Medical Society of Virginia2924 Emerywood Parkway, Suite 300 Richmond, VA 23294 Phone: (804) 353-2721 Fax: (804) 355-6189www.msv.orgVIRGINIA MEDICAL NEWS

December 2017

Virginia Medical News · Fall/Winter 2017 www.msv.org2 3

2017 House of Delegates MSV Delegates Establish Policy on Pressing Health Care Issues

Over 250 people attended the 2017 Annual Meeting, which included the House of Delegates, Gubernatorial Candidate Lunch, Foundation Gala, and Physician Leadership CME Bootcamp. Delegates at the 2017 House of Delegates (HOD) considered more than twenty submitted resolutions that ranged the health care continuum, including public health, insurance, and practice issues. As MSV’s policy-making body, the HOD determines how MSV will consider legislation, regulation, and stakeholder issues by establishing an official position, also known as a policy. Delegates also approved the proposed 2018 budget and elected new officers and directors, including President Kurt Elward, M.D.

Thank you to the over 100 delegates representing component societies, specialty societies, at-large districts, health systems, and medical schools from across Virginia. Physician participation from different geographic regions, specialties, and practice settings is essential to fortify MSV’s policy with a full range of perspectives and practice experiences. We send a special thank you to the 65 new delegates that registered for the first time this year!

Delegates approved new policy on pertinent health care issues:

� Insurance coverage and access to care• Improve Medicare and commercial insurance

coverage for health care costs associated with obesity treatment

• Reaffirm MSV’s support of fiscally responsible Medicaid expansion

• Allow Virginians on Social Security Disability Income to meet income eligibility requirements for Medicaid

• Improve options for individual insurance coverage in the Commonwealth

By Julie Galloway, MPP Health Policy Analyst

� Practice Issues: Step Therapy, Prior Authorization, and E-Prescribing • Improve step therapy and prior authorization

processes in Virginia • Oppose health plan restriction of medically necessary

care and require health plans to provide physicians with real time access to covered benefits, the criteria for medical necessity, and cost information

• Improve e-prescribing of medications for physicians � Maintenance of Certification

• Request the Virginia AMA Delegation to support efforts to ensure financial transparency and a fair fee structure for Maintenance of Certification

� Public Health• Revise the “Good Samaritan” statutes to provide

liability protection for volunteer physicians providing health care at athletic events or programs

• Assist physicians in identifying victims of human trafficking and provide guidelines for anonymous reporting

• Support gun violence restraining orders as a mechanism to decrease gun related suicides and homicides

• Support an increase in Virginia’s tobacco tax to align with the national average

The HOD also approved a proposed Speakers’ update to the policy compendium, ensuring that MSV’s policies are aligned and organized in the most effective way.

Developing policy at the HOD is the first step of MSV’s advocacy process. This step determines MSV’s position on a wide range of health care issues, which is a necessary foundation prior to deciding each year’s advocacy priorities.

For more information on MSV’s Advocacy Process, please visit our website: https://www.msv.org/programs/advocacy

Policy

You can find more photos of the House of Delegates and other Annual Meeting events at www.msv.org/AM2017photos

www.msv.org4 5

Policy

Closing Remarks

Mr. Speaker, Honored guests, esteemed delegates, MSV family including staff and associated individuals.

About a year ago, you gave me the honor of being the 196th President of this professional organization. My journey in Medical Society of Virginia started more than 20 years ago as a member of MSV, and then being a part of it in various capacities. This journey prepared me for my duties this year and I feel blessed for that. I have tried to play my role with dedication, commitment and sincerity. Thank you again for this opportunity to grow and serve.

It is time for me to reflect on the year and report to you. Some of you know that I started my term with some challenges. My first goal was to finish my term without any crisis or division among the membership and I am happy to report that my term is ending without any such crisis. We have remained focused on what is best for MSV. Secondly, I wanted to have a great transition and continuum with our President Elect Dr. Elward. He has been a great leader and he is now familiar with all operations and projects of our society that a President should know about.

I want to thank the members of my Executive committee, particularly my advisers, Drs. Barbara Allison Bryan and Sterling Ransone. A special thanks to our General Counsel Scott Johnson, who helped me remain focused on what would be right for the society, even when I thought it was not right for me. Cort Kirkley started as our CFO at about the time I became the Treasurer. He managed our MSV through the transition of our EVP seamlessly. He has served our MSV as the CFO and COO during the last two years. He is moving on to other opportunities. On behalf of MSV, I wish him all the best.

