Stephen F. Lefler, MD, section chair
Arkansas Section leaders have been busy planning and attending meetings. William “Sam” Greenfield, MD, section vice chair, and Ashita Gehlot, MD, section Junior Fellow chair, represented Arkansas at the Congressional Leadership Conference, in Washington, DC, in March. I attended the Interim District Advisory Council Meeting in Memphis, TN, in February.
Dr. Greenfield and I have been working with Kathryn E. Sawchak, MD, Kansas Section chair, Octavio R. Chirino, MD, Missouri Section chair, and Nirupama K. DeSilva, MD, Oklahoma Section chair, on plans for our combined Annual Section Meeting at Big Cedar Lodge near Branson, MO. The meeting will be held June 13–14, and we expect it be another great event. I hope many of our members can attend.
Kathryn E. Sawchak, MD, section chair
For the next three years, I will be serving as section chair, and Melissa Hague, MD, will be serving as section vice chair. Our goals during this time are to promote more involvement from Fellows statewide and to facilitate growth and leadership among Junior Fellows. Your thoughts and ideas are welcome. Feel free to contact us with your ideas or concerns.
Dr. Hague and I attended the Interim District Advisory Council Meeting in Memphis, TN, in February. Topics such as elective deliveries prior to 39 weeks’ gestation, upcoming challenges with ICD-10 implementation, and differences among states regarding tort reform were discussed.
The March of Dimes and Kansas Department of Health and Environment are working to reduce overall preterm births rates in Kansas. The Kansas Perinatal Quality Collaborative will work to develop a plan to enforce a hard stop on elective deliveries prior to 39 weeks’ gestation. The concern regarding ICD-10 implementation is payment delays, which could significantly impact medical practices.
The $250,000 cap on non-economic damages in Kansas was recently challenged. The Kansas Supreme Court upheld the cap. The court’s ruling signaled two necessary actions for those wanting to preserve the cap and its protection. The first action is to increase the amount of the cap. The second action is to participate in purchasing professional liability insurance from the Kansas Health Care Stabilization Fund as a defined health care provider.
The Kansas Medical Society has proposed to increase the cap incrementally over an eight-year period to $350,000. This action would cause an increase in insurance premiums over this period. Currently, the average liability policy for $1 million/$3 million coverage in Kansas is approximately $36,350.
Our Annual Section Meeting will be held with the Arkansas, Missouri, and Oklahoma sections at Big Cedar Lodge near Branson, MO, June 13–14. All our Kansas colleagues are invited to join us for a fabulous conference and to get involved in the meeting’s planning.
We look forward to interactions with more of our members. Together we can make a difference!
William D. Binder, MD, section chair
Money drives everything, and we live in a time of tight money for health care. In Louisiana, Gov. Bobby Jindal has cut hundreds of millions of dollars from higher education and health care. Poor perinatal outcomes are a huge expense for our state, and state government officials don’t think they’re getting their money’s worth.
In the last year, I’ve been to meetings sponsored by the National Governors Association, Louisiana Department of Health and Hospitals and Institute of Healthcare Improvement, Capital Area Human Services District, and March of Dimes. I have acted on behalf of Woman’s Hospital in Baton Rouge to improve outcomes in our service area.
Few ob-gyns attend these meetings or are even aware they take place. I’ve learned a few things from these meetings. First, Louisiana is almost dead last in every perinatal measure. The March of Dimes again gave Louisiana a failing grade for prematurity. Though, our rate of 15.3% was a slight improvement over the previous rate of 15.6%.
Second, I now really appreciate the difference between the practicing ob-gyn view of the world and the public health view of the world. It is helping one person at a time vs. helping millions at a time. I always thought I was doing a good enough job until I started seeing the numbers.
As an individual ob-gyn, I never saw elective inductions as a problem. We now know that a hard stop on elective deliveries prior to 39 weeks’ gestation has improved outcomes, reduced unexpected admissions to neonatal intensive care units by 20%, and saved the health care system millions of dollars.
There will not be change without measurement. And to continue to improve, we have to decide where we want to end up, what changes can help us get there, and most importantly, what to measure to ensure that our changes are an improvement.
The Louisiana Section will have new officers take over at the Annual District Meeting in October. We will welcome Kathleen T. Sullivan, MD, as section chair, Marshall S. St. Amant, MD, as section vice chair, and Robin B. Bone, MD, as section secretary-treasurer.
