Maryland Chapter, American College of Cardiology

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President's Message

May 2024

Dear MDACC Members,

The US Federal Trade Commission (FTC) banned non-competes on April 23 but it is unclear if their regulations will withstand lawsuits or apply to non-profit hospitals and physician practices. Regardless of what happens, non-competes will still be severely limited in Maryland as of July 2025. Because of YOUR efforts, Maryland ACC was able to successfully advocate in Annapolis for legislation that greatly benefits our patients and improves our work environment. We advocated for HB1388 (link), which was signed by Governor Moore on April 25. This law will effectively ban all non-compete agreements (restrictive covenants) signed after July 1, 2025, for all health professionals licensed in Maryland who make less than $350,000/year. For those that make more than $350,000/year, non-compete agreements are allowed but cannot exceed 1 year/10 miles from the primary practice location.

HB1388 is a big deal! This law means you will never be run out of the state if you leave your job, and your relationship with your patients will still be preserved.

Unfortunately, the hospital lobby strongly opposed this bill. But their efforts failed, and this bill passed. The time and effort spent on this bill taught us many valuable lessons:

Patients matter: No bill passes in health care legislation if it doesn’t help patients in Maryland. This legislation strengthens the doctor-patient relationship and increases patient access to health care professionals.
Representation Matters: This bill was introduced by Dr. Terri Hill in the House of Delegates and shepherded by Dr. Clarence Lam in the Senate. Because they were physicians, they were most sympathetic to this legislation and were able to effectively persuade their colleagues to pass this bill.
Relationships Matter: Our previous work with legislators and joint sponsorship of the Maryland AHA/ACC legislative dinner in early January were important. The legislators clearly understood that this bill makes a huge difference in well-being for health professionals and for patients. Investing in these relationships before asking for support on an issue pays dividends.
Our Time Matters: We are all busy cardiovascular professionals, so it ended up being impressive that we spent our time on driving to Annapolis to testify, and in writing letters and calling legislators. I cannot stress enough that the major reason that this bill passed is because of persistent calls, letters, and testimony from hundreds of Maryland ACC members.
Partnerships Matters: Advocacy for this bill highlighted the importance of leveraging partnerships. We worked closely with leaders of MedChi, our state medical society, who have deep advocacy insights, skilled lobbyists, and strong legislator relationships. Partnering with them is exponentially more effective than going it alone. In addition, we strengthened new and old relationships with sister medical societies. The Maryland Chapter of the American College of Physicians was a particularly strong one, since their Governor encouraged letters to be sent to the Senate Finance Committee from their 2500 members.
Financial Support Matters: While we are happy that this bill passed, it was not a total win, since the lobbyists from the hospital association managed to get amendments to allow restrictive covenants for those above $350,000, even though testimony in favor of a total ban was more than 10-1. To combat big money, I encourage you to donate some money (and more of your time) to Heart PAC (at the national level) and the MedChi PAC at the local level. I guarantee that the “other” side is donating lots more. Also, if you believe in a candidate for office, it doesn’t hurt to donate to their campaign with your time and perhaps financially. Your support for legislators can build relationships that matter on common issues we support.
Facts matter: We were armed with facts and the right amount of passion for patient care. An ACC taskforce led by Dr. Joe Marine summarized the determinants of non-compete agreements (and was published in JACC: Advances). It was easy for us to argue for this legislation when we had the facts on our side.

Thank you again for your efforts in support of this legislation. You are the reason for the passage of this bill! We must be vigilant because there may be efforts to repeal this legislation in the future. This actually happened in DC, where a ban on restrictive covenants was amended in 2022 to specifically exclude physicians making more than $250,000. Or we can advocate further to eliminate restrictive covenants altogether and start conversations with health system leaders to argue that this issue is important for clinician wellbeing and retaining physicians and cardiovascular professionals. In the long run, everyone in the Maryland medical market will benefit.

Advocacy matters!

Thank you again!

Sammy Zakaria, MD, FACC

President, Maryland Chapter ACC

P.S. We successfully advocated for other legislation too! These laws included changes in several other high priority areas, including prior authorization/utilization reform, caps on economic damages for medical malpractice suits, ensuring cardiovascular invasive specialists are able to provide services for which they are trained to provide, and maintaining fair reimbursements for E/M codes under Medicaid. If you have questions or comments about how these issues impact your practice, please contact Frank Ryan at ACC at 240-620-9352 or fryan@acc.org.

