Posts Tagged advocacy

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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The New Department of Justice Initiative: Aggressively Investigating and Prosecuting Opioid-Related Cases

The New Department of Justice Initiative: Aggressively Investigating and Prosecuting Opioid-Related Cases

Before joining Burr & Forman, LLP, I was a federal prosecutor for a little over a decade specializing in health care fraud and general white collar matters. In that role, I was the member of a prosecution team that secured guilty verdicts earlier this year against two pain management doctors in Mobile, Ala., following a protracted jury trial. The doctors were convicted of a litany of federal crimes arising from their operation of a pain management clinic, including, among others, violations of the Controlled Substances Act and the Anti-Kickback Statute. The doctors received substantial prison sentences of 20 and 21 years, respectively, and forfeited virtually all of their assets (including bank accounts, houses and cars) to the government.

The doctors in this case were convicted of running what the government calls a “pill mill,” a pain management clinic that allegedly prescribes narcotics for illegitimate purposes. Pain management professionals should be aware this is just one example of what will likely be an onslaught of “pill mill” and other opioid-related prosecutions by the Department of Justice (DOJ) during the current administration. In fact, just a few months after the convictions in the Mobile case, Attorney General Jeff Sessions announced a nationwide takedown of 120 doctors, pharmacists and nurses – dubbed “Operation Pilluted” – who were charged with various federal crimes related to their alleged “unlawful distribution of opioids and other prescription narcotics.” In announcing the takedown, Sessions noted the DOJ would continue to “aggressively pursue corrupt medical professionals,” and “the Department’s work is not finished. In fact, it is just beginning.”

On the heels of that announcement, in August of this year, Sessions heralded a new DOJ pilot program called the “Opioid Fraud and Abuse Detection Unit.” According to Sessions, the unit “will focus specifically on opioid-related health care fraud using data to identify and prosecute individuals that are contributing to the opioid epidemic.” Sessions warned, “If you are a doctor illegally prescribing opioids or a pharmacist letting these pills walk out the door and onto our streets based on prescriptions you know were obtained under false pretenses, we are coming after you.” Sessions explained the DOJ would be appointing a special federal prosecutor in 12 select districts across the country whose sole purpose will be to prosecute “pill mill” and other opioid-related cases.

One of the districts, which has received one of the special “pill mill” prosecutors, is the Northern District of Alabama, in Birmingham. The U.S. Attorney for that district, Jay Town, separately confirmed the new prosecutor will spend “100 percent of their time working these types of cases…What we’re going after is the medical providers who are operating outside the boundaries of the law and the medical practice.” Echoing the Attorney General’s statements, Town vowed, “We’re going to rid the Northern District of these pill mills.”

Note “pill mills” are not the only opioid-related cases on the DOJ’s radar. In fact, it is also concentrating on the “diversion” of opioids in hospital settings. Such “diversion” schemes include, for instance, the theft of opioids from a hospital “Pxyis” machine (a device hospitals utilize to regulate the dispensing of controlled substances) by nurses, or the forgery or fraudulent creation of opioid prescriptions by hospital personnel.

In sum, the DOJ has fired a warning shot that physicians, pharmacists and other medical professionals involved in the treatment of patients will be under intense scrutiny for the foreseeable future. This is especially true for physicians who operate pain management clinics. These doctors should, in general, prescribe opioids reasonably and carefully in the context of each patient’s presentation and thoroughly document their treatment.

To that end, doctors should, among other things: maintain a thorough intake procedure, which requires the patient to give a detailed medical history and provide previous diagnostic studies; have the patient sign, if applicable, an “opioid treatment agreement” requiring the patient to abide by certain opioid use guidelines; perform exhaustive physical examinations during the initial visit and at regular intervals during the patient’s treatment (which should be carefully documented); consider alternatives to opioid treatment, such as non-narcotics drugs, physical therapy and surgery (and, where applicable, carefully document why alternative treatments would be ineffective); prescribe the lowest dosage and quantity of opioids possible to treat the patient’s condition; closely monitor for signs of diversion and addiction by regularly ordering urine drug screens and reviewing the patient’s prescription drug monitoring data; and have regular independent audits conducted by a billing consultant or another pain management specialist to ensure compliance with all regulations and laws. Implementing these practices should help doctors avoid government scrutiny as part of the DOJ’s new initiative to crack down on alleged “pill mill” operations.

Adam Overstreet is counsel at Burr & Forman, LLP. Prior to joining Burr, Adam practiced with the U.S. Attorney’s office and gained extensive experience with health care fraud matters. Burr & Forman, LLP, is a partner with the Medical Association. Please read other articles from Burr & Forman, LLP, here.

Posted in: Legal Watch

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Organized Medicine: Why Physician Membership is More Important Now than Ever Before.

Organized Medicine: Why Physician Membership is More Important Now than Ever Before.

“There’s strength in numbers” is a saying we all know well. Whereas one person can say something, it becomes a much more powerful display when more people join together in support or protest.

In the past, it was not unusual for physicians to be members of their county medical society, specialty society, state medical association, national specialty society, and national medical association, but these days those numbers are waning. When the practice of medicine seems to be changing almost daily, support for organized medicine as a whole seems to be dropping during a time at which patients and their physicians need help more than ever before.

