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Not a “Rock Throwing” Committee; Pandemic Response Task Force Holds First Meeting

On Thursday, July 1, the first meeting of a legislatively-created task force to examine the state’s response to the COVID-19 pandemic was held in Montgomery.  During the 2021 Legislative Session, amidst a flurry of bills being introduced related to the pandemic (like Sen. McClendon’s bill to abolish the position of State Health Officer and abolish the State Committee of Public Health), the Medical Association asked state lawmakers to “press pause” on any such bills until an out-of-session, full and complete analysis of pandemic response could be completed.  That request was largely honored, and a task force was created to do just that. 

At the task force’s inaugural meeting, Gov. Kay Ivey, Senate President Pro Tem Greg Reed and House Speaker Mac McCutcheon addressed members of the task force.  All three agreed the past year created unprecedented challenges for Alabamians and that while there may have been and in some instances may continue to be disagreement among some regarding how the state handled certain things, the desire of the Governor, Sen. Reed and Speaker McCutcheon was for the task force to identify positive steps the state can take for the future.  Sen. Reed reminded the group there wasn’t a “manual” for how to manage a global pandemic within Alabama but that he wanted their help in moving the state forward.  

“We aren’t interested in rock throwing here,” Sen. Reed said.  “We want this group to identify how Alabama can be better prepared for the next pandemic.”

Speaker McCutheon echoed his words, adding COVID-19 had continued to change so rapidly that it made responding effectively difficult at times. He thanked State Health Officer Dr. Scott Harris and the Governor for their work and leadership during the pandemic.  Speaker McCutcheon said he wanted to be sure the task force had “facts to promote our [recommended] actions.”

In her remarks, Gov. Ivey encouraged Alabamians who haven’t been vaccinated to do so and outlined the “team effort” between her administration, Dr. Harris and the Health Department, Director Brian Hastings and the state Emergency Management Department and others.  She also acknowledged that business closures, the many lives lost and setbacks in education as some of the most difficult effects of the pandemic.  

“The response to the pandemic wasn’t perfect,” Gov. Ivey said, “and we regret some of the decisions made but [ultimately] we prevailed.” 

Task force co-chair Sen. Tim Melson, M.D., said his intention was for the task force to be a “fact-finding and not a fault-finding committee.”  Rep. Paul Lee, House Health Chairman and co-chair of the task force, said COVID-19 had been “a moving target” and that “hindsight is 20/20”.  Both Sen. Melson and Rep. Lee welcomed ideas from committee members and the public as to how to improve Alabama’s pandemic response moving forward.  The task force plans to meet again before the end of the summer.  

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SD14 Special General Election

SD14 Special General Election is Tuesday, July 13, 2021. The seat was previously held by Cam Ward (R) and covers Bibb, Chilton and Shelby counties.

As the political action committee representing physicians across the state, Alabama Medical PAC (ALAPAC) is proud to support April Weaver in this special election. At a time when healthcare policy is so polarized, electing candidates who understand these issues and value physician input is a top priority. April Weaver, having previously served as the Chair of Alabama House Health Committee and a Regional Director with HHS, is that type of candidate, and we encourage all physicians in Senate District 14 to support her campaign.

“Supporting April Weaver for Senate District 14 was an easy decision,” said ALAPAC Board Chairman David Herrick, M.D. “From her previous roles in both the Alabama House and HHS, Weaver has consistently been a leader in healthcare industry and an advocate of policies that move medicine forward. The overwhelming outreach and support from physicians in her area, as well as statewide, is a testament to the positive impact Weaver has made both personally and professionally.”

For those physicians who live in Senate District 14 (Bibb, Chilton, and Shelby), we hope you’ll go to polls on Tuesday, July 13, and cast your vote for April Weaver.

Unsure about voting in-person? Can’t remember what polling location you vote? Please click here to find out.

