Ask the crystal ball

25 February 2011

By MSV President Cynthia C. Romero, M.D., FAAFP

Over the past few weeks I’ve shared information with you about some of the Medical Society’s (MSV) key 2011 legislative issues including Medicaid, medical liability and peer review. Our team, with direction from our legislative committee and board of directors, also pursued a variety of initiatives that impact physicians but may not have made the headlines. Today I’d like share updates on a few of these with you.

Those of us who run our own businesses are familiar with the Business, Professional and Occupational License Tax (BPOL). Since the BPOL tax is levied on gross receipts and deductions for overhead expenses are not permitted, physicians are often taxed at the highest rate because we cannot use overhead expenses to offset revenue in calculating the tax rate. This higher tax rate, combined with decreasing payments from Medicare and Medicaid, makes survival for physician practices even more challenging. MSV has supported efforts to repeal or revise the BPOL tax rate to create a more equitable tax system. This year, Del. Mark Cole (R-Spotsylvania) introduced HB 1437 which is designed to give localities the discretion to tax businesses on their taxable income as opposed to their gross receipts. This measure passed both chambers and now awaits the governor’s signature.

When it comes to preventing attempts to codify additional conditions for physician licensure, Del. Chris Stolle, M.D. (R-Virginia Beach) introduced HB 2218, which ensures that physicians will not be forced to accept Medicaid or any other third-party reimbursement program as a condition of obtaining their license to practice medicine in Virginia. This bill was unanimously supported by the House of Delegates and Senate. Many of you who participated in MSV's White Coats on Call lobbying days spoke with your legislators about this bill noting that with the mounting financial pressures on the Medicaid system, physicians must retain the flexibility to make their own business decisions and not be required to accept payments for their services that do not even meet their costs. Physicians were effective in explaining to legislators that just like other business owners, we should be able to make individual decisions about with whom we contract.

A bill introduced by Del. John O’Bannon, M.D. (R-Henrico) will change the requirement for assessing physicians who have had three medical malpractice judgments or claims in a 10-year period so that it only affects actively practicing physicians. The bill, HB 2229, also changes the amount required to trigger the assessment from $10,000 to $75,000 and allows the Board of Health Professions to post the number of assessments completed on a physician on its Web site, rather than through a report to the General Assembly. MSV worked with the Department of Health Professions to craft the language for this bill and fully supports the proposed changes. The bill was passed unanimously.

As we come to the end of the 2011 session, we have many successes to celebrate and there is still more to be revealed in the final budget proposal and its impact on Medicaid provider payment cuts. Perhaps only a fortune teller with a crystal ball could have seen how truly significant this General Assembly session would be for medicine in Virginia.

Its significance is not only due to legislative “wins” but also to the tremendous strides we made in forging collaborative relationships, in being the compelling voice for physicians and patients, and in maintaining our daily White Coats on Call presence. As we and our staff worked relentlessly to influence important legislation and policy decisions, we have also proudly stood for the best interests of health care in Virginia.

As for the remaining question about the budget, we must rest in knowing that we have exhausted all efforts to demonstrate the patient and economic impact of Medicaid provider payment cuts. And you have answered our calls to action and have continued to contact your legislators with information about how cuts will directly touch your communities.

We understand the political realities of this budget. Now it is in the hands of the budget conferees. How we fare there is anyone’s guess . . . maybe we should get out that crystal ball.