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Proposed Importation of Prescription Drugs from Canada

Proposed Importation of Prescription Drugs from Canada

On December 18, 2019, the Food and Drug Administration (“FDA”) issued a proposed rule (the “Proposed Rule”) to amend its regulations to implement a provision of the Federal Food, Drug, and Cosmetic Act to allow importation of certain prescription drugs from Canada.  The purpose of the Proposed Rule is to lower prices and reduce out-of-pocket costs for American patients.  If the Proposed Rule is finalized as proposed, States or certain other non-federal governmental entities and their co-sponsors, if any (collectively “Sponsors”), would be able to submit drug importation program proposals (each a “Drug Importation Proposal”) to the FDA for review and authorization.  If a Drug Importation Proposal were approved, it would be authorized for a 2-year period, with the possibility of extensions for additional 2-year periods. 

The Proposed Rule would require each Drug Importation Proposal to:

  • Specify the eligible prescription drug the Sponsor seeks to import;
  • Demonstrate that the proposed importation program will pose no additional risk to the public’s health and safety;
  • Provide an explanation as to why the Sponsor expects the importation program would result in a significant reduction in the cost of such prescription drug to the American consumer; and
  • Identify the foreign seller in Canada that would purchase the drug directly from its manufacturer and the importer in the United States that would buy the drug directly from the foreign seller. The foreign seller must be registered with the FDA as a foreign seller and be licensed by Health Canada as a wholesaler, and the importer must be a State or FDA licensed wholesale drug distributor or State-licensed pharmacist.

At least one State, tribal, or territorial governmental entity would be required as a Sponsor of a Drug Importation Proposal to offer enhanced accountability and to protect the public health.  Co-sponsorship is included in the Proposed Rule to allow the State, tribal, or territorial governmental entity to benefit from the experience of pharmacists and wholesalers. 

To be eligible to be imported, a prescription drug would need to be approved by the Health Products and Food Branch of Health Canada and, but for the fact that it deviates from U.S. labeling, also meet the conditions in an FDA-approved new drug application or abbreviated new drug application.  Essentially, eligible prescription drugs are those that could be sold legally on either the Canadian market or the American market with appropriate labeling.  An eligible prescription drug would need to be relabeled with the required U.S. labeling, prescribing information, and patient information before sold in the United States. Also, to be eligible for importation, the prescription drug must be currently marketed in the United States (which would allow the FDA to be better able to determine if there is a safety issue with an imported drug).  Several categories of prescription drugs are excluded from the Proposed Rule including controlled substances, biological products, infused drugs, intravenously injected drugs, and drugs that are inhaled during surgery. 

The FDA is seeking comments on the Proposed Rule until March 9, 2020.  Stay tuned for updates as to whether or not the Proposed Rule is revised or finalized as proposed. 

Anthony Romano practices with Burr & Forman LLP in the firm’s Health Care Industry Group. Anthony may be reached at

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Competing Surprise Billing Measures Released

Competing Surprise Billing Measures Released

Early this week, Senator Lamar Alexander (R-TN), the Chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, and Representatives Frank Pallone (D-NJ) and Greg Walden (R-OR), the Chairman and Ranking Member of the House Energy and Commerce Committee announced an agreement on legislation to end surprise medical bills. The two members issued a joint press statement with the hope of creating momentum to include their legislative agreement as part of any year-end omnibus appropriations bill.

The agreement is essentially a merging of the surprise billing legislation approved by both the House Energy and Commerce (H.R. 2328) and Senate HELP Committees (S.1895) earlier this year. Both bills aim to protect patients by limiting their out-of-pocket costs to amounts they would have owed if they had been treated by an in-network physician. However, both bills include provisions strongly opposed by physician and hospital groups (including the Medical Association of the State of Alabama) that would resolve payment disputes between physicians and insurers by using a benchmark rate setting out-of-network payments at the median amount each insurer pays for in-network care. The new agreement includes similar benchmark rate provisions as well as a very limited independent dispute resolution process with a $750 threshold that would only allow for the consideration of median in-network rates.

It was believed by many early in the week, that the surprise billing agreement would pass before the end of the year. However, the House Ways and Means Committee also has jurisdiction over the surprise billing issue and the committee was not included in this initial agreement. Ways and Means subsequently released its own bipartisan proposal that focuses on an arbitration process that protects the patient and said that the committee will consider the legislation in early 2020. With competing bipartisan bills now on the table, it is likely that any action on the legislation will be delayed until January.

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Opioid Cumulative Daily Morphine Milligram Equivalents Limit – MME Decrease

Opioid Cumulative Daily Morphine Milligram Equivalents Limit – MME Decrease

Effective December 2, 2019, the Alabama Medicaid Agency will implement hard edits on cumulative daily MME claims exceeding 200 MME/day. A phase-in period for claims exceeding 150 MME/day, but less than 200 MME/day, will also be implemented.

Examples of MME calculations/day include:
• 10 tablets per day of hydrocodone/acetaminophen 5/325 = 50 MME/day
• 6 tablets per day of hydrocodone/acetaminophen 7.5/325 = 45 MME/day
• 5 tablets per day of hydrocodone/acetaminophen 10/325 = 50 MME/day
• 2 tablets per day of oxycodone 15 mg = 45 MME/day
• 3 tablets per day of oxycodone 10 mg = 45 MME/day
• 10 tablets per day of tramadol 50 mg = 50 MME/day
• 1 patch per 3 days of fentanyl 25mcg/hr = 60 MME/day

More information regarding MME calculations

IMPORTANT: Only when the override is denied will the excess quantity above the maximum unit limit be deemed a non-covered service. Then the recipient can be charged as a cash recipient for that amount in excess of the limit. A prescriber must not write separate prescriptions, one to be paid by Medicaid and one to be paid as cash, to circumvent the override process. FAILURE TO ABIDE BY MEDICAID POLICY MAY RESULT IN RECOUPMENTS AND/OR ADMINISTRATIVE SANCTIONS. Source: Provider Billing Manual 27.2.3

Any policy questions concerning this provider ALERT should be directed to the Pharmacy Program at (334) 242-5050.

