Tag Archives: doctors

Task force can’t resolve doctors-versus-nurses turf war

A divisive “turf war” between doctors and nurse practitioners has broken out across Tennessee and a state task force created by state legislators to find common ground has, thus far, only illuminated the depth of the schism, reports The Tennessean.

The dispute centers on exactly what types of treatment can be provided by advanced practice registered nurses (APRN), and under what level of oversight. Tennessee is among the dozen states with the most restrictive scope of practice laws — and the reform debate is a recurring flashpoint in legislative sessions. The nurses contend they are equipped to administer many of the same primary care and preventative treatments as doctors. Further, they point to a growing primary care physician shortage across the region.

Doctors, meanwhile, question whether nurse practitioners can offer the same level of care and have opposed efforts to expand the scope of treatment, preferring legislation to reinforce physician roles in primary care.

The task force created by Sen. Becky Massey, R-Knoxville, and Rep. Jeremy Faison, R-Cosby, was designed to give doctors and APRNs — nurse anesthetists, nurse practitioners, nurse midwives and clinical nurse specialists — a forum outside of legislative session to find consensus on how to reform the rules governing treatment. The resulting recommendations could result in legislation that impacts how Tennesseans receive primary care — a key step toward improving the state’s dismal health.

Yet the debate has devolved into a fight between doctors and nurse practitioners, with both sides becoming entrenched and the task force’s meetings becoming forums for people to air individual frustrations and opinions.

“Reluctantly I say no (we haven’t made progress). We’ve met twice and we’re closer to the beginning than the end,” said Dr. John Hale, a primary care doctor in Union City, who is co-chair of the panel alongside Carole Myers, a registered nurse and associate professor at the University of Tennessee College of Nursing.

Physician PAC endorses Dr. Dickerson over Dr. McDow in Senate District 20

The Tennessee Medical Association has endorsed incumbent physician state Sen. Steve Dickerson in the District 20 race over his physician challenger, Dr. Ron McDow, reports Nashville Post Politics.

A list of TMA endorsements through its PAC (known as IMPACT for Independent Medicine Political Action Committee of Tennessee) shows only incumbents endorsed so far. But the doctors made a special point in an email of endorsing all physician legislators up for reelection — Sen. Mark Green, MD (R-Clarksville), Sen. Joey Hensley, MD (R-Hohenwald), Rep. Sabi Kumar, MD (R-Springfield) and Rep. Bryan Terry, MD (R-Murfreesboro) — but especially Dickerson.

From the email:

Dr. Dickerson is competing in one of the most contested races in the state. He is being aggressively targeted by his opponents. His primary opponent is also a Nashville physician who is not a TMA member and has never been involved in organized medicine here in Tennessee. We are calling on all members to support Dr. Dickerson and IMPACT to help protect those that support us on Capitol Hill.

Dr. Dickerson as well as Tennessee’s other physician legislators work with TMA on every issue that affects physicians and their patients. They work hard to ensure Tennessee remains one of the best states for practicing medicine.

TMA and IMPACT is fully behind Senators Dickerson, Green and Hensley and Representatives Kumar and Terry. We have worked hard to put these physicians in the legislature but we now have to keep them there. Their campaigns need support from TMA members.

Bill seeks secrecy for doctor fees in lawsuits

The state’s doctors’ lobby wants to make expert witness fees in court cases secret and the lawyers’ lobby is against that idea, reports The Tennessean.

The bill (HB1446)+ is sponsored by Rep. Mark Pody, R-Lebanon, and Sen. Mae Beavers, R-Mount Juliet, and would make confidential the fees paid to all expert witnesses.

Pody said he believed government should be completely transparent, but citizens have a different expectation of privacy.

“Physicians are having to spend time, energy and resources to preserve a standard degree of privacy that other citizens and professionals enjoy,” said Dave Chaney, a spokesman for the Tennessee Medical Association, which helped draft the bill.

Chaney said it is not relevant in a trial how much an expert makes. One doctor who has been negatively affected declined via the TMA to be interviewed, saying to do so would draw more negative attention.

Allan Ramsaur, executive director of the Tennessee Bar Association, said lawyers on both sides of a case can ask for an expert or doctor’s compensation to create question about that person’s opinion. A larger payment could create concern of someone’s bias, he said.

Ramsaur said the TBA opposes the bill because rules that deal with court procedure should be handled by an existing rulemaking commission, not the legislature. The Advisory Commission on the Rules of Practice and Procedure was created by statute and its members are appointed by the Tennessee Supreme Court.

Doctors want to amend TN Constitution on jury trials

Fearful that Tennessee courts could eventually strike down a 2011 law capping jury awards in medical malpractice lawsuits, doctors plan to press legislators to protect the statute with an amendment to the state’s constitution, reports the Times-Free Press.

The Tennessee Medical Association wants lawmakers to put before voters new constitutional language clarifying that the General Assembly has authority to set caps on noneconomic damages such as pain and suffering in cases involving medical malpractice liability.

The group’s would require persuading lawmakers in the current GOP-dominated 109th General Assembly to approve the proposed amendment in 2016 and then getting their successors in the 110th General Assembly to pass it by a two-thirds majority.