Do Your PART

The Maryland Chapter ACC supports the American College of Cardiology’s statement of support for the Ukrainian people; see this link for the full statement.

ACTION NEEDED:

ABMS Seeking Comments on the Proposed CV Board

The American Board of Medical Specialties (ABMS) has announced the start of a 90-day Public Comment Period seeking input on the new, independent Board of Cardiovascular Medicine proposed by the ACC, American Heart Association, Heart Failure Society of America, Heart Rhythm Society and The Society for Cardiovascular Angiography & Interventions. The comment period is a critical part of the ABMS application review and an important opportunity for the cardiovascular community, hospitals and health systems, patients and other stakeholders to show their support for the new Board and engage in the decision-making process.

All comments must be submitted electronically by July 24. In addition to providing basic identifying information, including your name and email, the comment form consists of three main questions: 1) Do you agree with the creation of a new American Board of Cardiovascular Medicine; 2) Does the new Board meet ABMS requirements for initial certification; and 3) Does the new Board meet ABMS requirements for continuous certification? Along with indicating your agreement, the form includes opportunities to provide any comments related to your responses, as well as a chance to upload a letter or document. Additional comments on the ways a specialized, independent Board of Cardiovascular Medicine would benefit you, your hospital, practice and/or your patients are strongly encouraged.

To submit your comments, as well as access detailed FAQs, on-demand webinars and a listing of the initial Board of Directors, visit CVBoard.org. In addition, we encourage you to help spread the word about the comment period using the social media graphic and sample messaging below. Should you need any additional communication support, please contact Shalen Fairbanks (sfairban@acc.org).

Advocacy Updates

View MDACC's 2024 Annapolis Session Priorities

Click here to support the Non-compete Ban legislation

MDACC SUPPORTS CHANGES IN PRIOR AUTHORIZATION

Bills in both the Maryland House of Delegates and Senate have been introduced to reform prior authorization and step-therapy. MDACC is supporting these reforms through letters, in-person testimony, and an email campaign to the membership. See below for more details.

RE: SUPPORT FOR SB 308 Health Insurance – Utilization Review – Revisions and

SB 515 Health Insurance – Step Therapy or Fail First Protocol – Revisions

These bills target the unnecessary denial of health care services by health insurers. Commonly known as prior authorization or step therapy, these practices often delay or deny medications and services that have received clinical consensus through stringent vetting and are published and updated regularly in medical journals and literature.

Time is critical for cardiovascular patients. The sooner a cardiologist can treat and monitor a

patient, the more likely the patient is to recover and thrive. Unfortunately, insurer prior authorization program denials in Maryland are rising.

Increasingly, cardiovascular professionals use point of care tools (ACC Practice Tools) and other technological resources (NCDR National Cardiovascular Data Registry) to access information that provides update information that guides treatment decisions and helps them provide timely care.

In 2018, there were 78,314 denials based on medical necessity.
In 2021 that number increased to 81,143.
The Maryland Insurance Administration (MIA) ruled that in over 70% of complaints they received from patients, the denial was invalid, and that the patient should have received the health care service.

In 2021, an American Medical Association (AMA) survey revealed the following about the impact of prior authorization on physicians and patients:

93% of physicians reported delays in access to necessary care.
82% of physicians reported that patients abandoned recommended treatments because of prior-authorization denials.
73% of physicians reported that criteria used by carriers for determining medical necessity is questionable - 30% of physicians reported that it is rarely or never evidence-based and 43% only sometimes evidence-based.
88% of physicians describe the burden of prior authorizations as high or very high with 40% of physicians reporting that they have staff dedicated exclusively to prior authorizations.

Not only are these policies hurting patients, but they are hurting physicians, too.

The process to secure prior authorization is labor intensive, costly, and stressful. Surveys consistently reveal that undue administrative burden is a leading cause of physician burnout and depression.

@ACCMaryland

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Maryland Chapter, American College of Cardiology

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Annapolis, MD 21401