JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY VOL 173 | ISSUE 2 | SUMMER 2021 IN THIS ISSUE: Louisiana Legislature Adjourns Sine Die HB 495, HB 442 - Legislative Timeline Internal Medicine Residency Response to the COVID-19 Effects of the COVID-19 Pandemic on one Louisiana Medical School JOURNAL EDITORIAL STAFF EDITOR D. Luke Glancy, MD CONTENTS ASSOCIATE EDITOR VOL 173 | ISSUE 2 | SUMMER 2021 L.W. Johnson, MD CHIEF EXECUTIVE OFFICER Jeff Williams 4 PRESIDENT’S MESSAGE JOURNAL EDITORIAL BOARD Vice Chair, K. Barton Farris, MD 5 LOUISIANA LEGISLATURE ADJOURNS SINE DIE Secretary/Treasurer, Richard Paddock, MD Anthony Blalock, MD D. Luke Glancy, MD 8 LEGISLATIVE TIMELINE L.W. Johnson, MD Fred A. Lopez, MD 9 SCOPE OF PRACTICE, NURSE PRACTITIONERS LSMS 2021 BOARD OF GOVERNORS 10 ROLL CALL HB 495 OFFICERS President, Katherine Williams, MD 11 ROLL CALL HB 442 Past President, Lee Stevens, MD President-Elect, William Freeman, MD 12 COMMUNITY CONNECTOR PARTNERSHIPS Vice President, R. Reece Newsome, MD Speaker of the House, T. Steen Trawick, MD Vice Speaker, William “Beau” Clark, MD 14 PHYSICIAN COALITION OF LOUISIANA Secretary/Treasurer, Richard Paddock, MD Obstetrician-gynecologist Dr. Katherine Williams has Chair, COL, David Broussard, MD 15 INFORMING OUR LEGISLATORS trusted LAMMICO to provide her medical malpractice insurance for over 13 years. COUNCILORS 16 WHAT DO PATIENTS SAY? District 1 Member, George Ellis, Jr., MD District 1 Alternate, Anne Borreson, MD 18 WHITE COAT WEDNESDAY District 2 Member, Robert Chugden, MD District 2 Alternate, Gabriel Rivera-Rodriguez, MD 21 LEGISLATIVE RECEPTION EXCEEDING District 3 Member, Allen Vander, MD District 3 Alternate, Mark Hebert, MD District 4 Member, F. Jeff White, MD 23 LEGISLATURE BOOTCAMP EXPECTATIONS District 4 Alternate, Susan Veillon, MD District 5 Member, Adrienne Williams, MD 24 AN INTERNAL MEDICINE RESIDENCY RESPONSE District 5 Alternate, Gwenn Jackson, MD District 6 Member, Michael Roppolo, MD TO THE COVID-19 PANDEMIC IN LOUISIANA I left LAMMICO for lower rates that were offered at another medical malpractice District 6 Alternate, Azeen Sadeghian, MD insurer. I later learned that this other insurer had no follow up, risk management District 7 Member, Brian Gamborg, MD 28 THE EFFECTS OF THE COVID-19 PANDEMIC ON education or relationships. So I came back to LAMMICO. District 7 Alternate, Donald Higgins, MD THE UNDERGRADUATE MEDICAL EDUCATION District 8 Member, Lance Templeton, MD When I was faced with a claim, which can be a difficult experience District 8 Alternate, Michael Dole, MD EXPERIENCE AT LOUISIANA STATE UNIVERSITY for any physician, LAMMICO went above and beyond with claim District 9 Member, Andy Blalock, MD SCHOOL OF MEDICINE IN NEW ORLEANS support during the defense of the claim. I felt like they cared. District 9 Alternate, Vacant Throughout the claim process, LAMMICO fought beside me so District 10 Member, Nicholas Viviano, MD that I prevailed in court when they could have chosen a simpler, District 10 Alternate, Jeremy Henderson, MD Senior Physician Member, Robert McCord, MD less expensive path. Building Enduring Partnerships Senior Physician Alternate, Greg Lord, MD 800.452.2120 | lammico.com Young Physician Member, Amberly Nunez, MD LAMMICO maintains relationships that are far reaching and benefit Young Physician Alternate, Randall G. White, Jr., MD all physicians. They’re more than an insurance company. Resident/Fellow Member, Omar Leonards, MD Resident/Fellow Alternate, Ken Ehrhardt, Jr., MD – Katherine Williams, M.D., obstetrician-gynecologist Medical Student Member, Jacob Boudreaux, MD Medical Student Alternate, Dan Frechtling J LA MED SOC | VOL 173 | SUMMER 2021 3 LEGISLATIVE UPDATE LOUISIANA LEGISLATURE ADJOURNS SINE DIE PRESIDENT’S MESSAGE Maria Bowen, LSMS - Vice President Governmental Affairs Independent Practice for Nurse Practitioners and Physician Assistants Louisiana’s 2021 regularly-scheduled, fiscal-only session of the is Bad Medicine for Louisiana. Legislature adjourned sine die on Thursday, June 10, at 6 p.m. For LSMS and our membership, the session was dominated by non-fiscal legislation, but we would be remiss in not sharing the passage of five bills pushed by legislative leaders with the backing of the business community. The first four bills are a package including a constitutional For physicians, the 2021 session focused on two amendment that must pass a vote of the people prior to controversial issue areas: scope of practice and noncompete any taking effect: clauses. Incredibly, LSMS members delivered more than 75,000 messages through email and text to legislators on • SB 159 (Act 134) by Sen. Bret Allain (R-Franklin) is a the following bills. We thank you for your advocacy on Constitutional Amendment which would remove the behalf of your profession! requirement of a federal income tax deduction and Allowing non-physicians to provide physician-level care Medicare beneficiaries from 2003 to 2015, found ordering would cap the maximum individual income tax rate at On scope of practice, we had four pieces of legislation