Posts Tagged advocacy

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

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

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

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

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

Dr. Lindsay Robbins, MD, MPH

OB/GYN, Maternal-Fetal Medicine Fellow

University of Alabama at Birmingham

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

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

The Statistics

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

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

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

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

The MMRC

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

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

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

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

The Campaign

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

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

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

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Discussions with Decisionmakers: Rep. Paul Lee

Discussions with Decisionmakers: Rep. Paul Lee

Get to Know Representative Paul Lee

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Advocacy Efforts During COVID-19

Advocacy Efforts During COVID-19

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

Executive Actions & Proposals

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

Telehealth Payment Parity

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

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

Posted in: Advocacy, Coronavirus, Liability, Members

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Three Simple Steps for Increasing Medicine’s Influence

Three Simple Steps for Increasing Medicine’s Influence

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

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

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

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

Step 1: Join, join, join

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

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

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

Step 2: Get to know a few key people

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

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

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

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

Step 3: Put your money where your mouth is

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

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

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

Summary

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pictured are Association President Underwood and his wife, Sara.

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The New Department of Justice Initiative: Aggressively Investigating and Prosecuting Opioid-Related Cases

The New Department of Justice Initiative: Aggressively Investigating and Prosecuting Opioid-Related Cases

Before joining Burr & Forman, LLP, I was a federal prosecutor for a little over a decade specializing in health care fraud and general white collar matters. In that role, I was the member of a prosecution team that secured guilty verdicts earlier this year against two pain management doctors in Mobile, Ala., following a protracted jury trial. The doctors were convicted of a litany of federal crimes arising from their operation of a pain management clinic, including, among others, violations of the Controlled Substances Act and the Anti-Kickback Statute. The doctors received substantial prison sentences of 20 and 21 years, respectively, and forfeited virtually all of their assets (including bank accounts, houses and cars) to the government.

The doctors in this case were convicted of running what the government calls a “pill mill,” a pain management clinic that allegedly prescribes narcotics for illegitimate purposes. Pain management professionals should be aware this is just one example of what will likely be an onslaught of “pill mill” and other opioid-related prosecutions by the Department of Justice (DOJ) during the current administration. In fact, just a few months after the convictions in the Mobile case, Attorney General Jeff Sessions announced a nationwide takedown of 120 doctors, pharmacists and nurses – dubbed “Operation Pilluted” – who were charged with various federal crimes related to their alleged “unlawful distribution of opioids and other prescription narcotics.” In announcing the takedown, Sessions noted the DOJ would continue to “aggressively pursue corrupt medical professionals,” and “the Department’s work is not finished. In fact, it is just beginning.”

On the heels of that announcement, in August of this year, Sessions heralded a new DOJ pilot program called the “Opioid Fraud and Abuse Detection Unit.” According to Sessions, the unit “will focus specifically on opioid-related health care fraud using data to identify and prosecute individuals that are contributing to the opioid epidemic.” Sessions warned, “If you are a doctor illegally prescribing opioids or a pharmacist letting these pills walk out the door and onto our streets based on prescriptions you know were obtained under false pretenses, we are coming after you.” Sessions explained the DOJ would be appointing a special federal prosecutor in 12 select districts across the country whose sole purpose will be to prosecute “pill mill” and other opioid-related cases.

One of the districts, which has received one of the special “pill mill” prosecutors, is the Northern District of Alabama, in Birmingham. The U.S. Attorney for that district, Jay Town, separately confirmed the new prosecutor will spend “100 percent of their time working these types of cases…What we’re going after is the medical providers who are operating outside the boundaries of the law and the medical practice.” Echoing the Attorney General’s statements, Town vowed, “We’re going to rid the Northern District of these pill mills.”