View the full ALERT here.

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ALAPAC Ends with Record Year!

ALAPAC Ends with Record Year!


Last week, ALAPAC capped off its FY 2018-2019 fundraising campaign on a high note. Although we narrowly missed our total fundraising goal, ALAPAC set multiple new giving records thanks to the generosity of Alabama physicians.

In total, nearly 120 physicians gave more than the standard amount of $250!

Specifically, 10 physicians contributed $1,000 or more; 44 physicians contributed over $500; and, 63 physicians contributed between $250 and $500.

Thank you! Thank you! Thank you!

Below is a list of the physician “top donors” who helped make 2019 a record year. ALAPAC sincerely appreciates all of our contributors and appreciates each and every dollar donated.

$1,000 + Donors

Aaron Timothy Shinkle, M.D.

Amanda Jean Williams, M.D.

Bradley Phillip Katz, M.D.

David P. Herrick, M.D.

Mark H. LeQuire, M.D.

Marnix Ernestus Heersink, M.D.

Patricia Louise Frierson, M.D.

Robert Howard Story, M.D.

Sarah Kathleen Mullican, M.D.

William Jay Suggs, M.D.

$500+ Donors

Alfred LaShawn Malone, M.D.

Charles R. Horton, Jr., M.D.

Collin King, M.D.

David Thomas Cozart, M.D.

Donald Hodurski, M.D.

Earl M.B. Wyatt, M.D.

Gregory Scott Tucker, M.D.

Grigor Merijanian, M.D.

Hernando Carter, M.D.

J. Eugene Lammers, M.D.

J. Noble Anderson, Jr., M.D.

James B. Byrne, Jr., M.D.

James D. Izer, M.D.

James Vann Worthen, M.D.

Jane Ann Weida, M.D.

John David Moorehouse, M.D.

John F. Cabelka, M.D.

John Lyman Drew, D.O.

John Olen Newcomb, M.D.

Jorge A. Alsip, M.D.

Julia L. Boothe, M.D.

Kurt Arnold Senn, M.D.

Leisa DeVenny, M.D.

Masoud Hamidian, M.D.

Michael F. DeVenny, M.D.

Michael W. Cantrell, M.D.

Michelle Downing, M.D.

Neil Yeager, M.D.

Patricia Wade, M.D.

Paul Michael Nagrodzki, M.D.

Paul W. Pickard, M.D.

Richard Henry Esham, Sr., M.D.

Robert Joseph Stanley, M.D.

Robert Wood Nesbitt, M.D.

Roland Spedale, Jr., M.D.

Ron Benton Pitkanen, M.D.

Sebastian B. Heersink, M.D.

Stephanie Snyder Jiminez, M.D.

Thomas Harvey McCulloch, M.D.

Thomas James Weida, M.D.

Thomas Martin, M.D.

Tim Melson, M.D.

William Bennett, M.D.

William Scheider, M.D.

$250+ Donors

Adam Jay Handwerger, M.D.

Alan Thomas Mann, D.O.

Albert Fox Haas, M.D.

Alexis Tanishia Mason, M.D.

Anthony DeVan Hollman, M.D.

Arden LeRoy Aylor, Jr., M.D.

Bendt P. Petersen, III, M.D.

Beverly F. Jordan, M.D.

Brett Lee Storm, M.D.

Burt Fowler Taylor, M.D.

Charles Henry Wilson, IV, M.D.

Charles Hugh Holloway, M.D.

Christopher Jason Green, M.D.

Christopher Rauf Ahmed, M.D.

Christopher T. Nichols, M.D.

Clint Thomas Wade, M.D.

Clinton W. Howard, IV, M.D.

Dewey H. Jones, IV, M.D.

Eric Conrad Lund, M.D.

Glenn M. Woods, M.D.

Guy Leslie Rutledge, III, M.D.

Ivan Daniel Sequera-Sanchez, M.D.

Jacob Fant Kidder, M.D.

James C. Mann, M.D.

James Keith Spain, M.D.

James L. West, III, M.D.

James M. Cockrell, M.D.

James Nicholas Rachel, M.D.

James Reza Fernandez, M.D.

James Scott Bolton, M.D., PC

Jeffrey M. Conrad, M.D.

John Sansbury Meigs, Jr., M.D.

Joseph F. McGowin, III, M.D.

Julia Ann Alexander, M.D.

Leon Williams Bell, III, M.D.

Liang Gu, M.D.

Lowell Dean Mason, II, M.D.

Matthew Lloyd Busbee, M.D.

Michael A. Eslava, M.D.

Michael Andrew Cochran, M.D.

Michael Devon Smith, M.D.

Michael F. Blum, M.D.

Michael Todd Ellerbusch, M.D.

Milton A. Wallace, Jr., M.D.

Nina L. J. Terry, M.D.

Richard E. Jones, III, M.D.

Richard Matthew McKean, M.D.

Robert Ball McGinley, M.D.

Robert Carl Baird, III, M.D.

Robert Evans Egbert, M.D.

Robert Neil Honea, Jr., M.D.

Robert Wayne Williams, Jr., M.D.

Sara Margaret Mullins, M.D.

Stephen B. Cope, M.D.

Stephen Louis Fernandez, M.D.

Suzanne S. Blaylock, M.D.

Thomas M. Barbour, III, M.D.

Timothy L. Frerichs, M.D.

Todd David Engerson, M.D.

Todd K. Volkman, M.D.

Weston James Welker, M.D.

William Isaiah Park, IV, M.D.

William W. Beckett, Jr., M.D.



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Alabama Hospitals Want to Limit Physician In-Office Procedures

Alabama Hospitals Want to Limit Physician In-Office Procedures
The Alabama Hospital Association (ALAHA) submitted a letter to a state health agency this week complaining of increasing instances of physicians performing interventional procedures in their offices instead of in acute care hospitals.  The ALAHA letter states “We strongly believe most interventional procedures should be done in a general acute care hospital setting.”  It further states “…the growing number of interventional/therapeutic procedures being done in a physician’s office setting where the providers are requesting letters of non-reviewability is alarming.”
Read the letter here, and provide us feedback.