that would be a step in the wrong direction. We must continue increased substantially—more than 400% by NPs and 4.75 percent. It will appear on the October 9 ballot. we focused on: to educate legislators and encourage their oppostion PAs during this time frame. They further found greater to bills like HB 495 and HB 442, which risk patient safety, coordination in health care teams may produce better • SB 161 (Act 389), also by Sen. Allain, eliminates the • HB 495 by Rep. Barry Ivey (R-Baton Rouge) would have increase costs, and do not improve access to care. outcomes than merely expanding scope of practice. A 2020 federal income tax deduction and phases in lower granted full practice authority to advanced practice study published in the Journal of Internal Medicine found, franchise tax rates gradually as certain positive registered nurses. This legislation was the most The best way to ensure patient safety is to keep physicians that in states that allow independent prescribing, NPs were economic and tax revenue triggers are met. contentious bill of the entire session and finally died at the helm of the health care team. Patients deserve the 20 times more likely to overprescribe opioids than those on the calendar when the legislature adjourned. LSMS most qualified health care provider, and that is a physician, in prescription-restricted states. Furthermore, while the • HB 278 (Act 395) by Rep. Stuart Bishop (R-Lafayette) and other physician groups fought hard to educate who has unmatched training, education, and experience. number of NPs doubled between 2010-2017, there has eliminates the federal income tax deduction and legislators as to the dangers associated with the bill. been no noticeable increase of nurse practitioners within lowers individual income tax rates with similar tax As the legislature adjourned, the Louisiana Association Scope of practice changes do not decrease costs, nor do rural, underserved areas. A recent CMS study confirmed few revenue triggers. of Nurse Practitioners has already challenged its they increase access to care. Studies from the Mayo Clinic nurse practitioners choose to work in rural areas following membership to continue advocating and promised and JAMA found nurse practitioners (NPs) and physician graduation. It’s clear: scope of practice changes do not • HB 292 (Act 396) by Rep. Neil Riser (R-Columbia) to return next year. It is incredibly important for our assistants (PAs) are more likely to make unnecessary benefit patients, they benefit for-profit entities and non- reduces the number of tax brackets for corporate membership to remain engaged and work to educate referrals and imaging orders, resulting in higher costs for physicians. Legislators must see past the false promises income taxes, lowers rates and eliminates the federal your legislators on our concerns. patients. A study in the Journal of the American College and oppose continued legislative efforts to increase scope income tax deduction. of Radiology, which analyzed skeletal x-ray utilization for of practice for non-physician practitioners. ■ • HB 442 by Rep. Larry Bagley (R-Stonewall) would • HB 199 (Act 131) by Speaker Clay Schexnayder have changed how all physician assistants practice by (R-Gonzales) creating the State and Local Streamlined removing physician involvement from any requirement Sales and Use Tax Commission will also be on the October of oversight. This bill died on the house floor with a 39 9 ballot. If approved by the voters, this commission to 39 tie vote. will be tasked with the promulgation of rules aimed President at simplifying electronic filing and remittance of local • HB 181 by Rep. Dustin Miller (D-Opelousas) was Louisiana State Medical Society sales taxes. It will also serve as the entity to perform intended to provide mental health nurse practitioners audit functions for out-of-state businesses and develop the ability to admit patients to inpatient mental health rules to streamline the audit process for companies with hospitals among other items. The bill was amended a physical presence in Louisiana. to only allow these items to occur if authorized by a 4 J LA MED SOC | VOL 173 | SUMMER 2021 J LA MED SOC | VOL 173 | SUMMER 2021 5 collaborative practice agreement. The bill was signed by the Governor and became Act 373. • HB 187 by Rep. Larry Bagley (R-Stonewall) allows nurse practitioners and physicians assistants to order home health. While LSMS did oppose the bill, it is reflective of changes made by CMS during COVID-19. The bill passed the legislature and became Act 181. • HCR 94 by Rep. Stuart Bishop (R-Lafayette) and SCR 73 Louisiana Physicians: Have You by Sen. Patrick McMath (R-Covington) was requested by LSMS in response to many legislators who sought a different way to review scope of practice increases. Completed Your 20 Hours of CME? The resolution would have required all healthcare professional licensing boards to review processes Louisiana providers have trusted MI with their continuing education for more than utilized in other states and report back to the Health 20 years.