State Med Board approves new opioid CME, chaperone rules

The State of Wisconsin's Medical Examining Board (MEB) gave final approval to two administrative rules at its monthly meeting on August 16. One is the culmination of a multi-year exploration into establishing chaperone requirements; the other modifies current rules for physicians' continuing medical education (CME) responsibilities. 

Opioid CME Requirements

The new rule alters the current requirement that a physician complete two credits of coursework each reporting period in a specific area of controlled substances prescribing; the specific subject area has varied over the previous cycles. Under the new rule, the two-credit requirement can be fulfilled with coursework pertaining to "prescribing opioids and other controlled substances." While previous cycles required those courses to be approved by the MEB, the new rule eliminates that requirement. 

Since first establishing this subject-specific requirement, the MEB created each version of the rule with a sunset clause, meaning the requirement would expire if the MEB determined that specific prescribing education was no longer needed. As the state continues to experience overdose-related deaths – including an increase in synthetic opioid-related abuse – the MEB decided not to include a sunset clause for the new rule. Therefore, the requirement will remain until such time as the MEB decides to alter the rule. 

The new rule is expected to take effect on October 1, 2023, which means it applies to the current CME cycle. 

Chaperones

The MEB also finished work on a new rule related to utilization of chaperones when providing certain patient care. What originally started in February 2021 as a proposal that would have flipped the burden of proof for physicians accused of inappropriate conduct during a sensitive physical exam had they not utilized or offered a chaperone, the approved version focuses on ensuring physicians comply with their employer's chaperone requirements, or if self-employed establish written procedures for the use of chaperones. 

Copies or access to the clinic's chaperone procedures should be made available to patients likely to receive a sensitive physician exam. This requirement does not mean chaperones are required – but that a clinic describe its chaperone situation (which can include not offering chaperones). An employed physician will not be found in violation of this rule if the employer fails to create a chaperone policy or neglects to make the facility's policy available to patients.

The Wisconsin Medical Society testified in favor of the modified rule late last year. This rule is also scheduled to take effect on October 1, 2023. Violation of the rule could result in a finding of unprofessional conduct. 

You can read the approved language of both rules here.

Contact Mark Grapentine, JD for more information.

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A warm Western Wisconsin welcome

Great things happen when physicians take the time to connect and relax together. Once again, the Western Wisconsin Medical Society Annual Corn Roast created a perfect opportunity to do just that. Wisconsin Medical Society President Don Lee, MD, and President-elect Cynthia Hart, MD, along with La Crosse County Medical Society President Michael White, MD, and Wisconsin Medical Society Foundation and Society staff attended to witness the great Western Wisconsin Welcome on Tuesday, August 15 at Carson Park in Eau Claire. It was wonderful to see so many physicians with their families enjoying the perfect summer evening together. The corn, picked just that morning according to Donn Dexter, MD, was just as fresh and sweet as the conversations that spanned care for fellow physicians and ways to get more involved to support neighbors in need.

Attending this informal gathering made it clear that opportunities like these allow physicians to connect, helping to develop relationships to work collectively on the issues facing the profession and make a meaningful difference. For staff it was a great chance to hear directly from physicians about their concerns and the pride they have in their work and their communities, including organizations that are making a difference to improve the lives of their patients outside of the clinic.

Supporting programs that increase health equity and access is central to the Foundation’s work. Through our annual survey, physicians in Western Wisconsin identified several community organizations working towards that mission, including the Open Door Free Clinic. Just before the Corn Roast, Foundation staff were given a tour of the clinic. The Foundation was proud to support this physician-championed program with a community health grant. The clinic is run by volunteers with only one employee who coordinates the program. Located just a few blocks from the river in Chippewa Falls, Open Door Free Clinic provides full-service care to patients between the ages of 18 – 64 who are uninsured or underinsured. Before scheduled clinic hours, a meal is provided for volunteers to thank them for their service and give them the nourishment needed to focus on the care being provided. Community partners volunteer to provide the meal. There is also a food pantry right on campus. Patients are able to speak with a care coordinator who reviews their situation every three months to make referrals to available services and check for eligibility for benefits outside of the clinic. Kim Renaud, RN, MS, Clinic Coordinator, shared how elated patients are when they report food insecurity at intake, and in minutes she’s able to bring them food from the pantry to help with that immediate need.

From the intake, patients go to a waiting area where they can sign up for a free YMCA gym membership, get hygiene and personal care items and find health and community program educational pamphlets. The nurse screening area, lab and exam rooms are all set up to provide maximum dignity and comfort during patients’ visits. There’s even a full formulary where volunteer pharmacists and pharmacy technicians can dispense necessary medication free of charge to patients. In addition, the clinic is able to provide mental health telemedicine and scheduled counseling appointments. “Our patients are really happy. We are their care home,” Renaud reports.

Open Door Free Clinic needs support, though. First and foremost, volunteers! Physicians are needed at all our community Free and Charitable clinics, along with nurses, lab techs, pharmacists and pharmacy technicians. All the equipment in the clinic was also donated. If your clinic is upgrading equipment, please consider donating the equipment that is being replaced to a free clinic. There is always a need for things like blood pressure cuffs and otoscopes. Additionally, it is a great help to the patients to be able to obtain basic hygiene items like deodorant, toothpaste and toothbrushes. Not to be overlooked, financial donations are also essential. Funding in the form of a grant like that from the Foundation, along with donations from individuals, make it possible for the clinic to continue to provide prescriptions that their patients need that are not in their formulary.

Shining a light on the wonderful organizations like Open Door Free Clinic that physicians recognize are increasing health equity and access, the comradery of physicians and traditions like the annual Corn Roast, are all ways to strengthen community and the profession and the staff of the Wisconsin Medical Society and Foundation are grateful for the opportunity to be a part of these important occasions.

If you would like to learn more about Open Door Free Clinic, please visit chippewaopendoor.org. Help us improve health equity and access in your community by donating today to the Foundation.

For questions or to learn more about the Foundation or our programs, please contact Executive Director, Elizabeth Ringle at elizabeth.ringle@wismed.org

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Consolidate student loans by December 31, 2023

Many student loan borrowers will benefit from consolidating their federal student loans this year due to the Department of Education’s payment count adjustment.

Loan Forgiveness Background

The federal government has two primary loan forgiveness programs for all student loan borrowers. First, the Public Service Loan Forgiveness program (PSLF) forgives a borrower’s loan balance after 120 monthly payments while working for a qualifying employer (typically a government, tribe or 501(c)3 nonprofit organization). Many health care organizations are 501(c)3, so physicians often qualify for PSLF. Second, borrowers who don’t work for a qualifying organization can still have their loans forgiven. However, they need to make 240 or 300 monthly payments (depending on payment program) instead of 120 payments. In addition, borrowers need to be enrolled in one of the several income driven repayment (IDR) plans for their monthly payments to count.

2023-2024 Payment Count Adjustment

The Department of Education is reviewing all direct loans and Federal Family Education Loans (FFEL) to give credit toward the forgiveness programs. Per the announcement on StudentAid.gov, “The account adjustment will count time toward IDR forgiveness, including

• any months in a repayment status, regardless of the payments made, loan type or repayment plan;
• 12 or more months of consecutive forbearance or 36 or more months of cumulative forbearance;
• any months spent in economic hardship or military deferments in 2013 or later;
• any months spent in any deferment (with the exception of in-school deferment) prior to 2013; and
• any time in repayment (or deferment or forbearance, if applicable) on earlier loans before consolidation of those loans into a consolidation loan.”

Benefits of Consolidating by December 31, 2023

• The loan with the longest payment history will be applied to the consolidation loan. This could result in “free” payment credits on loans with short or no payment history.
• Consolidation loan payments will count toward forgiveness going forward even if non-qualifying loans, like FFEL, were consolidated.
• Normally, consolidating restarts the payment count for loan forgiveness. However, an exception currently applies, and the payment count will not reset due to consolidation.

Resources

Your loan servicer should be able to help, but black and white documentation is always best.

1. Account adjustment and consolidation studentaid.gov/announcements-events/idr-account-adjustment
2. The new SAVE repayment plan studentaid.gov/announcements-events/save-plan

For personalized help eliminating debt, investing smart and securing retirement, please contact Mark Ziety, CFP®, AIF® 608.442.3750.

Mark Ziety, CFP®, AIF®
WisMed Financial, Inc. part of the Wisconsin Medical Society.  

Note: This article is for informational purposes only and should not be considered as financial or tax advice. Please consult with a qualified financial advisor or tax professional before making any financial decisions.

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Message from Hawaii Medical Association regarding Maui fire disaster

Thank you for your many emails and messages of concern about the Maui fire disaster. Hawaii Medical Association (HMA) President Angela Pratt, MD, and her team have been ensuring open communications with various entities. HMA’s president-elect, Elizabeth A. Ignacio, MD, lives in Maui and is in the thick of things.

HMA has published a Maui Support page, which is being regularly updated as news and additional resources become available. HMA is in direct communication with the incident commander, as well as the governor's office and Maui mayor's office, ready to assist. Bookmark the Maui Support page to stay in touch. Several news outlets are linked, as are donation pages. HMA has been asked to gather names of physicians who may be able to assist, but we’ll need to wait patiently for when that need arises. The road to recovery will be long.

Hawaii Medical Association has been advised that the best supports right now are cash and patience.

Mahalo for all your support.

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AMA webinar Healing the healer: Legislative and regulatory advocacy to support physician wellness

Physician burnout can lead to devastating consequences for individual physicians, patients, the physician workforce and the U.S. health care system as a whole. Dealing with burnout requires system-level solutions, as well as initiatives and programs that provide protections to help encourage physicians and medical students to seek help when needed and improve their practice environment.

Support for enhancing physician wellness is growing. For example, a number of state medical associations have successfully enacted laws that provide confidentiality protections for physicians seeking help for burnout, and the AMA has worked closely with state medical associations to urge state medical boards to eliminate or revise stigmatizing mental health related questions on licensing applications to match AMA policy and lower barriers to physicians from seeking help.

Click here to register for the webinar Healing the healer: Legislative and regulatory advocacy to support physician wellness, to be held on Wednesday, August 23 at noon central. Join the chair of the AMA Board of Trustees Willie Underwood III, MD, MSc, MPH, in conversation with expert panelists who are working with the AMA in advocating for such changes—and implementing them:

• Mark Staz, Management Consultant, Regulatory Policy, Federation of State Medical Boards
  • How FSMB is changing licensing questions to remove stigmatizing questions that often serve as a barrier to care
• Barb Smith, Chief Executive Officer, South Dakota State Medical Association
  • How South Dakota State Medical Association advocated to have its state board change licensing questions to support physician wellness
• Abraham Segres, Vice President, Quality and Patient Safety, Virginia Hospital & Healthcare Association
  • How the Virginia Hospital & Healthcare Association is leading efforts to get all VA hospitals and systems to make positive changes to support physician wellness—and attract new physicians to its workforce
• Joel Bundy, MD, Vice President, Chief Quality and Safety Officer, Sentara Healthcare
  • How the health system identified changes needed and the steps it took to implement and communicate changes across the system

Click here to learn more and register.

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Counseling and coaching services discounts for WisMed members

The Wisconsin Medical Society (WisMed) works to support physicians through every stage of their careers (from medical school through retirement), which is why WisMed is offering behavioral health services options for our members. WisMed has partnered with Marvin, Core Choice and LifeBridge to provide confidential counseling and coaching services with flexible hours. Board certified psychiatrists and licensed psychologists are available via teletherapy when you need them.

Initial feedback from Marvin users has been positive. WisMed members can register online to get started or call with questions. Members may choose to pay out of pocket at a special WisMed discounted rate or have the services billed to their insurance. Your initial appointment will be within 72 hours of your outreach. 

To reach Marvin, call 424.322.6881, visit meetmarvin.com/wisconsin or scan the QR code on the flier.

Core Choice, is a physician wellness resource for our physician members. Core Choice, provided by Erica Larson, DO, focuses on your complete wellness. Dr. Larson uses a holistic approach with a comprehensive assessment and advanced diagnostics, and provides Wisconsin Medical Society members a 25% discount on the assessment. Learn more here.

Additionally, members of Dane County (DCMS) and La Crosse County (LCMS) Medical Societies can access LifeBridge Physician Wellness Program. This completely confidential offering provides up to six free coaching/counselling sessions per year with a psychologist. Appointments are available via telemedicine and are scheduled within 72 hours.

Members of LCMS and DCMS can learn more and access this member benefit here. For information on how to launch Lifebridge Physician Wellness Program in your county, please contact Jim Lorence.

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