Dr. Steven J. Stack of Lexington is sworn in as 170th president of the American Medical Association

Dr. Steven J. Stack, an emergency physician practicing in Lexington, was sworn in as the 170th president of the American Medical Association, the nation’s largest physician organization.

Dr. Steven J. Stack

He is the organization’s youngest president in the past 160 years and is the first board-certified emergency-room physician elected to the post.

Stack says he will focus his tenure on advancing the AMA’s three strategic areas: improving health outcomes for those with pre-diabetes and hypertension; accelerating change in medical education to ensure physicians are prepared to meet the needs of a 21st century health care system; and enhancing physician satisfaction and practice sustainability.

"I am honored and privileged to be named president of an organization that is dedicated to the art and science of medicine and the betterment of public health and a profession that is working to improve the health of our nation," Stack said in a press release. "I look forward to serving on behalf of America’s physicians to not only create a brighter future for the medical profession but a healthier America one patient at time, one family at a time and one community at a time."

Stack gained national recognition for his expertise in health information technology while serving as chair of the AMA's Health Information Technology Advisory Group from 2007 to 2013. He has also served on multiple federal advisory groups for the Office of the National Coordinator for Health Information Technology and as Secretary for eHealth Initiative, a non-profit multi-stakeholder organization committed to advancing health care through health information technology.

In Kentucky, Stack has served as medical director of the emergency departments at Saint Joseph East in Lexington and Saint Joseph Mount Sterling, both part of KentuckyOne Health. He was also previous medical director of the emergency department at Baptist Memorial Hospital in Memphis, Tenn.

Stack was elected to the AMA Board of Trustees in 2006. In the last eight years, he has served in many leadership positions, including chair and secretary. Prior to his service on the AMA board, he was an elected leader in numerous state, national and specialty medical associations.

He is the second Lexington physician to lead the AMA in three years. Dr. Ardis Dee Hoven, an infectious-disease specialist at the University of Kentucky, led the group in 2013-14.

How has the federal health-reform law changed your care?

Despite the controversy that continues to surround the Patient Protection and Affordable Act five years after its passage, it has probably changed the way your health care is delivered as it drives new models of payment, forces providers to approach care differently, and changes how health care is evaluated, Kavita Patel and Domitilla Masi report for the Brookings Institution.

Here are five ways the authors say that your health care might be different than it was five years ago because of the reform law:

Your physician might be part of a patient care team. New payment models in the ACA encourage an interdisciplinary team-based approach, which evidence shows "can lead to higher quality care and better health outcomes for patient." This approach allows the physician to spend more time diagnosing and devising a treatment plan, while the patient may spend more time interacting with non-physician staff for support care.

Prevention and wellness are more important than ever. The ACA requires health plans to cover all preventive screenings, immunizations and well visits for women at no cost, as part of the minimum benefits required in order for health-insurance plans to participate in exchanges like Kynect. The new payment models also pay physicians who work toward keeping their patients healthy, instead of just treating them when they are sick. " Since the policy took effect in September 2010 it is estimated that an additional 76 million people now receive preventive care," the authors write.

You may have better access to care on evenings and weekends. New payment models are driving this change as practices are often required to offer extended hours to decrease the overuse of emergency departments. Many offices now offer clinical advice around the clock with a clinician who has immediate access to their medical records.

Chances are your health information is being stored in an electronic health record, not a paper file. A separate law encouraged the use of EHRs, but "participation in the new ACA-promoted delivery models is practically impossible" without them. And while EHRs can be used to greatly improve patient care, not all EHRs are created equal and it will take time before patients see seamless integration and exchange between different doctors and settings in "real-time".

You can access care remotely, wherever you are. Doctors are using mobile technology and tele-health in rural and remote areas to provide more efficient care to patients. Insurance companies and employers are beginning to recognize this mode of treatment not only as a way to save money, but to also provide timely access to care, that does not involve the emergency room.

Most Kentuckians don't communicate with doctors electronically; most are confident about access to pricing information for care

Most Kentuckians don't communicate with their doctor electronically, according to the latest Kentucky Health Issues Poll.

The poll, taken Oct.8-Nov.6, found that 73 percent of Kentuckians have not communicated with their doctor using text, email or a website during the last year. A national poll found similar results.

This finding was consistent in all age groups, but there was a difference among socioeconomic groups.

Seventy-nine percent of those whose incomes are 200 percent of the federal poverty level or below said they had no electronic communication with their doctor in the past year, but only 66 percent of those above this level said they had had no electronic contact. In 2013, 200 percent of poverty level was $47,100 for a family of four.

Electronic communication with doctors was most common in Northern Kentucky and least common in Eastrern and Western Kentucky.

The Kentucky Health Information Exchange, the hub that connects participating providers with each other to share health information via certified electronic health records, is now working to connect patients to their electronic health records via a pilot program.

