Chicago Physicians Lead Change

Attacking practice burdens, scope intrusions, and recreational marijuana

AS THE STATE’S most active local group, the Chicago Medical Society unites and fights for physicians in Cook County. Not only is CMS the hardest working county; it is also the largest within the Illinois State Medical Society. So when ISMS’ annual meeting took place in early April, Chicago-area physicians came out in force, carrying more resolutions than any other region. Nearly all of CMS’ measures won adoption, and many are now up for prompt consideration by the AMA. At every level, CMS invigorates debate, advocating on issues that impact physicians in the state’s largest urban area. Here’s a recap of key measures that will shape the formation and introduction of local and national legislation.

Unpaid Patient Deductibles & Physician Staff Time
This CMS initiative attacks the burden on physician practices by seeking national legislation to bring an end to insurance company practices that make it the physician’s responsibility to recoup patient out-of-pocket costs and deductibles.
The resolution goes to the AMA for consideration this June.

Maintenance of Certification
A CMS effort to end high-stakes exams that don’t correlate with patient outcomes or reflect actual practice and provision of care. The measure calls for:
• The phase-out of all ABMS Boards’ use of mandated, periodic, pass/fail, point-in-time examinations, and quality improvement/practice improvement components of the MOC process, and their replacement with longitudinal and formative assessment strategies that provide feedback for continuous learning and improvement and support a physician’s commitment to ongoing professional development.
• The ABMS Boards to immediately begin the process of implementing longitudinal and other formative assessment strategies that support learning, identify knowledge and skills gaps, and help diplomates stay current, as per the recommendation from the Continuing Board Certification Vision for the Future Commission Final Report.
The resolution goes to the AMA for consideration this June.

Experience and Satisfaction Surveys
CMS backed this measure to ensure fairness and transparency when it comes to salaries and compensation for employed physicians. The resolution opposes:
• Any association between anonymous patient satisfaction scores (“loyalty scores”), or the coworkers’ observation reporting system, and employed physicians’ salaries.
• Any publication of anonymous scores or observation reporting directed at an individual physician.
• The use of any unsubstantiated and poorly sampled anonymous patient satisfaction scores or individually and anonymously posted patient or co-worker comments to formulate the salaries or other compensation for employed physicians.

Repeal or Fix the Physician Payment Sunshine Act
Backed by CMS, this measure addresses the reporting burden and hassle factor by:
• Seeking the repeal or significant modification to the Act.
• Increasing the monetary threshold for reporting and administrative simplification for physicians.
The resolution goes to the AMA for consideration this June.

Gender Bias in Medical Research
CMS endorsed this resolution that establishes best practices for removing gender bias from the review and adjudication of grant applications and submissions for publication in peer-reviewed journals. This will include removing names and gender identity from the applications or submissions during the review process.
The resolution goes to the AMA for consideration this June.

Anesthesia Care Delivery
This measure from CMS recommits to protecting patient safety in Illinois. As such, both CMS and ISMS will lobby against any legislation that seeks to expand the scope of practice including independent practice of nurse anesthetists.

HSAs for Direct Primary Care
A CMS initiative, this resolution helps primary care providers and their patients by pursuing federal legislation or regulation to amend appropriate sections of the IRS code to specify that direct primary care access or direct primary care medical homes are not health “plans” and that the use of HSA funds to pay for direct primary care provider services in such settings constitutes a qualified medical expense.
The resolution goes to the AMA for consideration this June.

Legalization of Marijuana for Recreational Use
A CMS measure comes in the wake of a new administration in Illinois, and potential movement to legalize marijuana for recreational use. This measure affirms:
• CMS and ISMS do not endorse legislation to legalize recreational marijuana in Illinois.
• All medical stakeholders, including CMS/ISMS, should have the opportunity to provide input into rulemaking or other processes establishing regulation of recreational marijuana.
• In the event recreational marijuana is legalized in Illinois, CMS/ ISMS will maximize the safeguards to limit adverse events and further advance scientific study.
• Urges lawmakers to slow the process of legalization in Illinois, so that stakeholders and experts alike have the chance to consider the societal impact of legalization and examine all the data from other states that have passed similar legislation.

