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Mobile Physician Becomes New President of Medical Association of the State of Alabama

Mobile Physician Becomes New President of Medical Association of the State of Alabama

Dr. George Koulianos sworn in during Association’s annual meeting

George Koulianos, M.D., F.A.C.O.G., of Mobile was sworn in as the new President of the Medical Association of the State of Alabama during the Association’s annual meeting on Saturday, April 29th in Huntsville.

Dr. Koulianos is the founder and medical director of The Center for Reproductive Medicine in Mobile. He is board certified in Obstetrics and Gynecology. Prior to founding The Center in 1993, he served as assistant professor of Obstetrics and Gynecology at the University of South Alabama.

“It is a privilege to serve the Medical Association as President during this pivotal time for healthcare in Alabama. Our goals are to address the physician shortage, expand access to quality care for all Alabamians, prioritize patient safety by supporting physician-led team-based care, and to support physicians and the patients they serve during some of the most significant moments of their lives,” said Dr. Koulianos.

Mark Jackson, Executive Director of the Medical Association, said Dr. Koulianos has “not only impressive medical experience but also a true passion for helping people. It’s why he became a doctor in the first place.”

Dr. Koulianos served the past year as President-elect of the Medical Association under President Julia Boothe, M.D., of Reform, whose term has expired.

Dr. Koulianos completed a fellowship in Reproductive Endocrinology and Infertility at Tulane Medical School and the University of South Alabama. He did his residency in Obstetrics and Gynecology at Texas Tech Regional Academic Center in Amarillo. He graduated from the University of Texas Medical School at Houston. His professional accomplishments include winning the ACOG/CIBA (American College of Obstetricians and Gynecologists) Fellowship for Endocrinology of the Postreproductive Woman, authoring several book chapters and articles with original research for peer review and presenting original research at numerous national and international meetings.

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OIG Unveils Telehealth Toolkit to Analyze Program Integrity Risks

OIG Unveils Telehealth Toolkit to Analyze Program Integrity Risks

By: Jim Hoover, Burr & Forman, LLP

Over the course of the last year, audits of telehealth services and the associated claims data has continued to increase.  As a result, it may be useful for physician practices to conduct a compliance review of the telehealth claims they submitted since the beginning of the COVID-19 pandemic.  Of course with any compliance audit, healthcare providers should think carefully about the manner and procedures used in an audit.

A useful source of information related to telehealth claims is the OIG’s telehealth toolkit.  On April 20, 2023, the Office of Inspector General (OIG) unveiled a new telehealth toolkit designed to help identify program integrity risks associated with telehealth services.  A copy of the toolkit is located here. The toolkit provides detailed information on methods to analyze telehealth claims to identify program integrity risks. While the OIG created the toolkit to assist public and private sector partners such as Medicare Advantage plan sponsors, private health plans, State Medicaid Fraud Control Units, and other Federal health care agencies with analyzing their telehealth claims data, it can also be used by physician practices to review their telehealth claims.

The OIG created the toolkit because the COVID-19 pandemic changed how patients visit and interact with their health care providers. The use of telehealth services grew dramatically during the first year of the pandemic and is now an important part of the health care system. For example, Medicare beneficiaries used 88 times more telehealth services during the first year of the pandemic than in the year prior, with more than 2 in 5 Medicare beneficiaries using telehealth services in that year. Medicaid and private health plans also experienced exponential growth in the use of telehealth. With the dramatic increase of telehealth visits, came concerns about fraud, waste and abuse associated with the use of telehealth.  

The toolkit includes detailed descriptions of seven data analysis measures providers can apply to their own data.  The toolkit also includes steps for analyzing telehealth claims such as (1) reviewing program policies, (2) collecting claims data, (3) conducting quality assurance checks, (4) analyzing data to identify program integrity risks, and (5) interpreting the results of the analysis. When beginning the analysis process, it is important to be familiar with payment and coverage policies of the particular program being reviewed, such as traditional Medicare or a commercial payor.  The toolkit is based on Medicare fee-for-service payment and coverage policies for telehealth services during the first year of the COVID-19 pandemic (March 2020 through February 2021).  Be aware that Medicare telehealth policies changed over time and different programs may have different policies.  As a result, the analysis of the telehealth claims will vary according to the coverage and billing policies of a particular program and for the particular time period.  During the COVID-19 pandemic, Medicare claims for telehealth services used a modifier of 95, GQ, or G0 or a place of service code of 02 to indicate that the service was delivered via telehealth.  The Centers for Medicare & Medicaid Service’s website also maintains a complete list of services that may be provided using telehealth under Medicare.

