By CLINT CUMMINGS, MHA
2023 will be a year of working to clean up, rehabilitate, and polish several areas that impact the practice of medicine. Medical groups are taking on large issues that have plagued the practice of medicine for decades and others that have popped up in the most recent year. TMA, MMS, and MGMA will be traveling to Nashville on March 7, 2023, to advocate for better healthcare for Tennesseans and a better environment to practice medicine in our state. As with any legislative session, things are always moving. This article was written March 1, 2023.
Abortion Trigger Law – Saving the Life of the Mother
The US Supreme Court overturned Roe v. Wade in 2022, thereby invoking the abortion “trigger law” in August. The trigger law makes most abortions illegal in Tennessee. Physicians facing terminating a pregnancy to protect the life and health of the pregnant women may face up to 15 years in prison. There is an affirmative defense which allows doctors to address life and health issues, but it can only be raised after a doctor is charged. The affirmative defense needs to be an exception to the criminal offense, which was intended to stop elective abortions. Other changes are needed in the law so physicians can feel safe addressing fetal anomalies and other common pregnancy complications. Opponents to the bill argue that no physician has been charged thus far; therefore, the law is not needed. If you were a physician, would you want even the slightest potential of a lawsuit when considering saving the life of the mother? As of this writing, SB 745 is scheduled to be heard by the Senate Judiciary Committee on March 14. There are other laws seeking to address abortion as well.
Scope of Practice
This issue is expected to rear its head once again this year, as it has every year since 2014. Tennessee Medical Association, Memphis Medical Society and many other physician groups feel a physician-led team is still the best environment for patient care in our state because it does not compromise patient safety or quality of care. Furthermore, silos and fragmentation are one of the greatest issues in healthcare today, creating unnecessary waste and fostering poor communication in healthcare systems. Nurse advocacy and physician assistant groups feel that advanced practitioners’ scopes should be expanded to allow for no physician oversight, allegedly allowing those providers to open practices in rural areas. The current laws require physician oversight of any medical clinic opened in our state. Physician groups counter that there is no evidence that expanding scope will prompt any healthcare discipline to move to a rural area, and patient safety could be compromised, particularly in more complex cases. This year, bills are also expected to address scope for “graduate physicians,” those who have graduated medical school but not completed a residency training, and physician assistants.
Balance Billing
For years, TMA has been a member of a coalition of hospital-based physician specialty organizations advocating for a balance billing solution that protects patients from narrow networks and ensures physicians are offered a fair, in-network rate for out-of-network services. In 2020, Congress passed the No Surprises Act (NSA) to protect patients from expensive surprise bills. Unfortunately, rules implementing the federal law have led to fewer in-network healthcare options and more out-ofpocket expenses for Tennessee patients. TMA will work to implement a fair state-level solution that promotes network adequacy across all health plans. Keep your eye on HB 1503/SB 1345, as it should be heard in committee soon.
Prior Authorization
Whether you are reading this as a patient or provider, how many times (per hour) has your care been disrupted due to an insurance employee, with no medical background, halting the treatment plan? Many times, this occurs during a procedure or within the prescription of a medication that a physician has successfully administered hundreds of times.
In May 2022, TMA’s House of Delegates voted to make prior authorization reform a priority of the association. The resolution aims to achieve four primary goals: reduce the number of medical and pharmacy services that require prior authorization; ensure patients gain quicker access to care through the reduction of denials; streamline the prior authorization process to reduce burdens and retroactively denied payments; and support federal efforts to reform prior authorization for Medicare advantage and other government-regulated plans. TMA is leading the charge to convince insurance plans that comprehensive prior authorization reform is in patients’ best interest. SB 666 (not a typo or a joke) is the bill to keep your eye on.
Physician Wellness
TMA is working to enact safe harbor reporting systems for medical professionals to prevent physician burnout and mitigate the risk of suicide. Currently in Tennessee, some health plans and hospital credentialing committees require physicians to disclose personal mental health information to practice at facilities or serve on panels. These requirements serve as barriers to physicians seeking mental health treatment, ultimately contributing to reduced professional performance, high turnover rates, and the adverse consequences of medical errors. We hope that SB 734 comes to pass. We hope that SB 734 comes to pass to enable our medical leaders to prioritize their own mental wellbeing.
These are the top priorities among hundreds of bills that will be filed and monitored by the advocacy team at TMA and other healthcare organizations. Other topics will include medical marijuana, gender affirmation for minors, certificate of need, and many others.
Finally, I would like to give a special shoutout the local leaders who volunteer their time to advocate on behalf of these issues. Physicians George Woodbury, MD, Dale Criner, MD, and Desiree Burroughs-Ray, MD lead the volunteer efforts locally that shape policy and facilitate conversations with our elected officials. Many more from the ranks of MGMA and local hospital leadership also lend their time and energy. Thank you!
Clint Cummins, MHA, is Chief Executive Officer/Executive Vice President, Memphis Medical Society and board member of the American Association of Medical Society Executives (AAMSE) and Mid-South Medical Group Management Association (MSMGMA).