• Specialty Group Spotlight: Allegheny County Immunization Coalition

    Introduction by: Melanie Mayer, ACMS Marketing and Administrative Assistant

    Blog by Vice President of the ACIC Ashley Ayres MBA, BS, CIC
    Director, Infection Prevention
    UPMC Presbyterian Shadyside Infection Prevention and Control

    The Allegheny County Medical Society provides association management support to several specialty associations. ACMS staff members provide administrative support and resources to these smaller groups who do not require a full-time staff member to support their operations. Recently, the Allegheny County Immunization Coalition (ACIC) signed a contract to receive administrative services from the ACMS. The ACIC is a great resource for many physicians in Allegheny County. We asked Executive Committee member Ashley Ayers to share the history of the Immunization Coalition and how ACMS members can get involved in this local organization.  

    Ashley Ayers: The Allegheny County Immunization Coalition (ACIC) was formed 17 years ago in 2006, after separating from the southwest coalition.  Since then, this group has focused its time and energy on understanding the current needs of immunization, educating individuals on the importance of immunization, and helping provide services to those needing to receive immunizations.  The focus of this organization is to ensure the the citizens of Allegheny County are informed and protected from preventable diseases. Members of this coalition are physicians, nurses, pharmacists, teachers, and other health service staff.

    The ACIC supports ongoing educational efforts to ensure that the public and healthcare providers are informed on the most up to date information. Since 2006, the ACIC has hosted an annual conference. This conference provides a great educational opportunity to learn from experts in the field about vaccination and the science behind where it is needed. Past conferences have included medical representatives from the CDC, nationally recognized vaccine expert, Dr. Paul Offit, Allegheny County Health Department experts, and well-known local vaccine providers.  We look forward to announcing our 2023 Conference date in the coming weeks (tentative for the beginning of October 2023 at the Doubletree Monroeville).

    In addition to the Conference, the ACIC spends time working with the underserved populations in Allegheny County, as well as children in schools, to help improve the vaccination rates.  Year over year the nation has seen a decline in vaccination rates in school age children.  The ACIC helps review the data that the county receives to help align resources where vaccine education is needed, and then coordinate ways to share the education with those communities.

    The ACIC has provided so much to many individuals in Allegheny County, but it has also meant a lot to those who are members of the organization. I asked some of the other leaders of the ACIC what this group has meant to them. One of the key takeaways from several of the longtime members, was the value of working with interdisciplinary teams in other professional environments to help figure out the barriers in lack of compliance with vaccination.  First and foremost, this organization has helped the community and increased vaccine awareness, but secondary to that, it has helped our members develop professional relationships with colleagues they would not normally work with.  It has created meaningful connections and better communication amongst those who truly wish to make a change in the way we discuss vaccinations in the county.

    Seventeen years seams like a long time, and this group has done so much with that time, however there is much more that can be done to help promote the importance of vaccination.  Membership is free and any interested person can become a member by visiting the ACIC website. Together we can prepare the next generation to be safe and protected from preventable diseases. 

    For more information on the ACIC, contact Melanie Mayer at mmayer@acms.org.

  • FTC Proposes a Rule to Prohibit Non-Compete Agreements

    Article written by: Jeremy V. Farrell, Esq., Ryan James, Esq. and Michael A. Cassidy, Esq. of Tucker Arensberg, P.C.

    On January 5, 2023, the Federal Trade Commission (FTC) took a dramatic step by proposing a new rule that would prohibit companies from entering into non-compete agreements with its workers. The proposed rule, if approved, takes sweeping action to prohibit employers from entering into non-compete agreements with both employees and independent contractors. And the proposed rule does not stop there. It would also require that employers take affirmative steps to rescind existing non-compete clauses and explicitly inform workers that the contracts are no longer effective.

