insurance company policy He can be contacted at 314-966-7733, email tom.financial burden on the doctor. An- can easily cover a physician’s prior acts [email protected] Van Way III, MD cont’d from page 34 the opportunities I have been given,” William A. Reed, MD cont’d from page 35 Dr. Van Way said, “and with the things I With the perspective of a long career, have been able to do.” shop teacher he had in high school, aDr. Van Way can now compare com- man who imbued in Dr. Reed a senseplaints about the Affordable Care Act to of self-worth. But help from others cansimilar pronouncements he heard from only go so far; personal responsibilitya highly regarded surgeon when he was takes you the rest of the way, he said.in medical school at The Johns HopkinsUniversity. That, he said, is what spurred him to earn the best grades he could in his The physician warned that the U.S. last year of college—so he could get intowould soon have socialized medicine medical school after an initial rejection.and that doctors would derive limitedsatisfaction from the profession. “Somebody else is not going to do it for you,” Dr. Reed said, admitting that Government intervention in health belief made him a stern leader in thecare has certainly increased since the operating room. “You can’t be satisfied1960s, Dr. Van Way said, but that devel- with doing half a job.”opment has not altered the basic doc-tor-patient relationship. Nor, he said, hasthat greater role diminished his experi-ence in the field. “I have really been very blessed with kansas city medicine 37

Practice management Is Strategy Driving Your Marketing Plan? Build a thriving and sustainable practice through relational marketing By Julie Amor, Amor Consulting Build it and they will come. Not the of successful strategic marketing that are consistently branded, communicatecase anymore, health care has become builds relationships. a positive message and build a brandedone of the most competitive industries relationship with your customer.in our market. How does a private Is strategy driving your marketingpractice build new patient volume and plan? The most important step you Start with your best and bright-retain current patients? Reaching your can take in building your practice is to est. Your staff is your best marketingtarget audience and creating a rela- start with a communication strategy. asset. Having a real person answertionship with them for their long-term The tactics are the easy part; defining the phone is one of the best ways tohealth care needs is vital to the success the strategy is more difficult. Using the build an immediate relationship withof the practice. Patients are not look- STIM process, a strategic marketing your customers. In today’s technologying for a health care transaction; they communication plan should directly world, speaking with a real person hasare seeking a health care relationship. support your business plan through become a unique differentiator. TheCreating a relationship is substantially the development process called STIM person answering your phone is onedifferent than providing a transaction- (strategy, tactics, implementation and of your best brand ambassadors, salesal service. measures), to ensure you are meeting persons and marketers. Ensure you the strategic business goal for your have your best and brightest as your Relational health care is the abil- practice. A well-executed strategic point of entry into your practice.ity for physicians and consumers to marketing communication plan willdevelop a relationship around the guarantee targeted growth for your Thank your customers for choosingpatients’ health care needs and service private practice. you for their health care needs. Con-expectations. It is beyond treating sumers have a choice in where they gotoday’s condition, it is the ability to Define your brand with each for their health care; don’t take yourcare for the whole-person, to have customer interaction. Understand the customers for granted. Create loyaltythe patient feel connected with the perception you give when your pa- by sending a thank you note after eachhealth care provider/practice and to tients see your communication, read visit, making a phone call to first timeknow this is where they choose to go your ads, see your lobby and meet patients and offering an e-newsletter tofor their health care needs. Relational your front desk staff. Every interaction maintain communication with them,marketing creates physician-patient with your customer is an opportunity keeping yourself top of mind with yourrelationships built around retaining to build your branded relationship. Be customer.the patient long-term, understanding consistent across all points of contact,what they consider a benefit of being a every interaction is an opportunity. Julie Amor owns Amor Consulting whichpatient, and an interest in a long-termcommitment to their health. Project a clear and consistent partners with physician practices to strategically image. A clear and consistent image They don’t teach marketing in med- is essential in every form of commu- build practice brand, drive new patient volumeical school. nication. Ensure all customer-facing communication is clear, consistent and and enhance patient experience. She can be As a health care marketer, I have connects to each other. All communi-seen marketing tactics expand with cation should be integrated with each reached at 913-209-2388 or jamor@amorcon-technology, but the core principles still other and should easily connect for theapply when marketing a private prac- patient. Easier said than done, commit sultingkc.com. Her website is www.amorconsult-tice. Strategic marketing is a defined to a comprehensive review of all com-process; here are a few key components munication elements to ensure they ingkc.com.38 april 2015

Special Thanks to Our Partners Thanks to the following for their special commitmentto the Kansas City Medical Society and our service to physicians in the Greater Kansas City area. saint luke’s health system north kansas city hospital meritas encompass medical group kindred hospital kansas city kansas city internal medicine the physicians of menorah medical center the physicians of centerpoint medical center

www.metromedkc.orgHave you heard what’s going on at your medical society? APRIL 2015 3000 2800 JOURNAL OF THE KANSAS CITY MEDICAL SOCIETY 2500 PHYSICIANS IN LEADERSHIP ROLES 2000 What does it take? What are the rewards? 1500 kansas city medicine 1 1000 (a new magazine) 650 500 0 2013 2014(a new website) (extreme growth)