WHAT HAVE WE DONE FOR YOU LATELY
The Gifts That Keep On Giving
BY DAVID WROTEN AMS EXECUTIVE VICE PRESIDENT
Recently I was preparing for a meeting with a hospital executive to discuss the importance of AMS membership . Most hospital executives want to know not just what AMS does for physicians , but how those issues impact the hospital .
It didn ’ t take long to come up with a long list of advocacy successes to help make the case for maintaining membership in AMS . With the current legislative session in full force , now seems like an appropriate time to walk down memory lane while highlighting the significant impact the AMS has on the lives of physicians and their patients .
LET ’ S BEGIN WITH ANY WILLING PROVIDER .
How many hospitals and clinics in Arkansas would not exist today without this legislation ? Young physicians may have no idea what this is , but travel to other states and you ’ ll find that insurance companies get to decide who they will contract with . These insurance companies can create very narrow networks by picking and choosing which hospitals and physicians are in network and it doesn ’ t matter how good a physician you are .
Think for a moment how your practice ( or your hospital ) would be impacted if you or the hospital were excluded from the largest network in Arkansas for no reason . That ’ s exactly what was happening in our state prior to the work AMS did to pass the Patient Protection Act , or Any Willing Provider . Under this law , health plans must contract with any physician or hospital that is willing to accept the terms of the contract and meet the credentialing requirements .
NEXT IS PROMPT PAYMENT AND RECOUPMENT .
I put these two together because they are certainly related . AMS led the charge to get the Arkansas Insurance Department to issue regulations that require health insurance carriers to pay providers in a timely manner while establishing interest penalties for late payments . In 2005 , AMS worked to pass legislation limiting to 18 months the time carriers can recoup payments from providers , except in cases of fraud .
THE NEXT GIFT IS ECONOMIC CREDENTIALING .
Imagine getting kicked off staff at your local hospital because you or your spouse ( or your mother , daughter , son , etc .) had an ownership interest in a competing hospital . That almost happened in Arkansas before the AMS and AMA intervened in two separate lawsuits to prevent it from happening . One of the cases was settled and the other went to the Arkansas Supreme Court . This is referred to as economic credentialing , and the Court agreed with AMS that this interferes with the patient physician relationship and is therefore against public policy .
FINALLY , LET ’ S DISCUSS CREDENTIALING .
Few things are more financially disruptive than bringing in a new physician then waiting six months or longer for the carriers to credential them and add them to their network . In 2009 , AMS worked to pass legislation requiring carriers to complete credentialing within 90 calendar days ( it was originally 180 days ). Then in 2015 , AMS worked to amend the act to reduce the time to 60 calendar days .
OTHER ADVOCACY WINS .
AMS has recently been at the forefront of passing or supporting is legislation that benefits physicians , hospitals , and other health care providers . Since I ’ m running out of space , I ’ ll just mention a few :
• Limitations on prior authorization requirements
• Medicaid expansion
• Telemedicine
• POLST
• Physician dispensing
• Treatment of chronic pain , and much more .
It ’ s fair game for physicians and hospitals alike to ask AMS , “ What have you done for me lately .” But the point I ’ m trying to make is that many of the successful efforts of the AMS are timeless . Any willing provider , prompt payment , recoupment , credentialing , prior authorization reform … these are all gifts that keep on giving long after the wrapper has been removed . Their existence is a direct result of strong and engaged physician membership in the Arkansas Medical Society . ■
many of the successful efforts of the AMS are timeless .
78 THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY