Archive for Advocacy

MOC UPDATE: Working to Solve Problems with Certifications

MOC UPDATE: Working to Solve Problems with Certifications

UPDATE DEC. 12, 2018:  The Continuing Board Certification: Vision for the Future Commission has released its draft report for public comment. The report, which includes the Commission’s key findings and recommendations, will be posted on the Vision Initiative website for comment through Tuesday, Jan. 15, 2019 at 11:00 p.m. CST.

The Medical Association continues to work with the American Board of Medical Specialties concerning physician frustrations with the current Maintenance of Certification process, but this is your opportunity to voice your opinion as well. Take a moment, review the draft report, and offer your comments by Jan. 15.

The Medical Association remains committed to working with the American Board of Medical Specialties and its 24 Member Boards to improve the continuing certification process so that it becomes a system that demonstrates the profession’s commitment to professional self-regulation, offers a consistent and clear understanding of what continuing certification means, and establishes a meaningful, relevant and valuable program that meets the highest standard of quality patient care. The Boards will seriously consider the Commission’s findings and recommendations once finalized, as they continue implementation of improvements and pilots currently underway.


UPDATE JULY 20, 2018: The Continuing Board Certification: Vision for the Future or “Vision Initiative” is a collaborative effort that brings together multiple stakeholders to envision a system that is responsive to the needs of those who rely on it and that is relevant, meaningful and of value to physicians. The Vision Initiative includes physicians, professional medical organizations, national specialty and state medical societies, hospitals and health systems, the general public and patients, and the 24 Member Boards of the American Board of Medical Specialties.

The Vision Initiative held in-person meetings in March and May to solicit testimony from ABMS member boards, national specialty and state medical societies, key stakeholders, and the public regarding their perspectives on the continuous certification system as well as innovations and possible changes.

Here is a summary of the March and May meetings for your information.

Upcoming meetings, to be held August 29-30 and October 15-16 will discuss solutions in relation to MOC. (See timeline.) A draft report for public comment is anticipated in November 2018, with a final report from the Commission to ABMS due February 2019.

Interested medical societies can sign up for monthly updates to follow the Commission’s progress and be notified about opportunities for feedback and input at this link.

RELATED NEWS: MOC UPDATE: Two Certification Programs Transition from Pilot to Permanent


UPDATE APRIL 20, 2018:  The Continuing Board Certification: Vision for the Future Commission is continuing its quest  to bring together physicians, medical organization, state medical societies, hospitals, health systems, patients and the ABMS to investigate the future of board certification and recently hosted its first in-person meeting in March in Washington, D.C. Commission members heard testimony on continuing certification from stakeholders who provided their perspectives and experiences with continuing certification, the challenges they currently face, and their thoughts about opportunities about the future. The presentation components of the meeting were open to the public and video streamed for all to view live.

HOW  CAN YOU PARTICIPATE? The Commission launched a stakeholder survey in February, which will remain open until May 11. Complete the survey, share the link with your colleagues, and urge them to participate as well. TAKE THE SURVEY

The next Commission meeting will be held May 30 – June 1. The meeting will feature sections open to the public and will be live video streamed. Details regarding the agenda and live streaming will be featured in next month’s update and posted on visioninitiative.org. Please make sure to bookmark the site for access to Commission meeting information, progress updates, and opportunities for your feedback and input, and remember to share this update with your colleagues and encourage them to become involved in the process as well.


The Medical Association continues to work with the American Board of Medical Specialties concerning physician frustrations with the current Maintenance of Certification process. Late last year, Association Executive Director Mark Jackson and Council on Medical Service member Jeff Rickert, M.D., joined representatives from other state medical societies and individual specialty boards for a meeting with the ABMS in Chicago, which included discussions about innovations the medical boards are working on to address continuous learning for physicians, many of which include input from various outside stakeholders and focus on greater consistency amongst the medical boards.

