| board-of-naturopathy-agrees-vasectomies-are-outside-scope | Board of Naturopathy Agrees Vasectomies Are Outside Scope | Latest_News | Shared_Content/News/Membership_Memo/2023/may-26/board-of-naturopathy-agrees-vasectomies-are-outside-scope | <div class="col-md-12">
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<h5>May 26, 2023</h5>
<h2>Board of Naturopathy Agrees Vasectomies Are Outside Scope</h2>
<p>After nearly a year of persistent advocacy from the WSMA, the Washington State Urological Society, and the American Urological Association, the state Board of Naturopathy has agreed with our position that the performance of vasectomies is outside the scope of practice for naturopaths.</p>
<p>In July of 2022, the state's professional association for naturopaths requested that the board issue guidance on whether the performance of in-office abortions and vasectomies is within their scope of practice. The board clearly responded that in-office abortions are not within their scope, in part because they are surgical procedures, which are not within the scope of practice for naturopaths. However, the board was ambiguous on the question of vasectomies, simply noting that it could not provide guidance and naturopaths should consult with their malpractice carrier and legal counsel to determine the risks and benefits of providing the procedure.</p>
<p>Responding to the gray area created by the board, the WSMA, WSUS, and AUA submitted a letter in January and testified publicly at the board's February meeting explaining that vasectomies are surgical procedures and requesting that the board reconsider its opinion, to which it agreed.</p>
<p>At a meeting earlier this month, the board amended its opinion to reflect that vasectomies are outside the scope of practice for naturopaths. In a letter to the WSMA, the board concludes "…that the practice of vasectomy was not included by the legislature in drafting RCW 18.36A as it is currently written."</p>
<p>This is a considerable win for patient safety in our state, and the WSMA is grateful to WSMA President Katina Rue, DO, Jeffrey Frankel, MD, and the state and national urological associations for their partnership in this effort.</p>
</div> | 5/26/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| cigna-delays-implementation-of-modifier-25-policy | Cigna Delays Implementation of Modifier 25 Policy | Latest_News | Shared_Content/News/Membership_Memo/2023/may-26/cigna-delays-implementation-of-modifier-25-policy | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/may/billing-invoice-645x425.jpeg" class="pull-right" alt="Billing invoice" /></div>
<h5>May 26, 2023</h5>
<h2>Cigna Delays Implementation of Modifier 25 Policy</h2>
<p>The Cigna Group, one of the country's largest health insurers, has announced that it is delaying implementation of a concerning <a href="https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/Notifications/Modifier_25_Significant_Separately_Identifiable_Evaluation_and_Management.pdf" target="_blank" rel="noreferrer">policy</a> that would have required the submission of medical records with all evaluation and management claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed. The policy, that was due to go into effect on May 25, would have added significant, unnecessary administrative burden and compliance costs to physician practices, disincentivized physicians from providing unscheduled services, and created duplicate requests.</p>
<p>In addition to the WSMA executive committee meeting with Cigna's market medical executive for the Pacific Northwest, the WSMA signed onto <a href="https://wsma.informz.net/WSMA/data/images/AMA-Cigna-modifier-25-signon-040323.pdf" target="_blank" rel="noreferrer">an American Medical Association letter</a> urging Cigna to rescind the policy. We also submitted <a href="https://wsma.informz.net/WSMA/data/images/WSMA-Cigna-Letter-April-2023.pdf" target="_blank" rel="noreferrer">our own letter</a> to Cigna outlining the negative impact the policy will have on Washington state physicians if it is enacted as proposed.</p>
<p>Cigna is currently reevaluating this reimbursement policy update. The WSMA has urged Cigna to work collaboratively with the physician community to ensure any future policy under consideration is not administratively burdensome and is focused on education to ensure modifier 25 is being billed appropriately.</p>
</div> | 5/26/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| register-now-virtual-training-on-treatment-and-management-of-oud-sud | Register Now: Virtual Training on Treatment and Management of OUD, SUD | Latest_News | Shared_Content/News/Membership_Memo/2023/may-26/register-now-virtual-training-on-treatment-and-management-of-oud-sud | <div class="col-md-12">
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<h5>May 26, 2023</h5>
<h2>Register Now: Virtual Training on Treatment and Management of OUD, SUD</h2>
<p>
<em>Save the dates: June 16-17. Free.</em>
</p>
<p>
Participation in this no-cost, virtual training will meet the federal Drug Enforcement Administration's new one-time, eight-hour training requirement on the treatment and management of opioid use disorder and other substance use disorders, as <a href="https://deadiversion.usdoj.gov/pubs/docs/MATE_Training_Letter_Final.pdf">outlined in the Consolidated Appropriations Act of 2023</a>. This activity has been approved for <em>AMA PRA Category 1 Credit<sup>TM</sup></em>.
</p>
<p>
The WSMA, the Washington Society of Addiction Medicine, the Women and Addiction Group, and CHOICES Education Group have planned a robust two-part program on compassionate addiction medicine on Friday, June 16, and Saturday, June 17. Offering comprehensive education on the treatment and management of opioid use disorder and other substance use disorders, this event will bring together physicians and health care professionals from all specialties to engage in an important conversation on compassionate care that fosters a nonjudgmental, trauma-responsive, and patient-centered response.
</p>
<p>
Topics covered:
</p>
<ul>
<li>Education on stigma, myths, and truths.</li>
<li>Evidence-based treatments, including initiation of buprenorphine and methadone.</li>
<li>Appropriate care for various populations.</li>
<li>Pharmacotherapy.</li>
<li>Drug-related policies and harm-reduction efforts.</li>
<li>Caring for pregnant, postpartum, and parenting people with opioid or substance use disorders.</li>
</ul>
<p>
In order to register for this free event, please complete this <a href="https://www.surveymonkey.com/r/G7VKM8R">survey</a>, which will provide event planners a foundational understanding of your experience in treating individuals with opioid and/or substance use disorder. Upon completion of the survey, a registration link will be provided for you to complete the registration process. Contact Shelby Wiedmann at <a href="mailto:shelby@wsma.org">shelby@wsma.org</a> with questions.
</p>
</div> | 5/26/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| weekly-rounds-may-19-2023-meeting-the-challenge-of-improving-access-to-physician-services | Weekly Rounds: May 19, 2023 - Meeting the Challenge of Improving Access to Physician Service | Latest_News | Shared_Content/News/Weekly_Rounds/2023/weekly-rounds-may-19-2023-meeting-the-challenge-of-improving-access-to-physician-services | <div class="col-md-12">
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<h5>May 19, 2023</h5>
<h2>Meeting the Challenge of Improving Access to Physician Services</h2>
<p>Jennifer Hanscom, CEO</p>
<p>
In case you missed it:
</p>
<ul>
<li><a href="https://www.seattletimes.com/seattle-news/health/wa-hospitals-close-labor-and-delivery-units-raising-fears-for-new-parents/">WA hospitals close labor and delivery units, raising fears for new parents</a></li>
<li><a href="https://www.kitsapsun.com/restricted/?return=https%3A%2F%2Fwww.kitsapsun.com%2Fstory%2Fopinion%2Fcolumnists%2F2023%2F05%2F05%2Flow-reimbursement-rates-are-crippling-healthcare-in-kitsap-and-beyond%2F70188239007%2F">Obstetrics canary in coal mine</a></li>
<li><a href="https://www.beckershospitalreview.com/strategy/confluence-health-cuts-coo-role.html">Confluence Health cuts COO role</a></li>
<li><a href="https://www.thenewstribune.com/news/local/article274517126.html">Tacoma hospital's latest issue: 'Anesthesia doctors have been leaving for several months'</a></li>
</ul>
<p>
These headlines are just the latest from recent media reports that demonstrate the growing need for investments in health care. Cutting costs alone will not fix this problem, at least not in the short term. The WSMA has been focused in several areas to improve access to physician services in Washington state: This past legislative session, we were successful in getting additional dollars for Medicaid professional services (although more must be done) and we made <a href="[@]Shared_Content/News/Weekly_Rounds/2023/weekly-rounds-may-5-2023-progress-on-improving-prior-authorizations?_zs=B3aFd1&amp;_zl=HVU19">improvements to the prior authorization process</a>. Additionally, Washington lawmakers appropriated dollars toward residency programs, loan repayment for health care professionals, and public health. However, while all of these investments are appreciated, they aren't enough to stem the tide of continuing workforce shortages, growing expenses, and the unfortunate situation of patients losing access to critical services in their local communities.
</p>
<p>
Over the legislative interim, the WSMA will continue to strategize on solutions we can put into action to both ensure access to affordable care and that our members are paid appropriately for their services and their time spent on patient care, rather than on inefficient processes.
</p>
<p>
While we will be working with our members to shape and drive our success, I thought I would also ask the A.I. community for some ideas. Here's what ChatGPT had to say when I asked, "Got any ideas for improving access to physicians in Washington state?":
</p>
<p>
"Improving access to physicians in Washington state can be a multifaceted challenge, but there are several potential strategies that could help enhance access to health care services. Here are some ideas:
</p>
<ol>
<li>Telemedicine expansion: Promote and expand telemedicine services to allow patients to remotely consult with physicians. This approach can help overcome geographical barriers and improve access for individuals in rural or underserved areas.</li>
<li>Incentives for rural practice: Implement programs that offer financial incentives or loan forgiveness for physicians who choose to practice in rural or underserved areas. This approach can help attract health care professionals to regions with limited access to medical services.</li>
<li>Increase medical school capacity: Expand the capacity of medical schools in the state to train and graduate more physicians. By increasing the number of medical students and residency positions, Washington can address the physician shortage and improve access to health care services.</li>
<li>Enhanced scope of practice for non-physicians: Review and consider expanding the scope of practice for nurse practitioners, physician assistants, and other non-physician practitioners. Allowing these professionals to practice to the full extent of their training and capabilities can help meet the increasing demand for primary care.</li>
<li>Collaborative care models: Develop and promote collaborative care models that involve interdisciplinary teams of health care professionals. This approach encourages shared responsibilities, with physicians focusing on complex cases while other health care practitioners handle routine and preventive care. This can help optimize physician resources and improve access to care.</li>
<li>Streamline licensing and credentialing: Simplify the licensing and credentialing processes for physicians, especially those trained out of state or internationally. Reducing bureaucratic barriers can expedite the entry of qualified physicians into the workforce and increase access to care.</li>
<li>Community health centers: Invest in and expand community health centers, particularly in underserved areas. These centers often provide comprehensive primary care services, including preventive care, chronic disease management, and mental health services, improving access for vulnerable populations.</li>
<li>Health information technology: Invest in robust health information technology infrastructure, including electronic health records and health information exchanges. Seamless sharing of patient information across health care settings can improve coordination and continuity of care, making it easier for physicians to provide timely and efficient services.</li>
<li>Public health initiatives: Implement public health initiatives focused on preventive care, health education, and disease management. By promoting healthier lifestyles and preventing diseases, the demand for physician services may decrease, enabling physicians to dedicate more time to complex cases.</li>
<li>Physician workforce planning: Conduct comprehensive physician workforce planning to identify areas of need and develop targeted recruitment and retention strategies. This approach ensures a balanced distribution of physicians across the state, addressing access disparities."</li>
</ol>
<p>
Well done, ChatGPT. With the exception of No. 4, these strategies align with WSMA's advocacy agenda in recent years and encapsulate many of our successes (see numbers 1, 2, 3, 5, 7, 8, and 9).