If it wins approval from lawmakers, it would go before voters on the 2018 ballot to decide.

“The General Assembly needs to act now to prevent us from going backwards on the issue of a noneconomic damages cap,” Dr. John Hale, president of the Tennessee Medical Association said in a recent statement. “The cap fosters growth in Tennessee’s health care industry by cutting back on frivolous lawsuits and the costs that come with them.

“I’m confident Tennessee voters will support it if given the chance to have their voices heard,” Hale added.

… Tennessee’s constitution includes a declaration that the right to trial by jury shall be inviolate and some contend the damage caps are unconstitutional infringement on jury rights. The proposed constitutional amendment comes with a push already underway to scrap court involvement in malpractice completely.

The Alpharetta, Ga.-based nonprofit advocacy group, Patients for Fair Compensation, is calling on lawmakers to yank malpractice suits out of the courts entirely and put them under a first-of-its-kind Patients’ Compensation System.

Patients for Fair Compensation says its proposal is similar to the workers’ compensation system for helping injured workers. It would create an independent panel, appointed by Republican Gov. Bill Haslam as well as the Republican House and Senate speakers. The panel would retain physicians to serve on panels. They would affix specific costs on physician errors in treating patients.

Proponents say the result would slash billions of dollars now spent on lawsuits and “defensive medicine” practices by physicians seeking to protect themselves in court.

The group presented its plan Tuesday before a study panel of the Senate Commerce Committee where Chairman Jack Johnson, R-Franklin, is sponsor of the bill. It was introduced earlier this year… Johnson acknowledged he is already in discussions with state Attorney General Herbert Slatery over whether the bill meets constitutional muster.

Audit finds delays in disciplining doctors

The Tennessee Board of Medical Examiners is taking too long to investigate misconduct charges brought against doctors, subjecting patients to “potentially harmful medical practices,” according to an audit by the state comptroller’s office. In reviewing a sample of 21 cases, auditors found 10 were not completed within the time frame set by state rules.

From a Tennessean article on the audit:

The audit also found the board, which consists of nine physicians and three health care consumers appointed by the governor, has not taken steps to comply with a 1979 state law requiring it to collect information from state courts that would alert it to a physician who has been convicted of a crime.

“Citizens expect state medical boards to protect them against unethical practitioners, though occasionally physicians have committed serious crimes that went undetected for years,” the audit noted.

The Tennessee Department of Health will examine each of the cases highlighted in the audit, according to Michelle Long, assistant commissioner for health and licensure regulation.

“The BME (Board of Medical Examiners) and the Office of Investigations take very seriously their responsibility to protect the health and welfare of Tennesseans, and are committed to working more effectively to track and monitor complaints against medical doctors while those complaints are under investigation,” she said.

TennCare’s new payment system gets negative doctor diagnosis

TennCare is moving to a new “outcome-based” system of payments to health care providers and doctors are concerned about the ramifications, reports the Times-Free Press.

“This is the biggest shift in payment since TennCare was introduced,” said Tennessee Medical Association president Dr. John Hale, a family practitioner in Union City, Tenn.

Starting this year, TennCare — which covers low-income children, pregnant women and people with disabilities — is phasing in a new payment model for hospitals and doctors as part of an effort called the Tennessee Health Care Innovation Initiative.

“The goal is to move from paying for volume to paying for value,” said Brooks Daverman director of the Tennessee Division of Health Care Finance and Administration’s Strategic Planning and Innovation group, which has worked on the overhaul since 2013.

The new TennCare system will have carrot and stick elements, rewarding or penalizing doctors based on patients’ outcomes.

The program has been designed so that commercial insurance companies may one day follow suit. BlueCross BlueShield of Tennessee spokeswoman Mary Danielson said the company’s philosophies “align with the state of Tennessee and its efforts to pay providers for quality.”

Right now the new system is being applied only to TennCare physicians who provide joint replacement, treatment for acute asthma exacerbation, and perinatal care. In five years it will affect 75 different treatments.

But TMA officials say the rollout is occurring too fast for doctors to grasp the changes. They see defects in data collection and a lack of transparency about the goals doctors need to reach.

“Every physician would agree that health care spending is out of control. We’ve got to do something,” said Hale. “But we need more time, and a better plan to make this work.

…Daverman said the system encourages doctors to better coordinate and follow through with a patient’s care.

But doctors worry they will be disciplined for things out of their control, said Hale: an infection, a problem with a prosthesis, patients who won’t take their medicine.

That makes him fear that more physicians could cherry-pick patients. Doctors may opt not to operate on a smoker or someone who is obese because of the greater risks involved, he said.

“These are people’s lives, here,” he said.”We know it’s the future of medicine and we want it to work. But you’ve got to have physicians feel like they’re part of this process, instead of feeling like they have a gun to their head.”

Discipline disparity for doctors having sex with patients? DesJarlais contrasted with Murfreesboro physician

U.S. Rep. Scott DesJarlais got a slap on the wrist for a sexual relationship with two patients compared to the punishment recently handed down against a Murfreesboro doctor who had a fling with only one patient, according to The Tennessean.

