Archive for December, 2017

UPDATE: BCBS New Opioid Management Strategy Effective April 1

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UPDATE: BCBS New Opioid Management Strategy Effective April 1

UPDATED MARCH 21, 2018 — Blue Cross and Blue Shield of Alabama is launching an opioid management strategy in an effort to battle the growing opioid epidemic in Alabama, as well as a response to concerns for customers’ care and safety and the rising costs of health care. The new requirements will be effective April 1, 2018.

BCBS Alabama’s opioid management strategy implements the following requirements:

  • Members will be limited to a seven-day supply the first time they fill a short-acting opioid medication. If an initial fill for a supply of more than seven days is needed, a member can ask his or her doctor to submit a one-time prior authorization for an initial fill of a supply greater than seven days. Short-acting opioid medications include Lortab, Vicodin, Percocet, etc.
  • Members will be required to obtain a prior authorization for all first-time prescriptions for long-acting opioid medications, including OxyContin and MS Contin.
  • Naloxone (the generic of Narcan), the antidote for an opioid overdose, will be available to most members for the generic copayment. This includes both the prefilled syringes and nasal spray. Evzio is no longer covered. Evzio is naloxone packaged in an auto-injector.

In 2015, Alabama ranked first in the nation in the number of opioid scripts per capita. The recent Blue Cross and Blue Shield Association’s Health of America report on the opioid epidemic showed over 26 percent of its commercial members in Alabama filled at least one opioid prescription in 2015, and 16 per 1,000 members were diagnosed with opioid use disorder. The Centers for Disease Control and Prevention reports between 2000 and 2015 more than half a million people across the U.S. died from drug overdoses, and 91 Americans die each day from an opioid overdose.

The Medical Association’s Third-Party Task Force and Board of Censors continue to collaborate with Blue Cross to help curb the growing epidemic of opioid misuse by offering support, resources and educational tools. For more information, please contact your Blue Cross representative.

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Alabama Experiences Significant Influenza Activity this Season

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Alabama Experiences Significant Influenza Activity this Season

Influenza activity levels are increasing across the State of Alabama. Several positive influenza specimens in northern Alabama have been identified in the previous three weeks. While the flu season is just getting started in much of the country, activity is already high in Alabama. Flu is a very contagious respiratory illness. Some of the symptoms of influenza include fever, cough, sore throat, runny/stuffy nose, headache, muscle aches and extreme fatigue.

“Increased numbers of providers who report influenza-like illness and send influenza samples for testing to public health suggest an indication of a geographic spread of influenza in Alabama,” said Dr. Karen Landers, District Medical Officer for the Alabama Department of Public Health. “This is concerning because influenza can be a serious disease for anyone, even children, pregnant women and previously healthy young adults.”

An annual influenza vaccination is recommended for everyone age 6 months and older and is the best prevention against getting the flu. Physicians, pharmacists and county health departments can provide flu vaccinations for Alabamians.

In addition to taking the flu vaccine, other measures can reduce or prevent the spread of influenza. These include staying at home when sick, covering the mouth and nose with a tissue/cloth when coughing or sneezing, and washing hands or using hand sanitizer frequently.

“Even healthy people can get very sick from the flu and spread it to others. It’s not too late to get a flu shot to protect against this serious disease. People become protected about two weeks after receiving the vaccine,” said Dr. Landers.

Contact your physician, pharmacy or local county health department to receive an influenza vaccination. For more information about the flu visit http://www.alabamapublichealth.gov/immunization/index.html, and to save money on your flu medicine visit AlabamaRxCard.com.

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An Overlooked Epidemic: Older Americans Taking Too Many Unneeded Drugs

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An Overlooked Epidemic: Older Americans Taking Too Many Unneeded Drugs

Consider it America’s other prescription drug epidemic.

For decades, experts have warned that older Americans are taking too many unnecessary drugs, often prescribed by multiple doctors, for dubious or unknown reasons. Researchers estimate that 25 percent of people ages 65 to 69 take at least five prescription drugs to treat chronic conditions, a figure that jumps to nearly 46 percent for those between 70 and 79. Doctors say it is not uncommon to encounter patients taking more than 20 drugs to treat acid reflux, heart disease, depression or insomnia or other disorders.