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Sign-on Letter: Improving Seniors’ Timely Access to Care Act

Sign-on Letter: Improving Seniors’ Timely Access to Care Act

September 9, 2019

Dear Members of Congress:

The undersigned patient, physician, health care professional, and other health care stakeholder
organizations strongly support the Improving Seniors’ Timely Access to Care Act of 2019 (H.R.
3107) recently introduced by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger
Marshall, MD (R-KS), and Ami Bera, MD (D-CA). This bipartisan legislation would help
protect patients from unnecessary delays in care by streamlining and standardizing prior
authorization under the Medicare Advantage program, providing much-needed oversight and
transparency of health insurance for America’s seniors. We urge you to join your colleagues in
supporting this important legislation.

Based on a consensus statement on prior authorization reform adopted by leading national
organizations representing physicians, medical groups, hospitals, pharmacists, and health plans,
the legislation would facilitate electronic prior authorization, improve transparency for
beneficiaries and providers alike, and increase Centers for Medicare & Medicaid Services (CMS)
oversight on how Medicare Advantage plans use prior authorization. Specifically, the bill

  • Create an electronic prior authorization program including the electronic transmission of
    prior authorization requests and responses and a real-time process for items and services
    that are routinely approved;
  • Improve transparency by requiring plans to report to CMS on the extent of their use of
    prior authorization and the rate of approvals or denials;
  • Require plans to adopt transparent prior authorization programs that are reviewed
    annually, adhere to evidence-based medical guidelines, and include continuity of care for
    individuals transitioning between coverage policies to minimize any disruption in care;
  • Hold plans accountable for making timely prior authorization determinations and to
    provide rationales for denials; and
  • Prohibit additional prior authorization for medically-necessary services performed during
    a surgical or invasive procedure that already received, or did not initially require, prior

The demand and need for such reforms is growing — particularly as more seniors choose
Medicare Advantage for their health insurance needs. According to a recently released Kaiser
Family Foundation report, “A Dozen Facts About Medicare Advantage in 2019,” Medicare
Advantage enrollment has nearly doubled in a decade. One-third (34%) of all Medicare
beneficiaries — 22 million people — are enrolled in Medicare Advantage plans, and nearly four
out of five enrollees (79%) are in plans that require prior authorization for some services. The
Congressional Budget Office (CBO) projects that beneficiaries enrolled in Medicare Advantage
plans will rise to nearly half of all Medicare beneficiaries (about 47%) by 2029. Recognizing the
need to protect a growing number of Medicare beneficiaries, more than 100 members of
Congress called for such reforms in a letter last year to the CMS.

For our seniors — and as representatives of organizations seeking to protect patients from delays
in care and relieve unnecessary administrative burdens that impede delivery of timely care—we
are committed to advancing this legislation in Congress and ask that you join Representatives
DelBene, Kelly, Marshall, and Bera in co-sponsoring H.R. 3107 and securing its enactment.
Thank you.


