There’s no time like now to get involved in legislative advocacy

December 2011

The 2012 General Assembly session is right around the corner. Prepare for session now by becoming familiar with the issues and marking your calendars for the Medical Society of Virginia’s (MSV) White Coats on Call (WCOC)days during which you can help advance MSV’s legislative agenda and influence your elected representatives. Attending a WCOC day is a great way to start 2012 and to jump right in to advocacy. WCOC participants benefit from a morning briefing by MSV government affairs staff and then meet with their legislators to discuss relevant issues. Legislators tell us that this face-to-face advocacy is very effective. They welcome your visit because they want to hear directly from you.

With the rapidly changing health care environment, it has never been more important for physicians to speak out on behalf of health care in Virginia. Please take whatever opportunities you can to help lead the way to make Virginia the best place to practice medicine and receive medical care.

This year, MSV will be advocating for a number of issues and will need you to lend your voice. MSV’s top legislative priorities for 2012 include the following:

Medicaid
As in recent years, MSV will devote significant resources to ensuring that legislators understand the importance of the Medicaid system and the consequences for patients if provider payment cuts are enacted. As Medicaid enrollment is expected to grow by an additional 271,000 to 426,000 individuals in 2014, and the commonwealth faces an expected $500 to $750 million shortfall in the Medicaid budget, it is critical for Virginia to protect its Medicaid provider network.
Virginia’s health care system is already strained to provide care to its existing Medicaid enrollees. As of press time, Gov. Bob McDonnell had not yet announced his budget for the upcoming biennium (fiscal years 2013-2014).

As the governor prepared his budget package this fall, MSV and a coalition of specialty societies appealed to him in October to not cut physician provider payments. Noting that physicians see first hand the challenges Medicaid patients have in accessing the care they need, the physician groups expressed significant concerns over the governor’s request for each state agency to prepare budget reduction plans to help Gov. McDonnell prepare his budget. Sec. of Health and Human Resources William A. Hazel Jr., M.D. sent a response stating, "I can promise you that the Governor will do everything he can to preserve a viable Medicaid delivery system despite difficult budget constraints. The Governor is well aware that adequate rates are essential to a viable Medicaid delivery system."

Having faced three and four percent reimbursement cuts in the last two years, physicians have indicated the following:

• 91.6 percent of physician survey respondents have reported that their Medicaid patients have had difficulty
  accessing care. (MSV Survey, Dec. 2010)
• A three percent cut to Medicaid reimbursement would force 50.8 percent of physician survey respondents who are currently part of Virginia’s Medicaid network to stop accepting new Medicaid patients; another 17.5 percent would have to stop seeing Medicaid patients altogether. (MSV Survey, Dec. 2010) 

The coalition explained that low levels of reimbursement do not just impact patients and their access to care. As a result of the three percent Medicaid provider payment cut that was in place from July 1, 2010 to Oct. 1, 2010, 18 percent of Medicaid physician providers who responded to a survey were forced to make personnel changes including reductions in staffing, compensation and benefits (MSV Survey, Dec. 2010).

Many Virginia physicians face a difficult choice between their desire to provide care for Medicaid patients and the reality of keeping their practices open when physicians are already paid well below the cost of providing care to those patients.

Scope of practice
MSV physicians remain committed to a collaborative patient-centered team approach to health care, as well as a willingness to assess the impact of any scope of practice changes on patient care and quality before offering our support or opposition. Balancing the nexus among health care workforce capacity challenges, providing quality patient care and ensuring access to care is a top priority for MSV.

During the 2012 General Assembly session, MSV will support efforts by the Virginia Academy of Physician Assistants (VAPA) to change the physician to PA supervision ratio from 1:2 to 1:6. MSV supports this VAPA initiative, in which PAs will still work under the leadership and supervision of a physician.

MSV will support legislation crafted after a series of talks with the Virginia Council of Nurse Practitioners (VCNP) over the last two years. VCNP will seek a bill that outlines a team-based care model designed to help improve access to physician and NP care and reduce paperwork. The changes will emphasize a consultative and collaborative approach between physician and NP with the physician providing leadership and management of the care team. Other changes will be made to provide NPs more flexibility to treat patients in nursing homes and free clinics, as well as an increase in the
physician to NP management ratio from 1:4 to 1:6. 

Definition of surgery
MSV will pursue legislation during the 2012 General Assembly session that will establish a statutory definition of surgery. The MSV Board of Directors agreed with the recommendations of the ad hoc “definition of surgery” task force, a multi-specialty committee which studied the concept and developed language earlier this year. Passage of this legislation will be a top priority for MSV and numerous specialty societies.

Many physicians, patients, policymakers and other stakeholders are surprised that a legal definition of surgery is not already in the Code of Virginia. Increasingly, and as federal and state policies promote “team care” approaches, there is a need to clearly define what constitutes surgery, who may perform surgical procedures on patients, and which entities are appropriate to monitor and ensure patient safety and quality. The proposed definition accomplishes this without unnecessarily restricting physicians or other professionals from practicing to the appropriate limits of their education and
training.
 
The definition of surgery is based on language developed by the American College of Surgeons (ACS) and adopted by the American Medical Association (AMA). The task force was further guided by the following parameters:

• A definition of surgery should limit surgery to physicians, dentists and podiatrists licensed by the Board of Medicine or Board of Dentistry.
• No other board or agency should regulate performance of surgery.
• It should not limit currently allowed or legal procedures performed by allied health professions.
• It should not limit or attempt to define procedures performed by different
• physicians practicing within their professionally accepted scope.

Health reform
MSV and member physicians have been active participants in the Virginia Health Reform Initiative, which most recently has focused on health benefit exchanges. MSV continues to work to ensure that physician and patient interests are represented and heard as changes are considered to improve Virginia’s health insurance and health care delivery systems.

In defense of medicine
MSV is prepared to address any legislation that would be harmful to patients and the physician community. Often such legislation is well-intentioned, but may have unintended consequences that will affect patient care or quality.
 
Following the legislative session, MSV offers many opportunities, like its legislative summit and annual meeting, for physicians to communicate issues they would like to see addressed through legislative advocacy. At MSV, advocacy is year-round work; there are many opportunities to get involved to help Virginia become the best place to practice medicine and receive care.