The 2016 Survey of America’s Physicians: Practice Patterns & Perspectives conducted on behalf of The Physicians Foundation by Merritt Hawkins, captured a snapshot of what the nation’s physicians think about the state of medical care today. Some of the findings were enlightening.

  • 80 percent of physicians are at capacity or have no time to see new patients
  • 49 percent of physicians often have feelings of burnout
  • 28 percent of physicians are only somewhat unfamiliar with MACRA
  • 49 percent of physicians would not recommend a career in medicine
  • 42 percent of physicians agree that EHRs have either reduced or detracted from their ability to deliver quality care

Ideally, physician membership in organized medicine would increase during difficult times facing the House of Medicine – times in which medicine is facing more intrusion by government regulation and restriction on how physicians can and do practice medicine, and the protection of patients’ rights. However, it would seem more physicians are moving away from the strength-in-numbers unified front that organized medicine provides to policymakers and replacing it with conflicting voices.

For example, in the 1950s, about 75 percent of all practicing physicians in the United States were members of the American Medical Association. According to a December 2016 article by Mother Jones online, its membership now is representative of about one-sixth of the nation’s physicians. So, where are all the physicians going?

What is the role of organized medicine?

Organized medicine groups are groups of physicians categorized into physician, young physician, resident and medical student sections. Each section works together to advocate collectively on behalf of the physician-patient relationship, patients’ rights, and medicine as a whole, but then each individual group works together to advocate for their section’s interests.

Giving physicians and medical students a voice in the business of medicine allows physicians to advocate for the best quality of care for their patients and ensures physicians are also treated fairly on the state and national levels.

In some cases, many young physicians may not even know about options to join organizations such as the AMA, the Medical Association, or even their local county medical society until the organization reaches out to them or a colleague mentions it. In Dr. Amber Clark’s case, it was a trip to an AMA meeting in Chicago that opened her eyes to the potential for organized medicine.

Dr. Amber Clark, who is in her second year of residency training in Physical Medicine and Rehabilitation at the University of Alabama at Birmingham School of Medicine, knew she wanted to be a physician since she was a little girl watching her pharmacist mother interact with her customers. But, even back then she knew she wanted more from her chosen profession.

female doctor smiling

“I always wanted that one-on-one relationship with patients, but (going to) Chicago introduced me to this concept of how we can make changes on more than just an individual basis but a population basis. That’s meaningful change!” Dr. Clark said. “It really is the responsibility of the physician, whether you’re in medical school or still in training or have completed your residency, to be a voice for yourself and your patient. Yes, we’re going to have more members that are going to be more vocal, that’s just the nature of life, but it’s still important to be one of those speaking out and being heard.”

Dr. Clark’s trip to Chicago was “mind-blowing,” allowing her to serve as an alternate delegate for the first time. Because the AMA trip to Chicago was her first introduction to organized medicine on a national stage, she did not know what to expect, which made for an even better experience.

“You have this collegiality of residents from all different walks of life and all different types of programs all coming together for one specific cause. We’re all advocating on behalf of our patients, but we’re also advocating on behalf of ourselves. There are so many other things that go on during these meetings behind the scenes that many physicians don’t know about because they don’t attend, but you assume people are advocating on your behalf. You can’t ever assume someone is fighting for you. You have to be willing to speak up. It just makes sense to participate,” Dr. Clark said.

Staying connected.

Across the country, organized medicine is having difficulty attracting and keeping members. As state and national membership organizations continue to add member benefits to entice members to stay connected, the number of physicians who are leaving the larger organizations for the smaller specialty societies seems to be increasing.

While there are still benefits of joining specialty societies, the larger membership organizations are left feeling the blow in their ranks…which means less bargaining power when it comes to negotiating on behalf of medicine.

Dr. Conrad Pierce has seen firsthand the power that comes with large membership organizations. He has seen it work well…and he has seen how it can fall apart when the members of the organization cannot manage its collective bargaining power.

About a year after he retired, Dr. Pierce began working for then-Sen. Jeff Sessions as a health care policy advisor when the Affordable Care Act was making its way through Congress. It was an arduous job trying to understand the proposed legislation, but condensing it down for someone not in medicine to understand was just as difficult.

“Legislators don’t know or understand much about medicine,” Dr. Pierce explained. “We all have to admit what we don’t know. Physicians know about medicine, so it only makes sense for physicians to be the ones to inform our policymakers about health care. Physicians are on the health care battle lines, out there taking care of their patients, helping them make those decisions that are truly life or death decisions for their families. Physicians have clout when we talk to our legislators. We can make them understand, in simple terms, the most complex issues in medicine. We do this every day when we discuss medical situations with our patients. If I have a patient with cancer, I can discuss that situation with my patient and explain the prognosis and treatment options. So, I should be able to discuss exactly why something in a proposed piece of legislation is either very good or very bad and how it will affect my patients and my practice. If we as physicians cannot talk to our legislators about medicine, where do you think they are going to get this information? From very biased people who could give them very bad advice,” Dr. Pierce said.

