Twenty-one states introduced legislation this year to either institute or expand moral conscience laws called Medical Conscience Objection laws. These measures seek to protect health care professionals who refuse to perform an abortion or provide transgender services. The exception is emergency rooms, where the federal Emergency Medical Treatment and Labor Act takes precedence.

Background: In 1973, federal regulations known as the Church Amendments were implemented after the Supreme Court’s Roe v. Wade decision. Under the Church Amendments, any institution receiving funds from the federal Department of Health and Human Services may not require health care providers to perform abortion or sterilization procedures if doing so would violate their religious or moral principles. Additionally, providers who refuse to perform these services may not be discriminated against for their decision.

Why it matters:
While initially seeking to provide legal protections for health care professionals refusing to provide abortion or sterilization services, the bills introduced this year go even further to include contraception, gender-affirming care, and other services. (article)

Earlier this month, the ACS State Affairs team attended the AMA’s State Advocacy Roundtable event for staff of state and national medical organizations. Over 30 state medical societies, represented by 55 staff, and 21 national medical associations, represented by 30 staff attended the event, along with 28 AMA staff.

Several topics were discussed during the three-day event, including prior authorization, scope of practice, physician unions, Medicaid, and non-compete clauses. Throughout the event, the AMA provided information and resources to assist the attendees as they discussed successful and not so successful campaigns in the state legislatures.

While the AMA provided many resources, the greatest takeaway from this meeting is making new and strengthening old relationships within the state advocacy ecosystem. Building those relationships only makes the ACS stronger when action needs to be taken in a state.

National Conference of State Legislatures

The ACS State Affairs team attended and hosted an exhibit at the 2023 National Conference of State Legislatures (NCSL) Legislative Summit in Indianapolis, Indiana. Each year, state legislators and their staff from across the country flock to the NCSL Legislative Summit to learn about policy trends and innovative solutions they can apply to legislative issues in their home state. For the past decade, ACS co-hosted an exhibit with other national medical organizations titled, “Physicians Advocating for Patients.” This year, the ACS State Affairs team took the opportunity to showcase the STOP THE BLEED® campaign through raffling off three enhanced STOP THE BLEED® kits. David Welsh, MD, FACS, currently serving on the ACS Board of Regents, was a special guest of the exhibit, and along with the ACS State Affairs team, was able to directly engage with over 40 state legislators and their staff.

Other participating medical organizations in the 2023 Physicians Advocating for Patients exhibit included the American Academy of Dermatology, the American Society of Anesthesiologists, the American Society for Dermatologic Surgery Association, the American Academy of Ophthalmology, the American Academy of Anesthesiologist Assistants, the Federation of State Medical Boards, the Interstate Medical Licensure Compact, the American College of Emergency Physicians, and the American Association of Orthopaedic Surgeons. Planning for the 2024 NCSL Legislative Summit is already underway and is scheduled to take place August 5-7 in Louisville, Kentucky.

LEGISLATIVE TRACKING

To view a complete list of bills ACS State Affairs is tracking, visit our online State Legislative Tracker.

While College leadership continues working to prevent Medicare payment cuts, you can use ACS resources and tools to advocate for ACS legislative priorities in your home state and Congressional districts.

The ACS Practice Management web page was recently updated with information on two topics of use for surgeons, including those in private practice: Certified financial planners and considerations for closing a practice.

Medical Students: Access Free National Professional Development Seminars

Medical students interested in advancing their knowledge in key clinical and professional developments areas are encouraged to take advantage of the free ACS National Professional Development Seminars for Medical Students.

In New York | Visit our website for priority legislation

A 7901 – Scope of Practice

Introduced by Assemblymember Joahn McDonald (D), A 7901 provides for the licensure of naturopathic doctors; defines naturopathic medicine as primary health care, including specimen collection and ingestible sensors; allows them to be called “doctor”; the use of injection therapy (intravenous, intramuscular, intra-articular, subcutaneous, and intradermal), limited to a formulary of substances; prohibited from surgery as a medical procedure; emergency or trauma care. The bill was introduced and referred to the Assembly Higher Education Committee.

S 1679A – Scope of Practice

Introduced by Senator Michelle Hinchey (D), S 1679A provides for the licensure of naturopathic doctors; defines naturopathic medicine as primary health care, including specimen collection and ingestible sensors; allows them to be called “doctor”; the use of injection therapy (intravenous, intramuscular, intra-articular, subcutaneous and intradermal), limited to a formulary of substances; prohibited from surgery as a medical procedure; emergency or trauma care. The bill was introduced and referred to the Senate Higher Education Committee.

IN THE NEWS

New law addressing Alabama’s physician shortage takes effect August 1

Senate Bill 155, The Physician Workforce Act signed into law by Governor Kay Ivey (R) May 23, takes effect August 1. Designed to address the state’s physician shortage, the new law:

• removes the Special Purpose Exam (SPEX) requirement for out-of-state physicians;
• allows international medical graduates (IMGs) to apply for a state medical license a year earlier in training; and
• creates a program where graduate physicians — those who did not match to a residency program — can practice under a supervising physician as they wait to reapply for residency.

