The Gifts That Keep On Giving

AMS Journal, Winter 2023 issue
By David Wroten, AMS Executive Vice President

David Wroten, AMS EVP

Recently I was preparing for a meeting with a hospital executive to discuss the importance of AMS membership. Most hospital executives want to know not just what AMS does for physicians, but how those issues impact the hospital.

It didn’t take long to come up with a long list of advocacy successes to help make the case for maintaining membership in AMS. With the current legislative session in full force, now seems like an appropriate time to walk down memory lane while highlighting the significant impact the AMS has on the lives of physicians and their patients.

Let’s begin with Any Willing Provider.

How many hospitals and clinics in Arkansas would not exist today without this legislation? Young physicians may have no idea what this is, but travel to other states and you’ll find that insurance companies get to decide who they will contract with. These insurance companies can create very narrow networks by picking and choosing which hospitals and physicians are in network and it doesn’t matter how good a physician you are.

Think for a moment how your practice (or your hospital) would be impacted if you or the hospital were excluded from the largest network in Arkansas for no reason. That’s exactly what was happening in our state prior to the work AMS did to pass the Patient Protection Act, or Any Willing Provider. Under this law, health plans must contract with any physician or hospital that is willing to accept the terms of the contract and meet the credentialing requirements.

Next is Prompt Payment and Recoupment.

I put these two together because they are certainly related. AMS led the charge to get the Arkansas Insurance Department to issue regulations that require health insurance carriers to pay providers in a timely manner while establishing interest penalties for late payments. In 2005, AMS worked to pass legislation limiting to 18 months the time carriers can recoup payments from providers, except in cases of fraud. 

The next gift is economic credentialing.

Imagine getting kicked off staff at your local hospital because you or your spouse (or your mother, daughter, son, etc.) had an ownership interest in a competing hospital. That almost happened in Arkansas before the AMS and AMA intervened in two separate lawsuits to prevent it from happening. One of the cases was settled and the other went to the Arkansas Supreme Court. This is referred to as economic credentialing, and the Court agreed with AMS that this interferes with the patient-physician relationship and is therefore
against public policy.

Finally, let’s discuss Credentialing.

Few things are more financially disruptive than bringing in a new physician than waiting six months or longer for the carriers to credential them and add them to their network. In 2009, AMS worked to pass legislation requiring carriers to complete credentialing within 90 calendar days (it was originally 180 days).  Then in 2015, AMS worked to amend the act to reduce the time to 60 calendar days.

Other Advocacy Wins.
AMS has recently been at the forefront of passing or supporting is legislation that benefits physicians, hospitals, and other health care providers. Since I’m running out of space, I’ll just mention a few:

It’s fair game for physicians and hospitals alike to ask AMS, “What have you done for me lately.” But the point I’m trying to make is that many of the successful efforts of the AMS are timeless. Any willing provider, prompt payment, recoupment, credentialing, prior authorization reform…these are all gifts that keep on giving long after the wrapper has been removed. Their existence is a direct result of strong and engaged physician membership in the Arkansas Medical Society.   ■