Archive for September, 2016

Managing Your Practice New Overtime Law Could Be a Land Mine

Managing Your Practice New Overtime Law Could Be a Land Mine

Editor’s note: This article was originally published in the 2016 Summer Issue of Alabama Medicine magazine.

This is the time of year when many physician groups are evaluating their employees’ performances for the purpose of giving raises or bonuses. For most groups, the majority of their employees are not exempt from the overtime law. The Department of Labor’s (DOL) Fair Labor Standard’s Act (FLSA or Overtime Law) requires a business to pay its employees at an hourly rate of time-and-a-half if that employee worked more than 40 hours per week. The new law does not affect this group of employees. It’s those employees who are “exempt” from the overtime requirement that could trip a practice up and subject the owners to penalties by DOL and the IRS.

On May 18, 2016, the DOL released new regulations related to employees who are “exempt” from the Overtime Law. The new law is effective Dec. 1, 2016. A practice still has time to determine if the new law applies to any of its employees and what changes should be made to avoid penalties.

The new law changed the wage threshold amount from $23,660 ($455 per week) to $47,476 ($913 per week). This threshold has been frozen since 1975 but will now be adjusted every three years beginning Jan. 1, 2020. Any employee earning less than these thresholds are considered non-exempt; thus, entitled to overtime pay.

Generally, an employee is exempt from the “time-and-a-half” pay if both of these tests are met:

First: Their pay exceeds the new wage threshold amount of $47,476 ($913 per week).

Second: Their duties are primarily executive, administrative, or professional. The regulations have specific criteria that should be reviewed with your CPA or tax advisor to be sure this test is met. The duties test did not change with the new regulations.

Many office managers and nurses are paid by salary rather than an hourly rate. Oftentimes, these individuals work more than 40 hours per week. Until now, it was not important to track their time to know when their hours exceeded 40 in a workweek. Beginning Dec. 1, 2016, if any salaried employee is paid less than $47,476 per year, including the office manager and nurse, their time must be tracked and receive overtime pay. Their overtime pay must be calculated based on their salary converted to an hourly basis for a 40-hour workweek. You can still pay them on a salary basis, but you will need to be sure their hours do not exceed 40 hours in a workweek.

For example, suppose your practice manager is expected to be paid $50,000 this year, which includes a base salary of $46,000 plus a Christmas bonus of $500 and expecting a year-end performance bonus of $3,500 (if the practice has a good collection year; this was the bonus last year). Because the total salary of $50,000 exceeds $47,476, no overtime is required to be paid if the manager worked more than 40 hours per workweek.

However, suppose the practice’s collections are not so good and the performance bonus is not paid. This practice manager’s total salary of $46,500 is less than the threshold of $47,476. If this manager routinely worked more than 40 hours, he/she would be entitled to overtime pay. The problem is that the physician owner would not know until year-end how much the performance bonus will be. It is likely that the practice manager has already worked 250 hours over the 40-hour workweek. Just one extra hour per day for 50 weeks would result in 250 overtime hours. At a salary of $46,500 translated to $894 per week, divided by a 40-hour workweek results in the hourly rate of $22.35. The practice manager would be entitled to overtime pay of $5,587. Because of the changes in the law, this manager would be paid more in a bad year than in a good year simply by working an extra hour per day. (The law requires nondiscretionary bonuses to be included in the calculation of the rate per hour. Consult your tax advisor to determine if this provision affects your situation.)

There are some immediate actions needed by all practices to be sure there are no landmines after Dec. 1. Remember, the new regulation only impacts the exempt employees in your practice.

  • Using last year’s W-2 wages, assess whether any of your exempt employees were paid less than the threshold of $47,476; be sure to evaluate the employee classification as exempt or non-exempt.
  • Do your exempt employees generally work more than 40 hours per week? If you are not sure, this is a conversation you should have right away with your exempt employees: they should begin tracking their time, and all overtime must be pre-approved by you.
  • Compute the amount of overtime pay to which they could be entitled if they continue to work more than 40 hours per week.
  • Determine if the exempt employees earning less than the threshold should be given a raise to avoid having to track their hours and avoid potential penalties.
  • Another consideration is the exempt employee whose overtime hours cannot be avoided. A potential solution might include reducing their salary for the amount expected to be paid by the overtime hours. This is a more difficult conversation to have with your employee and would require careful calculations by your tax advisor.
  • How will hours be tracked for your salaries employees? Discuss with your tax advisor for the best method for an accurate and complete method that will meet the DOL regulation.
  • Determine if you need to meet with your exempt employees to discuss any potential changes. Exempt employees who work from home will have to assist in tracking their own hours. Flexible work schedules must be reviewed as well.
  • It’s important to communicate the reason for this salary change if you do not typically adjust it every year. By doing so, employees’ expectations for a raise next year and disappointment for not getting it will be avoided.

