Ob-GynPAC is ACOG’s federal political action committee (PAC) and an integral part of the ACOG’s efforts to win legislative and political victories for our specialty. Ob-GynPAC is the only national PAC in Washington, D.C., representing ob-gyns before Congress. Ob-GynPAC educates Members of Congress about issues that are important to our specialty and helps elect candidates to the U.S. House of Representatives and Senate who support us on our issues.
Georgia OBGyn Society 2021 Legislative Update
With Georgia reeling from both a New Year’s surge in COVID cases and an unprecedented “blue wave” washing over our state, this year’s legislative session was certainly one for the ages. Despite these extraordinary circumstances, our Georgia Ob/Gyn Society (GOGS) Legislative Committee remained aptly focused on advocating for our patients and for our physicians. With the help of our lobbyists, executive director, and longstanding partners, we navigated the new political environment and pandemic protocols with relative ease. Despite not being physically present under the Gold Dome, we found other ways to make our presence (and position) known on several important issues. The legislative session concluded on April 2nd, and I am proud to report on several successes!
One of the annual highlights for both GOGS and the Georgia General Assembly is the Patient-Centered Physicians Coalition (PC2) of Georgia “Legislative Day at the Capitol.” In 2020, nearly 300 physicians met at the Georgia Train Depot for this tradition, which ultimately became one of the final in-person advocacy events before the coronavirus quarantine began. Our maskless attendees walked en masse to the Gold Dome, elbowed other advocates out of the way at the ropes, finagled a less-than-six-foot space to meet with legislators face-to-face, and then shook hands without using alcohol-based sanitizer. Oh, how things have changed!
This year, like much of the world, we pivoted to a virtual format and hosted the first-ever PC2 Legislative Webinar Series. Our first event featured Brian Robinson of Robinson Republic, a consulting firm specializing in public affairs messaging. He provided our brimming Zoom room insight on “How to Lobby in a Virtual World.” We then employed those newly acquired virtual advocacy skills at our two remaining webinars featuring Georgia General Assembly Members from the House of Representatives (Sharon Cooper and Butch Parrish) and Senate (Michelle Au, Dean Burke, and Bo Hatchett). We asked the Representatives and Senators to update us on health and healthcare legislative efforts under the Gold Dome, and we also clued them in on our crucial positions and top priorities. In case you missed these informative webinars, recordings are available on the GOGS website at www.gaobgyn.org/resources/webinars.
Due in part to these virtual lobbying events, and certainly to the unwavering efforts of our GOGS lobbyists Skin Edge and John Walraven, our Legislative Committee successfully influenced several bills during the 2021 session. A summary of all legislation tracked by our team is provided below, courtesy of our tireless GOGS Executive Director, Kate Boyenga. Thank you, Skin, John, and Kate for all your hard work on behalf of GOGS! Also, sincere thanks to our membership for sticking with us during these challenging times. Please do not hesitate to contact me with suggestions for legislative priorities, advocacy strategies, or anything at all. We remain impressed and inspired by your ongoing engagement in our efforts to improve the health and healthcare of the women of Georgia. Our team is proud to serve you!
