The Second J. Jerry Rodos Lecture: Mark E. Clasen, MD, Ph.D.

“[W]e as healthcare professionals know that most compliance occurs in the milieu of a trusting relationship that is culturally competent.

“In this major thrust, that creating a real change in behavior, occurs best when the message is negotiated in one’s own language, articulated with the proper mixture of science, theology, and always love.

“There is little doubt that a culturally competent care giver is more valuable than the high priest of technology who possesses 100% knowledge to heal, but who lacks the human translation about how to heal.

“To loosely paraphrase an old adage: “a physician is frequently in error, but never in doubt.” For those in the audience who are not physicians, I want to assure you that ego strength is required to deal with pain and suffering, and demands a decisive, take charge approach, and is more egocentric than George Patton, especially when life and death matters hang in the balance.

“. . . [H]owever, when the issues are weakness, being sick unto death, being rendered helpless, we more likely want to be a patient of a loving, caring physician who will guide us through the storm to the shoreline of restoration, health, and well-being.”

Group 1 Pugno, Lead; Goodman, Scribe; Babitz, Crawford, Leong and Palafox

Group 2 Bejinez-Eastman, Lead; Peck, Scribe Fine, Hansen and LeRoy

Group  3 Flinders, Lead; Kopes-Kerr, Scribe; Boltri, Hixon, Levitt and Squire

Group 4 Fowkes, Leader; Bowman, Scribe; Kimball, Lewis and Wilke

Group 5 Herman, Leader; Maudlin, Scribe; Burnett, WH; Fredrick and Schlegel 

Group 6 Frey, Leader; Wu, Scribe; Burnett, L, North and Schwartz

Group 7 Hines, Leader; Clasen, Scribe; Geyman, Olsen and Saffold

[See  Proceedings of the First National Conference on Community Health Center Primary–  Care Residency Program Linkages, “Community-Oriented Primary Care and the Role of Community Health Centers” (Part 1, Babitz).]

Marc E. Babitz, MD

“[P]rimary care is not simply opening up an office and seeing those patients who come to you. Primary care is having a practice that makes sure people do not have artificial barriers to care. Obviously, financial barriers are the biggest ones.  But there are also transportation barriers and those are found both in urban and rural areas, as you well know . . . 

“But we can also talk about culture and language.  We link culture and language together all the time, but being fluent in a language has little or nothing to do with being culturally competent . . . Even so, we need to talk about the two together.  Culture and language are really a combined entity and we must recognize the access barrier that this combined entity presents . . .

“My definition of primary care includes its having to be “acceptable.”  “Acceptable” is the one word I unfortunately never see in other definitions of primary care.  But primary care has to be acceptable care, because, unless primary care is given in a way that a patient can use it, it has no value.”

Group 1 North, Leader; Squire, Scribe; Bowman, Clasen and Fine

Group 2 Wilke, Leader; Schwartz, Scribe; Boltri, Flinders, Fowkes and Haughton

Group 3 Babitz, Leader; Herman, Scribe; Crawford, Hansen, Kimball and Leong

Group 4 Burnett (WH), Leader; LeRoy, Scribe; Goodman, Hines, Levitt and Saffold

Group 5 Burnett (L), Leader; Bejinez-Eastman, Scribe; Kopes-Kerr, Maudlin and Schlegel

Group 6 Frey, Leader; Fredrick, Scribe; Hixon, Lewis and Pugno

Group 7 Geyman, Leader; Olsen, Scribe; Palafox, Peck and Wu

The following is the Group Discussion Question, based on a quote from the Proceedings of the Twenty-Second National Conference on Primary Health Care Access, held in April 2011.

Hector Flores, MD; White Memorial Medical Center, Los Angeles

“Back in 1992, a very colorful California State Assembly member, Richard Alatorre, who . . . was Chair of the Assembly Committee on Health, held a hearing on health services to needful populations. Three health care entities, among others, came in to testify.

“Alatorre finally threw up his arms and said, “You know the hospitals come in and say we’re doing God’s work. Just give us more money we’ll fix the problems of the world. Then the community clinics come in and say we’re doing God’s work. Just give us more money and we’ll fix the problems of the world. Then the doctors come in and say the same thing. If we’re all doing God’s work, then why are we in healthcare Hell?”

“It’s true!  We’re all beating up on each other with our lobbying. The counties have their own public hospital associations. The health plans have their own lobbying firms and their own cartels. Then we also have the academic medical centers. Then we have organized labor playing both sides.  We need to unite ourselves.”

Hector Flores, MD

22nd National Conference on Primary Health Care Access

Hyatt Regency

San Francisco, California

___________________________________________

Group 1 (Coastal Research Group Board Meeting) Pugno, Executive Chair; Babitz, Clover, Flores, Herman, LeRoy and Wilke; Burnett, L; Burnett, W. H.; Burnett, W. J. and Turner

Group 2 Bejinez-Eastman, Chair; Boltri, Scribe, Crawford, Fredrick and Saffold

Group 3 Flinders, Lead; Fowkes, Scribe; Frey, Geyman and Goodman

Group 4 Haughton, Lead; Hansen, Scribe; Bowman, Fine and Squire

Group 5 Maudlin, Lead; Hixon, Scribe; Kopes-Kerr, Olsen and Wu

Group 6 North, Lead; Leong, Scribe; Palafox, Schlegel and Sundwall

Group 7 Hines, Lead; Kimball, Scribe; Levitt, Lewis, Peck and Schwartz

[See First National Conference on Primary Health Care Access (3rd Plenary Panel, Part 1, Sundwall).]

David N. Sundwall MD

“. . . . our policy makers for two decades have focused almost exclusively on financing of care and they’ve let so many other things essential in public health efforts slide.  The reasons for this focus is understandable, given that those who benefit from the financing are clearly the most vocal lobbyists.

“The providers, meaning doctors, hospitals, pharmaceuticals, medical devices, many more who are employed in our “medical-industrial complex,” are in a position to benefit from attention being paid to the financing. 