</p>
<p>
The WSMA continues to grapple with No. 4 and remains committed to using teams to their fullest potential. Our stated policy, however, is clear that absent commensurate education and training requirements to ensure patient safety and a demonstrable and compelling societal need, the WSMA opposes efforts of non-physician practitioners to expand the scope of their practice to include additional services currently performed by physicians.
</p>
<p>
During this interim, the WSMA will be working on No. 10, with a particular focus on workforce in the outpatient ambulatory community. We'll work with physician leaders, the Washington State Medical Group Management Association, and other experts on workforce issues to put forward solutions to improve access to care and physician services in communities throughout Washington.
</p>
<p>
Speaking of solutions, we continue to be vexed by decreasing <a href="[@]wsma/advocacy/legislative_regulatory/issue-briefs/medicaid-professional-services-rate-increase.aspx?WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927&amp;_zs=B3aFd1&amp;_zl=IVU19">Medicaid</a> and <a href="[@]Shared_Content/News/Membership_Memo/2023/may-12/wsma-urges-washingtons-congressional-delegation-to-support-medicare-payment-reform?_zs=B3aFd1&amp;_zl=KVU19">Medicare</a> payments. While not addressed by ChatGPT, we remain committed to improving payment via these public programs. We continue our efforts at both the state and federal levels to draw attention to the need to pay physicians adequately to ensure patients have access to care in their communities.
</p>
<p>
At the closing of my inquiry with ChatGPT, the program noted:
</p>
<p>
"Collaboration between policymakers, health care organizations, and communities is crucial for successful implementation."
</p>
<p>
Agreed! Together, no matter how tired the message may seem, we need to continue to advocate for change if we are to make Washington the best place to practice medicine and receive care.
</p>
</div> | 5/19/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| better-prescribing-better-treatment | Better Prescribing, Better Treatment | Latest_News | Shared_Content/News/Latest_News/2023/better-prescribing-better-treatment | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/may-june/may-june-reports-cover-cropped-645x425px.jpeg" class="pull-right" alt="cover of May/June 2023 issue of WSMA Reports" /></div>
<h5>May 8, 2023</h5>
<h2>Better Prescribing, Better Treatment</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<br />
<p>
As the ravages of the opioid epidemic became increasingly apparent a decade ago, lawmakers began to look for ways to stop the escalating toll from addiction. Unfortunately, the options they frequently came up with were ham-fisted and likely to cause more harm to clinical practice than help to patients. In Washington state, the suggestions being considered were prior authorization for any opioid prescription and a seven-day pill limit.
</p>
<p>
Still early in her role as chief executive officer of the WSMA, Jennifer Hanscom knew that prior authorization was an inefficient approach that was unlikely to get to the heart of the problem. Instead, she realized that all sides needed to collaborate to find a solution that would work for everyone.
</p>
<p>
"I still remember the moment in the conference room when we decided to tackle this," Hanscom recalls. "I was really focused on how do we get away from this contentious situation. We don't want opioids to be misused and overprescribed and the state doesn't either. Let's get everyone around the table. Put the stick away and focus on the carrot."
</p>
<p>
Working with the state Health Care Authority and the Washington State Hospital Association, the WSMA worked to develop a program that would provide meaningful data and change long-term behavior. The result was the Better Prescribing, Better Treatment program, which celebrates its sixth anniversary this year.
</p>
<p>
The program has multiple components. It encourages compliance with Health Care Authority opioid prescribing guidelines that establish pill limits
for all prescriptions for acute pain while allowing prescriber discretion to override those limits if they feel it is in the best interest of their patients.
</p>
<p>
Importantly, physicians and physician assistants can see data to understand how they compare to the guidelines, if their system opts in. Each quarter, the WSMA sends prescribers in the state an opioid prescribing feedback report. Using data from the state prescription monitoring program, the report shows how their opioid prescribing practices compare to others in their hospital, health system, or medical group, as well as within their specialty.
</p>
<p>
The program also provides coaching on opioid management. The coaching is done in partnership with the Six Building Blocks program, developed by the University of Washington Department of Family Medicine and Kaiser Permanente Washington Health Research Institute, which provides an evidence-based quality improvement roadmap to help primary care teams implement effective guideline-driven care for their chronic pain and long-term opioid therapy patients.
</p>
<p>
By any standard, Better Prescribing, Better Treatment has seen tremendous success in a relatively short period of time. The initiative now encompasses more than 20,000 clinicians with 62 hospitals, health systems, and medical groups in the state. Nearly 11,000 prescribers receive regular peer-to-peer comparative data reports and accompanying guidelines. These guidelines serve as educational interventions to help ensure clinicians maintain quality care and better control how opioids are prescribed. Collectively, thanks to Better Prescribing, Better Treatment, opioid prescriptions above the prescribing guidelines have been reduced by an impressive 46% since 2018.
</p>
<p>
Those numbers have a two-fold effect, says Nathan Schlicher, MD, JD, WSMA's lead on Better Prescribing, Better Treatment. For one, fewer people are being exposed to the possibility of getting opioids longer than the three days considered optimal in most cases of acute pain. "The longer the initial prescription, the more likely you are to develop tolerance and conversion to addiction down the road," he says.
</p>
<p>
At the same time, as a result of the drop in prescriptions, says Dr. Schlicher, "the number of excess pills or opioids in the community is less, which helps prevents kids from getting access." Data show that teenagers and young adults often misuse drugs for the first time by stealing or borrowing them from friends or family.
</p>
<p>
"These two things together-fewer prescriptions and fewer opioids in the community-are hopefully helping reduce the creation of chronic use and the risk of addiction," says Dr. Schlicher.
</p>
<h3>Implementing in a system or networked setting</h3>
<p>
There's no question that undertaking any kind of organizational change is challenging, and a topic as sensitive as opioid prescribing could seem especially fraught. However, many systems embraced the opportunity to understand not just their prescribing patterns but their entire approach to pain treatment. The result could be unexpectedly exhilarating.
</p>
<p>
"It was exciting to engage a cross- continuum multidisciplinary team and patients in this effort," says Donna Smith, MD, president of Franciscan Medical Group and Virginia Mason Franciscan Health and senior vice president of the PNW Division of CommonSpirit Health, recalling the work to implement Better Prescribing, Better Treatment systemwide. "We engaged team members and changed practices. We surfaced the myths and fears and helped create safety on the team about what was not known or did not feel right. People really cared about the work."
</p>
<p>
Virginia Mason brought together a cross-disciplinary team that included physicians, nurses, pharmacists, social workers, and even front-desk workers. Just as important as this multidisciplinary approach was the individual experience that each person brought to the group, making the work as much personal as professional.
</p>
<p>
"People on the team had family members who had died from overdoses," says Dr. Smith. The team also brought in family members of people who suffered or died from opioid use to hear their perspectives. "Team members would talk about the assumptions they were making about not sharing the risks and family members were saying, 'Are you kidding me? Tell us! I need to know if I should get off pain medications by a certain day or my risks increase,' " Dr. Smith recalls.
</p>
<p>
The work was an opportunity to, in Dr. Smith's words, "connect the dots and connect our care."
</p>
<p>
"We were coming together to establish organizational standards and help everyone realize that the care we provide to a patient in the ED or hospital post- operative period impacts the care we provide for that same patient in primary care, and vice versa," she says. "For example, if someone dealing with an opioid addiction had it under control and then needed surgery, the surgeon needed to be aware of the patient's history to optimize pain control and long-term outcomes for that person."
</p>
<p>
"We worked to get this in the frame of a chronic disease," said Dr. Smith. "You don't opt out of treating diabetes, so you wouldn't opt out of treating this either."
</p>
<p>
At the same time, physicians and PAs needed to understand their own biases. "We had a team of amazing educators-pain doctors, social workers, pain psychologists, an ethicist-so people could start to understand a patient's experience and how medication could be influencing patient communication," says Dr. Smith. Physicians and PAs learned how to listen and talk compassionately to patients while setting limits. "We developed a curriculum to build these skills that helped the team feel that they could make a difference," says Dr. Smith.
</p>
<p>
That experience is duplicated in other systems, as well. Christine Hancock, MD, is the medical director for Sea Mar Bellingham Medical Clinic, one of 32 community health centers under the Sea Mar umbrella located along the I-5 corridor stretching from Vancouver to Bellingham.
</p>
<p>
"We started with the Six Building Blocks program in 2017 with improvements to the process for opioid prescribing that ran the gamut from fixing the patient agreement to changing the language we use with patients," says Dr. Hancock. "We worked with WSMA to get prescribing data from different sites across our system."
</p>
<p>
That wasn't always simple. "There are certain things you can pull out of the health record easily and other things you have to build complex and time- consuming reports to try and figure out," says Dr. Hancock. However, the work has paid off.