The measures in the toolkit are intended to be a starting point for the analysis of telehealth claims and are based on patterns in the Medicare claims data during the first year of the COVID-19 pandemic. Billing patterns in other data may be different from those in Medicare data, so it may be necessary to adjust the analysis accordingly. For example, the OIG considered providers who billed telehealth services for 2,000 or more Medicare beneficiaries during a year to be high risk. This number is far higher than the median of 21 Medicare beneficiaries. 

The toolkit contains seven measures the OIG developed to focus on different types of billing for telehealth services.  Some the measures include billing telehealth services at the highest most expensive level for a high proportion of the services billed, billing a high average number of hours of telehealth services per visit and billing telehealth services for a high number of days in a year or a high number of patients.  

Although the OIG designed the toolkit to analyze program integrity risks, it is a useful resource for physician practices to help them understand the particular areas of concern of the OIG.  It provides easy to understand analysis of claims and thresholds the OIG considers to indicate a high risk of fraud, waste or abuse.   

Jim Hoover is a Partner at Burr & Forman LLP practicing exclusively in the firm’s healthcare group. Jim may be reached at (205) 458-5111 or jhoover@burr.com.

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Physician Workforce Act Addresses Alabama’s Doctor Shortage So Patients Get the Care They Need

By Julia M. Boothe, M.D.

If it seems you are having to to wait longer to get a doctor appointment than you used to, it’s not your imagination. Alabama is experiencing a physician shortage, and the results can be far worse than a mere inconvenience for your schedule.

The physician shortage means patients are experiencing delays in access to medical care for a range of prevention, wellness and treatment options. When patients have difficulty accessing care, their health problems worsen. Most eventually end up in already crowded hospital emergency departments. This puts extra strain on overworked hospital staff and ends up increasing health care costs for everyone.

Fortunately, there is legislation before the Alabama Legislature that would help address the physician shortage of today and build the physician workforce we need for tomorrow.

This legislation is the Physician Workforce Act – House Bill 243 sponsored by Rep. Paul Lee and Senate Bill 155 sponsored by Sen. April Weaver. Patients and physicians across the state can be grateful these two leaders are proactively dealing with this looming health care crisis.

The Physician Workforce Act focuses on three key areas: cutting red tape to boost physician recruitment, better utilizing our existing physician workforce, and establishing an apprenticeship-like program for future physicians.

Alabama does a great job recruiting industries to our state with incentives. But when it comes to recruiting doctors, we throw up unnecessary barriers and red tape. Physicians licensed to practice medicine in other states can’t relocate to Alabama and practice medicine unless they take an additional test. And we make this test even more burdensome by requiring that it be taken in-person. So, a fully licensed physician from Georgia, Florida or any other state who is thinking of moving to Alabama must physically show up to take this test.

This requirement is unnecessary, outdated and a barrier to better health care. The Physician Workforce Act repeals this red tape. Doing so won’t lessen standards because all other medical licensure requirements will stay the same. But removing this bureaucratic barrier will make Alabama more competitive when it comes to recruiting physicians.

As Sen. Weaver has said, if we want more doctors in Alabama, we need to make Alabama more welcoming to doctors. With this important change, the Physician Workforce Act does that.

In addition to recruiting physicians, we need to do a better job utilizing the physician workforce we already have. International Medical Graduates (IMGs) currently make up 20 percent of Alabama’s physician workforce. They are required to complete three years of training in a residency program to become eligible for an initial medical license. By contrast, U.S. and Canadian medical graduates must complete only one year of residency to become licensed.

