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MAG 2015 Legislative Update

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Medical Association of Georgia

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MAG 2015 Legislative Update

This week we continued our ongoing series with Medical Association of Georgia to get the MAG 2015 legislative update.  MAG CEO, Donald Palmisano, Jr. and Director of Government Relations, Marcus Downs came by with Georgia Representative, Rick Jasperse.  We talked about several of the health-related issues Rick and his colleagues have been and continue to work on in the Georgia legislature to promote and protect the health outcomes, safety, and access to care for the citizens of our state.

Rep. Rick Jasperse represents Georgia’s 11th district, which includes all of Pickens and parts of Gordon and Bartow counties. He serves on a number of committees in the House of Representatives – and he is the vice chair of the House Health and Human Services Committee. Rep. Jasperse graduated from UGA with a degree in food science. He retired in 2009 after 29 years as a county agriculture agent.

H.B. 416 by Rep. Carl Rogers (R-Gainesville) will require licensed health care practitioners to wear an ID on their “lab coats or similar distinguishing clothing or uniforms” that states their name and license or educational degree. The only exceptions include optometrists, dentists and chiropractors – except those who practice in hospitals and nursing homes. This has been one of MAG’s legislative priorities for the last two years as voted on by MAG’s Board of Directors. A number of other groups also supported the bill, including speech language pathologists, audiologists, respiratory therapists, marriage and family therapists, ophthalmic technicians, registered dieticians, and APRNs.

The FY 2016 budget (H.B. 76) includes some $23 million in additional funds to increase the reimbursement rate for select Medicaid primary care and OB-GYN codes. This included $17.1 million for primary care physicians (i.e., 90 percent of the 2014 Medicare fee schedule for the applicable codes) and $5.9 million for OB/GYN physicians (90 percent of the 2014 Medicare fee schedule for the applicable codes).

The FY 2016 budget also includes $199,000 to maintain the Prescription Drug Monitoring Program in the state.

H.B. 504 by Rep. Sharon Cooper (R-Marietta) extends the flu vaccine protocol that is in place between physicians and pharmacists and nurses for adults to pneumococcal, shingles, and meningitis. MAG’s Board Directors voted to support this kind of measure given strict limits and notification requirements. MAG worked with Rep. Cooper to ensure that appropriate sanctions are in place for any violations.

S.B. 158 by Sen. Dean Burke, M.D. (R-Bainbridge) would have addressed rental networks, all-products clauses, and other key issues. MAG’s Board of Directors voted to support this measure. The bill evolved into S.R. 561, which is a “study bill” – which means that a group of legislators will develop a report for the General Assembly’s consideration in 2016.

Special Guests:

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia  twitter_logo_small  linkedin_small1  facebook_logo_small3

Medical Association of Georgia

  • JD Law, Loyola School of Law
  • Board of Directors, Physician Advocacy Institute
  • Medical Payment Subcommitte Member, State Board of Workers’ Compensation
  • Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
  • Former Director, Government Relations/General Counsel/Director, GAMPAC

Marcus Downs, Director of Government Relations, MAG  linkedin_small1  

Medical Association of Georgia

  • Recipient, 2012, Outstanding Advocate Award, National Association of School Psychologists
  • National Institutes of Health Research Fellow, 2000
  • Former Director, Government Relations/External Coalitions/Research, Georgia Association of Educators

Representative Rick Jasperse, Georgia 11th District  facebook_logo_small3  twitter_logo_small-e1403698475314  youtube logo  flickr (2)

JasperseRick755

  • BS, Food Science, University of Georgia School of Agriculture
  • Member, House Committees: Agriculture & Consumer Affairs, Appropriations, Human Relations & Aging, Public Safety and Homeland Security
  • Vice Chair, Health & Human Services Committee
  • Served on numerous boards:  Mountain Conservation Trust Board, Chattahoochee Technical Collegeand Appalachian Cattlemen’s Association’s Board

Senate Bill 158

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Medical Association of Georgia

 

Senate Bill 158

On this week’s show we continued our monthly series with the Medical Association of Georgia.  MAG’s CEO/Executive Director, Donald J. Palmisano, Jr. stopped by for a discussion on the state of Senate Bill 158, changes in the insurance contracting arena, and other topics on the MAG agenda.  Donald also shared how he and a colleague were able to raise over $40,000 to support the Think About It campaign to raise awareness and fight prescription drug abuse/addiction in Georgia, participating in a 100 mile race and completing it in under 24 hours.  In the days since Donald joined us on the show, Senate Bill 158 was passed.