</p>
<p>
"In the last year, we've gotten all of the processes in place to look at acute prescribing and present that to the medical directors group," says Dr. Hancock. "WSMA gives us individual-level reports, and physicians can sign up for those voluntarily. In addition, they give us data on our practice as a whole. At a system level, it's good to get a bird's-eye view." The data is divided by practice types, which allows Sea Mar to understand if a prescribing practice is out of line with a whole group. "It's a powerful suite to have at our fingertips," says Dr. Hancock.
</p>
<p>
Physicians have been receptive to seeing the data. "Sometimes someone will write back to me and say, 'Thanks, I totally missed that,' " says Dr. Hancock. "That level of intentional intervention is where people will retain the learning and change their behavior going forward."
</p>
<p>
One of the key elements of the state's opioid prescribing rules is that they provide physicians and PAs with flexibility in making clinical decisions. "It's important that you prescribe appropriately, but it's also important that you treat patients with chronic pain," says Dr. Hancock. "We're trying to walk the fine line where we're accountable to the standard of care and not shutting the door completely." In addition to creating barriers of care to the largely Latino population that Sea Mar serves, suddenly cutting off a patient's access to pain medications increases their risk for suicide and use of street drugs.
</p>
<h3>Safer communities</h3>
<p>
One of the specialties that was contributing to excess opioids in the community, despite the best of intentions, was hospice care. Thomas Schaaf, MD, who was involved with Better Prescribing, Better Treatment at the beginning, was also increasingly responsible for Providence's hospice services in Washington and realized that the way pain medications were being prescribed was excessive.
</p>
<p>
"Many of our patients would have pain crises in the middle of the night or on weekends, so depending on their locations, we sent them an emergency kit, or e-kit, to put in the back of the closet," he says. "If they suddenly became symptomatic at 3 a.m., rather than try to find a pharmacy that was open, they could get the e-kit out."
</p>
<p>
The problem was that the e-kits contained a lot of medication. "We were using liquid medications for ease of administration," says Dr. Schaaf. "Those tend to come in largish quantities. We were putting a lot of morphine, oxycodone, and lorazepam into the community that might not ever get used. The patient dies, the family pulls the e-kit out of the closet, and my gosh, here are these very large doses."
</p>
<p>
To reduce the risk of having the drugs misused, physicians revamped the nature of the e-kits. "We changed to pills and substantially lowered the number of doses," says Dr. Schaaf. "They didn't need a month of stuff, just enough to get them through until they could use a regular pharmacy for a new dosing strategy."
</p>
<p>
The change resulted in a "staggering" decrease in the volume of opioids being prescribed. "It was a remarkable quantity," says Dr. Schaaf. "At the same time, it wasn't just cutting the amount of medications. We also changed the protocols around how we would think about a patient's baseline symptom management regimen. In the end, we believed patients were getting better symptom management and less probability that these leftover meds were ending up in the hands of people other than the patient. It accomplished both the goal of better treatment for patients and a safer community."
</p>
<h3>Growing the success, short-term and long-term</h3>
<p>
The Washington State Department of Health recently awarded the WSMA a $425,000, nine-month grant to expand Better Prescribing, Better Treatment. The money will help create reports focused on prescriptions for chronic opioid use and co-prescribing of opioids; previously, reports have concentrated on prescribing for treatment of acute pain. As with the earlier reports, the new reports will be an opportunity to identify outliers who are high prescribers to engage them in discussion about their prescribing practices.
</p>
<p>
Providing data on opioid prescriptions beyond treatment for acute conditions is an important next step, says Dr. Schlicher. "The prescribing of opioids with sedatives like Ambien can increase the risk of respiratory depression and death," he notes. "We want to provide feedback on that danger and how often that's happening. Getting at that challenge would be a next step."
</p>
<p>
The grant is just one step in the effort to expand the safe-prescribing initiative in the coming months and years. The program is looking to continue to expand its reach.
</p>
<p>
"Over the next five years, we want to reach as many prescribers as possible with the initiative on acute prescribing," says Dr. Schlicher. "We're looking at our own membership that hasn't been able to participate through their own clinics." The idea is to create an enrollment category for member physicians and PAs who are not in enrolled health systems and clinics but who wish to participate in the program, with the option to opt out.
</p>
<p>
The program's sights for growth extend beyond physicians and PAs. "We also want to reach out to other professional societies, like dentists, nurse practitioners, and podiatrists, to expand the program to everyone," says Dr. Schlicher. Dr. Schlicher is also planning an education series to add to the existing library of resources for physicians and PAs.
</p>
<p>
Still, the spine of the program remains the data, which shows physicians and PAs how they compare to others. "Data management is not an easy job," says Dr. Hancock. "You have to work really hard to provide valid, good quality data that are meaningful. I have to give a shout out to the folks at WSMA. I appreciate all their efforts to get that info into an accessible place."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the May/June 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/8/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| so-long-x-waiver | So Long, X-Waiver! | Latest_News | Shared_Content/News/Latest_News/2023/so-long-x-waiver | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/may-june/may-june-reports-cover-cropped-645x425px.jpeg" class="pull-right" alt="cover of May/June 2023 issue of WSMA Reports" /></div>
<h5>May 8, 2023</h5>
<h2>So Long, X-Waiver!&nbsp;</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<br />
<p>
In her 11 years treating those struggling with substance abuse, Lucinda Grande, MD, a family practice and addiction medicine specialist in Lacey, has seen firsthand the benefits of initiating buprenorphine to treat opioid use disorder. People who were once unhoused now have a job and a place to live. Estranged families are reunited. Someone caught in a cravings- usage-overdose-withdrawal cycle now has hope of managing their disorder so they don't end up a statistic. And the stats from the Centers for Disease Control and Prevention are startling: Nearly 75% of overdose deaths nationwide in 2020 involved an opioid. Here in Washington state, provisional data show 1,831 opioid-related deaths in the most recent 12-month period ending in October 2022.
</p>
<p>
In the U.S., some 7 million people are currently living with opioid use disorder. For them, buprenorphine is life-changing, says Dr. Grande. "Buprenorphine reduces mortality rates. It relieves cravings and withdrawal without causing respiratory depression, so overdose is nearly impossible."
</p>
<p>
Despite the safety and efficacy of buprenorphine, until recently Dr. Grande was among only 5% of physicians and medical professionals licensed by the Drug Enforcement Administration to prescribe the drug for opioid use disorder, a result of onerous training requirements to get a DATA-Waiver, or "X-waiver," added to their DEA registration. The X-waiver requirement was eliminated, effective immediately, with the passage of the bipartisan Mainstreaming Addiction Treatment Act of 2023, included in the Consolidated Appropriations Act of 2023 signed into law by President Joe Biden on Dec. 29, 2022.
</p>
<p>
The X-waiver removal represents a watershed moment in the fight against the opioid epidemic, says Dr. Grande. "The most important thing about passage of the MAT Act is the opportunity to galvanize the medical community into engaging in treatment of opioid use disorder."
</p>
<h3>Removing legislative barriers to treatment</h3>
<p>
The WSMA hopes to partner with the Washington State Department of Health, the Washington State Health Care Authority, and other state agencies to get the word out and develop workflow guidance, says Jeb Shepard, WSMA's director of policy. "Ideally, we'd like to connect our members with a start- to-finish overview on how they can incorporate buprenorphine, including pharmacological education and how to bill public and private payers," says Shepard. It's part of WSMA's ongoing efforts to remove barriers to medications for opioid use disorder, or MOUD.
</p>
<p>
Buprenorphine is one of three Food and Drug Administration-approved medicines, including methadone and naltrexone, proven to benefit those with opioid use disorder. Use of these medications decreases the duration people use opioids, reduces hospitalization, prevents deaths, and reduces drug-seeking behavior. Yet in the U.S., only 27% of people who qualify for these life-changing drugs currently receives them.
</p>
<p>
The WSMA supported a provision in Senate Bill 5380, opioid omnibus legislation passed by the Legislature in 2019, that prohibits prior authorization for MOUD. That law, which requires insurance carriers to cover at least one FDA-approved MOUD drug, became effective in January 2021. "We didn't want people who would benefit from these treatments and perhaps are in a fleeting moment where they were willing to move their life in a different direction have to wait to get started because insurance carriers needed to approve it first," says Shepard. "But we could only do so much at the state level when that DEA waiver was in place."
</p>
<p>
In 2019, the WSMA also joined the fight to remove the federal buprenorphine X-waiver, spearheaded by a resolution put forth by Dr. Grande, then serving as a member of the WSMA House of Delegates, which called on the WSMA to support American Medical Association advocacy on the issue. "There were joint letters that we signed on to and we also reached out to our congressional delegation, who were pivotal in getting the MAT Act passed. Sen. Patty Murray and Rep. Cathy McMorris Rodgers were key votes," says Shepard.
</p>
<h3>Removing the stigma</h3>
<p>
Removal of the X-waiver alone won't change the trajectory of the opioid epidemic unless other system-level changes take place, says Richard Waters, MD, a family physician with Neighborcare Health in Seattle and an advocate for low- barrier buprenorphine access. "We have all created this divide where addiction medicine for a long time, and to a certain extent continuing now, was set apart from the rest of health care."
</p>
<p>
In the U.S., removal of the X-waiver was long overdue, says Dr. Waters. France, for example, has allowed doctors to prescribe buprenorphine without special education or licensing since 1995. As a result, within three years deaths from opioid overdoses there fell 79%. Research found X-waiver removal in the U.S. would translate to more than 30,000 fewer opioid overdose deaths in the U.S. each year.
</p>
<p>
Dr. Waters hopes the U.S. will continue being proactive in removing other barriers to MOUD, such as those surrounding methadone therapy. "There is also a continued imperative, given the overdose crisis, to look at what has been effective elsewhere and how we can move toward these evidence-based practices," he says.
</p>
<p>
A safe and effective treatment for chronic pain, buprenorphine can also help prevent opioid use disorder by replacing addictive narcotics, says Dr. Grande. Even before the MAT Act, physicians and physician assistants could legally prescribe it for chronic pain, but confusion caused by the X-waiver kept doctors from using it, she says.
</p>
<p>
Removal of the X-waiver comes amidst a growing fentanyl crisis nationwide. From 2019 to 2021, Washington state saw a 66% rise in overdose deaths, more than half due to fentanyl.