    As of right now, the FTC’s rule (available here) is merely a proposal, and the agency is soliciting public comments on whether any changes should be made before it is finalized. Litigation challenging the enforceability of the rule is almost sure to ensue, and the U.S. Chamber of Commerce has already threatened to sue to FTC over its proposed non-compete ban.

    Regardless of whether or not the FTC rule is adopted, physician non-compete agreements are closely scrutinized in Pennsylvania under a multi-tiered analysis because of the value of doctors’ services to the public. Initially, the covenant in order to be enforceable must be “reasonably related to the protection of a legitimate business interest*.” As recognized in Wellspan, this type of interest includes showing that a non-competition provision is necessary to protect such things as trade secrets and confidential information, unique or extraordinary skills, customer goodwill, patient relationships, patient referral bases, and investments in an employee’s specialized training. If a post-employment covenant merely seeks to eliminate competition and is not designed to protect a legitimate business interest, it will not be enforced.

    If the threshold requirement of a protectable business interest is satisfied, courts will then balance the employer’s interests against that of the employee to find other work in her field and earn a living. Under this factor, the temporal and geographic restrictions imposed on a former physician must be reasonably limited**. If not, the non-compete provision will not be upheld.

    After the second step, the interests of the public will be assessed as they are of “paramount importance in the context of non-competition covenants for physicians.” This in essence means that courts will examine whether there is a shortage of physicians in the particular practice area in the relevant geographic region. If patient demand in the geographical area exceeds the ability of appropriately trained physicians to provide expeditious, skilled treatment, the public interest supersedes a right to enforce a non-compete agreement. Following Wellspan, courts in Allegheny County have viewed this factor as critical*.

    As we can see, even without the implementation of the FTC rule, an employer faces significant hurdles in attempting to enforce a physician non-compete agreement.

    Furthermore, many early comments suggest the FTC proposal would not apply to non-profit healthcare systems, based upon the FTC’s actual jurisdiction and the definition of “employer” in the proposed rule itself. Given the prevalence of non-profit healthcare systems nationwide, and especially in Pennsylvania, it remains to be seen whether this rule would have any significant impact in the healthcare arena.

    The Allegheny County Medical Society has been collaborating with various Pennsylvania state legislators over the past few years to restrict or eliminate physician restrictive covenants. The most recent legislative action was the introduction of HB 681 of 2019, the Healthcare Practitioner Non-Compete Agreement Act, which has not been passed. This was an effort to limit this scope and impact of physician’s non-competes. However, as the trend of employing physicians increases, with tens of thousands of physicians employed by healthcare systems rather than private practices in Pennsylvania, there is less support for eliminating restrictive covenants. Organized medicine actively supports and enforces the use of restrictive covenants even the relatively few remaining private practices seem to utilize restrictive covenants.

    *Wellspan Health v. Bayliss, 869 A.2d 990 (Pa. Super 2005).
    ** Wellspan
    *** See Allegheny Specialty Practice Network v. Joseph J. Colella, M.D., GD No. 09-006813 (C.C.P. Allegh. Co.) (Ward, J., Opinion entered on Sept. 9, 2009, p. 27) (noting that a physician non-compete was enforceable because there was no shortage of bariatric surgeons in Allegheny County).

  • “Physician, Heal Thyself”

    By: Natalie Gentile, MD – Family Medicine Doctor

    With the new year inevitably comes new year’s resolutions. By definition, resolutions are resolute, finite, inflexible. On the other hand, there are intentions. These are more fluid ideas and goals toward which we can aim. If we don’t reach those goals, intentions can be readdressed and reset. Resolutions are either kept or not. This black and white, all or none mentality is so common in our society – and, especially in high achieving, type A individuals (like many physicians) it is the norm. When we pigeon-hole into wellness resolutions that are not sustainable, it can feel hopeless and discouraging. This, coupled with the minimal amount of time we all have for ourselves in the first place, worsens the uphill battle to check off the self-care box on our endless to-do list.

