Maryland Medicine Volume 23, Issue 5

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VOLUME 23 ISSUE 5 Magazine of MedChi, The Maryland State Medical Society MedChi’s Priorities for the 2023 Maryland Legislative Session

From the President...

“How are you doing” is a casual question we hear each and every day. As your newly appointed president, what I want to know is how are you really doing.

How many hours per day are you in the office treating patients? How many additional hours are you working due to post-pandemic staffing shortages, which equates to taking on more and more administrative and billing responsibilities?

For those of us who are employed, how was that last contract renegotiation with your employer?

For those in private practice, do you feel that you are fairly compensated for patient care as compared to the industry average for your specialty and in your market? As the pandemic wanes, has your schedule readjusted or are you still working a pandemic schedule at the expense of time with your spouse, significant other, or kids?

The American Medical Association recently reported that physician burnout is running as high as 63 percent, which translates to six out of every ten physicians! It is one of MedChi’s many goals and areas of focus to advocate for our physician members and that includes ensuring work-life balance and quality of life. To address the quality-of-life topic, MedChi will be hosting a series of virtual webinars on physician empowerment beginning in 2023.

As stated in our mission: MedChi is here is to serve as Maryland’s foremost advocate and resource for physicians, their patients, and the public health.

And speaking of patients: Does access to care vary from county to county? How different is access to care for someone living in Chevy Chase versus living in Baltimore City or the Eastern shore? Mental and behavioral health remains a top legislative priority in our 2023 agenda. An article cited by the World Health Organization (WHO) stated that the Covid pandemic triggered a 25 percent increase in the prevalence of anxiety and depression worldwide. Among healthcare workers, exhaustion and work burn-out has been a triggering factor for harmful behavior. Fatigue, stress, and feeling overwhelmed are typically the underlying factors behind most behavioral health issues including addiction, substance abuse, depression, and suicide ideation. As recently cited by the journal JAMA Pediatrics, in 2020 the adolescent population accounted for a much larger share of suicides in many U.S. states than in previous years. An analysis of data from fourteen states found that the proportion

of overall suicides that occurred among young people ages ten to nineteen increased by 10 percent in 2020 compared with the average share over the pre-pandemic period of 2015 through 2019. MedChi will continue to advocate for the expansion of Maryland’s crisis treatment centers throughout the state and address access to care barriers for behavioral health services before people are in crisis.

Legislative work encompasses many issues and causes, and the work is never-ending. MedChi continually represents the physician and patient voice in Maryland, with the help of its nonpartisan political action committee, MMPAC.The Maryland Medical PAC (MMPAC) is the only PAC representing the unified voice of medicine in our state, so please consider supporting it by visiting medchi.org/mmpac. As the saying goes: We are either at the table or we are on the menu. I plan on sitting at the head of the table for the coming year, and I hope you will join me.

What You Need to Know Now

1. Maryland’s 2023 Legislative Session is January 11 through April 10. Participate in your component society’s Annapolis House Call now.

2. The AMA’s National Advocacy Conference is February 13–15 at the Grand Hyatt in D.C. More information can be found at: https://www.ama-assn. org/about/events/national-advocacy-conference MedChi holds Capitol Hill visits in conjunction with the AMA conference; to participate, contact Susan D’Antoni at sdantoni@montgomerymedicine.org

3. The CY 2023 Medicare conversion factor (CF) is $33.06, a decrease of $1.55 or 4.5 percent from the 2022 CF of $34.61. The decrease is a result of an expiring 3 percent increase funded by Congress through 2022. The additional 1.6 percent decrease is the result of budget neutrality requirements that stem from revised E/M changes. The AMA and the Federation are strongly advocating that Congress avert this payment cut, as well as implement an inflationary update for physicians, extend the 5 percent Advanced APM incentive, and waive the 4 percent PAYGO sequester.

2 Maryland Medicine
From the President

Addressing Shortfalls in Utilization Management Techniques

Over the years, there has been increased focus on patientcentered care across the health care industry. Empowering patients to play a greater role in their health care decisions can ultimately improve treatment quality and outcomes and can lead to better patient satisfaction. Yet despite these benefits, physicians and patients often face significant barriers resulting from health insurance carriers’ use of utilization review techniques, such as prior authorization. MedChi, along with the American Medical Association, believes that carriers are overusing prior authorization, creating significant barriers for patients by delaying the start or continuation of necessary treatment and overly burdening physician offices. These delays and hurdles negatively affect patient health outcomes.

The 2021 AMA physician survey on prior authorization found that:

• 93 percent of the time physicians report that prior authorization can result in care delays;

• 82 percent of the time physicians reported that prior authorization can lead to treatment abandonment;

• 73 percent of the time physicians question whether the criteria used in prior authorization decisions is evidencebased medicine and/or guidelines from national medical specialty societies; and

• 88 percent of physicians describe the burden associated with prior authorization as high or extremely high, with 40 percent of physicians reporting that they have staff that work exclusively on prior authorization requests.

According to the 2021 report on the Health Care Appeals and Grievances Law (released November 30, 2022), patients are being erroneously denied care. Carriers rendered 81,143 adverse decisions in 2021 compared to 78,314 in 2018, representing an increase of 3.61 percent over the four-year period. Of those where a grievance decision or complaint was filed, the Maryland Insurance Administration reversed (or the carrier reversed its own grievance decision during the course of the Administration’s investigation) 70.5 percent of the time, an increase in reversals of 3.5 percent from 2020. All of the reversals of the carrier’s grievance decisions resulted in more benefits for Maryland consumers.

Therefore, MedChi will be seeking the introduction of legislation during the 2023 Session to reform carrier’s utilization review policies to ensure that care is placed back into the hands of physicians. These reforms may include but will not be limited to:

• standardizing electronic systems across all carriers;

• requiring a study to determine the feasibility of implementing a program (e.g., gold card) that selectivity implements prior authorization requirements based on physician performance;

• requiring carriers to use evidence-based medicine and/or guidelines from national medical specialty societies;

• increasing transparency and communication between physicians and the utilization review entity; and

• streamlining prior authorization requirements by exempting prior authorization for certain drugs or procedures.

Danna L. Kauffman, Esq., is a Partner at Schwartz, Metz, Wise, and Kauffman PA

Scope of Practice Remains Front Burner Issue for MedChi

Following the 2022 General Election, the Maryland General Assembly will be comprised of many new members when it convenes in January of 2023. Despite this turnover, the body will consider and vote on many of the same issues that have previously been presented to the General Assembly. As in previous years, we anticipate a heavy volume of bills which favor the expansion of scope of practice for non-physician practitioners. MedChi’s Legislative Council reviews each of these bills to determine its impact on the practice of medicine and on patients. Schwartz, Metz, Wise & Kauffman, P.A. coordinates with MedChi to determine what position to take on these bills.

In recent years, non-physicians have increasingly turned to the General Assembly to expand their “scope of practice.” For example, podiatrists have sought to become “podiatric physicians,” thereby implying to patients that they are physicians in the same nature of an MD or DO Naturopaths have sought to prescribe prescription drugs, despite obtaining licensure years ago based wholly on the notion that they were an alternative to traditional medicine and prescription drugs. And pharmacists continue to provide medical care and counseling and to prescribe an increasing number of medications, such as smoking cessation products, HIV treatments, or vaccinations.

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Scope of Practice, continued from pg. 3

In 2023, we also anticipate physician assistants to propose changes to their statute, though we are currently working with them to identify areas of agreement under the guidance of the General Assembly. Overall, non-physician groups are using the argument that their enhanced scope of practice is necessary to provide increased “access” to patients, given the attention being given to current workforce shortages in health care.

MedChi has traditionally approached these proposals as follows: When there is a reasonable argument that increased access is necessary, the role of non-physicians should be enhanced only when they are supervised by or in collaboration with a physician who is trained in that particular medical area. But increased access is not the only consideration; quality of care is equally if not more important. An October 2022 study issued by the National Bureau of Economic Research entitled “The Productivity of Professions: Evidence from the Emergency Department,” illustrates this point. The study found that Nurse Practitioners use more medical resources than physicians because they require longer lengths of stay and incur higher costs with less favorable outcomes. Clearly expanding access to care can come at the expense of the quality of care provided.

The key to increased access and quality care lies in recruiting more physicians to the workforce to meet population growth and the higher demands being placed on the health care system. MedChi is working through the Commission to Study the Healthcare Workforce Crisis in Maryland, established in 2022 by the General Assembly, to educate policymakers about the need for more physicians as the solution to the problem — not expanding the scope of non-physicians.

MedChi has also worked to achieve record funding for the Maryland Loan Assistance Repayment Program as an incentive for physicians — who are oftentimes burdened with thousands of dollars in med school debt, to choose to practice in underserved areas.

The new General Assembly will be faced with untold numbers of scope of practice proposals in 2023 and the years that follow. MedChi will be there, advancing these arguments and working to protect patients and the practice of medicine.

J. Steven Wise, Esq. is a Partner at Schwartz, Metz,Wise, and Kauffman PA.

Restoration of E & M Code Payment Rates to 100% Parity Remains Top Priority

During the 2022 Session, MedChi successfully advocated to fully restore evaluation and management (E&M) code payment rates to 100 percent parity with Medicare for Fiscal Year 2023. The last time E&M code payment rates fully aligned with Medicare was in 2012 when the Affordable Care Act passed, and more people enrolled in the Medicaid program. The 2012 fully funded rate was a success, as it resulted in greater participation in Medicaid by health care practitioners to meet the increased demand for services resulting in no changes to the rate in 2013 and 2014. However, despite the success in increasing practitioner participation and greater access to care, the following year — 2015, rates were reduced to 87 percent of Medicare. Subsequently, the Hogan Administration restored rates to 94 percent of Medicare in 2016 and maintained the 94 percent rate through Fiscal Year 2022 until it fully restored the rate to 100 percent parity with Medicare for Fiscal Year 2023.

The COVID-19 pandemic has resulted in greater Medicaid enrollment, creating an increase in those seeking care and an increased need to maintain strong practitioner networks. Considering the impact on communities affected by lack of access to health care services as well as socio-economic inequities and health disparities, there is an imperative need to ensure robust Medicaid practitioner networks. Access to proper health care is a key means to addressing these inequities.

Adding to this, medical practices have been economically impacted by the pandemic. Workforce availability, coupled with the costs associated with managing and maintaining the financial viability of a business, has an influence over which payers they contract with, including participation with Medicaid. Maintaining Medicare parity for E&M codes will support the ongoing financial viability of those practices and enable them to continue to contract with Medicaid to ensure access to health care services for Maryland’s most disadvantaged patients.

Therefore, advocating to maintain E&M code payment rates at 100 percent parity with Medicare for Fiscal Year 2024 will be a priority for MedChi advocacy in the 2023 Session.

Pam Kasemeyer, Esq., is a Partner at Schwartz, Metz, Wise, and Kauffman PA

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Protecting Access in a Post-Roe Climate: The Journey of a MedChi Resolution

My heart sank into my chest. The Dobbs vs. Jackson’s Women’s Health Organization decision had just been leaked. Dobbs overturned decades of access to live-saving abortions and to an inherent right to medical privacy set by Roe v. Wade in 1973. Although Roe v. Wade had been challenged before in the 1992 supreme court case, Planned Parenthood v. Casey, the institutional rights set by Roe v. Wade had never faltered.

I was speechless, unable to voice my feelings right away. I understood the ramifications of this decision on women and other people who give birth. And at that point, so did everyone else. That is when the flood of messages started pouring in.

“How can they do this?” “Do they understand what this means for women? What are they telling us about our rights?”

I was angry, upset, mournful of the prospective downstream effects of losing such an integral and intimate aspect of women’s healthcare. By this time, over a dozen states’ trigger laws came into effect — changing the abortion landscape in those states instantaneously. The accessibility and criminality of abortion became dependent on a political governing body — sending a clear message to women and other people who give birth across the nation—that this aspect of their healthcare and future was not up to them anymore. Fueled by my feelings and the voices of my fellow women-identifying classmates, I knew that this did not end here.