</p>
<p>
Despite this increasingly urgent backdrop, many physicians and PAs may still be hesitant to prescribe buprenorphine, in part because of the impression created by the X-waiver that buprenorphine is a riskier, scarier, and more complicated medicine than it is, says Dr. Waters. "The jarring contradiction was that any [physician] could prescribe as much fentanyl, oxycodone, and hydromorphone as they wanted, without necessarily any training, but could not prescribe buprenorphine, which is a far safer medication than all of those."
</p>
<p>
As more medical schools and residency programs embrace teaching addiction medicine, Dr. Waters remains hopeful for the future. "The X-waiver going away was a symptom of an ongoing cultural shift in modern medicine that is starting to embrace the care of people with substance use disorders as people worthy of care for whom we have a variety of effective tools that can help improve their lives."
</p>
<h3>How you can get started</h3>
<p>
While the MAT Act eliminates the X-waiver, it doesn't remove the need for buprenorphine education. The appropriations bill also included the Medication Access to Training Expansion Act of 2023, supported by the American Society of Addiction Medicine, which calls for new training requirements for all prescribers scheduled to go into effect on June 21, 2023. According to the DEA, these requirements don't impact the specific changes related to the X-waiver elimination. The WSMA and the AMA did not support the MATE Act, concerned that eight hours of mandated training requirements would add additional burden to already overwhelmed physicians, says Shepard.
</p>
<p>
Some education is still needed before prescribing buprenorphine, says Greg Rudolf, MD, immediate past president of the Washington Society of Addiction Medicine. But the society wants to ensure that training doesn't create additional obstacles for physicians. "We're hoping for something modest, in the one- to three-hour range of educational commitment ... understanding a little bit more about how to start somebody, how to dose appropriately, how to keep them engaged and in treatment," he says.
</p>
<p>
One immediate way physicians and PAs can get comfortable prescribing buprenorphine is assuming management of patients already stable on the medication, says Dr. Rudolf. "Some of my patients come from great distances to see me. If primary care physicians in their local area can take over their prescriptions, they don't have to worry about transitioning the patient from an unstable situation to stability ... This can help take the burden off specialists, who, at this point, are having a hard time meeting demand."
</p>
<p>
X-waiver elimination also benefits underserved populations who have historically struggled with access to buprenorphine because there were few or no X-waivered prescribers nearby. In rural communities, even if just one additional physician now provides care with buprenorphine that can make a real difference, says Shawn Andrews, MD, senior medical director for ambulatory care services at Summit Pacific Medical Center in Elma. Rural patients often don't have the money, time, or means to travel for MOUD elsewhere, she says.
</p>
<p>
"Geographic barriers are very significant in rural areas," says Dr. Andrews. "The MAT Act will make it much easier to staff our low-barrier MAT clinic. It also decreases the administrative burden of tracking how many waivers each [physician] has available."
</p>
<p>
Addiction medicine professionals <em>WSMA Reports</em> interviewed emphasized the need for mentorship in prescribing buprenorphine. "Physicians should not feel helpless. If they see someone who's a good candidate for it, they should not delay when there are resources to help physicians initiate buprenorphine. They shouldn't let that patient get away without treatment," says Dr. Grande.
</p>
<p>
Dr. Grande especially encourages emergency department professionals- often on the front lines of the opioid epidemic-to consider initiating buprenorphine. She cites a 2015 study showing that those who were started on buprenorphine in the ED were twice as likely to be engaged in formal addiction treatment at 30 days compared to people given a referral to treatment alone, even with a brief psychosocial intervention.
</p>
<p>
"They don't come back to the ED because their life is better. Their habits are healthier," she says. But ED physicians can't do it alone, says Dr. Grande. "Hospitals and health care systems need to be motivated and incentivized to make changes to how they treat those with opioid use disorder."
</p>
<p>
At minimum, physicians and PAs can play a vital role in educating patients about MOUD, says Dr. Waters. "Learning how to talk about the benefits of methadone, buprenorphine, and extended-release naltrexone is the kind of thing all of us should be able to do."
</p>
<p>
Whenever she can, Dr. Andrews appears on local radio stations to promote MOUD. It's a required part of the curriculum at Summit Pacific's family medicine residency, where Dr. Andrews serves as program director. "Physicians and other [prescribers] need to see what is at stake. And I think they are seeing it with the explosion of fentanyl deaths. They need to know that they are likely to save lives," she says.
</p>
<p>
Dr. Rudolf encourages all doctors to reflect on what prescribing buprenorphine means for their community. "To literally change someone's life with the right care intervention at the right time, it's a thrill," he says. "Any doctor who shies away from it is really missing a great opportunity to provide the kind of impactful care that I think most of us went into medicine to try to do."
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the May/June 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 5/8/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| weekly-rounds-may-5-2023-progress-on-improving-prior-authorizations | Weekly Rounds: May 5, 2023 - Progress on Improving Prior Authorizations | Latest_News | Shared_Content/News/Weekly_Rounds/2023/weekly-rounds-may-5-2023-progress-on-improving-prior-authorizations | <div class="col-md-12">
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<h5>May 5, 2023</h5>
<h2>Progress on Improving Prior Authorizations</h2>
<p>Jennifer Hanscom, CEO</p>
<p>When the WSMA surveys our members on the most pressing advocacy issues we face, reforming prior authorization almost invariably is at the top of the list. It's easy to see why-prior authorization can delay care for patients, increase administrative burden and costs for physicians, and divert scarce health care workforce from care delivery.</p>
<p>The reforms contained in <a href="https://app.leg.wa.gov/billsummary?BillNumber=1357&amp;Year=2023&amp;Initiative=false">House Bill 1357</a>, which passed the House and Senate unanimously during the 2023 state legislative session, will help establish Washington state as a leader in prior authorization reform. The bill expedites turnaround times for determinations and mandates the implementation of electronic prior authorization processes that integrate into electronic health records, which has been proven to reduce administrative burden. And importantly, the bill applies as broadly as possible on the state level - to all state-regulated health plans and not only to health care services, but also to prescription drugs.</p>
<p>I'd like to take a moment to thank the following WSMA members who joined our prior authorization task force last summer to develop legislation for the 2023 session:</p>
<ul>
<li>Katina Rue, DO</li>
<li>Carrie Horwitch, MD</li>
<li>Garrett Jeffery, DO</li>
<li>Nathan Schlicher, MD, JD</li>
<li>Rodney Anderson, MD</li>
</ul>
<p>Task force members drew from their own firsthand experiences, as well as from insights shared at the WSMA Annual Meetings and policy changes on prior authorization proposed by Teresa Girolami, MD; Hal Quinn, MD; Jeffrey Frankel, MD; and the King County Medical Society via the resolution process. Through this highly member-driven process, HB 1357 was drafted, and Rep. Tarra Simmons (D-Bremerton) signed on as the prime sponsor of the bill.</p>
<p>As history often shows, the legislative process demands patience and tempered expectations. This year was no exception with the Centers for Medicare and Medicaid Services releasing a <a href="https://www.cms.gov/regulations-and-guidance/guidance/interoperability/index">draft prior authorization rule</a> on the eve of the state legislative session.</p>
<p>Undeterred by the federal announcement, WSMA's government affairs team worked with Rep. Simmons to amend HB 1357 to build on the CMS rulemaking, expediting the implementation of integrated prior authorization requirements for health care services (to take effect in 2025, rather than 2026 as proposed by CMS) and extending the requirements to prescription drugs beginning in 2027.</p>
<p>Passing both the House and the Senate unanimously and now awaiting Gov. Jay Inslee's signature, the new law will go into effect Jan. 1, 2024 for all state-regulated health plans across health care services and prescription drugs. The bill applies the following timelines for prior authorization determinations:</p>
<ul>
<li>For prior authorizations submitted through electronic processes such as web portals:
<ul>
<li>One calendar day for expedited requests</li>
<li>Three calendar days for standard requests (excluding holidays)</li>
</ul>
</li>
<li>For prior authorizations submitted through non-electronic processes such as faxes:
<ul>
<li>Two calendar days for expedited requests</li>
<li>Five calendar days for standard requests</li>
</ul>
</li>
</ul>
<p>Throughout the recent legislative session, HB 1357 faced strong opposition from insurance carriers who argued that the bill would prove costly and the timelines proposed were overly aggressive. Legislative leaders such as Rep. Simmons, Rep. Marcus Riccelli (D-Spokane), and Rep. Joe Schmick (R-Colfax) convened negotiations and worked toward compromise. Support from patient groups and the hospital community was integral in maintaining momentum for the bill throughout the process. And to their credit, insurance carriers negotiated in good faith on a difficult issue and ultimately moved to neutral on the final bill.</p>
<p>The WSMA will be actively engaged in the implementation of HB 1357, as well as in the associated rulemaking from CMS. There's more work to be done on the issue of prior authorization-this year's successes represent important steps forward, rather than the finish line. But we're proud of this work and deeply appreciative of the physician leaders who helped develop and advocate for House Bill 1357, and for the support of legislators such as Rep. Simmons who helped shepherd the bill through the legislative process.</p>
</div> | 5/5/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| action-alert-urge-congressional-support-of-medicare-annual-inflation-update | Action Alert: Urge Congressional Support of Medicare Annual Inflation Update | Latest_News | Shared_Content/News/Membership_Memo/2023/april-28/action-alert-urge-congressional-support-of-medicare-annual-inflation-update | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/april/medicare-barcode-645px.jpeg" class="pull-right" alt="Medicare bardode" /></div>
<h5>April 28, 2023</h5>
<h2>Action Alert: Urge Congressional Support of Medicare Annual Inflation Update</h2>
<p>The WSMA joined the American Medical Association and nearly 120 national physician specialty societies and state medical associations in <a href="https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2Fltrf.zip%2FHR-2474-AMA-Federation-Letter-of-Support-4-19-23.pdf" target="_blank" rel="noreferrer">a letter</a> commending Reps. Raul Ruiz, MD (D-CA), Larry Bucshon, MD (R-IN), Ami Bera, MD (D-CA), and Mariannette Miller-Meeks, MD (R-IA), for introducing H.R. 2474, bipartisan legislation that would tie annual Medicare physician fee schedule updates to the Medicare Economic Index. If passed by Congress, the legislation would help provide financial stability to physician practices and preserve access to care for Medicare beneficiaries.</p>