    We use this term “self-care” because it is catchy and all-encompassing, but what does it really mean? The Oxford dictionary definition of “care”: the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something. So, theoretically, if you are caring for yourself, you are seriously considering your health and welfare. This is what we are doing for patients everyday, but when the tables turn and we look in the mirror, how much consideration do we have leftover to give to ourselves?

    “Physician heal thyself”. The quote popped into my head the other day while sitting down to write this post. I couldn’t remember where it originally came from, so I did some digging. Turns out (and maybe if you’re reading this, you’re saying “duh, Natalie”) it comes from the Bible. The excerpt in Luke where this quote resides highlights the challenge for healers to turn the healing back onto themselves. If we can’t heal ourselves, then how can we be expected to heal others?

    Unfortunately, most physicians have little to no control over their work schedules. The traditional healthcare model lends itself to inflexibility when you’re at work, and immense amounts of work you then take home to play catch-up. In my direct primary care practice, where I work for myself, it allows for significantly more control over my own schedule, but even then I have to make self-care a priority. If we don’t fight for that time, then we will quickly get bulldozed over with work, family, and life commitments.

    I’ve often felt like my self-care routine is like a fire drill. A day comes around that I suddenly have a block of time available, and I frantically call every massage therapist and salon in town asking for a last minute appointment. Inevitably, there never is a last minute appointment available. And I’m left feeling defeated and embarrassed. Mainly embarrassed that I didn’t plan ahead enough to carve out time for myself.

    So what are some ways that we can make self-care less of a pie-in-the-sky fire drill, and more of an appointment with ourselves that we hold as sacred as a patient visit. First, I recommend scheduling it like any other commitment. Planning your workout, meditation session, hair salon visit, date-night, etc. in your calendar increases the chances you’ll stick to it. Second, know your worth in the workplace when it comes to your wellbeing. Most employers, especially in healthcare, aren’t going to go out of their way to make your self-care time a priority. But they need you more than you need them. Advocate for yourself and for your input about your schedule. Lastly, have self-compassion. The shame we feel when we don’t take care of ourselves is not going to get us anywhere. Recognize that you are not alone and that it is hard for most of us physicians to heal ourselves. The journey to self-care is non-linear. The intentions we set need to be flexible, malleable, and most importantly: realistic.

    Follow Dr. Gentile on social media via @nataliegentilemd on Instagram and on Facebook. Learn more about Rebel Wellness at rebelsinwellness.com and @rebelwellnessllc on Instagram.

  • POLST Legislation and Education Are Key to Successful Implementation

    By: Lisa George, MPH, CHES – Jewish Healthcare Foundation

    The POLST (Pennsylvania Orders for Life-Sustaining Treatment) form has been used in Pennsylvania since 2010 (and the Oregon POLST form in use from 2000 to 2010)—providing a standardized way to translate patients’ wishes for care into actionable medical orders. Given this long history of use, it may be surprising to many that the Commonwealth does not have legislation on the books related to POLST. That, however, may soon change.

    Pennsylvania State Senator Gene Yaw (R – District 23) announced that he will be reintroducing POLST legislation, previously SB 572 of the 2021–22 session, in the Pennsylvania Senate this session. The legislation will update and revise Pennsylvania law (Title 20) to include the codification of “Pennsylvania Orders for Life Sustaining Treatment (POLST)” to be used by medical professionals across all healthcare settings for patients who voluntarily wish to execute a POLST order. It also would result in discontinuation of the Out of Hospital Do-Not-Resuscitate orders. POLST legislation is critical to ensure appropriate use of POLST across the Commonwealth, in the appropriate populations, as part of a conversation about wishes for end-of-life medical care. More information on Senator Yaw’s plans for reintroduction is available here.