IMGs are subject to the same rigorous credentialing standards as any other U.S. physician and are held to the same demanding educational standards as students attending medical schools in the U.S. and Canada. Alabama’s licensing requirements need to reflect that.

Therefore, the Physician Workforce Act would allow IMGs to apply for an initial medical license after two years of residency. This would enable IMGs to begin working more quickly in Alabama and allow our busy clinics and hospitals to utilize these highly trained medical professionals for hard-to-staff overnight shifts in emergency departments.

If a medical graduate is looking to apply for a residency, they will go to states where they can work as soon as possible. And if these physicians are allowed to work sooner in Alabama, the higher the chances they will stay in Alabama when their residency training is over.

Twenty other states already follow this accelerated route toward a medical license for IMGs. Alabama should join them.

Lastly, the Physician Workforce Act would create an apprenticeship-like program to help bolster the physician workforce of tomorrow. If this were to become law, Alabama would join nearly 10 other states that allow medical graduates who do not match into residency programs to increase their knowledge and skills under the supervision of licensed physicians as they prepare to reapply for residency.

With physicians serving as their mentors, these medical graduates would receive additional training that will benefit them tremendously in the future and help to ease pressure on our health care system today.

Legislators should make passage of the Physician Workforce Act a priority. It would significantly expand the pool of trained physicians practicing in our state, it would increase the number of patients getting the medical care they need and it would improve health outcomes for Alabama’s sick and injured. For these reasons, it has earned the support of the Medical Association of the State of Alabama, the University of Alabama at Birmingham (UAB), the University of South Alabama, Federally Qualified Health Centers, and numerous medical specialty groups.

The sooner the Physician Workforce Act becomes law, the sooner we’ll put Alabama on the path toward a healthier future.

Dr. Boothe is a primary care physician caring for patients in Reform, Alabama. She serves as Immediate Past President of the Medical Association of the State of Alabama.

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WHAT DID THE FIRST QUARTER OF 2023 TEACH US?

WHAT DID THE FIRST QUARTER OF 2023 TEACH US?

by Lindsey Phillips, Burr & Forman, LLP

The first quarter of a new year often brings new laws, rules, regulations, and updates that have significant impact on the remainder of the year, and the first quarter of 2023 was no different. This article will briefly outline three of the most impactful healthcare law updates from the first quarter of 2023. 

The End of the Public Health Emergency

On January 30, 2023, the Biden Administration announced that it will end the public health emergency declaration on May 11, 2023. The end of the public health emergency declaration (PHE) comes three years after the effects of COVID-19 were first deemed a public health emergency across the country back in January 2020. The declaration allowed the federal government to implement several waivers that modified the requirements of various health-related laws and programs like Medicare and Medicaid. While some of the flexibilities implemented during the PHE have already been made permanent or otherwise extended, many of the waivers permitted during the PHE will expire at the end of the day on May 11, 2023. According to the Department of Health and Human Services (HHS), one key flexibility that will not be substantially impacted once the PHE ends is the ability to deliver telehealth services under Medicare and Medicaid, especially in rural areas. While COVID-19 brought significant negative consequences across the country and the world, the pandemic did prove that there are positive aspects to providing healthcare via telehealth and telemedicine. This realization led to the passing of the bipartisan Consolidated Appropriations Act, which will allow many of the telehealth waivers to remain in effect until at least December 2024.

The Centers for Medicare & Medicaid Services (CMS) has created a roadmap that is designed to assist and help prepare healthcare providers as they return to operations outside of the PHE. Healthcare providers should assess which waivers they have used during the PHE, identify whether those waivers will end on May 11, 2023, and implement the proper processes to ensure they are in compliance once those waivers are no longer in effect.

The Joint Commission Has Revised Practitioner Evaluation Time Periods

The Joint Commission (JC), which accredits and certifies more than 22,000 healthcare organizations across the country, has revised its requirements related to how often licensed practitioners must be re-evaluated. Effective immediately, Joint Commission-accredited ambulatory care organizations, behavioral healthcare and human services organizations, critical access hospitals, hospitals, nursing care centers, and office-based surgery practices must reevaluate its licensed practitioners at least every three years. The previous rule required that these entities reevaluate its practitioners at least every two years. The JC announced that this change was implemented to better align with current standard practices. Notwithstanding, the change is subject to state requirements. Fortunately, there are no laws in Alabama that prohibit the aforementioned healthcare providers from implementing the change.       