<p>Unlike virtually all other health professionals participating in the Medicare program, physician services do not receive an annual inflationary update. Providing an annual inflation update <a href="[@]Shared_Content/News/Membership_Memo/2023/march-24/medpac-recommends-tying-physician-payment-update-to-inflation">equal to the MEI for Medicare physician payments is essential</a> to enabling physician practices to better absorb payment distributions triggered by budget neutrality rules, performance adjustments, and periods of high inflation. It will also help physicians invest in their practices and implement new strategies to provide high-value care.</p>
<h3>Contact your members of Congress</h3>
<p>Organized medicine is united in support of a long-term payment solution that centers on annual inflationary updates. To help this effort, take a moment to <a href="https://physiciansgrassrootsnetwork.org/be-heard?vvsrc=%2fCampaigns%2f103669%2fRespond">contact your legislators</a> and urge them to help fix the flawed Medicare physician payment system by supporting H.R. 2474.</p>
<p>The AMA provides the following charts, which may be used in conversations with members of Congress to let them know the Medicare physician payment system needs reform to become a more sustainable, value-based system that better meets the needs of patients and physicians:</p>
<ul>
<li><a href="https://www.ama-assn.org/system/files/medicare-provider-updates-chart-2023.pdf" target="_blank" rel="noreferrer">Medicare payment updates for 2023</a> </li>
<li><a href="https://www.ama-assn.org/system/files/medicare-updates-inflation-chart-cumulative.pdf" target="_blank" rel="noreferrer">Medicare updates compared to inflation (with comparison)</a> </li>
<li><a href="https://www.ama-assn.org/system/files/medicare-updates-inflation-chart.pdf" target="_blank" rel="noreferrer">Medicare updates compared to inflation (without comparison)</a> </li>
<li><a href="https://www.ama-assn.org/system/files/key-measures-medicare-economic-index-chart.pdf" target="_blank" rel="noreferrer">Key measures of practice expense in the Medicare Economic Index</a> </li>
<li><a href="https://www.ama-assn.org/system/files/medicare-spending-enrollee.pdf" target="_blank" rel="noreferrer">Medicare spending per enrollee</a> </li>
<li><a href="https://www.ama-assn.org/system/files/real-inflation-adjusted-spending-enrollee.pdf" target="_blank" rel="noreferrer">Real (inflation-adjusted) Medicare physician spending per enrollee</a> </li>
</ul>
</div> | 4/28/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| ian-morrison-phd-turning-the-corner-whats-next-for-health-care | Ian Morrison, PhD: Turning the Corner: What's Next for Health Care? | Latest_News | Shared_Content/News/Membership_Memo/2023/april-28/ian-morrison-phd-turning-the-corner-whats-next-for-health-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/april/2023-ldc-graphic-morrison-645x425px.png" class="pull-right" alt="2023 LDC Conference Keynote Speaker Ian Morrison, PhD" /></div>
<h5>April 28, 2023</h5>
<h2>Ian Morrison, PhD: Turning the Corner: What's Next for Health Care?</h2>
<p>The annual WSMA Leadership Development Conference returns once again to the shores of Lake Chelan on May 19-20 at Campbell's Resort. This year's theme is leading transformational change, with keynote presenter and health care futurist Ian Morrison, PhD, recently featured in an <a href="https://wsma.org/Shared_Content/News/Latest_News/2023/ian-morrisons-crystal-ball.aspx">in-depth interview in WSMA Reports</a>, on hand to kick things off with his presentation on "Turning the Corner: What's Next for Health Care?"</p>
<p>Morrison is an internationally known author, consultant, and futurist specializing in long-term forecasting and planning with particular emphasis on health care and the changing business environment. During his keynote address, you'll hear from Morrison on his predictions for health care based on observations and data from 40 years of working with physicians, health care organizations, and related nonprofits. With top-notch research and consulting skills, combined with an <a href="[@]Shared_Content/News/Latest_News/2023/ian-morrisons-crystal-ball.aspx">incisive Scottish wit</a>, Morrison's insights are designed to help organizations plan their longer-term future.</p>
<p>For more a full conference agenda, faculty, and registration information, visit the <a href="[@]WSMA/Events/Leadership_Development_Conference/WSMA/Events/LDC/leadership_development_conference.aspx?hkey=c7532c38-057a-4568-8a3c-078182469222">Leadership Development Conference webpage</a>. This activity has been approved for <em>AMA PRA Category 1 Credit</em>â„¢.</p>
<h3>Accommodations </h3>
<p>The WSMA Leadership Development Conference will be held at Campbell's Resort on Lake Chelan, 104 W. Woodin Ave., Chelan, WA 98816. Please call the resort directly to make your room reservations: 800.553.8225. If no rooms are available for your preferred dates at Campbell's Resort, they can assist with reservations at their sister property, the Midtowner.</p>
</div> | 4/28/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| a-call-to-climate-action | A Call to Climate Action | Latest_News | Shared_Content/News/Latest_News/2023/a-call-to-climate-action | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/may-june/heartbeat-website-image-mzfy-badger-do-645x425px.png" class="pull-right" alt="WSMA Reports Heartbeat logo with Mary Badger, DO's name on it" /></div>
<h5>April 25, 2023</h5>
<h2>A Call to Climate Action</h2>
<p>
By Mary Badger, DO
</p>
<p>
My interest in the outdoors and sustainability started as far back as my time in the Girl Scouts, with its emphasis on community betterment, and those many days and weekends spent with friends or on my own hiking and backpacking, carefully and thoughtfully following the "leave no trace" ethic of good wilderness stewardship. These interests only grew as I became an adult, then a practicing (and now retired) physician, and rapidly expanded to include health as I saw firsthand the increased vulnerability of my older patients and my patients with chronic diseases to climate change.
</p>
<p>
The 2022 Intergovernmental Panel on Climate Change impacts report states that climate and health care are inseparable, that addressing climate change is the greatest public health opportunity of the 21st century, and that failure to adequately address it could undo most of the progress in global health over the past century. Climate change is putting increased pressure on vulnerable systems, populations, and regions, compounding existing medical conditions and health disparities. A host of medical societies, including the WSMA, the American Medical Association, the American College of Physicians, the American Osteopathic Association, and the American College of Osteopathic Internists, have position papers on climate and health (ACOI, AMA, and ACP are members of the Medical Consortium on Climate and Health).
</p>
<p>
But what can we do as individual physicians?
</p>
<p>
Educate ourselves: Sixty percent of physicians cite lack of knowledge about climate as a reason they don't address climate-related health concerns with patients. There are free webinars available from the <a href="https://medsocietiesforclimatehealth.org/educate">Medical Consortium on Climate and Health</a>, <a href="https://www.hhs.gov/climate-change-health-equity-environmental-justice/climate-change-health-equity/actions/health-care-sector-pledge/webinar-series/index.html">Office of Climate Health Equity</a>, and <a href="https://www.publichealth.columbia.edu/research/centers/global-consortium-climate-health-education">Global Consortium on Health</a>. "Global Climate Change and Human Health, from Science to Practice," second edition by Lemery and Sorrenson, is a great resource. Several institutions now offer fellowships in climate and health.
</p>
<p>
Educate our trainees: Medical schools are implementing either required or voluntary lectures on climate and health, and residencies are including patient-specific climate discussions during rotations. According to colleagues in several climate groups, rumors are that the Accreditation Council for Graduate Medical Education may be considering adding climate to competencies in the future.
</p>
<p>
Educate our patients: Even though patients trust their physicians more than anyone else, when it comes to discussions on climate change, 40% of physicians report lack of time as a reason they don't do this. You can briefly review their individual risks as part of disease prevention strategies. To save time, give them printed information, available from the <a href="https://mygreendoctor.org/waiting-room-brochures/">My Green Doctor website</a>, which can be set up with your practice information and emailed or printed for patients in English or Spanish; from the <a href="https://climatehealthconnect.org/resources/posters/">Public Health Institute</a>; and from websites such as <a href="https://www.ready.gov/kit">ready.gov/kit</a>, for emergency preparedness, and <a href="https://www.airnow.gov/">airnow.gov</a>, for air quality.
</p>
<p>
Serve as an example: Use the Native American "seventh generation" principle, which says that in every decision, be it personal, governmental, or corporate, we must consider how it will affect our descendants seven generations into the future.
</p>
<p>
Reject, reuse, and recycle: The health care sector is responsible for about 10% of U.S. greenhouse gas emissions. We need to address this in our places of work. The U.S. government has provisions to help with this.
</p>
<p>
Finally, be sure that vulnerable populations are specifically included-visit the <a href="https://www.epa.gov/cira/social-vulnerability-report">U.S. Environmental Protection Agency website</a> for a social vulnerability report.
</p>
<p>
It's said that weather is what is happening where you are at a given moment and that climate is how you got there over time. I would add that climate change is adversely affecting that journey. Addressing climate change will help our patients' and our own health and the health of our planet. We must all do our part to "leave no trace." Please start now!
</p>
<p>
<em><strong>Mary Schaefer Badger, DO, FACOI, FAWM</strong>, is an emeritus member in Spokane and chair of the American College of Osteopathic Internists Committee on Climate and Health.</em>
</p>
<p>
<em>This article was featured in the May/June 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 4/25/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| weekly-rounds-april-21-2023-make-a-difference-by-leading-and-serving-the-profession | Weekly Rounds: April 21, 2023 - Make a Difference by Leading and Serving the Profession | Latest_News | Shared_Content/News/Weekly_Rounds/2023/weekly-rounds-april-21-2023-make-a-difference-by-leading-and-serving-the-profession | <div class="col-md-12">
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<h5>April 21, 2023</h5>
<h2>Make a Difference by Leading and Serving the Profession</h2>
<p>Jennifer Hanscom, CEO</p>
<p>
<em>Nominate yourself or a colleague by next Friday, April 28
</em></p>
<p>
Leadership is one of WSMA's strategic priorities-perhaps an obvious choice, as we strive to influence and shape the future of the medical profession. We've heard, loud and clear, from our members that leadership development is one aspect of our work that they highly value. That's another reason why we work hard to offer top-ranked educational opportunities to the medical community through our leadership courses and <a href="http://wsma.org/ldc?_zs=B3aFd1&amp;_zl=dM4w8">Leadership Development Conference</a>.
</p>
<p>
We're so committed to strong physician leadership that it's called out specifically in our motto: "Physician Driven, Patient Focused." With the ever-shifting landscape of health care, the unpredictable direction of regulation and policy, and the need to preserve the sanctity of the physician-patient relationship, we know that physicians must be directly involved in leadership to navigate a healthy way forward for patients and the profession.
</p>
<p>
Another way to grow your leadership skills is to serve in a leadership position with the WSMA. We depend on your engagement so that we are equipped to represent your voice, and those of patients, as we seek to shape the future of health care in Washington state. Your voice, your leadership, and your service with the WSMA do make a difference.
</p>
<p>
I am personally inviting you to consider stepping into WSMA leadership by nominating yourself or a colleague for consideration for a position on the WSMA board of trustees, executive committee, or as a delegate to the American Medical Association.
</p>
<p>
More information about the desired qualifications, a roster of current board members, a nomination form, conflict of interest disclosure statement, and candidate information sheet <a href="[@]wsma/about_us/who_we_are/board-of-trustees/wsma/about/who_we_are/board-of-trustees.aspx?hkey=57dca355-fca4-4f4e-9c83-6e35aa4baabe&amp;_zs=B3aFd1&amp;_zl=fM4w8">are available here</a>.
</p>
<p>
Here are a few more things to know about the nomination process:
</p>
<ul>
<li>The WSMA Nominating Committee will meet in late May to prepare a slate of nominees.</li>
<li>The slate will be presented to the House of Delegates during the 2023 WSMA Annual Meeting, scheduled for Sept. 23-24 at The Westin Bellevue (all are welcome to attend the meeting-save the dates).</li>
<li>The deadline for nominations is next Friday, April 28, although additional nominations may be made from the floor of the House of Delegates.</li>
<li>In considering yourself or colleagues for the board of trustees, consider whether you or they are:
<ul>
<li>Well-informed.</li>
<li>Forward-thinking.</li>
<li>Committed to the future of the profession.</li>
<li>Committed to service and the profession above oneself.</li>
<li>Experienced, enthusiastic, credible, and open-minded.</li>
<li>Able to put the WSMA above personal desires or agenda.</li>
<li>Capable of serving as a future president of the WSMA.</li>
</ul>
</li>
</ul>
<p>
It takes bold leadership and a strong sense of service to tackle the challenges facing the profession, your patients, and our communities. If you believe in our mission to provide strong physician leadership and advocacy to shape the future of medicine and advance quality of care for all Washingtonians, I hope you will consider this opportunity.
</p>
</div> | 4/21/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| wsma-praises-lawmakers-for-protecting-health-and-safety-of-patients-access-to-care | WSMA Praises Lawmakers for Protecting Health and Safety of Patients, Access to Care | Latest_News | Shared_Content/News/Press_Release/2023/wsma-praises-lawmakers-for-protecting-health-and-safety-of-patients-access-to-care | <div class="col-md-12">
<div class="col-sm-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div>
<h5>April 20, 2023</h5>
<h2>Washington State Medical Association Praises Lawmakers for Protecting Health and Safety of Patients, Access to Care</h2>
<p>
SEATTLE, WA - The Washington State Medical Association, which represents more than 12,000 physicians and physician assistants, today commended the Washington State Legislature for enacting legislation that prioritizes the health and safety of all Washingtonians and the sanctity of the patient-physician relationship, including provisions ensuring abortion access, addressing gun violence, and reforming those prior authorizations that unnecessarily delay patient care.
</p>
<p>
The following bills were passed by the Legislature during the 2023 state legislative session and are expected to be signed into law by Gov. Jay Inslee.
</p>
<p>
<strong>Abortion access </strong>
</p>
<ul>
<li>House Bill 1340 clarifies that providing reproductive health and gender-affirming care services consistent with Washington state standards of care, even in a state where such services are prohibited, does not constitute unprofessional conduct under Washington's Uniform Disciplinary Act.</li>
<li>House Bill 1469 establishes criminal and civil liability protections for patients and health care professionals receiving or delivering abortion services and gender-affirming care.</li>
<li>Senate Bill 5242 prohibits cost sharing (e.g., copays, deductibles) for abortion services.</li>
</ul>
<p>
<strong>Gun violence </strong>
</p>
<ul>
<li>House Bill 1240 prohibits the manufacture and sale of semiautomatic "assault weapons," including firearms such as the AR-15 and AK-47.</li>
<li>House Bill 1143 requires individuals to have recently completed a firearm safety training program and undergo a background check and 10-day waiting period to be eligible to purchase firearms.</li>
<li>Senate Bill 5078 establishes a right of action against the firearm industry in circumstances where violence results from their conduct such as advertising targeted at minors and promoting the illegal conversion of firearms.</li>
</ul>
<p>
<strong>Prior authorization</strong>
</p>
<ul>
<li>House Bill 1357 helps ensure timely access to care by streamlining insurance carrier prior authorization practices. The legislation will help shorten turnaround times for decisions and mandate insurance carriers implement electronic prior authorization processes that integrate into physicians' electronic health record systems.</li>
</ul>
<p>
"Washingtonians' ability to access care and addressing social determinants of health have been central to many of the biggest conversations in Olympia this year," said WSMA President Katina Rue, DO. "We are pleased to see lawmakers keep patients' health and safety top of mind by passing strong policies to protect abortion services and address gun violence, while supporting their ability to access timely care with sensible prior authorization reforms."
</p>
<p>
As the state's largest professional association representing physicians and PAs, the WSMA works to advance health care policy that prioritizes the health and wellness of Washingtonians and their communities, supports patients' ability to access their physician and health care services, and helps create and maintain a robust practice environment for physicians so they can thrive professionally.
</p>
<p>
"Everything we do at the WSMA is done with our patients in mind," said Dr. Rue. "With the continued rise in senseless gun violence, unconscionable efforts to limit reproductive health care services, and seemingly endless barriers to practicing medicine, sometimes it feels like the cards are stacked against both the individual patient and their physician. Each patient-centered policy that passes is a beacon of hope - and a step toward making our state the best place to practice medicine and to receive care."
</p>
<p>
As the 2023 session moves towards adjournment on Sunday, April 23, and legislators negotiate the final state operating budget for the 2023-25 fiscal biennium, one item that is being considered is Medicaid reimbursement rate increases for health care services delivered by physicians, PAs, and advanced registered nurse practitioners. The budget proposed by the House of Representatives would appropriate $67.8 million to raise rates while the Senate did not include this funding. The WSMA is advocating that the rate increases be included in the final operating budget.
</p>
<p>
Dr. Rue adds, "We are hopeful there will be at least modest increases in Medicaid physician payments in this budget cycle, in addition to the increases slated for hospital payments. In all likelihood, Medicaid payments for physician services will still fall short of the cost of delivering care, requiring continued work this year and in the 2024 legislative session to fully fund the state's Medicaid system and ensure access to care for all Medicaid enrollees."
</p>
<p>
For more information, contact:
</p>
<p>
Graham Short<br />
WSMA Director of Communications<br />
206.329.6851 (cell/text)<br />
<a href="mailto:gfs@wsma.org">gfs@wsma.org</a>
</p>
<p>
<strong>About the Washington State Medical Association </strong><br />
The WSMA represents more than 12,000 physicians, physician assistants, resident physicians, and medical students across all specialties and practice types in Washington state. The WSMA has advocated on behalf of the house of medicine for more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care.
</p>
</div> | 4/20/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| the-washington-medical-commission-is-seeking-new-physician-leadership | The Washington Medical Commission is Seeking New Physician Leadership | Latest_News | Shared_Content/News/Membership_Memo/2023/april-14/the-washington-medical-commission-is-seeking-new-physician-leadership | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/april/wa-medical-commission-645x425px.jpeg" class="pull-right" alt="Washington Medical Commission logo" /></div>
<h5>April 14, 2023</h5>
<!-- **************************NEW ARTICLE****************************** -->
<h2>
The Washington Medical Commission is Seeking New Physician Leadership
</h2>
<p>
The WMC is seeking physicians from the following specialties to serve as pro tem members: urology, radiology, neurosurgery, general surgeon, and psychiatry. If any members are interested or may be interested, please email <a href="mailto:amelia.boyd@wmc.wa.gov">amelia.boyd@wmc.wa.gov</a>.
</p>
<p>
The WMC is also recruiting for the following vacancies. These positions will be available beginning July 1, 2023:
</p>
<ul>
<li>One physician representing Congressional District 2 - Dr. Lyle's position - eligible for reappointment.</li>
<li>One physician representing Congressional District 4 - Dr. Murphy's position - eligible for reappointment.</li>
<li>One physician representing Congressional District 10 - Dr. Wohns' position - eligible for reappointment.</li>
<li>One Physician-at-Large - Dr. Currie's position - eligible for reappointment.</li>
<li>Two Public Members - Michael Bailey - eligible for reappointment; Scott Rodgers - eligible for reappointment.</li>
</ul>
<p>
Interested members may email <a href="mailto:amelia.boyd@wmc.wa.gov">amelia.boyd@wmc.wa.gov</a> for information about service. Note that all the above commissioners have been notified that their first term is ending June 30, 2023, they are eligible for reappointment, and they must submit a new application to be considered for reappointment. The application deadline was March 24, 2023.
</p>
</div> | 4/14/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| we-need-your-feedback-on-pharmacy-quality-assurance-commission-rulemaking | We Need Your Feedback on Pharmacy Quality Assurance Commission Rulemaking | Latest_News | Shared_Content/News/Membership_Memo/2023/april-14/we-need-your-feedback-on-pharmacy-quality-assurance-commission-rulemaking | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/april/rx-bottle-doctor-laptop-645x425.jpeg" class="pull-right" alt="physician holding prescription bottle" /></div>
<h5>April 14, 2023</h5>
<h2>
We Need Your Feedback on Pharmacy Quality Assurance Commission Rulemaking
</h2>
<p>
The Pharmacy Quality Assurance Commission has begun rulemaking on accessible medication labeling. Acknowledging that the regulatory agency's intention is to address health inequities and improve patient safety, the WSMA is interested in your feedback to understand whether this rulemaking could also result in unintended hardship for physician practices both large and small.