    A crucial part of effective POLST implementation, whether POLST is codified into legislation or not, is standardized education for healthcare providers on appropriate use of POLST. The PA POLST Learning Center is a new continuing education resource that provides access to a library of on-demand trainings on POLST—all of which offer free continuing medical education and continuing nursing education credits. Developed by a multidisciplinary, statewide curriculum committee, the training equips healthcare providers with tools to hold conversations with seriously ill patients and their loved ones about treatment options near the end of life and to document the patient’s wishes via a POLST form—translating their wishes into portable medical orders. Previously, the only option for POLST education was via in-person trainings. The new on-demand virtual curriculum enables providers to gain valuable skills in having POLST conversations when and where it is most convenient for them. Topics include an introduction to POLST and advance directives, POLST conversations, POLST tools, POLST implementation, Medicare reimbursement for advance care planning conversations, case-based conversation scenarios, POLST and EMS, pediatric considerations, and cultural humility. This project was supported by a grant from the McElhatten Foundation to enhance access to POLST education and resources for healthcare providers and personnel throughout Pennsylvania.

    To stay up to date on POLST legislation, education, and resources subscribe to the POLST Notes newsletter. Visit www.papolst.org to sign up. For more information on the POLST educational offerings or answers to your questions about POLST, contact info@papolst.org.

    Lisa George, MPH, CHES is the PA POLST Coordinator and Senior Communications and Program Specialist at the Jewish Healthcare Foundation.

  • Supporting Caregivers of Patients with Dementia

    By: Amy Kowkinsky – Director, Dementia360 Program

    It’s challenging for doctors to give family caregivers the support and guidance they need during infrequent and brief office visits, especially if the person living with dementia is there.

    Though your actual patient may be the person with dementia, it’s likely that it’s the family caregiver who is most in need of your support. Often they feel unprepared, alone, and overwhelmed with the role of caregiver for a loved one with dementia.

    First, let them know that life does not prepare anyone to be a dementia caregiver and, secondly, they don’t have to face this alone—it’s never too early or too late to ask for help. Everyone is impacted by this disease in a different way. Finding answers and solutions to the challenges of daily life with dementia is a very personal journey, a journey no one should have to go on alone.

    Dementia360 Can Help

    The Morris family shares their dementia journey and how Dementia360 provided support, education and guidance along the way.


    Designed specifically for the family caregiver, the highly skilled Care Coordinators at Dementia360 provide the support, resources, connections, and ongoing coaching caregivers need to keep people with dementia at home – living comfortably and safely, for as long as possible.

    Dementia360 helps families wherever they are on their journey to:

    • Understand and accept a new dementia diagnosis,
    • Develop good habits to shape the disease as it progresses,
    • Overcome behavioral challenges,
    • Have a life that is better because they have the confidence, skills, and support to be successful.

    To learn more about Dementia360 or to make a referral, call 412.435.8950, email Dementia360@SrCare.org or visit our webpage at PSCNDementia360.org.

  • Non-Competes: What’s Happening to Your Employment Contract?

    The ACMS, in collaboration with the Philadelphia County Medical Society, has put forth this blog post as informational-only. The ACMS team is keeping a pulse on the ongoing FTC proposed rule change regarding non-compete clauses and we will continue to update members accordingly. Restrictive covenants have been a hot button issue that the physicians of Allegheny County have been very vocal about over the years. We will continue to work collaboratively with the Pennsylvania Medical Society, and our counterparts in other parts of the state, to ensure we are advocating properly for the physicians in Western Pennsylvania.

    Here’s what is happening nationally:

    In January, the FTC proposed a new federal rule that would ban all non-compete clauses, except for in a few limited exceptions, and would require companies to rescind any existing non-compete agreements at the time of the rule’s effective compliance date.  The proposed FTC rule would apply to all businesses including healthcare, such as physicians practices and hospitals. Healthcare in some states, like Pennsylvania, have relied heavily on non-compete agreements, and should the proposed rule be finalized, it would have a significant impact for physicians and those healthcare institutions that employ physicians.

    The proposed rule was published in the Federal Register, which then triggered a 60-day public comment period which opened Jan 9, 2023. Once a final rule is published, it will become effective 60 days after publication, and compliance is mandatory 180 days after publication. To learn more or to submit a comment:  FTC Non -Compete Comment.

