Posts Tagged advocacy

Here’s How Alabamians Can Fight Insurance Red Tape That Delays Medical Care

Here’s How Alabamians Can Fight Insurance Red Tape That Delays Medical Care

Alabama doctors and patients frustrated with delays in care caused by insurance companies’ prior authorization process now have a new way to share their stories and promote change.

A new online platform — — invites Alabamians to share their experiences with prior authorization problems. The website and the initiative behind it to encourage faster insurance approvals for medical care was started by doctors with the Medical Association of the State of Alabama.

Doctors say delays caused by prior authorizations can have dangerous impacts on their patients’ health.

>>>Watch this video: Doctors Discuss the Burdens of Prior Authorization<<<

“With prior authorizations, we definitely see a delay in patient care,” said Dr. Tonya Bradley, a physician in Auburn. “I see delays in patients getting chemo, I see delays in patients getting tests they need to diagnose problems that can be very urgent.”

What is Prior Authorization?
Before your doctor provides a treatment, your insurance requires them to prove you need it. Decades ago, prior authorization was used sparingly and typically only to make sure some expensive treatments were absolutely necessary.

But today, even routine medical care requires insurance approval. Denials mean patients and doctors must spend time fighting insurance companies for care.

Takes Time Away From ‘What Really Matters’
When doctors have to spend time arguing with insurance companies over prior authorizations, it means there’s less time for doctors to spend with their patients – their number one priority.

“The bureaucracy. The paperwork. The institutional inertia. The list goes on and on, and it makes it very difficult for us to do what really matters, which is take great care of our patients,” said Dr. George Koulianos of Mobile.

What Alabamians Think
A survey of Alabama doctors found that 76 percent said the time they spend on prior authorizations means they see fewer patients in a day. One-third of doctors said they and their staff spend nearly an entire workday each week filling out prior authorization paperwork, following up with phone calls and fighting denials.

A separate survey of 500 Alabamians showed that 80 percent agree with the statement that “doctors in Alabama are working to spend more time with patients, so that patients and doctors have the time together to make the best health care decisions.”

Dr. Hernando Carter said being able to spend more time with patients rather than prior authorizations results in better health care.

“If you can spend the time to explain to your patient why you’re recommending a test or why you’re recommending a treatment and be able to answer all the questions they have and assuage any concerns or apprehensions they have, then that directly affects how well they do. It directly affects whether they get better or not,” the Birmingham physician said. “So, we abhor anything that interferes or cuts into that time that we have to do that with our patients.”

“We need to have the ability to take care of our patients in an efficient manner, expedite the care and not go through all the red tape,” said Dr. William Admire of Mobile. “When we slow down the progress of patients’ recovery, no one wins.”

Steps to Fix Prior Authorization
Physicians with the Medical Association have begun conversations with the health insurance community to push for changes. Stories submitted through will help support efforts to fix prior authorization in Alabama.

Among the changes doctors want to see are an end to repeat prior authorizations for patients with chronic conditions and faster response times from insurers.

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Association Kicks Off 11 Regional Receptions Tour Across Alabama

Association Kicks Off 11 Regional Receptions Tour Across Alabama

This Fall, the Medical Association’s Governmental Relations team kicked off its Regional Receptions Tour across the state to bring lawmakers and physicians together to help discuss issues affecting medicine in Alabama.  Partnering with 9 medical specialty societies to put on these events, the Association is working to host 11 receptions reaching from Mobile to the Shoals area of Alabama and many places in between. 

At each of these receptions, the Association and other partnering specialties present information to lawmakers to educate them on a variety of topics of interest to physicians and patients.  Local physician involvement is vital to the Medical Association’s success for its members and the patients under their care.  These receptions serve as an excellent opportunity for physicians and local lawmakers to interact and discuss the challenges medicine faces in maintaining access to quality care for patients.