Internally, we built upon the reforms started last year and organized our Legislative process in the form of Advocacy Summit and Advocacy Committee. This has resulted in better selection of issues, not only legislatively but for advocacy.

By Bhushan H. Pandya, M.D.MSV President 2016-2017

The other significant development is the direction we have taken in terms of our budget. We have been in a deficit budget for the last few years and we would have been in deeper deficit if we had followed the approved budget this year. Our Board made a responsible decision to turn the cruise ship around with the goal of having a balanced budget. Our staff has made responsible changes so that the deficits will be much smaller than they would otherwise be.

A small but important change during our Board meetings is the reporting by each Board member of developments in their district. This helped other Board members understand what is going on at the grassroots level.

Our biggest strength, and an objective way of determining success, is in the General Assembly. Opioids are a crisis nationwide and that has been the focus of the Medical societies in the states I visited representing MSV. MSV was in the forefront of being a part of the solution in Virginia,

working closely with our partners on the Board of Health, Board of Medicine, Virginia Department of Health and others. We are working with others about the issue of COPN. The most important thing is averting the bills that would have affected the practice of medicine negatively. One example is having physicians write the reason for prescribing each medication.

Friends, you are here because you believe that organized medicine, particularly that MSV makes a difference. As the practice of medicine is changing, more physicians are in employment, networking being more on social media, the participation in organized medicine is decreasing. Advocacy benefits all physicians whether they are MSV members or have paid their dues. But we are only as strong as our membership and revenues. The staff is working hard in conveying this message and recruiting more members, but are we all doing all that we can? Can we do better? In a recent visit to a component society, I was told that 5 out of 55 physicians were MSV members. How can we serve all physicians with that much participation and revenues?

One always thinks, what more could have been accomplished? I wish we could have focused more on diversity and proportional representation from minority groups both in the leadership and this House of Medicine.

We had a wonderful presentation from Lynne Hughes, from the MSV Foundation, in Danville about physician burnout and resilience recently. It clearly exists. I hope we can implement specific solutions to help our fellow physicians. I will leave the incoming President and the Board with these challenges.

I see life as getting on that ride at Disney World, go through the tracts where pirates jump out of caves or see beautiful dolls dancing around. At the end of the ride, you get off with your family and go for the next ride. I am getting off this ride as your President and am ready for the next ride life takes me to.

Thank you for the privilege of serving our MSV.

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Kurt Elward, M.D., MPH, FAAFP was installed as president of the Medical Society of Virginia (MSV) at the organization’s Annual Meeting in Norfolk on October 21. He has over 30 years of full spectrum Family Medicine experience and has contributed to over 30 peer reviewed publications. MSV is the largest physician organization in the Commonwealth, representing more than 9,000 physicians, physicians-in-training and medical students.

In his inaugural speech before meeting attendees and their guests, he spoke of the challenges presented by the current U.S. health care system and the need for patient-centered, innovative collaborations being greater than ever. Dr. Elward committed his presidential year to three areas– influencing a greater collaborative approach to health care reform, supporting opportunities to foster resilience in Virginia physicians, and advocating for multi-disciplinary strategies to improve approaches to pain management. His overarching focus, however is how the MSV can empower Virginia physicians to best serve their patients in challenging times.

“We do not advocate because it is easy; we advocate because it is hard.”

“We do not dedicate ourselves to patients because it is convenient. We do it because it is necessary and right,” Dr. Elward told attendees of his

inauguration. “I am humbled by taking on this position of leadership. I commit this evening, and tomorrow and the days thereafter, to carrying the torch and lead your – our – medical society this year.”

After graduating from the University of Illinois in Chicago, he completed residencies in Family Medicine at UVA, Internal Medicine at University of Rochester, and then a combined National Institutes of Health (NIH) Fellowship, Preventive Medicine residency and MPH program at the University of Washington. He is Board-certified in Family Medicine, Internal Medicine, and Geriatrics. He completed the Improvement Advisor Program at the Institute for Health care Improvement and has led major practice transformation and quality initiatives with over 7 major health systems and over 500 physicians.