Following the Association’s Annual Governmental Affairs Meeting in Washington in February where Richard Hawkins, President and Chief Executive Officer of ABMS, was a guest speaker, the organization issued a statement as an update on the progress of issues of concern to physicians about Maintenance of Certification.

As a result of these meetings, and other meetings initiated by State Medical Societies, the Continuing Board Certification: Vision for the Future was formed as a collaborative effort bringing together physicians, medical organization, state medical societies, hospitals, health systems, patients and the ABMS to investigate the future of board certification.

The Commission invites input from all stakeholders. To participate in the discussion, you may provide comments to inform the future of board certification, learn how you can engage in the process, and sign up for monthly email updates from the Commission. LEARN MORE

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STUDY: Independent Practice Declines Due Partially to EHRs

STUDY: Independent Practice Declines Due Partially to EHRs

A new study conducted by the Trump Administration suggests electronic health records are currently failing at reducing the cost of billing for medical facilities, especially for independent practices.

“Small physicians’ groups and solo providers could not afford to purchase and maintain electronic medical records and comply with government reporting requirements,” the White House report stated. “As a result, hospital mergers are booming, leading to horizontal integration, and large hospitals are buying up physicians’ practices and outpatient service providers to form large, vertically integrated health care networks.”

A study published in the Journal of the American Medical Association shows that billing costs consumed significant chunks of revenue even at a large academic center with a fully implemented EHR system. They represented about 14.5 percent of costs of primary care visits and 13.4 percent of costs for ambulatory surgical procedures. “These findings suggest that significant investments in certified health information technology have not reduced high billing costs in the United States,” the authors state in the report.

Independent physicians have also commented on the burdens of the EHR system. Three out of four physicians believe electronic health records (EHRs) increase practice costs, outweighing any efficiency savings, and seven out of 10 think EHRs reduce their productivity, according to a Deloitte’s recent 2016 Survey of U.S. Physicians.

The results of the survey also indicate physician satisfaction with EHRs varies by practice characteristics. About 70 percent of employed physicians are more likely to think that EHRs support the exchange of clinical information and help improve clinical outcomes compared to 50 percent of independent physicians. The results also revealed 72 percent of independent physicians are more likely to think that EHRs reduce productivity compared to 57 percent of employed physicians. Additionally, 80 percent of independent physicians think that EHRs increase practice costs, compared to 63 percent of employed physicians.

The federal government has financial interests in making it easier for physicians to cope with EHR requirements, according to President Trump’s 2018 Economic Report. As part of its 2018 economic report, released Feb. 21, the White House drew a direct connection between physicians’ struggles to purchase and operate EHR systems and the increase in consolidation among hospitals.

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Bipartisan Budget Act Boosts Health Programs

Bipartisan Budget Act Boosts Health Programs

In a rare show of bipartisanship for the mostly polarized 115th Congress, the Bipartisan Budget Act of 2018 is officially one for the record books. The week leading up to the final vote was far from smooth with Sen. Nancy Pelosi impressively filibustering on the floor of the U.S. Senate for eight hours to Rep. Rand Paul blocking the final vote late Thursday night/early Friday morning and forcing a six-hour government shutdown before allowing the final vote to be taken.

Now that President Trump has signed the Bipartisan Budget Act of 2018 here’s what you need to know:

Technical Amendments to MACRA. Makes several changes to the Medicare Access and CHIP Reauthorization Act (MACRA) that the medical community has been strongly advocating for, including:

  • Excludes Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination;
  • Eliminates improvement scoring for the cost performance category for the third, fourth and fifth years of MIPS;
  • Allows CMS to reweight the cost performance category to not less than 10 percent for the third, fourth, and fifth years of MIPS;
  • Requires CMS to update on CMS’ website by Dec. 31 of each year, information on resource use measures including measures under development, the time-frame for such development, potential future resource use measure topics, a description of stakeholder engagement and the percent of expenditures under Medicare Part A and B that are covered by resource use measures.
  • Allows CMS flexibility in setting the performance threshold for years three through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year;
  • Allows the Physician Focused Payment Model Technical Advisory Committee (PTAC) to provide initial feedback regarding the extent to which models meet criteria and an explanation of the basis for the feedback.