Note “pill mills” are not the only opioid-related cases on the DOJ’s radar. In fact, it is also concentrating on the “diversion” of opioids in hospital settings. Such “diversion” schemes include, for instance, the theft of opioids from a hospital “Pxyis” machine (a device hospitals utilize to regulate the dispensing of controlled substances) by nurses, or the forgery or fraudulent creation of opioid prescriptions by hospital personnel.

In sum, the DOJ has fired a warning shot that physicians, pharmacists and other medical professionals involved in the treatment of patients will be under intense scrutiny for the foreseeable future. This is especially true for physicians who operate pain management clinics. These doctors should, in general, prescribe opioids reasonably and carefully in the context of each patient’s presentation and thoroughly document their treatment.

To that end, doctors should, among other things: maintain a thorough intake procedure, which requires the patient to give a detailed medical history and provide previous diagnostic studies; have the patient sign, if applicable, an “opioid treatment agreement” requiring the patient to abide by certain opioid use guidelines; perform exhaustive physical examinations during the initial visit and at regular intervals during the patient’s treatment (which should be carefully documented); consider alternatives to opioid treatment, such as non-narcotics drugs, physical therapy and surgery (and, where applicable, carefully document why alternative treatments would be ineffective); prescribe the lowest dosage and quantity of opioids possible to treat the patient’s condition; closely monitor for signs of diversion and addiction by regularly ordering urine drug screens and reviewing the patient’s prescription drug monitoring data; and have regular independent audits conducted by a billing consultant or another pain management specialist to ensure compliance with all regulations and laws. Implementing these practices should help doctors avoid government scrutiny as part of the DOJ’s new initiative to crack down on alleged “pill mill” operations.

Adam Overstreet is counsel at Burr & Forman, LLP. Prior to joining Burr, Adam practiced with the U.S. Attorney’s office and gained extensive experience with health care fraud matters. Burr & Forman, LLP, is a partner with the Medical Association. Please read other articles from Burr & Forman, LLP, here.

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Organized Medicine: Why Physician Membership is More Important Now than Ever Before.

Organized Medicine: Why Physician Membership is More Important Now than Ever Before.

“There’s strength in numbers” is a saying we all know well. Whereas one person can say something, it becomes a much more powerful display when more people join together in support or protest.

In the past, it was not unusual for physicians to be members of their county medical society, specialty society, state medical association, national specialty society, and national medical association, but these days those numbers are waning. When the practice of medicine seems to be changing almost daily, support for organized medicine as a whole seems to be dropping during a time at which patients and their physicians need help more than ever before.

The 2016 Survey of America’s Physicians: Practice Patterns & Perspectives conducted on behalf of The Physicians Foundation by Merritt Hawkins, captured a snapshot of what the nation’s physicians think about the state of medical care today. Some of the findings were enlightening.

  • 80 percent of physicians are at capacity or have no time to see new patients
  • 49 percent of physicians often have feelings of burnout
  • 28 percent of physicians are only somewhat unfamiliar with MACRA
  • 49 percent of physicians would not recommend a career in medicine
  • 42 percent of physicians agree that EHRs have either reduced or detracted from their ability to deliver quality care

Ideally, physician membership in organized medicine would increase during difficult times facing the House of Medicine – times in which medicine is facing more intrusion by government regulation and restriction on how physicians can and do practice medicine, and the protection of patients’ rights. However, it would seem more physicians are moving away from the strength-in-numbers unified front that organized medicine provides to policymakers and replacing it with conflicting voices.

For example, in the 1950s, about 75 percent of all practicing physicians in the United States were members of the American Medical Association. According to a December 2016 article by Mother Jones online, its membership now is representative of about one-sixth of the nation’s physicians. So, where are all the physicians going?

What is the role of organized medicine?

Organized medicine groups are groups of physicians categorized into physician, young physician, resident and medical student sections. Each section works together to advocate collectively on behalf of the physician-patient relationship, patients’ rights, and medicine as a whole, but then each individual group works together to advocate for their section’s interests.

