Archive for Advocacy

Senior Physicians: We Need Your Voices!

Senior Physicians: We Need Your Voices!

Any physician that has reached the age of 65 is considered by the American Medical Association and the Medical Association to be a Senior Physician, even if you are not currently working in a medical practice. That does not mean your voice cannot still work for the House of Medicine.

Did you know the Medical Association has a Senior Physician Section Representation on the Board of Censors? This is an elected office, and even though it is a non-voting position by statute, it is nevertheless an important platform for voicing the issues affecting older physicians in Alabama, such as requesting payment for services, malpractice coverage, new technologies, personal health issues, etc…

The position has benefits, too, such as reimbursement for travel to and from monthly board meetings, which are the second Tuesday and Wednesday of the month, and accommodations and food are also provided during your time in Montgomery. Your transportation, hotel and food expenses are covered for the two annual meetings of the AMA. In 2019, the meetings will be June 8-12 in Chicago and Nov. 16-19 in San Diego.

I have served as the Senior Physician Section Representative for the past year, and I will vacate the office during the next Annual Meeting in April 2019 when a new representative will be elected. I urge all Association senior physicians to attend because we are the ones who elect OUR representative – and practicing physicians can also earn CMEs for attending the conference.

I would recommend choosing someone who is still practicing medicine and would like to serve the Medical Association. This position requires someone that understand the difficulties that face all physicians and especially senior physicians in the current medical environment. If you have questions, please email Executive Director Mark Jackson.

Article contributed by Dr. Jim Alford, Senior Physician Section Representative, 2018-2019.

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Three Simple Steps for Increasing Medicine’s Influence

Three Simple Steps for Increasing Medicine’s Influence

From the outside looking in, the political process likely seems as inviting as a shark tank, as navigable as a corn maze, as predictable as the Kentucky Derby. Intimidating, confusing and frustrating are often used by citizens to describe advocacy-related interactions with government and frankly, this isn’t surprising given most citizens’ level of understanding of the political process.

In his Gettysburg Address, President Abraham Lincoln famously opined our nation’s form of government – “of the people, by the people, for the people” – would long endure. Unlike the direct democracy of 5th century Athens, Americans live in a representative democracy, electing individuals from city councilmen to the President to make decisions for them.

Representative democracy eliminates the need for the citizenry to be involved in the minutiae of modern governance. The downside, however, can be a culture of complacency on the part of the electorate. Outcomes are typically directed by those choosing to engage government on issues important to them, and so government becomes “of the people, by the people, for the people [who choose to participate].” The citizenry is ultimately still responsible for holding government accountable, through either direct engagement with lawmakers or the electoral process (or both), though few understand how to do so.

By following the three simple steps below, physicians can increase their influence on issues important to them and the patients they serve.

Step 1: Join, join, join

A significant portion of success is simply showing up, but most physicians don’t have the time to spend flying back and forth to Washington or driving to Montgomery for Congressional or legislative meetings, hearings and sessions. Laws and or regulations are constantly under consideration in either the nation’s or state’s capitol directly affecting medical care. A practicing physician can’t possibly make all the scheduled meetings and still see patients, much less attend to the very necessary continual monitoring of legislative and regulatory bodies that is required of successful modern-day advocacy operations.

But when like-minded people pool their resources good things can happen. Advocacy organizations concerned with ensuring delivery of quality care and a positive practice and liability environment – from individual state and national specialty societies to the Medical Association of the State of Alabama – all deserve your support and membership.

They are all working for you and joining them gives these organizations the resources to hire qualified personnel to represent physicians and their patients before legislative and regulatory bodies.

Step 2: Get to know a few key people

Physicians are responsible for a lot, and in today’s world especially, it’s easy to get in a routine and leave the job of representing the profession to someone else. After all, isn’t that what membership dues are for? Yes and no. While membership in organizations advocating for physicians helps fund advocacy operations, paying membership dues alone is not enough, not in the era of social media, 24-hour news and increased engagement by those on the other side of issues from organized medicine.