</p>
<p>
The <a href="javascript://[Uploaded files/News and Publications/newsletters/2023/3-2-accessible-labeling-rule-language-march-2023-rules-workshop.pdf]">draft rules</a>&nbsp;require "…any facility that dispenses and delivers to patients," including physician practices, to provide at least the following visual accessible labeling accommodations at no cost to the patient:
</p>
<ul>
<li>A minimum 12-point font size; </li>
<li>Braille; or </li>
<li>A QR reference code that can direct the patient to a separate print or digital resource that provides all required information for the dispensed prescription </li>
<li>A prescription reader or other technology </li>
</ul>
<p>
The draft rules would also require any facility that dispenses medication to patients to provide free translation and interpretation services for prescription information in a minimum number of languages, in addition to English, that address the needs of the community around the facility.
</p>
<p>
The exemptions to this draft rule are limited to:
</p>
<ul>
<li>Pre-packaged emergency medications </li>
<li>Opioid reversal medication </li>
<li>Bubble packs </li>
<li>Medication packs dispensed in strip machines </li>
</ul>
<p>
While the PQAC doesn't regulate physicians directly, it does have <a href="https://www.atg.wa.gov/ago-opinions/regulation-dispensing-lengend-drug-and-controlled-substances">regulatory authority over dispensing</a>. The PQAC will meet again in early May to discuss this rule and the WSMA will be providing comments on how best to improve accessibility while minimizing impact to physician practices. To help improve our feedback, please share any thoughts you may have on the rulemaking with WSMA Associate Policy Director Billie Dickinson at <a href="mailto:billie@wsma.org">billie@wsma.org</a>.
</p>
</div> | 4/14/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| wsma-joins-acog-to-facilitate-mifepristone-access-oppose-legal-restrictions | WSMA Joins ACOG to Facilitate Mifepristone Access, Oppose Legal Restrictions | Latest_News | Shared_Content/News/Membership_Memo/2023/april-14/wsma-joins-acog-to-facilitate-mifepristone-access-oppose-legal-restrictions | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/april/bill-oxford-oxghu60nwxu-unsplash-645x425px.jpeg" class="pull-right" alt="gavel" /></div>
<h5>April 14, 2023</h5>
<h2>
WSMA Joins ACOG to Facilitate Mifepristone Access, Oppose Legal Restrictions
</h2>
<p>
The WSMA has issued a <a href="https://wsma.org/Shared_Content/News/Press_Release/2023/wsma-and-wc-acog-joint-statement-on-federal-rulings-concerning-mifeprestone">joint statement</a> with the Washington Chapter of the American College of Obstetricians and Gynecologists responding to two federal rulings issued last week concerning mifepristone. The statement, together with recent legal action by the WSMA, ACOG, and others in organized medicine, underscores the overwhelming support for reproductive freedom and access to reproductive and abortion services within the house of medicine and starkly highlights the increasing politicization of medicine in the country.
</p>
<p>
Last Friday, in an expected ruling in Alliance for Hippocratic Medicine v. FDA, a federal judge in Texas
</p>
<p>
suspended the U.S. Food and Drug Administration's approval of mifepristone, a <a href="[@]Shared_Content/News/Press_Release/2023/wsma-and-wc-acog-joint-statement-on-federal-rulings-concerning-mifeprestone">gross interference in the practice of medicine and of the patient-physician relationship</a>. Mifepristone is one of two drugs used for medication abortion, a protocol that has been approved by the U.S. Food and Drug Administration for two decades. The WSMA supports the American College of Obstetricians and Gynecologists <a href="https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/10/medication-abortion-up-to-70-days-of-gestation">clinical guidance on medication abortion</a>.
</p>
<p>
Also on Friday in a separate lawsuit, Washington v. FDA, a federal judge in Spokane issued a ruling asserting that the FDA's approval of mifepristone is legal. The ruling further prevents the FDA from taking action to remove or reduce the availability of mifepristone and orders the agency to eliminate unnecessary restrictions applied on mifepristone. The Washington ruling impacts the 18 plaintiff states. Both the Washington chapter of ACOG and the WSMA joined an amicus brief in support of the plaintiffs. (Update: on Thursday, April 13, the court denied the motion for leave to file an amicus brief in support of Washington v. FDA without explanation, which can happen from time to time, especially on expedited matters.)
</p>
<p>
The situation is fast-moving and the WSMA will continue to work with WC-ACOG and others in organized medicine to ensure there's understanding among physicians and their patients in Washington state of their care options.
</p>
</div> | 4/14/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| wsma-joins-voices-in-opposition-to-cigna-modifier-25-policy | WSMA Joins Voices in Opposition to Cigna Modifier 25 Policy | Latest_News | Shared_Content/News/Membership_Memo/2023/april-14/wsma-joins-voices-in-opposition-to-cigna-modifier-25-policy | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/april/billing-invoice-645x425.jpeg" class="pull-right" alt="stethoscope and calculator" /></div>
<h5>April 14, 2023</h5>
<!-- **************************NEW ARTICLE****************************** -->
<h2>
WSMA Joins Voices in Opposition to Cigna Modifier 25 Policy
</h2>
<p>
Cigna is rereleasing its policy to require the submission of medical records with all evaluation and management (E/M) claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed. The updated policy, due to go into effect on May 25, will add significant, unnecessary administrative burden and compliance costs to physician practices, disincentivize physicians from providing unscheduled services, and create duplicate requests. The WSMA has signed onto an <a href="javascript://[Uploaded files/News and Publications/newsletters/2023/ama-cigna-modifier-25-sign-on-040323.pdf]">AMA letter</a>&nbsp;urging Cigna to rescind the policy and we have submitted our own letter to <a href="javascript://[Uploaded files/News and Publications/newsletters/2023/draft-cigna-letter.pdf]">Cigna</a>&nbsp;outlining the negative impact the policy will have on Washington state physicians if it is enacted as proposed. If you have any questions or concerns about the policy, contact Cigna customer service at 800.882.4462 or WSMA Policy Analyst Hillary Norris at <a href="mailto:hillary@wsma.org">hillary@wsma.org</a>.
</p>
</div> | 4/14/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| wsma-priority-bills-advance-as-end-of-session-nears | WSMA Priority Bills Advance as End of Session Nears | Latest_News | Shared_Content/News/Membership_Memo/2023/april-14/wsma-priority-bills-advance-as-end-of-session-nears | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/april/2023-legislative-session-updates-645x425px.png" class="pull-right" alt="2023 Legislative Update logo" /></div>
<h5>April 14, 2023</h5>
<!-- **************************NEW ARTICLE****************************** -->
<h2>
WSMA Priority Bills Advance as End of Session Nears
</h2>
<p>
With just nine days remaining in the 2023 legislative session, lawmakers took action over the last week to advance legislation and further their budget negotiations. As is often the case, the physician community has been central to many of the biggest conversations in Olympia this year, including ensuring abortion access, addressing gun violence, and reforming prior authorization, and WSMA priority policies in these areas continue to move. Budget talks will continue for the remainder of session, and we encourage WSMA members to <a href="https://votervoice.net/WSMA/Campaigns/99646/Respond">contact their legislators to urge support for professional services Medicaid rate increases</a>, WSMA's top budget priority.
</p>
<p>
The following is a brief overview of the status of WSMA priority legislation. For a comprehensive overview of legislative outcomes, all WSMA members are invited to attend a <a href="https://us06web.zoom.us/meeting/register/tZApceCvpzkiEtXgZ909nm1SinaVvKf7h4LF#/registration">post-session Advocacy Council webinar on Wednesday, April 26 at noon</a>, hosted by our government affairs team in Olympia.
</p>
<h3>
Abortion access
</h3>
<p>
<a href="https://app.leg.wa.gov/billsummary?BillNumber=1340&amp;Initiative=false&amp;Year=2023">House Bill 1340</a>, concerning medical license protections, was approved by the Senate on April 6 by a vote of 28-19. HB 1340 would clarify that reproductive health and gender affirming care services delivered consistent with Washington state standards of care, even in a state where such services are prohibited, do not constitute unprofessional conduct under the UDA.
</p>
<p>
<a href="https://urldefense.com/v3/__https:/app.leg.wa.gov/billsummary?BillNumber=1469&amp;Initiative=false&amp;Year=2023__;!!K-Hz7m0Vt54!nPeLTkE81nZg7kIhcc5Vk_D5Cvag8w62hQV2-KC4A2qhOZRYA8_WKfoCkOPWhyG-qj6fBypRVA$">House Bill 1469</a>, concerning the Shield Act, was approved by the Senate on April 10 by a vote of 29-20. HB 1469 would establish liability protections for patients and health care professionals based on the receipt or delivery of abortion services and gender affirming care.
</p>
<p>
<a href="https://urldefense.com/v3/__https:/app.leg.wa.gov/billsummary?BillNumber=5242&amp;Initiative=false&amp;Year=2023__;!!K-Hz7m0Vt54!nPeLTkE81nZg7kIhcc5Vk_D5Cvag8w62hQV2-KC4A2qhOZRYA8_WKfoCkOPWhyG-qj7Z37HCUA$">Senate Bill 5242</a>, concerning abortion cost sharing, was approved by the House on April 7 by a vote of 57-39. SB 5242 would prohibit cost sharing (e.g., copays, deductibles) on abortion services.
</p>
<h3>
Gun violence
</h3>
<p>
<a href="https://app.leg.wa.gov/billsummary?BillNumber=1240&amp;Initiative=false&amp;Year=2023">House Bill 1240</a>, concerning assault weapons, was approved by the Senate on April 8 by a vote of 27-21. HB 1240 would generally prohibit the manufacture and sale of semi-automatic "assault weapons," including firearms such as the AR-15 and AK-47.
</p>
<p>
<a href="https://app.leg.wa.gov/billsummary?BillNumber=1143&amp;Initiative=false&amp;Year=2023">House Bill 1143</a>, concerning firearm purchases, was approved by the Senate on April 7 by a vote of 28-18. HB 1143 would require individuals to have recently completed a firearm safety training program and undergo a background check and 10-day waiting period to be eligible to purchase firearms.