To help support the state’s primary care and maternal health practices amidst the ongoing financial burden of the COVID-19 pandemic, we asked the legislature for an increase in Medicaid rates for 18 of the most commonly used CPT codes to 2020 Medicare levels. We are pleased to report the $7.1M needed to fund this measure to help ob/gyns across Georgia keep their doors open (especially those in rural areas, where the payor mix is dominated by Medicaid) was included in the State Fiscal Year 2021-2022 budget. ACHIEVED
We remain concerned about the high rate of claims experienced by ob/gyns, considering 5 of Georgia’s top 25 recent verdicts were for medical malpractice. Both SB 189, which would have required trial bifurcation, as well as SB 190, which would have eliminated phantom damages in med-mal trials, failed to pass. Both bills introduced by Bill Cowsert (R-Athens) were considered by the Senate Judiciary Committee. We continue to support tort reform efforts that may control professional liability costs, make Georgia a more attractive place to practice medicine, and thereby address the shortage of rural obstetricians. DID NOT ACHIEVE
HB 307 revises the Georgia Telehealth Act to allow physicians to provide telemedicine services from their home and authorizes patients to receive telemedicine services from their home. Telehealth has quickly become integrated into nearly every aspect of obstetrics and gynecology, and current trends indicate expansion of its use. This bill constructs much needed abilities for technology-enhanced health care. ACHIEVED
HB 458 introduced by Sharon Cooper (R-Marietta) updates educational requirements surrounding sexual misconduct for physicians and requires the mandatory reporting by health care providers who have ‘actual knowledge’ that a physician has committed a sexual assault on a patient. The Georgia OBGyn Society worked diligently to define the reporting terms and educational standards that best serve our membership. ACHIEVED
Maternal mortality record retrieval regulation
Georgia’s Maternal Mortality Review Committee’s abstraction team has had difficulty obtaining timely access to critical documents from healthcare facilities, coroner’s offices, police departments, and other authorities. We worked with Rep. Sharon Cooper (R), Chair of Health and Human Services, to create a mandatory 30-day compliance reporting deadline. This recommended legislation was amended to HB 567 which provides for a Newborn Screening and Genetics Advisory Committee. GOGS continues to monitor the record request and retrieval process and has implemented new collection methods to accelerate the collection process and improve the efficiency and depth of the maternal review process. ACHIEVED
Rural Birthing Centers
SB 270 would have created a pilot program to fund rural birthing centers associated with emergency departments. The bill introduced by Gail Davenport (D- Jonesboro) did not make it out of the Senate prior to crossover day but we remain optimistic that similar legislation may be revisited next year. DID NOT ACHIEVE
Prevention of Postpartum Maternal Mortality and Morbidity
Last year the passage of HB 1114 extended comprehensive Medicaid coverage for low-income Georgia mothers to six months postpartum and provided for much needed lactation services. While we were pleased with this progress, a one-year extension is certainly our ultimate goal – to facilitate ongoing monitoring, diagnosis, and management of potentially fatal postpartum issues like mental illness, addiction crisis, hypertension, and cardiovascular disease. On April 12, 2021 Illinois became the first state to win approval from the Centers for Medicare and Medicaid Services (CMS) for its 1115 waiver to extend Medicaid coverage for pregnant individuals to 12 months postpartum. Illinois can now move ahead to implement this coverage extension with federal financial assistance. This indicates CMS financial support and now clearly gives states like Georgia two viable pathways – an 1115 waiver or the SPA made available through the American Rescue Plan Act. TO BE CONTINUED…
Summer 2020 Legislative Update
Adrienne D. Zertuche, MD, MPH, FACOG, Co-Chair, GOGS Legislative Committee
The local, national, and international events of the past six months have been, in a word, unimaginable. Since my last “Legislative Update” (February 2020), we have been confronted by a global pandemic that has politicized science and public health and metamorphosed every aspect of our daily lives. We have also seen national indignation over police brutality and overdue public discourse regarding systemic racism and the prioritization of diversity, inclusion, and equity. While these times are certainly unprecedented — and often disheartening – our advocacy efforts have become more critical than ever. Atlanta lost a great man when John Lewis passed away in July, but his voice lives on and words like these push us forward: “Do not get lost in a sea of despair. Be hopeful, be optimistic. Our struggle is not the struggle of a day, a week, a month, or a year, it is the struggle of a lifetime. Never, ever be afraid to make some noise and get in good trouble, necessary trouble.”
Our GOGS Legislative Committee may not be getting in precisely the good and necessary trouble to which Lewis was referring, but we have certainly been hard at work on the legislative advocacy front. When we have been lobbying for our 2020 health policy priorities, we have been, in our own way, advocating to improve the health and livelihood of Georgia physicians, women and infants — despite a debilitating virus, in the face of institutional injustice, and regardless of race, ethnicity, or socioeconomic status.
GOGS’ primary focus during the Georgia General Assembly 2020 Session was to continue the fight to improve our state’s maternal mortality/morbidity rates and disparities. Georgia’s 2019 House Study Committee on Maternal Mortality (which included GOGS Advisory Board Members) recommended postpartum Medicaid extension as a vital strategy, and GOGS’ main “ask” during this year’s Georgia Patient Centered Physicians Coalition “Day at the Capitol” was means to support this measure. To that end, I am thrilled to report that House Bill 1114 passed both chambers (despite the intervening COVID-related months-long recess) and was approved for $19 million in funding (despite an overall 10% cut to the state budget due to COVID). This (now) law extends comprehensive Medicaid coverage for low-income Georgia mothers to six months postpartum and provides for lactational support services. While a one-year Medicaid extension is certainly the ultimate goal – to facilitate ongoing monitoring, diagnosis, and management of potentially fatal postpartum issues like mental illness, addiction crisis, hypertension, and cardiovascular disease – the magnitude of this victory in the current state of affairs simply cannot be overstated.
