by Jed Delmore, MD —
This article cannot start with my usual attempt at being witty. The past few weeks have brought suicide to the forefront for me and, I suspect, all in the community.
While attending the funeral and celebration of life for the child of good friends, I couldn’t help the constriction in my chest and tears of sorrow for the loss of such a wonderful, talented person and the lasting impact that loss would have on her family and all she touched.
Just weeks ago, a front-page article in the Wichita Eagle reported that the Kansas suicide rate had risen 45 percent since 1999, exceeding the U.S. rate. Only four other states exceeded that degree of increase. Within days, news outlets were reporting the deaths of fashion designer Kate Spade and then celebrity chef and author Anthony Bourdain, both reportedly by suicide. Next came the apparent suicide in Wichita of Emily Glass, the stepmother of the little boy, Lucas Hernandez, whose body was found after going missing three months ago.
I suspect that most of us have an impression or notion of what factors would lead someone to be sufficiently desperate to end his or her own life. Those notions are likely overly simplistic.
Within the past year we have been informed, warned and educated regarding the opioid epidemic. These reports have resulted in proposed state and federal legislation, in addition to restrictions placed by third-party and government payers on prescription narcotics. The Centers for Disease Control reported 42,249 opioid-related deaths in the U.S., with an incidence of 10.4 per 100,000 population for all narcotics and 4.7 per 100,000 for prescription ones.
Allow me to put these statistics in perspective. Data from the CDC shows 44,965 suicides in 2016, making it the nation’s 10th-leading cause of death. The incidence of suicide is 13.4 per 100,000 population. For every death from suicide, there are 25 attempts. Men die by suicide 3.5 times more often than women, with males accounting for 7 in 10 suicide deaths in 2016.
In Kansas, 514 suicides were reported in 2016, an incidence of 19.9 per 100,000, placing us 15th in the nation. Suicide in Kansas is the second-leading cause of death for ages 15-44, and the fourth-leading cause of death for ages 45-54. It seems that opioid misuse is an epidemic, while an equal or bigger problem, suicide, doesn’t receive the same attention.
The factors and causes leading to death by suicide are complex. There is no single cause or etiology. A combination of emotional and physical stressors may produce hopelessness, despair and the ultimate decision to end one’s life. Although mental health conditions including depression, bipolar disorder, anxiety disorders, substance abuse and schizophrenia may be risk factors, almost 50 percent of deaths by suicide occur in those without a documented mental health disorder.
What can we do? As physicians, health care providers and members of the human race, we should be observant and caring regarding those around us. There are multiple organizations, websites and helplines with lists of actions, behavior and changes in personality that raise concern.
Perhaps of greatest help is the ability to mention the word “suicide.” Asking about suicide does not precipitate the action. If someone we know or care for appears to be barely holding it together, asking if they have considered suicide may result in a call for help and action on our part.
Dr. Ravi Bajaj, one of the original two physicians at Heartland Cardiology, likes knowing someone is keeping licenses and privileges up to date for his practice, now 12 doctors and growing.
“MPR has been invaluable,” Dr. Bajaj said. “They will be proactive; they will let my office know we need a renewal six months from the date. They will contact the hospital; they will get the applications. They take care of my VA application. Just handling those details is so important.”
For MSSC members and others, Medical Provider Resources offers a unique service. It is the only credentialing company in the United States that allows a physician to share information once and have provider enrollment, hospital privileges, licensure renewals and other on-going administrative tasks completed. A physician-owned, for-profit affiliate of the MSSC, MPR is one of only three credentialing services affiliated with a county medical society, offering a breadth of services others don’t.
Some offer central verification but not provider enrollment or network credentialing, while MPR is a one-stop shop for providers, medical practices, health care facilities and others.
“No other medical society credentialing service offers what we do to the depth we do it,” said MPR CEO Vicki Bond, who is active in the National Association of Medical Staff Services. “Our goal is to provide services to the physicians that allow them to focus on what they were trained to do, and that is to provide great patient care.”
Having that expertise and experience at hand means practices have one less thing to worry about, Dr. Bajaj said, adding “services like MPR let us focus on patients and the hospitals.”
“MPR is profitable and sustainable, providing not only ready access for members and their practices but also supporting the mission of the Medical Society,” said Dr. Zachary Kuhlmann, chairman of the MPR board.
MPR currently does credentialing for over 65 facilities and networks. It also does provider enrollment for over 40 facilities. Four employees are dedicated to handling enrollment with insurance companies.
The company has a veteran staff, one benefiting from a commitment to professional development. A recent example is that Nathan Huerter, business operations coordinator, recently became dual certified, becoming a Certified Professional in Medical Services Management (CPMSM) in addition to his existing Certified Provider Credentialing Specialist (CPCS) status.
Dual certification isn’t the norm, nor is passing the certification test on the first try, as Huerter did this year. His recent designation demonstrates competency in credentialing management and overall mastering of the systems involved.
“I’m proud of Nathan and his accomplishments. Certification of our staff provides credibility and a deepening of our knowledge of our industry.– that’s what sets us apart,” Bond said.
In the past several years, MPR began offering recruitment credentialing, running checks and building files on possible employees for medical practices and others. Having that information in hand serves as a solid foundation for obtaining hospital privileges and provider enrollment once a candidate is hired.
“Collecting all that information up front gives us a jumpstart on centralized verification, network credentialing and provider enrollment,” Huerter said.
Until not long ago, Associates in Women’s Health did its provider enrollment in-house, but when the employee handling left, it talked with MPR. Going outside was a big change, and there was some nervousness at first, said Chris Francis, CEO of the 18-doctor practice.
“We gained confidence quickly,” Francis said. “They have one person assigned to us, and they are easy to get ahold of, follow up quickly and are easy to work with.”
“Credentialing involves so many different details, and you need somebody who really understands them and the order involved,” he said. “MPR has been a great partner.”
The recently concluded legislative session was as notable for what passed – a telemedicine bill supported by KMS – as it for what didn’t come out of a Legislature preoccupied with school finance issues.
The MSSC Legislative Committee, chaired by Dr. Kevin Hoppock and working closely with KMS advocacy efforts, met several times earlier this year to discuss issues and formulate the Medical Society’s official positions on them.
Dr. Hoppock noted that, through education and advocacy, a number of measures that would have affected the practice of medicine did not advance during the 2018 session. These included ones to expand the scope of practice for pharmacists and podiatrists; allow pharmacists to administer psychotropic drugs; expand independent practice for nurse midwives; and allow law enforcement to gain access to K-TRACS.
“Building on our belief that a physician-led team is the best approach for the practice of medicine and for providing excellent care for patients, we effectively made our case on a number of issues in Topeka,” Dr. Hoppock said. “Our efforts to build relationships with legislators and educate them on medical matters really paid off.”
House Bill 2028 was the most significant health-related legislation to come out of the session, and was later signed into law by Gov. Jeff Colyer. Another piece of legislation supporter by the MSSC and KMS was a measure that delayed implementation of KanCare 2.0 without additional oversight by legislators. KanCare has been plagued by problems since the service-privatization initiative began.
The telemedicine bill establishes a statutory framework for the practice and overcame hurdles to finally reach the governor’s desk, having been delayed by some lawmakers seeking to ensure that abortions could never be allowed via telemedicine.
The new law defines the necessary components for a telemedicine platform, mandates HIPAA compliance and requires that the same standard of care must be upheld for services delivered via telemedicine as in person. In addition, if insurance covers an in-person procedure, the same procedure delivered via telemedicine cannot be denied. The requirements for insurance coverage parity affect not only physicians but also physician assistants, advanced practice registered nurses and behavioral health providers. With the coverage parity and legal framework, telemedicine practice is expected to expand in the state.
The Board of Healing Arts has been charged with adopting rules and regulations under the telemedicine act, which takes effect Jan. 1, 2019. The board, after consulting with the Board of Nursing and the Board of Pharmacy, will adopt regulations involving the prescribing of drugs via telemedicine.
With the June 10 filing deadline for candidates, legislators seeking re-election are focusing on their campaigns for primaries this summer and final elections in the fall. Both provide additional opportunities for the MSSC and its members to advocate for and support the practice and business of medicine.
“The input from physicians has mattered and will continue to matter in our state,” Dr. Hoppock said. “Members can voice their views directly to the Legislative Committee and provide support for local and state candidates in another way, through SedgPAC, our political action committee.”
Members interested in donating to SedgPAC, the MSSC’s political action committee, can send donations to the MSSC office or call 683-7558 for details. Donations are divided between SedgPAC and the statewide KaMPAC, with donors becoming members of both committees. Funds raised by SedgPAC support worthy candidates for local and state offices.
Fourteen MSSC members are among more than three dozen doctors, health care providers and organizations named Health Care Heroes by the Wichita Business Journal.