“Unfortunately, the poor and the disadvantaged don’t have a very effective lobby.  The other observation I have made is that we have, in fact, “medicalized” or made part of the health care system things which really are not traditional health concerns. 

“And I don’t mean to say they aren’t eventually a health problem, but if you look at the big-ticket items we’re dealing with, many are the result of social-behavioral problems.”

David N. Sundwall, MD

The First National Conference on Primary Health Care Access

April 20, 1990

The American Club

Kohler, Wisconsin 

+++++++++++++++++++++

 The Scribe Notes from the first Discussion Group:

Group 1 Boltri, Lead; Babitz. Scribe; Bejinez-Eastman,

Flinders, Levitt and Schwartz

Rick Flinders, MD, reminded everyone that summary comments of the Group’s discussion would be posted on www.coastalresearch.org.

Potential Beneficial and Adverse Impacts of PPACA

Marc Babitz, MD, expressed concern that a lack of support for primary care (increasing the number of primary care providers and increasing primary care reimbursement) may bankrupt ACA by forcing newly insured to use ERs and sub-specialists since they cannot find a primary care provider.

Frederic Schwartz, DO, noted that ACA eliminated additional funds for CHCs and THCs after a five-year period, hoping that THC program will receive long-term support from elsewhere.

Dr Flinders asked if ACA better than nothing? He noted that there are some good things:  no exclusion on pre-existing conditions, no lifetime cap, the ability to keep dependents on parent’s insurance until age 26. He expressed his belief that Ted Kennedy’s death had a negative impact on the resulting legislation.  He believes that major players (pharmaceuticals, hospitals, equipment manufacturers) have a stranglehold on the American health care system. He also noted that states have options under ACA.

Ana Bejinez-Eastman, MD agreed that the politics of ACA was affected by strange events; ACA is better than nothing, but we can’t rely on the goodness of people to pick up the pieces that are left unfunded.

Dr Schwartz asked if we can judge Medicare in the same way as we look at ACA?

Carol Levitt, MD suggested that from the standpoint of patient care, Medicare has proven to be very valuable.

Dr Schwartz asked how long it was, before we could state that Medicare is valuable?  Will some wish to give up some of their income for the benefit of others?

Dr Flinders remarked that the general public’s view now is to “keep government out of my Medicare!”

Dr Levitt expressed her belief that if everyone would give up a little bit, it would help others.

Dr Babitz suggested that the movement of “Tea Party” conservatives to reduce the size of government, has the power to prevent expansion of social programs.

Dr Boltri asked whether the resistance to ACA is about fear of change, loss of wealth, loss of choice?

Dr Flinders asked how much does a person need to make?  The answer is always More! He  said that he recently started a chapter of Physicians for a National Health Plan, but for the first time in years, there is no proposed legislation in California for a single-payer system. The health care systems problems are a financial issue.  Time magazine’s analysis “A Bitter Pill” is important.

Community health centers (CHCs) and federally-qualified health centers (FQHCs)

Dr Schwartz suggested that nobody advocates for the poor,, but that ACA [the Patient Protection and Accountable Care Act] helps the poor with something besides rhetoric. It has funding for teaching health centers [THCs].

Dr Boltri noted that FQHCs are comprehensive systems of care (medical, dental, etc.) that were expanded under President George W. Bush.  These could be expanded to provide more service.

Dr Bejinez-Eastman asked why FQHC’s are limited to underserved areas?  This system could serve all.

Dr Schwartz observed that the last burst of funding for CHCs went for capital improvements, not expansion of service.  CHC’s are hoping to survive until 2014.  The problem is that they serve “those people.”  That is why some “private” patients won’t go to CHCs, but he expressed his belief that only community health centers among United States providers still had reasonable costs.

Current issues in primary care: costs and patient dissatisfaction

Dr Bejinez-Eastman observed that in the managed care world, a patient comes to an appointment with a “WebMD” note stating that they need a MRI, but, if the doctor doesn’t agree, then the patient is unhappy and reports that they waited for an appointment, couldn’t get what they wanted, and had to “buy” an Over the Counter med).

Dr Boltri remarked that medical bills are very confusing to patients.

Dr Schwartz put forward the case of a patient who has a relatively minor operation, and looks at unbundled bill.  The patient calls the insurance company about the costs, to which the insurance company responds “what do you care?, the bill has been paid.”

Dr Bejinez-Eastman recalled a story from Dr Rob Ross about Canadian charges to treat his daughter’s serious injuries in a skiing accident in Canada.  The total for all services, was $5,000, including $200 for a plastic surgeon and  EMS helicopter transport!) She recounted a recent experience with a routine appendectomy, which cost $25,000 without including the surgeon’s fee.

Dr Boltri raised the issue that insurance companies take a monetary approach to health care, The “medical loss” ratio is their term for paying for health care

Dr Babitz noted that insurance companies don’t have an incentive to pay for anti-smoking efforts, since those patients’ diseases will be covered later (under Medicare, usually)

Dr Schwartz stated that the health cares system in the United States does a lousy job delivering care compared to other countries. He gave the example from Germany of medical care that included a public health intervention.

Dr Boltri noted that a patient living in Germany, who discovered testicular cancer was treated, and his bills were under $5,000.  The costs in Germany are affordable for the average person.

Dr Bejinez-Eastman remarked that the emergency room costs $275/half hour, even when the patient is just waiting for a doctor.  Other countries have sensible approach. They pay more attention to public health and all other parts of the health care system.  In Ireland during flu season there were ads and commercials everywhere with public health messages.

Dr Flinders said that consumers think our higher costs are because of higher quality, but, he noted that Dr John Saultz [of Oregon Health Sciences University] said that we have passed the point of diminishing returns on health – i.e., the more money we spend on health, the worse our health outcomes, because we take money away from “social determinant” factors like education, healthy environments, etc.  We lay off teachers and close state parks to save money for health care costs. He noted that family physicians still have those special moments with patients in the room. He expressed his belief that the EHR is a huge invasion into that personal encounter.