Giving physicians and medical students a voice in the business of medicine allows physicians to advocate for the best quality of care for their patients and ensures physicians are also treated fairly on the state and national levels.

In some cases, many young physicians may not even know about options to join organizations such as the AMA, the Medical Association, or even their local county medical society until the organization reaches out to them or a colleague mentions it. In Dr. Amber Clark’s case, it was a trip to an AMA meeting in Chicago that opened her eyes to the potential for organized medicine.

Dr. Amber Clark, who is in her second year of residency training in Physical Medicine and Rehabilitation at the University of Alabama at Birmingham School of Medicine, knew she wanted to be a physician since she was a little girl watching her pharmacist mother interact with her customers. But, even back then she knew she wanted more from her chosen profession.

female doctor smiling

“I always wanted that one-on-one relationship with patients, but (going to) Chicago introduced me to this concept of how we can make changes on more than just an individual basis but a population basis. That’s meaningful change!” Dr. Clark said. “It really is the responsibility of the physician, whether you’re in medical school or still in training or have completed your residency, to be a voice for yourself and your patient. Yes, we’re going to have more members that are going to be more vocal, that’s just the nature of life, but it’s still important to be one of those speaking out and being heard.”

Dr. Clark’s trip to Chicago was “mind-blowing,” allowing her to serve as an alternate delegate for the first time. Because the AMA trip to Chicago was her first introduction to organized medicine on a national stage, she did not know what to expect, which made for an even better experience.

“You have this collegiality of residents from all different walks of life and all different types of programs all coming together for one specific cause. We’re all advocating on behalf of our patients, but we’re also advocating on behalf of ourselves. There are so many other things that go on during these meetings behind the scenes that many physicians don’t know about because they don’t attend, but you assume people are advocating on your behalf. You can’t ever assume someone is fighting for you. You have to be willing to speak up. It just makes sense to participate,” Dr. Clark said.

Staying connected.

Across the country, organized medicine is having difficulty attracting and keeping members. As state and national membership organizations continue to add member benefits to entice members to stay connected, the number of physicians who are leaving the larger organizations for the smaller specialty societies seems to be increasing.

While there are still benefits of joining specialty societies, the larger membership organizations are left feeling the blow in their ranks…which means less bargaining power when it comes to negotiating on behalf of medicine.

Dr. Conrad Pierce has seen firsthand the power that comes with large membership organizations. He has seen it work well…and he has seen how it can fall apart when the members of the organization cannot manage its collective bargaining power.

About a year after he retired, Dr. Pierce began working for then-Sen. Jeff Sessions as a health care policy advisor when the Affordable Care Act was making its way through Congress. It was an arduous job trying to understand the proposed legislation, but condensing it down for someone not in medicine to understand was just as difficult.

“Legislators don’t know or understand much about medicine,” Dr. Pierce explained. “We all have to admit what we don’t know. Physicians know about medicine, so it only makes sense for physicians to be the ones to inform our policymakers about health care. Physicians are on the health care battle lines, out there taking care of their patients, helping them make those decisions that are truly life or death decisions for their families. Physicians have clout when we talk to our legislators. We can make them understand, in simple terms, the most complex issues in medicine. We do this every day when we discuss medical situations with our patients. If I have a patient with cancer, I can discuss that situation with my patient and explain the prognosis and treatment options. So, I should be able to discuss exactly why something in a proposed piece of legislation is either very good or very bad and how it will affect my patients and my practice. If we as physicians cannot talk to our legislators about medicine, where do you think they are going to get this information? From very biased people who could give them very bad advice,” Dr. Pierce said.

But, getting that seat at the negotiating table takes time, and this, according to Dr. Pierce and other physicians, is where associations like the Medical Association come in and take a leadership role to make the negotiation process easier.

male doctor smiling

“Doctors are busy, literally working 60-100 hours a week in some cases, easily working more than the average person. So, it’s hard for them to take time out of their family life or professional life to get involved in organized medicine. But that’s absolutely why they should get involved. The effects of the passage of bills and restrictions on them from legislative actions or insurance company actions can be completely disruptive,” Dr. Pierce said. “That may be one of the main focuses of what the Medical Association is about, and what we do a good job of.”