Background: The law is to alleviate the physician shortage to recruit new physicians and retain those already working in the state. The bill is the result of discussions with members of the Medical Association of Alabama. The Alabama Board of Medical Examiners will begin drafting regulations to govern the graduate physician program.

Why it matters: The physician workforce is dwindling in the state and legislators believe by removing some of the barriers to licensure, they will be able to attract and retain more physicians.

Office of Inspector General (OIG): High Rates of Prior Authorization Denials by Some Plans and Limited State Oversight Raise Concerns About Access to Care in Medicaid Managed Care

Three factors raise concerns about Medicaid managed care organizations use of prior authorization inappropriately delay or deny care for Medicaid enrollees:

• The high number and rate of denial of prior authorization requests;
• The limited oversight of PA denials in most states; and
• The limited access to external medical reviews.

Background: Medicaid managed care organizations (MCOs) ensure enrollees have access to covered services. Allegations the MCOs are inappropriately delaying or denying care for thousands, including treatment for cancer and cardiac conditions.

Why it matters: More state oversight is needed to ensure Medicaid enrollees have access to medically necessary and covered services. States should: review the appropriateness of MCO prior authorization; collect data on MCO prior authorization decisions; work to identify and address inappropriate prior authorization denials. Read the OIG report.

Earlier this year, a bill passed by the state legislature greatly expanding damages awardable in wrongful death actions was vetoed by Governor Kathy Hochul. New versions of the bills, A.6698 and S.6636, were recently introduced without addressing any of the real concerns physicians raised about the previous legislation.  This legislation will enable the awards of new categories of damages, expand the statute of limitations, and result in nearly 40% growth in liability costs.

State lawmakers only have until June 8th to act on this bill.

Surgeons cannot work in an environment where the state legislature increases their already enormous liability insurance cost burden, which exceeds every other state in the country. Worst of all, these costs disproportionately impact physicians working in underserved communities.

Please contact your local Assemblymembers and Senators urging them that renewed legislation to update New York’s wrongful death law must be balanced to address the extraordinary medical liability costs in our state.

On Wednesday, May 10, 2023, the New York Chapter hosted a training at the New  York State legislative offices.  The event was sponsored by Senate Health Committee Chairman, Senator Gustavo Rivera.   Attendees included representatives from the Senate, Assembly, the Medical State Society of New York, and other interested stakeholders. As a result of the training, legislative offices are interested in learning more about hosting trainings in their districts. The Chapter continues to support legislation (A3868) that would place STB kits in schools across New York.

Additionally due to the Chapter's efforts, the Governor Hochul has officially proclaimed May as STOP THE BLEED month in New York! 

We look forward to making this an annual event.

THANK YOU!
The Chapter is grateful to the NY Division of the New York State Trauma Society for helping to coordinate, volunteer and provide the free training. We'd also like to thank Kurt Edwards, MD, FACS, Chief of the Division of Trauma and Critical Care in the Department of Surgery at Albany Medical Center for providing opening remarks and helping to advocate for efforts to advance STB in the state.

The ACS Committee on Medical Student Education is hosting a free webinar, “What to Expect Now That You’ve Matched,” Wednesday, March 29, 7:00–8:00 pm CT, to mark this momentous occasion. The webinar will feature a panel of residents:

• Nikhil Bellamkonda, MD | University of Utah | Otolaryngology 
• Ryoko Hamaguchi, MD | Mass General Brigham | Plastic surgery
• Jacob Mago, MD | Albany Medical College | General surgery
• Paulina Villanueva, MD | The Ohio State University | Vascular surgery
• Midori White, MD | The Johns Hopkins Hospital | General surgery

Attendees will be able to submit questions ahead of time when they register, as well as submit questions to the panelists during the live session.

For those unable to attend, a recording of this webinar will be posted on the National Professional Development Seminars for Medical Students webpage. 

Register in advance to participate. Once registered, you will receive a confirmation email containing the information necessary to join the webinar.

For more information, contact Cassie Buchignani at cbuchignani@facs.org.

The ACS SSR™ is an online quality improvement tool and software application database that allows surgeons to track their cases and outcomes in an easy-to-use manner from their computer or mobile devices (iOS and Android). When performance can be tracked, outcomes can be improved. Clinically relevant data collection informs meaningful data review with several analytics and report functions being available in realtime. A new feature is the SSR Practice Improvement Initiative you can enroll in under SSR, Form Management, Clinician Form, Preferences, check PII.

For ACS members, the SSR is free of charge (discount will be applied after ACS login); for non-members the annual subscription fee is $299.00.

• Improve your practice and participate in the SSR Practice Improvement Initiative.
  
• Use case logging for the individual surgeon.
  
• Easily record cases and outcomes within a matter of minutes entering key clinical data variables.
  
• Improve your practice using benchmark and real-time online reports.
  
• Delegate account access and create custom fields.
  

Visit the ACS website or more information about the Surgeon Specific Registry or e-mail SSR@facs.org.