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Tackling Regulatory Relief and Prior Authorization
Original Program Date :
Length: 1 hour, 32 Minutes (Three Parts)

  • How Regulatory Relief is an Important Component of Tackling Physician Burnout—and what we can do about it with Koryn Rubin

Physician burnout is an issue medical societies must tackle and a big contributing factor is an administrative burden. In this session, you will learn about regulatory relief priorities and success, and how advocacy from medicine continues to achieve improvements for patients and physicians.

  • Part 2: How One Medical Society Addresses Regulatory Relief and Prior Authorization with James Scroggs

This presentation will describe how a medical specialty society has worked to address the ongoing burden of prior authorizations for pharmaceuticals. Specifically, it will provide 1) a brief description of the advocacy process at the AADA, including how priorities are determined 2) an overview of recent survey exploring how prior authorizations are affecting dermatologists, 3) discuss the process the organization took to develop an appeals letter generator tool that aids physicians in handling prior authorizations, 4) a summary of other efforts to reduce barriers to providing appropriate drugs to patients. Attendees will learn how the intersection of practice management and advocacy efforts is essential to success today.

Prior authorization poses a major administrative burden for physician practices, and the AMA offers a variety of resources to help state medical associations, national medical specialty societies, and their physician members advocate for meaningful changes. We will provide a “state of the states” overview of current state legislative efforts to address prior authorization hassles and discuss how states are achieving success; review AMA research that offers a strong evidence base to support advocacy on this issue; discuss our ongoing conversations with health plans and benefit managers to press for program reforms; and showcase educational resources that can support physicians in automating and simplifying the approval process.

Heather McComas, PharmD, Director, Administrative Simplification Initiatives, American Medical Association

Heather McComas, PharmD, is Director of the American Medical Association’s (AMA’s) Administrative Simplification Initiatives division. In her role at the AMA, Heather focuses on reducing administrative burdens and streamlining manual processes so that physicians can focus on what matters most—patient care. She regularly participates in standards development organizations, such as the National Council for Prescription Drug Programs, and has testified on the AMA’s behalf before the National Committee on Vital and Health Statistics Subcommittee on Standards on various administrative simplification issues. She is also Co-chair of the Workgroup for Electronic Data Interchange’s (WEDI’s) Prior Authorization Workgroup.

Prior to coming to the AMA, Heather worked for several years in the pharmaceutical industry in medical publishing and medical information. She received bachelor’s and master’s degrees in English from the University of Kansas and a PharmD from the University of Wisconsin–Madison. She is a registered pharmacist in Illinois.

James Scroggs, Assistant Director of Healthcare Economics, American Academy of Dermatology

James is Associate Director of Regulatory and Payment Policy at the American Academy of Dermatology Association (AADA), the leading professional society for dermatologists, with over 13,500 U.S. based dermatologists and over 20,000 total members. He provides leadership in development of responses to regulatory and payment issues that affect dermatologists and their patients. James oversees most of the AADA’s regulatory activities, including interactions with the Center for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA). He coordinates the AADA’s responses to the annual Medicare Physician Fee Schedule and CMS’s Quality Payment Program. In addition to his work in physician professional societies, James has previous experience in the Medical Service Corps of the U.S. Navy and in healthcare administration at a regional healthcare center.

Koryn Y Rubin, Assistant Director, Federal Advocacy Group, American Medical Association

Koryn Rubin is an Assistant Director with the American Medical Association’s (AMA) Federal Advocacy Group based in Washington D.C. Koryn provides strategic direction on setting the AMA’s quality-related advocacy agenda in order to advocate before the Executive Branch on behalf of the nation’s physicians and a lead on MACRA implementation for the AMA. In particular, she is responsible for analyzing regulations and legislation on Medicare and Medicaid quality reporting programs, health information exchange quality ratings system, physician performance measurement and public reporting, and comparative effectiveness research. Prior to joining the AMA, Koryn was a Senior Manager at the American Association of Neurological Surgeons where she provided guidance on the implementation of the Medicare quality programs and Meaningful Use, reviewed performance measures, as well as assisted neurosurgery with the launch of their registry, National Neurosurgery Outcomes and Quality Database (N2QOD). Koryn also previously worked at the American Academy of Ophthalmology. During her tenure, ophthalmology had the highest participation rate by specialty in the Physician Quality Reporting Initiative program (now Physician Quality Reporting System program). Koryn earned her masters of health administration from the George Washington University with a graduate certificate in health information technology, and her undergraduate degree also from George Washington with a concentration in Political science. 


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