Aimed Alliance
Alliance for Aging Research
Alliance for Balanced Pain Management
Alliance for Patient Access
Alliance of Specialty Medicine
Alzheimer’s Association
Alzheimer’s Impact Movement
AMDA – The Society for Post-Acute and Long-Term Care Medicine
American Academy of Allergy, Asthma & Immunology
American Academy of Dermatology Association
American Academy of Facial Plastic and Reconstructive Surgery
American Academy of Family Physicians
American Academy of Hospice and Palliative Medicine
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Otolaryngology – Head and Neck Surgery
American Academy of PAs
American Academy of Physical Medicine & Rehabilitation
American Academy of Sleep Medicine
American Alliance of Orthopaedic Executives
American Association of Clinical Endocrinologists
American Association of Clinical Urologists
American Association of Hip and Knee Surgeons
American Association of Neurological Surgeons
American Association of Nurse Practitioners
American Association of Orthopaedic Surgeons
American Association of Pediatric Ophthalmology and Strabismus
American Association on Health and Disability
American Autoimmune Related Diseases Association
American Brain Coalition
American Cancer Society Cancer Action Network
American Clinical Laboratory Association
American Clinical Neurophysiology Society
American College of Allergy, Asthma and Immunology
American College of Cardiology
American College of Emergency Physicians
American College of Gastroenterology
American College of Mohs Surgery
American College of Obstetricians and Gynecologists
American College of Osteopathic Surgeons
American College of Physicians
American College of Radiation Oncology
American College of Radiology
American College of Rheumatology
American College of Surgeons
American Congress of Rehabilitation Medicine
American Dance Therapy Association
American Gastroenterological Association
American Geriatrics Society
American Glaucoma Society
American Group Psychotherapy Association
American Liver Foundation
American Medical Association
American Medical Rehabilitation Providers Association
American Medical Women’s Association
American Music Therapy Association
American Nurses Association
American Occupational Therapy Association
American Osteopathic Association
American Osteopathic Colleges of Ophthalmology and Otolaryngology
American Physical Therapy Association
American Psychiatric Association
American Psychoanalytic Association
American Society for Clinical Pathology
American Society for Gastrointestinal Endoscopy
American Society for Radiation Oncology
American Society for Radiology and Oncology
American Society for Surgery of the Hand
American Society of Anesthesiologists
American Society of Cataract & Refractive Surgery
American Society of Clinical Oncology
American Society of Echocardiography
American Society of Hematology
American Society of Interventional Pain Physicians
American Society of Nephrology
American Society of Neuroimaging
American Society of Neuroradiology
American Society of Nuclear Cardiology
American Society of Ophthalmic Plastic and Reconstructive Surgery
American Society of Plastic Surgeons
American Society of Retina Specialists
American Society of Transplant Surgeons
American Spinal Injury Association
American Urological Association
American Uveitis Society
American Vein & Lymphatic Society
American-European Congress of Ophthalmic Surgery
America’s Physician Groups
Arthritis Foundation
Association for Molecular Pathology
Association of Academic Physiatrists
Association of American Medical Colleges
Association of Black Cardiologists
Association of Rehabilitation Nurses
Association of University Professors of Ophthalmology
Beyond Type 1
Brain Injury Association of America
Bridge the Gap – SYNGAP Education and Research Foundation
Cancer Support Community
Caregiver Action Network
Child Neurology Foundation
Children with Diabetes
Christopher & Dana Reeve Foundation
Clinician Task Force
CMSC- Consortium of Multiple Sclerosis Centers
Coalition For Headache And Migraine Patients
College Diabetes Network
College of American Pathologists
Community Oncology Alliance
Congress of Neurological Surgeons
Cornea Society
Crohn’s & Colitis Foundation
Delaware Academy of Ophthalmology
Depression and Bipolar Support Alliance
Derma Care Access Network
Diabetes Patient Advocacy Coalition
Digestive Disease National Coalition
Disability Rights Education and Defense Fund
Dystonia Advocacy Network
Dystonia Medical Research Foundation
Epilepsy Foundation
Eye and Contact Lens Association
Eye Bank Association of America
Federation of American Hospitals
GBS|CIDP Foundation International
Global Alliance for Behavioral Health and Social Justice
Global Healthy Living Foundation
Global Liver Institute
Healthcare Information and Management Systems Society
Hematology/Oncology Pharmacy Association
IFAA – International Foundation for Autoimmune & Autoinflammatory Arthritis
International Essential Tremor Foundation
International Foundation for Gastrointestinal Disorders
International Society for the Advancement of Spine Surgery
Interstitial Cystitis Association
Lupus and Allied Diseases Association, Inc.
Medical Group Management Association
Movement Disorders Policy Coalition
Multiple Sclerosis Association of America
National Alopecia Areata Foundation
National Association for the Advancement of Orthotics & Prosthetics
National Association of Rural Health Clinics
National Association of Social Workers
National Association of Spine Specialists
National Association of State Head Injury Administrators
National Association of State Mental Health Program Directors
National Comprehensive Cancer Network
National Diabetes Volunteer Leadership Council
National Health Council
National Infusion Center Association
National Lipid Association
National Medical Association, Ophthalmology Section
National Multiple Sclerosis Society
National Osteoporosis Foundation
National Pancreas Foundation
National Patient Advocate Foundation
NephCure Kidney International
North American Neuro-Ophthalmology Society
Ocular Microbiology and Immunology Group
Outpatient Endovascular and Interventional Society
Partnership to Advance Cardiovascular Health
Partnership to Fight Chronic Disease
Partnership to Improve Patient Care
Prevent Blindness
Pulmonary Hypertension Association
Remote Cardiac Services Provider Group
Renal Physicians Association
Restless Legs Syndrome Foundation
Sjogren’s Syndrome Foundation
Society for Cardiovascular Angiography and Interventions
Society for Vascular Surgery
Society of Critical Care Medicine
Society of Gynecologic Oncology
Society of Hospital Medicine
Spine Intervention Society
The Headache and Migraine Policy Forum
The Leukemia & Lymphoma Society
The Marfan Foundation
The Michael J. Fox Foundation for Parkinson’s Research
The Retina Society
The Society of Thoracic Surgeons
Tourette Association of America
Treatment Communities of America
Uniform Data System for Medical Rehabilitation
United Spinal Association
US Hereditary Angioedema Association
Alabama Academy of Ophthalmology
Alabama Society for the Rheumatic Diseases
Lakeshore Foundation
Medical Association of the State of Alabama
Neurosurgical Society of Alabama
Alaska Rheumatology Alliance
Alaska Society of Eye Physicians and Surgeons
Denali Oncology Group Alaska Chapter ASCO
Arizona Medical Association
Arizona Neurosurgical Society
Arizona United Rheumatology Alliance
The Arizona Clinical Oncology Society
Arkansas Medical Society
Arkansas Ophthalmological Society
Arkansas Rheumatology Association
Association of Northern California Oncologists
California Academy of Eye Physicians and Surgeons
California Association of Neurological Surgeons
California Medical Association
California Rheumatology Alliance
Medical Oncology Association of Southern California, Inc.
Cedars/Aspens, non-profit society of ophthalmic surgeon educators
Colorado Medical Society
Colorado Neurosurgical Society
Colorado Rheumatology Association
Colorado Society of Eye Physicians and Surgeons
Connecticut Rheumatology Association
Connecticut Society of Eye Physicians
Connecticut State Medical Society
Delaware Society for Clinical Oncology
Delaware State Neurosurgical Society
Medical Society of Delaware
Medical Society of the District of Columbia
Florida Medical Association
Florida Neurosurgical Society
Florida Society of Clinical Oncology
Florida Society of Ophthalmology
Florida Society of Rheumatology
Georgia Society of Clinical Oncology
Georgia Society of Rheumatology
Medical Association of Georgia
Hawaii Medical Association
Hawaii Society of Clinical Oncology
Association of Idaho Rheumatologists
Idaho Medical Association
Idaho Society of Ophthalmology
Illinois Medical Oncology Society
Illinois Society of Eye Physicians & Surgeons
Illinois State Medical Society
Illinois State Neurosurgical Society
Indiana Academy of Ophthalmology
Indiana Chapter, American College of Cardiology
Indiana Oncology Society
Iowa Medical Society
Iowa Oncology Society
Midwest Neurosurgical Society
Kansas Chapter, American College of Cardiology
Kansas Hospital Association
Kansas Medical Society
LeadingAge Kansas
Midwest Rheumatology Association
Kentucky Academy of Eye Physicians and Surgeons
Kentucky Association of Medical Oncology
Kentucky Chapter, American College of Cardiology
Kentucky Medical Association
Louisiana Academy of Eye Physicians and Surgeons
Louisiana Chapter, American College of Cardiology
Louisiana Neurosurgical Society
Louisiana State Medical Society
Rheumatology Alliance of Louisiana
Maine Medical Association
Maine Society of Eye Physicians and Surgeons
Maryland Chapter, American College of Cardiology
Maryland DC Society of Clinical Oncology
Maryland Society for the Rheumatic Diseases
Maryland Society of Eye Physicians and Surgeons
MedChi, The Maryland State Medical Society
Massachusetts Society of Clinical Oncologists
Massachusetts Medical Society
Michigan Society of Eye Physicians and Surgeons
Michigan Society of Hematology & Oncology
Michigan State Medical Society
Minnesota Medical Association
Minnesota Neurosurgical Society
Mississippi Arthritis and Rheumatism Society
Mississippi Oncology Society
Mississippi State Medical Association
Missouri Oncology Society
Missouri Society of Eye Physicians & Surgeons
Missouri State Medical Association
Montana Medical Association
Montana Neurosurgical Society
Montana State Oncology Society
Nebraska Chapter, American College of Cardiology
Nebraska Medical Association
Nebraska Rheumatology Society
Nevada State Medical Association
Northern New England Clinical Oncology Society
New Hampshire Medical Society
Medical Oncology Society of New Jersey
Medical Society of New Jersey
New Jersey Academy of Ophthalmology
New Jersey Neurosurgical Society
New Mexico Medical Society
Empire State Hematology & Oncology Society
Medical Society of the State of New York
New York State Neurosurgical Society
New York State Ophthalmological Society
New York State Rheumatology Society
North Carolina Medical Society
North Carolina Rheumatology Association
North Carolina Society of Eye Physicians & Surgeons
North Dakota Medical Association
North Dakota Society of Eye Physicians and Surgeons
Ohio Association of Rheumatology
Ohio Chapter, American College of Cardiology
Ohio Hematology Oncology Society
Ohio Ophthalmological Society
Ohio State Medical Association
Ohio State Neurosurgical Society
Oklahoma Academy of Ophthalmology
Oklahoma Chapter, American College of Cardiology
Oklahoma Neurosurgical Society
Oklahoma State Medical Association
Oregon Academy of Ophthalmology
Oregon Medical Association
Oregon Rheumatology Alliance
Oregon Society of Medical Oncology
Pennsylvania Academy of Ophthalmology
Pennsylvania Medical Society
Pennsylvania Neurosurgical Association
Pennsylvania Rheumatology Society
Philadelphia Rheumatism Society
Pittsburgh Ophthalmology Society
Pennsylvania Society of Oncology & Hematology
The Hospital and Healthsystem Association of Pennsylvania
Puerto Rico’s Hematology and Medical Oncology Association
Rhode Island Chapter, American College of Cardiology
Rhode Island Medical Society
Rhode Island Neurosurgical Society
Rhode Island Society of Eye Physicians and Surgeons
South Carolina Medical Association
South Carolina Oncology Society
South Carolina Rheumatism Society
South Carolina Society of Ophthalmology
South Dakota Academy of Ophthalmology
South Dakota State Medical Association
Tennessee Chapter, American College of Cardiology
Tennessee Medical Association
Tennessee Rheumatology Society
State of Texas Association of Rheumatologists
Texas Medical Association
Texas Ophthalmological Association
Society of Utah Medical Oncologists
Utah Medical Association
Utah Ophthalmology Society
Vermont Medical Society
Medical Society of Virginia
Virginia Association of Hematologist & Oncologist
Virginia Chapter, American College of Cardiology
Virginia Society of Eye Physicians and Surgeons
Neurosurgical Society of the Virginias