The Tennessee Board of Medical Examiners revoked the license of Dr. Brad Blankenship and fined him $5,000 after he voluntarily stopped practicing medicine, submitted to behavioral evaluation for physicians and then underwent an inpatient treatment program for people in professional occupations.

That punishment compares to a $500 fine and a reprimand for the congressman.The revocation of the Murfreesboro doctor’s license occurred two years after DesJarlais’s reprimand.

Neither the The Tennessee Board of Medical Examiners nor the office of DesJarlais responded to inquiries made by The Tennessean about the disparity in disciplinary actions.

Blankenship prescribed controlled substances to the woman, records show. DesJarlais also prescribed controlled substances to women while having affairs with them, according to documents.

Divorce records in the case between DesJarlais and his first wife includes testimony that DesJarlais pressured a patient with whom he’d had a romantic relationship to seek an abortion and prescribed pain medication to a second woman while they dated.

But the disciplinary order issued against DesJarlais makes no mention of any medicine being prescribed. That order was handed down in 2013 for sexual misconduct that occurred in 2000.

…Blankenship previously was disciplined by the Tennessee Board of Medicine Examiners in 2009 when his license was put on probation for two years for failing to properly supervise the use of lasers and other cosmetic procedures by unlicensed staff at a Brentwood med spa.

TN doctors list legislative agenda (topped by lobbying war with insurance companies)

News release from Tennessee Medical Association
NASHVILLE – The Tennessee Medical Association, the state’s largest professional group for physicians with more than 8,000 members statewide, has announced its top priorities for the 2015 legislative session ahead of its annual Day on the Hill on March 3.

Atop the list of doctors’ legislative focus is a bill that would reduce health insurance companies’ ability to arbitrarily change reimbursement terms in the middle of a contract. TMA gained traction with its Payer Accountability bill in 2014 and has continued discussions with insurance companies during the past several months to try to reach a compromise. It will be the first law of its kind in the U.S. if TMA is successful this session.

“Our goal with Payer Accountability is the same as it was last year – stability and predictability for medical practices,” said Dr. Ron Kirkland, a Jackson physician and Chairman of TMA’s Legislative Committee. “In no other industry are contracts so lopsided toward one party to essentially allow them to change payment at any time, for any reason. We want to level the playing field, especially for smaller physician groups and solo practitioners, and prohibit insurance companies from using their typical ‘take it or leave it’ approach. It’s a pretty straightforward business issue.”

The TMA will also introduce the Tennessee Healthcare Improvement Act of 2015, which is designed to support the state’s vision for a more efficient and effective team-based healthcare delivery model. TMA is advocating for a physician-led, coordinated care approach that leads to high-quality patient outcomes at the lowest possible cost.
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New physician guidelines established for prescribing pain drugs

A committee of physicians appointed by the Tennessee commissioner of health agreed Friday on new guidelines for prescribing opioids in an attempt to curb the state’s problem with addiction to prescription drugs, reports The Tennessean.

The guidelines set limits on daily doses doctors can prescribe to patients, spell out protocols for giving the drugs to women of childbearing age and establish new certification requirements for pain medicine specialists.

They also establish two levels of doctors who can prescribe controlled substances. Most doctors can write prescriptions for daily doses up to 120 milligrams of morphine equivalents. For example, this measure works out to four 30 milligram dosages of hydrocodone a day. Anything above that requires doctors to refer their patients to a pain medicine specialist.

There is concern this rule could create a bottleneck because about 90,000 Tennesseans get pain meds that exceed this daily dosage, and the number of certified pain specialists may not be able to handle that patient load.

Some doctors who already practice pain management question the need for having to go through a new certification process.

Addressing the committee, Dr. Scott Baker asked if the guidelines were creating an access-to-care issue. Committee member Dr. Rett Blake said they were not, adding, “I think we have an over-utilitzation problem.”

Doctors do not have to transfer patients taking more than 120 milligram morphine equivalents a day to a pain specialist, but they do have to refer them to a pain specialist for an least one annual visit.

Dr. James Choo, a pain specialist and committee member, said the 90,000 number should decrease as opioid prescriptions taper off and more patients are referred to addiction experts.

Doctors Vs. Nurses Fight Looms in Legislature

By Eric Schelzig, Associated Press
NASHVILLE, Tenn. — The growing demand for medical care that is expected to accompany the full implementation of the federal health care law in January is adding urgency to a Tennessee debate over whether nurses should be allowed to provide more independent care to patients.
Nurses currently see patients in a variety of settings ranging from private practices to retail clinics, but they want to remove a layer of supervision from physicians. Doctors’ groups oppose giving nurses more independence. A legislative fight is on the horizon.
“We’re in the ring,” said Gary Zelizer, who lobbies on behalf of doctors for the Tennessee Medical Association. “We’re warming up, but it’s coming.”
Sharon Adkins, the executive director of the Tennessee Nurses Association, said in an email that her group is “in full support of removing practice barriers and support full practice authority for all health care professionals.”
Adkins said advance practice registered nurses, or APRNs, “give as good or in some cases better care than physicians.”

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