Research has found that patients who are better informed about their health and health care cost are more engaged with their health, according to the release.

Patients at UKHealthCare who have access to their "patient portals" seven days after discharge are an example of how few Kentuckians are engaging with their health care provider via electronics.

“About 8 to 10 percent of hospitalized patients look at their patient portals, of our inpatients,”Dr. Carol Steltenkamp, chief medical information officer at UKHealthCare, said in a phone interview “We would love for that to increase.”

Steltenkamp said that patients often don't understand how to use their portals and that the hospital is working diligently to educate them.

The poll also found that most Kentuckians think they can find out what doctors charge for treatments and procedures if they need this information, finding 36 percent extremely or very confident that they could find out how much treatments and procedures cost; 34 percent moderately confident and 28 percent not too confident or not confident at all. These answers did not vary by income, age or region.

The poll is conducted by the Institute for Policy Research at the University of Cincinnati and was funded by the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed a random sample of 1,597 adults via landline and cell phone, and has a margin of error of plus or minus 2.5 percentage points.

AMA president-elect, from Lexington, talks with KET host about the myriad issues facing his profession and its patients

Steven J. Stack

The new president-elect of the American Medical Association, Dr. Steven J. Stack of Lexington, covered a range of topics with Bill Goodman on KET's "One to One" in December, including the AMA's advocacy role, health information technology, improving health disparities in Kentucky and medical liability reform.

Stack, an emergency physician in Lexington, told Goodman that his experience as an emergency room physician would bring a unique perspective to his role as AMA president because he has seen first-hand how many people don't have health insurance and therefore a lack of access to routine care.

"As an emergency-room physician, it has been for me a personal hope and aspiration and a great joy to see that we are making strides finally to improve American's access to care because we know that those without access to health insurance and support live sicker and die younger," Stack said. "And that's a tragedy that we should not stomach easily or tolerate in this nation."

Not only is Stack the first board-certified emergency physician elected president, when he takes office in June he will be the youngest person to lead the AMA, the nation's largest organization for physicians. He is a longtime member of the organization and has held many leadership positions. He is the second Lexington doctor in three years to hold the office. AMA's immediate past president is Dr. Ardis Dee Hoven, an infectious disease specialist at the University of Kentucky.

Stack said the AMA as an association is non-partisan and works with people in both partie "to advance policies that we hope will improve patient care and the practice of medicine." That being said, he then said he fully recognized the role of politics in health policy and said he will, "have to advocate strenuously at times for those policies that we think will be helpful."

He talked about the privilege of being an advocate before Congress, federal agencies and the state legislature. "It is an incredible privilege and it is one that I take very seriously," he said.

Stack headed the AMA’s Health Information Technology Advisory Group from 2007 to 2013 and is a member of the federal advisory groups for the Office of the National Coordinator for Health Information Technology.

"Healthcare is one of the last big sectors in the U.S. economy to go digital in its management of information. And there are good reasons for that delay," Stack said. He listed several reasons: the complexity of health care, the varying needs of different types of health-care facilities, maintaining patient privacy, continuing technological barriers, and politics.

Asked why it is taking so long to make advancements with electronic health records, Stack blamed "policy issues, differences in opinion, protecting privacy, a variation across all 50 states and layering on top of that different federal requirements." But he added, "We will get there."

Stack suggested that focusing on improving health outcomes, which is part of the AMA strategic plan, would ultimately help improve many of the health disparities that face so many Kentuckians.

Asked about the continued calls by some to repeal the Patient Protection and Affordable Care Act, Stack said the time to quit arguing about it is long past, it is "the law of the land" and recent polls show that the many people who have received insurance through the PPACA are happy with it.

"It is here to stay and we need to  get to work on fixing the things that have to be fixed," he said.

At the same time, the AMA firmly supports medical liability reform, which was not included in the reform law. Stack told Goodman that this reform is not only important for physicians, but also patients. "Only one in 100 cases actually prevail against the physician at trial," he said, and "Nearly 90 percent of cases are either dismissed or dropped, closed or settled with no payment from the physician to the plaintiff. It is clearly not helping the patients."

He called for "a rational system" that appropriately compensates patients who are "inappropriately harmed" and treats physicians fairly, while not making a "small number" of lawyers rich.

Asked what his overarching goal as president of the AMA would be, Stack said, "I would really like to see all Americans have access to high quality, reliable health care that is affordable and within their means. So the AMA and I will work diligently to that end and it is a great privilege to do that."

Click here to view the program.

Women leading Kentucky health: State health commissioner sees 'stars aligned' for Kentucky to finally get healthier

Health Commissioner Stephanie Mayfield Gibson

This is the third in a series of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick

Kentucky Health News

“The stars have aligned” and Kentucky has at last “created an infrastructure” to make the state healthier, says Dr. Stephanie Mayfield Gibson, commissioner of the state Department for Public Health.