Maryland was one of the few states that had an institutional protection to abortion passed by its legislature in 2022. The Abortion Care Access Act established a state-wide requirement regarding abortion services and expanded the coverage for abortion care. However, when I inquired of a MedChi staff member what the MedChi policy was, I was told that the policy was “neutral” and followed that of the American Medical Association (AMA). The other students in the MedChi medical student section and I were appalled by the revelation that our state society did not represent the feelings and thoughts of women, others who give birth, and the state.

A couple weeks passed, and everyone started making their way to Chicago for the national AMA meeting in June 2022. Several contentious topics were on the docket, such as gun violence, marijuana legalization, and, of course, abortion access. I was working integrally with the AMA medical student section to write and provide testimony for several resolutions that we felt strongly on. As an alternate delegate, there were moments where I was even able to vote directly on these

resolutions. The tide had changed in Chicago. We all felt the buzz of hope and strength among our members. The AMA had passed Preserve Access to Reproductive Health Services (D-5.999). This established reproductive health services, including contraception and abortion, as a human right and formally announced that the AMA will advocate for legal protections and the expansion of abortion access across the nation — opposing criminal, civil, or retaliatory penalties against patients, patient advocates, physicians, and other healthcare workers or health systems.

I distinctly remember feeling hopeful that the AMA’s influential and dramatic changes would strike a match among the states, including Maryland. In MedChi’s July 2022 Board of Trustees (BOT) meeting, the topic of abortion arose in the form of a position letter that MedChi was asked to sign. The conversation was polite, civil, and ultimately neutral — despite mentioning that the medical students and myself wanted MedChi to take a strong position. And again, in September 2022, the MedChi Board of Trustees (BOT) meeting formally established a neutral position on abortion and the patient-physician relationship that neither ensure access to abortions nor protected physicians who perform abortions in Maryland. I asked Dr. Loralie Ma, MedChi’s current Immediate Past-President, how this can be addressed. She explained that the only way to change this was to have a resolution presented to the House of Delegates.

In October 2022, I wrote and submitted Resolution 20-22 titled “MedChi Abortion Policy.” The resolution’s intent was to align MedChi policy with the newly passed AMA policy, D-5.999. The everchanging criminal, legal, and accessibility climate in the nation required a strong stance from our state’s medical society for this important matter. There are dangerous safety and criminal risks that exist for those who are unable to access abortion services, ranging from increases in maternal mortality among individuals in marginalized communities to criminal investigations and imprisonment. The risk to the patientphysician relationship, though discussed in the position that the BOT took in September, needed to be safeguarded. Physicians who perform life-saving abortions and the patients who seek out this service need to be institutionally protected from undue

Volume 23, Issue 5 5 continued on page 7 Cover Story

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6 Maryland Medicine
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Protecting Access, continued from pg. 5

legal proceedings. Aligning MedChi policy to AMA policy would address any outstanding issues that concerned the medical student section. We wanted iron-clad protections for women and other people who give birth in Maryland.

In the weeks leading up to the MedChi House of Delegates (HOD) meeting, there were several discussions regarding strategy and subsequent edits to the resolution. Attorney Pam Kasemeyer of Schwartz, Metz, Wise, and Kauffman PA, recommended a few edits to prevent tangent discourse. Dr. Karen Dionesotes, one of the original authors of the AMA D-5.999 resolution, also offered guidance and support. When the BOT reviewed the resolution, I provided a final author edit to remove one of the unnecessary resolved clauses. It took a strong team effort to rally around this resolution and for that I was grateful.

Excitement was building for the November House of Delegates meeting. I was expecting pushback but felt confident about our work. When the time came to extract, my resolution was one of many selected. I was nervous yet confident, ready to address any criticism. This meant more to me than just a resolution. This represented something so important to women and those who give birth — abortion access and the patientphysician relationship — in the face of a threatening national environment. I was born in Maryland and have lived here my whole life. This topic was important to me, to my sister, and to my classmates. It was necessary that MedChi protect the desires of so many Maryland citizens.

The moment came when the resolution reached the floor for discussion. The opposing testimony rested on the polarizing nature of this topic, citing contrasting views among MedChi members. I testified in favor of the resolution along with other members of the Medical Student Section and Resident and Fellow Section. I cited that a controversial topic does not eliminate an obvious and necessary need for women and those who give birth — a topic’s opposition does not equate to no action. The MedChi body agreed and voted in favor of the resolution.

My heart was lifted. This is how MedChi is supposed to work. A moment that was so hurtful and painful in May had manifested into a powerful moment only months later. The entire process ensured that each side had a chance to share their thoughts and that the output was something beneficial for our citizens. As stated by the AMA, there is an inherent right to abortion and contraceptive access, and MedChi has just ensured that — for now, this right is protected.

Shani Kamberi is a MD/MPH Candidate at the University of Maryland School of Medicine, Class of 2026.

MedChi Components – 2023 Advocacy Lobby Days

Maryland Chapter of the American College of Obstetricians and Gynecologists (ACOG)

Date/Time: Friday, Jan. 27, 2023, 8:00 a.m.–TBD Location: MedChi Annapolis Office Address: 224 Main Street, Annapolis, MD 21401

Contact: Jenine Feaster (jfeaster@medchi.org; 410.878.9892)

MedChi Medical Students Date/Time: Monday, Jan. 30, 2023; 5:00–8:00 p.m. Location: MedChi Annapolis Office, 224 Main Street, Annapolis, MD 21401

Contact: Ginger Tinsley (gtinsley@mechi.org; 410.878.9708)

Baltimore City Medical Society (BCMS) Date/Time: Wednesday, Feb. 22, 2023; 7:30 a.m.–1:00 p.m. Location: MedChi Annapolis Office, 224 Main Street, Annapolis, MD 21401

Contact: Lisa Williams (info@bcmedicalsociety.org; 410.625.0022)

Baltimore County Medical Association (BCMA) Date/Time: Wednesday, Feb. 22, 2023; 7:30 a.m.–1:00 p.m.

