Archive for Advocacy

Legislators: Just Apply Heat

Legislators: Just Apply Heat

Through years of medical school, residency and fellowships, physicians earn not only more knowledge and expertise than any other health professional, they also earn the right and responsibility of leading the health team.  It is through physician-led care that we ensure continued quality and safety for patients.  But each year, “scope creep” proposals seek to “replace medical education with legislation” and to blur the lines between medicine and other health disciplines. 

Legislators, when confronted with such proposals, often ask how they can be expected to determine whether a particular piece of health legislation is in their constituents’ best interest.  After all, the extent of most legislators’ experience with health care is only on the patient side.  While muscle soreness can be alleviated by applying heat, legislators reviewing scope legislation would be well served by, as explained below, just applying H.E.A.T.  

What is HEAT?

Could the proposal harm patients and will its effects adhere to the Hippocratic Oath’s directive to “first, do no harm?”

Do the proponents of the proposal have the requisite education today to safely perform the tasks or functions they are seeking to amend the law to allow; and, have all members of the profession to whom the proposal would apply received the same levels of specified education to cover the subject of the proposal? 

Would the proposal expand access to additional quality care for patients or just additional care, perhaps of a lower standard? 

Do proponents of the proposal possess the requisite training at present to perform the tasks they are seeking to amend the law to allow?

What does it mean?

If the answers to any of the above questions is no, then the answer to the legislative proposal in question should likewise be a resounding “no.”   Medical education, residency and fellowships prepare physicians for the challenges of delivering quality care in today’s ever-changing health landscape.  While proponents of “scope creep” pitch their proposals as cure-alls for the state’s health delivery system, there are no shortcuts to addressing Alabama’s health challenges. 

To the contrary, removing physician supervision and reducing safety standards and protocols will only endanger patients and reduce quality.  By investing in and supporting programs, proposals and initiatives that recruit and retain physicians to this state, legislators can grow the physician workforce, maintain quality of care and boost Alabama’s economy. 

In the meantime, lawmakers utilizing the four-step HEAT process to analyze legislative proposals should find it helps them separate appropriate changes to Alabama’s health laws from the many dangerous “scope creep” bills that are on the increase. 

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New Maternal Mortality Statistics Highlight the Need for Alabama to Take Action

New Maternal Mortality Statistics Highlight the Need for Alabama to Take Action

Largely due to the slow implementation of a standardized death certificate by states, data on maternal deaths has not been reported on the National Vital Statistics System since 2007. Meaning that, for over a decade, the United States has not recorded an official count of pregnancy-related fatalities, nor an official maternal mortality rate. 

This year, however, we finally got a look at the numbers and, to the surprise of no one, they aren’t good.

The biggest takeaway is that the way we record deaths still isn’t very reliable and, for the second time in less than twenty years, the government is reformatting the death certificate.

Still, the government’s findings (separated by three separate formulas and spanning over sixty pages) help to shed light on the current maternal mortality crisis. Whatever statistical issues there might be, the data conclusively shows that the rate of pregnancy-related deaths has increased substantially over the past decade.

In total, 658 women were identified as having died from pregnancy-related causes (during pregnancy, at birth, or within 42 days after birth) in 2018 – resulting in a maternal mortality rate of 17.4 deaths per 100,000 live births. These numbers place the U.S. in dead last among similar, developed countries.

Even more appalling are the stark disparities in maternal deaths of black women. Specifically, the maternal mortality rate for black women (37.1 deaths per 100,000 live births) was 2.5 times that of white women (14.7 deaths per 100,000 live births) and 3.1 times that of Hispanic women (11.8 deaths per 100,000 live births).

Significant disparities also exist among different age groups, with the maternal mortality rate of women 40 and older nearly 8 times (81.9 deaths per 100,000 live births) that of women under 25 (10.6 deaths per 100,000 live births).

Unfortunately, the numbers for Alabama are much worse. In fact, with 36.4 deaths per 100,000 live births, Alabama’s maternal mortality rate is more than double that of the national average. And since the state figures are merely a top-line summary, there’s no telling what the numbers are if you were to separate by race and age.

In our state, “becoming a mother can turn into a life-or-death situation,” said Dr. Grace Thomas, assistant state health officer for family services at the Alabama Department of Public Health. “It’s a failure of our healthcare system when that happens. We’ve got to do better.”

The good news? Alabama is working to do better.