Dr Bejinez-Eastman suggested that residency programs need to teach residents how to prevent the computer from taking over the visit.

Issues with the medical school training and specialty choices of physicians

Dr Levitt raised the problems caused by the lack of primary care providers.

Dr Schwartz suggested that an historical analysis should be made of the consequences of adoption of the RB/RVS scale which created disparity in compensation between sub-specialists and primary care.  Blue Shield was organized by surgeons.

Dr Boltri stated that our health care system is a like a broken down Gremlin.   We need to replace the system rather than keep trying to repair it.  Detroit has been pioneering ACOs.  There are four hospital-based ACOs that are in competition with each other.  But working together would decrease their individual revenue.

Dr Schwartz suggested that we need to recognize the undersupply of primary care providers, and change the methods of training physicians.

Dr Babitz noted that medical schools train students to be like the medical school’s sub-specialty faculty.  Those that cannot be like the faculty end up trying to do primary care, but these are not appropriate primary care physicians (failed ortho surgeons, etc.)

Dr Flinders noted that MD schools only have 8% going into primary care.  DO schools graduate many more.  There needs to be more loan forgiveness for primary care.

Dr Bejinez-Eastman suggested that if you want something that is in short supply, pay more for it.

Dr Babitz asked whether that isn’t the idea behind boutique/concierge medicine?

Dr Flinders suggested that there was a need to determine what would be funded by which sources.

Dr Babitz suggested that boutique medicine aggravates the shortage of primary care providers because they see so few patients.

Dr Bejinez-Eastman suggested that students need to figure out how to pay off debt.

Dr Babitz said that there is a “debt payoff” study showing that you could be a family physician and pay off debt, although he believes it would be a bad idea for the nation to rely on that possibility to obtain an adequate supply of primary care physicians.

Dr Boltri asked whether the financing of health care has affected physician behavior?

Dr Babitz reported that at a 25 year medical school reunion, the medical sub-specialists were the most “unhappy” and many found their professional lives were boring and repetitive.

Dr Flinders said that the most satisfied physicians are family doctors.

Dr Schwartz asked whether the changes that are coming in health care will continue to provide satisfaction for FPs?

Dr Bejinez-Eastman noted that here have been past times when family physicians had lots of pressures to see large numbers of patients.  The move ove to team-based care helps.  She said she is looking forward to having more time with patients.

The other discussion groups:

Group 2 Flores, Lead; Burnett, L, Scribe; Clover, Geyman, Hixon and Wu

Group 3 Fowkes, Lead; Peck, Scribe: Crawford. Hansen, Herman and Wilke

Group 4 Sundwall, Lead; Burnett, WH, Scribe; Fine, Fredrick and Squire

Group 5 LeRoy, Lead; Haughton, Scribe; Bowman. Goodman and Leong

Group 6 Clasen, Lead; Hines, Scribe; Kimball, Maudlin, and North

Group 7 Pugno, Lead; Olsen, Scribe; Frey, Kopes-Kerr, Lewis and Palafox 

———————————————————————————————-

The National Conferences are invitational and invitations are by tradition first offered to previous National Conference registrants. Therefore, each conference consists of large majority of conferees who have attended one or more previous conferences in the  series.

Those persons who have made plenary presentations and have attended specified numbers of National Conferences are designated as Senior Fellows or Fellows of the National Conferences. [The Senior Fellows and Fellows are listed at Fellows and Senior Fellows: Three New Senior Fellows, Four Fellows, Inducted at 23rd National Conference.]

At the 23rd National Conference in Carlsbad, California a new position of honor was created, the National Conference Scholars. Each of these is a newcomer to the National Conferences, and whose Scholarship has been sponsored by his or her institution as a National Conference participant.

Each National Conference Scholarship bore the name of a current Fellow or Senior Fellow, except for two Memorial National Conference Scholarships honoring a deceased Fellow and Senior Fellow.

The 2013 National Conference Scholars

Michael Fine, MD, Director of Health, State of Rhode Island, has been designated to be the David N. Sundwall National Conference Scholar, named for the former Head of the Health Resources and Services Administration, United States Department of Health and Human Services.

Robert Bowman, MD, A. T. Still University School of Osteopathic Medicine or Arizona, has been designated the Mitchell Kasovac National Conference Scholar, named for an Emeritus Professor of the A. T. Still University SOMA.

Denise Crawford, of the Kalamazoo Family Health Center, has been designated the Virginia Fowkes National Conference Scholar, named for the Senior Research Scholar Emerita, Stanford University School of Medicine.

Mark D. Goodman, MD of Creighton University School of Medicine, has been designated as the Gary F. LeRoy National Conference Scholar, named for the Associate Dean of Student Affairs and Admissions, Wright State University Boonshoft School of Medicine.

Colin Kopes-Kerr, MD of Peach Tree Health Care, Marysville, California, has been designated as the Perry A. Pugno National Conference Scholar, name for the Vice President, Education, of the American Academy of Family Physicians.

Carol Levitt, MD, of Generations Family Health Center, Danielson Connecticut, has been designated as the CynthiaG. Olsen National Conference Scholar, named after the Acting Chair of the Department of Family Medicine at Wright State University Boonshoft School of Medicine.

Eugenie Lewis, MHSA, LCSW, has been designated as the Allan Wilke National Conference Scholar, named after the Chair of the Department of Family and Community Medicine of Western Michigan University School of Medicine.

Carol Wilson Saffold, MD . of the Family Health Center, Kalamazoo, Michigan, has been designated the Ana Bejinez-Eastman National Conference Scholar, after the Associate Program Director, Family Medicine Residency, Presbyterian Intercommunity Hospital of Whittier, California

Elizabeth Schlegel, Ph.D., MBA, of the Ross University, Dominica, West Indies, has ben designated the Marc E. Babitz National Conference Scholar, after the Director of the Division of Health Systems Improvement of the Utah Department of Health.

