Archive for Advocacy

U.S. House Passes SUPPORT for Patients and Communities Act

U.S. House Passes SUPPORT for Patients and Communities Act

In a 396-14 vote, the U.S. House of Representatives passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, or H.R. 6 —bipartisan opioid legislation that aims to curb drug abuse.

Sponsored by Greg Walden, R-Oregon, the package of legislation contains more than 50 individually approved bills to address what Pres. Donald Trump has called a health emergency.

The SUPPORT bill is intended to fight the opioid crisis by advancing treatment and recovery programs, improving prevention efforts, providing resources to communities and fighting drugs like Fentanyl. The legislation also calls for a review of current opioid prescriptions, development and usage of non-addictive painkillers, making a patient’s addiction history as part of their medical records to prevent relapse and reducing the trafficking of Chinese fentanyl into the country. Additionally, the legislation will expand Medicare and Medicaid-related services to combat drug abuse.

Opposition votes came from 13 Republicans and a lone Democrat. Alabama’s Rep. Mo Brooks voted against the legislation, which is now headed to the Senate for review and passage.

In short, the bill makes several changes to state Medicaid programs to address opioid and substance use disorders. Specifically, the bill:

  • modifies provisions related to coverage for juvenile inmates and former foster care youth,
  • establishes a demonstration project to increase provider treatment capacity for substance use disorders,
  • requires the establishment of drug management programs for at-risk beneficiaries,
  • establishes drug review and utilization requirements,
  • extends the enhanced federal matching rate for expenditures regarding substance use disorder health home services, and
  • temporarily requires coverage of medication-assisted treatment.

The bill also alters Medicare requirements to address opioid use. Specifically, the bill:

  • exempts substance use disorder telehealth services from specified requirements,
  • requires the initial examination for new enrollees to include an opioid use disorder screening,
  • modifies provisions regarding electronic prescriptions and post-surgical pain management,
  • requires prescription drug plan sponsors to establish drug management programs for at-risk beneficiaries, and
  • requires coverage for services provided by certified opioid treatment programs.

The bill also addresses other opioid-related issues. Specifically, the bill:

  • establishes and expands programs to support increased detection and monitoring of fentanyl and other synthetic opioids, and
  • increases the maximum number of patients that health care practitioners may initially treat with medication-assisted treatment (i.e., under a buprenorphine waiver).

Additionally, the bill temporarily eliminates the enhanced federal matching rate for Medicaid expenditures regarding specified medical services provided by certain managed care organizations.

The Medical Association is closely monitoring the status of this legislation, but we encourage you to read more about the legislation here.

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Association’s New Task Force to Address Health Care Manpower Shortage

Association’s New Task Force to Address Health Care Manpower Shortage

In response to a resolution passed by the House of Delegates during the 2018 Annual Meeting in Montgomery in April, the Board of Censors formed a new task force to develop and restore adequate health care manpower in all geographic areas in order to provide quality local health care for all Alabama citizens.

The resolution, submitted by the Pickens County Medical Society, stands as a reminder that Alabama ranks in the last five of 50 states in health status categories, and while primary care medicine is effective in raising health status, supporting hospitals and improving the economic status of disadvantaged communities, the state’s aging population is causing an escalation in need for primary care physicians.

The task force had its first meeting the week of July 23 and will meet again on Aug. 14. We will post details as they become available.

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Association’s Board to Evaluate Prior Authorization Process

Association’s Board to Evaluate Prior Authorization Process

The Medical Association recently received information from a consortium of health care providers, which included the American Hospital Association, America’s Health Insurance Plans, the American Medical Association, the American Public Health Association, Blue Cross Blue Shield Association and the Medical Group Management Association, who have partnered to identify opportunities to improve the prior authorization process. The Board of Censors during its last meeting tasked the Council on Medical Services to further investigate the consortium’s report.

The consortium’s goals are to promote safe, timely and affordable access to evidence-based care for patients; enhance efficiency; and reduce administrative burdens. However, according to a 2012 Kaiser Family Foundation estimate, physicians spend 868.4 million hours annually on prior authorizations. In a 2011 study by Health Affairs, the average annual per-doctor cost of interacting with insurance plans to complete prior authorizations was about $83,000.