Gary M. Agena, MD, was our only representative at the Congressional Leadership Conference, in Washington, DC, in March. The conference was held at the same time as Mardi Gras, so it was difficult finding anyone available to go. The Louisiana Annual Section Meeting was held on March 22 in New Orleans, with J. Martin Tucker, MD, District VII chair, and James N. Martin Jr, MD, past ACOG president and past District VII chair, as speakers.
Wayne A. Slocum, MD, section chair
The Mississippi Section is eagerly awaiting its Annual Section Meeting with the Alabama Section in lovely, sun-drenched Sandestin, FL, May 8–11. The program includes preeminent speakers in our specialty, as well as past and present ACOG leaders. We plan to honor Helen B. Barnes, MD, as a legend in ob-gyn for the state of Mississippi. There should be plenty of time for social activities as well, so please come on down and see us on the beach. We’ll do our best to make sure you’re glad you came.
Octavio R. Chirino, MD, section chair
The Missouri Section welcomed new officers at the 2013 Annual District Meeting in September. I assumed the role of chair and am looking forward to a productive, educational three years on the Section Advisory Council. The new section vice chair is Peter B. Greenspan, DO, and the new section secretary-treasurer is Ravi S. Johar, MD.
The Section Advisory Council has met twice via teleconference since September and discussed a variety of issues affecting the state. We recently ratified an update of the section policies and procedures. Section leaders are busy planning for our Annual Section Meeting with the Arkansas, Kansas, and Oklahoma sections. The meeting will be held at the beautiful Big Cedar Lodge near Branson, MO, June 13–14. This joint effort has been successful for us all and enables a more efficient use of our combined resources.
Legislative efforts this year will focus on tort reform and reversing damage done by the Missouri Supreme Court in July 2012 when it declared medical non-economic liability award caps unconstitutional. We continue to work with a lobbyist group hired over the last few years to help us communicate with the Legislature. The group will work in tandem with the Missouri State Medical Association on this issue in 2014.
In addition, we will continue to push oversight legislation to have only adequately trained and licensed midwifery providers offering obstetric care to patients in Missouri. Other issues we will follow closely in the Legislature are Medicaid transformation, advanced practice registered nurse independent practice, and prescription drug monitoring.
Dr. Greenspan, Beth A. Rasmussen, MD, and Simon P. Patton, MD, District VII Junior Fellow secretary-treasurer, attended the Congressional Leadership Conference, in Washington, DC, in March to represent the section in national legislative efforts.
The Missouri Women’s Health Advocates Political Action Committee is seeking donations from Missouri ob-gyns to help move our legislative efforts forward. Because of the nationwide implications of tort reform efforts in Missouri, we have sought help from District VII as well. Missouri continues to work with state pediatricians to collaborate on issues of mutual interest.
Nirupama K. DeSilva, MD, section chair
Lydia D. Nightingale, MD, section secretary-treasurer, Katherine C. Arnold, MD, section Junior Fellow vice chair, and I are working to improve health education in Oklahoma City and rural areas of our state. We’ve made several contacts regarding the introduction of sexual education into Oklahoma City schools. We’re also meeting with local organizations that house teen clinics within high-risk schools to obtain objective data demonstrative of the usefulness of the proposed health education. Lastly, the Oklahoma Institute for Child Advocacy in Oklahoma City plans to partner with the Oklahoma Section to teach medical students advocacy and to work on best practices for teen pregnancy prevention.
Tulsa now has a sexual health education curriculum established in the majority of its schools. The Campaign to Prevent Teen Pregnancy was initiated in Tulsa in late 2013. Grant R. Cox, MD, District VII secretary and program chair, and I, on behalf of the Oklahoma Section, continue to be intimately involved in this campaign through speaking engagements with the community on this topic and assistance with the initiation of teen-friendly clinics.
The GirlSmarts website is growing on an international level and being increasingly used as a resource for teens in health education. We are working to overhaul the site to make it even more teen friendly and accessible. We also continue to add to the question-and-answer databank where teenage girls can get answers to common health questions.
With the assistance of our lobbyist and the leadership of Mark C. Genesen, section vice chair, we are moving toward making legislative allies with representatives and senators within the Oklahoma government. We also are bracing ourselves for the current legislative session.