 The 2012 National Conference Scholars

David Squire, then a member of the Utah Medical Education Council, received the F. Marian Bishop Memorial National Conference Scholar position, named after the late Chair of the Department of Family and Preventive Medicine at the  University of Utah and President of both the Society of Teachers of Family Medicine and the Society of Teachers of Preventive Medicine.

Danielle Renaud, Ph.D., received the Thomas C. Brown Memorial National Conference position. Dr Brown was a major figure in the development of family medicine curricula in several California resident programs.

Sally Bachofer, MD, of the University of New Mexico, received the Charles Q. North National Conference Scholar position, named for the former clinical director of the United States Indian Health Service.

Benjamin Fredrick, MD, of Penn State University/Milton S. Hershey College of Medicine, received the Mark Clasen National Conference Scholar position, named for the emeritus Chair of Family Medicine at Wright State University, Dayton.

Frederick Schwartz, DO, of the A. T. Still College of Osteopathic Medicine, Mesa, Arizona, received the J. Jerry Rodos National Conference Scholar position, named for the former Dean of the Midwestern University College of Osteopathic Medicine.

Ramiro Zuniga, MD, of the San Joaquin General Hospital, French Camp (Stockton), California, received the John Geyman National Conference Scholar position, named for the Emeritus Chair of Family Medicine at the University of Washington.

An interior view of Dondero’s Restaurant

The 24th National Conference on Primary Health Care Access, to be held April 8-11, 2013 at the Grand Hyatt Kaua’i, begins on Monday April 8. The theme of the National Conference is What Has Changed. 

Conference registration includes four night’s accommodation at the Grand Hyatt Kaua’i, beginning April 7, 2013,  the night before the first National Conference session.

[For further information on the National Conference, see: The 24th National Conference on Primary Health Care Access at the Grand Hyatt Kaua’i April 7-11, 2013.]

Each morning will begin with assigned breakfast breakout groups at 6:30 a.m.  in the beautiful surroundings of Dondero’s Restaurant, with its magnificent views of the Pacific Ocean.

Each breakout group will be led by a Fellow or Senior Fellow of the National Conferences, and each will  have an assigned discussion topic on issues of health care access and health care reform.

Both the topics for discussion and the questions and the notes on each discussion developed by each breakout group’s designated scribe will be posted on this website.

The First Day’s Plenary Sessions

The Monday plenary sessions, moderated by Doctor Ana Bejinez-Eastman of the Presbyterian Intercommunity Hospital of Whittier, California, begin at 8:15 a.m.

Kevin Haughton, MD; Providence Health Systems, Olympia, Washington

The first plenary session will begin with welcoming remarks by Doctor Kevin Haughton of the Providence Health Systems of Olympia, Washington, who presented the closing remarks of the 23rd National Conference.

Dr Haughton’s remarks will be followed by the two principal plenary sessions of the day.

The first plenary, led by Doctor David Sundwall of the University of Utah, will discuss the politics and policy bases that underlie the Patient Protection and Accountable Care Act [PPACA].

Dr Sundwall’s overview will include discussion the events of the past year relating to the implementation of the health care reform legislation[see 24th National Conference: Dr David Sundwall Discusses Policy Bases, Politics of PPACA.]

A secluded venue on the Grand Hyatt Kaua’i resort

Dr Allan Wilke of Western Michigan University (Kalamazoo) will be the reactor to Dr Sundwall’s remarks.

Dr Sundwall will be followed by Dr John Geyman, a critic of the health reform legislation, that highlights his continuing concerns [see What Has NOT Changed: Dr John Geyman to Analyze, Characterize the Defects of the PPACA Legislation at 24th National Conference on Primary Health Care Access].

Dr Charles Q. North of the University of New Mexico will be the reactor to Dr Geyman’s remarks.

Impact of Reform Initiatives on State and Local Health Care Delivery Systems 

Throughout the four days of the National Conference, there will be plenary sessions relating to the impact of reform initiatives on states and on local communities and health care entities, including hospital systems, physician residency programs and teaching health centers and public health departments.

Assessing the current state of primary health care access in Hawai’i and in the American Trust Territories in the Pacific will be Dr Neal Palafox, who administers the University of Hawai’i's  Pacific Disparities Research mission. He will be joined by his colleague, Doctor Allen Hixon. [See 24th National Conference: the Plenary Presentations of University of Hawaii Doctors Palafox and Hixon.]

Following the plenary session on Hawai’i and the Pacific Islands will be the presentation of the 23rd G. Gayle Stephens Lecture, by Doctor Donald Frey, Creighton University’s Vice President for Health Sciences.  [See 24th National Conference on Primary Health Care Access: Creighton University’s Doctor Donald Frey to Present 23rd G. Gayle Stephens Lecture .]

MONDAY, APRIL 8, 2013

6:30 AM – 8:00 AM

Assigned Breakfast Breakout Groups

8:15 AM – 8:25 AM

Welcome to the National Conferences

Kevin Haughton, MD

Providence Health Systems

Olympia, Washington

8:25 AM 8:30 AM

Opening Statement of the First Plenary Session by Session Moderator

Ana Bejinez-Eastman, MD

Presbyterian Intercommunity Hospital

Whittier, California

8:30 AM – 9:05 AM

The Policy Bases and Politics of the Patient Protection and Accountable Care Act [PPACA]

