2010 Legislative Agenda

• Virginia is forecasting a revenue shortfall of $1.5 billion for 2010 following two tough years for providers when cuts to Medicaid were only narrowly avoided. Currently, physicians treating Medicaid recipients are reimbursed well below their cost of providing care.
• Virginia’s most vulnerable citizens, including children, the elderly, expectant mothers and the disabled, rely on Medicaid for the primary care they need. Virginia ranks 48th nationally in Medicaid expenditures per capita.
• According to a survey of physicians conducted by MSV in 2009, as little as a 3 percent cut in Medicaid reimbursement would have a disastrous effect on the accessibility of physician care to a growing number of uninsured Virginians.
• Although the Commonwealth has made efforts to increase physician Medicaid rates in specific areas of service, there has never been an effort to develop a long-term solution.

• Virginia’s physicians continue to strongly encourage the General Assembly to maintain its support for the medical malpractice cap in its current form.
• The cap on medical malpractice awards protects the health, safety and welfare of patients by ensuring the availability of physicians and the adequacy of health care services in Virginia.
• The $2 million cap has effectively stabilized malpractice premiums and attracted insurers to the state, helping keep physicians in Virginia.

• In recent years a variety of ancillary health care providers have sought to expand their scope of practice; from changes to their medical supervisory arrangements, to being granted prescriptive authority, or to being granted licensure or independent practice.
• MSV has monitored perennial scope of practice issues advanced by groups representing nurse practioners, naturopaths, chiropractors, physician assistants, podiatrists, and lay midwives.
• MSV is committed to working with ancillary health care providers to assess the impact on patient care and quality before offering our support or opposition.

• MSV supports HB 11 as introduced. HB 11 would specify that upon receiving an adverse decision, a treating physician may request reconsideration by a physician peer rather than by physician advisors (nurses) or panels of other health care providers.
• HB 11 retains the current requirement that a health plan or HMO respond within 10 days to a reconsideration of an adverse decision.
• This bill provides patients with a timely response and reduces the uncertainty in receiving physician-recommended treatment.
• The bill enhances treating physicians’ ability to have a reconsideration conducted by a physician peer, to best ensure quality health care services can be delivered to their patients.

• MSV continues to coordinate the efforts of the Physicians for Mental Health Reform (PMHR) coalition to call for improvements to the Commonwealth’s mental health system.
• Virginia presently faces a shortage of primary care physicians who are adequately trained to deal with patients displaying symptoms of mental illness.
• MSV supports increasing the capacity of primary care physicians to care for children with mental health disorders by seeking state funding to grow a successful pilot program so that access to pediatric mental health care in Virginia may be expanded.

• The Medical Society of Virginia traditionally has not supported legislation that defines and attempts to codify the standard of care.
• Long-term antibiotic treatment for Lyme disease is controversial, as demonstrated in NIH studies. In addition to showing that long-term treatment is not effective after a certain point, studies have also shown that long-term treatment may pose serious risks for patients.
• If legislation were passed, in the future should a physician, in accordance with his or her clinical judgment, choose not to render long-term care, such treatment decision could be called into question.
• The Virginia Board of Medicine has never sanctioned a physician for prescribing long-term antibiotics for Lyme disease.
• The Virginia Administrative Code, at 12-VAC-5-90-80 (A), already lists “Lyme disease” as a disease that must be reported to the Board of Health. Legislation requiring reporting would be duplicative of already existing law.

• MSV has been an active participant in the Healthcare for All Virginians Coalition, which is working to help create and advocate for accessible, affordable, quality health care for all Virginians.
• MSV supports incentives for medical school loan relief through the Virginia Loan Repayment Program for any new physicians willing to practice primary care for two years in an underserved community.