These 11 receptions offer a first-rate occasion for a supportive, multi-specialty effort to proactively educate lawmakers on issues of interest to medicine and foster strong working relationships between local physicians and their elected officials. While the Association and its Government Relations team serve as the “boots on the ground” when working with legislators on health care policy in Alabama, there is no more impactful outreach to legislators on health care issues than that of a local physician constituent. 

The Medical Association appreciates its specialty society partners and the physicians participating in these events.  The Association looks forward to updating its physician members at the conclusion of the 11-reception tour.

Thank you to the specialty societies partnering with the Association on these events:

Alabama State Society of Anesthesiologists

Alabama Academy of Family Physicians

Alabama Section – American College of Obstetricians and Gynecologists

Alabama Academy of Eye Physicians and Eye Surgeons

Alabama Orthopaedic Society

Alabama Psychiatric Physicians Association

Alabama Academy of Radiology

Alabama Chapter – American College of Emergency Physicians

Alabama Society of Allergy, Asthma & Immunology

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Medical Association Supports Continued Funding for Maternal Death Investigations

Medical Association Supports Continued Funding for Maternal Death Investigations

‘Shocking’ Nearly 70% of Deaths Are Preventable, Experts Say      

MONTGOMERY – The Medical Association of the State of Alabama today joined Alabama legislators in calling for continued state funding to investigate why Alabama mothers die from childbirth and pregnancy complications at more than double the rate of women nationally.

The funding for this research, which was first appropriated by Governor Kay Ivey and the Alabama Legislature just last year, enables the Alabama Maternal Mortality Review Committee (AL-MMRC) to pay for additional autopsies and costs associated with compiling case files and reviewing medical records of Alabama mothers who died up to a year after giving birth. While the AL-MMRC was launched in 2018, it relied solely on the work of volunteers to undertake such reviews until last year.

Appearing at a press conference in Montgomery today, Aruna Arora, MD, MPH, President of the Medical Association, applauded Senator Linda Coleman-Madison for sponsoring a resolution spotlighting the findings of the first AL-MMRC report and acknowledging continued funding of the program is critical to saving Alabama mothers.

“The recent report of the Maternal Mortality Review Committee was both shocking and informative,” said Dr. Arora. “That nearly 70 percent of the deaths could have possibly been prevented highlights the inequities of our current health system and underscores the need for the continued annual review to determine why these high numbers of deaths are occurring. Funding the review committee provides invaluable insight into the deaths of Alabama mothers and will enable the experts to develop specific strategies to save lives in the future.”

For its initial report, the AL-MMRC undertook a review of all maternal deaths in the state from 2016. Highlights from that report include:

  • 36 mothers lost their lives within one year of the end of pregnancy and 36 percent of those deaths were directly related to the pregnancy.
  • Nearly 70 percent of deaths were determined to be preventable.
  • Mental health and substance use disorders were identified as key contributors in almost 50 percent of deaths.
  • 67 percent of deaths occurred 43 to 365 days after the end of pregnancy.

Additionally, the AL-MMRC also made more than 100 recommendations to improve maternal health. Chief among those recommendations is for the state to expand Medicaid. 

“Right now, amid a global pandemic, affordable and accessible health care is more important than ever,” continued Dr. Arora. “Just last week, new research found the risk of maternal mortality to be 22 times higher in women who tested positive for COVID-19 during pregnancy. Thus, with other research showing reduced maternal mortality rates and positive maternal health outcomes in states that expanded Medicaid, the decision to expand here in Alabama is abundantly clear.”

The Medical Association appreciates Governor Ivey’s recommendation for initial funding for the review committee for 2020-21 as well as the continued efforts from legislative leaders like Senator Coleman-Madison, Rep. Laura Hall, and others.                                                                                 

The Medical Association also launched an online social media effort aimed at increasing awareness of maternal health needs with #SaveAlMoms and a website:

Posted in: Advocacy, Members, Official Statement

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Physicians’ Perspective: Dr. Lindsay Robbins & Funding the MMRC

Physicians’ Perspective: Dr. Lindsay Robbins & Funding the MMRC

The Alabama Maternal Mortality Committee completed its inaugural year, reviewing a full year’s worth of maternal deaths in the state of Alabama. During the review process of each maternal death, the committee ensures that the cause of death is recorded correctly, weighs in on whether or not the death was preventable, and makes recommendations to prevent similar deaths in the future. The Alabama Perinatal Quality Collaborative, a separate entity, will use the MMRC’s recommendations to implement state-wide changes and reforms so that together we can improve reduce maternal mortality and morbidity in the state of Alabama.