Washington Academy of Eye Physicians and Surgeons
Washington Rheumatology Alliance
Washington State Medical Association
Washington State Medical Oncology Society
West Virginia Academy of Eye Physicians & Surgeons
West Virginia State Medical Association
West Virginia State Rheumatology Society
Wisconsin Academy of Ophthalmology
Wisconsin Association of Hematology & Oncology
Wisconsin Medical Society
Wisconsin Rheumatology Association
Wisconsin State Neurosurgical Society
Wyoming County Community Health System
Wyoming Medical Society
Wyoming Ophthalmological Society

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First Impressions

First Impressions

In the last few years, healthcare providers have come to realize the effect of consumerism on their practice.  Consumers increasingly view healthcare as a commodity to be compared and shopped. Social media has allowed patients to share experiences, good and bad.  Online reviews are visible on many websites, it is now more likely for consumers to seek reviews or ask friends before selecting a practice or physician. Even a physician referral may be only a suggestion not an assurance the patient will present for care.

Many physicians fail to realize the first impression is the initial phone call not the initial visit.  Seventy-five percent of patients who abandon calls do not call back. It is important to measure the abandonment rate in multiple departments of your practice.  A practice should have no more than five options on an automated attendant. The first option is usually a prompt for making an appointment. These calls should be answered promptly and never go to voicemail.  A queue can be utilized to line calls into a holding pattern allowing staff to manage a larger volume of calls and give undivided attention to the caller. The goal of the patient is to finalize the call; a voicemail does not allow the patient to finalize the call by obtaining an appointment or other service.  The front office staff should focus on patients who are arriving to see a provider; they should not answer calls for appointments or other high volume tasks. The timeline to an appointment is very important to capturing a new patient. If a patient has to wait more than 2-4 weeks for an appointment, they will seek service elsewhere depending on the specialty.  I worked with a practice last week, the physician had no idea there was a six month wait for a new patient appointment and a two month wait for a follow-up appointment. Providers should track no-shows in correlation to wait time to appointment.

Sometimes, a first impression is based on the effectiveness of the practice website.  A good website is easy to navigate and it showcases important information related to making an appointment and information related to the physicians and other providers.  Phone calls can be controlled by offering requests for appointments via the website or patient portal. Patients prefer to communicate through various methods; most pediatric practices use a portal to communicate with parents of established patients.  The parents can speak directly to a nurse and obtain an answer quickly.  

Another important first impression is the preparation for a visit.  Most patients prefer to register online via link from an automated appointment confirmation.  Online registration allows the patient to use their own device to complete needed information. The staff receives the information before the appointment allowing for quick verification of coverage, and it reduces the time in the waiting room upon arrival.  It also prepares the front office staff with accurate information related to the co-pay and other benefit considerations.