</p>
<p>
<a href="https://app.leg.wa.gov/billsummary?BillNumber=5078&amp;Year=2023&amp;Initiative=false">Senate Bill 5078,</a> concerning gun industry liability, was approved by the House on April 10 by a vote of 57-41. SB 5078 would establish a right of action against the firearm industry in circumstances where violence results from their conduct such as advertising targeted at minors and promoting the illegal conversion of firearms.
</p>
<h3>
Prior authorization
</h3>
<p>
<a href="https://urldefense.com/v3/__https:/app.leg.wa.gov/billsummary?BillNumber=1357&amp;Year=2023&amp;Initiative=false__;!!K-Hz7m0Vt54!nPeLTkE81nZg7kIhcc5Vk_D5Cvag8w62hQV2-KC4A2qhOZRYA8_WKfoCkOPWhyG-qj6tgMy_zQ$">House Bill 1357</a>, concerning prior authorization, was approved by the Senate on April 11 by a vote of 49-0. HB 1357 would modernize and standardize prior authorization by shortening turnaround times for determinations and mandating insurance carriers implement electronic prior authorization processes that integrate into physicians' EMR.
</p>
<p>
For a bill to pass into law it must be approved by the House and Senate in identical form. Most of these bills will require further action before being eligible to be signed into law by the Governor.
</p>
<p>
Scope of practice is another perennial priority issue area for the WSMA. As of this writing, <a href="https://app.leg.wa.gov/billsummary?BillNumber=5389&amp;Year=2023&amp;Initiative=false">Senate Bill 5389</a> expanding optometrists' scope of practice has passed both chambers of the Legislature and is pending final approval. While the bill has been narrowed to exclude the use of lasers and other dangerous procedures, it still confers expanded prescriptive authority and the ability to administer injections and perform surgery (among other provisions). Other scope bills opposed by the WSMA pertaining to practitioners such as naturopaths, psychologists, and pharmacists are considered "dead" for the purpose of the 2023 session.
</p>
</div> | 4/14/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| wsma-provides-feedback-on-dea-rulemaking-extending-telemedicine-flexibilities | WSMA Provides Feedback on DEA Rulemaking Extending Telemedicine Flexibilities | Latest_News | Shared_Content/News/Membership_Memo/2023/april-14/wsma-provides-feedback-on-dea-rulemaking-extending-telemedicine-flexibilities | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/april/telemedicine-patient-tablet-645x425px.jpeg" class="pull-right" alt="telemedicine appointment" /></div>
<h5>April 14, 2023</h5>
<h2>
WSMA Provides Feedback on DEA Rulemaking Extending Telemedicine Flexibilities
</h2>
<p>
The U.S. Drug Enforcement Administration recently proposed rules for the prescribing of controlled medications via telemedicine. The <a href="[@]Shared_Content/News/Membership_Memo/2023/march-24/dea-proposes-extending-telemedicine-flexibilities-for-prescribing-controlled-substances.aspx?_zs=A3aFd1&amp;_zl=ToAt8">proposed rules</a> apply to a narrow subset of telemedicine consultations: those by a physician or health care professional who has never conducted an in-person evaluation of a patient and that result in the prescribing of a controlled medication. The WSMA, in collaboration with the American Medical Association, submitted comment letters, <a href="javascript://[Uploaded files/News and Publications/newsletters/2023/wsma-docket-no-dea-948-expansion-of-induction-of-buprenorphine-via-telemedicine-encounter-03312023.pdf]">here</a>&nbsp;and <a href="javascript://[Uploaded files/News and Publications/newsletters/2023/wsma-comment-docket-no-dea-407-telemedicine-prescribing-of-controlled-substances-when-the-practition.pdf]">here</a>. While we are generally supportive of DEA's efforts to provide permanent telemedicine flexibilities, we have specified various concerns with the rules as they are currently drafted, such as the 30-day limitation, critical gaps in the type of medications that can be prescribed to certain populations, and the imposition of additional recordkeeping requirements. The WSMA requested that the DEA amend these elements of the proposed rules to avoid a lapse in patient care, promote patient safety, and avoid nonoptimal treatment options. The WSMA will keep you apprised of the progress of these rules and will review final language to determine its impact on physician practices. Reach out to WSMA Policy Analyst Shelby Wiedmann at <a href="mailto:shelby@wsma.org">shelby@wsma.org</a> with any questions or concerns.
</p>
</div> | 4/14/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| join-wsmas-government-affairs-team-for-a-post-session-webinar | Join WSMA's Government Affairs Team for a Post-Session Webinar | Latest_News | Shared_Content/News/Latest_News/2023/join-wsmas-government-affairs-team-for-a-post-session-webinar | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><a href="https://vimeo.com/812098090"><img src="/images/Newsletters/latest-news/2023/april/sean-alex-post-session-webinar-2023.png" alt="Sean Graham and Alex Wehinger" /></a></div>
<h5>April 11, 2023</h5>
<h2>Join WSMA's Government Affairs Team for a Post-Session Webinar</h2>
<p>
Wednesday, April 26 at noon. Free for WSMA members.
</p>
<p>
The 2023 Washington state legislative session adjourns on Sunday, April 23, and all WSMA members are invited to attend a post-session Advocacy Council webinar on Wednesday, April 26 at noon, hosted by our government affairs team in Olympia. The team will review the outcome of WSMA's priority bills, the final state operating budget, and give an insider's perspective on the broader health care policy landscape.
</p>
<p>
And as always, we want to hear your feedback on everything that's happening in Olympia and any concerns or issues you or your practice are facing, so we will hold time during the meeting for open discussion.
</p>
<p>
<a href="https://us06web.zoom.us/meeting/register/tZApceCvpzkiEtXgZ909nm1SinaVvKf7h4LF#/registration" class="TextButton">Register</a>
</p>
<p>
You will receive a confirmation email containing the connection information after completing the registration. For those who can't attend, the meeting will also be recorded and posted to WSMA's website.
</p>
<p>
As a reminder, WSMA's 2023 legislative priorities include:
</p>
<p>
<strong>Policy priorities:</strong>
</p>
<ul>
<li>Standardizing and modernizing prior authorization</li>
<li>Ensuring access to abortion and reproductive health care services</li>
<li>Addressing gun violence</li>
<li>Preventing numerous inappropriate scope-of-practice increases</li>
</ul>
<p>
<strong>Fiscal priorities:</strong>
</p>
<ul>
<li>Across-the-board Medicaid reimbursement rate increases</li>
<li>Health care workforce and physician residency funding</li>
<li>Foundational Public Health Services</li>
</ul>
<p>
If you have any questions regarding this webinar, please reach out to WSMA Government Affairs Coordinator Chelsea Thumberg at <a href="mailto:chelsea@wsma.org">chelsea@wsma.org</a>.
</p>
<p>
For more information on WSMA's legislative priorities and activities during the 2023 session, check out our <a href="[@]wsma/news_publications/latest_news/advocacy_report/wsma/news_publications/newsletters/wsma_advocacy_report.aspx?hkey=fbce906b-dbfb-4af3-8790-11f84275cf1e&amp;_zs=B3aFd1&amp;_zl=tBmu8">Advocacy Report webpage</a>.
</p>
</div> | 4/11/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| wsma-and-wc-acog-joint-statement-on-federal-rulings-concerning-mifeprestone | WSMA and WC-ACOG Joint Statement on Federal Rulings Concerning Mifeprestone | Latest_News | Shared_Content/News/Press_Release/2023/wsma-and-wc-acog-joint-statement-on-federal-rulings-concerning-mifeprestone | <div class="col-md-12">
<div class="col-sm-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div>
<h5>April 10, 2023</h5>
<h2>WSMA and WC-ACOG Joint Statement on Federal Rulings Concerning Mifepristone </h2>
<p>
SEATTLE, WA - (This release was updated on Friday, April 13.) Mifepristone is one of two drugs used for medication abortion, a protocol that has been approved by the U.S. Food and Drug Administration for two decades. Washington state law continues to ensure access to abortion services; however, Friday's ruling in Alliance for Hippocratic Medicine v. FDA seeks to constrain the options physicians are able to provide to their patients even in protected states and represents a gross interference in the practice of medicine and of the patient-physician relationship.
</p>
<p>
The WSMA supports the American College of Obstetricians and Gynecologists clinical guidance on medication abortion, which includes the following: The medication abortion regimen supported by major medical organizations nationally and internationally includes two medications, mifepristone and misoprostol. If mifepristone is unavailable, then a misoprostol-only regimen is an acceptable alternative.
</p>
<p>
On the other hand, both the Washington chapter of ACOG and the WSMA joined an amicus brief in support of Washington v. FDA and are encouraged by this ruling in this case, which impacts the 18 plaintiff states. This is a separate lawsuit that asserts the FDA's approval of mifepristone is legal and orders the FDA from taking action to remove or reduce the availability of mifepristone, as well as eliminate the unnecessary restrictions applied on mifepristone. (Update, April 13, 2023: The court denied the motion for leave to file an amicus brief without explanation, which can happen from time to time, especially on these expedited matters.)</p>
<p>
In light of these two contradictory rulings, our organizations will work to ensure there's understanding among physicians and their patients of their care options. Despite increasingly hostile and restrictive efforts to constrain access to essential reproductive health care services, Washington state physicians are dedicated to continuing to provide medication and procedural abortion services.
</p>
<p>
For more information contact: </p>
<p>
Cindy Sharpe<br />
Washington State Medical Association Communications<br />
<a href="mailto:cindy@wsma.org">cindy@wsma.org</a> / 813.244.2883 cell/text</p>
<p>
<strong>About the Washington State Medical Association </strong><br />
The WSMA represents nearly 12,500 physicians, physician assistants, resident physicians, and medical students across all specialties and practice types in Washington state. The WSMA has advocated on behalf of the house of medicine for more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care.
</p>
<p>
<strong>About the American College of Obstetricians and Gynecologists </strong><br />
Founded in 1951, ACOG is the premier professional membership organization for obstetrician-gynecologists. Today, ACOG is the nation's leading group of physicians providing obstetric and gynecologic care, with 60,000 members. ACOG's vision is an equitable world in which exceptional and respectful obstetric and gynecologic care is accessible to all.
</p>
</div> | 4/10/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |