Now Is The Time to Unite as Physicians

Posted September 14, 2018

I was honored to be installed as the 2018-2019 KMA President during the Association’s Annual Leadership Dinner on Aug. 25. During my inauguration, I spoke of the importance of our profession uniting together at a time when there is so much division within our country. Today, I’d like to share part of that message with our entire membership.

The Kentucky Medical Association is all about bringing physicians together in the best interest of our patients and our profession. Over the last year, under the leadership of Dr. Maurice Oakley and our board working with our incredible KMA staff, we have had a number of victories, yet there is much more to be done.

First, let’s start with our broken professional liability system, which:

  • places unlimited, unpredictable risks on physicians,
  • exacerbates the Kentucky physician shortage,
  • weakens quality control,
  • drives up healthcare costs,
  • and leaves injured patients in a lottery like system where the only winners are the lawyers.

Our advocacy team has been hard at work. Last year, legislation creating medical review panels was passed, and this year peer review protections were signed into law, but of course the trial lawyers aren’t happy and we now must defend these gains in court.

There is also much work to be done in public health as Kentucky continues to place near the bottom in health rankings. We continue to have the highest death rate from tobacco in the United States.  Certainly, Senate Bill 89, supported by KMA and signed into law in 2017, mandating that health plans cover tobacco cessations medications and treatment, is a step in the right direction. Joining other groups concerned about public health, we must continue to advocate to reduce the ravages of tobacco.

As Kentucky physicians, we see first-hand the impact of the opioid epidemic both from prescription opioids and now the shift to heroin. Advances have been made in the number of physicians who are gaining a better understanding of opioid abuse and getting educated on treatment options, including medication assisted treatment. Thankfully, opioid prescribing is declining. We must continue to educate the public and our legislators to recognize the underlying disease of addiction and advocate for coverage of treatment.

Shifting from public health to the health of our practices…. those of us that were in practice in the mid-90s remember the multi-year fight in the legislature and the courts to eliminate the provider tax. It reared its ugly head again near the end of last legislative session as the General Assembly looked for “easy money” to balance the budget. Thankfully, with quick action and discussions with key legislators we were able to kill that – but several weeks ago, a coalition of hospitals held a press conference to try to revive the monster. For many practices a provider tax could spell the end. If there ever was a time for us to unite around an issue, THIS IS IT!

As a practicing physician myself I know that physicians are overwhelmed by administrative burdens that are not meaningful and do not improve quality. A recent survey of physicians showed that more than 50% of physicians report symptoms of burnout, and the greatest factors causing this burnout are barriers to practicing high quality care.

Near the top of most physicians’ list of administrative burdens that “add no value” is prior authorization.

More than 40% of physicians reported spending greater than 10 hours per week on prior authorizations. A study published in Health Affairs estimated that physician practices spend between 23 and 31 billion dollars per year on administrative issues such as prior authorization. What a waste of resources!

But beyond cost, inefficiency and physician frustration, these burdens also impact the quality of patient care. Ninety percent of physicians surveyed reported delays in needed medical care because of prior authorization, not to mention the added stress upon the patient because they are not able to receive the medication, the diagnostic study or procedure that their trusted physician has recommended.

In the 2018 legislative session, legislation on prior authorizations was introduced by Sen. Ralph Alvarado, M.D., and between legislative sessions your leadership team is actively engaged in efforts to reduce this burden.

Earlier this year, the American Medical Association (AMA), KMA, the Greater Louisville Medical Society (GLMS) and specialty societies worked together and were able to convince Anthem to withdraw their plan to cut reimbursement of office-based procedures by 50%. Now health plans want to retrospectively review emergency visits to see if they were real emergencies, so they can deny payment, or alternatively, they have proposed that they just stop paying for the highest severity level of emergency department visits. At least one insurer has proposed that anesthesiologists are not necessary for cataract surgery. Rest assured, KMA will continue to advocate to protect our patients from onerous health plan policies.

Another major cause of physician dissatisfaction and burnout is the electronic health record. If you think your days are filled with too much paperwork (or should I say computer work), and not enough time with patients, you are not alone. A recent AMA study found that physicians spend an average of two hours working on electronic records for every one hour of direct patient care. Computers should reduce repetitive tasks, yet a study published in the American Journal of Emergency Medicine found that on average an emergency medicine physician clicks 4,000 times in an 8-hour shift. KMA is working together with AMA for meaningful change for simplification of EHRs and reduction in documentation requirements.

As your President, this coming year I will continue to work on all these issues and the other challenges that are sure to arise, but I cannot do it alone. Thank you for your membership. Please stay involved.  We need every one of you and your colleagues to join us in our fight.

NOW is the time for us to unite as physicians. Our profession and our patients deserve nothing less.