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Save the Date! January 31, 2013
VOS “White Coats on Call” Day on the Hill
Please make plans to join your fellow orthopaedic surgeons for our first “White Coats on Call” Day at the Virginia General Assembly on January 31, 2013. This opportunity to visit your Delegates and Senators at the Capitol during the legislative session is coordinated with the Medical Society of Virginia's successful “White Coats on Call” grassroots advocacy program. Your participation will be a rewarding and eye-opening experience.
The day will begin with an issue briefing from our lobbyists and light breakfast with orthopaedists and other physicians. Participants will then visit with their Delegate and Senator and observe committee meeting business. At mid-day, the “White Coats” can view the daily session from the Gallery in the Capitol where they will be recognized by the House and Senate. That afternoon VOS will have a Board meeting followed by a reception and dinner with key legislators. All VOS participants are invited to attend any or all portions of the program.
Please put the 2013 VOS “White Coats on Call” Day on the Hill on your schedule and stay tuned for additional details. Questions can be directed to VOS lobbyists Cal Whitehead (cwhitehead@whiteheadconsulting.net) or Ralston King (rking@whiteheadconsulting.net).
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By Ralston King, MD
On Friday, June 1st, the Medical Society of Virginia (MSV) hosted their annual MSV Legislative Summit to hear proposals on current issues that are affecting the practice of medicine in Virginia. Those in attendance included; MSV members, local and specialty medical societies, MSV staff, and lobbyists. Below is a brief summary of proposals and the request made to MSV.
Much discussion that surrounded the MSV Legislative Summit dealt with Medicaid reimbursement for physicians. It has been over 10 years since Virginia’s physicians approached the General Assembly asking for an increase and in recent years, it has been a struggle to make sure rates do not get cut. With an increase in Medicaid recipients, but a decrease in Medicaid payments due to inflation, another possibility will be inflation rate adjustment. Hospitals and nursing homes annually receive this adjustment rate. This proposal could quite possibly be better in terms of long term payment than a one-time Medicaid reimbursement.
Top issues and concerns in the day to day practice of medicine have come from the emergency physicians that have continued to battle reduced Medicaid payments under a federal system that mandates all emergency departments provide care to all those who walk through the door. A complicated state system for mental health patients also causes emergency physicians to have concerns about the delivery of quality care and efficiently providing the proper setting for MH patients.
In policy talks that will involve business, insurance, and provider stakeholders is the worker’s compensation system. It is believed that the insurance companies will propose legislation that would create a fee schedule for worker’s compensation cases. With business premiums increasing annually, insurance companies are pushing businesses to help advocate for a fee schedule. While insurance companies claim that premiums will go down, it is not mentioned that access will be affected along with quality care.
Each issue will be discussed and voted on at the Medical Society of Virginia’s House of Delegates at MSV’s Annual Meeting in November. We will keep you updated on changes and greatly appreciate any feedback you can give regarding proposals.
Summary of Issues
Definition of Surgery Loophole
Edwin Epstein, MD
- Loophole allows non-licensed medical assistants to perform surgery in an office-based setting under physician “supervision”. Concern comes from field of hair restoration surgery of “surgical assistants” who may have no medical training other than on-the-job and use powered instruments to remove bundles of hair. We would like to amend language to “licensed healthcare professionals” and to better define “appropriate supervision”, especially office-based setting.
- We request MSV propose legislative/regulatory solution with VA Dermatology Association, VA Plastic Surgery Association, and International Society of Hair Restoration
Worker’s Compensation Reform
Virginia Orthopaedic Society
- WC insurers are targeting surgery costs to find savings and identifying “multiple procedures” and “assistants-at-surgery” as areas needing attention. Their hope is to expand managed care fee schedules to WC. Physicians and other providers oppose fee schedule and have adopted policy statements.
- MSV should work with all stakeholders and develop legislation that will embody these goals.
Medicaid Reimbursement Increase
Hugh Bryan, MD
- MSV, along with coalition of health care entities, has been successful in avoiding cuts to physicians Medicaid reimbursement during the past four years. There has been only one general increase in physician reimbursement during the past 10 years. Physicians should be treated on an equal basis and an inflation adjustment should be instituted.
- We request MSV coalition to develop process for budget amendments to provide annual increase in physician reimbursement that is equivalent to that of the hospitals.
Medicaid Payment Increase
AAP-VA Chapter
- With an increase in Medicaid recipients and a decrease in Medicaid payments due to inflation, we request an inflation rate adjustment. Hospitals and nursing homes request and receive each year an adjustment rate of inflation from the general fund.
- Request MSV work with AAP- VA, VACEP, VAFP, PSV, VSEPS, VOS in the effort to develop a strategy to increase physician Medicaid rates in 2013.
EMTALA Special Liability Protection
VACEP
- Mandates by federal law to treat anyone who comes to an ED regardless of nature, severity or complexity of their condition. This results in uncompensated care for ED physicians. MSV’s Medical Liability Advisory Group (MLAG) is to study the issue of how best to extend special liability protection for ED providers including on-call specialists and ED physicians.
- Request study be completed and proposals made by MSV Board of Directors by September 2013.
Disclosure of Physician Identity in Malpractice Case
Scott Reed, MD
- Proposes in a medical malpractice case that identity, credentials and written opinion of any physician be made known to the defense. Before a medical malpractice case can be filed, it must be certified as having merit by a physician who reasonably could serve as an expert witness in the field. The identity of this physician and their opinions concerning the case are not discoverable by the defense. This could cause abuse by plaintiff’s attorney.
- Request MSV draft legislation to require the identity, qualifications and opinion of the certifying physician be part of the discovery process for the defense.
Mental Health Issues in the Emergency Department
VACEP
- Inappropriate medical clearance requested by receiving facility, often resulting in unnecessary testing, expiring ECO’s and a lack of bed space. Lack of inpatient bed availability resulting in TDO denial because there is no receiving facility to name, which results in emergency physicians being required to release patients who have been deemed a danger to themselves or others.
- Request MSV assist to develop administrative and legislative strategy to work with DHBHDS, HHR, AG’s Office, and legislature to address issues.
Emergency Custody Orders (ECO) & Temporary Detention Orders (TDO)
RAM
- For the purpose of medical and psychological evaluation, stabilization and treatment of a patient, RAM is requesting MSV seek an alternate pathway to attain Emergency Custody Orders (ECO) and Temporary Detention Orders (TDO). The current protocol for an ED physician to obtain an ECO or TDO within the Commonwealth requires oversight and validation by a Magistrate, which may take hours to accomplish. Other states have enacted legislation to provide physicians the authority to detain and provide necessary evaluation and emergent management of a patient.
- Request MSV work with RAM, PSV, and VACEP to amend current legislation.