David Sundwall, MD

University of Utah

Salt Lake City, Utah

Reactor: Allan Wilke, MD, MA

Western Michigan University School of Medicine

Kalamazoo, Michigan

9:05 AM – 9:15 AM

Audience Questions and Comments

Lead Question: Perry A. Pugno, MD, MPH

American Academy of Family Physicians

Leawood, Kansas

9:15 AM – 9:50 AM

What Has NOT Changed: Characterizing the Defects of the PPACA Legislation

John P. Geyman, MD

University of Washington, Emeritus Professor

Friday Harbor, Washington

Reactor: Charles Q. North, MD

University of New Mexico

Albuquerque, New Mexico

9:50 AM – 10:00 AM

Audience Questions and Comments

Lead Question: Cynthia G. Olsen, MD

Wright State University

Dayton, Ohio

10:00 AM-10:15 AM

Break

10:15 AM -10:50 AM

Impact of PPACA Reform Initiatives on State and Local Health Care Delivery Systems: the Case of Hawai’i

Allan Hixon, MD

Neal Palafox, MD

University of Hawai’i

Honululu, Hawai’i

10:50 AM – 11: 00 AM

Audience Questions and Comments

Lead Question: Hector Flores, MD

White Memorial Medical Center

Los Angeles, California

11:00 AM – 11:30 AM

The 23rd G. Gayle Stephens Lecture

Donald R. Frey, MD

Creighton University

Omaha, Nebraska

11:30 AM – 11:40 AM

Audience Questions and Comments

Lead Question: John M. Boltri, MD

Wayne State University

Detroit, Michigan

11:40 AM – 12:00 PM

24th National Conference as a Whole: Reactions and Discussion of Morning’s Presentations

Moderator:Ana Bejinez-Eastman, MD

Presbyterian Intercommunity Hospital

Whittier, California

12:00 PM

Adjournment of First Day

 For the program of the second conference day, see: The 24th National Conference’s Second Day Program – April 9, 2013.

Anyone with questions about the 24th National Conference, should contact us at coastalresearchgroup@gmail.com.

Dawn in Kaua’i

The 24th National Conference on Primary Health Care Access, to be held April 8-11, 2013 at the Grand Hyatt Kaua’i, begins on Monday April 8. The theme of the National Conference isWhat Has Changed. 

Conference registration includes four night’s accommodation at the Grand Hyatt Kaua’i, beginning April 7, 2013,  the night before the first National Conference session.

[For further information on the National Conference, see: The 24th National Conference on Primary Health Care Access at the Grand Hyatt Kaua’i April 7-11, 2013.]

Each morning will begin with assigned breakfast breakout groups at 6:30 a.m.  in the beautiful surroundings of Dondero’s Restaurant, with its magnificent views of the Pacific Ocean.

Each breakout group will be led by a Fellow or Senior Fellow of the National Conferences, and each will  have an assigned discussion topic on issues of health care access and health care reform.

Both the topics for discussion and the questions and the notes on each discussion developed by each breakout group’s designated scribe will be posted on this website.

The Second Day’s Plenary Sessions

A  Grand Hyatt Kaua’i Pathway

The second day’s plenary sessions begin with a presentation by Doctors David Sundwall of the University of Utah and Michael Fine, who is the Director of Health for the State of Rhode Island.

Its subject matter, on policy proposals currently being considered for the Medicaid program is discussed at 24th National Conference, 2nd Day: “Medicaid in the Crosshairs?”: Doctors David Sundwall, Michael Fine to Discuss Current, Emerging Issues in the Structure, Financing of Medicaid.

Tuesday morning’s second plenary panel will consist of Doctors Hector Flores of White Memorial Medical Center in Los Angeles, Doctor Perray A. Pugno of the American Academy of Family Physicians, and James Herman of the Penn State University College of Medicine and Penn State/Milton S. Hershey Medical Center in Hershey, Pennsylvania.

The Reform Theme Overview Panel

Doctors Flores, Pugno and Herman will present the thesis that PPACA, the Patient Protection and Accountable Care Act, contains elements that will advance other long-term objectives of health care reformers.

Many such reforms have been advocated by those who have participated in the National Conferences on Primary Health Care Access. [See 24th National Conference: the Potential for Primary Healthcare Improvements as a Result of Reform Legislation.]

The Reform Theme Special Presentations

Tropical Foliage and Water Images; Grand Hyatt Kaua’i

At this point in the National Conference, a series of clustered thematic presentations on long-desired reforms, that will include case studies and the Naitonal Conferences’ signature Thought Provocateur Sessions.

The first of these thematic clusters relates to the long-desired goal of better integrating behavioral health and clinical medicine [24th National Conference Theme Presentations: A Reform Objective – Better Integration of Clinical Medicine and Behavioral Health.]

This will include a reports of an ongoing study of the observable differences between psychiatric patients with a primary care physician and those without, presented by faculty of the Wayne State and Wright State medical schools. It will also feature a Thought Provocateur session relating to the integration of behavioral science and clinical medicine in the community health center setting.

The plenary session also includes the Twenty-second Charles E. Odegaard Lecture [24th National Conference: Boston University’s Doctor Thomas Hines to Give 22nd Charles E. Odegaard Lecture.]

TUESDAY, APRIL 9, 2013

6:30 AM – 8:00 AM

Assigned Breakfast Breakout Groups

8:15 AM – 8:20 AM

Introduction to the Day’s Themes

Moderator: Gary L. LeRoy, MD

Wright State University

Dayton, Ohio

8:20 AM – 8:55 AM

Medicaid in the Crosshairs?