The work we have done this year has been incredibly eye-opening. While formal data analyses are not yet available, trends became clear over the course of the year. We need better infrastructure to provide mental health care before, during, and after pregnancy; substance use continues to be a major issue for the women of our state; and we absolutely must keep a laser focus on ensuring that equal care is available to all women regardless of race, ethnicity, geographic location, insurance status, socioeconomic status, disability status, or citizenship.

We are very grateful for the funding recently allocated to this committee so that the work can continue. We need to continue to track these tragic cases so we can find ways to reduce the rates of maternal mortality in the future. Funding and support must continue until preventable maternal deaths no longer exist.

Dr. Lindsay Robbins, MD, MPH

OB/GYN, Maternal-Fetal Medicine Fellow

University of Alabama at Birmingham

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Funding the Maternal Mortality Review Committee: An Effort to #SaveALMoms

Funding the Maternal Mortality Review Committee: An Effort to #SaveALMoms

The Statistics

According to the most recent statistics, Alabama’s 2018 maternal death rate of 36.4 maternal deaths per 100,000 live births means women in this state die from pregnancy and childbirth complications at more than double the rate of women nationally (17.4 deaths). The numbers also mask a glaring racial disparity: black women die at a rate of (37.1) more than double the rate of white women (14.7) and Hispanic women (11.8).

Unfortunately, the issue of maternal mortality is not cut and dry, and determining what is (and isn’t) a maternal death can be complicated. In fact, prior to 2018, the Centers for Disease Control and Prevention (CDC) and the National Vital Statistics System had not published data on maternal deaths since 2007.

So, what can we do to obtain better statistics and reverse this unacceptable trend?

To the Medical Association and the Alabama Section of the American College of Obstetricians and Gynecologists, the answer was simple: fund the Maternal Mortality Review Committee (MMRC).


The MMRC is a collaboration of agencies and health professionals working to better understand factors causing maternal deaths and identify the strengths and weaknesses of current programs and services. At its core, the purpose of an MMRC is to conduct reviews of each maternal death, create actionable prevention strategies, and implement positive changes in health systems.

Take, for instance, a 2018 report from MMRC’s in 9 states which found more than half of maternal deaths were ultimately preventable, and Tennessee found that number to be as high as 85 percent.

Or consider how California’s MMRC, which was established in 2006, created a set of best practices which resulted in a 55 percent reduction in maternal deaths.

Unfortunately, Alabama is behind the curve, having only recently launched a zero-budget, all-volunteer committee in early 2019 under the Alabama Department of Public Health (ADPH). Knowing the impact a funded MMRC can have, the Medical Association led a coalition of partners to obtain just that during the past legislative session.

The Campaign

Initially comprised of only the Medical Association, ACOG, and ADPH, our coalition grew to attract an array of other partners in short order. From physician groups like AAP to the nonprofit, March of Dimes, and even Johnson & Johnson, the call for legislators to fund the MMRC grew rapidly.

Ultimately, Governor Ivey included a $478,000 request specifically for the MMRC in her budget and, even amidst budgetary uncertainty due to COVID-19, the legislature chose to keep the funding in the final budget.

With the MMRC funded, now begins the work to #savealmoms.

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Discussions with Decisionmakers: Rep. Paul Lee

Discussions with Decisionmakers: Rep. Paul Lee

Get to Know Representative Paul Lee

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

I am the currently Executive Director of the Wiregrass Rehabilitation Center, which is located on a 26-acre campus in Dothan and hosts over 200 employees. At Wiregrass Rehab, we work to assist individuals in securing employment, overcoming vocational barriers and achieving personal independence. I am extremely proud to say that our operations have grown tremendously, and we now serve over thirty counties across three states.