Physician fee schedule update (in lieu of Misvalued Codes). Reduces the Physician Fee Schedule conversion factor for 2019 from 0.5 percent to 0.25 percent. This is more favorable language than, and is in lieu of, the language in the House bill that would extend the “misvalued codes” provision for one additional year. The AMA estimated, based on the recommendations of the AMA / Specialty Society Relative Value Scale Update Committee (RUC), that the misvalued code provision in the House bill would have reduced the statutory 0.5 percent payment update in 2019 by 0.45 percent. Rejection of the misvalued code policy is an important outcome for future budget saving exercises. On a bipartisan basis, policymakers have recognized that the misvalued code “budget dial” is tapped out and should be shelved.

IPAB. Permanently repeals the Independent Payment Advisory Board. IPAB was a 15-member government agency created in 2010 by the Affordable Care Act for achieving specified savings in Medicare without affecting coverage or quality.

Children’s Health Insurance Program (CHIP). CHIP is extended for an additional four years beyond the previous Continuing Resolution’s six-year extension, with appropriations made through 2027.

Community Health Centers. Funding for community health centers is reauthorized for two years at a level of $3.8 billion for FY 2018 and $4 billion for FY 2019.

Medicare payment cap for therapy services. Permanently repeals the outpatient therapy caps beginning on Jan. 1, 2018.

National Health Service Corps. Funding for the National Health Service Corps is extended at the FY 2015 – 2017 annual level of $310 million for two additional years.

Teaching Health Center Graduate Medical Education. Funding for Teaching Health Center Graduate Medical Education is extended for two years at an annual level of $126.5 million, more than doubling annual funding for this program.

Geographic Practice Cost Indices (GPCI) floor. Extends the work GPCI floor for two additional years through Jan. 1, 2020.

Reducing EHR Significant Hardship. Removes the current mandate that meaningful use standards become more stringent over time. This eases the burden on physicians as they would no longer have to submit and receive a hardship exception from HHS.

Closing the Donut Hole for Seniors. Closes the Medicare Part D prescription drug “donut hole” sooner than under current law by increasing the discounted price manufacturers provide from 50 percent to 70 percent.

Emergency Medicaid Funds for Puerto Rico and the U.S. Virgin Islands. Puerto Rico’s Medicaid caps for 2018 – 2019 are increased by an additional $4.8 billion. The Virgin Islands’ caps are increased over the same time period by $142.5 million. Also, 100 percent federal cost sharing for Medicaid is provided for both territories through Sept. 30, 2019.

Prevention and Public Health Fund (PPHF). The Senate bill reduces funding for the PPHF by $1.35 billion between FY 2018 – 2027.

Other Select Budget Agreement Provisions:

Note: there is an agreement to include these funds in the Omnibus before the March 23 deadline.

  • $6 billion in funding for the opioid crisis and for mental health
  • $4 billion to rebuild and improve VA Hospitals and clinics
  • $2 billion for NIH research (above CURES Act increases)

Click here if you would like to see how Alabama’s Congressional Delegation voted.

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Physician Groups Issue Joint Statement in Support of Raising Alabama’s Legal Tobacco Age to 21

Physician Groups Issue Joint Statement in Support of Raising Alabama’s Legal Tobacco Age to 21

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MONTGOMERY — The Medical Association of the State of Alabama, the Alabama Chapter-American Academy of Pediatrics, the American College of Cardiology-Alabama Chapter, the Alabama Dermatology Society, and the Alabama Academy of Family Physicians have joined in support of legislation that would raise Alabama’s legal tobacco age from 19 to 21.