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Discussions with Decisionmakers: Senator Tom Butler

Discussions with Decisionmakers

Background

Senator Butler has been a member of both the Senate and House of Representatives and has served in the Legislature for over 30 years. He is on the Senate Healthcare Committee. Senator Butler is also a registered and certified pharmacist and recently passed a bill that allows pharmacies to find more affordable alternative drugs for patients.

What first prompted you to consider running office?

John Kennedy challenged youth in this country to run for office. When I left college, I joined the Huntsville JC. I like serving people.

How does your background help serve you on the Health Committee and also the Legislature?

Having a background in medical technology and pharmacy.

What are some of your legislative priorities this term?

The Pharmacy Benefit Manager bill which prevents practices of pharmacy benefit managers relating to patient steering to use mail-order pharmacies and prevents price discrimination. It requires the PBM to act as a fiduciary to clients and prevents them from stopping pharmacists from disclosing prices.

We need to give patients freedom.

What can be done to alleviate the unnecessary and growing administrative and regulatory burdens and laws being placed on the medical community by insurers and government payers like Medicare and Medicaid?

We are spending about a billion dollars a year on Medicaid, but we need to monitor how it is administered and what it costs taxpayers.

What do you think people understand the least about our healthcare system?

People don’t understand how long it takes to fill a prescription. Overall, people want healthcare as fast as possible. People also sometimes don’t understand the financial side of healthcare, and just how expensive it really is.

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

Prevent medical shortages in rural communities. We don’t have enough physicians in rural communities. It is hard to see current physicians fleeing rural areas due to a lack of incentives. We need more incentives.

Do you have a position on the expansion of Medicaid?

I can’t support it right now for one reason: it would cost us $300 million in new funding, and I don’t see how we can take that on right now. I would like to see greater access to quality healthcare, but I don’t believe this costly choice is the state’s best option

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Rep. Kirk Hatcher Wins the Special General Election for Senate District 26

Democratic Candidate, State Rep. Kirk Hatcher, won the special general election against Republican candidate, William Greene, for Senate District 26 seat on Tuesday, March 2, 2021. The seat was previously held by David Burkette (D).

According to the Alabama Political Reporter, Hatcher received 4,565 votes of the 5,827 votes, 78.3%. He vacated his House District 78 seat when he was sworn in to the Senate on March 3, 2021. Governor Ivey will issue a proclamation for a special election on House District 78 to fill the vacancy.

Click here to read more about the election from the Alabama Political Reporter.

As the political action committee for the Medical Association, ALAPAC supports candidates who best represent the interests of physicians and their patients. This is why ALAPAC supported Kirk Hatcher (D) for Senate District seat 26.

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Ben Robbins Wins the Special General Election for House District Seat 33

Republican candidate, Ben Robbins, won the special general election against Democrat candidate, Fred Crum, for house district seat 33 yesterday, Tuesday, January 19, 2021. The house district seat was previously held by Rep. Ron Johnson (R) who passed away on July 14, 2020.

According to the Alabama Daily News, Robbins received 2,232 of the 3,269 votes, 68%, Tuesday. He is an attorney in Sylacauga.

Click here to read the full article about the election from Alabama Daily News.

As the political action committee for the Medical Association, ALAPAC supports candidates who best represent the interests of physicians and their patients. This is why ALAPAC supported Ben Robbins (R) for the house district seat 33.

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Major Changes Coming to 2021 E/M Coding

Major Changes Coming to 2021 E/M Coding

Considerable changes are being made to Medicare outpatient evaluation and management (E/M) codes. The transition will take effect on January 1, 2021 and will likely affect physicians across all specialties.

The changes are currently restricted to new and established outpatient visits (CPT codes 99202-99205, 99211-99215) and will impact everyone who assigns codes, manages patient information, or pays claims including physicians, health information managers, coders, payers, health systems, and hospitals. 

Why was modification needed?

Because of advocacy by the Medical Association and other organizations, the Centers for Medicare and Medicaid Services (CMS) adopted a revised E/M documentation methodology proposed by the American Medical Association (AMA). 