The new law also included an adjustment to the class of highly compensated employees. The threshold for this group also increased from $100,000 to $134,004. Employees whose salary or pay is above those amounts will be deemed as exempt and not entitled to overtime pay. The duties test does not apply to the highly compensated class of employees.

Avoid any landmines for your practice. Start looking at these law changes before Dec. 1.

The information in this article is not intended as tax or legal advice. Please consult your tax advisor for specific information regarding your individual situation.

bronzemvpContributed by Patti G. Perdue, CPA.CITP, Jackson Thornton. Jackson Thornton is a Certified Public Accounting and Consulting Firm and an official partner with the Medical Association.

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It’s Great to Be an Auburn Tiger!

It’s Great to Be an Auburn Tiger!

AUBURN – Mike Goodlett grew up in Moulton, Ala., dreaming of being a sports star…or at least being able to hit a home run or run for a touchdown. That life wasn’t meant for him. Little did he know such a humble beginning would lead him to The Plains as the team physician for the Auburn Tigers.

“I was a very asthmatic child,” Dr. Goodlett explained. “Had my mother not been a nurse, I probably would have died several times before I was 12 years old. One night I was already pronounced dead in the emergency room when my mother called Dr. Robert Rhyne to the hospital. Dr. Rhyne came into the room and squirted some epinephrine down my tube and saved my life. I wouldn’t wheeze very much. I’d just turn black. The resident on call in the ER looked at my color and decided I was already gone. Dr. Rhyne saved my life that night.”

Dr. Goodlett never forgot that night in the emergency room, or Dr. Rhyne Years later, after tearing his ACL, he found himself in the famed Hughston Clinic for Orthopaedics and Sports Medicine and in the care of Dr. Jack Hughston. Now, his path was set.

“I had always wanted to play sports. And, ending up in Dr. Jack Hughston’s clinic…I just thought he was so cool! I really wanted to be a combination of Dr. Robert Rhyne and Dr. Jack Hughston. I wanted to be able to do what they did every day!” He laughed. “So, I did.”

Dr. Goodlett went to the University of South Alabama College of Medicine, and he specialized in family medicine at UAB affiliated Gadsden Baptist Memorial Hospital. He worked with Drs. James Andrews and Lawrence Lemak to gain expertise in sports medicine. In 1993 while en route to a family vacation, he got the surprise of a lifetime delivered in the most unusual way.

“My family and I were driving to Destin for a vacation when we were stopped by a State Trooper,” Dr. Goodlett said. “He said he didn’t know who I was but handed me a piece of paper and asked me to call the number on it. That’s how I found out we had just gotten the Auburn Tigers job. There went our vacation that summer, but what a trade off!”

Dr. Goodlett wasn’t exactly sure just how much his life was about to change that day, but he knew one thing was certain…change it would. He was about to become the team physician for about 600 athletes in all 21 of Auburn’s athletic programs. For the first 22 years, he was the only full-time physician. Now, there are two more full-time partners that are also VCOM professors and sports-trained physicians as well as a fellow.

“Every day has been an adventure since that first day. It has been a true pleasure taking care of these student athletes. It’s a unique practice to say the least,” Dr. Goodlett said.

While he doesn’t necessarily travel with the team to every away game, there is a lot of behind the scenes safety preparations that go on between Dr. Goodlett’s staff and the medical staff of the opposing team. There are no secrets here. The conversation is always about safety, or a “medical time out.” Procedures are discussed to make sure everyone is comfortable with equipment, entrances, exits, use of the medical cart, etc. Then, it’s game time.

The roar of the crowded stadium is nothing compared to the adrenaline pumping through the veins of the players, staff and media on the sidelines. As the players don their helmets and rush the field, it’s game on for the Auburn Tigers, but for Dr. Goodlett those aren’t players on the field. Those aren’t fans in the stands. Those aren’t officials on the sidelines. Those are patients.