But, getting that seat at the negotiating table takes time, and this, according to Dr. Pierce and other physicians, is where associations like the Medical Association come in and take a leadership role to make the negotiation process easier.

male doctor smiling

“Doctors are busy, literally working 60-100 hours a week in some cases, easily working more than the average person. So, it’s hard for them to take time out of their family life or professional life to get involved in organized medicine. But that’s absolutely why they should get involved. The effects of the passage of bills and restrictions on them from legislative actions or insurance company actions can be completely disruptive,” Dr. Pierce said. “That may be one of the main focuses of what the Medical Association is about, and what we do a good job of.”

Dr. Amber Clark agreed that because the mechanics of practicing medicine is moving so quickly and the rules are changing so often today, physicians cannot afford not to have a voice in that change…whether that physician agrees with the philosophy of the organization doing the advocacy work or not, it remains of the utmost importance to be involved in order to ensure the best types of changes are made for the sake of the patient and the physician.

“It’s so important to not only learn the business of medicine but to also learn how the system works. Organized medicine organizations like the AMA and the Medical Association are all doing the same thing – advocating for you and your patients. You don’t realize how important it is until you’re stuck in the middle. It’s comfortable when you operate in a bubble. It’s safe there. We will always have patients to take care of, and the only constant thing in medicine today is change. We are all intelligent beings. We don’t all have to agree on the same things. But, we’re doing a disservice to ourselves, our patients, and our colleagues to simply sit on the sidelines and be passive observers. That doesn’t mean you have to go lobby in Washington or Montgomery every day. That’s not realistic,” Dr. Amber Clark said.

Filtering out the noise.

One of the primary concerns of organized medicine is keeping members informed. Organizations act as filters or gatekeepers to allow the most important information flow to the members while keeping the noise at bay. The Medical Association’s Government Relations and Public Affairs Department works to do just that.

Dothan family physician Carlos Clark suggested not only does membership with the Medical Association give physicians a voice in the ultimate conversation about the practice of medicine and your relationship with your patient, but having a strong Government Relations team is extremely important in guiding that conversation down the best path.

male doctor in scrubs

“Having a strong Government Affairs department like the Association’s to stay in touch with the rest of us and help us see things coming down the pike and see things that we just wouldn’t normally see is vitally important,” Dr. Carlos Clark said. “It puts you more in tune with what’s going on. Unless you have all the free time in the world, I can’t imagine all the medical news websites you would have to search through to try to catch everything coming down the pike. Being part of organized medicine allows us to get all that information filtered so we get the most important information sent to us to act on. It’s hard enough for us to keep up with what drugs insurance companies are covering much less what rules and regulations are coming our way and when.”

Organized medicine offers more than advocacy.

For Ben Bush, who’s a medical student at the University of South Alabama College of Medicine, being a member of organized medicine and serving in leadership positions with the Medical Association and the AMA, has afforded him more opportunities in medicine than his medical school education alone could provide.

“I enjoy the relationships I’ve made. I’ve met a lot of other students and doctors from all over and created good relationships I value very much. And, there’s also the education component. I learn so much through the Medical Association and the AMA about medicine, advocacy and the practice of medicine that I can’t learn in medical school. I wanted to get involved in organized medicine primarily because of the advocacy,” Bush said.

Bush said he often gets questions from his classmates about his involvement in organized medicine, mostly concerns about why he’s participating in organizations that are often seen as not necessarily aligned with the overall beliefs of the majority of physicians treating patients today. But, he feels organized medicine is historically misunderstood and often misrepresented. In fact, he strongly encourages his colleagues who oppose medical organizations to become more involved with them.

male doctor smiling

“When my classmates ask why I’m involved in organized medicine,” Bush explained, “I tell them it’s because if I’m not a member and don’t go to those meetings to voice my opinion, then what happens? I think I’m so involved because I can voice an opinion on those policies that could negatively affect us here in Alabama. If we aren’t collectively using our voice for medicine, then the opinion we disagree with will only be that much louder, and we’ve already seen that this year in the Alabama Legislature. It’s important we defend medicine as a whole, for those in private practice to those who are employed or in academia, for every specialty…if we’re not actively moving forward to defend the practice of medicine as a whole, then we all lose.”

Dr. Pierce agreed that when involvement in organized medicine filters down to a small group, then the opinions of a small percentage of physicians are the ones expressed causing a very narrow view of the House of Medicine. As Dr. Amber Clark put it, medical students don’t graduate into any specific field of medicine, such as plastic surgery, family medicine, or gastroenterology. Being part of organized medicine means being part of medicine as a whole.

“The only way the Medical Association will ever know what the majority of physicians in the State of Alabama will need to make their practice better is if the physicians of the State of Alabama tell us,” Dr. Pierce said. “If you are not involved, you can get a small group of physicians making decisions that a majority of doctors may not believe in. That’s not good medicine, and that’s why you should be involved in organized medicine.”

Jennifer Hayes, the Medical Association’s Director of Membership and Specialty Society Management, agreed with Dr. Pierce and equally expressed concern for the widening gap in the number of younger physicians entering practice as older physicians begin to make plans for retirement in the State of Alabama.