Unlike the overuse of opioid painkillers, the polypharmacy problem has attracted little attention, even though its hazards are well documented. But some doctors are working to reverse the trend.

At least 15 percent of seniors seeking care annually from doctors or hospitals have suffered a medication problem; in half of these cases, the problem is believed to be potentially preventable. Studies have linked polypharmacy to unnecessary death. Older patients, who have greater difficulty metabolizing medicines, are more likely to suffer dizziness, confusion and falls. And the side effects of drugs are frequently misinterpreted as a new problem, triggering more prescriptions, a process known as a prescribing cascade.

The glide path to overuse can be gradual: A patient taking a drug to lower blood pressure develops swollen ankles, so a doctor prescribes a diuretic. The diuretic causes a potassium deficiency, resulting in a medicine to treat low potassium. But that triggers nausea, which is treated with another drug, which causes confusion, which in turn is treated with more medication.

For many patients, problems arise when they are discharged from the hospital on a host of new medications, layered on top of old ones.

Alice Cave, who divides her time between Alexandria, Va., and Tucson, Ariz., discovered this when she traveled to Cheyenne, Wyo., after her 87-year-old aunt was sent home following treatment for a stroke in 2015.

Before her hospitalization, Cave said, her aunt, a retired telephone company employee whose vision is impaired by glaucoma, had been taking seven drugs per day. Five new ones were added in the hospital, Cave said.

“She came home and had a huge bag of pills, half of which she was already taking, plus pages and pages of instructions,” she said. Some were supposed to be taken with food, some on an empty stomach. Cave said she spent several hours sorting the medications into a giant blue pillbox. “It was crazy — and scary.”

Cave said she felt helpless to do much; her aunt’s doctors didn’t question the need for more drugs.

When Shannon Brownlee’s mother was taken to an emergency room recently to determine whether her arm pain might signal a heart attack (it didn’t) a cardiologist prescribed five new drugs — including an opioid — to the small dose of a diuretic she had been taking to control her blood pressure.

Brownlee, senior vice president of the Lown Institute, a Boston-based group that seeks to improve health care quality by reducing unnecessary treatment, said that when her brother questioned the necessity of so many new drugs for a woman in her late 80s, the specialist replied frostily, “I don’t see anything wrong with prescribing lots of medication to older people.”

Bring the Pill Bottles

“This problem has gotten worse because the average American is on a lot more medications than 15 years ago,” said cardiologist Rita Redberg, a professor of medicine at the University of California at San Francisco.

Studies bolster Redberg’s contention: A 2015 report found that the share of Americans of all ages who regularly took at least five prescription drugs nearly doubled between 2000 and 2012, from 8 percent to 15 percent. University of Michigan researchers recently reported that the percentage of people older than 65 taking at least three psychiatric drugs more than doubled in the nine years beginning in 2004. Nearly half of those taking the potent medications, which include antipsychotic drugs used to treat schizophrenia, had no mental health diagnosis.

Redberg and other doctors are trying to counter the blizzard of prescriptions through a grass-roots movement called “deprescribing” — systematically discontinuing medicines that are inappropriate, duplicative or unnecessary.

Interest in deprescribing, which was pioneered in Canada and Australia, is growing in the United States, bolstered by physician-led efforts, such as the five-year-old Choosing Wisely campaign. The Beers Criteria, a list of overused and potentially unsafe drugs for seniors first published in 1991, has been followed by other tools aimed at curbing unnecessary drug use.

“Lots of different medications get started for reasons that are never supported by evidence,” said Redberg, editor in chief of JAMA Internal Medicine. “In general, we like the idea of taking a pill” a lot better than non-drug measures, such as improved eating habits or exercise.

“That’s what we were taught as physicians: to prescribe drugs,” said Ranit Mishori, a professor of family medicine at Georgetown University and a proponent of deprescribing. “We are definitely not taught how to take people off meds.”