MAG continues to take steps to enhance the relationship between health insurer Blue Cross Blue Shield of Georgia, Inc. (BCBSGa) and physicians in the state.

At the end of 2014, Georgia Insurance Commissioner Ralph Hudgens rescinded physician contract amendments that BCBSGa had put into place in Georgia following “numerous complaints from physicians (and their practices).”

First MAG/BCBSGa “Physician Advisory Group” meeting took place on February 12. It is forum for physicians to express their concerns, it will give Blue Cross the opportunity to disseminate information about new payer initiatives, it will be a venue for improving communications, and it will serve as a mechanism for physicians to weigh in on Blue Cross’ clinical policies, operations and contracting practices.

The advisory group consists of four MAG member physicians as well as MAG Health Policy and Third Party Payer Advocacy Department Director Susan Moore and BCBSGa Senior Clinical Officer Mark Kishel, M.D., and BCBSGa Director of Network Management/Georgia Provider Solutions Hayden Mathieson. They will meet a minimum of three times a year.

Rental Networks

 

MAG supports legislation that would limit rental networks in Georgia. A rental network involves a health insurer that rents or sells its network of physicians to another health insurer. These second-level insurers then include the physicians in their health insurance plans – and pay the physicians an even deeper discount – even though they don’t have a contract with the physicians.

 

It’s not uncommon for physicians to offer their services to a health insurer at a discounted rate because the higher patient volume offsets the costs. However, the aforementioned insurers rent or sell their networks without the physician’s knowledge – so the physicians often aren’t aware that they are in a given network or that they are contractually obligated to deliver patient care at a greater discount.

 

Rental networks result in mass confusion and higher administrative costs (e.g., the additional staff time that is required to verify a patient’s health insurance coverage and/or confirm the proper payment). Rental networks can also reduce the accessibility of care because physicians are forced to accept the lower (i.e., “re-priced” or “re-rented”) payment or refuse to see the patient for any follow-up or future care.

 

Rental networks are an inappropriate, profit-driven tactic that undermines the practice environment in Georgia that will exacerbate the physician shortage in the state. Sixteen states have now adopted laws that regulate or limit or prohibit rental networks.

 

Insurers are prohibited from using rental networks in federal employee health benefits plan contracts.

 

 

All-Products Clauses

 

Insurance companies use ‘all-products or all-or-nothing’ clauses as a cost-control tactic to force physicians to participate in every health insurance product that they offer or be blocked from caring for patients in the insurer’s plan altogether.

 

By forcing physicians and their practices to agree to all-products clauses, health insurers are undermining the economic viability of the medical profession in Georgia – keeping in mind that a report that was prepared by IMS Health for the American Medical Association determined that physicians in Georgia “created a total of $29.7 billion in direct and indirect economic output (i.e., sales revenues) in 2012… [and] each physician supported $1,559,494 in [economic] output.” It is also worth noting that the report found that “…physicians supported 205,869 jobs (including their own)…[and] $1,089.6 million in local and state tax revenues in 2012.”

 

Because physicians are constantly wrestling with these manipulative contract provisions, they have less time to spend with their patients.

 

All-products clauses violate several individual rights, including the right to contract and an owner’s right to operate a business in a free and autonomous way.

 

Physicians and medical practices in Georgia should be free to accept the health insurance products of their choice versus the ones that’s imposed on them by profit-driven insurance companies.

 

Eleven states have enacted prohibitions on all-products clauses, including Alaska, Arkansas, Florida, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Minnesota, Ohio, and Virginia – as well as Washington, D.C.

