It's difficult to believe Fraser Cobbe has been executive director of the 108-year-old Orange County Medical Society for only two years. A Florida State University political science graduate, Cobbe hit the ground running, drawing on experience interning for the Florida Medical Association's political action committee, managing the Manatee County Medical Society, Florida Orthopaedic Society, and representing Bones Society of Florida, Florida Orthopaedic Risk Purchasing Group, Florida Society of Nephrology, and the South Carolina Orthopaedic Association.
Through Cobbe Consulting & Management, an award-winning association management firm focusing on specialty societies, Cobbe also folded Seminole County Medical Society into the portfolio in his quest to dive into the economic side of physician practices, advance medical education, and lobby for legislative advocacy for Florida physicians.
Cobbe spoke with Orlando Medical News about legislative priorities for 20 17, telemedicine advancement, the impact of consolidation between hospitals and physician practices, the sometimes unnoticed fine print that impacts newly employed physicians, and how he'll bring together Central Florida medical societies just before Election Day.
Which issues are high priority for the 2017 Florida Legislature?
The outcome of the presidential election will dictate a little bit which issues we'll pursue. Over the last few years, we've been championing several issues concerning prior authorization for services and denial of care, administrative burdens that'll remain high on the priority list for 2017.
In the past two years, bills dealing with retroactive denials and step therapy have been in the works. Concerning step therapy processes, carriers require trying certain medications before moving on to another medication in that class. We want to make sure a reasonable mechanism is in place for physicians to bypass that process if there may be undue harm to the patient, especially when the physician knows the medication the patient ultimately needs to be on. Delays can hamper patient wellness as they move through that process.
We'll support the ambulatory surgery center (ASC) legislation bill being filed again, which would expand use of ASCs to a full 24 hours. The current length-of-stay rule requires discharging a patient by midnight. Florida is one of few states that still has that midnight rule in place. Most other states and the Centers for Medicare & Medicaid Services (CMS) consider length of stay a full 24 hours from the start of the procedure. In Florida, the midnight time frame would potentially force a provider to transfer the patient to a hospital unnecessarily and could be avoided if the patient could stay another hour or so to recover and then go home.
We'll also focus on workers' comp, and restore some protections for injured workers. Since reforms were passed in 2003, some of those protections have deteriorated a bit.
What are your thoughts on telemedicine advancement?
We want to make sure the state has a way to hold physicians accountable for the quality of care rendered in telemedicine, including out-of-state telemedicine providers. The other component is pay. We're seeking reimbursement for telemedicine at the same rate as a face-to-face visit. CMS is restructuring Medicare's new reimbursement process for physician fees with three components - overhead, decision-making and liability. We want to make sure there's payment/reimbursement equity if we're truly going to adopt telemedicine in a significant manner.
With industry consolidation moving a greater number of independent physicians to hospital-employed physicians, membership in medical societies has decreased. What value does your organization offer to employed physicians?
Between independent physicians moving to employed status, and with the new generation of physicians in general, only one in four physicians are members of medical societies in Orange and Seminole counties. We want to get local physicians, regardless of their employment status, involved in our efforts, engage them, determine their needs, and identify ways we can assist them being successful both personally and professionally. That's why we went through a strategic planning process this year, and redefined our mission and vision. We hired a new membership outreach coordinator, and we're focusing on partnerships to expand our reach in the community, attract non-members, and provide our members with succinct, non-duplicated information and services.
For physicians moving from independent to employment status, we can help physicians with contract review ... some kind of standard templating language they need to consider in their employment contracts to protect their interests. We'd never get in a role of negotiating salary or pay, but we can help with certain working conditions and in other ways.
We're also going to look a great deal at physician wellness programs. When we see statistics on physician burnout, and unfortunately physician suicide, it's a significant issue. In an employment role, for example, physicians may have access to employee assistance programs. But physicians may be concerned about taking advantage of those programs, not knowing for certain if that information is truly confidential. We're looking at a couple of models being used across the country to help our physicians get help if they're experiencing mental health issues or burnout. For example, we're looking to create an anonymous referral source to implement in our region.
Also, there are many physician organizations in Central Florida, such as CAPI for Indian subcontinent physicians, Pan American, and the Central Florida Medical Society of African-American physicians. They're all doing great jobs representing and engaging physicians. On Nov. 2, we're going to pull those organizations together by hosting a leadership exchange in Orange County. The goal is to get us all aligned with mutually beneficial programs, services and initiatives we can launch together, especially when physicians are bearing the risk of population management.
We've been doing quite a bit of work with Dr. Kevin M. Sherin (director of the Florida Department of Health in Orange County) in the public health arena, keeping an eye on what's developing with the Zika virus. It's only a matter of time until it impacts our community to a larger degree. Dr. Sherin will be speaking at our September membership meeting to update physicians on Zika-related issues.
Which day-to-day issues are most frustrating to your members?
The regulatory burden. In the last decade, physicians have been bombarded with IT adoption, HIPAA mandates, reporting requirements. The constant changes without a break have been overwhelming. Most physicians would much rather focus on treating patients than the massive amount of regulations that have been put on them. Instead, they're spending a lot of time on the phone seeking approval, going through second opinions or peer reviews with carriers. That trend is driving a lot of the consolidation with practices.
On the flip side, insurers are struggling with Affordable Care Act requirements that impact the rising level of denials and authorization processes doctors face daily. In any industry where there's consolidation and a lack of competition, costs go up. There's also worry about quality of care. So there's a big fear that'll happen with the consolidation of insurers.