“About four years ago, they put a heart rate monitor on me. Before the game, my heart rate was like 140, but when the game started it was like 60. To me, it’s one player, one patient. Everything slows down on the field during the game, and I just have to take care of that patient. When a player goes down, it’s stark silent in the stadium. That’s scary. But, I’m constantly talking. The trainers tell me I’m constantly talking to my sports medicine team and to the patient. It’s all about the patient. You never know what you’re going to find when you get to that player. Sometimes when a player goes down on the other sideline, because of the slope of the field, you don’t have a visual or you didn’t get to see the play, you don’t know exactly what you’re going to find when you get across the field,” Dr. Goodlett said.

In 1996 when fire broke out just outside Jordan-Hare Stadium, Dr. Goodlett’s medical team rendered aid to the fans and firefighters affected by the smoke and flames. Dr. Goodlett said had the wind shifted drawing the flames, smoke and debris into the crowded stadium, disaster would have overtaken the day’s festivities in just a few minutes in what he called “one of the scariest days I’ve ever worked at the stadium.”

In the field of sports medicine, there are as many challenges as rewards. Dr. Goodlett said the most difficult part of his job is to disqualify a player because of an injury. Players want to play and sometimes feel that’s why they are there. But, with the awareness of sports injuries becoming more prevalent, players are coming around to more of an advocacy point of view by policing themselves better for healthier play.

“I always feel bad to a degree if I have to disqualify a player because of an injury or because of health reasons, but ultimately it’s for that player’s health. On the other hand, the most rewarding part of my job is when former players come back and say thanks for taking care of me during those times. That means so much to me!” Dr. Goodlett said.

Dr. Goodlett’s legacy with Auburn University will also be felt in the classroom. He was one of the original individuals approached by Auburn University President Jay Gouge in the early stages of the creation of the Edward Via College of Osteopathic Medicine – Auburn Campus.

“I’m very proud to be one of the three individuals that President Gouge enlisted to assist him in the creation of VCOM at Auburn. It’s incredibly important these medical students are exposed to rural settings and are trained in the State of Alabama, so hopefully some of them will want to stay in rural Alabama. This is an opportunity to keep our young physicians here in Alabama, and I’m very happy to be a part of it,” Dr. Goodlett said.

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The Ministry of Rural Medicine

The Ministry of Rural Medicine

PINE APPLE – The town of Pine Apple lies about 20 minutes off I-65 South tucked in the southeast corner of Wilcox County along Alabama’s Black Belt. Driving through this farming community, you quickly notice the picturesque countryside dotted with the occasional farm house and antebellum home. This is an old and settled community with a population of around 150 residents.

However, Pine Apple is nestled into one of the poorest counties in the country with a population of about 12,000 residents and few physicians to make the rounds. Roseanne Cook, M.D., is one of a handful of physicians serving the county. The Pine Apple Clinic is a community health center with its business center in Selma. The clinic receives some federal funding, and Dr. Cook has taken care of patients there since 1986. The clinic isn’t the average medical clinic, and Dr. Cook isn’t the average rural physician.

Dr. Cook is a Roman Catholic nun, a sister of St. Joseph out of St. Louis, MO.

In 1979 working as a biology professor, Dr. Cook said she felt her life had another mission. So, at age 40, she entered medical school, and her life’s work was about to fully take shape with the intent of delving even deeper into her ability to help our country’s poor residents.

“I loved teaching, but I knew the Lord wanted me to do more. When I first went to my major superior about going to medical school, I wasn’t sure what that answer would be!” she laughed. “The answer was if it’s the Lord’s inspiration, you’ll get in, if not, you won’t get in. And, I got in at age 40…the age of most of my student colleagues’ mothers.”

After medical school, Dr. Cook had planned to follow her order to Peru, but the nurse practitioner from her order was already in Pine Apple and convinced her to come to Wilcox County instead to join the practice.

Now as a family physician serving many counties, not just her own due to a shortage of family physicians in rural areas, she has more than her hands full of patients. But, she and her staff always make the best of the situation.

“I’ve been in this area since 1986, and it’s poverty stricken…actually it’s beyond poverty stricken,” Dr. Cook said. “These residents work hard, and because they work, they don’t qualify for Medicaid or subsidies, so we do everything we can to make their lives a little better.”