The goal of the suggested adjustments is to reduce physician burden by simplifying documentation requirements and administrative responsibilities. By reducing managerial concerns, physicians will have the ability to spend more in-depth, quality time with their patients. 

What are the changes?

There will be various changes to office and outpatient E/M visits. However, the most notable is the removal of the Level 1 new patient visit (99201), a new 15-minute extended services code that can be used with codes 99205 and 99215, and the following modifications of office code selection:

  • History and physical exams are no longer elements for code selection
  • Physicians can choose to use total time or medical decision making as the basis of their E/M documentation
  • Medical decision-making criteria has been revised and clarified
    • Removed ambiguous terms and concepts
    • Defined vague terms
    • Re-established data elements to move away from adding up tasks and instead focusing on how those tasks affect the patient’s care

What can you do to prepare?

  • Visit our website to find more resources on the 2021 E/M coding and guideline changes
  • Watch our NEW Online E/M Coding Changes for 2021 webinars hosted by Dr. Thomas Weida and Kim Huey and earn CME
  • Contact your medical billing company and/or coders to develop a plan for training office staff to ensure a smooth transition at the first of the year
  • Connect with your Electronic Health Records (EHR) provider to confirm that your practice’s system will be ready to implement the new coding changes
  • Reach out to your payers to negotiate implementing the new E/M rates

With changes this substantial, we encourage you to prepare early. Watch for more information in the coming weeks on our website and email alerts. If you have further questions, please email us at staff@alamedical.org.

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Discussions with Decisionmakers: Finance Director Kelly Butler

Discussions with Decisionmakers: Finance Director Kelly Butler

About Kelly Butler:

Kelly Butler was appointed as the Director of the Alabama Department of Finance by Governor Kay Ivey on December 1, 2018, after serving as acting State Finance Director since August 15, 2018. As the State’s chief financial officer, Butler serves as an advisor to the governor and the Legislature in all financial matters and is charged with protecting the financial interests of the State of Alabama. He is responsible for the administration and oversight of the Department of Finance and serves on various advisory boards and authorities.

Butler has worked for the state of Alabama for over 30 years and previously served as Assistant State Finance Director for Fiscal Operations since December 2016. Mr. Butler was also the State Budget Officer since June 2014. Prior to his employment with the Finance Department, he worked for 19 years with the Legislative Fiscal Office, most recently serving as the Senate Fiscal Officer. Earlier in his career, Mr. Butler worked as a revenue examiner with the Alabama Department of Revenue, where his duties included serving as a corporate income tax and financial institution excise tax auditor and serving as an assistant to the Chief of the Income Tax Division.

Mr. Butler is a graduate of Auburn University Montgomery (BSBA) and Troy University (MBA).

COVID-19 Grant Program

As the Alabama Director of Finance, Mr. Butler is in charge of overseeing the disbursement of all COVID-19 funds received via the CARES Act, including the new Health Care and Emergency Response Providers Grant Program. We recently hosted a Zoom call with Mr. Butler to discuss this program and answer any questions Alabama physicians might have.

Simply click the video below to begin watching where the Q&A with Mr. Butler begins.

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Medical Association Recognizes Racism as a Threat to Public Health

Medical Association Recognizes Racism as a Threat to Public Health

At the most recent Board of Censors meeting, the Medical Association of the State of Alabama pledged to recognize and confront racism and racial inequalities within our society and the healthcare system. The Medical Association further recognizes the need to end systemic racism in our country and to work towards a better, fairer, and more just society. 