“The 62 percent active membership market share we have in Alabama is excellent compared to other state medical associations, the reality is our membership is aging out,” Hayes explained. “Currently, 63 percent of our membership is over the age of 50. We have to ask, how long will these physicians stay in practice?”

The Medical Association is creating avenues for residents and students to become more involved. In 2016, the House of Delegates and College of Counsellors passed a resolution to waive all dues for residents and students hoping to garner more interest in organized medicine. The Medical Association also hosts educational events and socials around the state during the year, as well as participating in medical school Match Days.

“Since the dues were waived in 2016, student membership increased 73 percent and residents 66 percent. That’s great, but we must demonstrate value and lead by example to retain these individuals who remain in Alabama. The first step for the Association has been to participate in and support their programs,” Hayes said. “Earlier this year, we created a poster symposium and Friday conference at Annual Session to allow time for networking, hear great presentations on topics related just to them, and more time with representatives from residency programs and Alabama physician recruiters. This event was so popular that we will do it again for the 2018 Annual Session with free registration and hotel scholarships. Even though the Association is making great strides to reach out to this segment of our physician base, it’s not enough. If we don’t all join together to reach out to our early career physicians, residents and students, the integrity of the Association could be in jeopardy. We have to ask ourselves one question: Are we all doing our part?”

Ultimately, it’s always about the patient.

In the end, physicians practice medicine because of their patients. Protecting the physician-patient relationship and advocating for better care for the patient is at the forefront of patient care. This puts the physician-patient relationship often at the center of most health care-related advocacy conversations in Montgomery and Washington, D.C. However, as more physicians are leaving the unified front organized medicine provides, physicians may be losing the strength to advocate for their patients and patients’ rights to the best of their abilities.

“We are losing doctor involvement,” Dr. Pierce said. “You have to have physicians involved in organized medicine or bad things could happen. These things don’t happen in a vacuum. When you’re not involved, and bad things happen, it makes it hard complain. Bad things happen because the other side is involved even more.”

As Dr. Pierce explained, a physician is the patient’s primary advocate. Even with the weight of the Medical Association behind that physician, it takes the collective of all physicians from all specialties to make a difference.

“The Medical Association does a great job of protecting our patients. But, physicians are patient advocates, too. It’s not all about me, as a person or as a physician. It’s about my patient. We have to get one thing clear – and that’s understanding the most important thing here is our patients. The focus of what you are doing as a physician is healing, and healing a patient who trusts you, who has come to you because they have a relationship with you. Ultimately, it’s always about the patient, and we cannot ever forget that.”

Article by Lori M. Quiller, APR
Director of Communications and Social Media

Posted in: Members

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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 necessary continual monitoring of legislative and regulatory bodies 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 into 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)

Posted in: Advocacy

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House of Delegates Pass Policy Opposing Further Imposition of MOC

House of Delegates Pass Policy Opposing Further Imposition of MOC

During Annual Session, the Medical Association’s House of Delegates passed a resolution formally opposing additional Maintenance of Certification requirements as dictated by the American Board of Medical Specialties and the American Osteopathic Association. While it was agreed that the need for continuing medical education to improve the quality of care, the expense and clinically irrelevant process of MOC often proved overly burdensome.

MOC is designed to show that once a physician’s formal training is over, they are continuing to practice lifelong learning by continuing to challenge themselves to keep up with the latest developments in their chosen field. However, while physicians do support efforts to improve the quality of care of their patients, physicians have argued for years that MOC is overly expensive and often clinically irrelevant to everyday practice.

For example, the American Board of Internal Medicine has long required internists to pass Maintenance of Certification exams every 10 years to keep their board-certified status. However, this policy has recently come under scrutiny due to its high burden to doctors and the lack of sound evidence that recertification processes improve doctors’ quality of care. The ABIM announced it would offer a new assessment option starting in January 2018, allowing doctors to be recertified through shorter, but more frequent, assessments. But it’s not clear that this will make much difference.

To alleviate some burden on our physicians, the Medical Association’s Counsel on Medical Services studied the need for MOC and presented a formal resolution to the House of Delegates during Annual Session in April. The resolution, which passed, created a formal policy to oppose adding any further requirements for MOC as a condition of licensure, reimbursement, employment or admitting privileges at a hospital.

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Florida’s Physician “Gun Gag” Overturned on Appeal 

Florida’s Physician “Gun Gag” Overturned on Appeal 

The full panel of the U.S. Court of Appeals for the 11th Circuit struck down the Florida law restricting physicians from speaking to patients and families about the risks of guns in the home. The case, Wollschlaeger v. Scott, was filed on June 6, 2011, challenged the Florida law, which could censor, fine and revoke the licenses of physicians if the Florida Board of Medicine determined whether the physician violated the law.

The American Medical Association along with several other major medical societies opposed the gun-gag law arguing it infringed on the First Amendment right of physicians to discuss gun safety, especially when patients have children who may happen across a loaded, unsecured firearm in the home. The law banned asking gun ownership questions except when deemed clinically necessary and forbade physicians from recording whether a patient owned a weapon in the medical chart claiming that the question was discriminating and harassing of gun owners.