Kathryn McGrath, a Philadelphia geriatrician, said she tries to begin every appointment with a review of medications, which she asks patients to bring with them. “I think having the pill bottles” is much more powerful than a list, said McGrath, who has written about how to deprescribe safely.

Although support is growing, deprescribing faces formidable obstacles.

Among them, experts say, is a paucity of research about how best to do it, relentless advertising that encourages consumers to ask their doctors for new drugs, and a strong disinclination – baked into the culture of medicine — to countermand what another physician has ordered. Time constraints play a significant role. So do performance measures that are viewed as a mandate to prescribe drugs even when they make virtually no sense, such as giving statins to terminally ill patients.

A Reluctance to Overrule

“There’s a reluctance to tinker or change things too much,” said University of Michigan geriatric psychiatrist Donovan Maust, who labels the phenomenon “clinical inertia.” When inheriting a new patient, Maust said, doctors tend to assume that if a colleague prescribed a drug, there must be a good reason for it — even if they don’t know what it is. Maust said he tries to combat inertia by writing time-limited orders for medication.

He recently began treating a man in his 80s with dementia who was taking eight psychiatric drugs — each of which can cause significant side effects and most of which had been prescribed for undetermined reasons.

“It’s very typical to see a patient who has a few episodes of reflux and is then put on a [proton pump inhibitor, or PPI] and a few years later are still taking it,” said Georgetown’s Mishori. Many experts say the heartburn drugs are overprescribed, and studies have linked their long-term use to fractures, dementia and premature death.

“This is a cultural problem and an awareness problem exacerbated by the fragmentation of care,” said Brownlee, the author of “Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.” Many doctors, she added, have never heard of deprescribing.

Before his death several years ago, doctors advised Brownlee’s father, a hospice patient, to continue taking a statin, along with several other medications. None would improve or extend his life, and all had potentially harmful side effects.

Rx: What For?

Older people taking lots of medication was what Canadian pharmacist Barbara Farrell encountered when she began working at a geriatric hospital in Ottawa nearly two decades ago. Her experience, she said, was a catalyst for the Canadian Deprescribing Network, a consortium of researchers, physicians, pharmacists and health advocates she co-founded. The group seeks to drastically reduce inappropriate medication use among Canadian seniors by 2020.

Farrell, a clinical scientist at the Bruyere Research Institute, has also helped write guidelines, used by doctors in the United States and other countries, to safely deprescribe certain classes of widely used drugs, including proton pump inhibitors and sedatives.

“I’ve found a lot of receptivity” to the guidelines among physicians, Farrell said. “We know there are pockets around Canada and the world where they’re being implemented.”

One of Farrell’s most memorable successes involved a woman in her late 70s who was using a wheelchair and was nearly comatose.

“She would literally slide out of her chair,” Farrell recalled. The woman was taking 27 drugs four times per day and had been diagnosed with dementia and a host of other ailments.

After reviewing her medications, Farrell and her colleagues were able to weed out duplicative and potentially harmful drugs and reduce the doses of others. A year later, the woman was “like a different person”: She was able to walk with a cane and live mostly independently, and she reported that her doctor said she did not have dementia after all.

When Farrell asked another patient why she was taking thyroid medication, the woman replied that her doctor had prescribed it for weight loss after her last pregnancy — in 1955.

“The patients I see are the tip of the iceberg,” Farrell said.

One way to facilitate deprescribing, Farrell said, is to require doctors to record why a drug is being prescribed, a proposal the deprescribing network has made to Canadian health officials. A recent study by a team from the Boston VA Healthcare System found strong support among doctors for this concept.

While some doctors are reluctant to discontinue medications, patients can be wary, too.

“They may say, ‘I tried stopping my sleeping pill and I couldn’t sleep the next night, so I figured I needed it,’” Farrell said. ” Nobody explained to them that rebound insomnia, which can occur after stopping sleeping pills, lasts three to five days.”