David N. Sundwall, MD

University of Utah

Salt Lake City, Utah

Michael Fine, MD

Rhode Island State Department of Health 

Providence, Rhode Island

8:55 AM – 9:05 AM

Audience Questions and Comments

Lead Question: Richard D. Clover, MD

University of Louisville

Louisville, Kentucky

9:05 AM- 9:40 AM

What HAS Changed: Strategic Reforms Advanced by PPACA

Hector Flores, MD

White Memorial Medical Center

Los Angeles, California

James Herman, MD

Penn State University School of Medicine

Hershey, Pennsylvania

Perry Pugno, MD

American Academy of Family Physicians

Leawood, Kansas

9:40 AM – 9:50 AM

 Audience Questions and Comments

Lead Question: David N. Sundwall, MD

University of Utah

Salt Lake City, Utah

9:50 AM-10:05 AM

PPACA-Advantaged Strategic Reforms: “Mental Health and Medicine in a Community Health Center”

Eugenie Lewis, MHSA, LCSW

JWCH Institute

Los Angeles, California

10:05 AM – 10:10 AM

Audience Questions and Comments

Lead Question: Virginia Fowkes, FNP, MHS

Stanford University

Palo Alto, California

10:10 AM -10:25 AM

Break

10:25 AM – 11:05 AM

PPACA-Advantaged Strategic Reforms: “Integration of Behavioral Science and Medicine for Psychiatric Patients”

John M. Boltri, MD

Wayne State University

Detroit, Michigan

Mark E. Clasen, MD, Ph.D.

Cynthia Olsen, MD

Wright State University

Dayton, Ohio

11:05 AM -11:10 AM

Audience Questions and Comments

Lead Question: Ana Bejinez-Eastman, MD

Presbyterian Intercommunity Hospital

Whittier, California

11:10 AM – 11:50 AM

The 2oth Charles E. Odegaard Lecture

Thomas C. Hines, MD

Boston University

Boston, Massachusetts

11:50 AM – 12:00 PM

Audience Questions and Comments

Lead Question: John P. Geyman, MD

University of Washington Emeritus

Friday Harbor, Washington

12:00 PM

Adjournment of Second Day

 For the program of the third conference day, see: The 24th National Conference’s Third Day Program – April 10, 2013 .

For the previous days, see:  The 24th National Conference’s First Day Program – April 8, 2013 and The 24th National Conference’s Second Day Program – April 9, 2013.

A view of the Grand Hyatt Kaua’i from the lower lawns

The 24th National Conference on Primary Health Care Access, to be held April 8-11, 2013 at the Grand Hyatt Kaua’i, begins on Monday April 8. The theme of the National Conference isWhat Has Changed. 

Conference registration includes four night’s accommodation at the Grand Hyatt Kaua’i, beginning April 7, 2013,  the night before the first National Conference session.

[For further information on the National Conference, see: The 24th National Conference on Primary Health Care Access at the Grand Hyatt Kaua’i April 7-11, 2013.]

A view of the lower pools with the South Pacific beyond

Each morning will begin with assigned breakfast breakout groups at 6:30 a.m.  in the beautiful surroundings of Dondero’s Restaurant, with its magnificent views of the Pacific Ocean.

Each breakout group will be led by a Fellow or Senior Fellow of the National Conferences, and each will  have an assigned discussion topic on issues of health care access and health care reform.

Both the topics for discussion and the questions and the notes on each discussion developed by each breakout group’s designated scribe will be posted on this website.

The Third Day’s Plenary Sessions

Wednesday morning’s begin with a description of the United States Army’s incorporation of ideas of the primary care medical home into the Army’s health care delivery system. Lieutenant Command Lee Burnett, DO, a fellow of the National Conferences, who is a Brigade Surgeon for the Army’s elite 82nd Airborne paratroopers, will present the Soldier Centered Medical Home. [See 24th National Conference: Dr. Lee Burnett to Discuss the Soldier Centered Medical Home.]

A view of the Hyatt Regency Kaua’i from the hills above Shipwreck Beach

Following Dr Burnett’s presentation, an update on the innovative initiative in of the A. T. Still University/School of Osteopathic Medicine of Arizona, will be made by the college’s associate dean, Frederic Schwartz, DO.  That program decentralizes undergraduate and postgraduate medical education into participating community health centers [See 24th National Conference Theme Presentation: An Update on the ATSU-SOMA Distributed Teaching Health Center.]

 The next presentation is a three person panel from Kalamazoo, Michigan, reporting on new efforts to simultaneously create a new medical school at Western Michigan University while creating a new family medicine residency pathway in the recently expanded Family Health Center, an FQHC. [See  24th National Conference: Western Michigan University, Kalamazoo Family Health Center Report on a Community-Based Medical Education Project.]

Participating in the panel will be Allan Wilke, MD of the Western Michigan University School of Medicine, a Senior Fellow of the National Conferences, and also Denise Crawford, the Chief Executive Officer of Family Health Center, and the FQHC’s medical director, Carol Wilson Safford, MD.

Another view of the Gramd Hyatt pools bordering the South Pacific

A report from California will follow, in which initiatives of California’s Statewide Area Health Education Center are described that encourage the development of physician training linkages between California community health centers and primary care residency and other health professions training program in various parts of the state.

The Statewide AHEC program will be described by Virginia Fowkes, FNP, MHS, of Stanford University, a Senior Fellow of the National Conferences. Joining her will be Doctors Colin Kopes-Kerr of Vallejo and Jennifer Wu, MD, MSEd of the University of California, San Diego.

The morning’s last presentation is the 19th J. Jerry Rodos Lecture, to be prsented by Robert Maudlin, a Fellow of the National Conferences. Dr Maudlin is with the Providence Health Systems in Spokane. [See 24th National Conference: Dr Robert Maudlin to be 19th J. Jerry Rodos Lecturer.]

 

 

WEDNESDAY, APRIL 10, 2013

6:30 AM – 8:00 AM

Assigned Breakfast Breakout Groups

8:15 AM – 8:20 AM

Introduction to the Day’s Themes

Moderator: Marc E. Babitz, MD

Utah Department of Health

Salt Lake City, Utah

8:20 AM – 8:45 AM

The Soldier Centered Medical Home

Lieutenant Colonel Lee Burnett, DO

82nd Airborne, Fourth Brigade

Fort Bragg, North Carolina

8:45 AM – 8:50 AM

Audience Questions and Comments

Lead Question: Charles Q. North, MD, MS

University of New Mexico

Albuquerque, New Mexico

8:50 AM – 9:15 AM

Integrating DO Residents into Network of FQHCs

Frederic N. Schwartz, DO

A T Still University School of Osteopathic Medicine

Mesa, Arizona

9:15 AM – 9:20 AM

Audience Questions and Comments

Lead Question: Mark Clasen, MD, Ph.D.

