Tennessee Medical Association Legislative Agenda: 2009 on Nashville Medical News

Tennessee Medical Association Legislative Agenda: 2009

By: BRENT R. MOODY, MD

A Conversation with Newton Allen, MD

Newton Allen is chairman of the Tennessee Medical Association's (TMA) legislative agenda committee. He is a Memphis native and graduate of Vanderbilt University School of Medicine and internal medicine residency program, and has been in practice with the Saint Thomas Medical Group since 1989. He has served on the legislative committee for the past six years.

NMN: How did you become interested in your current position with the TMA?

I have always been interested in what happens with regard to legislation. I have become more involved with an increasing realization of just how important it is. Many young physicians coming into practice have no idea that their ability to practice medicine is completely controlled by the state legislature in downtown Nashville. Our 99 representatives and 33 senators write the rules and regulations which determine the practice of medicine.

What is the role of the TMA Legislative Committee?

We perform three main functions: We analyze bills that are proposed in the state legislature, we promote the TMAs agenda in the state government and we interact with our federal legislators as well.

Tell us about the first role you mentioned; analyzing bills that are put before the legislature.

Each year in the state, about 2000 bills are introduced. Usually 400 of them will affect the practice of medicine, which is really an unbelievable number. Twenty percent of all the bills introduced affect medicine in some way: insurance, scope of practice, all sorts of things that are related to medical care. These bills are commonly proposed to the legislature by some special interest group or other organization. Obviously each legislator can't be an expert in medical matters, so our job is to make sure our message is heard and that they fully understand issues before them.

How effective is the TMA in influencing the process in a way that is helpful to patients and physicians

The TMA is actually very effective. We have two very good full time lobbyists. No other medical organization in this state has this resource. Our lobbyists really know their way around the legislature. I work very closely with them. During the legislative session I'm in communication with them nearly every day.

How does the TMA set its legislative agenda? Who makes that decision?

It starts at the grass roots level with our House of Delegates, issues are brought to the TMA House of Delegates and we discuss them at a yearly meeting. A proposal will be voted up or voted down and that actually sets the agenda. However, we still have to prioritize. We have to decide what is most important and where do we really want to spend our political capital, because it's limited. The legislators get tired of seeing us and hearing us and they'll only do so much. The legislative prioritization is usually something that is determined at the TMA leadership level.

How does the TMA go about promoting its agenda?

When we at the TMA look at a problem that we want addressed, there are three things that we do. The first, the easiest, and possibly the best is to talk to the company or organization and negotiate with them separately. We don't involve the legislature at all. Failing that approach, we look at regulatory possibilities. What can the state regulatory agencies do to help remedy the situation? The effort of last resort is to actually take a piece of legislation to the hill. This is our last tactic, because the legislation gets amended and then after it's amended, it has to be passed. If it is passed, then it has to be interpreted to allow for implementation. There can be a gap between what's written and what the intention was and what actually eventually happens. There are all sorts of unintended consequences.

What are some of the goals that the TMA has for 2009? What would you like to see accomplished and what do you realistically think may be accomplished?

First you should understand that typically an organization will have one thing that they hope to get done. The TMA is different; we usually have several things that we have to get done. This is understandable, of course, since we have our items, but must also weigh in on those other 400 pieces of legislation that influence medicine. I think it's important to have that perspective, to realize that we do a lot even without our own agenda.

One area that we hope to focus on is the relationship between insurance companies and physicians. We have some efforts at leveling the playing field between insurance companies and physicians. There are several different areas that we're talking about. One I can mention is the whole process through which disagreements are settled between insurance companies and physicians. There are inequities in the way all these contracts are written, and we're working on that.

We spent a lot of time prioritizing what the issues are. However with the change in control of the Legislature, a new Speaker of the House and new committee assignments, there is some uncertainty. This is the first time we will deal with a Republican majority General Assembly. Even knowing what we can get out of committee is uncertain. The change in leadership may make some things more feasible but others may face the same fate.

As I mentioned earlier, we are also involved on the federal level. We have a good Tennessee delegation. We lobby at the federal level as well as we see these folks locally and sometimes in Washington depending on what's going on and how pressing the issue is. Since I've been the chair of the legislative committee, we certainly have made a lot of effort with regard to the Medicare Sustained Growth Rate (SGR) and with liability reform at the federal level.

Medicare's SGR controls physician reimbursement updates and it's a real problem. In 11 months there will be a 21 percent cut in physician reimbursement. Eventually, it's going to be a 40 to 50 percent cut. These cuts will absolutely drive physicians out of business. At the federal level, it will take $300 billion to fix SGR over 10 years. While that is a lot of money, it seems small compared to the kinds of figures we hear out of Washington for the financial crisis bailout. We will obviously be paying close attention to Medicare issues and any federal healthcare reform legislation.

Dr. Brent Moody is the founder and medical director of the Skin Cancer & Surgery Center in Nashville. Dr. Moody is a Mohs Micrographic Surgeon and skin cancer specialist.