The Medical Association released the following statement following their meeting last week:

  • The Medical Association opposes all forms of racism
  • The Medical Association considers racism a public health crisis and a threat to public health
  • The Medical Association understands the elimination of health disparities will not be achieved without first acknowledging the contributions of all races to health and social inequalities
  • The Medical Association understands that we have a responsibility to actively work to eliminate discriminatory policies and practices across all of healthcare
  • The Medical Association supports ending racial discrimination in medical care and the equitable access to quality health care services
  • The Medical Association encourages current and future physicians to be advocates for justice

We recognize that worsening inequities, unequal access to care, and the racial disparities of practicing physicians all have roots in systemic racism and must be confronted. The Medical Association of the State of Alabama understands that there is still tremendous work to be done to ensure that everyone has the opportunity, resources, and conditions to achieve optimal health. The Medical Association is committed to being a part of that solution.

Sincerely,

President John S. Meigs, MD and Board of Censors

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Summary of Liability Protection from Starnes, Davis Florie, LLP

Summary of Liability Protection from Starnes, Davis Florie, LLP

Starnes, Davis, Florie, LLP has drafted a summary with some guidance on documentation for physicians concerning some protection in response to potential liability issues facing physicians during the COVID-19 declared emergency.  Governor Ivey’s March 13, 2020 Proclamation declared a state public health emergency.  The Proclamation grants certain immunity from lawsuits if a provider in a covered “health care facility” is practicing pursuant to an “alternative standard of care” plan.  The “alternative standard of care” must be set forth in the “health care facility’s” emergency operation plan, and the specific language or “standards of care” may differ from facility to facility.  Starnes suggests documenting the circumstances surrounding each patient and the reasons for clinical decisions.  [LINK to previous article].  Personnel and a facility are entitled to limited immunity when practicing consistent with those methods outlined in the alternative standard of care.  Physicians should look to the hospital for the specific protective language.

The PREP Act provides limited immunity for the administration or use of covered countermeasures to treat, diagnose, cure, prevent, or mitigate COVID-19.  The PREP Act covers providers for the administration or use of any antiviral, any other drug, any biologic, any diagnostic, any other device, or any vaccine used in the treatment of a COVID-19 patient.  

See Summary Here.

This information is not intended to provide legal advice, and no legal or business decision should be based on its content. No representation is made that the quality of legal services to be performed is greater than the quality of legal services performed by other lawyers.  Read full disclaimer.

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Medical Cannabis Passes Senate Committee

Medical Cannabis Passes Senate Committee

Last Wednesday, the Alabama Senate Judiciary Committee advanced a bill allowing cannabis to be recommended for up to 15 conditions for medicinal purposes.

SB165, informally named the Compassion Act and sponsored by Sen. Tim Melson, M.D., would allow physicians to recommend medical cannabis for conditions such as cancer, anxiety and chronic pain. It would also let patients with state-issued cannabis cards to purchase cannabis products at licensed dispensaries. Cannabis products dispensed to patients would be under strict state regulation from seed to sale, including testing products for consistency and to ensure no contamination.

Under Melson’s bill, medical cannabis would available to anyone 19 years or older whom a physician certifies as having a qualifying medical condition. Patients 18 or younger would need a parent or guardian to administer cannabis. The patient would have to apply for a medical cannabis card, which would cost no more than $65.

Cannabis will only be available in encapsulated form or a topical agent. The bill would also establish a fund using tax proceedings for increased research on cannabis.

Having passed the Judiciary Committee 8-1, the legislation will now receive a vote before the entire Senate. Should it pass the Senate, it still must go to through a committee and floor vote in the House.

After surveying its members, the Medical Association found Alabama physicians believe if cannabis for medicinal use is legalized, then the growth, cultivation and sale of cannabis should be highly regulated by the state, and any physician involvement should be regulated not by some new state agency, but by the Board of Medical Examiners. Likewise, the survey found physicians believe any administration or use of legalized medical cannabis should be limited to encapsulated form and topical agents.

While there was no overwhelming consensus found regarding physicians’ support or opposition to the legalization of medicinal cannabis, the Medical Association has worked tirelessly with the bill sponsor to bring the legislation in line with the areas of broad agreement in our member survey. We appreciate the willingness of Sen. Melson in working with us and will continue monitoring the bill as it moves forward.

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