“What a great time to be in my position,” Mayfield said in an interview, in which she enthusiastically ticked off a list of aligned stars:

• Her bosses, including the governor and lieutenant governor, who are “extraordinarily supportive of health care;”
• The expansion of the federal-state Medicaid program to households with incomes up to 138 percent of the federal poverty level;
• The Kentucky Health Benefits Exchange, branded as Kynect, where Kentuckians sign up for Medicaid or subsidized private insurance;
• The Kentucky Health Information Exchange, an electronic network that makes a wide range of health information easily available; and
• Programs that enhance the quality of care to get better outcomes and decrease costs, such as the programs to stop over-use of emergency rooms.

Mayfield says her top priority is to decrease exposure to tobacco, because so many of Kentucky’s health issues are related to its most famous crop. About 28 percent of Kentuckians smoke, and “The single most important factor that negatively impacts the health of the commonwealth . . . is exposure to tobacco smoke,” Mayfield said. “I want people well.”

She said Kentucky must also address the epidemic of painkiller abuse, which has made it one of the top three states in deaths related to abuse of opioids; and obesity, which is connected to cancer, diabetes and cardiovascular disease. Kentucky ranks in the top five in each of those diseases, and is in the top 10 for child and adult obesity.  

“Who wants the reputation for being number one in cancer deaths?” Mayfield asked. “We know we can do better. These are winnable battles.”

These and other issues are included in Kentucky Health Now, a plan Gov. Steve Beshear has set forth to improve the health of Kentuckians, with specific goals to be reached by 2019, the end of the next gubernatorial term. Beshear’s term ends in December 2015.

Mayfield is vice-chair of the team overseeing the effort, led by Lt. Gov. Jerry Abramson.  She seems to have the full confidence of Audrey Haynes, the secretary of the Cabinet for Health and Family Services, who lit up when asked about her, but Haynes said she had to make sure that Mayfield, a pathologist who ran the state health lab for seven years, was cut out to be the state’s top doctor.

“It’s a job where … you have to kind of have a better understanding of politics,” Haynes said.  “But I wanted her to rise above all that because she is the public health commissioner. Hers is more about the science.  I need her to be honest and tell the truth.”

Haynes said she told Mayfield, “You are going to tell people what they don’t want to hear sometimes, but always stick with science.  You have to rise above the rhetoric, no matter what.”

“And so I recommended her to the governor and they also fell in love with her.” She became commissioner on Oct. 1, 2012.

Kentucky’s health problems have mounted for decades, but Mayfield is optimistic that they can be overcome because of the Medicaid expansion and increased access to health insurance under the federal health-reform law. Thousands of people have sought care for problems that went untreated because they had little or no money or no insurance.

The federal government is paying the entire cost of those newly eligible for Medicaid until 2017, when the state will begin paying 3 percent, rising to the law’s cap of 20 percent in 2020.  Republican legislators and candidates for governor have voiced concern about the state’s ability to pay its Medicaid bills.

Mayfield said the state is working on controlling costs, through the managed-care system that began in 2011.  One target of cost control is the “super-utilizers” of emergency rooms, or those who come to hospital emergency departments 10 or more times per month.

Mayfield, who was put in charge of finding a way to reduce super-utilizers, said 80 percent of them have mental-health issues, so she is working on the problem with Medicare, the state Department of Behavioral Health and Kentucky’s three medical schools. Kentucky is one of six states accepted into the National Governors Association Policy Academy to address super-utilization.

Dr. William Hacker, who preceded Mayfield as commissioner, said her broad training and deep experience in the department uniquely qualified her to succeed Dr. Steve Davis, who was interim commissioner after Hacker retired.

“She is multidisciplinary and thinks beyond the public-health world,” Hacker said. “She has done an excellent job.”

Mayfield, who has been nationally recognized for her contributions to the state’s electronic health information exchange, also stresses the importance of using technology to improve the health of Kentuckians – especially those who live in rural areas, far from specialists.

Mayfield describes her style of leadership as one of action.  “If we say we are going to do something, then let’s build that infrastructure and let’s get it done,” she said.

Hacker said, “Dr. Mayfield is a thoroughbred.  She is on the go at 90 miles per hour.  She is focused on accomplishing goals.”

Haynes said Mayfield “led massive change at the lab” and knows “how to cajole and support and lead” – and when to be firm. “There are times you have to stick to your guns. You have to choose sort of your poison and you have to say ‘I’ll give you this, but I’m not giving this.’ I needed somebody that didn’t feel the political pressure to give in, and that would stick with it. And really just be a great public face of public health.  And she is all of that.”