He is a member of national quality measurement panels including National Committee for Quality

Assurance (NCQA), the National Quality Forum (NQF) and the NIH Asthma Coordinating Committee. He has served as President of the Albemarle County Medical Society and has held leadership in MSV as 7th District Director and Speaker. He has also served in leadership in the

Virginia Academy of Family Physicians as their President and American Academy of

Family Physicians (AAFP) Delegate.

Kurt Elward Installed as New MSV President By Julia ChipkoCommunications Manager

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Virginia Medical News · Fall/Winter 2017 www.msv.org8 9

William K. Flemming, M.D., of RichmondService to the Uninsured and UnderservedDr. Fleming established a solo practice in Richmond after working at the Veteran’s Hospital and sees all patients

who come in to his office, regardless of their ability to pay. In addition to the generosity and compassion he provides to these patients and their families, Dr. Fleming founded what began as a soccer league for underprivileged children that he has help grow into a multi-faceted community organization with an increasing number of services and partnerships. He has been a pivotal member of the Jahnke Road Community Development Association (JRCDA), actively participating in many projects including: the development of Lucille Brown Middle School; reducing blight in the commercial areas; establishment of several housing efforts for seniors; community and personal safety strategies; and multiple recreational activities for youth.

Foundation

Salute to ServiceBy Julia ChipkoCommunications Manager

The MSV Foundation created the annual Salute to Service Awards in 2004 to recognize outstanding efforts of physicians, medical students, and alliance members who are dedicated to creating and nurturing a caring health promotion and disease prevention environment by providing service on behalf of patients everywhere. The MSV Foundation presented the 2017 Salute to Service Awards at this year’s Physicians’ Gala at Hilton the Main in Norfolk,

Virginia.

Randolph Gould, M.D., F.A.C.S., of NorfolkService to the Profession

Dr. Gould has held multiple medical leadership positions including over 20 years at the American Medical Association (AMA), President of the MSV, and service on American Medical Association Political Action Committee (AMPAC) and appointment to the Council on Legislation and Chair of the Virginia delegation. His contributions to organized medicine are significant, but it is his dedication to his patients and mentorship to students that has had the greatest impact to the profession.

Leigh Grossman, M.S., M.D., of CharlottesvilleService to the International CommunityDr. Grossman has made clinical, academic, and educational contributions to medicine at state, national, and global levels. Dr. Grossman has served children in the Commonwealth for over 35 years. She has a national reputation as a leading expert of pediatric infectious disease, hospital infection control, and global health education. Through the delivery of direct patient care and the establishment of programs, Dr. Grossman has made international

impact with her medical service work in Haiti for over 13 years, as program director for the Semester at Sea study abroad program, and as Associate Dean for International Programs at UVA. In addition, she has served in the Peace Corps and consulted for the Pan American Health Organization in Washington , DC and Chile, Project Hope, and the King Faisal Hospital in Saudi Arabia.

LoAn Nguyen, M.D., PhD, FACP of AshburnService for Advancing Patient Safety and Quality ImprovementUnder Dr. Nguyen’s leadership, the Kaiser Permanente (KP) NOVA team of Adult and Family Medicine has achieved hypertension control rates of greater than 90 percent, Colorectal cancer screening rates exceeding 80 percent, Breast cancer screening rates close to 90 percent and cervical cancer screening rates of 90 percent. She has built a team of diabetic care managers and has engaged our clinical pharmacists to improve diabetic care and control for KP members. She has built a program for weight loss which is available

to KP members at no cost, and members have lost over 1,000 pounds of weight total. Her best practices and ideas have been adopted across KP in the Mid-Atlantic states, and are being considered for adoption in California.

Omar A. Salman of RoanokeService by a Medical Student or ResidentHis leadership and community involvement spans multiple organizations including: Vice Chair of

LGBTQ+ Issues for the American Medical Association (AMA), Volunteer at the Roanoke Diversity Center, Founder and President of the VTCSOM Student National Medical Association, and Recruitment Vice Chair for the MSV. In his leadership positions, Omar has collaborated with leading LGBTQ advocates and organizations such as the AMA LGBT Advisory Committee, Lambda Legal and the Gay and Lesbian Medical Association to improve LGBTQ focused resolutions and AMA Medical Student Section (MSS) conference programming. Several programs Omar has organized for AMA MSS conferences include “LGBT+ Health Literacy” and a blood drive in remembrance of the PULSE Orlando shooting victims during the 2016 AMA MSS Interim Meeting in Orlando. Omar is dedicated to advocating for the LGBTQ community and uses this passion to drive change toward health care equality.

