An Interview with Representative Mark Green, MD
Issue: July/August 2021
Author: Lisa A. Moreno, MD MS MSCR FAAEM FIFEM
Welcome to the second installment of our new Common Sense column, designed to help you get to know your legislators, understand the legislative process and how you can influence it, and strengthen the Academy’s relationship with our lawmakers for the purpose of improving the working conditions of physicians and the health care of the nation. This issue, we interview Congressman Dr. Mark Green (R-TN). Rep. Green is an emergency physician and has recently introduced health related legislation pertinent to emergency medicine. His brief bio and text of the legislation follows this article.
Dr. Moreno: As emergency physicians, we see trends in public health and the impact of public policy faster and more frequently than any other specialty. So, it’s natural for us to be involved in public health and public policy. But, you chose to make public policy your primary focus and the primary way in which you serve our patients. How did you make that decision?
Rep. Dr. Green: When I was a practicing physician, I ran an emergency medicine management company. We wanted to see the delivery of care improve. I recognized there were serious flaws in the way that government impacted health care and I realized that I could have an impact there. I saw this as an opportunity to better serve both physicians and patients on a larger scale.
One of the ways I made an impact was early in my career, while I was still a Tennessee State Senator. I passed a bill that required the insurance companies to get physician input when pre-approval for medical procedures was necessary. I believe that if an insurance company is going to say “no,” then a medical professional must be involved, and it should preferably be an MD. This bill impacted 6.9 million people in the State of Tennessee. That is 6.9 million people who did not have a non-medical administrative person denying their procedure, resulting in delayed care while the patient and the doctor file a request for a review of the denial.
Dr. Moreno: What do you think are the three most critical legislative issues facing emergency medicine today?
Rep. Dr. Green: Telemedicine: We used to say in the military that certain elements are combat multipliers. Telemedicine can be a massive combat multiplier for EM. It can streamline the ED processes, and reduce backups. The use of telemedicine can enhance the impact of the physician intervention while decompressing the ED. It eliminates the need for a patient to have transportation to the ED and would certainly decrease the unnecessary use of EMS transport. It is a practical way of giving universal access for patients to the most highly skilled member of the ED health care team, the emergency physician, at a much, much lower cost than an ED visit. The physician would then be able to call in a prescription, send an ambulance, or get the patient an appointment with primary care or the appropriate specialist in the appropriate time frame.
Rural EM: I am very concerned about critical access hospitals and the possibility that many of them may close. CMS has a 35-mile regulation that says that Medicare will only reimburse if the off-campus clinic is within 35 miles of the main campus hospital. Now, we know as emergency docs that many of our patients across the country live a lot more than 35 miles from a main campus hospital. We know the mantras that “time is muscle” and “time is brain,” and so it is critical that rural patients have access to urgent and emergent care when they have a potentially time critical chief complaint. Every patient deserves access to a physician competent to assess the patient for their chief complaint, start the appropriate intervention, stabilize the patient, and move them to definitive care if this is indicated. If critical access clinics and centers are not reimbursed, they will not be able to afford to stay open, and then all the patients who are served by these institutions could find themselves on a four or five hour ambulance ride to the nearest emergency department. And as we know, patients who are not stabilized prior to transport to definitive care have far worse outcomes.
Something else that people fail to realize when discussing rural health is that critical access hospitals and clinics provide jobs in their communities. So, not only are they providing life- and limb-saving medical interventions and keeping doctors and nurses living in rural communities, but they are also providing jobs for housekeepers, pharmacists, pharmacy assistants, radiology technicians, transporters, security officers, clerical staff, and many others. Protecting these patients and these communities is an overlooked area and one that I champion, so much so that I have introduced two bills, the Rural ER Access Act and the Rural Healthcare Access Act, which is co-sponsored by Rep. Bennie Thompson (D-MS).
Overregulation: Balance billing is an example of this. The intent of the framers of the Constitution did not include overregulation by government. Physician practice, like everything else in our society, should be dependent on the supply/ demand curve. We need to make sure that insurance agencies don’t hinder patient care. We know that the government pays below market value for health care. Insurers keep us in business. The Government should not be involved in this relationship.
