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Government Relations

Articles & Updates


JUNE, 2019

MSOA members met with Missouri’s Congressional staff to discuss AAOS priorities including antitrust health insurance reform; the hospital competition act, surprise medical bills. Attending NOLC were: Dr. Akin Cil, Dr. Greg Della Rocca, Dr. Jasmine McGinty, Dr. Brian Fissell and Dr. Micah Sinclair.


JUNE, 2018

At the National Orthopaedic Leadership Conference in Washington D.C., MSOA was honored to meet with Senator Claire McCaskill and her legislative staff for a thoughtful discussion on improving HIT, issues surrounding the opiod crisis and health care in Missouri. Attending were Dr. Akin Cil of Lakewood Truman Hospital, Dr. Lukas Zebala of Washington University Orthopedics, Dr. James Keeney of Missouri Orthopaedic Institute, and Dr. Dirk Alander.


JUNE, 2018

Our thanks to Congressman Jason Smith for taking the time to visit with Missouri's Orthopaedic delegation and for a thoughtful discussion on critical health care issues in rural Missouri.


JUNE, 2018

We appreciate Sen. Roy Blunt's legislative assistant taking the time to visit with us about health care issues in Missouri.


MAY, 2015

MSOA physicians Ken Yamaguchi, Joel Jeffries, Dirk Alander, Doug Kiburz and Daniel Moon visit with Missouri Senator Claire McCaskill.


April, 2015

Rep John Rizzo, Dr. Mark Bernhardt, Rep. Sheila Solon visit at the MSOA legislative event at Arrowhead Stadium


April, 2015

Rep. Bill Kidd and Dr. Akin Cil visit at the MSOA legislative event


April, 2015

AAOS President David Teuscher speaks to the crowd at the MSOA Legislative event


May 23, 2012

Sen. Jean Carnahan, Ambassador Ann Wagner, MSOA Executive Director Brian Treece and MSOA President Jon Grantham, MD visit during the MSOA Legislative Reception at the 2012 MSOA Annual Meeting in St. Louis.


May 2, 2012

David Bumpass, MD; Michael Grillot, MD; Doug Kiburz, MD; Rep. Russ Carnahan; Andrew Schwartzkopf; Jan Vest discuss federal research grants for orthopaedic research.


May 2, 2012

Brian Treece, MSOA staff; Michael Grillot, MD; David Bumpass, MD; Doug Kiburz, MD; Mary Phillips, MSOA staff; Rep. Luetkemeyer; Andrew Schwartzkopf and Jan Vest visit about orthopaedic issues at the National Orthopaedic Leadership Conference in Washington D.C.


FEBRUARY 15, 2011

MSOA Executive Director Mary Phillips, MSOA President Doug Kiburz, M.D., MSOA Secretary Tom Reinsel, M.D., Sen. Robert Schaaf, M.D. and Executive Director Brian Treece meet to discuss the MSOA imaging bill, SB 76 during the MSOA Lobby Day on February 8, 2011. Senate Bill 76 is sponsored by Sen. Schaaf, M.D.

The MSOA Imaging bill in the House, HB 280, is sponsored by Rep. Keith Frederick, D.O. HB 280 was heard in the House Health Insurance Committee which is chaired by Rep. Mollendorf. During the MSOA lobby day, testimony on the bill was provided by MSOA President Doug Kiburz and Executive Director Brian Treece as well as several other medical associations.


JANUARY 6, 2011

MSOA Member Keith Frederick, D.O. was sworn in to the Missouri House of Representatives last week. MSOA staff Mary Phillips and Brian Treece met with Sen. Rob Schaaf, M.D. and Rep. Keith Frederick, D.O. who are sponsoring MSOA's legislation to protect the ability of physicians to utilize in-office imaging.


MAY 6, 2010

Gov. Nixon Signs Prompt Pay Legislation

Left to right: Michael Clark, M.D.; Doug Kiburz, M.D.; Wayne Cooper, M.D., chair of the House Healthcare Policy Committee; and Tom Reinsel, M.D. at the MSOA Lobby Day.

Legislation to improve enforcement of Missouri’s prompt pay laws has been approved by the Missouri House and Senate and signed into law by Gov. Jay Nixon.During the Annual MSOA Lobby Day in April, MSOA members attended the final hearing of Senate Bill 636 in the House Healthcare Policy Committee. MSOA Director Brian Treece testified in favor of the legislation. Before a hearing room packed with stakeholder groups and orthopaedic surgeons, the committee approved the bill unanimously.

Last year, MSOA leaders met with Gov. Jay Nixon to express concern about unpaid claims. Under an Executive Order issued by Gov. Nixon, the Missouri Department of Insurance began tracking complaints from healthcare providers regarding unpaid health insurance claims. Their study found that nearly 25% of all claims are unpaid after 90 days because claims were suspended.

