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Maura P. Quinlan, MD, Illinois Section chair; Sloane L. York, MD; Jessica Kiley, MD; and Christopher G. Olson, MD, at the 2013 Illinois Section Lobby Day
Illinois passed a sexual education act in 2013, requiring sexual education to be age appropriate, medically accurate, and comprehensive. A nurse practice act was also passed, maintaining a collaborative agreement between advanced registered nurse practitioners and physicians.
A bill to license direct-entry midwives was introduced late to the Legislature, just prior to recess, and was not passed. Bills mandating stricter requirements for clinics providing medical or surgical abortions and the offer of ultrasounds to women prior to abortion also failed to pass. The section will host a Lobby Day on March 20. All members are welcome to attend.
Section leadership now has representation from members throughout the state and from most of the medical schools. Section members are collaborating with the Chicago Department of Public Health and other professional organizations for Vaccinate Illinois Week to raise awareness for influenza vaccination.
Congratulations to Tashera E. Perry, MD, District VI Junior Fellow vice chair and former section Junior Fellow officer, who was selected as a 2014 Gellhaus Resident Advocacy Fellow. Dr. Perry will spend two to four weeks working with the ACOG Government Relations and Outreach department in Washington, DC.
ACOG Assistant Secretary Thomas M. Gellhaus, MD, past District VI chair, speaks at the Iowa Section Meeting.
The Iowa Section held a successful meeting in October in conjunction with the University of Iowa. Section members were active in the Iowa Medical Society Lobby Day held in February. Legislative asks included improved funding for Medicaid in the state budget, reduced medical liability litigation, and expedited restitution to patients harmed by medical care.
Funding to support additional residency training, a 1% increase in Medicaid reimbursement, and the repeal of site-of-service fee differential for Medicaid passed through the Legislature in 2013. Legislation regarding breast density reporting, tort reform, and shackling of pregnant prisoners did not pass. The Iowa Department of Corrections adopted new restraint procedures for pregnant prisoners that met the section’s goals. Legislation for licensure of direct-entry midwives and breast density reporting has been proposed again in 2014.
The Iowa Board of Medicine adopted a proposed rule to regulate drug-induced telemedicine abortions in Iowa. Additionally, the governor must now approve reimbursement for each Medicaid-funded abortion.
Michael J. McCoy, MD, section chair, chaired the Iowa Medical Society Tort Reform Task Force under the Iowa Medical Society Committee on Legislation. The task force’s recommendations were to:
- Pursue establishment of an early disclosure and compensation model
- Enact legislation to establish an affirmative defense in medical liability suits for the practice of evidence-based medicine
- Enact a provider shield law
- Enact legislation that sets parameters for contingency fee arrangements in medical liability cases
Congratulations to Marygrace Elson, MD, section vice chair, who was recently selected to be the 2014 District VI McCain Fellow.
The Manitoba Section is launching TeamSTEPPS training in the province to improve patient safety. The Regulated Health Professions Act is expected to be functioning by September 2014. It will set standards of practice for medicine, nursing, midwifery, and other allied health professions. Winnipeg continues to struggle with high delivery volumes at St. Boniface Hospital. A new Women’s Hospital is under construction.
The master agreement between Manitoba physicians and the province expired March 31. Health care budgets are strained, with low probability of fee increases. Doctors Manitoba is setting up work groups to make a proposal to Manitoba Health, a department within the government, by September 2014. Then, negotiations will begin. The next provincial election is projected to be October 4, 2015.
MNsure, Minnesota’s health insurance exchange, had a rocky start in October. Issues with the exchange’s call center persist. Kathryn Duevel, MD, a retired ACOG Fellow, is the only health care provider on the MNsure Board of Directors. The Minnesota Section will continue to work with its lobbyist this legislative session. The Minnesota Medical Association Day at the Minnesota State Capitol is scheduled for March 13. All are welcome to attend.
Several bills related to women’s health and the ob-gyn specialty passed the state Legislature in 2013, mandating:
- Funding to train health care workers about maternal depression
- Medicaid coverage for doula services
- Grants to prevent fetal alcohol syndrome
- A 5% increase in funding for nursing homes
- The unionization of in-home child care and personal assistants
Legislation to license facilities providing 10 or more abortions per month did not pass.
The Minnesota Section, in conjunction with the Minnesota Department of Health, has a multidisciplinary maternal mortality project underway. The project committee meets quarterly to review cases of maternal mortality in the state. Elizabeth P. Elfstrand, MD, gave an excellent report and presentation on the project at the 2013 Minnesota Section Annual Meeting in November.
The 2014 Minnesota Section Annual Meeting will be held November 22 at The Depot in Minneapolis. Douglas W. Laube, MD, MEd, past ACOG president, will be a featured speaker.
Congratulations to Christine S. Goudge-Walker, MD, on her election as District VI young physician, and to all the new section officers.
An initiative to reduce elective deliveries prior to 39 weeks’ gestation has been in motion since January 2013. All hospitals in Nebraska have hard stops in place for elective deliveries prior to 39 weeks. The number of these elective deliveries in the state is now less than 1% and approaching 0%.
The Newborn Associated Adverse Events Task Force continues to meet. The task force is a collaborative group that was formed through the Nebraska Medical Association working with the Nebraska Section to deal with the adverse neurological outcomes of newborns due to hypoxic ischemic encephalopathy and cerebral palsy from a care and financial standpoint. The Neonatal Encephalopathy Task Force is developing a case manager navigator program to help families get care for their affected children.
