Missouri State Medical Association’s COVID-19 Pandemic Presidency

My presidency started very low key with a few minutes on a Zoom call reciting the oath of office on April 4, 2020. Warren Lovinger, Jr., MD, visited all 114 Missouri counties during his term as MSMA President. I visited my home office, kitchen, TV room, and bedroom, and back again numerous times during my year. Mine was a truly virtual experience. Despite a lack of travel, MSMA has been engaged and successful at the state legislature for the benefit of our patients and Missouri physicians and virtually connected with our members statewide. We have kept you informed about the pandemic and worked with the state to get vaccines to all healthcare workers and vulnerable populations as quickly as possible.

MSMA and Missouri physicians are very fortunate to have two professionals, Heidi Geisbuhler and Shantel Dooling, advocating for us in Jefferson City all year long. The 2020 legislative session was compressed and, at times, virtual, due to the pandemic. Despite the legislators being preoccupied with COVID-19, MSMA had significant successes. We were able to get legislation passed (SB 591), that tightened requirements on awarding punitive damages in medical malpractice cases. There has been a rapid increase of such claims since the non-economic cap was put in place to get around the cap. Now punitive damages can only be claimed in cases of “clear and convincing” intentional or malicious misconduct by the physician.

Hiring or having an associate join your practice usually means many months of working through the arcane credentialing process to get the new associate onto managed care plans without being able to see patients and bill the insurance companies for taking care of their subscribers. We were able to get legislation passed (HB 1682) that allows insurance companies to reimburse physicians for services provided to their subscribers while the credentialing process is completed with a credentialing decision required within two months down from three. The physician submits the bills once they have been credentialed. This is akin to the credentialing process that Medicare uses and should help new physicians hit the ground running to take care of their patients.

Physicians have far more extensive and longer clinical training with the training focused on independent medical decision making before becoming licensed to practice medicine. That makes physicians the appropriate leader of the healthcare team. Non-physician clinicians try to expand their scope of practice and ask for less or no physician supervision or collaboration every year. For the benefit of our patients to receive optimal care, MSMA continues to advocate to keep physicians as leaders of the healthcare team. In 2020, we were able to convince our legislators to keep the status quo by not advancing physical therapist direct access (HB 1869), APRN collaborative practice (SB 965, HB 1617, HB 1816, HB 2226), APRN licensure (SB 714, HB 1441), and CRNA scope (SB 863, HB 2057). There were two special sessions in 2020: one to deal with violent crime and another to deal with COVID-19 liability reform. Neither achieved its goal, but overall, the 2020 legislative session was very good for Missouri physicians.

Even White Coat Day was a successful, virtual event with over 100 attendees/physicians from around the state!

We are now in the middle of the 2021 legislative session, again disrupted multiple times due to COVID-19 outbreaks at the capitol. Most important for Missouri physicians is COVID-19 liability relief so that we can take care of patients without worrying about frivolous pandemic-related lawsuits. The legislation is on its way to, hopefully, make it into law. MSMA has been advocating for the elimination of requiring maintenance of certification participation for hospital and health insurer credentialing (Missouri passed such a ban a few years ago as it relates to state licensure); for truth in advertising (dealing with advertising one’s board certification); for a statewide PDMP (patterned after the St. Louis County PDMP); and for insurance coverage for skin cancer screening.

MSMA has been testifying against bills to allow dentists to administer any vaccine; to allow non-physician clinicians to sign off on home health plans; to allow the establishment of a doctor patients relationship with an online questionnaire without in-person contact after the public health emergency has concluded; and to allow state government to overrule local and county health department decisions that they deem best for their population. I am sure there will be many other good and bad bills affecting our patients and Missouri physicians throughout the 2021 legislative session. MSMA will be at the Capitol every day to make sure that our voices are heard. Please make sure to respond to our calls to action by contacting your legislators to support our efforts on your behalf.

MSMA has kept and is keeping our members informed about all the legislative and advocacy happenings with weekly Zoom meetings. These meetings with legislators and our advocacy staff give regular legislative updates as well as our weekly Legislative Report throughout the session. We have also kept you informed on all aspects of COVID-19 through our website and weekly email communication of “5 Things you Need to Know.” MSMA members can get the latest unfiltered information and get their questions answered on COVID-19 at the weekly Saturday morning calls arranged by MSMA with the Director of Missouri’s Department of Health and Senior Services, Dr. Randall Williams.

Operation Warp Speed got two COVID-19 vaccines approved in less than a year. Healthcare workers (HCWs) and congregated facility residents and staff were the first category eligible to receive the vaccine. Employees of hospitals started receiving vaccine doses in December 2020. However, office-based physicians and staff seemed to not be included in the initial vaccine roll-out. MSMA went into action and worked with the Department of Health to make sure that office based HCWs be included in the vaccination effort. Hospitals were asked to vaccinate all HCWs (not just their employees or affiliated physicians) and county health departments also got into the action. Even the national guard helped out. By February 2021, all HCWs that wanted to get the vaccine should have been able to get it.

Leading MSMA during this COVID-19 year, while different than expected, was very satisfying due to the success we had at the legislature and helping our members cope with COVID-19, especially with vaccine access. I was honored to help inaugurate the St. Louis Metropolitan Medical Society, Boone County Medical Society, and Greene County Medical Society Presidents and Councils. I advocated for our members and patients at MSMA’s March 2, 2021, White Coat Day with our state legislators and at the AMA’s National Advocacy Conference February 22–25, 2021, with our members of Congress.

Finally, I want to thank our executive directors, Patrick Mills (2020) and Jeff Howell (2021) and MSMA staff, Benita Stennis, Carol Meyer, Cassie Williams, Cheri Martin, Heidi Geisbuhler, Liz Fleenor, and Shantel Dooling, for working tirelessly to keep MSMA strong, stable, and influential in Missouri. They made my job easy, but also very effective. This hard work benefits both our patients and members.