The consortium has targeted five areas that offer improvement in prior authorization programs that can bring meaningful reform:

  • Selective application of prior authorizations
  • Prior authorization program review and volume adjustment
  • Transparency and communication regarding prior authorization
  • Continuity of patient care
  • Automation to improve transparency and efficiency

Once the Council on Medical Services concludes its investigation, more information will be available.

Read the Consensus Statement on Improving the Prior Authorization Process from the consortium.

Read the Medical Association’s feature article from Alabama Medicine Magazine, Between Doctors & Patients: Prior Authorizations

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With Net Neutrality Gone, What’s in the Future for Physicians?

With Net Neutrality Gone, What’s in the Future for Physicians?

Net neutrality changed the digital landscape for millions of Americans, specifically physicians and health care professionals, but these changes may diminish due to the repeal of net neutrality. In December, the Federal Communications Commission voted to repeal the net neutrality rules set in place by the Obama Administration in 2015, and on June 11, 2018, net neutrality was officially repealed leaving many questions for Americans. Previously, most professionals were unfazed by the net neutrality rules, and many are still unaware of the positive impact net neutrality had in areas of the health care profession, such as telemedicine and technology education since it passed in 2015. Despite these technological advancements, many doctors still do not understand net neutrality or the effect the repeal could have on their practice or their financial bottom lines.

What is net neutrality?

Net neutrality is the concept that Internet Service Providers (ISPs) like Verizon, AT&T, Comcast and Spectrum are required to handle all data equally. The previous net neutrality rules protected against blocking, throttling and prioritization — meaning ISPs were not able to slow down or block some websites but speed up others. Net neutrality required all websites to load at equal speeds and treated all online content fairly. It also protected the consumer from paying more for slower internet speeds. In other words, all internet users were on a level playing field with the same rights to equally fast internet, and all websites were available at the same speed and quality.

What does life look like without net neutrality rules?

Without net neutrality, non-profit and educational websites and databases could be de-prioritized in lieu of commercial websites, meaning the importance of educational materials and research would be left up to the internet service providers. Allowing ISPs the ability to decide the importance of internet content leaves the potential for the medical and academic community to suffer because their content could potentially load at slower speeds or worse, blocked. Additionally, slower internet speeds will affect the ability to live-stream, upload and download promptly. Finally, many worry ISPs could offer multiple plans with different options on internet speed, leaving consumers paying more for high-speed internet. Overall, a divide will form between those who can afford faster internet service options and those who are stuck with slower bandwidth.

What does this mean for physicians?

For physicians and health care professionals, the repeal of net neutrality leaves the potential for devastating effects. First, medical professionals could be forced to pay significantly more for high-speed internet capable of downloading, uploading, sending and receiving digital medical records. Also, all the advancements made in telemedicine could become stagnant. Despite recent advancements, the future of telemedicine remains uncertain even if a physician can afford the high-speed internet to treat patients, many patients may not be able to afford the high-speed internet capable of live-streaming with their physician. Additionally, the repeal could be detrimental for physicians practicing in rural areas or with patients living in rural areas reliant on telemedicine.

Likewise, educational endeavors could suffer a significant impact. It could cost more for high-speed internet capable of downloading and uploading medical books and research vital to medical education, leaving medical students with the potential for an increase in tuition. Physicians could find it harder to stay up-to-date on the most recent research and studies in their field if educational and non-profit websites become overshadowed by commercial websites paying ISPs. Finally, the competition created between commercial websites and educational and non-profit websites will hinder and slow-down research. Overall, net neutrality created a level playing field on the internet making it possible for technological advancements that empower physicians with the education and tools they need to best care for their patients.

What can the medical community do now?

As of right now, ISPs have not changed their services despite the repeal of the net neutrality rules. In fact, many ISPs have publically stated they will not block or throttle but have left open the potential to charge more for some data transportation. On the contrary, just because an ISP publically states it will continue as if net neutrality is still in place does not mean it is locked into obeying that standard. As time goes on without net neutrality, look out for changes with ISPs. Many predict the changes will start small and add up over time.

How can you make a difference?

The U.S. Senate voted to reinstate the net neutrality rules repealed in December. The legislation is currently in the U.S. House of Representatives where it is given little hope of advancing. Contact your district’s representative and express your concerns over the end of net neutrality and the effects it will have on physicians and health care professionals.

