Pennsylvania Medical Society
By: Michael R. Fraser, PhD, CAE, PAMED executive vice president
Yogi Berra once said that “it’s tough to make predictions, especially about the future…” and I certainly agree. However, as we start 2014, the Pennsylvania Medical Society (PAMED) is predicting some interesting developments here in Harrisburg on a variety of issues impacting Pennsylvania physicians. So, in the spirit of Yogi Berra, here are our 15 physician advocacy issues to watch as 2014 unfolds:
With a crowded field of Democratic contenders, the outcome of the PA Governor’s race for 2014 is anyone’s guess. What is certain is that we will be hearing about it all the time for next 10 months. While PAMPAC is supporting Governor Corbett in his bid for a second term, close attention will be paid to the Democratic primary. Updates on the race and what it means for Pennsylvania physicians will be a key part of PAMPAC’s communications leading up to Election Day.
With redistricting taking effect in the 2014 election cycle, no one is taking the outcomes of the 2014 state legislative elections for granted. Look for more “certainty” about who is running where in early March after the candidate filing deadline has passed and campaigns start gearing up. Clearly, we will be tracking the physician-friendly candidates across the state and working with our county partners to identify where we may want to focus our PAMPAC resources. Also important is the election to fill the congressional seat being vacated by gubernatorial candidate Congresswoman Allyson Schwartz, in PA’s 13th District. Among the many Democratic candidates lined up for that race is Philadelphia-area physician Valerie Arkoosh, MD. PAMPAC supports her candidacy and has asked the AMA’s AMPAC for financial support.
Perennial scope of practice battles will certainly blossom again in mid-January when the General Assembly reconvenes in Harrisburg. What’s on the docket for the remainder of this legislative session? Continued debate on nurse anesthetist scope, pharmacists’ administration of vaccines to children, interpretation of intra-operative neuro-monitoring (IOM) by audiologists, and licensing of naturopaths. Looming in the wings is Senator Pat Vance’s bill granting independent practice to certified registered nurse practitioners (CRNP). Lots to pay attention to at the Capitol for the remainder of 2014.
With the Governor’s Pennsylvania-specific plan for insurance expansion now out for public comment, we expect the proposal to soon be sent down Interstate 83 for review in Washington by the U.S. Department of Health and Human Services (HHS). While I am not a betting man, my guess is that there is a good chance it will be approved—PA is an important state in the roll-out of the Affordable Care Act and state-specific solutions are hard to argue against as happened recently in Iowa and Arkansas. However, there is also the chance that HHS will not approve the plan, especially because federal Medicaid policy bars states from tying work search requirements to health care access. The fate of 500,000 Pennsylvania’s without health insurance is at stake.
Among the issues in the Governor’s Healthy PA Plan are two important items for our young physicians and medical students—loan repayment and residency slot expansions. As we approach budget season, PAMED will be working to advocate for increasing state resources for loan forgiveness and residency slot expansions – our “ask” for the 2014 State Budget on these two important programs is currently under development.
Like a bad cold, the discussion of Mcare just won’t go away. A mixed ruling by the PA Supreme Court tasked the Commonwealth Court to determine whether or not physicians (and others) were “harmed” by the state’s raid on the Mcare Fund in 2009. So, we go back to Commonwealth Court for more… Also, the state is seeking Supreme Court review of the Commonwealth Court ruling in our favor in our Mcare assessment appeals —finding that Mcare must use any year-end balance to reduce the next year’s assessment. Never a dull moment on this one!
With House approval of a CSDB bill, our eyes now turn to the Senate. Senator Pat Vance has introduced a bill of her own establishing a CSDB. PAMED is reviewing the bill with several specialty societies, including psychiatry, and is working with Senator Vance and her staff to strengthen the legislation. What will the final bill look like? Anyone’s guess at this point but many believe that something will get done this year.
Working with partners in psychiatry and emergency medicine, PAMED supports a program for hospitals to voluntarily report their psychiatric bed capacity. Now on to making the idea a reality… and the devil is in the details. PAMED will continue to work with partners to move this issue forward in 2014.
A bill to cap the duration (5 days) and prices that physicians can charge (110 percent of original manufacturer’s Average Wholesale Price) for medicine distributed in their offices to patients with workers’ compensation claims was recently introduced into the PA House and is receiving a great deal of attention from PAMED members who dispense medication. The bill aims to reduce costs to the workers’ compensation program but also raises issues of patient adherence and convenience and timely treatment on the part of many physicians. PAMED has opposed the bill and is working with the PA Department of Labor and Industry in an effort to offer alternatives that win PAMED support. Look for more on this issue this spring.
A bill sponsored by Representative Matt Baker to establish a statewide medical home advisory council has been recently amended and released from committee. This bill will raise some interesting questions for PAMED policy moving forward. The original bill codified the concept of “physician-led teams” in the implementation of medical homes, but a recent amendment allows nurse practitioners, with collaborative agreements with physicians (current law), to also be team leaders. Our continued support for the bill will need to be revisited in light of this amendment.
The legislative year ended with a day-long hearing on House bills 1621 and 1622 – two bills that support the “any willing Insurer” issue which is especially relevant to the UPMC/Highmark situation in the Western part of the state. PAMED will continue to monitor these two bills and work with physician leadership to evaluate options moving forward. While PAMED has not taken a position requiring integrated delivery networks to contract with “any willing” health insurance carriers, we believe several pro-patient and pro-physicians steps need to be taken to ensure continued access to care.
PAMED is seeking the introduction of legislation to standardize the prior authorization process, including the development of a standard form for use in all prior authorization requests. PAMED will be working with legislative leaders to move this bill forward this year.
As with the prior authorization legislation, PAMED also will seek introduction of a bill to make the insurer credentialing process faster for Pennsylvania physicians. We are hoping for progress on this issue earlier in the new year as well.
An emerging issue for 2014 is the use of narrow networks and the de-selection of physicians by health plans within the state. Our guess is that the issue will become increasingly important within new “Marketplace” health plans offered as insurers comply with the Affordable Care Act and with Medicare Advantage Plans. PAMED will continue to monitor this issue as the ACA rolls out and we hear about issues arising as a result.
Two items that are a major part of our renewed focus on physician advocacy includes economic credentialing and restrictive covenants. In light of existing PAMED policy related to these issues, and several others that directly impact physicians, our goal is to champion reforms that will positively benefit all physicians and their patients.
As you can see, 2014 will be an interesting and busy year for PAMED and our legislative advocacy staff. We are looking forward to continuing to advocate on behalf of all Pennsylvania physicians and to provide you with the best information possible about how the debate on these many issues directly impact your profession.