Dr. Mark Monahan on "Death, taxes... and prior-authorization"

 

Click here for an informative Op/Ed column on the collective foot-dragging and bureaucratic hurdles put up by insurers with "prior-authorization" of benefits. The piece by RAM Vice President Mark B. Monahan, MD, ran in last Sunday's Richmond Times-Dispatch Commentary page.

 

Dr. Monahan, who practices at Virginia Urology, was invited to write the column by the RTD's Editorial Board after a meeting with RAM leaders to discuss medical issues they'd like to better explain to readers.

Trying to decipher insurance benefits, and specifically the meaning of "prior-authorization," was right at the top of their list.

 

Dr. Monahan's column includes constructive suggestions to get Virginia's insurance companies to comply with an earlier agreement "to identify common evidence-based parameters for insurers' approval of the 10 most frequently prescribed chronic disease management drugs."

 

He notes that the Medical Society of Virginia, the Virginia Academy of Family Physicians, the Virginia Association of Health Plans and the AMA all are seeking more transparency from payers.

 

Citing an effective pilot project in Michigan, Dr. Monahan concludes, "The General Assembly should push insurance companies to keep upgrading the electronic approval of prescription requests.

 

"Such changes are long overdue - not only for doctors, but especially for you, our patients who deserve better."

 

In a related article, click here to read more about the AMA's efforts to end prior-authorization on medication-assisted treatment for substance-use disorders.

It includes discussion of insurers requiring step-therapy protocols, which Dr. Monahan also explores in his RTD column

here!

With "Match Day" Looming, Hospitals Deal with Travel-Ban Uncertainty

 

The Wall Street Journal reports that "President Trump's travel ban has thrown U.S. hospitals and medical schools into confusion ahead of the Feb. 22 deadline to match residency applicants with hospitals.

 

"Roughly 1,000 doctors who applied for U.S. residency slots this year are from the seven countries included in the White House's travel ban, out of a total of 56,530 applicants," the Journal reports, citing figures from AAMC, which manages the process.

 

"In recent years, about 14 percent of the more than 20,000 doctors who join the U.S. training programs aren't U.S. citizens."

 

The situation has left hospital officials in a tough spot, as they must decide whether to "forgo strong candidates from countries included in the ban or risk vacancies should rapidly shifting U.S. immigration policies bar foreign doctors from entering the country.

 

Click here to read another report on the issue from the Chicago Tribune.

 

Click here to read how 42 percent of office visits in rural American are with foreign-born physicians (according to the American Academy of Family Physicians).

McAuliffe Urges Mental Health Spending Over History Gala

 

Gov. Terry McAuliffe is fighting the General Assembly over the best use of $5 million in a tight state budget, reports the Times-Dispatch.

 

	Jamestown Island

After lawmakers restored funds to help finance the Jamestown-Yorktown 2019 gala, McAuliffe suggested they were backing a big event in lieu of funding critical mental health programs, the TD reports.

 

The governor called on the GOP-majority assembly to put $4.2 million in the budget for mental health screenings and assessments. Those had received bipartisan support earlier when they were included in his budget, but legislators later said there wasn't enough money to put them in place.
  

Click here to read more about the tough choices ahead. And here for an editorial on a proposed law that could limit group home options for people with mental disabilities or mental illness.

MSV Action Alert on COPN Reform Measure

 

Del. Peter Farrell's (R-Henrico) House Bill 1420 proposes removing mental health and substance abuse services from COPN.  These health care services would then be placed in a permitting process that includes Medical Society of Virginia-approved policy that requires applicants meet quality, accreditation, and safety standards, as well as a strict charity care requirement.

Click here to read HB 1420, which has passed the House and will now be heard in the Senate Education and Health Committee tomorrow.

 

While limited in scope, this bill would be an important first step in the path towards comprehensive COPN reform.  Please contact your senator about this issue by clicking here!

Proton Therapy Debated in State Senate

 

After hearing from the widow of a Richmond-area state senator who died of prostate cancer, "Legislation meant to increase coverage of proton therapy programs like one at Hampton University" cleared a Senate committee Monday, reports the Daily Press.

 

Sponsored by Republican Del. David Yancey of Newport News the bill "wouldn't require insurance companies to cover proton therapy as a cancer treatment," the paper reports. "But it would forbid them from holding the procedure to a higher standard of clinical evidence than other radiation treatments."