Dr. Amber Clark agreed that because the mechanics of practicing medicine is moving so quickly and the rules are changing so often today, physicians cannot afford not to have a voice in that change…whether that physician agrees with the philosophy of the organization doing the advocacy work or not, it remains of the utmost importance to be involved in order to ensure the best types of changes are made for the sake of the patient and the physician.

“It’s so important to not only learn the business of medicine but to also learn how the system works. Organized medicine organizations like the AMA and the Medical Association are all doing the same thing – advocating for you and your patients. You don’t realize how important it is until you’re stuck in the middle. It’s comfortable when you operate in a bubble. It’s safe there. We will always have patients to take care of, and the only constant thing in medicine today is change. We are all intelligent beings. We don’t all have to agree on the same things. But, we’re doing a disservice to ourselves, our patients, and our colleagues to simply sit on the sidelines and be passive observers. That doesn’t mean you have to go lobby in Washington or Montgomery every day. That’s not realistic,” Dr. Amber Clark said.

Filtering out the noise.

One of the primary concerns of organized medicine is keeping members informed. Organizations act as filters or gatekeepers to allow the most important information flow to the members while keeping the noise at bay. The Medical Association’s Government Relations and Public Affairs Department works to do just that.

Dothan family physician Carlos Clark suggested not only does membership with the Medical Association give physicians a voice in the ultimate conversation about the practice of medicine and your relationship with your patient, but having a strong Government Relations team is extremely important in guiding that conversation down the best path.

male doctor in scrubs

“Having a strong Government Affairs department like the Association’s to stay in touch with the rest of us and help us see things coming down the pike and see things that we just wouldn’t normally see is vitally important,” Dr. Carlos Clark said. “It puts you more in tune with what’s going on. Unless you have all the free time in the world, I can’t imagine all the medical news websites you would have to search through to try to catch everything coming down the pike. Being part of organized medicine allows us to get all that information filtered so we get the most important information sent to us to act on. It’s hard enough for us to keep up with what drugs insurance companies are covering much less what rules and regulations are coming our way and when.”

Organized medicine offers more than advocacy.

For Ben Bush, who’s a medical student at the University of South Alabama College of Medicine, being a member of organized medicine and serving in leadership positions with the Medical Association and the AMA, has afforded him more opportunities in medicine than his medical school education alone could provide.

“I enjoy the relationships I’ve made. I’ve met a lot of other students and doctors from all over and created good relationships I value very much. And, there’s also the education component. I learn so much through the Medical Association and the AMA about medicine, advocacy and the practice of medicine that I can’t learn in medical school. I wanted to get involved in organized medicine primarily because of the advocacy,” Bush said.

Bush said he often gets questions from his classmates about his involvement in organized medicine, mostly concerns about why he’s participating in organizations that are often seen as not necessarily aligned with the overall beliefs of the majority of physicians treating patients today. But, he feels organized medicine is historically misunderstood and often misrepresented. In fact, he strongly encourages his colleagues who oppose medical organizations to become more involved with them.

male doctor smiling

“When my classmates ask why I’m involved in organized medicine,” Bush explained, “I tell them it’s because if I’m not a member and don’t go to those meetings to voice my opinion, then what happens? I think I’m so involved because I can voice an opinion on those policies that could negatively affect us here in Alabama. If we aren’t collectively using our voice for medicine, then the opinion we disagree with will only be that much louder, and we’ve already seen that this year in the Alabama Legislature. It’s important we defend medicine as a whole, for those in private practice to those who are employed or in academia, for every specialty…if we’re not actively moving forward to defend the practice of medicine as a whole, then we all lose.”