Location: MedChi Annapolis Office, 224 Main Street, Annapolis, MD 21401

Contact: Russ Kujan (rkujan@medchi.org; 410.296.1232)

Anne Arundel County Medical Society (AACMS) Date/Time: Monday, Feb. 27, 2023; 5:00–8:00 p.m.

Location: MedChi Annapolis Office, 224 Main Street, Annapolis, MD 21401

Contact: Teresa Healey-Conway (thealey-conway@medchi.org; 410.544.0312)

Howard County Medical Society (HCMS) Date/Time: Monday, Feb. 27, 2023, 5:00–8:00 p.m.

Location: MedChi Annapolis Office, 224 Main Street, Annapolis, MD 21401

Contact: Teresa Healey-Conway (thealey-conway@medchi.org; 410.544.0312)

Prince George’s County Medical Society (PGCMS) Date/Time: Monday, Feb. 27, 2023, 5:00–8:00 p.m.

Location: MedChi Annapolis Office, 224 Main Street, Annapolis, MD 21401

Contact: Teresa Healey-Conway (thealey-conway@medchi.org; 410.544.0312)

Montgomery County Medical Society Date/Time: Wednesday, March 1, 2023, 7:30 a.m.–1:30 p.m.

Location: MedChi Annapolis Office, 224 Main Street, Annapolis, MD 21401

Contact: Susan D’Antoni (sdantoni@montgomerymedicine.org; 301.921.4300)

Volume 23, Issue 5 7 Cover Story

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8 Maryland Medicine
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Meet Your MedChi President: James York, MD

After graduating from Georgetown University and Georgetown University School of Medicine with honors from the Alpha Omega Alpha Medical Society, James York, MD, completed his Surgery Internship & Orthopaedic Residency at University of Maryland Hospital. At Georgetown, Dr. York was part of a work group that successfully lobbied Congress for legislation to assist recipients of the Health Professions Scholarship Programs (Military and Public Health Scholarships).

After serving three years in the Army, and beginning in 1988, Dr. James York was in private orthopaedic practice with Chesapeake Orthopaedic & Sports Medicine in Glen Burnie. Dr. York joined Anne Arundel Medical Group Orthopaedic and Sports Medicine Specialists in 2014. He specializes in reconstructive shoulder, knee, total joint, and cartilage transplant surgery. Dr. York is Board Certified in Orthopaedic Surgery and Subspecialty Board Certified in Orthopaedic Sports Medicine. Dr. York is an active member of the American Academy of Orthopaedic Surgeons (AAOS), Arthroscopy Association of North America (AANA) and American Orthopaedic Society for Sports Medicine. He has participated as an Associate Master Instructor at AANA Shoulder Surgical Courses and Clinical Assistant Professor in the Department of Orthopaedics at the University of Maryland School of Medicine. Dr. York was recognized by Annapolis Magazine as a “Top Doc” in 2011.

Dr. York served as Associate Chair of Surgery and Past President of the Medical Staff at Baltimore Washington Medical Center. He is Past President of the Maryland Orthopaedic Association (MOA) and for many years led legislative initiatives pertaining to Orthopaedists at the Maryland Legislature. He served as a Maryland representative for the American

Academy of Orthopaedic Surgeons Board of Councilors (BOC) for six years. The BOC is the policy making and advocacy arm of the AAOS. During the BOC years, he served on and was chair of the State Legislative and Regulatory Committee. This committee initiated and coordinated legislative initiatives across the country.

Prior to serving as MedChi President, Dr. York served as Speaker of the House. He participated actively in the MedChi Legislative Council since 2004 and served as chair for four years. He has served as Anne Arundel/Howard County delegate to the Board of Trustees and also served as Anne Arundel County Medical Society President.

Over the past thirty-six years, Dr. York has demonstrated a special interest in the treatment and prevention of sports injuries. He served as Team Doctor for Archbishop Spalding High School for twenty-six years and has provided game coverage, preseason sports physicals, and coach training seminars at Youth Athletic Organizations, High Schools, and the Community College. Dr. York served as a youth soccer coach for Severna Park Green Hornets organization for many years and earned a U.S. Soccer Federation ‘D’ coaching license.

He enjoys Martial Arts (Chen style Taijiquan and Chen sword), golf, Gaelic Irish Languages, and medieval and military history. He has recently been granted his FCC license in Ham Radio (KC3SOK) and is interested in use of Ham Radio in Medical Support of Emergency Communication.

Dr. York has two grown children and a grandchild. He and his wife, Maureen Carr, live in Millersville and are avid Ravens Fans.

Catherine Johannesen, CAE, is MedChi’s Chief of Staff and can be reached at CJohannesen@medchi.org.

Volume 23, Issue 5 9 Cover Story
10 Maryland Medicine

Aggressive Legislative Agenda

MedChi’s Annual Meeting, held on November 5, 2022, was a phenomenal showcase of all the ways that MedChi serves as your advocate and your resource. We had a spectacular turn-out of members — both current and soon-to-be, largely due to the addition of a special “Physician Empowerment Summit.”

The first-ever “Physician Empowerment Summit” was organized by the leaders of MedChi’s Medical Economics Council, and focused on the payment landscape in Maryland, with an emphasis on value-based medicine, practice sustainability, and contract negotiation skills for employed and private practice physicians. The themes of health care economics, payment models, and physician empowerment will continue into 2023 with a series of virtual “Physician Empowerment” sessions featuring many of the same guest speakers.

Established by MedChi House of Delegates

related issues. We also paused to respectfully honor our past presidents, Donald Dembo, MD, and George Malouf, MD, both of whom passed away earlier this year. It was a true privilege to work with them.

We were honored to be joined by Senator Clarence Lam, MD, Delegate Terri Hill, MD, Senator Melony Griffith, Delegate Sheree Sample-Hughes, and Senator Jeff Waldstreicher, as we celebrated the accomplishments we collectively achieved on behalf of Maryland’s patients.