“Research has shown our children are at the greatest risk of becoming smokers because they begin to experiment with cigarettes around the age of 18,” said Medical Association President Jerry Harrison, M.D. “Smoking remains one of the most preventable causes of heart disease by making the heart work harder and raising the blood pressure, which can trigger a stroke. So, raising Alabama’s legal tobacco age limit by a couple of years in order to add years to our children’s lives only makes sense.”

A study published last year in the journal Pediatrics showed raising the minimum tobacco purchase age to 21 would likely have significant public health benefits, including 249,000 fewer premature deaths and 45,000 fewer lung cancer deaths for those born between 2010 and 2019. The study also showed that younger adolescents were more likely to support the initiative, and past research has shown that up to 75 percent of adults favor the higher purchase age for tobacco products.

“This legislation is one of the most effective actions Alabama can make to ensure the health and safety of our children,” said Susan Walley, M.D., FAAP, member of the AL-AAP Executive Board and the Executive Committee of the American Academy of Pediatrics Section on Tobacco Control. “Any tobacco use in children and adolescents is not safe. Adolescents are more likely to become addicted to nicotine, even with experimental use, which has a ‘gateway effect’ to other substances of abuse. Once adolescents start using tobacco products, whether from electronic cigarettes or traditional combustible cigarettes or cigars, they risk a lifelong habit that kills one-in-three smokers from a multitude of diseases.”

According to the Alabama Dermatology Society, smoking is bad for the skin in multiple ways – ill effects that can begin in the teenage years. In addition to causing premature skin aging and wrinkles, smoking nearly doubles one’s risk of developing psoriasis. Even more worrisome, studies show smokers boost their risk for developing squamous cell carcinoma of the skin by 52 percent. Squamous cell carcinoma is the second most common form of skin cancer, and, while often treatable, can have deadly consequences.

A bill sponsored by Rep. Chris Pringle (R-Mobile) – HB 47 – would raise the age from 19 to 21 for anyone in Alabama looking to purchase, use, or possess tobacco products in Alabama. This proposed legislation includes any tobacco, tobacco product or alternative nicotine product. Our organizations fully support the passage of this legislation for the lives of Alabama’s children.

For more information or comment, please contact:

Lori M. Quiller, APR, Medical Association of the State of Alabama, (334) 954-2580

Linda Lee, APR, Alabama Chapter-American Academy of Pediatrics, (334) 954-2543

Christina Smith, American College of Cardiology-Alabama Chapter, and Alabama Dermatology Society, (205) 972-8510

Jeff Arrington, Alabama Academy of Family Physicians, (334) 954-2570

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ABMS Issues Statement about MOC Update

ABMS Issues Statement about MOC Update

Following the Medical Association’s Annual Governmental Affairs Meeting in Washington earlier this week where Richard Hawkins, President and Chief Executive Officer of the American Board of Medical Specialties, was a guest speaker, ABMS issued a statement as an update on the progress of issues of concern to physicians about Maintenance of Certification.

Late last year, frustrations with the current Maintenance of Certification process brought the Medical Association and representatives from other state medical societies and individual specialty boards to Chicago for a series of meetings with the American Board of Medical Specialties to discuss physician frustration with the MOC process. Leadership within ABMS and the specialty boards engaged in meaningful dialogue during the meeting with promises to address criticisms of the current MOC process.

As part of the ABMS statement, the organization vowed to continue to work closely with physician organizations to improve the certification process. The release included the following action statements:

  • To make testing more relevant to practice, Boards have modularized the exam in specific practice areas and given their diplomates more flexibility over the scope and frequency of assessment;
  • To eliminate the indirect costs of participation, Boards have modernized the assessment through convenient on-line testing or remote proctoring, eliminating the need for preparation courses, travel to exam centers, and time away from practices;
  • To simulate real-life application of knowledge and decision making, some Boards now permit the use of reference materials during the exam;
  • To assure that knowledge assessments help participating physicians to identify gaps in knowledge and guide their learning, assessments are accompanied by timely, actionable feedback;
  • To increase alignment between MOC and other quality and safety programs, a much wider variety of practice-based learning and improvement activities are now recognized, including those offered through hospitals, specialty societies, and state medical societies.
  • To assure opportunities for remediation of knowledge gaps, all Boards provide multiple opportunities for physicians to retake the exam.

