Summer 2018 Issue
In the News
Infuse 2018 took place on May 5-6 in Richmond, and provided an intentional moment for physicians to focus on themselves and enjoy presentations on resilience, joy of practice, and innovation along with the opportunity to connect with their fellow physicians. Infuse also included powerful interactive sessions that included music, meditation, artfulness, panel and group discussions. Look for speaker videos to be shared soon and as well as exciting new offerings from MSV on physician wellness!
The Medical Society of Virginia’s (MSV) Specialty Advisory Council met on May 16 to receive a legislative update and review fourteen proposals from MSV’s Advocacy Summit.
MSV staff began the meeting with a legislative update, including the state budget impasse over Medicaid expansion. Legislation highlights included bills or actions that protect physician bottom lines and increase patient access to care, such as HB 139 allowing physicians who are under review to be credentialed by a health plan to see patients and retroactively receive payments if they are ultimately credentialed. MSV helped defeat certain bills, including HB 323/SB 380 which would have created unlimited liability for damages to families of individuals who have been victims of personal injury, and SB 895 which would have raised the punitive damages cap – including the medical malpractice cap – from $350,000 to $500,000.
MSV defeated several other pieces of threatening legislation. Defeated bills legislating the practice of medicine included those on opioid limitations in statute and PMP checks prior to every issuance of an opioid, mandatory patient notification by a physician to the risk of cobalt poisoning associated with joint replacements, extension of the Lyme disease test notification, and mandatory physician usage of the Electronic Death Registry System. Defeated bills pertaining to scope of practice included one that would have created a new Doctor of Medical Science (DMS) license establishing an advanced level of physician assistants, and an optometry scope bill that would have allowed optometrists to perform surgical procedures.
A bill allowing nurse practitioners (NPs) to practice independently was amended to ensure NPs gain appropriate clinical training and standards to maintain patient safety and quality: five full-time clinical years of experienced attested to only by a physician.
After the legislative update, the Specialty Advisory Council reviewed and discussed fourteen proposals submitted to the MSV Advocacy Summit:
School Safety Initiative – Convene stakeholders to move forward with school safety plans.
The council discussed the option of providing basic medical response training for school teachers and staff.
Reduce Firearm Risk – Support legislation creating gun violence restraining orders and prohibiting gun ownership by individuals convicted of prior violent misdemeanors. Oppose any legislation that required concealed carry permits in Virginia.
Council members expressed support or no official position. This is a politically sensitive and controversial topic area that would represent legislative difficulties.
Limit Sales of Assault Weapons – Support legislation that limits sale and ownership of large capacity magazines, bump stocks, and firearms with features designed to increase their rapid firing ability. Support legislation that promotes uniform/universal background checks for gun sales.
Council members debated the scope and messaging of any proposed legislation, and the problematic definition of “assault weapon.”
Amending current Physician Assistant (PA) Code to reflect current practices in Medicine – Support legislation that will change the definition of Supervision of Collaboration, remove physician liability except in cases of physician directed care, update Code to reflect current standards of practice, remove current required language requiring attestation in the practice agreement by the physician to allow the establishment of a final diagnosis or treatment plan, and remove the barrier as to how many PAs a physician may supervise.
The council expressed friendliness to this concept.
New Legislation – Support working with the Board of Education to set guidelines for healthy food in school vending machines to deal with the obesity crisis.
The council supported this idea and recommended sending it to MSV’s House of Delegates.
Resolution to Regulate and License Pharmacy Benefit Managers (PBMs) who Serve Virginians – Bring PBMs under oversight and held accountable for their actions in the pricing, management and dispensing of medications to Virginians.
The council expressed support for this concept for various reasons.
Commonwealth of Virginia Health Insurance Protection Act: Establishment of a Reinsurance Program – Bring additional insurance carriers into the individual and small group marketplace, in addition to creating a more favorable environment for lower premiums and coverage of persons with costly medical issues.
The council agrees that there is a need for more insurance carriers to participate in the marketplace and lower premiums.
Prior Authorization Elimination – Make the elimination of Prior Authorization in Virginia a top legislative priority. Work with Insurers and PBMs to request that they be more open and transparent about their approval/rejection processes.
Step Therapy Appeal and Override Process Improvement – Improve the step therapy appeal and override processes in Virginia using legislation similar to that passed in 18 other states as a model.
The council agrees that reform of prior authorization, step therapy protocols (and PBMs) is necessary.
Resolution on Tobacco Control – Support a tobacco tax equivalent to at least the national average and support legislation that would required the funds generated by an increase in the state tobacco tax be used to support health related programs in Virginia.
The council supports this concept.
Incentivize physicians to practice in underserved areas – Support various state and federal incentives to practice in rural and underserved areas in Virginia.
The council discussed market- and population-based challenges and the need to clearly define “underserved area.”
Tax on Sugar-Sweetened Beverages – Support a statewide tax on sugar-sweetened beverages as a measure to help decrease obesity and use the funds raised by the tax to develop evidence-based approaches to addressing childhood obesity.
The Council is generally supportive of this concept but would like more information about how the proposed tax would be designed and levied, and how similar taxes work in other states.
End of Surprise Billing/Providing Fair Payment for Out-of-Network Physicians – Request MSV to be an active member of a coalition that will introduce legislation in 2019.
The council is generally supportive. There was discussion about rates for self-paying vs. insured patients, and assignment of benefits. Members asked about current MSV policy and whether it needs to be revised accordingly.
Prohibit Maintenance of Certificate (MOC) in Virginia – Various measures to prohibit hospitals and other entities that have organized medical staff or a process for credentialing physicians as members of staff or employ or enter into contracts for employment with physicians and are required to be licensed from requiring any MOC or equivalent certification as a condition of granting or continuing staff membership or professional privileges to a licensed physician.
Council members were divided on this issue. They generally agree that the MOC process is burdensome and in need of some reform.
The purpose of the Specialty Advisory Council is to give input to MSV as it develops its annual policy and legislative positions. MSV will continue its advocacy policy process before any final decisions are made on policy positions by MSV’s Board of Directors in the fall.
September 28-29, 2018
Stonewall Jackson Hotel
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