Perhaps surprisingly, getting to know a few key people is not difficult, even if only by phone or email. While those paid to represent physicians will know the members of the Legislature and Congress and try to convince them of medicine’s position, in lawmakers’ minds, there is no contact more important than one from a constituent.

Physicians should start locally, getting to know their State Representative and State Senator first, gradually working up to establishing relationships with their member of Congress and U.S. Senators. If they are doing their job well as an elected representative, these legislators and their staff will be glad to hear from a constituent and get his/her perspective. At the same time, don’t overlook the importance of encouraging fellow physicians to engage their local elected officials in meaningful dialogue as well so overall efforts will be amplified.

For more information on how to interact and communicate with lawmakers, check out the Medical Association’s ABCs of VIP.

Step 3: Put your money where your mouth is

Medical and specialty society membership dollars cannot be legally used for elections purposes, and so separate political action committees or PACs must be established and funds raised each year to help elect candidates physicians can work with on important issues. Not surprisingly, numerous entities whose objectives are at odds with medical liability reform, meaningful health system reform and with ensuring the highest standards for medical care are eager to get their allies elected to office.

Just like their parent organizations, the PACs of specialty societies and the official political committee of the Medical Association of the State of Alabama (ALAPAC) are all worthy of your support. When it comes to PAC contributions, never underestimate the impact of even a small donation.

Choosing not to participate in the political process – when it’s known the decisions of lawmakers directly affect medicine – is akin to getting sued, consciously sitting out voir dire and letting the plaintiff’s lawyer pick the jury.

Summary

The future of medical care, in Alabama and the nation, rests not with elected lawmakers and appointed bureaucrats but with the men and women actually caring for patients every day. A representative democracy functions best when the electorate holds those elected to office accountable. Increasing medicine’s ability to successfully advocate for physicians and the patients they serve will require increased participation in the political process. It is incumbent upon physicians to join the organizations fighting for them, to get to know their elected officials and to contribute to PACs whose goals align with their own.

By Niko Corley
Director, Legislative Affairs
Deputy Director, Alabama Medical PAC (ALAPAC)

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Midwife Board Votes to Accept Recommended Changes to Rule

Midwife Board Votes to Accept Recommended Changes to Rule

Last Friday, the Alabama State Board of Midwifery voted to accept recommended changes from a legislative oversight committee to its proposed regulation to, among other things, set the scope of practice for non-nurse midwives. By accepting the changes, the newly-formed Midwife Board will begin to license non-nurse midwives. Had the Midwife Board turned down the recommendations, it would have had to start over entirely in its regulation-making process.

The recommendations came mostly from a proposal authored by the Medical Association and the health coalition to prohibit non-nurse midwives from practicing pediatrics and procuring, storing and using drugs. The legislative oversight committee added a requirement that, in the event a woman attempting to give birth at home with a non-nurse midwife transfers to a facility, the non-nurse midwife is required to accompany her client.

As well, the legislative oversight committee struck language in the Midwifery Board proposed regulation that would have limited the Midwife Board’s disciplinary “look back” period to only 18 months. No professional health licensure boards in Alabama have such a limited timeframe for “look back.”

While the Medical Association maintains there are inherent dangers associated with planned home birth, it supports the recommendations from the legislative oversight committee as being in the best interest of pregnant women and their babies.

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Nearly All ALAPAC-Supported Candidates Won Their Elections

Nearly All ALAPAC-Supported Candidates Won Their Elections

Tuesday’s election nationally saw the U.S. House flip from Republican to Democrat-controlled, but U.S. Senate Republicans actually increased their majority. In Alabama, Republicans remain in control of both house of the legislature and all statewide elected offices.

From an election results standpoint within Alabama, the Alabama Medical PAC (ALAPAC) participated in 111 out of 140 state legislative races. 99 percent of ALAPAC-supported legislative candidates won their election bids Tuesday. Regarding statewide offices, the success rate for ALAPAC-supported candidates was 100 percent. Later today, ALAPAC contributors will receive a much more detailed breakdown by email of Tuesday’s election results, an analysis of voting trends and forecasts for what Alabama physicians may expect the next several years.