Updates were shared on the wealth of activities that MedChi addresses year-round on your behalf. To see the reports that were given by our myriad departments and affiliates, I encourage you to visit our website: www.medchi.org

Later in the day, the agenda switched from empowerment to advocacy as our House of Delegates convened. Your House adopted an ambitious legislative agenda with a particular focus on tackling the administrative burdens of prior authorization and other payor-

EDITORIAL STATEMENT

Editorial Offices: MedChi, The Maryland State Medical Society; 1211 Cathedral Street, Baltimore, MD 21201; 410.878.9897

Advisory Board: Bruce M. Smoller, MD (Chair); Stephen J. Rockower, MD (Vice Chair); Gene Ransom, III, Esq (CEO, MedChi); Susan G. D’Antoni (MedChi Director of Publications); Susanna M. Carey (Production Editor)

Managing Editor: Victoria Hecht, 410.878.9897; vhecht@medchi.org

Advertising: Victoria Hecht, 410.878.9897; vhecht@medchi.org

All opinions and statements of supposed fact expressed by authors are their own, and not necessarily those of Maryland Medicine or MedChi. The Advisory Board reserves the right to edit all contributions, as well as to reject any material or advertisements submitted.

Copyright © 2022. Maryland Medicine, The Maryland Medical Journal. USPS 332080. ISSN 1538-2656 is published by the Medical and Chirurgical Faculty of Maryland, 1211 Cathedral Street, Baltimore, Maryland 21201, and is a membership benefit.

The next House of Delegates meets on Sunday, April 30, 2023. This meeting will be held virtually for maximized accessibility, and ALL members are welcome and encouraged to attend.

All rights reserved. No portion of this journal may be reproduced, by any process or technique, without the express written consent of the publisher. Advertising in Maryland Medicine does not imply approval or endorsement by MedChi unless expressly stated.

DISCLAIMER: Some articles may contain information regarding general principles of law. They are not intended as legal advice and cannot be substituted for such. For advice regarding a specific legal situation, consult an attorney licensed in the applicable jurisdiction and with appropriate training and/or experience in the legal area in question.

Volume 23, Issue 5 11
Cover Story
Catherine Catherine Johannesen, CAE, is MedChi’s Chief of Staff and can be reached at CJohannesen@medchi.org Top photo: MedChi President Loralie Ma presents Senator Melony Griffith with the 2022 Legislative Award. Bottom photo: Former MedChi President Shannon Pryor presents Senator Jeff Waldstreicher with the 2021 Legislative Award.

As the statewide professional association for licensed physicians, we are dedicated to our mission to serve as Maryland’s foremost advocate and resource for physicians, their patients, and the public health.

“The 2022 General Assembly Session was a highly successful time of physician and patient advocacy. As we look ahead to the 2023 session, we will continue our efforts to ensure that Maryland is the best place to practice medicine and be a patient.”

Banda, MD

MedChi Council on Legislation

“MedChi’s Council on Legislation provides the framework for accessible, robust, science-informed debate on the issues that impact Maryland’s physicians and patients. Our process ensures that physicians of all specialties, modes of practice, and career stages have a seat at the table and a powerful voice in Annapolis.”

12 Maryland Medicine LEGISLATIVE AND REGULATORY PRIORITIES 2023 1211 Cathedral Street • Baltimore, Maryland 21201 • 1.800.492.1056 • www.medchi.org @medchiupdates facebook.com/medchiupdates @medchiupdates
Clement
Co-Chair,
Kathleen D. Keeffe Hough, MD Co-Chair, MedChi Council on Legislation

Anuradha Reddy, MD Chair, MedChi Health Insurance Subcommittee

Every physician is impacted by the insurance market, and our Health Insurance Subcommittee serves as your advocate for ensuring that legislation is physician-friendly and practice-sustaining.

ENSURING TIMELY DELIVERY OF HEALTH CARE SERVICES AND PAYMENT

• Advocate for initiatives that streamline and reform utilization management policies (i.e., prior authorization and step therapy laws) in both the commercial market and in Medicaid to reduce administrative burdens and increase transparency.

• Ensure that physicians and health care practitioners are not inappropriately excluded from participating on insurance panels.

• Support policies to ensure that women have equal access to breast cancer diagnostic examinations and evaluations without cost sharing.

• Address network adequacy and the further standardization of credentialing requirements.

• Advocate that the Fiscal Year 2024 Medicaid budget maintain E&M reimbursement rates to 100% of Medicare to support physician participation in the program and ensure that Medicaid patients have adequate access to physician services.

• Work to create fair and appropriate policies and procedures for Medicaid payment seizures.

PROTECTING ACCESS TO PHYSICIAN SERVICES AND THE PRACTICE OF MEDICINE

• Oppose policies that would adversely affect patient care by inappropriately expanding the scope of practice of non-physician providers, including the ability to independently diagnose, treat, prescribe medications, and/or manage medical disorders.

• Seek state funding for the Loan Assistance Repayment Program (LARP), which provides loan repayment to primary care physicians working in underserved areas, so as to encourage more physicians to practice in those areas.

• Fight initiatives that seek to weaken Maryland’s current medical liability environment and jeopardize the Total Cost of Care Model, including increasing the “cap” on damages in malpractice cases.

• Monitor the regulatory and disciplinary actions of the Board of Physicians.

• Ensure that the Board’s disciplinary process is transparent and that the laws governing the Board provide for accountability, including the adoption of a requirement that the physician complaint form includes a penalty of perjury for false allegations.

Kathleen D. Keeffe Hough, MD Chair, MedChi Public Health Subcommittee

The Public Health Subcommittee provides expertise on issues that directly impact our patients, our communities, and our state.

Lawrence Green, MD Chair, MedChi Boards & Commissions Subcommittee

The regulatory environment greatly impacts the practice of medicine, and MedChi’s Boards and Commissions Subcommittee is your voice of impact.

ADDRESSING BEHAVIORAL HEALTH TREATMENT AND RECOVERY NEEDS

• Advocate for expansion of Maryland’s crisis treatment centers and address access to care barriers for behavioral health services.

• Support innovative approaches to addressing the opioid crisis, such as a pilot program of supervised injection facilities.

• Support the continued establishment of partnerships between police and mental health professionals to ensure the appropriate response to individuals in a behavioral health crisis.

• Advocate for comprehensive behavioral health reform that addresses system deficiencies.