 

The Hampton University Proton Therapy Institute has complained that the procedure gets treated as experimental despite years of research. The insurance lobby counters that blind studies show that the therapy is effective in some cases - pediatric and skull surgeries - but not in others.

 

	Sen. Lambert

Click here to read more about the emotional hearing that featured testimony from Carolyn Lambert, widow of the late Sen. Benjamin Lambert, who served in the chamber for more than 20 years representing parts of Richmond, eastern Henrico and Charles City County. 

 

Sen. Lambert died in 2014, and now his son is battling prostate cancer as well, Mrs. Lambert told the Senate Commerce and Labor Committee.

 

State Sen. John Cosgrove, R-Chesapeake, motioned "as a cancer survivor" to send the bill to the floor.

Sharp Rise Reported in Seniors' Use of Multiple Psychotropic Drugs

 

The number of retirement-age Americans taking at least three psychiatric drugs more than doubled from 2004 to 2013, even though nearly half of them had no mental health diagnosis on record, according to a new study in JAMA Internal Medicine.

 

The analysis - based on data from doctors' office visits, "suggests that inappropriate prescribing to older people is more common than previous thought," reports The New York Times.

 

Geriatric medical groups have long warned about this trend, since older people are more susceptible to common side effects of various antidepressants, sleeping pills and painkillers.

 

The research was done by physicians at the University of Michigan and Columbia University. Click here to read more, including how the biggest increase was in rural areas, possibly reflecting a reliance on medications when other options (such as talk therapy, massage or relaxation training) weren't available.

Human Gene Editing Backed By NAS/NAM Panel  

How Tom Brady Got in Super (Bowl) Shape

 

	Brady going long on his body of work.

Click here to read Washington Post sports columnist Sally Jenkins on how Super Bowl MVP Tom Brady, on the cusp of turning 40, "appears to have more years left in those strikingly limber arms and legs."

 

The reason: The New England Patriots' star quarterback uses "an unconventional Eastern-medicine masseuse-trainer, Alex Guerrero, at whom NFL doctors look askance." It seems that Brady's trainer "has been called a quack and a fraud, because of a dicey past in which he made extravagant claims about unproven products."

 

But Jenkins continues, "Much of what he and Brady had done makes nothing but sense. NFL weight-training was hurting his joints and robbing him of flexibility, and the food he was eating was inflammatory and making him stiff.

 

"Brady now consumes no dairy, white sugar or white flour. He uses resistance bands and anti-gravity treadmills and focuses as much on pliability as strength. He meditates and does yoga."

 

Running counter to standard NFL-style weight training and drug usage, she writes, Brady also has "steered about half the team to Guerroro's care to the consternation of NFL medical staff."

 

Big Health Insurance Marriages Rocky

 

Two health-insurance mergers valued at a combined $82 billion "are unraveling in the wake of court rulings that found the transactions violated federal antitrust law, all but quashing a deal boom that would have reshaped the industry," reports The Wall Street Journal.

 

Reportedly down the tubes for now: A $34 billion Aetna-Humana hookup, and a $48 billion Anthem-Cigna tryst.

 

The Journal noted that Anthem's reported breakup with Cigna could be messy, with both sides accusing the other of violating a merger agreement. So while Anthem has said it unilaterally extended the merger agreement through April 30 to appeal the decision, "It faces numerous obstacles to salvaging the transaction."

Meanwhile, Humana said this week that it would no longer offer health insurance coverage in the state marketplaces created under the ACA, "becoming the first major insurer to cast a no-confidence vote over selling individual plans on the public exchanges for 2018," according to this report.  

Parham Doctors' Donaldson Named CEO

 

	David Donaldson

David Donaldson has been named CEO of Parham Doctors' Hospital after serving as its chief operating officer for the past three years, reports the Times-Dispatch.

 

He replaces Zach McCluskey, who was appointed CEO of Johntson-Willis Hospital in December.

 

Donaldson has helped lead the daily operations of the HCA Virginia-owned Parham Doctors' Hospital, which has 200 beds. He has overseen its cardiovascular, neurology, neurosurgery and oncology services, among others.

 

Donaldson joined HCA Virginia in 2014 after working as COO of Swedish Medical Center in his hometown of Denver.

Dr. Price Sworn in as HHS Chief

 

	Dr. Price (center) with wife, Betty, who's also an MD

Dr. Tom Price was sworn in last Friday as President Trump's secretary of health and human services with a promise to fix what he called a "broken health care system," reports The New York Times.