Wilcox County has a recorded median income for a household in the county is around $16,646, and the median income for a family is about $22,200. According to the last census, about 36 percent of families and 39 percent of the population were below the poverty line, including 32 percent of those age 65 or over.

Dr. Cook’s clinic is a small community unto itself and eagerly accepts donations to continue some of the services the surrounding residents have come to depend upon. The medical clinic building is flanked by an adult care building and learning center building. At the end of the square lies a thrift store-style facility. Unfortunately, due to lack of funding, the adult care and learning center has closed. Yet, the medical clinic building almost doubled in size due to a private donation in 1991.

“We do the best we can with what we have,” Dr. Cook said. “Sometimes we have more. Sometimes less. But we always make it work here.”

Working in a rural setting presents unique challenges for any physician. But in 2001, Dr. Cook was faced with one of her most challenging moments when she stopped to help a vehicle of stranded motorists just outside of town.

She was on her way to the clinic when she spotted the car on the side of the road. It needed a jump, so she pulled up and got out of her vehicle with her jumper cables. Ready to deliver roadside aide, Dr. Cook wasn’t prepared for what happened next.

She was knocked unconscious and tossed into the trunk of her vehicle. Driven down a desolate road deep into the county and only partially conscious, she wasn’t sure what was happening until shots were fired into the trunk. Five shots rang out. Four missed. One grazed her cheek.

“God didn’t want me to die that day,” she said. Today, she can look back on the incident with an ease that she surely didn’t have 15 years ago. It’s part of Dr. Cook’s character, woven into every fiber of her soul that keeps her soldiering on every day to treat the patients she’s grown to call members of her extended family.

And…she still makes the occasional house call.

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The Science of Food

The Science of Food

Vestavia Hills – Luis Pineda, M.D., MSHA, has been a practicing oncologist/hematologist for about 38 years. Like many in his field, he longed for a way to make the treatments for cancer easier for his patients.

His life’s work took an interesting turn in 2003 during rounds as he began to notice the cans of liquid supplements on the nightstands of his patients. Each day, there were more cans, and his patients continued to suffer the lingering effects of chemotherapy and radiation. Loss of appetite, nausea, vomiting, and other symptoms robbed Dr. Pineda’s patients from the simple act of eating a meal to regain the nutrients they needed to fight the cancer he was helping their bodies to overcome.

“I realized I needed to help my patients in a different way, by combining my knowledge of medicine with the science of food,” Dr. Pineda said. “This led me to Culinard where I could experiment with medicine and the art of cooking. I needed to find ways to stimulate their taste buds after their chemo and radiation. There truly is a science to food.”

For two years of eight-hour Saturdays, Dr. Pineda traded his physician’s jacket for a chef’s coat as he became a student again – this time at the Culinary Institute at Virginia College. His mission was different from the other chefs-in-training, but the outcome would be the same – to give others pleasure through food.

As a student, his instructors noticed some of Dr. Pineda’s culinary combinations were a bit unorthodox, yet they served a purpose. He began to craft dishes that used ingredients intended to stimulate taste, aid in digestion, ease mouth inflammation, and even detoxify the body. His concoctions are quite tasty as well!

“It’s easy to use simple, everyday inexpensive ingredients to bring good things back to the body,” Dr. Pineda said. “Our cultures center around the kitchen. It’s where we gather and make memories that last a lifetime. When something happens to take that away from us, it takes more than just food from us. It takes those good memories away from us.”

While Dr. Pineda’s recipes have not been scientifically tested by the traditional standards of medical research, they are based upon his knowledge as a trained physician and chef. Each recipe is created for a specific reason, highlighting ingredients that are known to be cathartic in some way. For example, many of Dr. Pineda’s recipes rely on chili peppers due to their levels of capsaicin, which can stimulate a cancer patient’s taste buds as well as ease symptoms of nausea.

Dr. Pineda’s mission to help those with cancer enjoy a better quality of life through good food culminated in the creation of Cooking with Cancer, Inc., a non-profit organization with the ultimate goal to provide better understanding of how food can be a healing factor in cancer patients. Cooking with Cancer, Inc., operates on donations and by the sale of Dr. Pineda’s cookbook, Prescription to Taste, A Cooking Guide for Cancer Patients. The cookbook and companion DVD have sold more than 30,000 copies nationally and internationally.