Wright State University

Dayton, Ohio

9:20 AM – 9: 55 AM

Strategic Reforms: Integration with Teaching Health Centers

Denise R. Crawford, EMBA, MSW

Carol Wilson Saffold, MD

Family Health Center

Kalamazoo, Michigan

Allan Wilke, MD, MA

Western Michigan University School of Medicine

Kalamazoo, Michigan

9:55 AM – 10:05 AM

Audience Questions and Comments

Lead Question: Gary L. LeRoy, MD

Wright State University

Dayton, Ohio

10:05 AM-10:20 AM

Break

10:20 AM- 11:00 AM

Strategic Reforms: Integrating FMRs, CHCs through AHECs in California

Virginia Fowkes, FNP, MHS

Stanford University

Palo Alto, California

Colin Kopes-Kerr, MD

Peach Tree Health Care

Marysville, California

Jennifer Wu, MD, MSEd

University of California

San Diego, California

11:00 AM – 11:05 AM

Audience Questions and Comments

Lead Question: James M. Herman, MD, MSPH

Penn State Hershey Medical Center

Hershey, Pennsylvania

11:05 AM – 11:35 AM

The 19th J. Jerry Rodos Lecture

Robert Maudlin, Pharm. D.

Providence Health Systems

Spokane, Washington

11:35 AM – 11:45 AM

Audience Questions and Comments

Lead Question: Kevin M. Haughton, MD

Providence Health Systems

Olympia, Washington

11:45 AM – 12:00 PM

24th National Conference as a Whole: Reactions and Discussion of Morning’s Presentations

Moderator: Marc E. Babitz, MD

Utah Department of Health

Salt Lake City, Utah

For the program of the fourth conference day, see: The 24th National Conference’s Fourth Day Program – April 11, 2013. 

Flower leis adorn rocks at the Grand Hyatt Kaua’i

The 24th National Conference on Primary Health Care Access, to be held April 8-11, 2013 at the Grand Hyatt Kaua’i, begins on Monday April 8. The theme of the National Conference isWhat Has Changed. 

Conference registration includes four night’s accommodation at the Grand Hyatt Kaua’i, beginning April 7, 2013,  the night before the first National Conference session.

[For further information on the National Conference, see: The 24th National Conference on Primary Health Care Access at the Grand Hyatt Kaua’i April 7-11, 2013.]

Each morning will begin with assigned breakfast breakout groups at 6:30 a.m.  in the beautiful surroundings of Dondero’s Restaurant, with its magnificent views of the Pacific Ocean.

Each breakout group will be led by a Fellow or Senior Fellow of the National Conferences, and each will  have an assigned discussion topic on issues of health care access and health care reform.

Both the topics for discussion and the questions and the notes on each discussion developed by each breakout group’s designated scribe will be posted on this website.

The Fourth Day Plenary Programs

A view of Kaua’i bungalows

Thursday’s plenary sessions begin with three consecutive Thought Provocateur sessions.

First, Doctor Darryl Leong will address the issue of care coordination, which he argues is the most important element within health care reform with any promise of reducing health care costs [See 24th National Conference: Doctor Darryl Leong Discusses the Potential Role of Care Coordination in PPACA .]

Next, Doctor Allen Hixon raises concerns abouts how to assure that the Primary Care Medical Home embodies the principles of social equity [See 24th National Conference: the Plenary Presentations of University of Hawaii Doctors Palafox and Hixon.]

The third Thought Provocateur Session will be presented by Doctor Robert Bowman [See 24th National Conference: Dr Robert Bowman’s Pessimistic View of Healthcare Workforce Innovations], who, despite the title he has chosen, believes there are some reasons to retain hope that the healthcare workforce can be changed for the better.

A special session on the medical student and healthcare reform

Another area of the resort designed for water recreation

In mid-morning a three part session on how healthcare insurance reform affects the medical student [See 24th National Conference: the Medical Student and the Future of American Healthcare.] It will first look at curriculum reform, using the example of Creighton University’s School of Medicine in Omaha, Nebraska. Doctors Thomas Hansen and Mark Goodman will present the Creighton experience.

It will be followed by information gleaned from the Second Student Doctor Network [SDN] survey of health professions students, presented by Lee Burnett, DO and Laura Turner, MS, who are principals of the Coastal Research Group’s website, www.studentdoctor.net.

Beth Herman, MPA, will comment on the relevant findings of the SDN survey, based on a her experience administering and counseling multispecialty residents and fellows as Director of Postgraduate Education at the Penn State Hershey Medical Center in Hershey, Pennsylvania.

Finally, Gary LeRoy, MD, Dean of Students at Wright State University Boonshoft School of Medicine, whose predictions on what the Medical School Classes of 2050 will be like comprised the 22nd G. Gayle Stephens Lecture. He will update his remarks to conclude the special session.

Dr Burnett is a Fellow and Dr LeRoy a Senior Fellow of the National Conferences.

 A Plenary Roundtable on PPACA’s Intended and Possible Unintended Consequences

At the 23rd National Conference on Primary Health Care Access, held in Carlsbad, California in April 2012, Dr J. Jerry Rodos raised several areas of concern that he believes has resulted from the rush to reform the American health system without any attempt at developing demonstration projects to try to determine what might work on a national scale.

Following up on Dr Rodos’ remarks will be a roundtable panel, consisting of Doctors Perry A. Pugno of the American Academy of Family Physicians and Charles Q. North of the University of New Mexico, both Senior Fellows of the National Conferences. Joining them will be Doctor Neal Palafox of the University of Hawai’i.

