For more information regarding ACS State Affairs Policy Priorities in your state, please contact Catherine Hendricks, State Affairs Manager, at chendricks@facs.org.

STATE AFFAIRS WORKGROUP

Arnold Baskies (NJ); Ali Kasraeian (FL); Kevin Koo (MN); and Kelly Swords (CA). The Workgroup will play a critical role in identifying state advocacy priorities, setting new policy objectives, and evaluating state advocacy grant applications among other duties.

 ACS STATE AFFAIRS PRIORITY ISSUES

• Trauma System Funding & Development
• Cancer Prevention, Screening, and Testing
• Insurance & Administrative Burden
• Professional Liability
• Criminalization of Physician Care
• Access to Surgical Care
• Health Equity

IN THE NEWS

10 Most Frequent Malpractice Allegations
Beckers provided the most common reasons physicians face professional liability allegations, according to Medscape’s 2023 “Physicians and Malpractice Report.”

1.     Failure to diagnose or a delay in diagnosis: 35% 
2.     Complications from treatment or surgery: 27% 
3.     Failure to treat or delayed treatment: 22% 
4.     Poor outcome or disease progression: 20% 
5.     Wrongful death: 15% 
6.     Patient suffered an abnormal injury: 10% 
7.     Errors in medication administration: 3% 
8.     Improperly obtained or lack of informed consent: 3% 
9.     Failure to follow safety procedures: 2% 
10.  Poor documentation of patient instruction and education: 2%

LEGISLATIVE TRACKING

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

NEW YORK

A 8117 – Licensure

Introduced by Assemblymember Michaelle Solages (D), A 8117 provides for a $2,000 fine and license suspension if they fail to disclose their probationary status; the cause of the probation; the length of the probation and the end date; any practice restrictions placed on the licensee; and the address and telephone number of the licensee’s state board. The bill was introduced and referred to the Assembly Higher Education Committee.

Last year, the New York state legislature passed a bill to expand the types of damages awardable in wrongful death actions which would result in a dramatic increase in professional liability insurance premiums. Although the bill was vetoed by Governor Kathy Hochul, new versions of the bill, A. 6698 and S. 6636, were introduced without adequately addressing the concerns physicians raised about the previous legislation. If signed into law, these bills would increase professional liability insurance premiums by nearly 40%. 

We believe this legislation may have unintended consequences that could impact patient care, medical practitioners, and the overall quality of our healthcare system.

The New York Chapter of the American College of Surgeons is working with the Medical Society of the State of New York and other physician organizations, to ensure legal remedies for grieving families.

To make a significant impact, we are participating in a series of coordinated contacts to the Governor's office on October 4th and October 27th. 

• Call the Governor 's Office: 518-474-8390, press option 1 to voice your concerns.
  
  
• If you are unable to call, we've created an email message for you to modify and send to the Governor.

Resources:

• NY Chapter ACS Fact Sheet
• MSSNY Talking Points

Members of the ACS are invited to attend the in-person only Annual Business Meeting of Members on Wednesday, October 25, at Clinical Congress in Boston, Massachusetts.

Activities will include reports from College leadership, presentation of several awards, and remarks from the newly installed President-Elect. 

The Office of Professional Medical Conduct (OPMC) has oversight of complaints about physicians, physician assistants and specialist assistants and monitors practitioners who are subject to orders of the State Board for Professional Medical Conduct. 

Some physicians have reported being contacted by scammers. 

These individuals pretend they are from the DOH, identify a threat to their professional license such as a suspension and then place pressure to act immediately to resolve the threat with monetary compensation.

Proceed with extreme caution. Here are some suggestions from MSSNY:

1. DOH never asks for credit card payment over the telephone or a wire transfer from a retail establishment such as Western Union.
   
   
2. Please secure all personal and financial information in response to unexpected requests and reach out to someone you trust to discuss further.
   
   
3. A legitimate contact from DOH will include contact information so you can respond to phone calls or letters; contact information for the DOH; a complete return mailing address; a specific explanation for why it was sent and an explanation of your rights.
   
   
4. Contact information for the Office of Professional Medical Conduct can be located on the DOH website at health.ny.gov/professionals/doctors/conduct/contact.htm .
   
   
5. If you have been contacted by a spammer, please report it to local law enforcement or the Federal Trade Commission.

(shared from MSSNY Pulse )

Federal IDR Initiation Fee of $150 Proposed for 2024
This week, the Departments of Health and Human Services (HHS), Labor, and the Treasury proposed a rule setting forth the fee for the federal Independent Dispute Resolution (IDR) process at $150 per party for CY 2024 – compared to $50 in CY 2022, and a proposed level of $350 in CY 2023, which was the subject of a District Court order.

Congressional Hearing Puts Spotlight on Flawed Federal IDR Implementation
This week, the US House of Representatives’ Ways and Means Committee held a widely attended hearing on the Implementation of the No Surprises Act.  Both Republican and Democratic Members emphasized the law must be implemented as Congress intended, and expressed dismay over challenges associated with implementation, and unintended consequences on patient costs and access to care

The Centers for Medicare & Medicaid Services (CMS) released proposed rules for 2024 that could have implications for surgeon payment, inpatient versus outpatient procedures and coding, and more.

See how the ACS responded.

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)

American Medical Association State Advocacy Roundtable

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.

Make an Advocacy Impact at Home: Urge Lawmakers to Prioritize Physicians and Patient Access

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.

New Practice Management Resources Provide Financial Planners and Detail Closing a Practice

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.