For Dr. Pineda, there is no standing still. He continues to push forward in educating his patients toward new eating habits, by guest lecturing on cancer prevention and community outreach, and with cooking demonstrations, but there is always more to learn.

“There’s always something new to learn in cooking and in medicine,” Dr. Pineda said. “There’s always someone we can help. My dream is that every patient diagnosed with cancer receives a copy of this book for free.”

To learn more about Cooking with Cancer, Inc., to order a cookbook or make a donation, visit the website at www.cookingwithcancer.org.

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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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Official Statement on the Medicaid Funding Crisis

Official Statement on the Medicaid Funding Crisis

May 5, 2016 – Alabama’s physicians are urging our state lawmakers and Gov. Bentley to start now to find a permanent revenue solution to fully fund Alabama Medicaid before the next fiscal year.

“Alabama already runs the most bare-bones Medicaid program in the country,” said Medical Association Executive Director Mark Jackson, “so to end this legislative session without an appropriate funding solution is more than heartbreaking. It’s dangerous. In just five months, one-quarter of our state’s population will be at risk of losing their access to health care because of the legislature’s inability to come to an agreement on funding options that would have helped close the $85 million gap in Medicaid’s budget. 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. We are asking Gov. Bentley and our legislators begin work today to find a permanent funding plan to secure Medicaid and reassure our residents that the medical care they need will remain within their grasp. The Medical Association remains ready to work with our elected officials to find a permanent solution to the Medicaid funding crisis.”

The Medical Association believes Alabama Medicaid is more than an insurance program for the poor and underinsured and must be fully funded as it is critical to the health care infrastructure of our state. Alabama Medicaid provides health coverage for eligible children, pregnant women, and severely disabled and impoverished adults – about 1 million Alabamians.

Alabama’s physicians strongly believe that Medicaid matters … to all Alabamians.

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Statement Opposing VA Proposed Rule on APRNs

Statement Opposing VA Proposed Rule on APRNs

Alabama Delegation Supports AMA Resolution Opposing Proposed VA Rule

UPDATE June 16, 2016: This week at the AMA Meeting the Association’s AMA Delegation joined others in support of a resolution opposing the proposed Department of Veterans Affairs rule that would expand the role of all Advanced Practice Registered Nurses, including nurse anesthetists.

The AMA resolution in opposition to the VA proposal follows earlier statements in opposition to the rule, and is in line with the Association’s position, and reads that the policy in the rule is “antithetical to multiple established policies of our AMA and thus should not be implemented.” The resolution directs AMA staff to assess feasibility of pursuing federal legislation to prevent the rule, calls on Congress to disapprove the rule, and suggestion collaborations between the AMA and other medical professional organizations to oppose the final adoption of the rule.

Dr. Carolyn Clancy, the VA’s Assistant Deputy Under Secretary for Health Quality, Safety and Value, spoke before the AMA reference committee encouraging members to submit comments during the 60-day public comment period, which ends July 25. Comments may be submitted online at www.SafeVACare.org.

It is the opinion of the Medical Association that this proposed rule change would undermine the delivery of care within the VA system. Our country’s health care system relies on physician-led teams to improve care and reduce costs. Physicians receive more than 10,000 hours of education and training and bring a wealth of value to the health care team. To deny any patient access to qualified physician-led, team-based care is simply inadequate, and our nation’s veterans deserve more from our health care system. In 2014 the Medical Association spearheaded a registry of physicians willing to treat veterans outside the VA system hoping to shorten the amount of time our veterans face before getting appropriate medical care.

Protecting Veterans’ Access to Physician-Led Medical Care

UPDATE June 10, 2016: As previously reported, the Medical Association is joining various medical associations and societies in opposition to the Department of Veterans Affairs’ proposed amendment to its medical regulations to permit full practice authority of all VA advanced practice registered nurses (APRNs) when acting within the scope of their VA employment.

Now, there is a letter being circulated by U.S. Rep. Dan Benishek (R-MI) expressing his “deep concern about the potential impact of this change to the long-standing best practices on the veterans the VHA serves.” Rep. Benishek, who is Chair and Ranking Member of the House Veterans’ Affairs Subcommittee on Health, began circulating his letter of support to continue physician-led health care in the VA medical system in late May, wrote “a sudden change to the status of nurses and the abandonment of the care team model would be extremely disruptive, leaving many of us with inappropriate staffing ratios which would directly compromise patient safety and limit our ability to provide quality care to veterans.”