Meanwhile, the entire Boards Community has:

  • Initiated a major redesign of ABMS governance to increase Board accountability and provide an ongoing opportunity for participating physicians to directly impact ABMS programs and policy;
  • Initiated the development of organizational standards to increase operational consistency, transparency and effectiveness across the Boards; and
  • Launched the Continuing Board Certification – Vision for the Future initiative to gather broad input about continuing certification from a wide range of stakeholders (especially physicians who spend most of their time in practice), consider alternatives, and make recommendations for the future.

Read the full statement here.

Read how the Medical Association has been working to ease MOC frustrations for our members.

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Possible Government Shutdown with CHIP in the Balance?

Possible Government Shutdown with CHIP in the Balance?

Friday, Jan. 19: Government shutdowns are rare, with the last shutdown in 2013 that lasted 17 days. Even though the U.S. House passed legislation that would fund CHIP for six more years, the Senate may not approve the measure. In fact, Congress is facing the possibility of another government shutdown, which could leave health care for more than 9 million children caught in the middle of the fray.

Late Thursday evening the House passed legislation 230-197 to keep the government open for business through Feb. 16. The measure now faces a steep battle with Senate lawmakers as time ticks down to midnight to avoid a full shutdown. It’s been widely reported that conservatives in the House Freedom Caucus largely backed the measure even after being locked in debate with the White House and GOP leaders over concerns of military funding and immigration reform. The legislation also includes a measure to renew the Children’s Health Insurance Program for another six years.

Now with the legislation in the Senate it faces steep opposition by Democrats who appear intent on securing concessions that would, among other things, protect from deportation young immigrants brought to the country illegally as children, increase domestic spending, aid Puerto Rico and bolster the government’s response to the opioid epidemic. Senate Democrats have publicly decried the GOP does not have the votes necessary to pass the legislation.

According to the Georgetown University Center for Children and Families, there are now 11 states in danger of running out of CHIP money by the end of February…a number that will double by the end of March. Complicating matters even more, the Congressional Budget Office has stated that extending CHIP funding for 10 years would save the federal government $6 billion whereas initial estimates were that renewing CHIP funding would cost $8.2 billion.

The CBO adjustment stems from changes Congress has made to the Affordable Care Act making private health insurance more expensive and an increase in federal spending on subsidies for that coverage makes CHIP a better deal in comparison.

A government shutdown means more to medicine than health care for America’s children. It will affect the Centers for Disease Control and Prevention during one of the most dangerous flu seasons in recent history. The National Institutes of Health will be forced to stop enrolling patients in clinical trials. Drug approvals by the Food and Drug Administration will come to a complete stop.

The Medical Association is closely monitoring legislation pertaining to CHIP funding and will report any changes as they occur.

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Medical Association Works to Ease MOC Frustrations

Medical Association Works to Ease MOC Frustrations

Frustrations with the current Maintenance of Certification process brought together Medical Association Executive Director Mark Jackson and Council on Medical Service member Jeff Rickert, M.D., and representatives from other state medical societies and individual specialty boards for a series of meetings with the American Board of Medical Specialties.

The daylong meeting in Chicago was called at the request of state medical societies, including the Medical Association, who have expressed increasing frustration with the MOC process and have demanded changes be made. Leadership within ABMS and the specialty boards engaged in meaningful dialogue during the meeting with promises to address criticisms of the current MOC process.