The National Labor Relations Board Has Limited the Scope of Confidentiality and Non-Disparagement Provisions

The National Labor Relations Board (NLRB) recently reversed two decisions entered during the Trump Administration that allowed broad non-disparagement and confidentiality provisions in severance agreements. When McLaren Macomb, a hospital in Michigan, laid off several employees and presented them with severance agreements, the agreements included very broad confidentiality and non-disparagement clauses. The NLRB held that such provisions violated the National Labor Relations Act (“the Act”). Additionally, the NLRB held that, where a severance agreement unlawfully conditions receipt of severance benefits on the forfeiture of rights protected by the Act, the mere proffer of the agreement is precluded. While severance agreements are still permitted, employers should ensure that such agreements do not contain overly broad confidentiality and non-disparagement clauses. General counsel for the NLRB has stated that an example of a confidentiality provision that is permissible would be a clause that was narrowly tailored to restrict the dissemination of proprietary or trade secret information for a period of time based on legitimate business justifications. Importantly, the prohibition primarily applies to non-supervisory employees, which are those individuals who do not have the authority to hire, discharge, direct, or take certain other actions with respect to other employees through the use of independent judgment. Notwithstanding, employers should keep in mind these new restrictions even when entering into severance agreements with supervisors and managerial employees. While it is possible that this decision could be appealed, the Board’s ban is effective immediately.

Lindsey Phillips is an associate at Burr & Forman LLP practicing exclusively in the firm’s Healthcare Industry Group. Lindsey may be reached at (205) 458-5370 or lphillips@burr.com. 

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New DEA Requirements for Prescribers of Controlled Substances

New DEA Requirements for Prescribers of Controlled Substances

The DEA has announced a new one-time, eight-hour training requirement for all DEA-registered practitioners on the treatment and management of patients with opioid/substance use disorder. This new requirement will go into effect with all DEA registrations or renewals occurring on or after June 27, 2023.

Beginning on June 27, 2023, physicians will be required to attest on their registration/renewal form that they have completed the required training.

Exceptions to the DEA requirement include:

1. Physicians who are board certified in addiction medicine or addiction psychiatry.

2. Physicians who graduated from a medical (allopathic or osteopathic) school in the U.S. within 5 years

    of June 27, 2023, and completed a curriculum of at least 8 hours on treating and managing patients

    with opioid/substance use disorder.

Physicians, who are not exempt, can satisfy this requirement in one of the following ways:

1. Obtain a cumulative total of 8 hours of training. This does not have to occur in one session and can

     be done across multiple sessions/courses that equal 8 hours.

2. Past training on the treatment and management of patients with opioid or other substance use

    disorders totaling 8 hours will count towards this requirement.

3. Previous DATA-Waived training will count towards this requirement

The following is a link to the DEA announcement: https://deadiversion.usdoj.gov/pubs/docs/MATE_Training_Letter_Final.pdf

The Medical Association Offers Opportunities to Meet the New Requirements

The Medical Association offers educational opportunities to meet the new DEA requirement thru two upcoming in-person prescribing conferences, and multiple online prescribing courses that total 8 hours of required training.

In-Person Conferences – The Association will offer two prescribing conferences later this year (August and November) that will meet the new DEA requirement. Information regarding these conferences can be found at the following link: alamedical.org/prescribing

Online Courses – The Association has 7 online prescribing courses (identified below) available that meet the 8 hours needed for the new DEA requirement. Information regarding these online courses can be found at the following link: https://alamedical.inreachce.com/