Notably, another almost $2 million of the slashed FY 2021 budget was also allocated to increase Medicaid reimbursement rates for selected E&M codes. Both the Medicaid postpartum extension and outpatient rate raise will help ob/gyns across Georgia keep their doors open during the COVID pandemic (especially in rural areas, where the payor mix is dominated by Medicaid, and maternal mortality rates and health disparities are often magnified).
In other good news from the Georgia capitol, none of the bills involving licensure of certified professional midwives (“lay midwives”) came to a vote on the chamber floor. This success was due at least in part to testimony provided by GOGS Legislative Committee members. As we emphasized at the committee hearings, our organization certainly has an interest in expanding access to obstetric services, particularly in our state’s rural shortage areas. However, it is critical that any midwife seeking to provide maternity care to Georgia women meet minimum education and training standards, and CPMs traditionally do not.
Unfortunately, Georgia’s first true attempt at tort reform legislation in 15 years (Senate Bill 415) failed to pass the Senate and cross over to the House. In partnership with the Medical Association of Georgia and our legislator allies at the capitol, our GOGS Legislative Committee will certainly attempt to reintroduce this critical issue next year. Georgia now ranks 6th on the list of “Top 10 Judicial Hellholes” and 41st in the U.S. Chamber of Commerce’s Lawsuit Climate Survey. In an increasingly litigious society, it is critical we make an effort to control professional liability costs. Georgia is already struggling with a shortage of obstetricians, so we must do everything we can to make our state a more attractive place to practice. To that end, one last-minute bright spot this Session was the Assembly’s passage and the Governor’s approval of Senate Bill 359, which provides certain liability protections for Georgia healthcare providers (including a heightened standard of gross negligence) during the COVID pandemic.
Before retreating into quarantine in mid-March, GOGS members did have the opportunity to meet with state elected officials at the Georgia Patient Centered Physicians Coalition “Day at the Capitol” (March 5th) and with federal elected officials as part of the ACOG Congressional Leadership Conference in Washington, DC (March 10th). At the Georgia capitol, we lobbied for postpartum Medicaid extension, medical liability reform, and stringent midwifery licensure processes. At the U.S. Capitol, we advocated for increased NIH funding for women’s health research and for postpartum Medicaid extension, as well. Furthermore, we asked our U.S. legislators to urge the Centers for Medicare and Medicaid Services (CMS) to correct an oversight in which they did not apply E&M payment increases to global maternity care codes (which was anticipated to lower payment rates overall for obstetric care). As a result, in early August CMS announced a proposal to increase the relative value of global obstetric care packages commensurate with increases for other types of office visits. ACOG is still working with a broad coalition of other medical societies to waive the Medicare budget neutrality requirements for 2021 and thereby stop any further payment cuts.
While we have not seen each another in-person since these pre-COVID advocacy events, our GOGS Legislative Committee continues to be in communication via Zoom calls and WhatsApp messaging. I am excited to announce that we recently reinvigorated the GOGS GynPAC Subcommittee, which has been strategizing a transparent process by which to evaluate and select state candidates deserving of PAC support. We are also developing processes by which we will hold elected officials accountable for their actions, or subsequently consider directing their funds to others. Furthermore, our Georgia Section recently submitted our inaugural application to the ACOG Ob-Gyn PAC Committee to request campaign contributions from this federal PAC to support our most-valued local women’s health champions. We are optimistic these supplemental funds may be an asset to our political strategy for years to come.
Moving forward, while we anxiously await the November elections and the 2021 Georgia General Session, our GOGS Legislative Committee will continue to closely monitor COVID-related policies, with a focus on extending coverage and maximizing reimbursement for telehealth services. Please do not hesitate to contact me with suggestions for legislative priorities, advocacy strategies, or anything at all. Thank you, as always, for staying engaged in our efforts to improve the health and healthcare of the women of Georgia. Our committee is proud to serve you!