Just last year, a coalition of Alabama doctors, nurses, public health leaders and others began forming a Maternal Mortality Review Committee (MMRC) under the umbrella of the Alabama Department of Public Health (ADPH) to get a deeper look at why mothers are dying and what we can do about it.

But volunteers can only do so much, and the MMRC lacks the funding for staff and supplies in order to properly review each death. We’re trying to change that.

Right now, the Medical Association of the State of Alabama – along with other stakeholders like March of Dimes, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and Johnson and Johnson – is spearheading an advocacy effort to bring attention to the issue of maternal mortality and see to it that the legislature provides ADPH with the resources it needs for the MMRC to be successful.

Dr. John Meigs, President of the Medical Association of Alabama, believes the MMRC, if properly funded, can reduce maternal mortality in a way similar to that of the initiatives ADPH has had in place on infant mortality – Alabama’s infant mortality rate was the lowest ever recorded in 2019.

“Ultimately, until we have a thorough review of the maternal death data, we can’t answer the all- important question of ‘why?’ when a mother dies and take steps to stop maternal death,” said Dr. Meigs. “But Alabama currently doesn’t fund maternal mortality review, and until we appropriately do so we can’t expect to be able to make informed health policy decisions as a state to move forward in eradicating maternal deaths.”

In other states, a funded MMRC has helped decrease the maternal mortality rate by over fifty percent. For only $478,000 (the amount ADPH requested for the MMRC in its budget), Alabama might be able to do the same.

Find out more about Alabama’s maternal mortality crisis and how you can join our campaign to Save Alabama Moms at alabamamedicine.org/savealmoms

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Medical Association Convenes “Treatment Hurdles” Work Group

Medical Association Convenes “Treatment Hurdles” Work Group

Earlier this week, the Medical Association convened a work group of stakeholders to discuss hurdles and or delays that patients and their physicians face in accessing the tests, treatments and medications the treating physician believes are appropriate.

Patient advocacy groups, many of them disease-specific, joined the Association and others in discussing the hurdles patients face in accessing what their doctors have ordered or prescribed. In addition to delays or denials of care patients and their caregivers face in these situations, the administrative tasks required of physicians by insurers increase annual health spending nationwide by more than $250 billion and occupy millions of uncompensated hours of American physicians and their staff’s time.

The coalition that’s been formed to work collaboratively on these issues is gathering information from other states. If you are interested in participating in this effort, contact cflack@alamedical.org

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Alabama medical experts ask for $478,000 to investigate pregnancy-related deaths

Alabama medical experts ask for $478,000 to investigate pregnancy-related deaths

 AL.com – Anna Claire Vollers

In the wake of increased attention to a rising maternal death rate, a growing chorus is calling on Alabama to investigate the deaths of mothers from pregnancy and childbirth complications.

“Each and every maternal death is devastating to families, and leaves everyone asking ‘why?’” said Dr. John Meigs, president of the Medical Association of the State of Alabama, in a statement. “As physicians, we feel like our state has got to do better, can do better and must do better, and our coalition partners feel the same way.”

In recent weeks, the Alabama Department of Public Health asked Gov. Kay Ivey for $478,000 to better investigate why Alabama mothers are dying from pregnancy and childbirth complications.

If the request makes it into the governor’s state budget recommendation, then the Medical Association, the nonprofit March of Dimes and consumer giant Johnson & Johnson are gearing up to push for the funding in the upcoming legislative session.

In states like Texas and Tennessee, efforts to investigate maternal deaths have found most of the deaths could have been prevented. Investigations in states like California and North Carolina led to changes in healthcare and services provided to mothers.

Alabama doesn’t really know why mothers are dying from childbirth and pregnancy complications. Or even how many.

“But until we have a thorough review of the maternal death data, we can’t answer the all-important question of ‘why?’ and take steps to stop maternal deaths,” said Meigs.

Officially, 41 mothers died from pregnancy or childbirth complications in 2017, according to death certificate data reported by the state. It’s the highest number of deaths related to childbirth and pregnancy that Alabama has recorded in recent years.

But using just the death certificate data has been shown to be unreliable. The U.S. Centers for Disease Control and Prevention doesn’t recommend using those numbers alone to get an accurate count of maternal deaths.

Instead, the gold standard for investigating deaths of mothers from pregnancy and childbirth is a statewide task force called a Maternal Mortality Review Committee, which reviews medical records and other documents related to every death of a mother, related to childbirth or pregnancy.

All of Alabama’s neighboring states have one already.