1. Benzodiazepines and the Diagnosis and Treatment of Anxiety Disorders – 0.75 credits

2. Case Studies from the Alabama Board of Medical Examiners – 0.75 credits

3. Navigating the Prescription Drug Monitoring Program (PDMP) – 0.50 credits

4. Controlled Substance Issues in Palliative Medicine and Geriatrics – 1.00 credit

5. Dilemmas in Controlled Substance Prescribing – 1.00 credit

6. Prescribing Controlled Drugs During a RXDA Epidemic, Part I and II – 3.00 credits         

7. Treating Postoperative Pain: A Better Way – 1.00 credit

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The End of the COVID-19 Public Health Emergency – What it Means for Alabama Healthcare Providers

The End of the COVID-19 Public Health Emergency –  What it Means for Alabama Healthcare Providers

By: Howard Bogard, Burr & Forman

The Biden Administration recently announced that the COVID-19 Public Health Emergency (“PHE”) will end May 11, 2023.  The PHE has been in effect since January of 2020.  During the PHE, the Centers for Medicare & Medicaid Services (“CMS”) and other regulatory agencies eased certain restrictions for healthcare providers so as to expand access to care during the PHE. With Biden’s announcement, many of these waivers, regulations and guidance announcements relied upon and utilized by Alabama healthcare providers will end requiring providers to review their current practices to ensure future compliance. Notably, however, the majority of current Medicare telehealth flexibilities and waivers will remain in place through December 31, 2024 due to the Consolidated Appropriations Act of 2023.  

Under Section 1135 of the Social Security Act, the Department of Health and Human Services issued waivers for certain provisions of the Medicare and Medicaid programs.  Some of the waivers were “blanket” waivers applicable to all healthcare providers participating in the Medicare and Medicaid programs and some were “application” waivers applicable to the requesting provider or State.  The number of waivers are too numerous to list individually, but apply to just about every type of healthcare provider, including physicians, hospitals (including rural, critical access, psychiatric, rehabilitation and long-term care), rural health clinics and federally qualified health centers, skilled nursing facilities, home health agencies, hospice, end stage renal dialysis facilities, ambulatory surgery centers, ambulance services and DMEPOS providers. For a summary of the COVID-19 blanket waivers visit https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf.  

During the PHE, the Office for Civil Rights issued guidance relaxing certain HIPAA privacy and security rules. Likewise, CMS relaxed certain restrictions under the Federal Stark Law and the Office of Inspector General relaxed certain restrictions under the Federal Anti-Kickback Statute.  These regulatory enforcement policies will end upon termination of the PHE.  

As referenced above, the PHE waivers for telehealth will remain in place through the end of 2024.  Under the telehealth waivers, CMS expanded the types of healthcare professionals who can furnish distant site telehealth services to include all eligible Medicare providers. This allows healthcare professionals who were previously ineligible to furnish and bill for Medicare telehealth services, including physical therapists, occupational therapists, speech language pathologists and others, to receive payment for Medicare telehealth services. Further, CMS waived the requirements for use of video technology thereby allowing the use of audio-only equipment to furnish certain telehealth services.  

For healthcare providers who have relied on a PHE waiver to offer services, it is critical to identify those waivers, confirm the applicable expiration date and take appropriate steps to change current operations to reflect the loss of the waivers and the implementation of the pre-PHE regulations, rules and guidelines. 

Howard Bogard is a partner with Burr & Forman LLP and is the Chair of the firm’s Health Care Practice Group. Howard may be reached at (205) 458-5416 or hbogard@burr.com.  

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Discussions with Decision Makers: Rep. Susan DuBose

Discussions with Decisionmakers

Representative Susan DuBose (R -Hoover) is the newly elected representative of district 45. Rep. DuBose worked as a residential, commercial and construction loan officer and business development officer for Compass Bank for over 12 years before becoming a stay-at-home mom to raise her two children in 1997.

She is president of the Republican Women of North Shelby County, is on the Governmental Affairs Committee and Women’s Business Council for the Shelby County Chamber of Commerce and is a member of the Shelby County Republican Party Executive Committee. Rep. DuBose will serve as committee member on the House Health Committee.

What First prompted you to consider running for office?