    Here’s what is happening in Pennsylvania:

    The Commonwealth is one in a minority of states that have no laws on the books to limit the use of restrictive covenants, also known as non-competes.  Back in December, several State House Representatives sought to to re-introduce a bill, formerly (HB 681) in the next legislative session: Barring Non-Compete Agreements in Healthcare Employment.

    PAMED policy has always looked for a compromise and sought to protect the interests of both employers and practitioner employees.

    To learn more, please check out:  Restrictive Covenants – Why It Should Matter to All Physicians Regardless of Practice Setting.

    What’s Next?

    ACMS legal counsel will be working on a more detailed blog post that will provide additional, and specific, updates to this proposed rule.

    If this issue is one that you are passionate about, you are urged to not only comment through the FTC comment link but you should also reach out to your local representative.

    Below are some additional articles that cover how a ban on non-competes would impact the Healthcare profession:

    FTC Official Press Release

    JDSupra: FTC Proposes Broad Rule Banning Non-Compete Covenants with Physicians and Other Healthcare Workers

    Fierce Healthcare: How FTC’s noncompete agreements rule could impact healthcare

    We want to hear from our members. If you have comments/concerns on non-competes, please contact us at acms@acms.org.

  • Mental Health + Wellness by Jordan Corcoran

    As the topic of mental health becomes more popular by the day, phrases like “prioritize your mental health” and “check in with yourself” are being used constantly, but what does it mean and how do we apply it to our very hectic schedules?

    As the Founder of the mental health organization, Listen, Lucy, an advocate, a wife, a mother of two little kids, and someone who lives with mental illness, I know how daunting and impossible it feels to add one more thing to the chaos. I also know what it is like to crash and burn because I couldn’t figure out how to manage my anxiety. We all need to find a happy medium.

    I have a few great coping techniques to share with you that I have been using for almost 20 years. The best part about them is that they are quick, easy, and accessible.

    1. Breathing techniques. I cannot express to you enough how important my breathing technique has become. For almost 20 years, I have been breathing in for 6 seconds, holding it for 8 seconds, and breathing out for 4 seconds on repeat. There are so many different versions of breathing techniques out there. Find the right one for you and you can cope with anxiety, a bit better, from anywhere.
    2. Fresh air. There are no two ways about it, Covid disrupted our routines and a lot of us stayed inside for days at a time, never getting out to breathe in fresh air. While that wasn’t the case for those in the healthcare industry, I can’t imagine the true chaos and burnout you have all endured through the worst of it and the aftermath. Taking 5 to 10 minutes to walk outside, without your phone if possible, and breathing in that fresh air is a way to separate for a minute without disrupting the work day.
    3. Exercise and healthy eating. We know how important exercise is for our physical health, but it has always served my mental health because it is my sanctuary and a place of my version of meditation. It is my time to shut the rest of the world out, blast my favorite music, and let my mind rest. Now when it comes to my diet, I am a girl that loves a slice of pepperoni pizza and a giant bag of Doritos, but everything in moderation. I find that when I eat healthy, I feel good physically. When I feel good physically, I can focus mentally.
    4. Apps. By a show of hands, how many of you have cell phones? (That’s a little joke I like to do when I am speaking in person. I am not sure it translates to text, but I hope you laughed.) There are so many apps and websites on your phone that are wildly beneficial and right at your fingertips. Here are a few of my favorites.
      1. Xhalr.com (breathing technique)
      2. TalkSpace (therapy)
      3. HeadSpace (meditation)
      4. BetterHelp (therapy)

    There are so many other options for coping techniques out there and I would venture to say I have tried most of them. I chose these specific ones to share with you because I wanted to be realistic on your approach and give you options that are doable without making major adjustments to your life. They are things that may have slipped down on the priority list without noticing how they could negatively impact your mental health.

