LMS President’s Message: KMA Physicians’ Day at the Capitol
By Khalil Rahman, MD, MBA
The KMA Physicians’ Day at the Capitol is an annual event in which physicians wear their white coats and make their presence known in their legislators’ offices and in the hallways. We discuss issues of concern for physicians that they encounter on a daily basis and legislative bills, ones that we support and others that we oppose. Today, I will highlight legislation pertaining to physicians that were discussed at this KMA event in Frankfort.
House Bill 343: An Act relating to exemptions from prior authorization requirements
HB 343 would require state-regulated commercial health benefit plans to issue a gold card to physicians for prior authorization exemption on a physician-by-physician basis. The prior authorization requirement will be waived for specific procedures, services, or medications if a physician is approved for the gold card. HB 343 will decrease overhead expenses and lead to improved management of patients and the medical clinics that serve them.
Prior authorization for procedures, diagnostic tests, and medications has major financial impacts and cause mental stress on physicians taking care of patients. Initially, the prior authorization was to control expenses due to overuse of unnecessary procedures and expensive medications. Insurance companies are now using this requirement for basic and routine medical treatments, causing delays in providing timely medical management of patients.
The American Medical Association (AMA) reported major adverse effects in patient care with wide use of the prior authorization by the health insurance companies leading to increased hospitalization, permanent bodily damage, disability, and early death. An AMA survey also highlighted 90% of physicians reported negative impact of prior authorization on patient outcomes. Most medical practitioners have one to two employees assigned to do only prior authorization leading to higher overhead cost.
The details of how HB 343 can potentially eliminate the need for prior authorization for qualified physicians remain to be completed. Questions such as who would issue the gold card, would it be renewed annually, and many other issues are still to be worked out.
House Bill 219: Lung Cancer Screening
Kentucky has the highest incidence of lung cancer and deaths, as we all know, in the United States due to heavy smoking. We have the tools to detect and treat cancer. HB 219 will increase the awareness and establish lung cancer screening programs within the Kentucky Department of Public Health. This bill will supplement low dose CT cancer screening initiatives in place.
State appropriations for physician recruitment efforts.
We met with State Senators Dr. Donald Douglas (Republican, District 22, Fayette-part, Garrard, Jessamine) and Dr. Ralph Alvarado (Republican, District 28, Winchester) and discussed how Kentucky is facing a physician workforce shortage. The provider shortage is going to get worse with aging physicians retiring, as 1 out of 3 plan to reduce their workload and 1 out 5 retiring in next 12 months due stress and burnout (Mayo Clinic 2021). Kentucky is ranked 36/50 states in terms of physicians per 100,000 population. The primary care shortage is ongoing in 94% of our counties and by 2025 the primary care physician shortage will increase by 960 providers.
Stagnant graduate medical education funding, increasing patient demand, ever rising liability insurance rates, lawyer friendly court systems, and physician education debt averaging $200,000 (AAMC 2020) all contribute to the current and future provider shortcomings. Recent surveys by the National Health Service Corp (NHSC) found that 87% of the participants in loan forgiveness programs practiced in underserved area for at least 2 years, 35% after 6 years. Loan forgiveness programs will not solve all the recruitment problems Kentucky faces, but it will surely help many underserved counties. The KMA supports loan forgiveness programs.
The KMA and LMS have always worked with the legislature to reach our common goal for the betterment of the population in Kentucky. The Lexington Medical Society works with the KMA to continue to work for patients and health care providers.
Khalil Rahman, MD, MBA.