The ALAPAC Board is incredibly appreciative of the resources Alabama physicians have contributed toward ALAPAC’s election efforts. As the official political committee of Alabama physicians and the Medical Association, ALAPAC exists to elect men and women whom physicians can work with on issues affecting patients and the practice of medicine. If you would like to contribute to ALAPAC, please click here.

Contributions to ALAPAC are not tax deductible as charitable contributions for Federal income tax purposes. Voluntary political contributions to Alabama Medical PAC (ALAPAC) are not limited to the suggested amount. The Medical Association will not favor or disadvantage anyone based upon the amount or failure to contribute. A portion of the contributions may be used in connection with Federal elections. Corporate funds will be used in either state elections or for education purposes. Federal contributions are subject to the limitations of FEC Regulations 110.1, .2, and .5.

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Association Secures Significant Changes to Midwife Board Rule

Association Secures Significant Changes to Midwife Board Rule

The Medical Association and a coalition of health organizations this week convinced a legislative committee with oversight of state board regulations to make changes to a dangerous proposed regulation by the newly-formed Alabama State Board of Midwifery.  The Midwifery Board was established by law in 2017 to license non-nurse midwives.

The proposed regulation – if adopted by the legislative committee as it was proposed by the Midwifery Board – would have allowed non-nurse midwives to practice pediatrics and procure, store and use drugs, neither of which is allowed by state law. In addition to striking these two provisions from the ASBM’s proposed regulation, the legislative committee also added a requirement that, in the event a woman attempting to give birth at home with a non-nurse midwife transfers to a facility, the non-nurse midwife is required to accompany her client. As well, the legislative committee struck language in the Midwifery Board proposed regulation that would have limited the ASBM’s disciplinary “look back” period to only 18 months. No professional health licensure boards in Alabama have such a limited timeframe for “look back.”

The Medical Association and others in the health coalition had worked with the Midwifery Board for more than six months in an attempt to get the Board to voluntarily bring its proposed regulation into compliance with state law. While the Midwifery Board chose not to accede to the coalition’s requests, the Medical Association supports the changes made to the proposed regulation by the legislative committee this week as being in the best interest of both pregnant women and their babies.

The Midwifery Board meets next week to take up the revisions the legislative committee made to its proposed rule. At that meeting or before the Dec. 4 deadline, the Midwifery Board will have to decide whether to adopt the changes the legislative committee made to its proposed regulation or to start over with the rulemaking process.

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President Signs Bills Lifting Pharmacist ‘Gag Clauses’ on Drug Prices

President Signs Bills Lifting Pharmacist ‘Gag Clauses’ on Drug Prices

Earlier this week, President Trump signed two bipartisan bills into law that will allow pharmacists to tell patients they can save money on drugs by paying cash or trying a lower-cost alternative. At issue was the “broken” drug pricing system in the U.S. that was forcing patients to make decisions, which could have negatively impacted their health.

The bills, the Patient Right to Know Act and the Know the Lowest Price Act, prohibit health insurers and pharmacy benefit managers from using “gag clauses” that prevent pharmacists from sharing with patients the lower-cost options when they are purchasing medically necessary medication. In addition, the legislation ensures the Federal Trade Commission will have the necessary authorities to combat anti-competitive pay-for-delay settlement agreements between manufacturers of biological reference products and follow-on biologicals. The Patient Right to Know Act would apply similar “gag clause” protections to Medicare and MA plans.

Under the new legislation, pharmacists will be allowed, though not required, to tell patients about lower-cost options. If pharmacists don’t tell, then patients will have to ask about the cost of the medication. However, some pharmaceutical industry experts say although eliminating the gag clause is a step toward consumer transparency, it doesn’t address the issue of lowering actual drug costs, making it unclear how much of a tangible effect the legislation will have.

According to research published in JAMA in March, people with Medicare Part D drug insurance overpaid for prescriptions by $135 million in 2013. Copayments in those plans were higher than the cash price for nearly 1 in 4 drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent.

Yet some critics say eliminating gag orders doesn’t address the causes of high drug prices. “As a country, we’re spending about $450 billion on prescription drugs annually,” said Steven Knievel, who works on drug price issues for Public Citizen, a consumer advocacy group. The modest savings gained by paying the cash price “is far short of what needs to happen to actually deliver the relief people need.”