 

His swearing in came after a party line vote of 52 Republicans to 47 Democrats. "Dr. Price has a thorough understanding of health care policy and the damage that Obamacare has caused," said Sen. Lamar Alexander, R-Tenn.

 

Democrats weren't so happy, with New York Sen. Chuck Schumer predicting a GOP "war on seniors" if the Affordable Care Act is repealed.

Dr. Price is married to Dr. Betty Price, an anesthesiologist and member of the Georgia Senate. There's been speculation she may run for his now-vacant congressional seat in the suburbs of Atlanta. 

 

Click here to read more about how Republicans are working to shore up the ACA's insurance marketplaces by limiting late sign-ups by enrollees.

Meanwhile, click here to read about how Dr. Price's confirmation "represents the latest victory in the ascendancy of a little-known but powerful group of conservative physicians in Congress he belongs to --- the GOP Doctors Caucus.

"During the Obama administration, the caucus regularly sought to overturn the Affordable Care Act, and it's now expected to play a major role determining the Trump administration's plans for replacement." 

Carly Fiorina vs. Tim Kaine?

 

Former GOP presidential candidate Carly Fiorina is testing the waters to challenge Virginia Sen. Tim Kaine in next year's Senate race.

 

"I'm certainly looking at that opportunity," Fiorina said recently on a Portsmouth radio show. "

Fiorina and her husband moved to Lorton, in Fairfax County, in 2011 "after a bruising loss in her bid to unseat Sen. Barbara Boxer (D-Calif.)," reports The Washington Post.

 

She ended her presidential campaign one year ago, and after a brief alliance with Sen. Ted Cruz as his vice presidential pick, she's been "helping other Republicans, particularly in Virginia, where she stumped for everyone from Rep. Barbara Comstock to little-known candidates for state legislature."

 

Kaine, who was Hillary Clinton's running mate on the Dems' presidential ticket, will be seeking a second term in the Senate in 2018.

If You're Not Already Opposed to MOC...

 

In this blog from KevinMD, a family physician explains why she opposes the Maintenance of Certification program run by the American Boards of Medical Specialties (ABMS).

10 Places You Don't Want to Get Sick

 

If you happen to come down with a serious illness during a trip to Arkansas, you may want to avoid Hot Springs where its two hospitals were ranked the worst in the country by The Wall Street Journal.

 

In a special report, the Journal said it had worked with a patient safety watchdog - the Leapfrog Group - to rate hospitals based on mortality and preventable infection rates, readmissions and other factors. Click here for the article and here for the list.

 

Given the stress on safety-net facilities, which primarily provide care for poor and often unhealthy populations, the Journal notes that this could skew the data in its report, "even for hospitals providing high quality care."

None of the cities or areas listed are large metropolitan areas, and many are in rural regions.  

	Carrie Fisher

"Heart disease is the leading killer of women, responsible for one in every four female deaths, and this danger was highlighted by the tragic death of actress Carrie Fisher in late 2016," according to The Doctors Company.

"But almost two-thirds of women who die suddenly from heart disease had no previous symptoms. Diagnosis of an impending heart attack in a woman may be more difficult, as women often show different early signs and symptoms than men."

Click here to read more!

The Doctors Company is the nation's largest physician-owned malpractice insurance company. Your RAM membership gets you a 5% discount in premiums in addition to receiving financial rewards for practicing good medicine upon your retirement. To learn more, or for a price quote, contact the Academy's endorsed insurance partner  - the Medical Society of Virginia Insurance Agency (MSVIA) - at (804) 422-3100.

   

No, Medicine is not Destroying Your Marriage

 

"Every medical couple knows that the lifestyle and career choice brings with it adjustments and sacrifices," blogs Sarah Epstein on KevinMd.com.

 

But for those who blame the profession for marital woes, she writes, "No. Medicine is not the culprit. Yes, a career in medicine tests a relationship's strength and stamina and yes, the sacrifices can lead to a very real frustration. But blaming the physician lifestyle robs the couple of the chance to examine what is truly happening when they have this conversation again and again.

 

"What is this couple feeling beneath the anger?"

 

Click here to read more, and here for her regular blog, Dating a Med Student.

Touché!

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Chip Jones
RAM Communications & Marketing Director