When I have time away from my two jobs (State Representative and Wiregrass Rehab), I enjoy fishing, golfing, and bird hunting.

What first prompted you to consider running for your House District seat?

Prior to being elected into the House of Representatives in 2010, I served as a City Commissioner in Dothan. It was during my second term that I realized how important our legislative delegation was and the impact that the state legislature can have on our district. So, I decided to give up my seat as City Commissioner and run for the House of Representatives in hopes of making a greater impact to my community. 

How do you believe your background and experiences help you serve in the legislature?

My background has tremendously helped me in my capacity as a state representative. Before my position with Wiregrass Rehab, I worked for 31 years in manufacturing with Sony. That experience is more relevant now than ever, as it furthers my belief that we need to invest in the production of goods and services here at home and not be so heavily reliant on other countries – whether it be related to healthcare or virtually anything. Additionally, the experience I gained while serving on the board of one of our local hospitals (along with my wife working in medical management) has vastly helped me in my position as Chairman of the House Health Committee.

As chairman of the House Health Committee, what will some of your priorities be in the next legislative session?

Mental health will be a major priority in the coming years. There are far too many caregivers who cannot care for and maintain the needs of those they serve.

We must find a way to save our local hospitals, pharmacies and physician practices. The closures of local healthcare facilities have a negative impact on the entire community and drives up the costs of services and drugs.

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

Expanding broadband access to rural Alabama so that those individuals can take advantage of telehealth services. The pandemic has shown how useful this resource can be, and we need to do everything we can to ensure all Alabamians are able to reap its benefits and received needed care.

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

Of course, there are many issues that need attention and must be addressed. However, I believe it is vital to look at ways to expand access to affordable care. Also, we need to maintain appropriate reimbursement rates for physicians and hospitals. Too many Alabamians are left without healthcare services, and too many providers are not compensated fairly for those services. 

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

We need new ideas to reform and expand primary care. Access to primary care is critical in preventing more serious disease complications; which, in turn, saves the entire healthcare system money.

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

I am grateful for the physicians in our district and have the highest degree of admiration and respect for them.  We are fortunate in Houston County to have access to many specialties. Over 500K people from 3 states come to our area for healthcare.

I am not sure they could ever adequately train and prepare for the current situation with COVID-19. Our physicians have stepped up and done more with less. In my district, we have many great physicians who are also effective leaders and fulfill their role effectively. I have the utmost confidence in our physicians.

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Advocacy Efforts During COVID-19

Advocacy Efforts During COVID-19

The spread of COVID-19 has affected nearly all aspects of our daily lives. For the Medical Association’s efforts in protecting physicians and patients, this was also true. Nonetheless, between March 13 (when Gov. Ivey issued the COVID-19 state of emergency) and mid-May, our advocacy work continued in full-force.

Executive Actions & Proposals

  • Worked with various stakeholders and Governor Ivey to secure liability protections via an Executive Order for physicians, their staff and their practices against frivolous COVID-19 lawsuits (summary available here);
  • Successfully advocated against multiple dangerous scope of practice expansions proposed by both state and national organizations. Among other things, these proposals would have (1) eliminated physician supervision and destroyed the team-based care model; (2) granted CRNAs the ability to prescribe controlled substances; and (3) allowed pharmacists to switch a patient’s drugs without prescriber authorization and without any requirement to notify to the prescriber or the patient; and
  • Successfully advocated against a proposal to give out-of-state telehealth corporations special treatment that physicians currently living, working, and paying taxes in Alabama do not enjoy.

Telehealth Payment Parity

  • As one of our longstanding priorities (payment parity between in-person visits and telehealth services), we were proud to see reimbursement rates addressed and the policy of parity come to fruition.

Miss our 2020 Legislative Recap, What if No One was on Call? Click here for the annual rundown.

