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Administrative Priorities

ISMS' Agenda to support Illinois physicians and patients

Ensure that health insurance companies support rather than obstruct patient access to care.

 Physicians are committed to working closely with their patients to promote health and well-being, and to achieve the best outcomes possible.Health insurance companies, in their efforts to streamline costs and demand physicians provide “value based care” as defined by actuaries rather than practicing physicians, continue to exert unacceptable power and influence over access to care and medical decision-making. 

Strengthened enforcement of laws aimed to ensure health plans support patients’ needs, such as the Network Adequacy and Transparency Act and the Prior Authorization Reform Act, is critical to ensuring that Illinois patients have timely access to primary care physicians and physician specialists, and are able to access the services and treatments recommended by those physicians without delay.

Reject proposed legislative and regulatory mandates that create hurdles for physicians who want to practice in Illinois.

Over the past five years, Illinois has passed five new laws mandating physicians fulfill specific CME content requirements in order to obtain or retain a medical license. A new mandate that physicians submit electronic prescriptions for controlled substances if submitting more than 25 prescriptions during a 12-month period is scheduled to go into effect January 1, 2023.

Other mandates are introduced every year related to how physicians should treat certain medical conditions, how they communicate with patients, and what they should report to the state. Physicians are already subject to numerous – and often inconsistent – mandates and administrative obligations imposed by federal law, Medicare and Medicaid participation, contracted health plans and other entities with whom they have service arrangements or credentialing privileges. 

Illinois does not need to add to the burden of practicing physicians by legislating the practice of medicine or mandating what specific content their CME requirement should include. Physicians need to treat patients as individuals and have the flexibility of selecting courses most relevant to their practice and patient populations.

Preserve the role of physicians as leaders of the healthcare team.

Non-physician practitioners, such as advanced practice registered nurses and physician assistants, are valuable members of the healthcare team, but they do not have the education, training and expertise that is required to become a practicing physician. According to a 2021 national survey, 95% of registered voters said it was important to them for a physician to be involved in the diagnosis and treatment decisions for their healthcare. 

Reform the Medicaid program to support increased physician participation and expand access to a broader range of physician specialists.

Approximately 25% of Illinoisans are enrolled in Medicaid under Illinois’ current rules. Unfortunately, Medicaid enrollees often have difficulty finding physicians who accept Medicaid patients, and those physicians who do often have long wait times for an appointment.

Illinois is proud of its Medicaid program and the security it promises for Illinoisans who cannot afford private health insurance, but the reality is that participation in the Medicaid program at the current reimbursement rates is unsustainable for many physicians in the state.

Illinois must commit to ensuring sustained access to all physician services by implementing a reimbursement rate increase. In addition, participating physicians (and patients) continue to experience challenges with the administration of the Managed Care Organization (MCO) program, resulting in care delays, payment denials, and unacceptable administrative hassles for physician offices. Illinois patients need a strong Medicaid program that physicians can commit to without jeopardizing their practices.

Develop, support and promote programs that make practicing medicine in Illinois a desirable option for medical school graduates and physicians completing residency programs.

Illinois ranks near the bottom third of states in terms of retention of medical students graduating from its medical schools. Illinois is home to nine medical schools and approximately 230 residency programs; yet, up to 70% of medical school graduates and more than 50% of residency program graduates move out of state, taking Illinois’ investment in their medical careers with them. 

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