Gearing Up for a Busy Fall at the State Capitol – Credentialing, Physician-Led, Team-Based Care

On Sept. 9, 2015, the Pennsylvania Medical Society (PAMED) held a media call-in to discuss some of the important health care-related issues on tap this fall. In this segment (Part 2), find out more about PAMED’s efforts to streamline the credentialing process and promote physician-led, team-based care in Pennsylvania from David Thompson, PAMED’s director of legislative affairs. His talk from the media call-in also is available on our website.

One hassle we’re hearing from Pennsylvania physicians is that the credentialing process by insurers is often burdensome and lengthy.

Legislation to streamline the credentialing process and make it more uniform across all insurers was recently introduced by Rep. Matt Baker. This bill – HB 1663 – has PAMED’s strong support. Learn more in this Weekly Capitol Update blog.

“It causes a problem with respect to direct patient care in that you have physicians, especially those that are graduating residency programs that want to get in to see patients,” said Thompson. “They move into the state from wherever they trained and they join a practice or a hospital system and they have to wait until they are credentialed by the insurer before they can see a patient [after they are already licensed by the state board, and many times, also credentialed by a hospital or health system]. Oftentimes that process can be upwards of four to five months, and in some extreme cases, it can be longer.”

As part of the legislation, PAMED is also advocating that, after the insurer has had a physician’s credentialing application for a certain amount of time, and no decision has been made, the physician be provisionally credentialed so that they can start seeing patients. Once they are formally credentialed, the insurer could then begin to pay the physician retroactively for care they provided during the time they were provisionally credentialed.

PAMED also led discussions with the state Department of Human Services (DHS) on improving the physician credentialing process for Medicaid. On Sept. 30, DHS announced that, beginning in 2016, it will impose additional requirements on it’s Physical Health Managed Care Organization related to credentialing timeframes. Among them, PH-MCOs will be required to begin their credentialing process upon receipt of a provider’s application. If the application contains all of the required information, they must complete the credentialing process within 60 days.

Physician-Led, Team-Based Care
PAMED supports physician-led, team-based care and is collaboratively working to promote team-based care with several physician specialties throughout the state. Pennsylvania is among 29 states that feel very strongly that team-based care is the way to go, and that physicians, nurses, and other members of the health care team, should work collaboratively with one another.

However, some nurse practitioners (NPs) in Pennsylvania feel very strongly that they want to break away from the team and practice independently, which PAMED believes would fragment care and jeopardize patient safety. PAMED opposes House Bill 765 and Senate Bill 717 – legislative proposals that would grant independent practice to NPs in Pennsylvania.

Thompson said there are a whole host of issues around NPs and other non-physicians practicing independently.

“Physicians are the most highly trained health care providers in the health system today,” said Thompson. “They have far more education and training than nurse practitioners. That is a fact that simply can’t be denied.”

Thompson went on to say that physicians have post-graduate education upwards of a minimum of seven years between medical school and residency.

“But, the real key here is the difference in the clinical training and the clinical exposure to patient care,” said Thompson. “A physician, though their residency training and medical school, has supervised clinical experience, meaning they are closely supervised by attending physicians, through about 15,000 hours of direct patient care. That is in comparison to a typical NP who may have anywhere from 500 to 700 hours of that same level of clinical experience.”

Thompson also said that though NPs say they are stepping up to the plate to address access to care concerns, when you look at states where NPs can practice independently, they are very much practicing in the same areas where physicians are practicing – in the urban areas – and often with physicians.

He also said that one thing we can do is encourage physicians and other health care providers to  practice in rural areas.

Advocating for additional funding for more residency slots, student loan forgiveness, and incentives for physicians to practice in rural areas is another priority for PAMED.

Part 1 of our Sept. 9 media call-in coverage discussed the state budget, as well as legislation related to the legalization of medical marijuana, liability protections for physician volunteers, the liability/negligence standard in the emergency department, and what PAMED is doing on behalf of Pennsylvania physicians and patients on these issues.

The final segment of our call-in coverage talks about PAMED’s efforts to ensure appropriate patient safeguards and standards and support coverage and insurance payments for telemedicine services in Pennsylvania.