Under current law, many health insurers used a loophole that allows claims to be suspended for a period of time before a decision is made by the health carrier to pay or deny the claim. House Bill 1498, along with Senate Bill 636, clearly defines a “clean claim” and requires insurers to pay more promptly, by removing the “suspension” period from Missouri’s 8-year-old prompt pay law and requires health insurers to pay or deny claims within 45 days.

Under the legislation which the Governor is expected to sign, health insurance carriers must send an electronic acknowledgement of the date of receipt within 48 hours after a healthcare claim is received. The legislation requires a health carrier to notify the health care provider within 10 processing days, instead of the current 15 days, for any request for additional information. If the health care provider submits the additional information, the health carrier must pay or deny the claim within five processing days, instead of the current 15 days, of receiving the additional information. After 45 days, a penalty of 1% is assessed for every day the unpaid claim is late.


MAY 6, 2010

MSOA Leaders Meet With Missouri Insurance Department Top Officials

l.-r. Tom Reinsel, M.D.; Rep. Chris Molendorp, member of the House Insurance Committee; MSOA President Doug Kiburz, M.D.; MSOA Director Mary Phillips; Michael Clark, M.D.; and Michael Burns, M.D. at the MSOA Lobby Day.

The Missouri State Orthopaedic Association hosted its annual State Lobby Day on April 7 in Jefferson City.

MSOA met with top officials of the Missouri Department of Insurance including Director John Huff and Jim McAdams, the general counsel for the department. MSOA thanked the Department of Insurance for the department's interim study documenting prompt pay issues and market conduct studies to improve timely payment from health insurance carriers to physicians. In addition to anecdotal Prompt Pay issues from MSOA members, MSOA members discussed HMO-driven second opinions, peer-to-peer reviews, and ongoing utilization review complaints.ary Kempker, market regulation director of the Missouri Department of Insurance, described the appeal statutes and regulation depicting the composition of the review team and the reasons DIFP may send an adverse determination on to the department's external review contractor. Director Huff indicated that all complaints are reviewed and investigated. In addition, complaints against health insurers are aggregated to determine if a more intensive market review is required.

Under a recent change by the Missouri Department of Insurance, physicians are now considered "consumers" and can file complaints for denial of coverage or unpaid claims on behalf of their patients or themselves. Physicians may file complaints directly with the Missouri Department of Insurance, Financial Institutions and Professional Registration by linking to http://insurance.mo.gov/consumer/complaints/.

Special thanks to MSOA President Doug Kiburz, M.D.; MSOA Secretary Tom Reinsel, M.D.; MSOA Board Member Michael Clark, M.D. and Michael Burns, M.D. for participating in this year's advocacy efforts.



Missouri Insurance Department to examine health insurers' reimbursements to Doctors

Gov. Jay Nixon issues prompt pay executive order

Missouri Insurance Department to examine health insurers' reimbursements to Doctors
Gov. Jay Nixon issues prompt pay executive order.

Gov. Jay Nixon has ordered the state Department of Insurance to determine whether health insurance companies in Missouri are withholding reimbursement payments to health care providers for unreasonable lengths of time.

Doctors, hospitals and other providers have complained to the department that after treating patients and submitting bills for reimbursements, health insurance companies are not paying the bills in a timely manner.

The Governor signed an executive order today calling on the Insurance Department to report on the scope of the problem and make recommendations on the sufficiency of Missouri's "prompt pay" statutes. State law requires health insurers to respond to and pay claims to health care providers within specific time frames, or they face penalties and interest payments.

This year the Department of Insurance has fielded complaints from health care providers involving thousands of unpaid claims. Complaint volume for 2009 is already six times as high as it was for all of 2006. Some examples of complaints submitted:

  • A rural hospital in eastern Missouri has waited more than two years to be reimbursed for $300,000 in claims dating back to 2007.
  • A St. Louis-area hospital has filed complaints regarding more than 3,000 unpaid claims.
  • A small central Missouri anesthesia practice has filed a complaint regarding almost $120,000 in outstanding claims, dating back to 2007.

MSOA members met with Gov. Nixon in April 2009 about payment delays with major carriers in Missouri. 

"This problem hits small and rural providers hardest, straining their cash flow and requiring them to dedicate staff time to paperwork and collections," said John M. Huff, director of the Missouri Department of Insurance, Financial Institutions and Professional Registration.

According to the executive order, "the lack of timely claims payments may significantly compromise the ability of hospitals and health care providers to continue to provide quality medical care to Missourians."

This fall, the department will be surveying dozens of hospitals and health care providers across the state to determine the extent of the problem. The department will then make a report to the Governor and General Assembly to determine whether new, stricter prompt pay legislation is needed in 2010. The department will give its report to the Governor and legislature by Dec. 31.