Dr. Pierce agreed that when involvement in organized medicine filters down to a small group, then the opinions of a small percentage of physicians are the ones expressed causing a very narrow view of the House of Medicine. As Dr. Amber Clark put it, medical students don’t graduate into any specific field of medicine, such as plastic surgery, family medicine, or gastroenterology. Being part of organized medicine means being part of medicine as a whole.

“The only way the Medical Association will ever know what the majority of physicians in the State of Alabama will need to make their practice better is if the physicians of the State of Alabama tell us,” Dr. Pierce said. “If you are not involved, you can get a small group of physicians making decisions that a majority of doctors may not believe in. That’s not good medicine, and that’s why you should be involved in organized medicine.”

Jennifer Hayes, the Medical Association’s Director of Membership and Specialty Society Management, agreed with Dr. Pierce and equally expressed concern for the widening gap in the number of younger physicians entering practice as older physicians begin to make plans for retirement in the State of Alabama.

“The 62 percent active membership market share we have in Alabama is excellent compared to other state medical associations, the reality is our membership is aging out,” Hayes explained. “Currently, 63 percent of our membership is over the age of 50. We have to ask, how long will these physicians stay in practice?”

The Medical Association is creating avenues for residents and students to become more involved. In 2016, the House of Delegates and College of Counsellors passed a resolution to waive all dues for residents and students hoping to garner more interest in organized medicine. The Medical Association also hosts educational events and socials around the state during the year, as well as participating in medical school Match Days.

“Since the dues were waived in 2016, student membership increased 73 percent and residents 66 percent. That’s great, but we must demonstrate value and lead by example to retain these individuals who remain in Alabama. The first step for the Association has been to participate in and support their programs,” Hayes said. “Earlier this year, we created a poster symposium and Friday conference at Annual Session to allow time for networking, hear great presentations on topics related just to them, and more time with representatives from residency programs and Alabama physician recruiters. This event was so popular that we will do it again for the 2018 Annual Session with free registration and hotel scholarships. Even though the Association is making great strides to reach out to this segment of our physician base, it’s not enough. If we don’t all join together to reach out to our early career physicians, residents and students, the integrity of the Association could be in jeopardy. We have to ask ourselves one question: Are we all doing our part?”

Ultimately, it’s always about the patient.

In the end, physicians practice medicine because of their patients. Protecting the physician-patient relationship and advocating for better care for the patient is at the forefront of patient care. This puts the physician-patient relationship often at the center of most health care-related advocacy conversations in Montgomery and Washington, D.C. However, as more physicians are leaving the unified front organized medicine provides, physicians may be losing the strength to advocate for their patients and patients’ rights to the best of their abilities.

“We are losing doctor involvement,” Dr. Pierce said. “You have to have physicians involved in organized medicine or bad things could happen. These things don’t happen in a vacuum. When you’re not involved, and bad things happen, it makes it hard complain. Bad things happen because the other side is involved even more.”

As Dr. Pierce explained, a physician is the patient’s primary advocate. Even with the weight of the Medical Association behind that physician, it takes the collective of all physicians from all specialties to make a difference.

“The Medical Association does a great job of protecting our patients. But, physicians are patient advocates, too. It’s not all about me, as a person or as a physician. It’s about my patient. We have to get one thing clear – and that’s understanding the most important thing here is our patients. The focus of what you are doing as a physician is healing, and healing a patient who trusts you, who has come to you because they have a relationship with you. Ultimately, it’s always about the patient, and we cannot ever forget that.”

Article by Lori M. Quiller, APR
Director of Communications and Social Media

Posted in: Members

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Three Simple Steps for Increasing Medicine’s Influence

Three Simple Steps for Increasing Medicine’s Influence

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

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

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

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

Step 1: Join, join, join.

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

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

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

Step 2: Get to know a few key people.

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

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

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

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

Step 3: Put your money where your mouth is.

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

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

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

Summary

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

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

Posted in: Advocacy

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