I felt my District 45 was not adequately represented by someone who was active and engaged in the community. We are a diverse district that stretches from Irondale to Chelsea and includes three counties- Jefferson, Shelby and St. Clair. We are also an area experiencing considerable growth, especially Chelsea and surrounding areas of North Shelby County. We also have a very politically informed electorate that deserves a representative that will be involved and available.

How does your background help serve you in the Legislature?

For about the last 12 years I have been very involved in a support role in the Republican Party. I was President of the Republican Women of North Shelby County when I decided to run for office. I was also a member of the Shelby County Republican executive committee. As a member of those groups, I was often asked to be a conservative female voice in Montgomery at committee meetings and press briefings. The transition to running for office was easy for me because I had spent so much time in the political arena. I also consider myself a policy nerd. I love studying bills, current policy issues and comparing model legislation with other states. My degree is in finance, and I started my career in real estate and construction lending with Compass Bank. Years of analyzing financial statements should be an asset when navigating our state budgets.

What are some of your legislative priorities next term?

School choice, Women’s Bill of Rights, Womens’ Sports Bill (HigherEd), Workforce Participation Rate- (Only 57%!), Mental Health, Fentanyl Crisis, ESG.

What are some health-related issues important to your district and your constituents?

By far the most heart wrenching stories I have heard from constituents involve overdoses from Fentanyl/opioids. Usually, the story involves losing a child and the parents are pleading for help to stop this crisis. Secondly, mental health is the issue I heard most about. Law enforcement has been the most vocal, more patient facilities are needed. Teachers and principals want more help for students. Mental Health of students is becoming a larger and larger concern in today’s culture. My third concern is the impact of marijuana dispensaries opening all over the state. Even though this is supposed to be “medical marijuana” the conditions that qualify for a marijuana card are vast and most people will be able to obtain a card if they want one. The industry will continue to push until recreation marijuana is legalized. I am very concerned about the detrimental health and safety impact this will have on our state.

What do you think people understand the least about our health care system?

I should be asking you guys this question. I have a lot to learn about our health care system myself.

If you could change anything about our health care system, what would it be?

Take out the bureaucracy and make it more about relationships with doctors and their patients. I’m always about less regulation and less interference from the government. When the government is involved, more controls are placed on physicians, and patients suffer. I believe doctors should have the freedom to make medical decisions they feel are best for the patients without undo mandates from our government.

How can the Medical Association- and physicians statewide- help you address Alabama’s health
challenges?

Open and honest communication will help me. I am not a health expert; I’m not trained in any health field, but I care about the people in the State of Alabama. We all need to work together to address vital issues in our state. I asked to be on the Health Committee because I believe the most pressing issues facing our state are tied to our health.

What is the one thing you would like to say to physicians in your district?

I have the upmost respect and admiration for physicians. I know the sacrifices you made for many years to obtain the advanced education and training it takes to be a physician. Medicine is a true calling, and you are a public servant to your communities. Thank you all for your continued service and your dedication to your fields. May God be with each of you.

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Grant Opportunity for Disaster Relief

Grant Opportunity for Disaster Relief

Are you or do you know a physician whose practice was affected by the recent storms in Alabama?

The Medical Association of the State of Alabama, in partnership with the AMA Foundation Disaster Relief Program, has a new grant opportunity to assist physicians to rebuild practices in their community. The grant aims to help practices that were affected by the severe storms, straight-line winds, and tornadoes in January of this year.

If you are interested in applying for or nominating another physician for this grant, please email us at mcamerio@alamedical.org. More details will be provided to you at that time.

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Discussions with Decision Makers: Rep. David Cole

Discussions with Decisionmakers

Rep. David Cole – a member of the Medical Association and supported by the Alabama Medical PAC (ALAPAC) – is a newly elected republican legislator from Alabama House District 10 in the Huntsville/Madison area. Rep. Cole is the only physician in the House and has been selected to serve on the House Health Committee.

Rep. Cole is a military trained physician and combat surgeon with senior executive management experience in Occupational and Aerospace medicine. Cole earned his medical degree from the University of Arkansas and completed his surgical internship in general surgery at Walter Reed Army Medical Center. Cole is a highly decorated military veteran, with a history of service in several overseas missions. He held the position of Chief Medical Officer at Fox Army Health Center on Redstone Arsenal for four years before taking the position of Medical Director for Huntsville Hospital’s Occupational Health Group.