Banning Edible Cannabis Products
Backed by CMS, this safety measure seeks a total ban on edible recreational cannabis products statewide and nationally.
The resolution goes to the AMA for consideration this June

Removing Ethylene Oxide as a Medical Sterilant
Advanced by CMS in response to the Sterigenics crisis, and the shuttering of the company’s Willowbrook plant, this public health measure urges:
• The substitution of ethylene oxide with less toxic alternatives, including hydrogen peroxide, steam, and other safer alternatives, which do not release carcinogens into the workplace or community air and allow no residual exposures to the patient.
• The prevention of emissions or the phase-out of EtO and replacement with other safer methods of sterilization in health care.
• The prioritization of safe sterilization modes when health care facilities evaluate surgical and medical devices that require sterilization, not only for best patient outcomes, but also for the highest degree of worker and environmental safety.
The resolution goes to the AMA for consideration this June.

Direct-to-Consumer Genetic Tests
This CMS initiative updates and extends privacy safeguards by:
• Amending the nation’s privacy laws to protect genetic testing results, by working with HIPAA, HHS, and others to modify the rules to prevent genetic testing entities from transferring the date of birth and state of residence to third parties.
• Working with the Illinois legislature and the U.S. Congress and HHS to extend the protections of the Genetic Information Non-Discrimination Act (GINA) of 2008 by adding long-term care, disability insurance, and life insurance to the Act.
The resolution goes to the AMA for consideration this June.

Herbal Remedies and Dietary Supplements
A CMS resolution renews the fight to regulate questionable products. The measure:
• Creates new policy that ingredients of all herbal remedies and dietary supplements sold over-the-counter be analyzed and their contents indicated on the labels.
• Prohibits advertising of products in such a way as to suggest they have a therapeutic effect.
• Calls upon the National Center for Complementary and Integrative Health (NCCIH) to institute stricter guidelines for advertising and labeling.
• Establishes a licensing body to regulate dietary supplements and herbal remedies, with the requirement that manufacturers supply proof that their products have health benefits.
• Requires manufacturers to pay for the cost of regulation.
The resolution goes to the AMA for consideration this June.

Post-discharge Topical OR and ER Medications
A CMS initiative reduces wastage and cost to patients by:
• Amending the Illinois Pharmacy Practice Act to state that topical antibiotic, anti-inflammatory, dilation, and glaucoma drops and/or ointments used in the hospital OR, ER, and other facilities from stored stock supplies on standby, retrieved from a dispensing system, or brought in from an outside pharmacy, may be provided on discharge to a specific patient.
• Working with state agencies to ensure that all facilities are in compliance with the Act to properly counsel, label, and dispense applied, unlabeled OR- and ER-derived topical medications to patients on discharge.
• Incorporating the amendments into policies in Illinois.

Treatment for Opioid Addiction
Backed by CMS, this measure ensures patients would have access to comprehensive treatment. The resolution:
• Calls for introducing Illinois legislation to prohibit health insurers from denying medication assisted treatment for substance use disorders and from requiring prior authorization for medications used to treat opioid use disorders.
• Encourages the potential use of model state legislation from the AMA to develop and implement legislation in Illinois.

Accessibility of Contraception
CMS supported a measure that expedites standing orders and physician follow-up as follows:
• A standing order from either a public health director (if a physician) or a medical director of a department of public health (if not a physician) for Short-Acting Hormonal Methods of Contraception and Contraceptive Injection (as defined by the FDA) to individuals not at risk. This would be determined via a selfscreening risk assessment tool, with confirmation by a pharmacist
• To ensure patient safety, pharmacists should strongly encourage patients to schedule a follow-up visit to a physician within one year of receiving the injection.
• During that follow-up visit, physicians should verify that patients are not at risk, as determined through the screening risk assessment tool. The State should monitor who receives the injection through the standing order, for purposes of follow-up.