Our Annual Section Meeting will be held with the Arkansas, Kansas, and Missouri sections at Big Cedar Lodge near Branson, MO, June 13–14. I hope many of you can attend.
Christopher T. Welsch, MD, section chair
As you are well aware, there are many evolving dynamics in the practice of medicine, and we are all in this together for the benefit of our patients. A few items of note, specific to our state:
- The cost of a $1 million/$3 million liability policy has decreased from previous years, mostly due to legislation that remains in place, despite challenges to similar laws in surrounding states
- Caps on damages still exist. A $750,000 cap on non-economic damages ($1 million in catastrophic injury cases) was enacted in 2011 and became effective in 2012. The cap has not been challenged in appellate courts yet
- There is a federally-administered health insurance exchange in Tennessee, and the state government has chosen not to participate in Medicaid expansion under the Affordable Care Act
- There are no Medicaid medical home products in Tennessee at this time. Ob-gyns are not designated as primary care physicians in commercial medical home products. Moreover, ob-gyns are not designated as approved providers for preventive exams for female Medicare patients
Each section within ACOG has three officers—chair, vice chair, and secretary-treasurer, all of which are three-year positions. The next Tennessee officer rotation will occur in the fall of 2015. The deadline for submission of election materials is June 1, 2014. A call for candidates will be sent from the national office this spring. The Nominating Committee will meet in the fall of 2014, and chosen nominees will be notified subsequently. We welcome anyone who is interested in serving the members of our section to submit election materials. Please feel free to contact any of the current officers if you have questions about these positions.
The section is returning this year to a regionalized section meeting format, sponsoring programs throughout the state in conjunction with local ob-gyn societies. We recognize the constraints of professional life, limitations on time away from a busy practice, and absence of need for formalized continuing medical education given the American Board of Obstetrics and Gynecology Annual Board Certification process. We are formatting these meetings accordingly.
The first meeting this year was a dinner program in conjunction with the Memphis Ob-Gyn Society in February. It featured ACOG President Elect John C. Jennings, MD, Gerald F. Joseph Jr, MD, ACOG vice president of practice activities and past ACOG president, and J. Martin Tucker, MD, District VII chair, as speakers. The second meeting was held in April in Knoxville and welcomed Ted L. Anderson, MD, PhD, immediate past District VII chair, as a speaker.
Gov. Bill Haslam has chosen to pursue a model similar to the one currently in place in Arkansas to address costs associated with delivery of health care. This approach establishes specific “episodes of care” for which different stakeholders are designated as “quarterbacks” and are responsible for the overall cost of delivery of that service. The intended goal is to provide savings sharing, quality control and assessment, and eventually cost-overrun accountability. Interestingly, one of the first three episodes of care and its respective quarterback is perinatal care and ob-gyn.
We surmise that—out of more than 250 specified episodes of care—perinatal care was chosen because the government pays for more than 50% of deliveries statewide. The outcome of how this episode is defined and how the specific parameters are assessed has yet to be fully understood.
The Tennessee Initiative for Perinatal Quality Care is currently in the sustainment phase of its 39-week delivery project and is still enrolling sites for its project on optimizing antenatal steroid use. Work is ongoing on its breast-feeding initiative with hopes to develop another around managing and/or decreasing maternal hemorrhage.
Bobby C. Howard, MD, Frank H. Boehm, MD, Giancarlo Mari, MD, and David Adair, MD, represent the section on the State Oversight Committee. Their annual meeting was in Nashville in February and featured Haywood L. Brown, MD, District IV chair, as a plenary speaker.
The section is committed to leadership training and facilitating interaction of our members with ACOG at the state, district, and national levels. To this end, the section will defer $100 of the cost of registration for any Tennessee Fellow or Junior Fellow interested in attending the Annual District Meeting in October.
The section will also support attendees to the Congressional Leadership Conference and Robert C. Cefalo Leadership Institute. These events are held each spring. Please contact any of your section officers by September 30 if you are interested in participating in 2015.
Are you a resident conducting clinical or lab research? Many opportunities exist to present your research on a local or district level, and the section has available funds to support these activities. Please have your program director contact a section officer for further information.
We appreciate the privilege of serving you. Please contact us at any time if we can be of assistance. I hope to see you at one of our section meetings or the ADM in October!