If the $478,000 is approved by the state legislature next year, it would fund Alabama’s new MMRC. Late last year, a coalition of Alabama doctors, nurses, public health leaders and other formed the state’s first MMRC under the umbrella of the Alabama Department of Public Health.

Right now, the MMRC operates on a shoestring budget, limiting the number of cases it can review. It’s mostly staffed with volunteers.

A group of Alabama OBYNs and the Medical Association worked with ADPH to come up with the $478,000 figure, said Trace Zarr, director of political development at the Medical Association.

The bulk of the money, about $300,000, would go toward hiring paid staff to compile and organize the case files of Alabama women who died from pregnancy or childbirth-related issues.

Another $108,000 would go toward autopsy reviews, and the rest would pay for support staff, equipment and supplies.

“We want to make sure we get not only a good count of the number of deaths, but qualitative data on the broader factors associated with these deaths,” said Britta Cedergren, director of maternal-child health and government affairs with the March of Dimes, which has partnered with the medical association and the state health department to lobby for funding.

“We want to determine whether these deaths were preventable. If it was a postpartum depression-related suicide, what could have been done differently? Or was there an undiagnosed issue related to pregnancy, like hypertension?”

If the MMRC is fully-funded, it could have a lasting impact on the health of mothers in the state.

Tennessee, which launched its MMRC program two years ago, found a whopping 85 percent of its maternal deaths were preventable.

California, one of the first to launch a review committee back in 2006, has since cut its rate of women dying in childbirth by 55 percent. That’s due in large part to is committee identifying two complications that were killing mothers but were largely preventable: hemorrhage and pregnancy-induced high blood pressure.

And Alabama already has a similar program that investigates infant deaths. Meigs credits the state-funded infant mortality review for reducing Alabama’s infant mortality rate in recent years. In 2017 Alabama’s infant mortality rate, still high by national standards, hit a state-record low.

“But Alabama currently doesn’t fund maternal mortality review, and until we appropriately do so and dig down into the root causes of maternal death in this state,” he said, “we can’t expect to be able to make informed health policy decisions as a state, to move forward in eradicating maternal deaths.”

The Medical Association, a private professional organization that lobbies state lawmakers on behalf of doctors, has recently launched a new initiative, the Save Alabama Moms campaign. On its website, alabamamedicine.org/savealmoms, is the tagline: “It’s time to solve the maternal mortality crisis.”

Read more on motherhood in Alabama at al.com/motherhood. Join the conversation around issues that matter to women in the South on the Reckon Women group on Facebook. And for the best stories delivered straight to your inbox, sign up for our Reckon Women newsletter.

Click the image above to learn more about Alabama’s maternal mortality crisis.

Click the image to view the document outlining our request to fund the MMRC.

Click the image to check out our Twitter page and share a post with #savealmoms

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Medical Association and Specialties Begin Work on 2020 Legislative Agenda

Medical Association and Specialties Begin Work on 2020 Legislative Agenda

Earlier this month, the Medical Association hosted a legislative roundtable with leaders from the various physician specialties. The event included a discussion of the prior legislative session and our past priorities, as well as an open forum for specialty delegates to discuss items and issues important to their physicians.

Each legislative session presents new and unique issues, and we rely heavily on the guidance of physicians and society leaders to advise the Association’s Board X regularly on the appropriate course of action to take on legislation.

Thank you to those physicians and specialty leaders who attended our roundtable. To further guide the Association’s Board in developing the 2020 Legislative Agenda, we have created a survey for all members to weigh in on our priorities.

If you have yet to take the survey, you can do so at this link or by simply clicking the button below. Don’t wait! Take the survey today!

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ALAPAC-Supported Van Smith Wins Special Election

ALAPAC-Supported Van Smith Wins Special Election

On Tuesday, Autauga County Commissioner Van Smith won the special election to fill the vacancy in Alabama House District 42 with 88% of the vote. ALAPAC has supported Van since the Primary, with a key reason being the advocacy of area physicians who have known and worked with Mr. Smith for years and who spoke to his support for physicians.

With the victory, Mr. Smith will now turn his attention to the upcoming legislative session. HD42 comprises Autuga and Chilton Counties, and supporting rural health care is a major interest of both area physicians and Mr. Smith.

“As an ALAPAC contributor, it’s important to know I have a voice in our campaign support process,” said Lee Carter, M.D., an Autaugaville family physician and HD 42 resident. “I’ve known Van for years and think he will represent our area well and be a voice for rural health issues.”

