The ACR recently spoke with Loralie D. Ma, MD, PhD, FACR, about Maryland’s advocacy wins battling non-physician scope-of-practice (SOP) expansion. Ma is past chair of the ACR State Government Relations Committee and past president of MedChi, the Maryland State Medical Society.

Can you explain the most recent SOP bill in Maryland and why the Maryland Radiological Society (MRS) advocated so heavily against it?

This year, the physician assistants (PAs) worked to introduce a bill into the Maryland Senate, SB 673, with a similar bill filed in the House, HB 727, to “modernize” PA practice.¹ It would have taken the current delegation agreement between a PA and a physician to a collaboration agreement. The MRS position is that collaboration could be considered if the physician remains the head of the healthcare team.

The PAs did not want this and also did not want to only have collaboration with a physician or group of physicians, but also wanted to be able to collaborate with an entity, such as a hospital or corporation. We felt this was essentially independent practice as there would be no overseeing physician. We tried to work with them on compromise language, but we could not agree. Such a bill is a danger to patients as PAs do not have the training of physicians, including lack of a residency program, and there would be no oversight of their activities. Improper and undertrained mid-level providers performing subspecialty procedures on patients is not acceptable. I am pleased to report that these dangerous bills did not pass this session.

Could you talk about the various advocacy efforts that MRS used during this SOP fight?

The bill was a reintroduction from last year.² At the time, I was serving as president of MedChi, and I convened a workgroup to find common ground. Last year’s bill was ultimately withdrawn by the sponsor. Unfortunately, the bill introduced this year was relatively unchanged from last year. We did not need to use a call-to-action, as the legislators understood both from MedChi and MRS, as well as the Maryland Board of Physicians, that the independent level of practice sought was a danger to patients. There were hearings in the House and Senate, and I testified at both. 

How did you prepare to testify before the Maryland Legislature? Any tips for other radiologists who are interested in doing something similar?

In preparation for my testimony, I carefully read the bill and asked our lobbyists for MedChi and MRS for the questions to better understand what they were specifically asking for. For these hearings, I felt it was important to explain in-depth the training a physician receives, first in medical school and then in residency, and how that training has testing and oversight and personal vetting, to be certain that a physician graduating from a residency is prepared to treat patients in a specialty. I pointed out that on-the-job training for PAs is not to that level and needs close oversight. I wrote out my testimony and timed it to the three minutes we were allowed and practiced a few times. It is also important to know, or have your lobby team know, how and when to sign up for testimony, as there are often strict deadlines.

Are there any best practices about what worked or did not work when trying to get your message across to legislators and other like- and non-like-minded organizations?

I think it was important to acknowledge that midlevel providers are an important part of today's healthcare team, but that the best patient care comes from a physician-led healthcare team. Being overbearing or dismissive of the roles of all members of the healthcare team is not helpful. It is also important to remember that legislators have at least hundreds, if not thousands, of issues to address each session. Explaining who we are as physicians, as specialists and the in-depth nature of our training, testing and vetting is very helpful in allowing legislators to understand our importance in patient care and safety.

Why is it important for radiologists to get involved in advocacy? What unique perspectives can a radiologist provide when discussing SOP?

If you are not at the table, you will likely end up on the menu. If we are not there to advocate for our specialty and for our ability to give the highest level of patient care, who will? Radiologists, often being imagers of multiple organ systems, can see a cross-section of patient illness that is sometimes not as well appreciated by our other specialist colleagues. In our work, we can see the value of their experience in evaluating and treating patients, as well as our unique role in the imaging diagnosis of disease.

Wins for Breast and Lung Cancer Screening

On May 3, 2023, Maryland Gov. Wes Moore held a bill-signing ceremony in Annapolis that included HB 376/SB 184 and SB 965/HB 815. Starting Jan. 1, 2024, state-regulated insurers will be prohibited from imposing a copayment, coinsurance or deductible on coverage for diagnostic mammograms, breast US or breast MRI for the detection and diagnosis of breast cancer and diagnostic ultrasound, MRI, CT and image-guided biopsy for the detection and diagnosis of lung cancer.

The Susan G. Komen organization helped push for the breast cancer screening bills and issued a statement after the signing, which included this from Molly Guthrie, vice president of policy and advocacy: “We thank the Maryland legislature and Governor Moore for eliminating a key financial barrier to care so that anyone with a state-regulated health plan can now receive medically necessary diagnostic and supplemental imaging without any out-of-pocket expenses.”

View the full text of the bills.

Read the full statement from Susan G. Komen.