The power of state advocacy
From the President
Dr. Hruza served as Academy president from March 2019 to March 2020.
By George Hruza, MD, MBA, November 1, 2019
When you think of advocacy, what do you think of? Capitol Hill and Congress? CMS and the FDA? If so, you’re not wrong. Many facets of medicine are governed at the federal level — from the Medicare physician fee schedule, to drug approvals, to regulatory reporting requirements. However, a lot of medicine is governed at the local and state level as well.
Our members have identified many of these state-governed issues as top priorities, such as scope of practice, truth in advertising, and access to pharmaceuticals. As a result, your AADA State Policy Committee, staff, and physician volunteers are diligently at work advocating on behalf of our patients and our specialty in halls of state houses, and I think it’s worth mentioning the incredible strides your Academy has made recently.
Scope of practice issues are a significant concern for our members and a top advocacy priority for the AADA. Consequently, the AADA works with all stakeholders to help appropriately define the practice of medicine. This effort helps to ensure a physician-led, team-based approach to care through the adoption or modification of regulations to ensure that, as the workforce expands to include greater use of non-physician clinicians, structures are in place to keep a focus on the highest level, appropriate care and to ensure patient safety.
The Academy serves on the Steering Committee of the Scope of Practice Partnership (SOPP), which is comprised of five national medical specialties, 13 state medical societies, the American Medical Association, and the American Osteopathic Association. In 2018, state legislatures considered over 1,000 bills seeking to expand the scope of practice of non-physicians — 200 of which would have affected advance practice registered nurses’ (APRN) scope of practice. Fortunately, the vast majority of the scope of practice bills did not pass.
Similarly, the AADA supports and promotes efforts to assure truth in advertising regarding who is providing patient care. The Academy works in collaboration with the AMA, state medical societies, state dermatology societies, and specialty societies to enact model legislation that requires health care practitioners to identify the license under which they practice as well as their ABMS/AOA Board certification in advertising their services. These efforts have led to successful enactment of legislation in 21 states.
Additionally, when it comes to access to pharmaceuticals, I bet there are few dermatologists who have never encountered onerous and obstructive step therapy protocols from insurers that can delay patient access to the most effective treatments for their conditions. Your Academy, as a steering member of the State Access to Innovative Medicines (SAIM) Coalition, has been working tirelessly advocating for states to enact step therapy laws. As a result of our work, 27 states have passed laws that protect patients from these harmful step therapy protocols.
Similarly, prior authorizations not only restrict access for patients to many important medications, but also pose a huge bureaucratic unfunded mandate on practices. We are fighting for prior authorization reform at the federal and state levels. At the 2018 AADA Legislative Conference, the AADA advocated for language included in the SUPPORT for Patients & Communities Act, that created a standardized electronic prior authorization (PA) form for Medicare prescription drugs to streamline and reduce PA delays. This bill became law and CMS recently proposed PA electronic standards for Part D. Since we became engaged in the issue, the Academy has been successful enacting meaningful prior authorization reform in Colorado, Kentucky, Missouri, New York, and Ohio.
Success at the state level hinges on strong relationships with state dermatology societies and state medical societies. It is very important for dermatologists to be active members of these organizations to strengthen our voice at state legislatures where so many issues affecting our patients and our day-to-day practice are decided.
These are just a few of the issues that our Academy’s state policy team is working on. Undeniably, many of our specialty’s top issues are arbitrated at the state level. As the saying goes: All politics are local. As such, we cannot afford to overlook state advocacy. I encourage every one of us to research the issues in our respective states using the Academy’s online resources at staging.aad.org/advocacy, and to reach out to AADA state policy staff members to find out what you can do to help advocate on behalf of our specialty and our patients in our own backyards.