    In case it has been a while since someone has told you, what you do is so important. How you showed up for your community during the pandemic was so heroic. Feeling overwhelmed or anxious or depressed – or whatever you are feeling– is so valid. Please, take some time to prioritize yourself. To check in and to make small, digestible steps to improving how you are doing mentally. You deserve the attention and support that you all so freely give to others.

    If you would like more ideas, I have tons of them. Feel free to email me at jordan@listenlucy.org.

  • Don’t Drop the Ball this January

    “Putting Self Care in Health Care” campaign comes to a close with great workout at Orangetheory Fitness in September 2022!

    In the United States, we have historically invested far more into treating sickness than we have in maintaining health. It is common knowledge that the past few years of crisis has placed tremendous mental, emotional, and physical stress on medical personnel. As the world rapidly changed and the stress placed on our medical system was at all-time highs, the idea of protecting physician well-being was no longer a lofty ideal. The impact of physicians trying to balance caring for patients with concerns of their own health, and that of their family, formed a turbulent downward spiral, creating behavior incongruent with what they stand for.   

    Self care has proven itself to be a strong answer. Life was the airplane in a state of emergency, and the pandemic was an unkind reminder to put on your own oxygen mask on before saving others.  

    For the physicians in Allegheny County, the question of how to best care for caregivers, has been asked and answered in multiple ways. Hospital systems delivered personal protective equipment, enforced social distancing guidelines when needed, created phone lines to address community questions, and focused on clear communication. They also reorganized clinical and surgical procedures, helped physicians navigate new virtual options, and fostered a community of peer support through phone lines and counseling options. 

    The city of Pittsburgh has never been a community to shy away from helping their own.  After the darkness of COVID-19 eventually passed and local businesses began to reopen their doors, they rallied together to offer medical professionals support and discounts. It was their way of saying “thank you” for going through the trenches and keeping us as safe as possible. These businesses are hoping their offers help physicians disconnect from work and find the joy in the little things again; a sweaty workout, a drink with a friend, a clean house, and some R&R are just some examples.  

    Below is a list of some of the great discounts to help our physician members move into 2023 as the healthiest versions of themselves. ACMS encourages you to visit these businesses, mention your physician career, and receive a discount on their product or service: 

    • Trace Brewing has an ongoing offer of $1 off any alcoholic beverage or coffee drink for anyone working in the medical field. In addition, every Tuesday from 4:00-8:00pm, they have a happy hour where the first drink is free! 
    • Enjoy Rest Active’s offer for healthcare workers for THREE FREE SERVICES! Just mention that you saw this blog or let them know you are a healthcare worker.
    • Adda Coffee and Tea House gives all healthcare workers a discount of 15% off. Adda has 5 locations in the Pittsburgh area, and they are all equally inviting, cozy, and perfect for that morning coffee run or midday break.
    • Clean Day Housekeeping’s offer to healthcare workers: 20% off your first clean! This is an ongoing offer in support of all our healthcare workers and everything that they do.  
    • CycleBar Robinson has an ongoing discount for healthcare workers, offering 20% off. Email: robinson@cyclebar.com for more information. 
    • CycleBar North Hills offers healthcare workers 50% off their first month of a monthly membership. In addition, healthcare workers will receive a lifetime discount of 10% every month after.
    • Lululemon has a 15% discount for all first responders. This is an ongoing offer and can be used at any time with a valid work ID.
    • With the code Doctors988, healthcare workers can get 20% off packs and memberships at  Steel House Cycle, Located in Lawrenceville.
    •  Take advantage of this meal prep promotion from Longevity Life! They offer 20% off with the code SAVESLIVES20 to all healthcare workers.

    As Helen Keller once said “Your success and happiness lie in you. Resolve to keep happy, your joy and you shall form an invincible host against difficulties.”  May your 2023 be full of the kind of days you want to see more of. 

  • ACMS Year in Review

    What a Year it has Been!

