March 23, 2017: State Advocacy Update

On March 17, the AMA filed its amicus brief (PDF) with the U. S. Court of Appeals for the District of Columbia asking the court to affirm the lower court's decision to block the proposed Anthem-Cigna merger. The AMA strongly disputes Anthem's claim that the merger is justified because it will give Anthem-Cigna bargaining power to reduce physician and provider payments. In its brief, the AMA emphasizes that:

• Increasing Anthem's bargaining power does not outweigh the anticompetitive effects in the health insurance market that the merger will cause.
• If the merger proceeds, consumer welfare will suffer and could cause quality to degrade and leave consumers deprived of meaningful choices.
• The evidence at trial showing harm to patient care echoed the experiences physicians provided to the AMA and state medical associations as part of the pre-trial strategy.

Of note, at the AMA's suggestion, 27 professors who have expertise in the subjects of health economics, antitrust and/or competition policy also filed their own amicus brief opposing the Anthem-Cigna merger. The professors are from leading academic centers and many are nationally renowned.

Gun violence in America has reached epidemic proportions. More than 30,000 deaths from gun violence each year underscore the need for a comprehensive public health approach to stem this epidemic.

To explore workable solutions to reducing gun violence in our communities, the AMA has joined with the American Bar Association to host Preventing Gun Violence: Moving from Crisis to Action on March 24 in Chicago. At this critical half-day program, expert speakers will examine what it means to take a public health approach to the gun violence crisis, evidence-based interventions being implemented in Chicago, potential policy interventions to limit high-risk individuals' access to guns and strategies physicians can use to promote gun safety.

Learn more about this event.

State legislatures continued to pursue legislation—many consistent with the model AMA Telemedicine Act—laying the ground work for the adoption of safe and effective telemedicine. Arkansas and Colorado passed legislation requiring coverage of medical care delivered through telemedicine. Arkansas' legislation also clarified the steps by which physicians can establish a relationship with a new patient via telemedicine. Legislation passed in Virginia will allow physicians to prescribe controlled substances based on an exam conducted through telemedicine, so long as certain clinical standards are met. Finally, states including Arizona, Hawaii, Indiana, Michigan, Montana, North Dakota, Oklahoma, Utah, Washington, West Virginia and Wyoming have passed telemedicine legislation through at least one chamber.

The AMA is working with these and other state medical associations as part of a state telemedicine advocacy campaign that provides advocacy materials focused on the various telemedicine issues above. Advocates can contact Kristin Schleiter of the AMA for more information.

In a recent survey, three out of five physicians in Ohio treating patients with substance-use disorders said that they have experienced administrative interference from private insurers and Medicaid.

The AMA and Ohio State Medical Association (OSMA) conducted the survey earlier this year to gain a better understanding of the barriers patients and physicians face when attempting to access treatment for substance use disorders. 47 of 165 physicians responding said that they treat patients with a substance use disorder (28 percent).

The summary findings also included:

• Administrative barriers, such as prior authorization, limit patients' access to care.
• Physicians who treat patients with a substance-use disorder commonly recommend or prescribe multimodal care, including mental health care.
• A lack of coverage and high cost are burdens for patients to access treatment for substance use disorders.
• It is difficult for many physicians who do not treat substance-use disorders to find another provider who does.

The full survey results are available upon request, and medical societies interested in conducting this survey in their state should contact Daniel Blaney-Koen of the AMA.

The Alabama State Board of Medical Examiners recently issued new "Risk and Abuse Mitigation Strategies by Prescribing Physicians." The new rule, which took effect March 9, set forth several requirements concerning mandatory use of the state prescription drug monitoring program (PDMP) that correspond to the total morphine milligram equivalency (MME) prescribed to a patient.

Among the requirements:

• For controlled substance prescriptions totaling 30 MME or less per day, physicians are expected to use the PDMP in a manner consistent with good clinical practice.
• When prescribing a patient controlled substances of more than 30 MME per day, physicians shall review that patient's prescribing history through the PDMP at least two times per year, and each physician is responsible for documenting the use of risk and abuse mitigation strategies in the patient's medical record.
• Physicians shall query the PDMP to review a patient's prescribing history every time a prescription for more than 90 MME per day is written, on the same day the prescription is written.

The PDMP requirements do not apply to physicians writing controlled substance prescriptions for:

• Nursing home patients.
• Hospice patients, where the prescription indicates hospice on the physical prescription.
• When treating a patient for active, malignant pain.
• Intra-operative patient care.

The board also will require, effective Jan. 1, 2018, that each holder of an Alabama Controlled Substances Certificate shall acquire two credits of continuing medical education (CME) in controlled substance prescribing every two years as part of the licensee's yearly CME requirement. The controlled substance prescribing education shall include instruction on controlled substance prescribing practices, recognizing signs of the abuse or misuse of controlled substances, or controlled substance prescribing for chronic pain management.

A detailed FAQ is available here.

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