A word with David Schmitz: ‘Patient access to care is an economic development issue’

Family medicine physician David Schmitz took over as president of the Idaho Medical Association this summer at a time of great change in the medical industry. Providers, patients and payers are all scrambling to adapt to the changes mandated by the Affordable Care Act passed by Congress three years ago.

Meanwhile, the IMA is setting its priorities for state policy to improve working conditions for physicians and to improve public health and administration.

Schmitz, the doctor in charge of rural health training at the Family Medicine Residency of Idaho, revels in Idaho’s rural nature and the teaching opportunities it provides for doctors who want to practice in small communities. Schmitz was a founder of the St. Maries Volunteer Community Clinic, and he’s a past president of the Idaho Rural Health Association. He serves on the board of the National Rural Health Association and is a past president of the Idaho Academy of Family Physicians.

He also works on national and state projects dedicated to health outreach and rural health. Amidst all this policy work, Schmitz also sees patients at the Family Medicine Residency. The Idaho Business Review sat down with Schmitz to talk about the IMA and the issues that its member physicians have placed at the top of their agenda this year. The interview has been edited for length and clarity.

Has the job description of physician changed in recent years? Are many of your members still in private practice, or are most now employed by hospitals?

It’s not as simple as “employed physicians vs. private,” because an employed physician can be employed by a group that is physician-owned, or by a hospital, or by an educational institution. That said, most members of the Idaho Medical Association are independent.

I can tell you that private practice is alive and well.

Why did you take the job of president at the IMA?

I see the IMA as an advocate for physicians and for patient care, and quite frankly for physicians’ ability to provide patient care. A representative advocacy organization has the job to cast a vision forward, to empower its members to deliver on the mission. Our mission is patient care in the state that is quality, collaborative, and provides access to what our patients need. And we have to do this with a shortage of physicians, which is certainly a challenge. But I’ve always rooted for the underdog; I’m from Buffalo, N.Y., and when you’re from Buffalo you get used to rooting for underdog sports teams.

The state of Idaho has for some time delivered above and beyond the average capacity for our resources. We also need the help of an organization like the IMA to make our efforts as efficacious as possible.

The American Medical Association’s mantra is, “Together we are stronger.” We represent the majority; 75 percent of Idaho doctors are members of the IMA. They form their policy in a House of Delegates, and that represents everything from the practice of medicine to the betterment of health amongst our patients.

What is it like being a physician right now? There’s a lot going on with health policy.

There are two transitions occurring at the same time in health care. There is certainly a reliance on the health care team in serving populations of patients that’s happening now and will be more prevalent in the future. The second is that there is an increasing use of technology in communication amongst the members of the team. There’s the stress of adapting to the new communication model, whether that be electronic medical records, whether that is between a hospital and a private practice 200 miles away, in a small practice that has a brand-new electronic medical record, or another place where that the patient is seeking something as simple as an immunization or filling an electronic prescription in a pharmacy.

Team communication has always been paramount for delivering quality, and that’s a challenge until we get good at it. The IMA can help us learn the best practices and highlight successful adapters.

Is the new technology making the practice of health care easier than it was 20 years ago?

The health care of larger groups of people will be benefitted by the access to information. But it won’t replace the human relationships around communication.

Checking the boxes as opposed to having a conversation with someone is like translating analog to digital data. It’s like going from vinyl to CD. It’s great to have it on CD, but there’s a translation process there. I can see it in younger physicians, and I’m not sure they’d go back to dictating. For those of us who grew up in both environments and started 20 years ago, going from a thought process in paragraphs to something that in an electronic medical record can produce – like a report on how many of your diabetics did not have their foot check – is a really different model.

It’s wonderful to be able to do that, but we need the relationship too. Technology is tied to payment reform, because in the future as we take care of both healthy people and sick, we’ll have well care to keep people healthy, and the information in the EMR will allow us to manage our practices in ways we didn’t have the power to do before.

The electronic medical records do affect whether a private practice can stay independent, or seek a partnership with another entity. It’s the cost, the administrative effort, the burdens associated with that, and then some of the new compliance requirements and various regulations including coding and billing. But there are increased pressures to have your practice management comply in order to receive payment.

Physicians want to do the right thing. … They want to have accurate medical records to manage one person in one room, as well as the health care of their population and their community. There’s much agreement around being able to provide better and more efficient health care to all of our patients. But there’s a cost in that.

What do you see in the future?

We will continue to see that health care delivery, especially if we have increased access to health care, will rely on everyone operating on the top of their license. That would include physicians being able to be as broadly adapted to their community needs as possible. I would like to see physicians being empowered to provide care locally, and less use of helicopters in our very remote state. When we provide care in the context of community and family, we get a lot for that. We have family at the bedside, a more seamless transition back to home, and perhaps even lower our readmission rate. When we have that, we get high-quality care and decreasing expense.

What are some of the IMA’s policy priorities?

Our perennial favorite is expanding opportunities for access to medical education and residency training. That’s always at the top of our list. Last year we were very happy to get five new seats in the WWAMI medical education program and increased funding support for residency programs in our state.

This year we’re coming back for five more WWAMI seats, and for some state support of the new family practice residency in Coeur d’Alene. It’s been accredited and will start to accept residents in 2014.

Medicaid redesign is also a top priority for us. We’re very much in support of Medicaid redesign and expansion, not only to cover people and ensure they have access to care and preventive care, but also just to stop the bleed of money that the counties and state are pouring into indigent programs and the CAT Fund, which are very inefficient and expensive systems.

If we can do something that saves the state millions of dollars and takes better care of people in a different kind of program that requires more accountability on the part of the patient, that’s what we would like to see.

Patient access to care is an economic development issue. Employers are a beneficiary of health care access through a healthy workforce. I practiced for six years in Benewah County; I know having access to health care in that area of the state helps to sustain everything, from the small mill to the larger employers.