“There was no evidence whatsoever before the Florida legislature that any doctors or medical professionals have taken away patients’ firearms or otherwise infringed on patients’ Second Amendment rights,” the court said, noting that lawmakers based their measure on six anecdotes about medical gun questions in a state with more than 18 million residents. “There is no actual conflict between the First Amendment rights of doctors and medical professionals and the Second Amendment rights of patients that justifies FOPA’s…restrictions on speech.”

Read the U.S. Court of Appeals for the 11th Circuit’s full decision here.

The continuation of the law would have prohibited a simple conversation in the physician’s office that can save lives. Research has shown that when physicians offer guidance on gun locks and safe storage, appropriate to a child’s specific age and development, it is more likely that families will take those necessary steps.

“Pediatricians routinely counsel families about safety issues, including firearm safety, as part of anticipatory guidance, in order to reduce risk of injury to children,” said Cathy Wood, M.D., FAAP, president of the Alabama Chapter of the American Academy of Pediatrics. “Florida’s ‘gun’ law was an assault on physicians’ right to counsel their patients. We are thankful for this court decision and the hard work of the pediatricians and other physicians in Florida that worked to protect this right, not just in Florida but hopefully for all states.”

Posted in: Advocacy

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Injured? Dial 1-800-4-MED-MAL

Injured? Dial 1-800-4-MED-MAL

Legislation Threatens Decades of Medical Tort Reforms

If 1-800-4-MED-MAL sounds like a personal injury firm advertisement, think again. But if proponents of a radical new alternative medical liability system get their way, 1-800-4-MED-MAL could be an avenue for turning every persistent migraine, bout of acute pain and post-operative bruise into cash payments.

This radicalized approach – called the Patients’ Compensation System (PCS) – would abolish a physicians’ right to trial by jury and undo decades of tort reforms championed by the Medical Association, laws that foster a stable liability environment in Alabama and laws which must be defended from personal injury lawyer attacks each year. Proponents of the PCS want Alabama physicians to trade existing, proven protections from trial lawyer shenanigans for the false hope of an untested, unrealistic and radical approach to medical liability.

Let’s examine arguments by proponents of PCS legislation one by one.

Proponents Say PCS Will Be Good for Physicians

While supporters claim the PCS would free physicians from burdens of the civil justice system, the opposite is true. The Medical Association won numerous hard-fought battles with personal injury lawyers since the 1980s in order to bring stability to Alabama’s medical liability environment. Maintaining that stability can only be achieved through a vigilant defense at the Legislature.

If it became law, the PCS would levy an annual tax on physicians to fund a new state government agency to handle all claims of physical injury or death allegedly at the hands of M.D.s and D.O.s. The PCS would be mandatory, with no option for a jury trial. The PCS would have authority to investigate, determine fault and award damages. Instead of a plaintiff hiring an attorney to file suit, each claim under the PCS would be initiated by dialing a 24-hour hotline.

The PCS would not govern allegations filed against a hospital though, meaning a physician could still be party to a suit involving an institution even with the PCS in place. Unlike a professional liability policy, the costs for defense counsel would not be included in the annual payment to the PCS. The committees reviewing PCS claims would be largely political appointees, meaning a physician’s fate could hinge on who’s in office at the time a claim is made. If the PCS found wrongdoing by a physician and compensated a claimant, it would be reported to the National Practitioner Databank. With the bar for entry lowered to the level of a phone call, a “woodwork effect” as word spreads about the PCS is an almost certainty. With the subsequent spike in payouts, Alabama physicians could see reports for minor injuries to the National Practitioner Databank increase as exponentially as their taxes to fund the PCS.

Proponents Claim PCS Will Be Good for Patients

Those pushing the PCS say the current system doesn’t adequately compensate injured patients, and those compensated wait too long for justice. Few physicians who’ve been sued would argue the civil justice process is a short one, but that is indicative of long dockets that are the product of an overly-litigious culture.

The practice of medicine is just that; a practice, with few certainties. Most patient injuries are no one’s specific fault. In a minority of situations, the opposite is true and those injured should be able to seek recourse. But under the bureaucrat-run PCS, the number of claims paid for even minor injuries could increase sharply, quickly depleting the balance of available funds through thousands of small payouts, funds that should be reserved for the aforementioned minority of situations of serious physical injuries or death.

Once the funds from the PCS physician tax dries up each year, no further claims can be paid, even those already filed but not completed. Given that, instances of serious physical injury would fare better in the court system. The PCS proponents also promise a dramatic reduction in the length of time between injury and award. That’s difficult to believe as few if any government programs have actually improved efficiency for those utilizing them.

Proponents Say PCS Will Reduce “Defensive Medicine”

Promised as a way to reduce unnecessary care and thereby shrink Medicaid expenses by giving physicians liability comfort, PCS supporters cling to the flawed premise physicians base their medical decisions on criteria other than established standards and what’s best for the patient. Statements to the contrary are not only insulting to most physicians, they’re false, as anyone intentionally billing unnecessary services would be committing fraud. Whether under the civil justice system or the PCS, standards of care will still exist. And, because all awards for injury are reported to the National Practitioner Databank, the reporting of thousands of minor injury awards under the PCS might actually encourage additional testing and procedures, creating the opposite atmosphere PCS proponents claim their system will eliminate.