Dr. Moreno: At AAEM, we are very aware of the impact of corporate practice on our lives and the lives of our patients. Profit is valued over what is best for the patient and over physician wellness. Patients per hour is valued over quality of care. We are encouraged towards suboptimal practices in order to get high patient satisfaction scores. How do you see the role of lawmakers in protecting the sanctity of the doctor-patient relationship and returning medical decision making into the hands and minds of those most qualified to do this: physician specialists?
Rep. Dr. Green: Lawmakers can do a lot, especially at the state level. In fact, we did a lot in Tennessee. States should run their own programs, because at the state level, the doctors know what the issues are for their communities and the state lawmakers are in touch with what their constituents want. The corporate practice of medicine is damaging to medicine. First and foremost, it drives up the cost of health care. It involves many more people than need to be involved in the delivery of care. We need to put physicians back into decision-making roles, specifically regarding admissions. If you are looking at a patient, and you are laying hands on a patient, and you are a licensed physician, then you know what the appropriate disposition for the patient should be better than some non-medical person in an office somewhere.
Dr. Moreno: Why are states better-placed to make decisions?
Rep. Dr. Green: I am at heart a Constitutionalist, and I believe that what the Constitution says should be followed. According to the Constitution, health care is not a federal issue. The 10th Amendment clearly says that if it is not in the Constitution, then it is within the power of the states to make decisions. (Author’s Note: For those of you who, like me, need a refresher on 8th grade Civics class, here is what the Tenth Amendment says: The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.) The federal government has
overreached in many areas, not just health care. Sometimes, they do not say exactly what an entity needs to do, but they will say that if you want specific federal money, then you have to comply with specific standards. That is not what the founders wanted; they wanted the power spread out among the different branches and levels of government, a system which better serves the people. One of the intents of the framers was to avoid tyranny. By decreasing the concentration of power, by sharing it among the branches of government and the levels of government (federal, state, and local), tyranny is avoided. The government closest to the people should be making decisions for the people in their states. I know my constituents in Tennessee want this level of autonomy, and I suspect most Americans share this view.
Dr. Moreno: Many lobbyists and citizens come to you to advance their agendas. Some of these contacts are impactful and change the way a lawmaker votes or what bills he introduces or supports. Some of these contacts make no impact on the lawmaker at all. What qualities in a person or in their approach cause you to sit up and listen?
Rep. Dr. Green: You have to take it at face value that lobbyists will pitch their positions well. I expect them to have done the research and to come prepared to discuss the issue they are lobbying for. What I really like to see is someone lobbying who has done what they are lobbying for. So, a physician lobbying for health care is someone I would listen to because they have practiced in the health care field. I think of lobbyists like drug reps, they are the detail people. They bring the details to us. I also always ask every lobbyist who comes to me: tell me the argument of the person on the other side; the opponent. If they can do that, then the lobbyist is honest, and they know the policy issue front and back. It gives them credibility. It goes without saying, but they also need to be articulate and able to sell their argument.
Dr. Moreno: What are some of the things that lobbyists or constituents do that make it less likely that their message will have an impact?
Rep. Dr. Green: Don’t threaten legislators. Some lobbyists will come in and say, if you don’t support this, then we are going to do this. This is not a collaborative stance. Our job as legislators is to represent the needs of our people, to adhere to Constitutional law, and to improve the lives of our constituents. We aren’t swayed by threats. Making threats is not a way to gain respect.
Dr. Moreno: Do you have a closing message for emergency physicians practicing in today’s health care environment?
Rep. Dr. Green: Our goal as medical professionals should be to change people’s lives. That nine-year-old child who comes in with a broken leg should leave wanting to become a doctor. We have that power to change people’s lives, and we should seize it.
Rep. Dr. Green Bio
Congressman Mark Green first took the oath of office to represent the 7th District of Tennessee in Congress on January 3, 2019. It is the exact oath he first took as a cadet, on the historic Plain at West Point more than thirty years earlier. As a successful business leader, decorated combat veteran, ER physician, and former Tennessee State Senator, Green is uniquely equipped to represent the people of his district.
The son of a hardworking father and loving mother, Congressman Mark Green grew up on a dirt road in Mississippi. He came to Tennessee in his last assignment in the Army as the flight surgeon for the premier special operations aviation regiment. As a Night Stalker, Green deployed to both Iraq and Afghanistan in the War on Terror. His most memorable mission was the capture of Saddam Hussein. During the mission, he interrogated Hussein for six hours. The encounter is detailed in a book Green authored, A Night With Saddam. Congressman Green was awarded the Bronze Star, the Air Medal with V Device for Valor, among many others.