Mishori said that she deprescribes only one medication at a time so she can detect any problem that arises from that change. And, she adds, “I never take people off of a medication without doing something else.” In the case of heartburn drugs, she might first recommend taking the drug only when needed, not continuously. Or she might suggest a safer alternative, such as an over-the-counter antacid tablet.

Maust, the geriatric psychiatrist, recommends that doctors actively focus on “the big picture” and carefully weigh whether the benefits of a drug outweigh its risks.

“In geriatrics,” he said, “less is more.”

By Sandra G. Boodman. KHN’s coverage related to aging and improving the care of older adults is supported in part by The John A. Hartford Foundation.

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Medical Association Works to Ease MOC Frustrations

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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

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

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

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

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

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

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

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

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

What is the role of organized medicine?

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

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

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

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

female doctor smiling

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

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

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

Staying connected.

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

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

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

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

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

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

male doctor smiling

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

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

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

Filtering out the noise.

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

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

male doctor in scrubs

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

Organized medicine offers more than advocacy.

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

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

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

male doctor smiling

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

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

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

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

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

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

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

Ultimately, it’s always about the patient.

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

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

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

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

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

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UPDATE: FCC Votes to Repeal Net Neutrality

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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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HIPAA and the Holidays

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HIPAA and the Holidays

As the holiday season builds momentum we are faced with numerous distractions like holiday decorations, taking advantage of online sales and soaking in the traditions that we look forward to each year. But this season of joy and giving should also be met with a heightened sense of awareness and adherence to HIPAA policies and procedures. You’re likely thinking to yourself, “How can Christmas, Hanukkah, Kwanza or the New Year impact HIPAA?” Well, those holidays can’t, but your employees’ behavior sure can.

Electronic Protected Health Information (ePHI)

This busy season will cause some employees to take advantage of online shopping while at work. While that seems relatively harmless, and in most cases it is, this also invites the possibility of introducing viruses into your system from unprotected and/or unapproved sites. It is important to have a clear policy and procedure regarding internet access on your entity’s equipment and it is equally important to ensure that your entity is enforcing compliance. Likewise, the threats of ransomware are ever increasing. A distracted employee is more likely to click a suspicious link or open a questionable email that could introduce ransomware into your computer system or electronic medical records. This is a great time to remind staff of their responsibilities to protect ePHI.

Physical Security

Unfortunately, the season of “giving” for some means a season of “taking” for others. Generally, criminal activity like property theft and break-ins rise during the shopping season. This makes it extremely important for your entity to adhere to mandatory HIPAA Physical Safeguards. The HIPAA Security Rule requires entities to have a documented Facility Security Plan, which memorializes the use of physical access controls. Specifically, entities are required to “implement policies and procedures to safeguard the facility and the equipment therein from unauthorized physical access, tampering, and theft.”[1] The entity’s designated HIPAA Security Officer should be reminding employees of the policy of not providing keys or swipe access to individuals who are not employees or staff members of the entity. Additionally, HIPAA Security Officers should review and document the use of cameras, alarm systems, keys and swipe cards to assess whether any changes need to be made to address any areas of vulnerability.

This is also particularly important for employees and staff who travel with PHI or ePHI. Whether it is paper records or a laptop, employees and staff should ensure they are not leaving these items in their vehicles in plain view. We advise our clients to have a policy that requires employees to leave any PHI or ePHI in the trunk of their vehicle where it is not visible or inviting for a would-be-thief. This can significantly reduce the entity’s risk of HIPAA breaches, as well as property loss.

Workstation Security

Many health care providers will experience an increase in patient activity as people clamber to make their end of the year appointments to take advantage of any cost savings before the new year begins. Combine that with flu-season and the prevalence of winter illnesses and all of a sudden the waiting room just became standing room only. The euphoric nature of the season, coupled with a dramatic increase in patient activity can be a recipe for HIPAA violations. While employees struggle to keep up with the demand, they are more likely to be careless about workstation security. They become less likely to lock their computers when they walk away from their station and more likely to share usernames and passwords in order to accomplish certain tasks more quickly. While these activities seem relatively harmless, these are violations that can cost the entity greatly if it leads to breaches of PHI or ePHI.