Proponents Say PCS Will Cut Health Care Costs, Especially in Medicaid

Also proposed as a cost savings for Alabama Medicaid via anticipated reduction of alleged unnecessary care, PCS supporters claim Alabama physicians order more than $1 billion worth of “defensive medicine” for fear of being sued. They claim the PCS, if implemented, could substantially slash the cost to Medicaid alone by hundreds of millions of dollars. As explained above, the myth of “defensive medicine” doesn’t hold up. How could a radical new system that pays out substantially more claims for injuries contain even its own expenditures, much less curb the growth in health care costs? The PCS will create a “woodwork effect” expected to increase the cost each year, leaving physicians burdened with higher taxes to fund the unrestrained and irresponsible growth.Conclusion

Conclusion

The PCS is an expansion of big government-funded on physicians’ backs that will undo decades of significant tort reforms. With uncertainty already surrounding the future of the state’s Medicaid program, destroying Alabama’s medical liability environment could push physicians into early retirement or send them to states with more stable liability atmospheres. The PCS legislation and its empty promises should be cast aside in favor of meaningful civil justice reforms that solve problems instead of creating them. The PCS is indeed an answer in search of a question, and one that’s bad for patients, bad for physicians and wrong for Alabama.

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Between Doctors & Patients…Technology in the Treatment Room

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Editor’s Note: This article was originally published in the Spring 2016 issue of Alabama Medicine magazine

Love them or hate them, electronic records are here to stay.

Electronic health records, or EHRs, are an evolution of the electronic medical records, or EMRs, that some medical practices use internally. EMRs are a digital version of the paper charts containing the medical and treatment history of the patients in one medical practice. EMRs have advantages over paper records in that they allow physicians to track patient data over time, identify which patients are due for preventive screenings and check ups, and monitor overall quality of care within the practice.

EMRs, however, are not built to travel easily outside the medical practice should the physician need to send the patient to another physician. This is where EHRs are intended to pick up and be more effective. EHRs are built to share patient information between medical practices, laboratories, hospitals and other health facilities. Should your patient be seen in the emergency room, EHRs are supposed to allow you to view those charts and results, including all the physician’s notes, labs and any films.

That’s how the system is supposed to operate. While the EHR systems work well for some, mostly larger practices and specialty physicians, they cause more problems than they solve for others, particularly smaller practices and family care physicians.

The surgeons with Alabama Orthopaedic Specialists, PA, in Montgomery, began looking for a solution to their charting issues in 2006, long before federal regulations started to trickle down concerning electronic records. Finding the best solution for the practice didn’t happen
overnight. It was a process, according to practice manager Ron O’Neal.“It took a little while for us to discover exactly what this would mean to the practice…the good and the bad…and it needed to be something everyone was on board with,” O’Neal explained. “It took time for us to come up with a checklist of everything we wanted and needed our EHR to do. It was important we found a system that would work for our practice instead of our practice working for that system, so we took our time.”

“It took a little while for us to discover exactly what this would mean to the practice…the good and the bad…and it needed to be something everyone was on board with,” O’Neal explained. “It took time for us to come up with a checklist of everything we wanted and needed our EHR to do. It was important we found a system that would work for our practice instead of our practice working for that system, so we took our time.”

Michael Davis, M.D., a surgeon with Alabama Orthopaedic Specialists, helped lead the search to find the perfect EHR for the group and agreed with O’Neal that while the search for the best system may have seemed long, it was for a good reason.“Historically we had paper charts. So, when a patient would be seen by one of our physicians yesterday and referred to me today didn’t really have any idea why they were seeing me and would expect me to know why they were here. It would take time for me to collect the paper chart, if everything was there, and sometimes re-interview the patient. That took a lot of time. If you don’t have to filter through all those notes to get to the bottom of the problem when someone else already has, you save a lot of time. You’re not duplicating tests and x-rays, and patients aren’t exposed to more tests or irradiated more than once just because you can’t get your hands on those results,” Dr. Davis said.

“Historically we had paper charts. So, when a patient would be seen by one of our physicians yesterday and referred to me today didn’t really have any idea why they were seeing me and would expect me to know why they were here. It would take time for me to collect the paper chart, if everything was there, and sometimes re-interview the patient. That took a lot of time. If you don’t have to filter through all those notes to get to the bottom of the problem when someone else already has, you save a lot of time. You’re not duplicating tests and x-rays, and patients aren’t exposed to more tests or irradiated more than once just because you can’t get your hands on those results,” Dr. Davis said.For Dr. Davis, having the EHR in hand can make explaining a complicated procedure a bit smoother when the tool can be used to illustrate the nuances of a surgical procedure by showing the patient his or her x-rays, MRIs, and other test results. But, the EHR is just that…a tool, which Dr. Davis is quite mindful of making sure doesn’t become an intrusive object in the treatment room.

For Dr. Davis, having the EHR in hand can make explaining a complicated procedure a bit smoother when the tool can be used to illustrate the nuances of a surgical procedure by showing the patient his or her x-rays, MRIs, and other test results. But, the EHR is just that…a tool, which Dr. Davis is quite mindful of making sure doesn’t become an intrusive object in the treatment room.

