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Examining Views on Medical Marijuana VOL. 111, NO. 1 | QUARTER 1, 2018 Examining views on medical marijuana 2018 Legislative Agenda 2018 TMA Voter Guide The Truth About Balance Billing tnmed.org VOL. 111,XXX, NO. NO. 1 X | | QUARTER QUARTER 1, 1, 2018 2018 Table of Contents PRESIDENT 3 Legislative Agenda NITA W. SHUMAKER, MD TMA to focus on payment reforms, scope of practice, CHIEF EXECUTIVE OFFICER public health issues RUSS MILLER, CAE EDITOR DAVID G. GERKIN, MD 5 Editorial: Another Tool to Reduce MANAGING EDITOR Narcotic Overdose Deaths in Tennessee JULIA COUCH Matthew Hines, MD EDITORIAL BOARD JAMES FERGUSON, MD KARL MISULIS, MD 7 Editorial: A Hospice Doctor Looks at GREG PHELPS, MD BRADLEY SMITH, MD Medical Marijuana JONATHAN SOWELL, MD Greg Phelps, MD ANDY WALKER, MD ADVERTISING REPRESENTATIVE 13 Ask TMA MICHAEL HURST 615.385.2100 [email protected] 14 The Truth about Surprise Medical Bills Douglas Springer, MD and Jonathan Hughes, MD 16 Ruffner: Marijuana Update from AMA 18 Guide to 2018 TMA Leadership Elections 24 For the Record Tennessee Medicine: Journal of the Tennessee Medical Association (ISSN 10886222) is published Quarterly by the Tennessee Medical Association, 701 Bradford Ave., Nashville, TN 37204. Tennessee Medical Association is a nonprofit organization with a definite membership for scientific and educational purposes, devoted to the interests of the medical profession of Tennessee. This Association is not responsible for the authenticity of opinion or statements made by authors or in communications submitted to Tennessee Medicine for publication. The author or communicant shall be held entirely responsible. Advertisers must conform to the policies and regulations established by the Board of Trustees of the Tennessee Medical Association. Subscriptions (nonmembers) $30 per year for US, $36 for Canada and foreign. Single copy $5.00. Payment of Tennessee Medical Association membership dues includes the subscription price of Tennessee Medicine. Periodicals postage paid at Nashville, TN and at additional mailing offices. POSTMASTER: Send address changes to Tennessee Medicine, 701 Bradford Ave., Nashville, TN 37204. In Canada: Station A, P.O. Box 54, Windsor, Ontario, N94 6J5. Copyright 2018, Tennessee Medical Association. All material subject to this copyright appearing in Tennessee Medicine may be photocopied for noncommercial scientific or educational use only. TENNESSEE MEDICINE 3 QUARTER 1 | 2018 2018 Legislative Agenda TMA Takes Aim at Episodes of Care, MOC, Balance Billing and More TMA enters each legislative session with a short list of priority items it hopes to accomplish on behalf of members, followed by a bevy of other issues that physician Protecting leaders and staff lobbyists expect to arise. Tennessee’s The legislative package is set after months of deliberation by the TMA Legislative Favorable Medical Committee, which considers member requests and sorts through hundreds of pages of research to come up with a recommendation for the TMA Board of Trust. Liability Climate TMA claimed an early legislative Once session begins, lobbyists carefully review draft bills filed in the state legislature, win for 2018 when it announced looking for landmines and making sure lawmakers understand the implications for in November 2017 that a three- doctors and patients. Every piece of legislation is carefully examined to determine year push to dismantle and whether it relates to healthcare and, if so, how it could affect the business of medicine replace the state’s medical or the delivery of patient care. Ultimately, TMA advocates for or against each bill liability system had ended. based on whether the physician members deem it good public policy. A Georgia-based group called Patients for Fair Compensation Following are just a few of the highest priority issues for TMA’s lobbyists in the had since 2015 lobbied the second session of the 110th Tennessee General Assembly. Tennessee General Assembly to shift physician liability cases TennCare Episodes of Care from the civil court system to a TMA members have grown increasingly frustrated by the state’s inconsistent, government-run administrative inaccurate and ineffective episodes of care payment model. Decisions about the system. Doctors raised program are continually made without physician agreement and in many cases with fundamental concerns about physician opposition. TMA has long advocated for improvements but the state has verifying proponents’ claims that not addressed fundamental flaws in the design and implementation of the program. their plan would save the state money, and preserving medical TMA redoubled its advocacy efforts in late 2017 at the same time it stopped liability insurance in the event a participating in a state grant that funded episodes-related education efforts for patient compensation system did physicians and practices. TMA President-Elect Matt Mancini, MD of Knoxville not work. The opposing groups testified in a Senate Health Committee hearing on episodes of care in October could not resolve fundamental 2017. TMA officials followed that meeting with a letter to Sen. Rusty Crowe, Chair issues, and Patients for Fair of the committee, and reiterated concerns during multiple meetings with state Compensation assured TMA policymakers in late 2017 and January 2018. that it does not plan to introduce Despite TMA’s advocacy efforts, significant concerns remain about data collection, any related bills in the 2018 data reporting and accuracy, and overall transparency of the episodes of care legislative session. program. TMA is opposed to further expansion of the initiative until or unless these TENNESSEE MEDICINE 4 QUARTER 1 | 2018 TENNESSEE MEDICINE 5 QUARTER 1 | 2018 fundamental issues are satisfactorily to the legislation and is advocating for a medical boards from requiring MOC for EDITORIAL: addressed and tested. different name to avoid patient confusion initial licensure or renewal. A task force in a clinical setting. was also created to further explore MOC TMA has been given no assurance or as it pertains to hospital and insurance confidence that the state is going to credentialing. TMA hopes the task force Balance Billing address the ongoing fundamental design will propose a solution to address those Another tool to reduce narcotic issues with the program, which we have TMA wants to protect physicians’ rights issues in 2018. If not, TMA will work with outlined repeatedly and most recently to balance bill and will continue to fight the 2017 bill sponsors (Sen. Richard ranked in priority order at the state’s for a solution to “surprise medical bills” Briggs, MD of Knoxville and Rep. Ryan overdose deaths in Tennessee request. TMA will ask the legislature to that is fair to all parties, especially Williams of Cookeville) to try to pass a intervene and needs members to contact physicians and patients. TMA opposes stronger bill to prohibit hospitals and By Matthew Hines, MD their elected officials to educate them on any effort that gives health insurance health insurance companies from this complicated but important issue. companies even more undue leverage requiring MOC for physician to force providers to accept unfair credentialing or network participation. Learn more about TMA’s position contractual terms and proliferates the Our practices will soon intersect with the therapeutic use of marijuana and related advocacy work at trend of narrow networks. (cannabis). During the past four years, the reported annual use of marijuana among tnmed.org/episodes. Indoor Tanning American adults has doubled from 7% to 14%, while the use by teens has declined. See more on this topic on page 14 TMA will encourage Tennessee to join Is this a good thing? Remarkably, I think so. from Doug Springer, MD and 28 other states that have some type Doctor of Medical Science I used to believe the public health hazards of allowing comprehensive medical marijuana Jonathan Hughes, MD of Kingsport. of prohibition on dangerous indoor (or successor name) programs outweighed benefits. But after many hours of study, I’ve reached the opposite tanning for minors. TMA and other Legislation first introduced in 2017 conclusion: public health benefits predominate. groups in a coalition of advocates, would create a new academic degree for Maintenance of Certification including dermatology and pediatric physician assistants. Sponsors filed the For the second year in a row, TMA will The criminalization of the substance has resulted in increased expenditure on incarceration organizations, will educate lawmakers updated version of the bill in January. have legislation filed to give physicians rather than effective public health education. In Tennessee, the possession of 1 cannabis about the preventable dangers of The language is much improved from relief from the costly, burdensome and plant remains a felony. The cannabis plant is classified by the federal Controlled Substances indoor tanning, such as skin cancer. the 2017 version; it does not give PAs in many cases valueless requirement of Act as a Schedule 1 substance, while the psychoactive ingredient (THC), as a 100% pure synthetic substance (Marinol) is classified as Schedule 3. A schedule 3 drug has accepted independent practice but requires Maintenance of Certification. Follow TMA’s legislative progress at medical use, while abuse of the drug may lead to moderate or low physical dependence or PAs to collaborate with a supervising tnmed.org/legislative or on twitter TMA successfully worked for passage high psychological dependence. It seems to me an accurate
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