STRENGTHENING PUBLIC HEALTH INITIATIVES

• Continue to support health equity initiatives that address health disparities and the social determinants of health.

• Support polices which increase access for all Marylanders (regardless of immigration status) to free or low-cost health care plans through initiatives that automatically enroll individuals in coverage and/or provide individual or small employer subsidies to enhance affordability.

• Advocate for public health and safety initiatives including improving child immunization rates; developing enhanced health education programs; developing health workforce mentorship programs; prohibiting the sale of flavored tobacco products; ensuring equitable access to public transportation; and supporting the development of evidenced-based occupational safety regulations for heat-related illness.

• Support initiatives that preserve access to reproductive health services consistent with AMA policy.

www.medchi.org/YourAdvocate | www.MMPAC.org | advocacy@medchi.org

Volume 23, Issue 5 13
GET INVOLVED!

collaboration on cases

Imagine a huge, global community of medical minds working together to improve patient outcomes. An app that knows no geographical boundaries, where doctors can safely weigh in on patient cases and share cases of their own. A free-flowing exchange of knowledge with experts on the front-line discussing cases that matter, and in real time. This community exists. It’s called Figure 1.

Figure 1’s mission is to democratize medical knowledge and bring better medicine to all patients. To date, Figure 1's global community of over 3 million members has contributed more than 100,000 real-world cases and fostered discussion on everything from rare conditions to strategies for patient care. A safe, secure platform with controls in place to maintain patient anonymity.

Figure 1 members have full access to an accredited CME Center, a hub offering free CME credits available on demand.

By downloading this app, you can now have access to the most relevant patient cases and the sharpest medical minds right at your fingertips. Literally.

Instagram for doctors.

14 Maryland Medicine
Peer-to-peer
that matter. Right at your fingertips. Literally.

Wes Moore Makes History as Maryland Governor

Wes Moore will make history on January 18, 2023, when he becomes the first Black Governor of Maryland. Winning by a landslide, he ran a campaign on the “leaving no one behind” slogan, which focused on strengthening public schools, closing the racial wealth gap, and creating safe communities. Regarding health care, we expect that the focus of his administration will be an extension of this emphasis on accessibility and equity.

During his race for Governor, Moore would often share the story of losing his father when he was almost four years old from acute epiglottitis — a rare but treatable virus if his father had received basic care. His father’s untimely and unnecessary death was a transformative moment in young Wes’s life. It made him realize that basic health care was a right that should be accessible to all, and it reinforced his commitment to seeing that every citizen receive health care. As Wes and Lieutenant Governor-elect Aruna Miller would frequently state: “health is wealth.”

Health care is a basic right that every Marylander deserves, period. Our state is home to some of the very best hospitals, medical research institutions, and health care facilities in the entire world — a fact we should all be proud of. But at the same time, so many Marylanders can’t access those institutions or even afford very basic care. This is a sad irony, which is not lost on Wes.

Wes understands the need for Marylanders to have coverage that will encompass behavioral health, mental health, and substance disorders, not just physical health. During the Covid-19 pandemic, he witnessed how citizens suffered with mental health issues and addiction due to limited or no access to much needed in-person services. As a result, one of his priorities is to ensure that systems are in place that will provide effective and affordable services to those in need.

Governor-elect Moore comes into office with the wind in his sails. There is a record budget surplus and an overall feeling of optimism about what the future holds for Maryland. On his website, Wes provides a partial list of systemic problems to tackle, including the protection of funding for the state’s community health centers that offer critical health services like

cancer screenings and birth control. Wes also supports the right to choose, and he has campaigned on the promise to steadfastly protect it.

It is MedChi’s hope that the opioid epidemic will be added to the list that Moore expects to accomplish because recent data shows that the number of deaths from overdoses in Maryland have begun to climb yet again. Additionally, the Total Cost of Care Model Agreement between Maryland and the Centers for Medicare & Medicaid Services is being scrutinized and will urgently require his attention. As Maryland transitions to a Moore-Miller administration, MedChi is looking forward to working with Governor-elect Moore and Lieutenant Governorelect Miller on expanding health care coverage and improving public health.

To learn more about Governor-elect Wes Moore and his administration, or to get involved: https://mooremillermd. com/

Gene Ransom III is the CEO of MedChi, the Maryland State Medical Society.

Volume 23, Issue 5 15 Cover Story
Gene Ransom III MedChi Speaker of the House Padmini Ranasinghe, MD, and Maryland Governor-elect Wes Moore.
16 Maryland Medicine

Health Was A Major Focus During Hogan’s Two-Term Tenure

In January, Maryland Governor Larry Hogan will leave Annapolis and begin his next chapter. During his two-term tenure, he was nationally recognized as a strong, independent leader who consistently delivered real results and achieved common sense, bipartisan solutions. Among his many accomplishments, health care remained at the forefront as he was diagnosed with cancer — making it his mission to raise awareness and support efforts to find a cure — and battled a global pandemic.

Some of his key accomplishments included:

Leadership in Addressing COVID-19

The Hogan administration was committed to being transparent as it worked to keep Marylanders fully informed, took actions based on detailed research, and made strategic decisions after careful planning. When other politicians became bogged down in bitter partisanship, Governor Hogan was a thoughtful and reasonable leader who worked with scientists and physicians alike in his response.

The Maryland Total Cost of Care Model

Under Governor Hogan’s leadership, the Maryland Department of Health worked with the Health Services Cost Review Commission and private stakeholders, including MedChi, to successfully negotiate the Maryland Total Cost of Care Model (“Maryland Model”) with the federal government. This innovative approach was made possible via a contract between the Centers for Medicare and Medicaid Services and the State. The Maryland Model achieved more than $586 million in savings through 2016 when compared to national spending, and the renegotiated contract is expected to provide an additional $300 million in savings per year by 2023 — a total of $1 billion in savings over the program’s first five years.

Maryland Cancer Moonshot Initiative

In 2022, Governor Hogan launched the Maryland Cancer Moonshot Initiative to expand and accelerate cancer detection, screening, prevention, treatment, and research in the State. The initiative committed $216 million in initial investment to leverage the State’s world-class public health facilities to expand early detection, screening, and patient education; advance

state-of-the-art inpatient and outpatient services; and support cutting-edge research of cures and treatments.

