By Lauren Schmitt
Commonwealth Strategy Group
Governor’s Certificate of Public Need (COPN) Work Group
Governor Northam’s professionally mediated COPN Work Group has met in full and topical subcommittees throughout the summer. The group includes CEOs and other top decision makers from hospitals, insurance companies, physician organizations, ASCs, and patient advocates. Chaired by Secretary of Health & Human Resources Dan Carey, MD, the group is charged with identifying opportunities to modernize Virginia’s COPN process to expand access, reduce cost, and encourage quality and innovation. Recently retired Richmond orthopaedic surgeon Dr. Claiborne Irby was appointed by the Secretary to bring the perspective of independent medicine and surgery.
The meetings have delved deeply into the issues surrounding how COPN was designed to work and how it does, or does not, work in today’s health environment. The physician community and the payor community are advocating for less barriers to entry so that providers can grow capacity and provide lower cost options for patients and insurance premium payors. The Medical Society of Virginia’s (MSV) policy, which was developed with VOS and other specialty societies, supports reducing COPN regulations and barriers but with requirements for quality, accreditation, and charity care. Unfortunately, hospitals and health systems have not indicated willingness to consider changes that would result in meaningful expansion of provider opportunities to innovate and expand or cost reducing competition.
The work group is expected to conclude its work in mid-autumn and submit its findings or recommendations to the Secretary and Governor. For additional information, please contact Cal Whitehead at email@example.com.
Surprise Medical Bills
At the federal level, legislative and regulatory activity has dramatically increased in recent months. Competing bills in Congress have similar goals in reducing patient exposure to unexpected medical bills that result from gaps in insurance coverage and out-of-network health services. Most major physician organizations are supporting any measures that establish fair payment determinations, several taking the form of “baseball style” arbitration where sides present their offers to settle out-of-network service dispute. Insurance companies have been pushing models that are based on regional average of their in-network. The negative net result of the insurance scheme is that it will extend in-network fee schedules to providers who are not under contract.
VOS is working with MSV and other specialty societies on state-based solutions to protecting patients from insurance gaps and surprise bills. Physician organizations successfully defeated insurance-backed legislation during the 2019 General Assembly. We will participate in a work group that Secretary Carey is convening to study Virginia’s role in the reform. If you are interested in advocating for fair surprise billing reforms at the federal and state level, please contact Lauren Schmitt at firstname.lastname@example.org
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