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Alabama Physicians Attend AMA Meeting in Chicago to Discuss State of Health Care

Alabama Physicians Attend AMA Meeting in Chicago to Discuss State of Health Care

Pictured from left in the back are Dr. Buddy Smith Jr., Dr. Jefferson Underwood and Dr. Jerry Harrison. In front from left are Dr. Steven Furr, Medical Student Delegate Hannah Ficarino from the University of South Alabama, Dr. Jorge Alsip and Dr. John Meigs.

During the AMA’s Annual Meeting held June 8-13, 2018, the House of Delegates debated a wide range of issues and adopted policies to expedite the free exchange of key patient data between EHR systems; to make e-prescribing of controlled substances and access to state PDMPs less cumbersome, and to reduce the MIPS reporting burden. The AMA also reaffirmed its strong opposition to the legalization of physician-assisted suicide and euthanasia.

Medical Association President Jefferson Underwood, M.D., joined the delegation in Chicago and represented Alabama physicians at the inauguration of the AMA’s new president, Barbara McAneny, M.D.

“The AMA House of Delegates is much like Congress in that the views of its members vary from region to region, and few members agree with every decision made by the organization. However, a state’s representation in the HOD is based on their number of AMA members, and Alabama along with the other Southeastern states are working vigorously to increase their AMA membership. I encourage our Medical Association members to also join the AMA, so we can have a greater impact on policy and help elect officers who share our views and values.” said Jorge Alsip, M.D., who chairs Alabama’s AMA Delegation.

Pictured are Association President Underwood and his wife, Sara.

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President Trump Signs VA Mission Act

President Trump Signs VA Mission Act

UPDATE JUNE 6, 2018: President Trump signed the VA Mission Act designed to increase veterans’ access to timely and private health care. The new VA law aims to combine and expand existing community care programs during the next year with intentions to roll out one centralized community care program next May.

Building off the positive changes enacted by the Choice Program, which was created in 2014 after two veterans died waiting for appointments, the Mission Act broadens the circumstances for which veterans can receive non-VA health care. Presently, veterans can seek third-party medical care if they live more than 40 miles away from a VA facility or if they must wait over 30 days for an appointment. The Mission Act will also allow veterans access to non-VA health care if they are in need of a service the VA does not offer or if their doctor thinks it is in the best interest of the patient.

With access to non-VA health care becoming more accessible, some lawmakers became fearful the new law would undermine the VA. The Mission Act recognizes this potential and includes incentives and funding to ensure the Act does not drive veterans away from the VA. The order will boost funding to allow the VA to hire more health care professionals in addition to offering scholarships to medical students willing to work for the VA.

Additionally, the new measure will help pre-9/11 veterans by giving them benefits to help cover the cost of in-home caregivers. Post-9/11 veterans already have access to such benefits. These benefits offer an alternative to institutionalized health care and will help take some of the cost of local governments.

While the Mission Act passed overwhelmingly in both the House and Senate with bi-partisan support in May 2018, there is a debate on exactly how the measure will be funded after May 2019. Sen. Richard Shelby (R-Ala.), head of the Senate Appropriations Committee, is working across party lines in both the Senate Appropriations Committee and the Veteran’s Affairs Committee to help establish the best possible funding plan for the VA Mission Act.

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President Trump Signs Right-to-Try Act

President Trump Signs Right-to-Try Act

On Wednesday, May 30, 2018, Pres. Donald Trump signed the Right-to-Try Act, which allows terminally ill patients the ability to try drugs in preliminary testing but not-yet-approved by the Food and Drug Administration. The aim is to make it easier for those patients suffering from fatal illness who have exhausted all other resources to access drugs unapproved by the FDA, which may provide them some relief from their illnesses.

The Right-to-Try Act is also intended to create a more open and competitive market for drugs still seeking FDA approval, therefore, lowering the cost of the drugs since insurance companies do not cover them. Supporters of the legislation say it gives hope to those who are out of options, while opponents argue the legislation gives a false hope to many who are already in a vulnerable and fragile state.

While the intent is to allow patients to try drugs not otherwise available to them, many point out the FDA already allows patients access to these drugs through an expanded access program. This program allows terminally ill patients access to drugs not FDA approved, ensures the drug is administered correctly and certifies those receiving the medication are adequately informed. Additionally, the approval rate of patients completing the application requesting these drugs since 2006 is 99 percent.