Yet, Dr. Davis and O’Neal agreed EHRs work better for specialties than with family practices when considering the diagnostic possibilities family physicians face with their patients. What’s streamlined in a specialty is often wide ranging in family practice.

Maarten Wybenga, M.D., a family physician in Prattville, hasn’t made the switch from paper charts to EHRs and doesn’t have any plans to in the immediate future. For Dr. Wybenga, e-prescribing and electronic billing are sufficient to keep the federal mandates at bay.

“I’m always going to be ‘pro-the-patient.’ I never jump on the bandwagon when something new comes out. I want to read the research, see how it works first before I start using it with my patients. It’s the same with technology in the medical office,” Dr. Wybenga said. “I’ve wanted to stand back and watch it a little rather than jump right in. When things started getting interesting with electronic records, we talked about it. Should we do this, or should we wait and see what’s going to happen? Should we give it a year or two? As we watched the technology arena grow and grow, the software companies exploded. There were just too many offering too much. We keep watching, but I’m just not satisfied, and I haven’t made that decision. To this day, we’re still on handwritten medical records.”

According to Amy Wybenga, Dr. Wybenga’s practice manager and immediate past president of the Alliance to the Medical Association of the State of Alabama, the number of reasons against using EHRs in the practice simply outweighed the positive outcomes.“No one could give us a good, sound reason of what benefit it would be to us or our patients if we changed over. For our practice, the negative reasons definitely outweigh the positive reasons,” Wybenga said. “We would have to cut down on the number of patients we could serve for at least a year because it could take up to that long for us to switch everything over, and it would slow us down too much. Being a family practice in a rural area, there’s just no way we can cut back on the number of patients we see. Those patients have to be seen. Why would we go to a system that would slow us down even more, something that we can’t share with anybody, would still have to print off information to fax or email to other doctors because it won’t communicate with other systems…where’s the benefit?”

“No one could give us a good, sound reason of what benefit it would be to us or our patients if we changed over. For our practice, the negative reasons definitely outweigh the positive reasons,” Wybenga said. “We would have to cut down on the number of patients we could serve for at least a year because it could take up to that long for us to switch everything over, and it would slow us down too much. Being a family practice in a rural area, there’s just no way we can cut back on the number of patients we see. Those patients have to be seen. Why would we go to a system that would slow us down even more, something that we can’t share with anybody, would still have to print off information to fax or email to other doctors because it won’t communicate with other systems…where’s the benefit?”

For one gastroenterologist who just started a new practice in January using paper charts, Bradley Rice, M.D., of Huntsville, who is also a member of the Association’s Board of Censors, is working to make the transition to EHRs a seamless one for his staff and patients. “I actually try to use the computer a small amount of time while in the room with a patient. I talk with the patient and take notes on a sheet I have designed,” Dr. Rice noted. “I prefer to speak with the patient instead of talking to them while looking at a computer, so I wait until the end of the appointment to then work on the computer, then escort them up to the check-out area. My goal is to make sure the patient feels comfortable and understands that I am there to meet with them instead of focusing on the computer in the room.”

“I actually try to use the computer a small amount of time while in the room with a patient. I talk with the patient and take notes on a sheet I have designed,” Dr. Rice noted. “I prefer to speak with the patient instead of talking to them while looking at a computer, so I wait until the end of the appointment to then work on the computer, then escort them up to the check-out area. My goal is to make sure the patient feels comfortable and understands that I am there to meet with them instead of focusing on the computer in the room.”

Dr. Rice and his staff have seen both sides of the EHR coin and agree with Dr. Davis and O’Neal that the initial setup of a system can be difficult and costly. It takes time to scan and input data into a new system, but once the system is online, it can help with documentation and accountability.

Interoperability was one of the initial selling points for EHRs from the Office of the National Coordinator for Health Information Technology. Fully functioning EHRs are designed to “talk” to other systems. However, many physicians are finding this may not be the case, and after years of voicing complaints through their medical societies and associations, their concerns seem to be getting through.

Department of Health and Human Services Secretary Sylvia Burwell recently announced the nation’s top five health care systems and companies, which provide EHRs covering more than 90 percent of hospital patients, have agreed to principles designed to improve patient access to health data and eliminate the practice of data blocking. These groups have also agreed to adopt federally recognized, national interoperability standards by 2018.

To unlock the data and make it useful to physicians, the companies have agreed to:

  • Implement application programming interface (API) technology so smartphone and tablet apps can be created, facilitating patient use and transfer of health care data.
  • Work so physicians can share health data with patients and other physicians whenever permitted by law, while not blocking such sharing either intentionally or unintentionally.
  • Use the federally recognized Fast Healthcare Interoperability Resources data standard.

In late 2015, the Medical Association led a coalition of nearly 40 Alabama specialty and county medical societies in asking to the Alabama Congressional Delegation to support the Patient Access and Medicare Protection Act, which granted the Centers for Medicare & Medicaid Services the authority to expedite applications for hardship exemptions from Meaningful Use Stage 2 requirements for the 2015 calendar year. President Obama signed the bill. Because CMS didn’t publish the MU Stage 2 final rule until Oct. 16, physicians weren’t informed of the requirement until fewer than the 90 required days remained in the calendar year, leaving most in a penalty-assured lurch. CMS extended the deadline for physicians to apply for MU hardship exemptions to EHR incentive program. The new deadline is now July 1, 2016. The extension is being granted “so providers have sufficient time to submit their applications to avoid adjustments to their Medicare payments in 2017.” The new application forms and instructions to file a hardship exemption are on the CMS website.