To date, Alabama Reps. Martha Roby and Mo Brooks have signed on in support of Rep. Benishek’s letter. The Medical Association will be calling on all of Alabama’s Congressional Delegation to do the same. While the Medical Association applauds the VA for addressing the challenges that face the patients inside the VA health care system, the Association is drafting comments to submit opposing the proposed rule because we believe a physician-led team is the best approach to improving quality care for our nation’s veterans.

UPDATE June 3, 2016: The Medical Association will be joining the American Medical Association and other state medical associations and societies in opposition to the Department of Veterans Affairs’ proposed amendment to its medical regulations to permit full practice authority of all VA advanced practice registered nurses (APRNs) when acting within the scope of their VA employment. While the Medical Association applauds the VA for addressing the challenges that face the patients inside the VA health care system, the Association is drafting comments to submit opposing the proposed rule because we believe a physician-led team is the best approach to improving quality care for our nation’s veterans.

This rule proposed by the Department of Veterans Affairs is intended to increase veterans’ access to VA health care by expanding the pool of health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians. The proposed rulemaking would establish additional professional qualifications an individual must possess to be appointed as an APRN within VA. The proposed rulemaking would subdivide APRNs into four separate categories including certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist, and certified nurse-midwife. The proposed rulemaking would also provide the criteria under which VA may grant full practice authority to an APRN, and define the scope of full practice authority for each category of APRN.

It is the opinion of the Medical Association that this proposed rule change would undermine the delivery of care within the VA system. Our country’s health care system relies on physician-led teams to improve care and reduce costs. Physicians receive more than 10,000 hours of education and training and bring a wealth of value to the health care team. To deny any patient access to qualified physician-led, team-based care is simply inadequate, and our nation’s veterans deserve more from our health care system. In 2014 the Medical Association spearheaded a registry of physicians willing to treat veterans outside the VA system hoping to shorten the amount of time our veterans face before getting appropriate medical care.

Therefore, the Medical Association urges the Department of Veterans Affairs to maintain the integrity of the physician-led health care team model within the VA health system to ensure greater integration and coordination of care for our veterans and improve health outcomes.

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Physician Groups Issue Joint Statement on 2016 Special Session Announcement

Physician Groups Issue Joint Statement on 2016 Special Session Announcement

July 27, 2016 | MONTGOMERY – Our organizations applaud the Governor and are encouraged that he has taken the first step toward fully funding Alabama Medicaid by announcing his intention to call a special session.

As for his proposal for a lottery, we support the passage of new revenue that will provide for a long-term fix for Medicaid. As with any legislation, we will need to see the details of what he is proposing to ensure that it does in fact fully fund Medicaid’s needs for the long term before we can take a formal position.

In addition to the need for long-term funding, there is also a critical need to fix the $85 million shortfall in the 2017 budget, which the lottery will not do because of the time necessary for implementation. Consequently, it is important that the Governor and lawmakers find both a solution for 2017 and a long-term a revenue stream for Alabama Medicaid. We are concerned that the Governor did not address a short-term funding solution in his announcement today.

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.

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.

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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Official Statement on Special Session/Medicaid Funding

Official Statement on Special Session/Medicaid Funding

Sept. 7, 2016 – The Medical Association of the State of Alabama would like to thank the members of the Alabama House of Representatives and Senate who supported the passage of the BP legislation today, which will provide much needed additional funding for Alabama Medicaid. We are pleased that our lawmakers have worked together for a solution for FY 2017 as well as providing additional funds for FY 2018. We are hopeful this additional funding will allow physician practices that were forced to lay off individuals to resume normal operations and continue to provide access to care to their Medicaid patients.

“Alabama already runs the most bare-bones Medicaid program in the country,” said Medical Association of the State of Alabama Executive Director Mark Jackson. “Without this additional funding, the cuts that Medicaid had implemented beginning Aug. 1, would have been dangerous to the infrastructure our state’s health care system. This additional funding will provide some stability to the system which covers more than half the births in Alabama, 47 percent of our children, and 60 percent of our nursing home residents.”

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