After his service in the Army, Green founded an emergency department staffing company that grew to over $200 million in annual revenue. The company provided staffing to 52 hospitals across 11 states. He also founded two medical clinics that provide free healthcare to under-served populations in Memphis and Clarksville as well as numerous medical mission trips throughout the world.
Green was elected to the Tennessee State Senate in 2012, where he distinguished himself as a conservative leader that fought for freedom and smaller government for all Tennesseans. His many legislative accomplishments include the repeal of the Hall Income Tax and the passage of the Tennessee Teacher Bill of Rights. He won the National Federation of Independent Businesses’ Guardian of Small Business award and the Latinos for Tennessee’s Legislator of the Year award, among many other recognitions.
In Congress, Green has worked tirelessly on behalf of people of Tennessee’s 7th District. He serves on the House Armed Services Committee, House Foreign Affairs Committee, and the Select Committee on the Coronavirus Crisis. In addition, Green serves as Ranking Member of the House Foreign Affairs Subcommittee on the Western Hemisphere, Civilian Security, Migration, and International Economic Policy.
Green has sponsored 24 pieces of legislation and cosponsored 168 pieces of legislation over issues facing the people of Tennessee. From strengthening rural healthcare, to holding China accountable, to supporting Gold Star families and bringing American businesses back home, Congressman Green’s well-rounded background in business, healthcare, and the military has made him distinctly qualified to address such issues.
Congressman Green’s experience building a successful healthcare company equips him to take on wasteful spending and over-regulation from Washington. He introduced the Balanced Budget Amendment to the Constitution that requires Congress to pass a balanced budget and stick to it.
His 24 years of service—between the Academy, active duty Army and Army Reserves—have impressed upon him the need for a well-cared for military family. Green made veteran families a priority during his time in the Tennessee State Senate, and has continued to do so during his time in Congress. His first bill introduced in the House was the Protecting Gold Star Spouses Act that allows for spouses to continue receiving benefits during government shutdowns. He introduced another bill for Gold Star families, the Protecting Gold Star Children Act, which places children receiving benefits in the appropriate tax bracket.
Green has also worked to improve resources for the mental and physical health of veterans. He introduced the Spiritual Readiness amendment to the NDAA to address spiking numbers of veteran suicides. In addition, he led the bipartisan fight to include provisions for veterans subjected to toxic exposure while serving at the K2 Air Base in Uzbekistan during the War on Terror. In January of 2021, the President signed an Executive Order modeled after Rep. Green’s bipartisan K2 Veterans Toxic Exposure Accountability Act that requests the Secretary of Defense recognize Uzbekistan as a combat zone for purposes of medical care. This action represents a crucial step toward recognition of K2 veterans’ severe and deadly service-connected illnesses.
His time serving in the Armed Forces also made him aware of the need for strong American leadership internationally and the threat China poses to this generation. Green has introduced 5 bills to hold China accountable: The Our Money in China Transparency Act, the Bring American Companies Home Act, the Protecting Federal Networks Act, the Secure Our Systems Against China’s Tactics Act, and the China Technology Transfer Control Act. He also introduced a resolution demanding China’s repayment of sovereign debt held by American families.
As a physician, Green recognizes life begins at conception and firmly advocates for the unborn. He introduced the Born-Alive Survivors Protection Act that requires medical attention for infants born during abortions. Green also brings the unique perspective of doctor, healthcare administrator, and cancer survivor to the issues surrounding rural healthcare in America. He introduced the bipartisan Rural Health Care Access Act and the Rural ER Access Act to cut regulation and improve emergency medical care in rural hospitals.
Congressman Green has won multiple awards for his work in Congress, including the American Freedom Fund’s Legislator of the Year Award for his work to empower veterans and the Guardian of Small Business award from the National Federation of Independent Business (NFIB). Green received a perfect A+ rating from the Susan B. Anthony List for his pro-life voting record. He also received the impressive distinction of being unanimously voted President of the Republican freshman class in the House of Representatives.
Green resides in Clarksville, Tenn., with his wife, Camilla. They are the proud parents of two grown children