Archive for December, 2020

Discussions with Decisionmakers: Barry Moore

Discussions with Decisionmakers: Barry Moore
Discussions with Decisionmakers

1. Please tell us a little bit about yourself – Primary occupation? Interests? Hobbies?

I am Barry Moore from Enterprise, Alabama. I grew up on a farm in Coffee County. In 1992 I graduated from Auburn University with a degree in Agricultural Science. Since 1998, my wife Heather and I own and operate Hopper-Moore Inc., a waste-hauling and demolition company. I served in the Alabama House as District 91’s State Representative for 8 years. During that tenure I served as Chairman of Military and Veteran Affairs and several other committees. Heather and I have four children- Jeremy, Kathleen, Claudia and Jeb.

2. What first prompted you to consider running for your House District seat and how do you believe your background and experiences help you serve in the legislature?

I have four fundamentals that guide all aspects of my life: Faith, Family, Finance and Freedom. I felt this has been a calling from God and I have answered that call. Our nation must have leaders with the courage to stand and serve with humility. I am a veteran and the only veteran serving in the Alabama delegation. I ran for Congress in 2018 against an incumbent. It laid the ground-work for 2020 when Congresswoman Roby decided to retire. With much prayer I entered the race along with seven other candidates and by the grace of God, I won. My experience in the Alabama House gave me a track record of how I voted and my work ethic. I was voted the most conservative dependable vote and I will continue to serve my constituents in the same manner.

3. Can you tell us a little about some health-related issues important to your district and your constituents?

Right now, protecting our rural hospitals is very important to District 2. These hospitals are front line to so many different health care emergencies to include CoVid and Mental Health.

4. If you could change one thing about our current healthcare system, what would it be?

I would encourage more physician-patient confidentiality and keep the government out of the decision-making process that may place unnecessary pressure upon the patient or the physician. In other words, let our doctors do their job without the interference of the government.

5. How can the Medical Association – and physicians statewide – help you better address our state (and nation’s) current health challenges?

Continue to work together with an open line of communication and dialogue that effectively serves the people.

6. What’s the one thing you would like to say to physicians in your district?

Absolutely want to say a huge THANK YOU for the incredible job you are doing. The year 2020 has been a year like no other and without our physicians working the way they have, especially the front-line physicians, working directly with CoVid patients, our state would have suffered even greater. My office will always be grateful and open to MASA and look forward to working together.

Posted in: Advocacy

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Discussions with Decisionmakers: Jerry Carl

Discussions with Decisionmakers: Jerry Carl
Discussions with Decisionmakers

1. Please tell us a little bit about yourself – Primary occupation? Interests? Hobbies?

I have spent most of my life creating and building small businesses, primary dealing with home healthcare equipment and specialty pharmacies. Presently, my wife and I own one pharmacy that serves hemophilia patients. In my spare time, I love being outdoors, hunting, fishing, and spending time with my grandkids.

2. What first prompted you to consider running for your House District seat and how do you believe your background and experiences help you serve in the legislature?

As a native of Mobile, I love everything about my district and have always been proud to call it home. I care about our area and want to do everything possible to help improve the lives of everyone who calls South Alabama home. I have no doubt my experience working with all levels of government as a county commissioner has prepared me well to serve as Congressman for the First District.

I felt prompted to run for Congress when my son, a Marine, came back from active duty in Afghanistan, and I saw the struggles he was having with the VA healthcare system. I knew with my business background and knowledge of the medical industry, I could help make a difference in the lives of our veterans.

3. Can you tell us a little about some health-related issues important to your district and your constituents?

The immediate issue facing our area is the Covid-19 pandemic. It will be key to work with local and state governments to continue limiting the spread of the virus, as well as distributing vaccines once they are available. Moving forward, we must refocus on the rising costs of healthcare, including prescription medication. I look forward to working closely with all levels of government and the AMA to help address these issues.

4. If you could change one thing about our current healthcare system, what would it be?

Our insurance markets need greater competition. I believe we need market-based insurance solutions rather than bloated government programs. This includes allowing individuals the ability to purchase their insurance across state lines and ensuring those with pre-existing conditions are protected.

5. How can the Medical Association – and physicians statewide – help you better address our state (and nation’s) current health challenges?

Overcoming the challenges our healthcare system faces is complex and will require hard work on all sides of the issue. Anytime the Association, physicians, and other medical stakeholders in our state have a concern or an idea, please reach out to me. The more I understand the challenges you face, the more likely we will be to find a solution together.

6. What’s the one thing you would like to say to physicians in your district?

Thank you for all you do for our community day in and day out, especially this year. Covid-19 has been difficult on every American. However, no one has felt this more than our physicians and healthcare workers. 2020 has reminded everyone just how important our physicians are, and I am grateful for the work you continue to do for the people of our district.

Posted in: Advocacy

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ALAPAC Announces New Regional Board Program

ALAPAC Announces New Regional Board Program

The Alabama Medical PAC (ALAPAC) recently revised its bylaws to create 10 Regional Boards (RB) that will increase specialty and individual practice participation in local and statewide candidate support decisions.

