ACOP PULSE
THE OFFICIAL NEWS PUBLICATION OF THE VIRGINIA ORTHOPAEDIC SOCIETY

CONTENTS OF THIS ISSUE
Summer 2017 Issue

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Legislative News

 

Policy Issues Affecting Orthopaedics

By Lauren B. Schmitt
Senior Manager of Government Affairs
Commonwealth Strategy Group

Legislative NewsEven though the legislative session ended in February, VOS is still hard at work on a number of policy issues affecting orthopaedic surgeons and our patients.

Workers' Compensation
The Virginia Workers’ Compensation Commission (VWC) held a public comment hearing on Tuesday, May 23, 2017 to receive additional input on the proposed medical fee schedules (MFS), related ground rules, and methodology report. This concluded the official public comment period which included opportunity to submit written comment from April 10 to May 10. At the May 23 hearing, the Commission provided an update on the process and received oral comment from stakeholders, including Karen Simonton, an administrator from OrthoVirginia’s Lynchburg office.

The fee schedules were created pursuant to Virginia law adopted in 2016 requiring the VWC to implement schedules for the reimbursement of medical services to injured workers subject to the Virginia Workers Compensation Act. The schedules will have maximum fees, in absence of a contract, for the reimbursement of categories of health care providers in six regions of the Commonwealth. The schedules were designed by an actuarial team and an appointed stakeholder advisory panel using workers’ compensation paid reimbursement data collected from insurers, third-party administrators, and providers. The law instructs VWC to create a unique Virginia-based fee schedule that reflects actual average historical reimbursements from 2014-15 as the baseline. The schedules will be implemented in January 2018.

Opioid Regulations
Legislation was passed during the 2017 session requiring the Boards of Dentistry and Medicine to develop emergency regulations around the prescription of opioids. The Boards adopted these regulations in February and became effective March 15. They will remain in effect until March 19, 2018 and will then be replaced by permanent regulations. You can view the Board of Medicine’s FAQ about the regulations HERE. MSV has compiled a summary of the regulations HERE.

COPN
VOS received a grant from the AAOS in December to fund an 18-month campaign around COPN reform. VOS formed the Virginia Coalition to Reform COPN, which is comprised of 22 organizations that all support significant reform. Our website can be viewed HERE. We have built a grassroots action network that now has over 600 supporters signed up. We will be coordinating legislative visits over the next couple of months.

At the end of the 2017 Virginia General Assembly session, the Chair of the House Health, Welfare and Institutions Committee, Delegate Bobby Orrock, convened a meeting of COPN stakeholders. Delegate Orrock and key leaders on the House HWI committee expressed frustration with the lack of movement on comprehensive COPN reform the past few years. As a result, they have indicated they are ready to move forward with reviewing individual project exemption bills during the 2018 legislative session. They have told us that Virginia is “open for business” and anyone who has a specific project that would need a COPN exemption should pursue legislation. The Virginia Coalition to Reform COPN is coordinating this effort. If you are interested in pursuing legislation, please visit HERE.

Elections
 It’s election year in Virginia, with the entire House of Delegates and the statewide offices up for election. After the primary election on June 13, we will know who the Democratic and Republican nominees are for the offices of Governor, Lieutenant Governor and Attorney General. For Governor, current Lieutenant Governor Ralph Northam is running against former Congressman Tom Perriello for the Democratic nomination. Ed Gillespie, Senator Frank Wagner and Corey Stewart are competing for the Republican nomination. For Lieutenant Governor, Susan Platt and Justin Fairfax are running for the Democratic nomination. Senator Jill Vogel, Senator Bryce Reeves and Delegate Glenn Davis are all competing for the Republican nomination. Our current Attorney General Mark Herring is already the Democratic nominee for AG and he will be running against John Adams, the Republican nominee. The whole country will be looking to see how Virginia’s elections go, so it will promise to be an interesting election season!

Medical Society of Virginia
MSV hosted its annual policy summit on Friday, May 5. The MSV Specialty Advisory Council reviewed policy proposals submitted by MSV members and is making recommendations to the MSV Advocacy Committee, which will meet in July. Dr. Doug Boardman presented a proposal submitted by VOS to clarify MSV’s COPN policy. Our proposal asks for confirmation that MSV can and will support COPN-exemption legislation, as long as it includes charity care requirements and accreditation standards. The Advocacy Committee will vote on these proposals in July.

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Reform Certificate of Public Need Laws Now

By Wilford K. Gibson, MD
VOS Past President
Virginia Beach, Virginia

May 7, 2017 - The Virginian-Pilot

Wilford K. Gibson, MD
Wilford K. Gibson, MD

With the General Assembly's veto session done, state legislators have gone home to campaign in their districts. With them goes any hope of modernizing Virginia's healthcare licensing process.

For the third year in a row, as the effort to reform certificate of public need laws gained momentum in Richmond, hospital executives demanded that legislators wait and see what would happen at the federal level before passing any state reforms that could affect hospital profits. The General Assembly obliged, and the session adjourned without reforms to the certificate of public need process.

I've practiced medicine in Virginia for more than 30 years. I know firsthand that there should be no time outs when it comes to healthcare. "Do no harm" rarely means "do nothing." Physicians are expected to refrain from causing harm, but we have an obligation to help our patients. The first step is understanding and accounting for the potential harm of inaction.

Under Virginia’s certificate of need process, health care executives are required to complete an expensive application process when they want to add facilities and equipment. They must demonstrate a public need for what they want to add. State government officials then must approve it. Stakeholders from every region and level of government agree that the certificate of public need law must be reformed. Approaches to reform have been widely discussed for years, but the harm that could be caused by doing nothing has been addressed very rarely.

Competition drives quality. But the certificate of need process results in limited access — geographically and financially — to quality care. Earlier this year, in a U.S. News & World Report ranking of how well states are meeting their residents' healthcare needs, Virginia placed 20th in access to care and was, shockingly, ranked 46th for its quality of care.

Additionally, studies have shown that certificate of need laws force states to pay more for less. 

States with the laws spend three percent more overall on healthcare, five percent more for physician care and 6.9 percent more for Medicare. A 2015 study by the Mercatus Center found that there are 131 fewer hospital beds per 100,000 people in Virginia when compared to the rest of the United States. Moms with critically ill infants are faced with the possibility that their baby could spend the first hour of its life on the road to another facility rather than receiving life-saving care immediately — because less than half of Virginia hospitals with a maternity ward have a neonatal intensive care unit capable of providing basic care and emergency services.

It’s not just doctors and patients who shoulder the consequences of waiting to reform these laws. Millions of dollars in healthcare investments are being ignored while we turn our backs on patients across the commonwealth. Last year alone, more than $44 million in certificate of public need requests were denied. That $44 million would have been spent on more hospital beds, CT scanners and NICU facilities for newborns in need.

This is a missed opportunity to strengthen our health care infrastructure, create jobs and expand our economy. Despite Virginia’s relatively low operating costs and access to global markets, we landed in 13th place on last year’s CNBC list of the United States' top states for business. That's down ten points from 2012. A new report from the University of Virginia shows that for the past three years, more people have been leaving Virginia for other states than are moving here. We’re also losing ground in other national rankings, including the Forbes Magazine list of the best places for business and the annual Manufacturing and Logistics National Report Card put together by the Center for Business and Economic Research. 

Every year, lawmakers postpone action on certificate of public need reform, patients and local economies suffer the consequences of inaction. We missed the opportunity this legislative session, but as our General Assembly members return home to campaign for voter support, perhaps their constituents will remind them that there's a hefty price to pay for their wait-and-see approach.

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