    ACMS 2022 Board of Directors

    This blog post is coming right off the heels of the December 6th ACMS Board of Directors meeting; the final board meeting of 2022. It’s hard to believe that 2022 is already ending, but when I reflect back to March of this year, when I started my role as Executive Director, I am in awe of how much we have accomplished in just a few short months.

    I’ll briefly hit the high notes of 2022. I say “briefly” because the team at ACMS is already preparing to hit the ground running to move forward into 2023. But without a doubt, we accomplished quite a bit in 2022. The ACMS has adjusted, shifted, added, removed, replaced, reorganized, and realigned in so many ways. With the hard work of the ACMS Board of Directors, and the diligence and support of the Executive Committee, ACMS is ready for a transformational 2023. We took 2022 to “get our house in order”. We are fully staffed. We have reinvigorated the work of our managed specialty groups. We have realigned with community partners. The ACMS Foundation issued over $200k in grants to local organizations. We launched new programming. And, as you will see in the election report included in the December edition of the bulletin, the membership elected a diverse and energetic board for 2023. With all that reorganizing work behind us, we look forward of moving into 2023 with the intention and focus.

    After we reminisced about 2022, we spent the bulk of our board meeting talking about where we will go in 2023. Your board set three primary goals for the next year. They will focus on membership, including benefits, value, education, and connection. They will focus on local advocacy, with the continuation of the Local Physician Advocacy ad-hoc committee that was launched in Q4 of 2022. And they will establish one additional ad-hoc committee that will focus on the future direction of the ACMS Bulletin.

    The ACMS Team (Jordan Corcoran, Sara Hussey, Nadine Popovich, Mel Mayer, and Eileen Taylor)

    Outside of the work that will happen at the board level, the team at ACMS looks forward to a few key initiatives. Early in 2023, we’ll launch our newly redesigned website. We’ll be working to establish a women physicians networking group. We’ll add additional CME options for those wishing to take part in local, in-person training. We will work alongside newly elected state representative, and ACMS member, Dr. Arvind Venkat, on advocating for issues that matter the most to physicians. We will provide opportunities to get ACMS members in front of local and state legislators. We will combat medical misinformation by getting ACMS members in the press to talk about the medical issues facing our community. We will continue to tweak and update member benefits for all our membership types, including residents and retired members. And we’ll continue the important work of the ACMS Foundation.

    We are excited about the opportunities that are ahead in 2023. In the January edition of the Bulletin, you will hear from the 2023 leaders of ACMS. As of January 1, we will welcome Dr. Matthew Straka as the 2023 ACMS Board President. Dr. Peter Ellis, immediate past president, will become the Chair of the Board of Directors for 2023. We encourage members to reach out to Dr. Straka, Dr. Ellis, or anyone on the ACMS team with feedback, questions, comments, and concerns. We want to hear from you!

    I wish the best to you and your families this holiday season. Thank you for allowing me to be part of such a tremendous organization. I am inspired every day by the work of our members, and I look forward to all that we will accomplish together in 2023.

  • Prior Authorization Reform

    What is Act 146 and what does it all mean?

    On November 3, 2022, Pennsylvania Gov. Tom Wolf signed PA Senate Bill 225 into law as Act 146. This new law does not eliminate prior authorization but it does aim to streamline the prior authorization process. It provides parameters that govern the relationships between patients, providers, and insurers for health care coverage decisions.

    Pennsylvania will now join 44 states that already have external review authority. In addition, the new law also lays out standards for the review of prior authorization requests and confirms in state law that there may be no prior authorization for emergency services, consistent with the Federal No Surprises Act.

    Prior Authorization: A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.

    https://www.healthcare.gov/glossary/preauthorization/

    When it comes to legislation, you might feel overwhelmed as soon as you start to dig into a new bill or law. Having that legislation broken down into more simple, bite-sized pieces can be helpful in understanding the breadth of its impact.