Because CMS didn’t publish the MU Stage 2 final rule until Oct. 16, physicians weren’t informed of the requirement until fewer than the 90 required days remained in the calendar year, leaving most in a penalty-assured lurch. CMS extended the deadline for physicians to apply for MU hardship exemptions to EHR incentive program. The new deadline is now July 1, 2016. The extension is being granted “so providers have sufficient time to submit their applications to avoid adjustments to their Medicare payments in 2017.” The new application forms and instructions to file a hardship exemption are on the CMS website.

For physicians contemplating switching from paper charts to EHRs, Dr. Rice and his office staff offer these tips:

  1. Always remember, “Treat the patient, not the computer”
  2. Think about the big picture in terms of technology and how the flow and setup will affect the office. For example, how many screens, what type of computers, scanners, etc., should I choose? Who will be using these computers? Laptops vs. desktop computers in treatment rooms? A personal analysis needs to be conducted of what type of layout/format fits your practice.
  3. Choose a good program that has excellent technology support. Make sure to choose the correct computers and equipment necessary for the EHR program that is chosen for your practice.

Article by Lori M. Quiller, APR, director of communications and social media

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Official Statement on Legalization of Non-FDA Approved Marijuana Substances

Official Statement on Legalization of Non-FDA Approved Marijuana Substances

March 18, 2016 – “The use of marijuana for the treatment of various symptoms of diseases is an evolving discussion in this state and nation. Two years ago, the Alabama Legislature wisely decided and the Medical Association supported putting the discussion surrounding the efficacy of cannabidiol (CBD) in the treatment of neurologic conditions in children to the test by establishing and funding a strictly controlled drug trial. The preliminary results of that study indicate promise for more widespread use of CBD in patients. The exact CBD drug itself and dosages administered to patients in this drug trial were strictly regulated to ensure the safety of those involved. As physicians, our Hippocratic Oath demands we ‘first, do no harm.’ As well, the practice of medicine is evidence-based whereby the treatments and procedures we use are extensively researched and tested to make certain they are as safe as possible for the patients under our care. Given these bedrocks of the medical profession, the Medical Association cannot support the expansion or legalization, whether by legislation or ballot initiative, of marijuana or marijuana products in any form that have not received the same FDA approval as other medicinal compounds. Taking any position otherwise would not be based on scientific evidence and could unnecessarily place patients at risk.”

– Buddy Smith, M.D., president, Medical Association of the State of Alabama

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Physician Groups Issue Joint Statement on Medicaid Funding Cuts

Physician Groups Issue Joint Statement on Medicaid Funding Cuts

April 8, 2016 | MONTGOMERY – Without Fully Funding Medicaid, Patient Care at Risk

With the passing of the General Fund budget, lawmakers appropriated $700 million for Medicaid next year, $85 million short of what is needed to fully fund Medicaid. Now the Medicaid Agency is left with the tough decisions of which programs to cut, and how deep to reach into the pockets of Alabama’s citizens who can already barely afford their medications and health treatments. Services at risk of being cut are prescription drug coverage for adults, eyeglasses for adults, outpatient dialysis, prosthetics and orthotics, hearing programs, Program of All Inclusive Care for the Elderly (PACE), among other programs and services that patients across Alabama need to survive.

Medicaid is a critical component of our health care system, covering the young and elderly. More than half the births in Alabama and 47 percent of our children are covered by Medicaid, as well as 60 percent of Alabama’s nursing home residents. Without full funding, the Medicaid program will collapse, leaving these individuals without coverage. While uncompensated care is delivered every day in all 67 counties of this state, without Medicaid, charity care needs could skyrocket, crippling the health care delivery system and potentially placing the burden on those with private health insurance through higher premiums and co-pays.

Alabama Medicaid is the backbone of our state, supporting the health and welfare of the young and elderly citizens that physicians have pledged to protect during their medical careers. Consequently, we cannot support any solution other than fully funding a program that touches so many lives. Allowing Alabama Medicaid to continue with adequate funding is a smart investment in Alabama and her citizens. The current appropriated budget will have dire consequences.

Physician practices, hospitals and nursing homes are among the economic engines driving many Alabama communities. Closure of these health care providers will have a devastating impact on the state of Alabama and the health and prosperity of its citizens. The ripple effect will be felt from Mobile to Huntsville.

Therefore we call on the legislature and the Governor to work toward a permanent revenue solution to fully fund Medicaid.

Our organizations strongly believe that Medicaid matters … to all Alabamians.

For more information or comment, please contact:

Mark Jackson, Medical Association of the State of Alabama, (334) 954-2500
Linda Lee, Alabama Chapter, American Academy of Pediatrics, (334) 954-2543
Jeff Arrington, Alabama Academy of Family Physicians, (334) 954-2570

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