 

Special Guest

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia  twitter_logo_small  linkedin_small1  facebook_logo_small3

Medical Association of Georgia

  • JD Law, Loyola School of Law
  • Board of Directors, Physician Advocacy Institute
  • Medical Payment Subcommitte Member, State Board of Workers’ Compensation
  • Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
  • Former Director, Government Relations/General Counsel/Director, GAMPAC

“Think About It”

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Think About It

 

“Think About It” Campaign to End Prescription Drug Abuse

Prescription medication abuse and subsequent addiction is a serious problem that needs our immediate attention as a community and as healthcare providers.  According to the National Institute on Drug Abuse, “Although most people take prescription medications responsibly, an estimated 52 million people (20 percent of those aged 12 and older) have used prescription drugs for nonmedical reasons at least once in their lifetimes.”  And, National Council for Alcoholism and Drug Abuse states, “Taking prescription drugs not prescribed for you by a doctor or in a way that hasn’t been recommended by a doctor, can be more dangerous than you think.  In fact, it can be fatal.  Prescription drugs are the third most commonly abused category of drugs, behind alcohol and marijuana and ahead of cocaine, heroin, and methamphetamine.  Some prescription drugs can become addictive, especially when used in a manner inconsistent with their labeling by someone other than the patient for whom they were prescribed, or when taken in a manner or dosage other than prescribed.  Overall, an estimated 48 million people have abused prescription drugs, representing nearly 20% of the U.S. population.”  

This week I sat down with Dallas Gay and Dr. Tennant Slack along with Lori Cassidy Murphy from the Medical Association of Georgia to talk about their recently-launched campaign to fight prescription medication abuse and addiction.  Dallas and Dr. Slack co-chair the campaign and they’re working hard to bring community focus to the problem.  The campaign is being funded by the Medical Association of Georgia Foundation and is working to raise awareness of this issue among Georgia’s residents as well as healthcare providers who prescribe controlled medications.  Their team has developed colorful handout materials that give key recommendations for persons who have prescriptions for controlled pain or anti-anxiety medications with regard to how they take it, how they store it, and how to dispose of it when they no longer need the medication.  Additionally, they’re involved with numerous events around the community to get people talking and thinking about how this problem can be prevented.

Think About It is a program conducted by the Medical Association of Georgia Foundation for the purpose of reducing the incidence of prescription drug abuse and resulting deaths. The concept for the program originated at NGMC in 2010 and is presently co-chaired by Dr. Jack Chapman, Dr. Tennent Slack and Dallas Gay. Hall County has served as the incubator of the program since its inception. The “Help Stop Rx Drug Abuse in Georgia” leaflets encourage Georgians to 1) only take their medicine as prescribed and 2) not share their medicine and 3) store their medicine in a safe and secure place and 4) properly dispose of any unused medicine.

The ‘Think About It’ campaign involves a wide array of organizations, including medical societies, the Georgia Composite Medical Board, the Georgia Board of Pharmacy, the Georgia Pharmacy Association, the Council on Alcohol and Drugs, and the Georgia Bureau of Investigation – as well as other law enforcement agencies, schools, and business and religious and other community organizations.

Thank you for listening and PLEASE SHARE! this podcast with your networks.  You may just help someone you care about.

Special Guests

Dr. Tennant Slack, MD, of Northeast Georgia Physician’s Group

Slack_Tennent_MD2_small (3)

  • Doctorate of Medicine, Emory University School of Medicine
  • Residency, Anesthesia, Emory University School of Medicine
  • Fellowship, Pain Medicine, Medical College of Georgia
  • Board Certified, American Board of Anesthesiology: – Anesthesiology – Pain Medicine

Dallas Gay, Co-Chair, “Think About It” Campaign

Dallas Gay

  • Board Member, Northeast Georgia Medical Center
  • MBA, Georgia State University
  • Member, Drug Free Coalition of Hall County
  • Former President, Protein Products, Inc
  • Former President, American Proteins, Inc.