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Congress Passes New Opioid Package; Awaiting Presidential Signature

Congress Passes New Opioid Package; Awaiting Presidential Signature

Earlier this week Congress reached agreement on legislation to address the opioid epidemic with the passage of the “SUPPORT for Patients and Communities Act,” which President Donald Trump is expected to sign. The legislation touches on almost every aspect of the epidemic and includes numerous provisions to expand access to substance-use disorder (SUD) prevention and treatment programs.

Below are some of the legislations significant provisions:

  • Expand existing programs and create new programs to prevent SUDs and overdoses, including reauthorization of the Office of National Drug Control Policy.
  • Expand programs to treat SUDs, including medication-assisted treatment (MAT); partially lift (for five years) a current restriction that blocks states from spending federal Medicaid dollars on residential addiction treatment centers with more than 16 beds by allowing payments for residential substance-use disorder services for up to 30 days; and allow Medicare to cover MAT, including methadone, in certain settings, to treat SUDs.
  • Increase funding for residential treatment programs for pregnant and postpartum women; and require the Centers for Disease Control and Prevention (CDC) to develop educational materials for clinicians to use with pregnant women for shared decision making regarding pain management during pregnancy.
  • Authorize an alternative payment model demonstration project developed by the American Society of Addiction Medicine, with support from the AMA, to increase access to comprehensive, evidence-based outpatient treatment for Medicare beneficiaries with opioid-use disorders.
  • Authorize CDC grants for states and localities to improve their Prescription Drug Monitoring Programs (PDMP), collect public health data, implement other evidence-based prevention strategies, encourage data sharing between states, and support other prevention and research activities related to controlled substances, including education and awareness efforts.
  • Expand the use of telehealth services for Medicaid and Medicare SUD treatment.
  • Provide loan repayment for SUD-treatment professionals, including physicians, who agree to work in mental health professional shortage areas (HPSAs) or counties that have been hardest hit by drug overdoses, and clarify that mental and behavioral health providers participating in the National Health Service Corps can provide care at a school or other community-based setting located in an HPSA as part of their obligated service requirements.
  • Help stop the flow of illicit opioids into the country by mail, especially synthetic fentanyl and its analogs.
  • Provide funding to encourage research and development of new non-addictive painkillers and non-opioid drugs and treatments.
  • Require the U.S. Department of Health and Human Services (HHS) to study and report to Congress on the impact of federal and state laws and regulations that limit the length, quantity, or dosage of opioid prescriptions.

The final bill also retained some provisions which may cause some concerns in the medical community, primarily related to mandates on physicians and duplicative requirements in state and federal programs. These provisions would:

  • Create a federal mandate for physicians to electronically prescribe controlled substances (EPCS) by January 2021 for Schedule II, III, IV, and V controlled substances covered under a Medicare Part D Prescription Drug Plan or Medicare Advantage (MA) prescription drug plans. The final language did, however, include the requirement that the Drug Enforcement Administration update its regulations pertaining to how prescribers authenticate prescriptions using biometrics to keep up with changing technology.
  • Require the HHS Secretary to establish a standard, secure electronic prior authorization system (ePA) for covered Part D and MA drugs but allow plans to continue to operate their individual proprietary online portals.
  • Require the U.S. Food and Drug Administration (FDA) to develop prescribing guidelines for the indication-specific treatment of acute pain where such guidelines do not exist. A provision was retained that requires the FDA Commissioner to publish a clear statement of intent to accompany the guidelines stating that they are intended to inform clinical decisions by prescribers and patients and are not intended to restrict, limit, delay or deny coverage or access by individual health care professionals.

One proposal not in the final legislation would remove patient privacy protections under federal law related to the confidentiality of SUD records. The Medical Association, AMA and other health care groups opposed the efforts to include this proposal partly out of concern that allowing more access to such records could discourage patients from seeking treatment for SUD. However, we are committed to working with Congress and other stakeholders to develop a solution that balances the need for health professionals to have the information they need to provide appropriate treatment to patients with SUD, while ensuring appropriate privacy protections for patients.

