By Bruce Scott, MD

The Kentucky Medical Association (KMA) has been busy over the last several months preparing for the 2019 legislative session. Our advocacy team worked with members to develop a list of priorities that focus on promoting healthier lives for our patients and protecting the practice of medicine in the Commonwealth.

In November, we were disappointed in the Kentucky Supreme Court’s ruling in the medical review panels case. In a ruling that frees people to file lawsuits over medical malpractice claims, the Kentucky Supreme Court struck down a 2017 law that required people to first submit their cases to an outside panel for review.

We worked closely with those who crafted the law to ensure it fit within the parameters of the state Constitution. Many thought this modest step, supported by a wide range of interests from physicians and hospitals to the business community, was a reasonable way to begin to improve the liability situation in our state.

Despite this setback, KMA remains resolute in restoring fairness and predictability in the legal liability system, and tort reform will again be a priority for the Association in 2019. We look forward to working with members of the General Assembly and other key stakeholders on initiatives that are designed to aid physician recruitment, facilitate access to quality healthcare and stabilize patient costs.

Additional priority issues for the KMA in 2019 include:

Prior Authorization: Over the past year, KMA has engaged members through its AIM for Better Care Initiative to identify and work toward solutions, either through legislation, regulation or public awareness, to lessen administrative burdens.

Through this effort, prior authorization has consistently been pinpointed as a nonclinical activity for which physicians and practice staff spend an enormous amount of time, energy and resources. The current prior authorization process being utilized by payers creates roadblocks for patients trying to access medications and treatment recommended by their trusted physicians, increases healthcare costs and restricts healthcare providers from doing their jobs effectively.

Therefore, KMA supports legislation that will remove these roadblocks by enhancing access to prior authorization information, establishing one-year approvals for chronic disease medications, preventing retroactive denial, improving the review process, standardizing review times, increasing access to electronic prior authorizations and eliminating prior authorization for medication-assisted therapy services.

Out-of-Network Billing: Insurance companies are increasingly narrowing their physician networks by offering physicians reimbursement contracts that are not financially sustainable. As a result, more physicians are being forced out of network and issues regarding patients’ access to care are growing.

Patients also have been increasingly feeling the impact of narrower networks through increased cost-sharing, often paying the difference between what it costs the physician to provide the service and what the insurer will pay for it, creating a “surprise insurance gap.”

KMA supports legislation that prevents patients from receiving these unanticipated out-of-network bills but also ensures that any out-of-network payment standards for out-of-network providers are based on data independent of the insurers and separate from Medicare.

Tobacco-Free Schools: Kentucky can enhance economic opportunity for all residents by creating a healthier future workforce. Comprehensive tobacco-free policies on school campuses are powerful tools for reducing tobacco use among teens and adolescents in Kentucky. These policies can help reduce peer pressure to use tobacco during school hours and at after-school events – creating an environment where tobacco use is not the norm.

KMA supports legislation that enacts a statewide, comprehensive tobacco-free school law that prohibits use of tobacco products, including e-cigarettes, vapor products and alternative nicotine products, by staff, students and visitors 24 hours a day, seven days a week, inside Board-owned buildings or vehicles, on board-owned property and during school-sponsored field trips, sports events and other activities. According to the Kentucky Health Issues Poll, 87 percent of Kentucky adults support tobacco-free school policies. This strong support is both bipartisan and found in all regions of the Commonwealth.

Membership-driven grassroots advocacy will be essential to achieving success. KMA will host its annual Physicians’ Day at the Capitol on Feb. 21, 2019, and physicians are encouraged to attend to engage their legislators and educate them about these and other issues that are important to physicians.

This year’s legislative session is a 30-day gathering that is scheduled to begin Jan. 8. Several impactful healthcare-related issues will be discussed, debated and voted on during that time. KMA will be there – as the voice for physicians – to advocate for policies that promote quality, accessible healthcare and advance the practice of medicine.

KMA Priorities

• Prior Authorization: Legislation that will remove roadblocks by enhancing access to prior authorization information, establishing one-year approvals for chronic disease medications, preventing retroactive denial, improving the review process, standardizing review times, increasing access to electronic prior authorizations and eliminating prior authorization for medication-assisted therapy services.
• Out-of-Network Billing: Legislation that prevents patients from receiving unanticipated out-of-network bills but also ensures that any out-of-network payment standards for out-of-network providers are based on data independent of the insurers and separate from Medicare.
• Tobacco-free Schools: Legislation that enacts a statewide, comprehensive tobacco-free school law that prohibits use of tobacco products, including e-cigarettes, vapor products and alternative nicotine products, by staff, students and visitors 24 hours a day, seven days a week, inside Board-owned buildings or vehicles, on board-owned property and during school-sponsored field trips, sports events and other activities.

 -Bruce Scott, MD, is the 2018-2019 president of the Kentucky Medical Association.