    Earlier this week, I was with two staff members from the Pennsylvania Medical Society’s legislative team. They helped break down the new law in a way that made it much more digestible for me to understand. Here is a summary of some of the main components of Act 146.

    What is Act 146?

    At its core, the legislation streamlines the prior authorization process, improving the sequence of events, ending with a quick and timely turnaround to move patient care forward.

    Phase 1: Meet the New Provider Portal: Within 18 months of the effective date (01/2023) of this specific section of Act 146, insurers/MA/CHIP are required to have established a provider portal on their publicly accessible website that includes electronic submission of prior authorization requests, access to applicable medical policies, information regarding how to request a peer-to-peer review, contact information for the insurer’s relevant clinical or administrative staff and instructions for submission of prior authorization requests if the portal is unavailable for any reason. Within six months following the establishment of a provider portal the insurer/MA/CHIP shall make access to training available to health care providers and their staff on the use of the portal. This is Section 2153 of Act 146 and it is the first section that will go into effect. The rest of Act 146 will go into effect January 2024.

    Phase 2 – January 2024

    Closely Related Procedures: Act 146 will allow physicians to bill insurance companies for “closely related procedures”. This means that if a patient is getting care for an already covered issue, and the doctor identifies a condition that could lead to future complications, the doctor can address the condition immediately without having to get second authorization for a service.

    Emergency Services: Section 2116 of Act 146 states that insurers/MA/CHIP can’t require a health care provider to submit a request for prior authorization for an emergency service.

    Step Therapy: Act 146 will create a basic framework for step therapy requirements. If an insurer/MA/CHIP has a medical policy that includes step therapy criteria for a prescription drug it must include, as part of its prior authorization process, a request for an exception to its step therapy criteria. A request for an exception shall be evaluated based on the covered person’s individualized clinical condition and consider contraindications, clinical effectiveness of required prerequisite drugs, expected clinical outcomes of the requested drug and whether the required step therapy criteria has already been satisfied under a previous insurer.

    Step therapy, also called step protocol or a fail first requirement, is a managed care approach to prescription. It is a type of prior authorization requirement that is intended to control the costs and risks posed by prescription drugs. The practice begins medication for a medical condition with the most cost-effective drug therapy and progresses to other more costly or risky therapies only if necessary.

    https://en.wikipedia.org/wiki/Step_therapy

    Minimum Qualifications for Independent Review Organizations – AKA “Peer Review”:

    Clinical reviewers assigned to conduct external reviews must be a physician or other appropriate health care provider who has expertise in the treatment of the covered person’s condition, is knowledgeable about the recommended health care service, is board certified in the area of medicine appropriate to the subject of the review and has no history of disciplinary action.

    Prior Authorization Review: This section – Section 2155 as it’s formally known – encompasses a good portion of Act 146. Our friends at PAMED were kind enough to share their overall analysis of this new law, which includes a deep dive into Section 2155. The document (linked here for members) details the updates to the process. It also includes much more information on some of the other sections noted above, and also some things that I didn’t get to mention in this post.

    A Quick Plug for PAMED and PAMPAC

    I must give all the kudos to the team at PAMED who worked very hard with many other organizations, including the Insurers, to take this from a bill into a law.

    Advocacy is one of the biggest, if not THE biggest benefit, of membership in your professional association. As a member of PAMED and the ACMS, you help our organizations have strength in numbers. We need physicians helping the decision makers in Harrisburg understand what you do in your workplace and why it’s important. The larger the group, the louder the voice, and the more your contribution will be known. If you are not a member of PAMED/ACMS, I encourage you to join and have your voice heard. If you are a current member, you might consider a contribution to PAMPAC, the political arm of the Pennsylvania Medical Society.

    The passage of Act 146 into law is a direct result of the work of your professional association and I implore you to consider how you can get involved in what comes next.

    For questions on legislation, you can contact the PAMED’s Government Relations Team at govtrelations@pamedsoc.org.