Managers and staff often enter the practice through a side or back door and never see the practice from the perspective of the patient.  I visited a practice a couple of years ago, the carpet was soiled and the receptionist was seated behind a frosted glass window not allowing her to see presenting patients.  In addition, a sign was posted on the glass stating “Don’t tap on the glass, have a seat until called.” It was evident they did not care about first impressions. Assure a manager or supervisor is entering through the front door daily to see the reception area through the eyes of a patient.  The call volumes and wait to obtain an appointment should be closely monitored to assure a good balance between scheduling and availability.

Patient satisfaction surveys are instrumental in measuring patient satisfaction.  The practice culture is essential to engaged and well-trained employees who care about high patient satisfaction.  

You only have 12 seconds to make a good first impression!  Review all the steps a patient must take to make it to the exam room.  If it is not a pleasant experience, make the necessary changes and continue to monitor the steps and the staff performing each step.  Compare yourself to your fiercest competitor, are you keeping staying abreast of changes in technology and healthcare?

Article contributed by Tammie Lunceford, Healthcare and Dental Consultant, Warren Averett Healthcare Consulting Group. Warren Averett is an official Gold Partner with the Medical Association.

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2019 Women in Medicine Month Begins

2019 Women in Medicine Month Begins

September is the AMA’s Women in Medicine (WIM) Month, which serves to showcase the accomplishments of women physicians as well as highlight advocacy affecting female physicians and health issues impacting female patients.

This year’s theme is Women in Medicine: Trailblazers, Advocates and Leaders. To celebrate the importance of current and future female physicians, the Medical Association of the State of Alabama will be following the AMA in recognizing female leaders in Alabama medicine.

Throughout the month, we will be sharing inspiring stories of the numerous accomplishments of women physicians as well as highlighting specific advocacy-related efforts of those who have played a vital role in shaping the practice of medicine in Alabama.

Over the years, the Medical Association of the State of Alabama has proudly had 3 females serve as President. Today, we are even more proud to have two women in leadership roles, with Aruna Arora, M.D. serving as President-Elect and Amanda Williams, M.D. as Vice President.

When asked about her career path and the impact women can have on the profession as whole, Dr. Williams said, “I can’t imagine any other career. Caring for patients and working to improve healthcare in my community brings me so much joy and fulfillment. It’s exciting to see so many women choosing medicine as a career – diversity in any arena leads to increased innovation, improved decision making and a broader spectrum of talent.”

For Dr, Arora the desire to effect positive change in patients and policies is what led her to serve. “Active involvement in organized medicine at the local and state levels fueled my desire to promote the very changes I would like to see in medicine. Holding a leadership position as a female physician creates a more diverse – but unified – voice and leads to more vetted solutions that represent the House of Medicine as a whole.”

Show your support for Women in Medicine by posting photos of yourself at work or in the classroom using the hashtag #WIMMonth. Also, be sure to check out our Facebook and share the various pictures and stories we have posted.

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Get To Know Charlotte Meadows

Get To Know Charlotte Meadows

1. While you have been active around Montgomery for quite some time, can you tell us a little bit about yourself? Primary occupation? Interests? Hobbies?

I grew up in Montgomery and graduated from Jeff Davis HS before going to Auburn for college. I married Allen in 1986 who, at the time, was a pediatrician in Mobile. In 1991, we came back to Montgomery and, together, we started his solo practice allergy clinic.

In addition to helping run the office, I’ve been involved with education in Montgomery since the early 2000’s and served on the Montgomery Board of Education from 2006-2012.  I’m also involved with the local Republican Party and Allen and I both have served on the county and state executive committees. Today, I am the current treasurer (and past president) of the Republican Club of Central Alabama.  I enjoy working to get good people elected to office, and have campaigned across Alabama and Florida to support Republican candidates in the last several years.

My hobbies are cooking, reading, taking care of my yard and travel. With Allen’s position as the incoming President of the American college of Allergy, Asthma and Immunology we were privileged to travel to Germany and Nairobi last year in conjunction with allergy training in those areas.

2. What prompted you to consider running for House District 74 this year?

After running unsuccessfully for this seat in the special election in 2013, I still felt like I could help to solve some of the problems in Montgomery from a state level. With my experience in education, and the fact that our number one concern in Montgomery is education, I believe I am the right person for this seat. I have seen firsthand how changes in education policy can change the lives of children and the families that love them. We can’t expect our state to move up in student achievement by doing the same things we’ve always done.  We have to change to focus on what makes a student achieve at higher levels. I am committed to bringing the voices of students and their families to the State House.

3. How will your background help you serve in the legislature and what will be some of your priorities?

My accounting and business administration degrees, as well as my background in medicine and small business, and my experience in education policy will enable me to be up to speed on both the education and general fund budgets, as well as many other committees in the State House.  My work as an education advocate allowed me to spend a lot of time in the State House between 2013 and 2016, including working directly with the Alabama Legislative Reference service, the office that actually researches and writes the legislation that comes before the legislators.  My priorities will always be to first have a balanced budget that prioritizes the needs of Alabama and district 74 over the wants and treats each entity fairly.

I will also work to improve the level of student achievement in Alabama by encouraging better teacher training and specific professional development for teachers and finding ways to keep excellent teachers in the classroom instead of moving up into administration. We also need to have a focus on students being ready for a career when they finish high school; this is accomplished through career pathways in middle/high school, dual enrollment and certification classes.

4. What do you believe are some health-related issues important to your district and/or your constituents?

One of the biggest problems in Alabama and District 74 is that those who need Mental Health services are not able to get it. Because our funding in AL is so low, we have fewer physicians willing to live in Alabama and offer counseling and mental health services. I am very concerned that many people in our prisons and jails are there because they did not get appropriate mental health treatment before they crossed a line.  I am also hearing from constituents about their interest in legalizing medical marijuana.  This would be a topic that I would particularly want to hear from physicians on their thoughts on the issue of using the drug for medical use and how that would impact doctors and their patients.

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

Change the GPCI so that Alabama physician’s get paid on par with Georgia and Florida. Also, Medicaid should be adequately funded.