Under this new structure:

  1. Each specialty with at least a 25% multi-year average participation in ALAPAC will be invited to nominate a physician for each RB throughout the state, and,
  2. Each individual practice with 100% multi-year ALAPAC participation will be invited to nominate a member of the practice to the local RB.  

“The ALAPAC Board is excited about this new direction and believes it will better help us raise funds to aid in the election of candidates we as physicians can work with on complex health policy issues,” Chair David Herrick, M.D., said.

Physicians nominated by either their specialty or their practice to serve on an RB must maintain Medical Association membership and ALAPAC contributor status to continue serving. As well, each RB member will work with ALAPAC to increase contributions from amongst local physicians of his or her respective specialty. 

If your specialty or your practice qualifies for the new RB program, society leadership and practice members and staff will soon be notified. If you have questions about or would like to check on your specialty’s or your practice’s eligibility, please contact Niko Corley at ncorley@alamedical.org or (334) 261-2000. 

Posted in: Advocacy, ALAPAC

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CMS and OIG Issue Historic Revisions to the Federal Anti-Kickback Statute and Stark Law

CMS and OIG Issue Historic Revisions to the Federal Anti-Kickback Statute and Stark Law

By: Anthony Romano with Burr Forman

On November 20, 2020, the Centers for Medicare & Medicaid Services and the Office of Inspector General of the Department of Health and Human Services issued two significant final rules to reform the Anti-Kickback Statute and Stark Law in an aim to reduce regulatory barriers to coordination of patient care, and to accelerate the transformation of the health care system to value-based care (a value-driven health care system that pays for health and outcomes, as opposed to the traditional fee-for-service payment system which rewards providers for the volume of care provided).

The 1,000-page Anti-Kickback Statute final rule does this by implementing seven new safe harbors, modifying four existing safe harbors, and codifying one new exception under the Civil Monetary Penalty Law.  As you are probably aware, the Federal Anti-Kickback Statute provides for criminal penalties for whoever knowingly and willfully offers, pays, solicits, or receives remuneration to induce or reward, among other things, the referral of business reimbursable under any of the Federal health care programs, including Medicare and Medicaid. Health care providers and others may voluntarily seek to comply with statutory and regulatory safe harbors so that they have the assurance that their business practices will not be subject to sanctions under the Anti-Kickback Statute. To receive safe harbor protection, an arrangement must squarely meet each requirement of an applicable safe harbor. However, failure to fit in a safe harbor does not mean that an arrangement violates the Federal Anti-Kickback Statute. Arrangements that do not fit in a safe harbor are analyzed on a case-by-case basis, including whether the parties had the requisite intent. Congress intended the safe harbor regulations to be updated periodically to reflect changing business practices and technologies in the health care industry, and the new final Anti-Kickback Statute regulations accomplish this by, among other things, removing potential barriers to more effective coordination and management of patient care, and by removing potential barriers to the delivery of value-based care.   

The 627-page Stark Law final rule creates new exceptions for value-based arrangements, provides additional guidance to make it easier for physicians and other health care providers to comply with the Stark Law, and provides protection for non-abusive, beneficial arrangements. Unless otherwise specified in the rules, the new provisions go into effect January 19, 2021.  When the Stark Law was enacted in 1989, healthcare was paid for primarily on a fee-for-service basis and the Stark Law recognized that a profit motive could influence some physicians to order services based on their financial self-interest rather than the good of the patient. For this reason, the Stark Law prohibits a physician from making referrals for certain healthcare services payable by Medicare or Medicaid if the physician (or an immediate family member of the physician) has a financial relationship with the entity performing the service. There are statutory and regulatory exceptions, but in short, a physician cannot refer a patient to any entity with which he or she has a financial relationship unless an exception is satisfied.  The Stark Law also prohibits the entity from filing claims with Medicare or Medicaid for services resulting from a prohibited referral, and Medicare or Medicaid cannot pay if the claims are submitted. Although the regulations that interpret the Stark Law have been updated several times, the Stark Law has not been significantly updated since it was enacted in 1989, and all previous changes left in place a framework that is tailored to a fee-for-service environment.  The new Stark Law final rule includes a comprehensive package of reforms to modernize the regulations that interpret the Stark Law while continuing to protect the Medicare program and patients from bad actors.

Overall, these new rules will have a significant, and expected positive, impact on healthcare providers by easing burdensome regulatory restrictions.  With over 1,600 pages of new rules to digest, be on the lookout for more detailed and specific analysis in the near future.  In the meantime, please do not hesitate to contact us if you have specific questions regarding the impact of the new Anti-kickback Statute or Stark Law final rules on you or your practice. 

Anthony Romano practices with Burr & Forman LLP in the firm’s Health Care Industry Group. Anthony may be reached at aromano@burr.com or (205) 458-5210.

Posted in: Legal Watch, MVP

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