Supporters of the Right-to-Try Act argue these numbers do not reflect the hundreds of patients neglected by the application process through incomplete applications and other factors. Now, the Right-to-Try Act takes the FDA out of the equation and leaves the power with patients and their physicians to work with drug companies directly to access unapproved drugs.

Despite its potential for success, the Right-to-Try Act comes with a significant downside. Since the only requirement for the drugs are that they have passed Phase I testing with the FDA stating they are safe on humans, there is no real understanding of possible side effects these drugs may have on patients. The uncertainty and margin of error around medications not approved by the FDA leave physicians concerned for the health and safety of the patients who choose to use them.

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Demand for Non-Physician Providers Rose to Make Up for Physician Shortage

Demand for Non-Physician Providers Rose to Make Up for Physician Shortage

The Medical Group Management Association has released its 2018 MGMA DataDive Provider Compensation Survey revealing primary care physicians’ compensation rose by more than 10 percent over the past five years. This increase, which is nearly double that of specialty physicians’ compensation over the same period, is further evidence of the worsening primary care physician shortage in the American health care system.

A closer look at this data shows this rise in compensation is not necessarily tied to an increase in productivity. When broken down by primary care focus, family medicine physicians saw a 12 percent rise in total compensation over the past five years, while their median number of work relative value units (wRVUs) remained flat, increasing by less than one percent. Practices offered more benefits to attract and retain physicians, including higher signing bonuses, continuing medical education stipends, and relocation expense reimbursements.

“MGMA’s latest survey has put strong data behind a concerning trend we’ve seen in the American healthcare system for some time—we are experiencing a real shortage of primary care physicians,” said Dr. Halee Fischer-Wright, President and Chief Executive Officer at MGMA. “Many factors contribute to this problem, chief among them being an increasingly aging population that’s outpacing the supply of chronic care they require. And with a nearly two-fold rise in median compensation for primary care physicians over their specialist counterparts and increased additional incentives, we can now see the premium organizations are placing on primary care physicians’ skills to combat this shortage.”

Further supporting this trend, the new survey identified meaningful growth in compensation for non-physician providers over the past 10 years. Nurse practitioners saw the largest increase over this period with almost 30 percent growth in total compensation. Primary care physician assistants saw the second-largest median rise in total compensation with a 25 percent increase.

“In many communities that we visit, nurse practitioners and other advanced practice providers provide immediate care and same day access. These providers play an important role in today’s health care system. It’s more efficient and less expensive than visiting the emergency room,” said Nick Fabrizio, Principal Consultant at MGMA.

Based on comparative data from over 136,000 providers in over 5,800 organizations, the 2018 MGMA DataDive Provider Compensation is the most comprehensive sample of any physician compensation survey in the United States. The survey represents a variety of practice types including physician-owned, hospital-owned, academic practices, as well as providers from across the nation at small and large practices.

Other highlights from the survey include:

  • Over the past five years, rises in median compensation varied greatly by state. In two states, median total compensation actually decreased for primary care physicians: Alabama (-9 percent) and New York (-3 percent). Many states saw much larger increases in median total compensation compared to the national rate, the top five being Wyoming (41 percent), Maryland (29 percent), Louisiana (27 percent), Missouri (24 percent) and Mississippi (21 percent).
  • Current median total compensation for primary care physicians also varies greatly by state. The District of Columbia is the lowest paying with $205,776 in median total compensation. Nevada is the highest paying state with $309,431 in median total compensation.
  • Over the last five years, looking beyond just nurse practitioners, overall non-physician provider compensation has increased at a rate of 8 percent. Looking at the changes over the past 10 years, that rate has doubled to 17 percent. As non-physician providers have increasingly become patients’ primary care providers over the past 10 years, combined with a subsequent shortage of non-physician providers, compensation rates continue to grow for nurse practitioners and primary care physician assistants.
  • The difference in compensation between the highest-paid state compared to the lowest ranges between $100,000 and almost $270,000 for physicians depending on specialties, and $65,000 for non-physician providers.

The 2018 MGMA DataDive Provider Compensation is the most trusted compensation survey in the U.S., undergoing a rigorous evaluation and inspection. Learn more at www.mgma.com/data.