Posted in: Advocacy, Coronavirus, Liability, Members

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Three Simple Steps for Increasing Medicine’s Influence

Three Simple Steps for Increasing Medicine’s Influence

From the outside looking in, the political process likely seems as inviting as a shark tank, as navigable as a corn maze, as predictable as the Kentucky Derby. Intimidating, confusing and frustrating are often used by citizens to describe advocacy-related interactions with government and frankly, this isn’t surprising given most citizens’ level of understanding of the political process.

In his Gettysburg Address, President Abraham Lincoln famously opined our nation’s form of government – “of the people, by the people, for the people” – would long endure. Unlike the direct democracy of 5th century Athens, Americans live in a representative democracy, electing individuals from city councilmen to the President to make decisions for them.

Representative democracy eliminates the need for the citizenry to be involved in the minutiae of modern governance. The downside, however, can be a culture of complacency on the part of the electorate. Outcomes are typically directed by those choosing to engage government on issues important to them, and so government becomes “of the people, by the people, for the people [who choose to participate].” The citizenry is ultimately still responsible for holding government accountable, through either direct engagement with lawmakers or the electoral process (or both), though few understand how to do so.

By following the three simple steps below, physicians can increase their influence on issues important to them and the patients they serve.

Step 1: Join, join, join

A significant portion of success is simply showing up, but most physicians don’t have the time to spend flying back and forth to Washington or driving to Montgomery for Congressional or legislative meetings, hearings and sessions. Laws and or regulations are constantly under consideration in either the nation’s or state’s capitol directly affecting medical care. A practicing physician can’t possibly make all the scheduled meetings and still see patients, much less attend to the very necessary continual monitoring of legislative and regulatory bodies that is required of successful modern-day advocacy operations.

But when like-minded people pool their resources good things can happen. Advocacy organizations concerned with ensuring delivery of quality care and a positive practice and liability environment – from individual state and national specialty societies to the Medical Association of the State of Alabama – all deserve your support and membership.

They are all working for you and joining them gives these organizations the resources to hire qualified personnel to represent physicians and their patients before legislative and regulatory bodies.

Step 2: Get to know a few key people

Physicians are responsible for a lot, and in today’s world especially, it’s easy to get in a routine and leave the job of representing the profession to someone else. After all, isn’t that what membership dues are for? Yes and no. While membership in organizations advocating for physicians helps fund advocacy operations, paying membership dues alone is not enough, not in the era of social media, 24-hour news and increased engagement by those on the other side of issues from organized medicine.

Perhaps surprisingly, getting to know a few key people is not difficult, even if only by phone or email. While those paid to represent physicians will know the members of the Legislature and Congress and try to convince them of medicine’s position, in lawmakers’ minds, there is no contact more important than one from a constituent.

Physicians should start locally, getting to know their State Representative and State Senator first, gradually working up to establishing relationships with their member of Congress and U.S. Senators. If they are doing their job well as an elected representative, these legislators and their staff will be glad to hear from a constituent and get his/her perspective. At the same time, don’t overlook the importance of encouraging fellow physicians to engage their local elected officials in meaningful dialogue as well so overall efforts will be amplified.

For more information on how to interact and communicate with lawmakers, check out the Medical Association’s ABCs of VIP.

Step 3: Put your money where your mouth is

Medical and specialty society membership dollars cannot be legally used for elections purposes, and so separate political action committees or PACs must be established and funds raised each year to help elect candidates physicians can work with on important issues. Not surprisingly, numerous entities whose objectives are at odds with medical liability reform, meaningful health system reform and with ensuring the highest standards for medical care are eager to get their allies elected to office.

Just like their parent organizations, the PACs of specialty societies and the official political committee of the Medical Association of the State of Alabama (ALAPAC) are all worthy of your support. When it comes to PAC contributions, never underestimate the impact of even a small donation.

Choosing not to participate in the political process – when it’s known the decisions of lawmakers directly affect medicine – is akin to getting sued, consciously sitting out voir dire and letting the plaintiff’s lawyer pick the jury.