The award recipients were recognized at the “Casino Royale”-themed Physicians Gala. Clockwise from above: Mr. Salman Dr. Nguyen Dr. Grossman Dr. Gould Dr. Flemming

Virginia Medical News · Fall/Winter 2017 www.msv.org10 11

Legislative Preview and Election Results

Podcast Announcement

By Sara Rose Wells Assistant Director of Government Affairs

By Sara Rose Wells Assistant Director of Government Affairs

Many changes are underway at the General Assembly in Richmond – the General Assembly building is under construction, Governor-Elect Ralph Northam, M.D. will begin his term in January, and joining him will be at least 15 more Democratic delegates than last year’s session. The MSV government affairs team is hard at work preparing for another eventful legislative session which will include a variety of health care related issues:

� Opioid prescribing and addiction treatment – while we’ve made much progress in combatting the opioid epidemic, we expect more legislation on these issues, which could include: prescribing limits, increased access to treatment, expanded PMP check requirements, and more.

� Certificate of Public Need reform – individual project bills are expected, as well as another comprehensive reform plan.

� Preservation of team based patient care – nurse practitioners have indicated they plan to file a scope of practice bill, effectively ending Virginia’s current system of team based care.

� Optometry scope of practice � Licensure of naturopaths � Medicaid expansion – with the dramatic shift in the balance of power in the House of

Delegates, expect a strong push from Governor-elect Northam on expansion. � Maintenance of Certification – expected legislation that would prohibit the

requirement for hospital privileges and health plan credentialing

Due to the General Assembly downsizing into the much smaller Pocahontas Building for the next few years, the difficult decision was made to postpone MSV’s traditional White Coats on Call lobby days this year. However, MSV is working on new, innovative ideas to make sure you stay connected during the 2018 session and beyond. We are excited to announce MSV’s first podcast series featuring interviews with Virginia’s health care leaders including Del. John O’Bannon, M.D., Sen. Siobhan Dunnavant, M.D., and more. The podcast will release its first episode prior to session. Stay tuned, more announcements and information on the podcast series will be sent via email and available on our social media platforms, Facebook and Twitter.

advocacy

Governor-elect Northam, prior to his electoral victory, addressed Annual Meeting attendees and met with MSV leadership on October 20th, 2017

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As chair of the MSV Medical Student Section, I’ve seen firsthand the impact that organized medicine has on my generation of future physicians. My time with MSV has been one of the most rewarding experiences outside of the classroom. I know these experiences are a direct result of the passion, excitement, and support for medical student engagement in our medical society from our MSV physician and PA members.

I am proud to announce that during the 2016/2017 academic year we were able to recruit more than 70 percent of the first year medical students at EVMS, VCU, UVA and VTC to join both the MSV and The American Medical Association. Our high recruitment numbers are a result of our over 60 student leaders across Virginia who share their MSV experiences with their peers.

The medical student section played an active role in advocacy during 2017. During the General Assembly session, we advocated for and were successful in supporting the passing of a harm reduction bill and the signing of a bill to create a needle exchange program in the Commonwealth.

On behalf of the over 1,500 medical student members of MSV, I thank you. MSV has taught us how to be patient advocates, fight for our profession, lead our peers, and work together to achieve a collective goal. We will be better physicians because of MSV. This student section has not only changed our lives but the lives of our future patients.

Medical Students in Action By Samantha Hay, M4, Virginia Commonwealth University School of Medicine MSV Student Chair

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Virginia Medical News · Fall/Winter 2017 www.msv.org14 15

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events

The Medical Society of Virginia has been a leading voice for physicians for nearly 200 years and recognizes now as a pivotal moment in health care. In the past decade, health care has seen significant changes, both challenging and rewarding, that have impacted physicians and the delivery of care nationwide.

With the expedited rate of health care changes, and the increasing burden that seems to be placed on physicians, there is rarely (if ever) a time for pause. Infuse 2018 provides an intentional moment for physicians to think

SYNCBy Kelsey Carnes, MBA Program Coordinator

The MSV Foundation, in partnership with VHHA, VNA and VDH, is proud to congratulate the eight graduating teams that made up our 3rd SYNC cohort this year! Our SYNC program is a team-based learning experience for multidisciplinary health care teams of 2-5 people who learn skills in interprofessional collaboration, creative problem solving, and impactful leadership to drive organizational performance. This year’s teams received CME credits for their participation in the program, and attended four hands-on workshops where they learned about innovation and collaboration from our nationally recognized faculty of field practitioners and knowledgeable support staff.