The Nebraska Medical Association has proposed two bills to increase the medical liability cap. The new total award amount would be $2 million to $2.5 million with a $250,000 non-economic cap on medical liability awards. Medicaid expansion in Nebraska is still being debated. Senators are offering amendments involving patient responsibility and a sunset clause in case federal funding doesn’t continue at 90%.
Several bills that impact reproductive health passed during the 2013 legislative session. One bill asks voters to change the state’s constitution to recognize “the inalienable right to life of every human being at any stage of development.” This proposition, which will be on the November 2014 ballot, would confer human rights on fertilized eggs and attempt to outlaw all abortion. Another bill makes it a misdemeanor for any provider to assist with abortive services for the reasons of sex selection or genetic abnormalities.
Another bill passed into law makes it a felony to perform an abortion on a woman before determining if there is a detectable heartbeat unless there is immediate risk of life or irreversible bodily harm to the woman. This law has been temporarily blocked by a federal judge. However, abortion after 20 weeks’ gestation is still banned in the state.
On a brighter note, the Legislature did appropriate an extra $7.4 million to increase the number of medical students to 70 per year as well as the number of residency positions within the University of North Dakota medical system. Also, congratulations to Siri J. Fiebiger, MD, who was named the Association of Professors of Gynecology and Obstetrics Educator of the Year for 2013.
The Saskatchewan Section is attempting to re-establish a provincial perinatal mortality and morbidity committee, in addition to a provincial perinatal database. Saskatchewan has an HIV rate that is four times the average rate in Canadian reproductive aged women. This high rate is due to the prevalence of injection drug use. A provincial HIV in pregnancy strategy and dedicated detox for pregnant women is under development.
Patient safety continues to be a focus of the section. The Saskatchewan government has adopted the Lean approach to improve the way its services work. Nearly 100% of the larger medical centers in the province are using surgical checklists in ob-gyn and improving patient and staff safety with a project called Stop the Line. The Saskatchewan Surgical Initiative has improved wait times for select gynecologic surgeries. However, wait times for non-emergency surgeries have not improved.
Other strategic priorities for the section and province include strengthening primary care, increasing the rural family physician supply, improving mental health and addiction services, and decreasing youth tobacco use.
Sanford Health in Sioux Falls is starting a surgical residency program with two residents per year. Several ACOG section members will help with didactic training and surgical training for the residents. Establishing a surgical residency is a prerequisite to starting an ob-gyn residency in the future, which has been discussed.
Sanford Health has implemented a policy to stop elective inductions prior to 39 weeks’ gestation. There are now financial disincentives for facilities that deviate from this standard of care. Therefore, many other health systems in the state have adopted the policy. Several health care systems in the state are also implementing SCOPE (Safety Certification in Outpatient Practice Excellence for Women's Health Program) standards for outpatient procedures.
Increased revenues in 2013 have provided a $75 million surplus in the state, which is earmarked to increase school funding and Medicaid reimbursement. A task force recommended refusing federal money for Medicaid for fear of an unfunded mandate in the future. This recommendation was contentious and will likely be reviewed again in 2014. The South Dakota State Medical Association has advocated for the increase of medical school class sizes from 50 students to 65 and the expansion of Medicaid for all South Dakota residents below 100% of the federal poverty level.
Several bills of interest to ob-gyn were passed by the Legislature. One bill offers debt repayment for family physicians that practice in rural areas. Another bill increases documentation for sale of phenylpropanolamine and other precursors for methamphetamine. A third bill permits confiscation of personal property and income from convicted sex traffickers.
The Wisconsin Section continues its efforts to build a more visible and influential political presence in the state. Over the last year, members have worked closely with ACOG’s Government Relations and Outreach staff to develop and distribute formal documents and opinions on issues affecting women’s health care in Wisconsin. These efforts, including video messages by advisory council members, culminated with an editorial piece by Kathy D. Hartke, MD, section vice chair and legislative chair, supporting women’s health care autonomy. Section leaders extend their sincere gratitude to Dr. Hartke for her dedication and efforts in expressing the section’s opinions.
The section was well represented at the ACOG Congressional Leadership Conference, in Washington, DC, March 2–4. Several new members were welcomed to the section’s contingent, assisting in relaying ACOG viewpoints to elected federal officials. Please consider applying for a position as a member of the 2015 Wisconsin Section contingent. Additional information will be available in early fall of this year.
The section participated in the Wisconsin Medical Society’s Lobby Day on February 12. This event is an excellent way to become involved in advocacy close to home. Please contact your section officers if you’d like to learn more about this opportunity. The Wisconsin Medical Society helped pass legislation that defines informed consent as information a reasonable physician would provide. The Wisconsin Section will sponsor a booth and will be represented at the Wisconsin Women’s Health Policy Summit in March 2014.
The 2013 Wisconsin Section Annual Meeting was held at the Kalahari Wisconsin Dells. It was a great success, and plans are already underway for the 2014 meeting, which will be held at the same venue August 8–9. With ICD-10 conversion rapidly approaching, the Section Advisory Council has decided to focus the meeting on coding and ICD-10 implementation. Additional details will be available soon.
Please also save the dates for the Annual Clinical Meeting, April 26–30, in Chicago and the Annual District Meeting, September 4–7, in Napa, CA. As always, feel free to contact any of the section officers if you have any concerns, interests, or issues you would like to discuss.