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

Advocate more to the legislature – pay attention to the Rotunda and get to know your state representative and state senators. All politics is local and physicians should be leaders in advocating for the change they want to see.  Physicians should be willing to work with legislators on task forces to improve access to mental health care, research marijuana legalization, and participate with MASA in lobbying for the changes they need to continue to practice medicine in Alabama.

7. If there is one thing you could say to physicians in your district before the election, what would it be?

Thank you for your support and make sure you vote in this election and every election. I know it’s difficult for physicians who work 12- and 14-hour days to prioritize voting, but each vote really is critical and the people that represent all of us must be willing to listen as well as work to solve the problems that MD’s face each day.  I will be that person, and I need each voter to go to the polls on Tuesday, June 11th. 

Learn More About Charlotte’s Campaign

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What If No One Was On Call?

What If No One Was On Call?

 In times of illness, injury, and emergency, patients depend on their physicians.  But what if no one was on call?  Public health would be in jeopardy. The same holds true for organized medicine when the legislature is in session.

If the Association had not been on call for its members, numerous inappropriate expansions to the scopes of practice for non-physicians would have passed; lawsuit opportunities against physicians would have increased; and poorly thought out “solutions” to the opioid abuse epidemic could have become law.

Overview of Legislation

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Moving Medicine Forward

The 2019 Legislative Session is over. For our advocacy efforts to remain successful moving forward, between now and the 2020 Session, the Association will be visiting with physicians and legislators around the state to ensure the views of medicine continue to be heard. Visit our Advocacy Portal to find out how you can get involved.

If no one was on call . . . legislation setting up a process for establishing guidelines for prescription of buprenorphine in nonresidential treatment programs would not have passed. The Association worked alongside the bill’s sponsor, Sen. Larry Stutts, M.D., in supporting this legislation and giving BME the authority to issue regulations on medication assisted treatment. The bill currently awaits the governor’s signature.

If no one was on call . . . the importance of updating statewide immunization registry requirements would not have received the exposure it did. The Association worked with Sen. Tim Melson, M.D. and the Department of Public Health on SB256. The bill was set for final passage in the House, but it unfortunately did not receive a vote on the final day of the session. The Association will support the bill again moving forward.

If no one was on call . . . “truth in advertising” legislation would not have been brought forward. The Association assisted Sen. Tim Melson, M.D. on the legislation to prohibit deceptive or misleading advertising and require all health professionals to take steps to inform patients of their certifications. Although the bill did not receive a vote for final passage, it remains a priority for the Association per a 2018 House of Delegates Resolution.

If no one was on call . . .  the rural physician tax credit would not have been introduced and support for this bill would not have grown. SB374 would have amended the current definition of rural, strengthened the residency requirement, and extended the tax credit from 5 to 6 years. The tax credit is a significant factor in physician retention in Alabama’s rural communities and, while it did not pass, it remains a priority for the Association.

If no one was on call . . . the Board of Medical Scholarship Awards may have been consolidated into some other state agency or seen its funding eliminated. The Association worked with BMSA to request additional funding for this highly successful program, but the increase was ultimately not included in the budget. Like the Rural Physician Tax Credit, the BMSA is a critical tool to placing physicians in rural areas and the Association will continue pushing increased BMSA funding moving forward.

If no one was on call . . . the upgrades that transformed the PDMP into a more user-friendly and valuable tool for physicians may not have continued to be funded. The Association supports maintaining the increased appropriations for the PDMP.


Scope Creep – Replacing Education with Legislation

Everyone wants to be a physician, but few are willing to endure medical school, residency, and all the other various education and training requirements to become an M.D. or D.O. Instead of pursuing higher education, non-physicians are pursuing legislative changes as a means to practice medicine. The Association opposes any scope of practice expansions that could endanger quality care for patients.

If no one was on call . . . the physician referral requirement for physical therapy would have been abolished. Patients would not receive a medical diagnosis, potentially receive unnecessary care, and could be delayed in obtaining appropriate care. In conjunction with the Alabama Orthopaedic Society and other allied specialties, the Medical Association convinced members of the Senate Health Committee to uphold the importance of a diagnosis and vote down SB25, 8-2. This bill is expected to return in 2020.

If no one was on call . . . safety standards for anesthesia care would have been significantly lowered. In addition to abolishing physician direction of CRNAs, SB156 could have also led to CRNA prescribing with no physician oversight. In conjunction with the Alabama State Society of Anesthesiologists and other allied specialty societies, the Medical Association convinced legislators not to support the legislation and it failed without receiving a vote. This bill is expected to return in 2020.

If no one was on call . . . optometrists could have begun performing eye surgeries using scalpels and lasers. Moreover, SB114 would have given the Alabama Board of Optometry the sole power to define what is considered to be the practice of optometry simply by regulation. Ultimately, the bill did not receive a vote in committee due to the work of the Alabama Academy of Ophthalmology, other allied specialty societies, and the Medical Association. This bill is expected to return in 2020.

If no one was on call . . . a new state board with unprecedented authority over radiation and medical imaging could have been created.  Among other things, SB165 would have allowed this new board to determine scopes of practice for x-ray operators, radiation therapists, radiographers, radiologist assistants, magnetic resonance technologists, and nuclear medicine technologists (to name a few). This bill could have increased costs for medical practices and dangerously expanded the scopes of practice for non-physicians. While the bill did not receive a vote in committee, it is expected to return in 2020.

If no one was on call . . . all podiatrists would have been granted the ability to perform surgery on the ankle and lower leg. HB310 significantly expanded the scope of practice of podiatrists, who only 10 years ago standardized their residency programs nationwide. This legislation failed to receive a vote in committee, but, similar to the other “scope creep” pieces of legislation, the bill is expected to return in 2020.

If no one was on call . . . physician collaborative practice with nurses could have been abolished. Under the legislation passed this session, nurses are now allowed to apply for a multistate license through a compact. Previous nursing compact legislation, however, had attempted to allow other states’ laws to be substituted for Alabama’s. The Association worked to ensure nothing in this bill alters current collaborative practice agreements.