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After EMR Implementation, Surgeons Spend Less Time Interacting with Patients

After EMR Implementation, Surgeons Spend Less Time Interacting with Patients

Implementing an electronic medical records (EMR) system at an orthopaedic clinic may have unanticipated effects on clinic efficiency and productivity – including a temporary increase in labor costs and a lasting reduction in time spent interacting with patients, reports a study in September 19, 2018, issue of The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

Even after an initial learning period, introducing a new EMR system may affect several aspects of clinic workflow, according to the paper by Daniel J. Scott, MD, MBA, of Duke University, Durham, N.C., and colleagues. They write, “Healthcare systems and policymakers should be aware that the length of the implementation period is approximately six months and that implementation may alter the time that providers spend with patients.”

Introducing EMRs Could Have ‘Negative Trade-Off’ for Patient Care

The researchers used time-driven activity-based costing methods to evaluate how a new EMR system affected costs and productivity at two outpatient orthopaedic arthroplasty (joint replacement) clinics. The analysis included detailed observations of 143 patient visits before implementation of the EMR system, and again at two months, six months, and two years after implementation.

At two months after EMR implementation, total labor costs had increased significantly, from $36.88 to $46.04 per patient visit. The cost increase was related to increases in the time that attending surgeons spent per patient, from 9.38 to 10.97 minutes, and in the time that certified medical assistants spent on patient assessment, from 3.4 to 9.1 minutes. For surgeons and medical assistants combined, the time spent documenting patient encounters more than doubled: from 3.3 to 7.6 minutes.

By six months after implementation of the EMR system, total labor costs were similar to costs in the pre-implementation period. From six months to two years, labor costs remained stable. Average weekly patient volume decreased for one of the surgeons studied, but remained stable for the other surgeon.

However, the increases in time spent on documentation persisted, even after the initial learning period. This was accompanied by a significant reduction in time spent interacting with patients, from 14.65 to 10.03 minutes.

Electronic medical records systems are rapidly being adopted throughout the US healthcare system, in part due to increased regulation. “EMR implementation can be costly and typically requires workflow redesign,” Dr. Scott and coauthors write. The study is the first to assess the impact of EMR systems in orthopaedic practice.

“This could suggest that providers ultimately were able to spend less time with patients as documentation requirements increased,” Dr. Scott and coauthors write. “If so, this could represent a negative trade-off for patient care and leave patients less satisfied, a trend worthy of further study.”

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Medical Association, AMA, Others Take a Stand on New CMS Rule

Medical Association, AMA, Others Take a Stand on New CMS Rule

The Medical Association joined with the American Medical Association and more than 170 other organizations to support some components of CMS’ “Patients Over Paperwork” initiative, and say three of its components need to be enacted immediately to reduce “note bloat” redundancy, yet also to oppose a proposal to collapse payment rates for physician office visit services over concern about unintended consequences included in the proposed 2019 Medicare Physician Fee Schedule and Quality Payment Program rule.

Read the letter here.

The AMA and other organizations called for the immediate adoption of these proposals:

  • Changing the required documentation of a patient’s history to focus only on the interval since the previous visit.
  • Eliminating requirement for physicians to redocument information that has already been documented in the patient’s record by practice staff or by the patient.
  • Removing the need to justify providing a home visit instead of an office visit.

However, the CMS proposal to “collapse” payment rates for five evaluation and management (E/M) office visit services into two has the potential to create unintended negative consequences for patients.

“We oppose the implementation of this proposal because it could hurt physicians and other health care professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care, ultimately jeopardizing patients’ access to care,” the letter states. The AMA and the other organizations joining the letter also oppose a proposed policy that would cut payments for multiple services delivered on the same day.

The organizations note their willingness to work with CMS to resolve issues connected with calculating the appropriate coding, payment and documentation requirements for different levels of E/M services. They also declare their support for the workgroup the AMA created of coding experts who would “arrive at concrete solutions” in time for CMS to implement in the 2020 Medicare physician fee schedule.

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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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