To coincide with the kickoff of the Georgia General Assembly 2020 Session, I am excited to announce some promising changes to the Georgia OBGyn Society’s (GOGS’) legislative and advocacy efforts. For many years, our work at the Gold Dome has been spearheaded by our Legislative Chair Dr. Andy Toledo and Co-Chair Dr. Carla Roberts and implemented by our lobbyist Skin Edge and former executive directors Pat Cota and Daniel Thompson. This Session, we are fortunate to have Skin Edge continuing to lobby on our behalf, but he will be joined by our new executive director, Kate Boyenga, and directed by an entire team of physician leaders.
In order to ensure our organization’s advocacy efforts are representative of our diverse members – and sustainable for years to come – we recently instituted a GOGS Legislative Committee. This team of eleven physicians meets in-person quarterly and by phone as often as needed during the Session. We are led by Co-Chairs Dr. Andy Toledo and Dr. Adrienne Zertuche and include representation from GOGS leadership, ACOG Georgia Section leadership, the Medical Association of Georgia (MAG), the Patient Centered Physicians Coalition (PCPC), Young Physicians, and Junior Fellows (in practice and in training).
The GOGS Legislative Committee’s primary focus during the 2020 Session will be to continue efforts to improve Georgia’s maternal mortality and morbidity rates. Georgia’s 2019 House Study Committee on Maternal Mortality – of which GOGS Advisory Board Members Dr. Jane Ellis and Dr. Chad Ray were members – recently released several recommendations regarding this endeavor. First on their list, and at the forefront of ACOG advocacy efforts nationally, is postpartum Medicaid extension.
Data from Georgia’s Maternal Mortality Review Committee (MMRC) demonstrates that 73 percent of maternal deaths in Georgia occur during pregnancy or the first 6 weeks postpartum; the remaining 27 percent occur between the sixth week and one year postpartum. However, Medicaid coverage – which is responsible for more than 50 percent of Georgia deliveries – ceases 60 days after delivery. Extending comprehensive service provision to a full year may decrease delayed postpartum maternal mortality and morbidity, especially that related to cardiovascular disease, cardiomyopathy, overdose, and suicide.
Therefore, in accordance with ACOG and the House Study Committee’s recommendations, the GOGS Legislative Committee will pursue postpartum Medicaid extension at the capitol this Session. Although it is expected to be a tight budget year, we will also fight to ensure appropriate Medicaid reimbursement rates for our obstetricians that tirelessly care for our highest risk pregnant and postpartum women.
Another legislative issue that the GOGS Legislative Committee will be monitoring closely this Session is that involving the licensure of certified professional midwives (CPMs, i.e. “lay midwives”). GOGS certainly has an interest in expanding access to obstetric services, particularly in our state’s rural shortage areas. However, it is critical that any midwife seeking to provide maternity care to Georgia women meet minimum education and training standards. While certified nurse midwives (CNMs) meet and often exceed these standards, CPMs traditionally do not. The Legislative Committee will thereby scrutinize any legislation proposed this year to ensure appropriate education and training stipulations for any CPMs pursuing licensure.
Finally, the GOGS Legislative Committee looks forward to supporting medical liability reform legislation this Session. In an increasingly litigious society, it is critical that steps be taken to control professional liability costs and improve stability within our healthcare delivery system. The field of obstetrics is particularly vulnerable to litigation, and Georgia may begin to curb the attrition rate of early- and mid-career obstetricians if progress is made at the capitol on issues such as caps for noneconomic damages. The Medical Association of Georgia (MAG) is also passionate about reform, and we look forward to collaborating with them this Session.
While the GOGS Legislative Committee only has space for eleven members, there is plenty of room for GOGS members to become engaged in advocacy efforts in other ways. We encourage you to:
- Attend the Georgia Patient Centered Physicians Coalition “Day at the Capitol” on March 5, 2020 and/or the ACOG Congressional Leadership Conference (in Washington, D.C.) from March 8 to 10, 2020
- Sign up to serve as the “Doctor of the Day” for the Georgia House of Representatives
- Get to know your state legislators and keep them informed on GOGS’ legislative priorities
- Donate annually to the GOGS’ GynPAC
- Request PAC funds for a candidate committed to improving women’s health and healthcare
- Contact the GOGS Legislative Committee with suggestions for legislative priorities, advocacy strategies, or anything at all
Thank you, GOGS members, for staying engaged in our efforts to improve the health and healthcare of the women of Georgia. Our committee looks forward to serving you!