As a cornerstone of the program, each group was asked to put learning into action by identifying a problem in their environment and tackling by developing a capstone project. Informational resources and support consultations were provided throughout the program to fine tune each team’s project focus and approach. Key focuses for this year’s projects included:

� managing poorly controlled diabetes, � increasing cancer screening rates, � providing nutritional education for patients with high blood pressure, and � improving transitions of care for discharged patients.

Stay tuned for future offerings of the program, as well as opportunities to get involved. If you have any questions, please feel free to reach out to MSV Foundation.

MAY 5 - 6, 2018 • RICHMOND, VA

about themselves, explore their passions, and connect with the joy in practicing medicine.

Infuse presents an exciting lineup of speakers ranging from Virginia influencers to national innovators. The summit infuses panel discussions, creative demonstrations, artistic fusion and culinary offerings to create an experience that is unlike any other conference. Disrupt your thinking; join MSV and 18 Virginia component and specialty societies on the path to possibility at Infuse 2018.

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Here’s what participants are saying about their SYNC experience,

“SYNC will help you look at yourself and others on a deeper level; it will challenge your way of thinking and there will be growing pains. You will be thankful you took advantage of the opportunity to participate in SYNC with your team”.

“SYNC provided a structured opportunity to address some real-world challenges in a safe, positive, non-threatening environment”.

BOARD OF DIRECTORS

2924 Emerywood Parkway, Suite 300, Richmond, VA 23294800-746-6768 | www.msv.org

PresidentKurtis S. Elward, m.d., m.p.h., faafp

Immediate Former PresidentBhushan H. Pandya, m.d.

Speaker of the HouseArthur J. Vayer Jr., m.d.

President-ElectRichard A. Szucs, m.d.

Secretary-TreasurerAlan L. Wagner, m.d., facs

Vice SpeakerAlan H. Wynn, m.d., facp

DirectorsMichael S. Amster, M.D.Joel T. Bundy, M.D., FACP, FASNJohn F. Butterworth IV, M.D.Sandra K. CarlsonSandy L. Chung, M.D., FAAP, FACHEJacqueline M. Fogarty, M.D.J. Mark Hylton, M.D.Larry G. Mitchell, M.D., FAAFPMohit Nanda, M.D.Edilberto Pelausa, M.D., FACS, FRCSCPatricia A. Pletke, M.D., FAAFPWilliam E. Prominski, M.D.Timothy L. Raines, M.D.Cynthia C. Romero, M.D., FAAFPJohn D. Ward, M.D., M.S.H.A.Chi Young, M.D.Peter A. Zedler, M.D.

Associate DirectorsTeresa W. Babineu, M.D., FAAFPSamuel D. Caughron, M.D.Trevar O. Chapmon, M.D.Clifford L. Deal III, M.D., FACSJames R. Dudley, M.D., M.B.A.Andrea R. Giacometti, M.D., FACRMeredith P. JohnsonLisa S. Kennedy, M.D., FAAFPW. David Kiser, M.D.Lee Ouyang, M.D.Adlai Pappy, M.D.Pradeep K. Pradhan, M.D., FACP

Executive Committee AdvisorsDavid A. Ellington, M.D.Thomas W. Eppes Jr., M.D.Karen S. Rheuban, M.D.

AMA DelegAtion

ChairRandolph J. Gould, M.D., FACS

Vice Chair Claudette E. Dalton, M.D.

DelegatesDavid A. Ellington, M.D.Edward G. Koch, M.D., FACOGHazle S. Konerding, M.D.Mitchell B. Miller, M.D., FAAFPLawrence K. Monahan, M.D., FACP

Alternate DelegatesJoel T. Bundy, M.D., FACP, FASNClifford L. Deal III, M.D., FACSThomas W. Eppes Jr., M.D.Bhushan H. Pandya, M.D.Sterling N. Ransone Jr., M.D., FAAFPWilliam C. Reha, M.D., M.B.A.Cynthia C. Romero, M.D., FAAFP