You are the medical director for Huntsville Hospitals Occupational Health Group.  What are some challenges facing your specialty and medicine in general in the Huntsville area?

I think the things facing my specialty is what’s facing all specialties in medicine in general.  Our academy had 33 students match in occupational medicine nationwide.  That’s not even 1 person per state.  I think all specialties would agree there are not enough of us.  In my specialty, we look at work injuries and ways to make the work environment safer.  Business in North Alabama is exploding and we are continuing to have more patients and we need to grow with it.  We are trying to hire more staff and recruit physicians just like any other specialty is trying to do. 

You were actively deployed in Iraq and Afghanistan as a medical doctor.  What was that experience like?  Thank you for your service!

It was different every time I went because I had different roles.  The first time in Iraq I was a brigade surgeon of a combat aviation brigade.  That job has several elements to it. The main one is to help plan and oversee air medical evacuation support.  The other part of my other job was to be the advisor to the commander on all medical aspects.  At the brigade level you are in charge of planning small movements and to make sure you have medical coverage for those operations. The first time I was in Afghanistan I was an infantry battalion surgeon.  We lived on top of mountains and went on foot patrols every day and did special visits to villages to provide training and care.  We trained PA’s in Afghanistan and were the very tip of the sphere.  The last time I was in Afghanistan, I was the Combined Joint Taskforce Surgeon for southeast Afghanistan and was General Abrams advisor to all medical assets in that region.  We had to coordinate with the Navy and other groups to make sure they had the supplies, personnel, and other tactical equipment. My last role was more macro unlike my previous jobs.  One of the things I enjoyed was as that I got to fly all the time. My favorite was air assault missions.

As a physician, what do you see as the biggest challenge in healthcare in Alabama?

Access. I don’t want to mistake that with lack of insurance.  I want to highlight that we need more medical physicians.  We have not done the greatest job of forecasting medical physician numbers in the last 15 years. We have been getting by, but the pandemic has shown us that we are not as robust as we thought we were.

What should the legislature prioritize for improving healthcare in Alabama?

I think the legislature should really look at how can we improve the number of physicians in our state which in turn will help with access for people to medical services. The more quality access we have, the better outcomes we have.  Chronic medical conditions are a problem in our state, and if we can treat the patients earlier, then that can save Alabama money. We need to be focusing on preventive medicine and medical services on the front end.

 You will actually be serving on the House health committee and are the only physician in the House.  Any specific healthcare priorities you are working on or bills that you are planning to file?

The Governor and the speaker have both indicated that they are supportive of improving mental health in Alabama.  I hope to help craft legislation and help them on that. The other issue Gov. Ivey has spoken of is improving the health of Alabama. I would like to partner with her and the senate to see how we can best tackle that. 

The Medical Association is an ardent supporter of the physician-led team in health care.  What are your thoughts on the numerous “scope creep” bills that are filed in the Legislature?

I haven’t seen any filed yet, but I know they are historically filed every year.  It goes back to training and education. However, if we are looking at expanding scope of practice, we should really need to look at increasing the physician workforce and fix that problem instead of putting a quick band-aid on it and not addressing the core issue. 

The Medical Associations 2023 Advocacy Agenda was recently released and one priority for the Association is to increase the physician workforce.  What are your ideas to recruit and retain physicians to Alabama?

There have been some previous incentives that have been passed. I would like to see if they have been effective and if they are not why. I would like to alternatively look at helping physicians starting new practices in places and communities that need those services

Healthcare costs continue to increase.  Besides addressing inflation, what are other ways the State could drive down the cost of care for the citizens of Alabama?

Increasing preventive care and increasing quality of care is really critical to driving down cost.  An example is untreated hypertension after decades, leading to the patient who may go on dialysis, which is very expensive.  So, if you can prevent those scenarios, it will drive down cost.  Much of healthcare is driven by federal policies, put it is prudent to look at how we can be effective with our care in the State.