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Trump Administration Releases Drug Pricing Blueprint

Trump Administration Releases Drug Pricing Blueprint

On May 11, The Trump Administration released “American Patients First,” the President’s blueprint to lower drug prices and reduce out-of-pocket costs, along with a request for information. The Blueprint was framed as advancing four specific goals:

  • Reducing list prices;
  • Improving government’s ability to negotiate better prices;
  • Encouraging competition through rapid entry to market of generics and biosimilars; and
  • Lowering patient out-of-pocket expenses.

The Blueprint proposes a broad number of changes to prescription drug programs in several federal health care programs – such as Medicare, Medicaid and other safety net programs – as well as Food and Drug Administration policies that should impact commercial and federal health care program access to affordable prescription drugs.

While some of these proposals can be undertaken through immediate regulatory or subregulatory actions, others are still on the drawing boards at the U.S. Department of Health and Human Services and some will require congressional action to implement. The Blueprint proposes a select number of programmatic and design changes, yet the Administration is seeking feedback for a large number of lingering questions.

Initial review appears to show an increased access to lower-cost alternative generics. But closer review is needed on proposed changes to the Medicare Part D Prescription Drug Benefit Program and the Part B drug reimbursement methods to alleviate concerns the changes may limit patient access to medically necessary alternative brand or specialty treatments and result in additional administrative burdens on physicians and patients. The proposal may also eliminate the requirement that Part D plans include a minimum of two drugs proven to be effective in each therapeutic category or pharmacologic class, if available.

The Medical Association will be closely monitoring the Administration’s “American Patients First” Blueprint and will keep our members updated on any new developments as they become available.

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What’s the Future for Physicians without Net Neutrality?

What’s the Future for Physicians without Net Neutrality?

Net neutrality has changed the digital landscape for millions of Americans, specifically physicians and health care professionals, but that could all change on June 11. In December, the Federal Communications Commission voted to repeal the net neutrality rules set in place by the Obama Administration, and on June 11 the repeal of net neutrality is set to take effect. Many professionals are unaware of the positive impact net neutrality has had in areas of the health care profession, such as telemedicine and technology education since it passed in 2015. Despite these technological advancements, many doctors still do not understand net neutrality, or the potential effect the repeal will have on their practice.

What is net neutrality?

Net neutrality is the concept that Internet Service Providers (ISPs) like Verizon, Comcast and Spectrum are required to handle all data equally. Meaning ISPs cannot slow down some websites and speed up others. Net neutrality operates all websites loading at equal speeds and treats all content online fairly. Also, it protects the consumer from paying more money for slower internet speeds. Net neutrality keeps everyone on a level playing field with everyone having the same rights to the equally fast internet, and all websites are available at the same speed and quality.

Life without net neutrality

Without net neutrality, non-profit and educational websites and databases run the risk of being de-prioritized for commercial websites, meaning the importance of educational materials and research is left up to the internet service providers. Allowing ISPs the ability to decide the importance of internet content leaves the potential for the medical and academic community to suffer. Additionally, we can expect slower internet speeds affecting the ability to live-stream, upload and download promptly. Overall, a divide will be created between those who can afford faster internet service and those who are stuck with the slower bandwidth.

What does this mean for physicians? 

For physicians and health care professionals, the repeal of net neutrality could be detrimental. First, professionals run the risk of paying significantly more for high-speed internet capable of downloading, uploading, sending and receiving digital medical records. Also, all the advancements made in telemedicine recently could become stagnant. Despite the recent advancements, the future of telemedicine remains uncertain because even if the doctor can afford the high-speed internet to treat patients, many patients may not be able to afford the high-speed internet capable of live-streaming with their doctor.

Likewise, the education of doctors will be impacted significantly. For medical students, there is potential for an increase in tuition since it will cost more for high-speed internet capable of downloading and uploading medical books and research vital to their education. For doctors, it will become harder to stay up-to-date on the most recent research and studies in their field. Educational and non-profit websites will be overshadowed by commercial websites paying ISPs, making it harder to access scholarly research. Finally, the competition created between commercial websites and educational and non-profit websites will hinder and slow-down research. Overall, net neutrality has created a level playing field on the World Wide Web. It has made possible technological advancements that empower physicians with the education and tools they need to best care for their patients.

How can you make a difference?

On Wednesday, May 17, 2018, the Senate voted to reinstate the net neutrality rules repealed in December. The legislation is currently in the House where it is given little hope of advancing. Contact your district’s representative and express your concerns over the end of net neutrality and the effects it will have on physicians and healthcare professionals.

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