Medicaid Rates

On April 1, 2015, reimbursement for Medicaid E&M codes was reduced from 100 percent of Medicare to 87 percent of Medicare, which was maintained in the Fiscal Year 2016 budget as part of former Governor O’Malley’s mid-year budget cuts. Governor Hogan recognized that failure to increase E&M code reimbursement would have a negative impact on physician participation and ultimately, access to care. During his tenure, Governor Hogan steadily increased Medicaid E&M rates and eventually restored them to 100 percent parity with Medicare.

Reinsurance

Amid spiking health insurance premiums and unsettled markets, the Hogan administration worked with the Maryland General Assembly to establish a state reinsurance program to mitigate the premium impact of high-cost enrollees on carriers that participate in the individual market. In 2019, Maryland implemented a tax on health insurance premiums, and officially established the State Reinsurance Program to offset the costs of the individual insurance market. The program was intended to stabilize an unstable market and reduce insurance costs for thousands of Marylanders. Since the implementation of the State Reinsurance Program, premiums in the individual market have decreased by an average of over 25 percent. From the outset, Governor Hogan made access to high-quality and affordable health care a top priority.

Indeed, the American Medical Association (AMA) presented Governor Hogan with the Nathan Davis Award for Outstanding Government Service in 2020. According to the AMA, Hogan set “an example for the rest of the country” by keeping “his promise to focus on bipartisan, commonsense solutions in the area of health care.” He has been a staunch ally to MedChi and to the betterment of medicine. His unwavering commitment has made a real difference across the State, and the public health of Maryland is stronger for his leadership.

Gene Ransom III is the CEO of MedChi, the Maryland State Medical Society.

Volume 23, Issue 5 17 Cover Story
Gene
18 Maryland Medicine Free prescription savings card Save on brand and generic medications Help support Children's Miracle Network Hospitals® No exclusions / No paperwork HIPAA compliant / Privacy secured Enter Year & Time (Example: Year 2022 & Time 9:14 = ID# 2022914) 022071 RX4MD2 RxBIN: RxGROUP: MEMBER ID: Learn more at Rx4Miracles.org Helping patients save money while supporting Children’s Miracle Network Hospitals® Proud Supporter of A PRESCRIPTION FOR MIRACLES! PATIENTS ARE ASKING FOR PROTON THERAPY. Here’s why. Proton therapy isn’t just saving lives, it’s making the quality of those lives better. This technology targets solid, localized tumors and spares healthy tissues and organs, causing fewer side effects. If you have a cancer patient who qualifies, consider a referral to the Maryland Proton Treatment Center – the region’s leader. FIND OUT MORE! Visit AskForProtons.com/physicians Or call 410-369-5200

BCMA Physicians Meet With Legislators and Plan For In-Person Return to Annapolis

With the pandemic receding, children back in school, and medical practices filled with patients, albeit masked, Baltimore County Medical Association is preparing members for a return to in-person advocacy of the Maryland General Assembly in 2023.

This past October, Baltimore County Physicians’ Political Action Committee held a successful in-person Ice Cream Social at the Y of Central Maryland in Towson. Michael Niehoff, MD, was there to welcome the attendees, including House Speaker Adrienne Jones, several legislators, and candidates. Everyone enjoyed ice cream from the Taharka Brothers’ truck while trading stories about summer vacations and campaigning.

BCMA physicians held its annual Legislative Breakfast as a virtual meeting on December 9. This meeting has been held virtually since 2020, allowing for top legislative priorities to be addressed remotely and without a hiccup. BCMA President James Williams, MD, welcomed physicians and legislators to the event — many heading to Annapolis for the first time after primary election wins. More than twenty-five physicians registered for the event with more than one-third of Baltimore County’s legislative delegation in attendance to discuss the legislative agenda and clarify objectives. The discussion was moderated by MedChi’s own Gary Pushkin, MD, with Loralie Ma, MD (MedChi’s Immediate-Past President), Amit Bhargava,

MD, (BCMA Vice President), and Jill Allbritton, MD, fielding questions on legislative issues.

For the 2023 legislative session, BCMA’s House Call On Annapolis will be held in-person on Wednesday, February 22. 2023. With our return to the State Capitol, this is an opportune time to get involved in advocating for your profession.

Physicians will meet at the MedChi office on Main Street in Annapolis at 7:30 a.m. for a briefing on our top priorities before heading to the House and Senate buildings. Carpooling members will meet at 6:00 a.m. in Towson to travel to the event. After morning meetings with your district’s legislators, attendees reconvene at noon for lunch with colleagues and legislators, returning to Baltimore County afterwards. Meetings with legislators always occur in the morning to allow physicians ample time to return to work in the afternoon. Association staff will schedule your meetings with your legislators and provide you with reference materials and handouts.

Physicians who regularly attend our House Call and political fundraisers know firsthand that developing relationships with legislators is the best way to foment change. Time spent in Annapolis can yield long-term results that may ultimately benefit your patients and your profession. To get involved or to register for our next House Call on Annapolis, contact Russel Kujan at rkujan@medchi.org or 410.296.1232.

Volunteer As Physician of the Day and Get the Royal Treatment

During the legislative session, MedChi commits to providing a physician member to serve as Physician of the Day for the State Legislature. This volunteer commitment involves one day of service at the Capitol in Annapolis by providing basic medical assistance to legislators and staff as needed.

Physicians of the Day have the unique opportunity to interact with legislators on the House and Senate floors and get a first-hand look at the legislative process and how it affects the practice of medicine. It also lets Senators and Representatives get to know physicians outside of testifying and meeting with them on bills.

Your presence at the Capitol shows legislators not only your expertise but also your concern for the health of Marylanders.