The future of medical care, in Alabama and the nation, rests not with elected lawmakers and appointed bureaucrats but with the men and women actually caring for patients every day. A representative democracy functions best when the electorate holds those elected to office accountable. Increasing medicine’s ability to successfully advocate for physicians and the patients they serve will require increased participation in the political process. It is incumbent upon physicians to join the organizations fighting for them, to get to know their elected officials and to contribute to PACs whose goals align with their own.

By Niko Corley
Director, Legislative Affairs
Deputy Director, Alabama Medical PAC (ALAPAC)

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President Signs Bills Lifting Pharmacist ‘Gag Clauses’ on Drug Prices

President Signs Bills Lifting Pharmacist ‘Gag Clauses’ on Drug Prices

Earlier this week, President Trump signed two bipartisan bills into law that will allow pharmacists to tell patients they can save money on drugs by paying cash or trying a lower-cost alternative. At issue was the “broken” drug pricing system in the U.S. that was forcing patients to make decisions, which could have negatively impacted their health.

The bills, the Patient Right to Know Act and the Know the Lowest Price Act, prohibit health insurers and pharmacy benefit managers from using “gag clauses” that prevent pharmacists from sharing with patients the lower-cost options when they are purchasing medically necessary medication. In addition, the legislation ensures the Federal Trade Commission will have the necessary authorities to combat anti-competitive pay-for-delay settlement agreements between manufacturers of biological reference products and follow-on biologicals. The Patient Right to Know Act would apply similar “gag clause” protections to Medicare and MA plans.

Under the new legislation, pharmacists will be allowed, though not required, to tell patients about lower-cost options. If pharmacists don’t tell, then patients will have to ask about the cost of the medication. However, some pharmaceutical industry experts say although eliminating the gag clause is a step toward consumer transparency, it doesn’t address the issue of lowering actual drug costs, making it unclear how much of a tangible effect the legislation will have.

According to research published in JAMA in March, people with Medicare Part D drug insurance overpaid for prescriptions by $135 million in 2013. Copayments in those plans were higher than the cash price for nearly 1 in 4 drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent.

Yet some critics say eliminating gag orders doesn’t address the causes of high drug prices. “As a country, we’re spending about $450 billion on prescription drugs annually,” said Steven Knievel, who works on drug price issues for Public Citizen, a consumer advocacy group. The modest savings gained by paying the cash price “is far short of what needs to happen to actually deliver the relief people need.”

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Alabama Physicians Attend AMA Meeting in Chicago to Discuss State of Health Care

Alabama Physicians Attend AMA Meeting in Chicago to Discuss State of Health Care

Pictured from left in the back are Dr. Buddy Smith Jr., Dr. Jefferson Underwood and Dr. Jerry Harrison. In front from left are Dr. Steven Furr, Medical Student Delegate Hannah Ficarino from the University of South Alabama, Dr. Jorge Alsip and Dr. John Meigs.

During the AMA’s Annual Meeting held June 8-13, 2018, the House of Delegates debated a wide range of issues and adopted policies to expedite the free exchange of key patient data between EHR systems; to make e-prescribing of controlled substances and access to state PDMPs less cumbersome, and to reduce the MIPS reporting burden. The AMA also reaffirmed its strong opposition to the legalization of physician-assisted suicide and euthanasia.

Medical Association President Jefferson Underwood, M.D., joined the delegation in Chicago and represented Alabama physicians at the inauguration of the AMA’s new president, Barbara McAneny, M.D.

“The AMA House of Delegates is much like Congress in that the views of its members vary from region to region, and few members agree with every decision made by the organization. However, a state’s representation in the HOD is based on their number of AMA members, and Alabama along with the other Southeastern states are working vigorously to increase their AMA membership. I encourage our Medical Association members to also join the AMA, so we can have a greater impact on policy and help elect officers who share our views and values.” said Jorge Alsip, M.D., who chairs Alabama’s AMA Delegation.

Pictured are Association President Underwood and his wife, Sara.

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