Health care providers with complaints about lack of prompt payment from insurance companies should file a complaint with the department's Insurance Consumer Hotline, 1-800-726-7390, or visit insurance.mo.gov.



Missouri Orthopaedic Physicians Lobby Federal Lawmakers in D.C.

A delegation of Missouri orthopaedic physicians participated in the National Orthopaedic Leadership Conference in Washington, D.C. from April 30 thru May 2, 2008. 

On Wednesday evening, NOLC participants heard from former U.S. House Speaker Newt Gingrich about his plan for comprehensive healthcare reform. On Thursday,  Missouri's team of orthopaedic physicians met privately with U.S. Sen. Kit Bond regarding the sustainable growth rate of Medicare reimbursements. U.S. Sen. Claire McCaskill spent nearly an hour discussing healthcare policy reform and encouraged doctors to remain involved in the process. U.S. Rep. Todd Akin discussed budget issues and healthcare marketplace concepts with Missouri's delegation. U.S. Russ Carnahan invited Missouri's entire delegation to join him in the members-only House Dining Room in the U.S. Capitol. During a 1 1/2-hour lunch, representatives from MSOA discussed a wide-ranging array of challenges facing physicians and issues including medical research, quality care, and insurance reform.

Representing the Missouri State Orthopaedic Association at the NOLC were:

  • Dirk Alander, M.D.; member, AAOS Board of Councilors
  • Jon Grantham, M.D.; member, AAOS Board of Councilors
  • Leesa Galatz, M.D.; member, AAOS Board of Directors,
  • Matt Matava, M.D.; AAOS Leadership Fellows Program
  • Ryan Nunley, M.D.; Alumnus, AAOS Leadership Fellows Program
  • Brian Treece & Mary Phillips; MSOA Executive Directors

In addition, Brian Treece was an invited speaker at the State Societies Strategies meeting on Wednesday, April 30. On behalf of MSOA, Treece presented the topic "Lessons from the field: Legislative Advocacy" highlighting lobbying techniques for state orthopaedic societies and recent successes in Missouri.

See pictures here.


  • Prohibits health insurers, the Missouri Medicaid Program, and the federal Medicare Program from discriminating against any provider located within the geographic coverage area of a health benefit plan who is willing to meet the terms and conditions for participation in the plan.

Current Status: In Rules Committee pending debate on the House Perfection Calendar.


Prohibits any agreement between a health insurance carrier and a licensed health care provider from containing a provision which:

  • Prohibits a provider from contracting with another carrier to accept a lower reimbursement than the payment specified in the agreement;
  • Requires the provider to accept a lesser reimbursement from the carrier if the provider agrees with another carrier to accept the lower reimbursement for services;
  • Terminates or renegotiates the agreement if the provider agrees to accept a lower payment from a different carrier for services; or
  • Requires the provider to disclose his or her contracted reimbursement rates with all contracted providers.

A violation of any of these provisions will make an agreement void and unenforceable.

Current Status: Heard in the House Committee on Healthcare Transformation on 2/20.


The Governor's proposed budget includes a 10% increase in reimbursements for physicians who treat lower-income Missourians. Currently, physicians' rates are 55 percent of rates for the federal Medicare program for senior citizens and disabled. 

The proposed increase would raise MO HealthNet reimbursement rates to a minimum of 65 percent of the Medicare rates and would cost nearly $53 million.

MSOA Position: MSOA has consistently requested a moratorium on Missouri-based "pay-for-performance" until Medicaid reimbursement rates are at least 100% of Medicare or private insurance. MO HealthNet legislation calls for reimbursements rates to be brought up to 100 percent of Medicare rates in five years.

Current Status: Pending in the House Budget Committee and Senate Appropriations Committee.


PAC Contributors Board (PDF, 140K)

Missouri State Orthopaedic Association Issues of Interest (Word, 300K)

Missouri State Orthopaedic Association Position Paper: Pay for Performance Issues (Word, 32K)


May 3, 2007

National Orthopaedic Leadership Conference

On May 3, 2007, members of the Missouri State Orthopaedic Association lobbied their federal elected officials in Washington, D.C. as part of the AAOS' National Orthopaedic Leadership Conference (NOLC). MSOA members met with U.S. Sen. Kit Bond, U.S. Sen. Claire McCaskill, and U.S. Reps. Kenny Hulshof, Ike Skelton, and Russ Carnahan. The MSOA delegation also met with the healthcare staff of rep. Roy Blunt. Missouri lobbied on issues pertaining to pay-for-performance, physician reimbursement formula, orthopaedic trauma from Iraq and the importance of well-trained surgeons.

Representing MSOA at the NOLC were Dr. Dirk Alander, BOC member; Dr. Jonathon Grantham, BOC member, Dr. Matt Dobbs, MSOA member, Dr. Sonny Bal, MSOA member and MSOA staff Mary Phillips and Brian Treece.


Government Relations

Articles & Updates