Discussions included 170 innovations the medical boards are working on to address continuous learning for physicians, many of which include input from various outside stakeholders and focus on greater consistency amongst the medical boards. Innovations also include alternatives to the high-stakes exams with a focus on longitudinal learning for physicians in their relevant practice areas. Many medical boards outlined current (or moving to) learning modules that would be seamless for physicians and provide a gap analysis. Most medical boards seemed to be moving away from the high-stakes examination that has been the challenge of the physicians. There was also discussion by some of the medical boards on reducing the fees collected from physicians for the tests and the need to be more customer friendly.

The Medical Association’s Board of Censors created MOC study committee to fully examine the MOC issue and provide feedback to the Board. Dr. Rickert is a member of this committee and will provide input in the coming weeks as the committee discusses recommendations to the Board of Censors.

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Medical Association’s 2018 State and Federal Agendas

Medical Association’s 2018 State and Federal Agendas

The Medical Association Board of Censors has met and approved the Association’s 2018 State and Federal Agendas. These agendas were developed with guidance from the House of Delegates and input from individual physicians. As the Alabama Legislature and U.S. Congress begin their work for 2018, additional items affecting physicians, medical practices and patients may be added to this list.

Download the Medical Association’s 2018 State and Federal Agendas (PDF)

 

2018 STATE AGENDA

 

The Medical Association supports:

  • Ensuring legislation “first do[es] no harm”
  • Extending the Medicaid payment bump for primary care to all specialties of medicine
  • Eliminating the health insurance-coverage gap for the working poor
  • Ensuring fair payment for patient care and reducing administrative burdens on physicians and medical practices
  • Strengthening existing tort reforms and ensuring liability system stability
  • Empowering patients and their doctors in making medical decisions
  • Continued physician compounding, dispensing of drugs
  • The same standards and reimbursements for telehealth and face-to-face visits
  • Training, education and licensing transparency of all individuals involved in patient care
  • Continued self-regulation of medicine over all areas of patient care
  • Increased state funding to upgrade the Prescription Drug Monitoring Program to a useful tool for physician monitoring patients at risk for drug interactions and overdose potential
  • Using data analytics to combat the drug abuse epidemic by strengthening research capabilities of pre-approved, de-identified prescription information
  • Maintaining the Alabama Department of Public Health as the repository for PDMP information to ensure continuity for prescribers and dispensers and security for patients
  • Standard opioid education in medical school so the physicians of tomorrow are prepared to face the realities and responsibilities of opioid prescribing

 

The Medical Association opposes:

  • The radical Patient Compensation System legislation
  • Legislation/initiatives increasing lawsuits against physicians
  • Non-physicians setting standards for medical care delivery
  • Tax increases disproportionately affecting physicians
  • Expanding access to the Prescription Drug Monitoring Program (PDMP) for law enforcement
  • Statutory requirements for mandatory PDMP checks
  • Further expansion of Maintenance of Certification (MOC) requirements
  • Changes to workers’ compensation laws negatively affecting treatment of injured workers and medical practices
  • Any scope of practice expansions that endanger patients or reduces quality of care
  • Biologic substitution legislation that allows lower standards in Alabama than those set by the FDA that doesn’t provide immediate notifications to patients and their physicians when a biologic is substituted, and that increases administrative burdens on physicians and medical practices

 

2018 FEDERAL AGENDA

 

The Medical Association supports:

  • Meaningful tort reforms that maintain existing state protections
  • Reducing administrative and regulatory burdens on physicians and medical practices
  • Repeal of the Affordable Care Act and replacement with a system that:
    • Includes meaningful tort reforms that maintain existing state protections
    • Preserves employer-based health insurance
    • Protects coverage for patients with pre-existing conditions
    • Protects coverage for dependents under age 26
    • With proper oversight, allows the sale of health insurance across state lines
    • Allows for deducting individual health insurance expenses on tax returns
    • Increases allowed contributions to health savings accounts
    • Ensures access for vulnerable populations
    • Ensures universal, catastrophic coverage
    • Does not increase uncompensated care
    • Does not require adherence with insurance requirements until insurance reimbursement begins
    • Reduces administrative and regulatory burdens
  • Overhauling federal fraud and abuse programs
  • Reforming the RAC program
  • Prescription drug abuse education, prevention and treatment initiatives
  • Allowing patient private contracting in Medicare
  • Expanding veterans’ access to non-VA physicians
  • Reducing escalating prescription drug costs
  • A patient-centered MACRA framework, including non-punitive and flexible implementation of new MIPS, PQRS and MU requirements
  • Congressional reauthorization of CHIP (Children’s Health Insurance Program) at the current enhanced funding level
  • Better interstate PDMP connectivity
  • Eliminating “pain” as the fifth vital sign
  • Repealing the “language interpreters” rule
  • Requiring all VA facilities, methadone clinics and suboxone clinics to input prescription data into state PDMPs where they are located

 

The Medical Association opposes:

  • Non-physicians setting standards for medical care delivery
  • Publication of Medicare physician payment data
  • National medical licensure that supersedes state licensure
  • Legislation/initiatives increasing lawsuits against physicians

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UPDATE: FCC Votes to Repeal Net Neutrality

UPDATE: FCC Votes to Repeal Net Neutrality

UPDATE: On Dec. 14 the FCC voted 3-2 along party lines to repeal net neutrality regulations, handing a victory to telecom providers over the objections of tech companies including Netflix, Reddit and Etsy. Net neutrality regulations had prevented internet providers like Comcast and AT&T from blocking or slowing web traffic, or creating paid fast lanes. Instead, providers will be required to disclose their practices, with the FTC expected to police anti-competitive behavior. The FCC’s new rules could usher in big changes in how we use the internet.

The meeting began this morning with protesters gathered outside the FCC, but the expected decision didn’t take very long to reach and fell along party lines.

FCC Chairman Ajit Pai, a Republican who says his plan to repeal net neutrality will eliminate unnecessary regulation, called the internet the “greatest free-market innovation in history.” He added that it “certainly wasn’t heavy-handed government regulation” that’s been responsible for the internet’s “phenomenal” development. “Quite the contrary,” he says.

“What is the FCC doing today?” he asked. “Quite simply, we are restoring the light-touch framework that has governed the internet for most of its existence.”

Broadband providers, Pai says, will have stronger incentives to build networks, especially in underserved areas. Ending 2015 net neutrality rules, he says, will lead to a “free, more open internet.”

“The sky is not falling, consumers will remain protected and the internet will continue to thrive,” Pai says.

 

THURSDAY, DEC. 7: Thousands of Americans protested across the country in all 50 states in support of continued net neutrality, the basic principle that prohibits internet service providers like AT&T, Comcast and Verizon from speeding up, slowing down, or blocking any content, applications or websites. Put simply, net neutrality is how the internet has always worked. In 2015 the Federal Communications Commission made history by placing broadband under Title II regulation in an attempt to permanently safeguard net neutrality. Now the Obama-era regulations may be repealed.

Although net neutrality rules make it illegal for high-speed Internet service providers to throttle speeds or block or slow down specific content, some health care experts worry the industry, and especially rural organizations, will struggle with the policy changes. While advocates of a repeal suggest there could be room for more competition and lower prices, others disagree arguing that if net neutrality rules are repealed, larger health care organizations may fare better than smaller ones simply because they can absorb the costs. Rural and community health centers may be left to struggle without the resources to pay for a fast internet connection on a tiered system.

Health care organizations rely on the web for telemedicine as well as data storage crucial because of government-mandated use of electronic health records. Even if the FCC were to create exemptions for health care providers or telehealth vendors, it would be difficult, if not impossible, to apply those same exemptions to patients on the other end. For homebound patients benefiting from advancements in remote monitoring, slower connectivity may not meet the demands of new technology that continuously transmits data to a primary care physician or relies on a video feed.

The FCC is expected to vote on the net neutrality rules on Dec. 14.

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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)

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