MedChi encourages all members to volunteer for one day at the State Capitol during the 2023 state legislative session. Contact Chip O’Neil at coneil@ medchi.org

Volume 23, Issue 5 19
Component News
MedChi and
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BCMS Foundation Celebrates 50th! (1972 – 2022)

Volume 23, Issue 5 21
News
MedChi and Component
The BCMS 50th Anniversary Gala was held at the Maryland Club on October 8, 2022. Pictured top row, left to right: Jos Zebley, MD, BCMS Foundation President, greets University of Maryland medical students; Padmini Ranasinghe, MD, visits with Johns Hopkins medical students; Middle row, left to right: Dr. Zebley applauds Physician Community Service Awardees, Dr. Basil Morgan (left) and Dr. Athol Morgan, for their long-standing “Health Talk” call-in radio program on WEAA-FM. Allan Jensen, MD, and Gene Ransom congratulate Shani Kamberi, one of three recipients of a $10,000 medical school scholarship. (Scholars Melika Marani and Henry Shu were not in attendance. ); Bottom row, left to right: Willarda Edwards, MD, Gala Keynote Speaker, welcomes Maria Oliva-Hemker, MD, (representing retired The Johns Hopkins University School of Medicine Dean, Paul Rothman, MD) and retired University of Maryland School of Medicine Dean, E. Albert Reece, MD; both Deans were presented the Foundation’s Pinnacle Award; Camellus Ezeugwu, MD, BCMS President, teaches in the classroom… and on the dance floor!

MedChi’s Newest Physician Members

MedChi welcomes the following new members, who joined between October 7, 2022, and November 21, 2022.

Afifa Adiba, MD

Mohammed Aamir Ali, MD — Capital Digestive Care

Kamal G. Bangoria, MD — Life Line Corporation

Ramneesh V. Bhatnagar, MD — Capital Diagnostics, LLC

C.J. Cancino, MD

Nathan Deckard, MD — Eastern Shore ENT & Allergy

Maria Ramona Evidente, MD — Kaiser Permanente

Emily Kathryn Fay, MD — Kaiser Permanente

Anupam Garg, MD —Johns Hopkins School of Medicine

Peter Hinderberger, MD — Ruscombe Mansion Community Health Center

Katherine Julia Jacobson, MD — University of Maryland Medical Center

David Jeong, MD — Institute for Asthma & Allergy

Rebecca Kamil, MD — ENT Specialists of Shady Grove

Katherine Kirksey, DO — Poolesville Family Practice

Soriayah Zaghab-Mathews, MD — Children’s Medical Group

Rameen J Molavi, MD — Park Medical Associates

Basil S Morgan, MD — The Johns Hopkins Hospital

Robin Motter-Mast, DO —GBMC at Hunt Manor

James S Novick, MD — James Novick, MD

Charles Park, MD — Mercy Medical Center

Ravi Passi, MD, CMD, FACP — Advanced Primary and Geriatric Care

Andrew Robinson, MD — Multi-Specialty Health Care

Lee A. Snyder, MD — Crossroads Eye Physicians

Rashika Sood, MD

Andrea Christina Steel, MD — Center for Cosmetic and Clinical Dermatology

Bernesta Williams, MD

Michael B Williams, DO — Kaiser Permanente

MedChi Calendar of Events

A complete list of MedChi and component events can be found at: http://www.medchi.org/Calendar-of-Events.

JANUARY

Washington County Medical Society

Baltimore City Medical Society Board Meeting

MedChi President’s Meeting

MedChi Executive Component Meeting

MedChi Legislative Council Meeting

MedChi Board of Trustees Meeting

MedChi Executive Component Meeting

MedChi Legislative Council Meeting

MedChi Medical Students House Call in Annapolis

MedChi Executive Component Meeting

MedChi Legislative Council Meeting FEBRUARY

MedChi Executive Component Meeting

MedChi Legislative Council Meeting

MedChi President’s Meeting

MedChi Executive Component Meeting

MedChi Legislative Council Meeting

MedChi Board of Trustees Meeting

MedChi Executive Component Meeting

MedChi Legislative Council Meeting

Maryland Neurosurgical Society Board Meeting

Baltimore City Medical Society House Call in Annapolis

Baltimore County Medical Association House Call in Annapolis

Howard County Medical Society House Call in Annapolis

Anne Arundel County Medical Society House Call in Annapolis 27: Prince George’s County Medical Society House Call in Annapolis

MedChi Executive Component Meeting 27: MedChi Legislative Council Meeting

MARCH 1: Montgomery County Medical Society House Call in Annapolis

MedChi Executive Component Meeting

MedChi Legislative Council Meeting

MedChi President’s Meeting

Baltimore City Medical Society Presidents’ Gala

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The John Archer Collection

John Archer, MD, one of MedChi’s original 101 Founders, was the first person to receive a medical degree in the United States. He was the first member of the first class at the College of Medicine in Philadelphia to graduate on July 21, 1768, and therefore, the first graduate from medical school in America.

Archer was the father of six sons, one of whom was also a founder of MedChi, and operated a small medical school from his home, Medical Hall, in Harford County, Maryland.

The Center for a Healthy Maryland recently acquired a cache of books and ephemera (items of collectible memorabilia, typically written or printed ones, that were originally expected to have only short-term usefulness or popularity) originally belonging to John Archer. The book collection includes volumes from the late 1700s and early 1800s. Among the titles acquired include 1801 Six Lectures of Medicine, by Benjamin Rush, MD, delivered at the University of Pennsylvania; six volumes of A System of Surgery, by Benjamin Bell printed in London in 1791; and Lectures on the Materia Medica, by William Cullen, MD, printed in Philadelphia in 1775.

These and other recent acquisitions of rare books will be available to view by appointment after the first of the year. Please contact mfielding@medchi.org to make an appointment.

Volume 23, Issue 5 23 MedChi History
9/30/20

Presorted Standard U.S. Postage PAID Permit No. 425 Southern, MD

Maryland Medicine
Address Service Requested
The Maryland State Medical Society 1211 Cathedral St., Baltimore, MD 21201
GET FREE CME/CEU CREDITS WWW MARYLANDMACS ORG/ECHO Join our ECHO learning communities this fall! Primary Care Opioid Treatment Programs Maternal Health Calling all Maryland healthcare providers and teams who practice in the following settings: MACS ECHO Clinics | Fall 2022 Cycle Collaborative medical education to expand access to substance use care