Dr. Alex Ammar, president and CEO of Wichita Surgical Specialists, and Dr. Claudia Perez-Tamayo, radiation oncologist at Central Care Cancer Center, are recipients of lifetime achievement awards. They and other members of this year’s class will be honored July 19 during a ceremony at the Hyatt Regency Wichita. Other MSSC member physicians honored and their award categories are: Ravi Bajaj, physician; C. Randy Blue, physician; Michael Cannon, physician; Pat Do, physician; Brett Grizzell, physician; Kerri Hild, physician; Brent Lancaster, physician; Moneeshindra Mittal, physician; Seth Page, physician; Dr. Randy Reed, health care educator; Dr. Sid Sivamurthy, community outreach; and James A. M. Smith, physician.
MSSC members recently traveled to Chicago for the 2018 Annual Meeting of the American Medical Association. Dr. Braden Foster, this year’s recipient of the Dr. Joe Meek Young Physician Leadership Award, was making his first trip to the AMA. He was joined by Dr. Michael Lievens, MSSC president-elect, KMS delegate Dr. Terry Poling, KMS alternate delegate Dr. Jay Gilbaugh and Dr. Donna Sweet, representing the American College of Physicians.
Here are some thoughts from Dr. Foster on the June 9-13 event: “It was a great experience. The things that stood out were first the dedication and time commitment physicians have for health care policy.
“The debate that took place when reviewing proposed resolutions was eye-opening to me, because physicians across the nation have such varying perspectives, and a policy that would affect health care in Kansas is often vastly different than the effect on the East Coast. The Kansas delegates play a major role in developing AMA policy, and I value their commitment toward representing fellow physicians.”
The Project Access program has received a $12,500 grant to coordinate care for uninsured Sedgwick County residents who are experiencing serious gynecological health issues.
Through the Wichita Community Foundation, the George R. Tiller, M.D. Memorial Fund for the Advancement of Women’s Health gives grants to nonprofits to “provide comprehensive health services, support, and compassion to vulnerable women to enhance their ability to realize their dreams.” Dr. Tiller, a MSSC member, was slain in 2009.
“This grant will help us coordinate donated health care for many women with critical health issues,” said Shelley Duncan, executive director of Central Plains Health Care Partnership, a nonprofit affiliate of the MSSC. “It will help us connect women most in need of care to doctors, other providers and services.”
MSSC member Dr. Pavan Reddy, an oncologist/hematologist with Cancer Center of Kansas, is among authors of a study that determined that many women diagnosed with early stage breast cancer do not need chemotherapy.
The study of more than 10,000 women found that those who had midrange scores on a 21-gene test, the Oncotype DX Breast Cancer Assay, had similar outcomes with endocrine therapy, including tamoxifen and related medicines, as they did with a combination of endocrine therapy and chemotherapy. Women in the category had recurrent scores of 11 to 25 and their cancer had not spread to lymph nodes, among other factors. The study appeared in the New England Journal of Medicine and can be found at www.nejm.org/doi/full/10.1056/NEJMoa1804710.
MSSC member Dr. Katherine Melhorn recently was honored with the 2018 Volunteer Leadership Award from the National Children’s Alliance, recognizing her decades of work in investigating and preventing child abuse.
The alliance is a national organization that helps communities provide a coordinated response to investigating and supporting victims of child abuse and accredits Child Advocacy Centers such as the one in Sedgwick County.
Dr. Melhorn, a pediatrician and clinical professor with KU Wichita Pediatrics, received the award June 10 in Washington, D.C. She was the first child-abuse pediatrician in the state and was integral in creating the Child Advocacy Center of Sedgwick County in 2008.
The Earl L. Mills Educational Trust is accepting applications from practicing physicians for scholarship funds to support additional study in medicine lasting 4-12 months at an approved institution or to attend local educational seminars offering postgraduate opportunities.
Applicants must have practiced in Kansas for at least five years and be a member of a medical group no larger than five. The deadline is Aug. 31, 2018. To request an application, call Stephanie Clausen with Intrust Bank at 383-1912.
KU School of Medicine-Wichita has appointed Rachel Brown as chair of its Department of Psychiatry and Behavioral Sciences.
Brown, who begins her duties July 2, most recently served as associate dean for student affairs, diversity and inclusion officer and professor of psychiatry at Central Michigan University College of Medicine. At KUSM-Wichita, Brown will lead 27 faculty and staff. She succeeds Lyle Baade, who is retiring after 40 years.
MSSC extends its condolences to the family of Dr. De Bakker.
Surgeon Jan B. de Bakker, MD, died June 9, 2018. Born in Tilburg, Holland, Dr. De Bakke attended medical school at Duke University and the Medical College of Virginia after serving as a medic and infantryman with the Royal Dutch Marines during and after World War II. He completed an internship and three years of residency at the Medical College of Virginia and then finished his residency at St. Francis Hospital and the VA in Wichita in 1965. Dr. De Bakker established his own practice in Wichita in 1965 and practiced for more than three decades.