Congrats again to Mr. Smith and thank you to the physicians who supported him in this election.

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Doctors Unite in Support of Physician Office Exemption

Doctors Unite in Support of Physician Office Exemption

We called and you answered!  Thank you to all the physicians who answered the urgent call-to-action and quickly signed on to the Medical Association letter (more than 600 doctors to date!) challenging the Alabama Hospital Association (ALAHA) and its member facilities’ contentions about the appropriateness of the physician office exemption (POE) from CON review.

As you know, ALAHA recently submitted a letter complaining of increasing instances of physicians performing interventional procedures in their offices instead of in acute care hospitals. ALAHA’s complaints are not in line with Alabama law and their letter was an attack on the practice of medicine and the services physicians safely provide patients in their offices.

Below is the letter the Medical Association sent in response to ALAHA’s assertions. We will continue to update you as things progress.

Thanks again!

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Letter to Congress: Don’t Give Health Plans Too Much Power

Letter to Congress: Don’t Give Health Plans Too Much Power

The American Medical Association wrote two letters to Congress to shed light on how physicians feel about the current debate in Washington over surprise billing. We, along with 109 other state medical societies and national specialty societies, co-signed this letter to support the AMA’s efforts.

The letters advocate for independent dispute resolution (IDR), a process that would “incentivize health insurers to make a fair initial offer of payment for out-of-network care […] while also preventing bills from physicians or other providers that are outside generally acceptable ranges.”

The most pressing priority is to take the patient out of the middle of physicians and insurers trying to negotiate out-of-network bills. Congress is considering several options to bring that to fruition; however, the options include language that could give health plans too much power to determine physician payments.

The Medical Association has been advocating to ensure that HR 3630 takes the patient out of the middle of out-of-network payment disputes but doesn’t give health insurance companies complete control over what they pay out-of-network physicians.

View the Letter here.

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Medical Association Opposes Scope of Practice Expansion Executive Order

Medical Association Opposes Scope of Practice Expansion Executive Order

President Trump issued an executive order on October 3, 2019 as an alternative to “Medicare for All”. Initially, the order was titled “Protecting Medicare From Socialist Destruction” but was changed to “Protecting and Improving Medicare for Our Nation’s Seniors.”

The executive order does include some items that the Medical Association of the State of Alabama supports; however, there are concerns that the language within the order appears to expand the scope of practice of non-physician providers.

President Trump directed the Secretary of Health and Human Services, Alex Azar, to propose a new regulation within the next year that would “eliminate burdensome regulatory billing requirements, conditions of participation, supervision requirements, benefit definitions, and all other licensure requirements […] that are more stringent than applicable federal or state laws require and that limit professionals from practicing at the top of their profession.”

Possibly the most alarming language found within the order is that President Trump gave Azar only one year to propose regulations that would “ensure that items and services provided by clinicians, including physicians, physician assistants, and nurse practitioners are appropriately reimbursed in accordance with work performed rather than the clinician’s occupation.”

Mark Jackson, the Executive Director of the Medical Association, believes the language within the order should raise serious concerns for physicians in Alabama. “We believe that medical school matters and physicians should always be the head of the healthcare team,” Jackson says. ”Our mission is to promote the highest quality of healthcare for the people of Alabama. Therefore, we fully support physician-led team-based care and will be co-signing a letter with the American Medical Association as well as working closely with our Congressional Delegation to address our concerns.”

View the letter here.

Posted in: Advocacy, Medicare, Members

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ALAPAC Ends FY2019 on a High Note

ALAPAC Ends FY2019 on a High Note

Over the past few months, ALAPAC has been in the midst of its summer fundraising campaign, seeking to raise $75k in 75 days. This week, both the summer campaign and the 2019 giving cycle came to a close.

First and foremost, thank you to all the physicians who chose to contribute to ALAPAC this year! We cannot succeed without your continued support.

Although we missed our summer goal by just $10,000, ALAPAC raised over $19,000 in the last month alone. Moreover, physician-giving made it possible for ALAPAC to positively impact special elections this year, with both ALAPAC-supported candidates (Charlotte Meadows and Van Smith) winning their primaries and advancing to the general election.

In the coming weeks, we will recognize all ALAPAC contributors and those individuals who went above and beyond. Also, we will provide a snapshot of the top specialties whose physicians donated to ALAPAC.

For now, we simply want to say THANK YOU!

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