Visitors and Guests

The holidays aren’t nearly as fun without office holiday parties. These parties generally include catered meals, outside delivery services and even invited guests. Entities should ensure that they have a documented visitor/guest policy and procedure and that their employees follow that procedure. This includes a visitor/guest sign-in. Depending on the layout of the facility, these visitor/guests should be escorted to their destination so that they don’t have an opportunity to view documents or lab reports that may be left unattended in the facility.

Delivery personnel and vendors are not the only individuals subject to that policy. Family members and friends who present to the facility to visit with staff members and employees must also adhere to the entities visitation policies. Just because the person may be a relative or close friend does not earn them the right to overhear conversations about patient PHI or the right to view PHI that may be on someone’s desk or workstation.

Tone of Voice

One of the biggest complaints that our office receives regarding patient privacy is the tone of voice used by employees and staff as they discuss their health conditions. During the holiday season, many entities play festive music in their waiting areas which automatically cause employees and staff to raise their voices as they converse with patients or other providers. Entities should pay particular attention to the location of their waiting rooms and the position of their reception desk. Employees and staff should be advised of this concern and reminded of the importance of using a professional tone that would not give rise to unauthorized or inappropriate disclosures of PHI.

This is without argument “the most wonderful time of the year.” It’s a time to enjoy family, get reacquainted with friends, and provide for the health and well-being of patients. As the activity of the season builds, it is important to make every effort to ensure that your entity is in compliance with HIPAA regulations. Adhering to appropriate policies and procedures will not only ensure that you provide appropriate patient care, it will also reduce the likelihood of liability for violations which is a great way to start the New Year.

[1] § 164.310(a)(2)(ii)

Samarria Dunson, J.D., CHC, CHPC is attorney/principal of Dunson Group, LLC, a health care compliance consulting and law firm in Montgomery, Alabama.  www.dunsongroup.com  Read other articles from Dunson Group here.

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AG Steve Marshall Speaks at November Education Weekend

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AG Steve Marshall Speaks at November Education Weekend

BIRMINGHAM – Alabama Attorney General Steve Marshall addressed attendees during the Association’s Annual Medical Ethics seminar on Friday, Nov. 17, at the Hyatt Regency Hotel in Birmingham and helped kick off one of the largest weekends of educational offerings the Association has hosted since 2014.

The weekend began on Friday, Nov. 17, with Ensuring Quality in the Collaborative Practice and Medical Ethics courses. This was the first time an attorney general has spoken to the participants.

By Saturday, Nov. 18, the room was filled with more than 430 participants for the final Prescribing of Controlled Drugs and Controversies of Pharmacology Prescribing course of 2017. The Association’s opioid prescribing courses began in 2009 and is offered at least three times annually. By the end of 2017, more than 5,000 participants – from physicians, physician assistants and nurse practitioners – had taken the course.

The Prescribing course will return in 2018 on March 17-18, August 3-5 and November 17-18. More information will be available at a later date.

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Annual Session Poster Symposium Winner Presents in Hawaii…and Wins!

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Annual Session Poster Symposium Winner Presents in Hawaii…and Wins!

Dr. Bradley Wills, who originally received first place at the Medical Association’s Second Annual Poster Symposium in April for his poster entitled Outcomes with Overlapping Surgery at a Large Academic Medical Center, presented his research poster at the 2017 AMA Interim Meeting in Honolulu in November and won the Resident-Fellow Section Division for Clinical Medicine.

At the Medical Association’s Annual Meeting, Dr. Wills’ poster was one of 32 entries from the Medical Student and Resident-Fellow Sections. All medical schools and many residency programs participated in this year’s program. Dr. Wills, an orthopaedic surgery resident at UAB, received $300 for his first place win, as well as the opportunity to present at the AMA Interim Meeting.

The Medical Association is preparing now for the Third Annual Poster Symposium as part of the Annual Meeting in April 2018. More details will be available soon.

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