Beating Back the Lawsuit Industry

Plaintiff trial lawyers are constantly seeking new opportunities to sue doctors. Alabama’s medical liability laws have long been recognized for ensuring a stable legal climate and fostering fairness in the courtroom. Yet, year after year, personal injury lawyers seek to undo those laws and allow more frivolous lawsuits to be filed against physicians.

If no one was on call . . . multiple bills dictating standards of care and increasing lawsuits against physicians may have passed. For instance, physicians could have faced lawsuits and criminal penalties if a patient overdosed as a result of an opioid prescription. Also, physicians participating in a state authorized needle exchange program aimed at curbing the spread of disease via IV drug use would not have received proper liability protections. None of the language proposed by plaintiff lawyers passed into law.

If no one was on call . . . plaintiff lawyer-drafted legislation concerning involuntary commitment procedures would have created new lawsuit opportunities against physicians.  These 6 different pieces of legislation amend current law to allow a nurse practitioner or physician assistant to coordinate with a physician in deciding to treat an individual who is unable to consent and without having to first attempt to contact a family member. Before passing, however, the Association successfully added much-needed liability protection for physicians to these bills.

If no one was on call . . . physicians administering chemical castration drugs to certain inmates would not have been shielded from liability. The Association worked with the bill sponsor to add language protecting physicians who administer these drugs to those individuals convicted of sexual offenses against children age 13 and under who opt to take the medication as a condition of parole.

If no one was on call . . . support would not have grown for legislation increasing penalties on attorneys who encourage lawsuits. HB181 would strengthen existing criminal and civil penalties on attorneys who give, offer, or promise valuable consideration to a potential client as an inducement to file a lawsuit. The bill passed committee but never received a final vote.


On the Prescribing Front

This session, many bills regarding prescribing practices and prescription drugs were introduced. Some of this legislation was pitched as improving access to quality care, but were actually back-door “scope creep” bills.

If no one was on call . . . Alabama’s existing prescription authorization law would have been repealed, endangering patients and creating hassles and expenses for physicians. Prior to revisions negotiated by the Association, the legislation would have given pharmacists the default ability to substitute drugs and could have allowed the Board of Pharmacy to issue regulations affecting physician prescribing practices. This language was successfully removed by the Association before the bill passed. Physician authority in issuing prescriptions is unchanged.

If no one was on call . . . poorly-written legislation could have passed on biologic substitution, delaying patient and physician notification. The Association negotiated language requiring pharmacists to communicate an authorized substitution within 24 hours to the physician and patient. The notification to physicians must be made via phone or fax or the e-prescribe software used by the physician. The bill that passed was supported by the Medical Association.

If no one was on call . . . legislation opening the door for widespread prosecution of physicians prescribing opioids could have become law. The legislation was successfully amended to adopt the federal standard that all prescribers and pharmacists are currently held to by the DEA. As passed, only someone who issues a prescription knowingly or intentionally for other than a legitimate medical purpose and outside the usual course of his or her practice may be charged.

If no one was on call . . . arbitrary physician requirements for prescribing controlled substances could have been enacted. Working with proponents of the bill, the Association sought to change the bill and default to existing medical regulations governing controlled substance prescribing practices. The legislation, however, did not pass.


Other Legislation of Interest

Medical Marijuana . . . having undergone significant changes as it moved through the legislature, this bill now reauthorizes CBD research at UAB via “Carly’s Law” and creates a study commission to make recommendations to the Legislature relating to medical use of cannabis in Alabama. The Commission will be comprised of 15 members and will issue its findings and draft legislation by December 1, 2019.

Abortion . . . this legislation criminalizes the performing of an abortion or attempted abortion, with exceptions for instances where the physical and mental health of the mother is at risk and for treatment of ectopic and cornu implantations. The sole purpose of the bill is to challenge the United States Supreme Court’s prior rulings on abortion laws and a lawsuit has already been filed asking a judge to block its implementation.

Pharmacist/Physician Collaborative Practice . . . this legislation allows pharmacists and physicians to voluntarily enter into agreements for medication management services.  Unlike collaborative practice laws of other states, HB35 does not specify what types of authority or activities a physician may delegate to a pharmacist.  For example, HB35 does not state that ultimate determinations regarding patient care rest with the physician.  Moreover, HB35 does not require pharmacists to input information into patients’ medical records if dosage strength or medication type is changed.  HB35 also does not prohibit pharmacists from prescribing any drugs – including controlled substances – and does not prohibit pharmacists from ordering lab tests.  Despite patient safety and public health concerns raised by the Association, the bill was passed and signed into law.  The Alabama Board of Pharmacy and the Alabama Board of Medical Examiners are now responsible for promulgating rules to enforce the act.

Human Trafficking . . . multiples bills introduced this session would have set new human trafficking training requirements and standards of care for physicians. The failure of a physician to follow these new guidelines could have effectively created liability. In the end, the bills were changed into resolutions calling for education and training which received widespread support.

Gunshot Wound Reporting . . . as introduced, these bills mandated physicians to report all patients receiving treatment for gunshot wounds or acts of violence and contained no language protecting reporting physicians from liability. The Association worked to successfully amend this legislation to limit its scope to only gunshots and provide protection for physicians.

Genetic Counselors . . . these bills would have created an entirely new board authorized to establish regulations for genetic counselors and genetic counseling in Alabama. Working with bill proponents, the Association exempted physicians from regulation under the act and specified that genetic counselors are not authorized to practice medicine. The bill did not pass.

Using Cell Phones While Driving . . . prior to the Association’s successful addition of an amendment, this bill would have outright prohibited the use of cell phones while driving, including physicians responding to an emergency situation. Ultimately, the bill did not pass, even with the Association’s amendment.

General Fund Appropriations . . . in addition to funding for the PDMP mentioned above, the general fund budget contained other appropriations for various health causes. Specifically, $200,000 will be expended for the Addiction Prevention Coalition; $100,000 for the Amyotrophic Lateral Sclerosis (ALS) Association; and $500,000 for the Breast and Cervical Cancer Early Detection Program. Also, the CHIP program received full funding; and there are no scheduled cuts to physician payments in next year’s Medicaid budget.

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