The topic of physician burnout has become a major issue before and since the pandemic.  What are ways we can address that?

Great question.  Every article you read has a different answer on this. People are burnt out for different reasons.  Some people work too hard because they have too many patients, some have multiple complicated critical care patients, and some are in an environment that’s not helping them succeed as much as they should.  I would like to tell all physicians how much they are appreciated. The physicians that I know work tirelessly for all their patients, which has been the model in our training.  We sacrifice for the patient.  Part of today’s medicine needs to include what we would call self-care.  There’s lot of facilities that have different approaches. Most organizations recognize that there is an issue which is a significant change from 5 years ago.  Burnout has always existed, but wasn’t really studied until the pandemic.  Institutions and companies are starting to address that which is a great start.

Streamlining prior authorizations seems to be part of the physician burnout equation.  How can we better improve and streamline the prior authorization process?

I will tell you that most physicians consider it a curse word.  I think the reasoning behind prior authorizations is trying to make sure patients are aware of cost and I understand the intention.  But a lot of these electronic fillings gets dumped in the physician’s lap.  Physicians are tired of all the red tape and we need to take a look at it at the state level.  It has lots of layers, but it’s something that I will be willing to tackle.

Anything you would like to say the members of the Medical Association?

I would like to thank them for their support of my campaign and continued support while I serve our state.  It’s been humbling and I value the bond that our group has together.  The support we give each other is unbelievable.  I hope that during my time at the state house I can help them in their daily lives and struggles. 

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2023 Advocacy Agenda

As the professional association for some 7,000 physicians of all specialties in Alabama, the
Medical Association of the State of Alabama exists to serve, lead, and unite physicians in
promoting the highest quality of healthcare for the people of Alabama through advocacy,
information, and education


General Policies Supported

The Medical Association supports the physician-led health team model and maintaining the highest standards for medical care delivery across all specialties of medicine.  The Association  supports prohibiting deceptive healthcare advertising and requiring health professionals identify their license to patients.

The Association supports physician autonomy in patient care and medical practice decisions, fair reimbursement for services and reducing the volume of administrative tasks required by insurers which increase annual health spending and negatively impact patient health.     

Further, the Association supports increasing health insurance options for Alabamians, including expanding Medicaid.  The Association supports increasing access to quality mental health care and continued state funding for the Maternal Mortality Review Committee and the Infant Mortality Review Committee.  Recognizing the long-term effects of social determinants of health on individuals, families and ultimately communities, the Association supports comprehensive solutions to addressing these challenges, with emphasis on pipeline programs, tax credits and loan forgiveness proposals benefitting rural and underserved areas.

Finally, by ensuring medical liability environment stability and pursuing further civil justice reforms, the Association believes Alabama can continue to attract highly-qualified physicians.

Specific Policies Supported

For 2023 , the Association specifically supports:

  • Streamlining the prior authorization process for physicians and patients
  • Initiatives to grow Alabama’s physician workforce
  • Increasing access to physician-led care in rural and underserved communities
  • The ability of medical practices to set patient practice policies
  • Increasing physician representation on state healthcare boards, task forces and committees

General Policies Opposed

The Medical Association opposes any scope of practice expansion for non-physicians that would fracture the physician-led health team model, lower quality of care and/or increase costs.  The Association also opposes any interference with the physician-patient relationship and attempts to reduce a physician’s autonomy in patient care or medical practice decisions.

The Association opposes legislation or other initiatives that could increase lawsuit opportunities against physicians, including the establishment of statutory standards of care or any statutory dictums for medical care delivery.  The Association also opposes any state-level increase of requirements for Maintenance of Certification.  Finally, the Medical Association opposes tax increases disproportionately affecting physicians.

Specific Policies Opposed

For 2023, the Association specifically opposes:

  • New lawsuit opportunities against physician employers and medical practices over employment policies
  • Efforts to reduce and/or politicize physician involvement in health regulatory affairs
  • Expanding Prescription Drug Monitoring Program (PDMP) access for law enforcement
  • Statutory requirements for mandatory Prescription Drug Monitoring Program (PDMP) checks

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