 The Coastal Research Group’s Thirtieth Anniversary and Final Presentations

William H. Burnett, MA, Program Coordinator of the National Conferences on Primary Health Care Access and a Senior Fellow of the National Conferences, will observe the thirtieth anniversary of the Coastal Research Group [See 24th National Conference: Observance of the 30th Anniversary of the Coastal Research Group.]

This will be followed by a summary of the 24th National Conference’s themes and presentations by Doctor N. Benjamin Fredrick, Director of the Center for Global Health at  the Penn State Hershey Medical School.

THURSDAY, APRIL 11, 2013

6:30 AM – 8:00 AM

Assigned Breakfast Breakout Groups

8:15 AM – 8:20 AM

Introduction to the Day’s Themes

Moderator: Mark E. Clasen, MD, Ph.D.

Wright State University

Dayton, Ohio

820 AM- 8:35 AM

Strategic Reforms: Will Better Coordination of Care Lead to a More Cost-Efficient Health Care System?

Darryl Leong, MD

Care 1st Health Plan

Monterey Park, California

8:35 AM – 8:45 AM

Audience Questions and Comments

Lead Question: Lt Col. Lee Burnett

Fourth Brigade, 82nd Airborne

Fort Bragg, North Carolina

8:45 – 9:00 AM

Thought Provocateur: Is the Goal of Social Equity at Odds with the Primary Care Medical Home (PCMH)?

Allen L. Hixon MD

University of Hawai’i

Mililani, Oahu, Hawai’i

9:00 AM – 9:10 AM

Audience Questions and Comments

Lead Question: Donald R. Frey, MD

Creighton University

Omaha, Nebraska

9:10 -9:25 AM

Thought Provocateur: Health Insurance Reform in an Era of Maldistribution of Health Providers by Specialty

Robert Bowman, MD

A T Still University

Mesa, Arizona

9:25 AM – 9:35 AM

Audience Questions and Comments

Lead Question: Thomas C Hines, MD

Boston Medical Center

Boston, Massachusetts

The Medical Student and Perceptions of the Future of American Health Care, Part I

9:35 AM – 9:55 AM

Redesigning the Medical School Curriculum for the Future

Thomas J. Hansen, MD

Reactor: Mark D. Goodman, MD

Creighton University

Omaha, Nebraska

9:55 AM – 10:05 AM

Audience Questions and Comments

Lead Question: Allan Wilke, MD

Western Michigan University School of Medicine

Kalamazoo, Michigan

10:05 AM – 10:40 AM

The Medical Student and Perceptions of the Future of American Health Care, Part II

Results of the Second Annual Student Doctor Network Survey of Healthcare Students

Lee Burnett, DO

Laura Turner, MS

Student Doctor Network

Southern Pines, North Carolina

Reactor: Beth Herman, MPA

Penn State Hershey Medical Center

Hershey, Pennsylvania

Gary L. LeRoy. MD

Wright State University

Dayton, Ohio

10:40 AM – 10:45 AM

Audience Questions and Comments

Lead Question: Robert Maudlin, Pharm. D.

Providence Health Systems

Spokane, Washington

10:45 AM – 11:20 AM

Plenary Roundtable: The Consequences of Health Care Reform – Expected and Unexpected

Perry A. Pugno, MD, MPH

American Academy of Family Physicians

Leawood, Kansas

Neal Palafox, MD

University of Hawai’i

Mililani, Oahu, Hawai’i

Charles Q. North, MD

University of New Mexico

Albuquerque, New Mexico

11:20 AM – 11:30 AM

Audience Questions and Comments

Lead Question: Rick Flinders, MD

Santa Rosa Family Medicine

Santa Rosa, California

11:30 AM – 11:40 AM

Observing the 30th Anniversary of the Coastal Research Group

William H. Burnett

Coordinator

The National Conferences on Primary Health Care Access

11:40 AM – 11:45 AM

Audience Questions and Comments

Lead Question: Marc E. Babitz, MD

Utah Department of Health

Salt Lake City, Utah

11:45 AM – 12:00 PM

Summary of the 24th National Conference

N. Benjamin Fredrick, MD

Penn State College of Medicine

Hershey, Pennsylvania

Dr Robert Maudlin; Providence Health Systems, Spokane, Washington

The J. Jerry Rodos Lectures (established in 1995) center on the subjects of community-based medical education and practice and the amelioration of health care disparities.

The 2013 Rodos Lecturer will be Robert Mauldin of Providence Health Systems, Spokane, Washington. His lecture will take place on April 10, 2013, on the third day of the 24th National Conference on Primary Health Care Access, held at the Grand Hyatt Kaua’i, Koloa, Kaua’i, Hawai’i.

Dr Maudlin, who is closely associated with the concept of the Rural Training Track for family medicine residents planning rural practices, will provide his current thinking on the subject on innovations in graduate medical education.

The previous Rodos Lecturers have been Doctors Thomas W. Allen of the Oklahoma State University-College of Osteopathic Medicine and Marc E. Babitz of the University of Utah; and Bruce Behringer of East Tennessee State University;

Also, Doctors Richard Clover of the University of Louisville; Gayle Dine’Chacon, University of New Mexico Center for Native American Health, Albuquerque; Roxanne Fahrenwald of Montana Family Medicine; Hector Flores of White Memorial Medical Center, Los Angeles; Count D. Gibson, Jr. of Stanford University; Mitchell Kasovac, of the A T Still University, Mesa, Arizona; and Gary LeRoy of the West Dayton Community Health Center and Wright State University, Dayton;

Also, Doctors Sandral Hullett of Cooper Green Hospital, Birmingham, Alabama; Kenneth Moritsugu, Deputy Surgeon General, Bethesda, Maryland; Neal A. Palafox of the University of Hawai’i, Mililani; Michael Prislin of the University of California, Irvine; Robert Ross of the Oregon Health Sciences University/Cascades East Family Medicine, Klamath Falls, Oregon; David Sundwall, Director of the Utah Department of Public Health; and Jonathan Weisbuch, former Director of the Maricopa County/Phoenix Department of Public Health.