A Resolution to Support MSNVA’s COPN efforts

WHEREAS,              MSV Policy 55.1.09 states, “The Medical Society of Virginia supports the goals of the initiatives of the Northern Virginia medical societies as they relate to participation in the national effort to change the policies of managed care companies; and

WHEREAS,               MSV, already has a policy to support Northern Virginia Medical Societies as they relate to participation in the national effort to change policies of managed care companies; and          

WHEREAS,               such policy is now mute, as payment structures have shifted to value-based contracting; and

RESOLVED,             that the Medical Society of Virginia amend Policy 55.1.09 to be the following:

As it aligns with existing MSV policy, the Medical Society of Virginia supports the Medical Society of Northern Virginia’s efforts, including deregulation of the COPN process.

Stop Medicare Cuts which will be Devastating to Surgeons and their Patients

WHEREAS,   One in three private surgical practices are at risk of closing due to the financial impact of COVID-19, and

WHEREAS,  The new rules from CMS reduce the Medicare conversion factor, the basic starting point for unit cost calculations for medical care, by nearly 11%, bringing it to its lowest point in 25 years, and

WHEREAS,  Additional Medicare cuts will force more surgeons to close their practices, reducing patients’ timely access to quality care, and

WHEREAS,  Our doctors and health care workers have been there for the American people during this pandemic and now doctors need Congress to help them, therefore be it

RESOLVED, that the Medical Society of Virginia encourages the Virginia American Medical Association (AMA) Delegation to oppose the Medicare cuts scheduled January 1, 2021.

Fiscal Impact:  None

Existing Policy: None

School Nurse (RN) Services in the School Setting

WHEREAS,   Over a million children spend roughly seven hours daily for 180 days annually in schools, and many of these children have special health care needs requiring medical management during the school day, and

WHEREAS,   Schools are required by various laws, such as but not limited to Individuals with Disabilities Education Act (IDEA), to provide health services within schools to allow all children, including, but not limited to those with special health care needs, to obtain “a free and appropriate education” in a safe and “least restrictive” setting, and

WHEREAS,   registered professional nurses (RN) are trained as to provide acute and chronic health care to school-aged children and adolescents such as but not limited to direct health assessment, emergency and routine health management, and health counseling, as well as ongoing implementation of medical aspects of health programs in schools as developed by the school medical director, which may include programs such as, but not limited to athletic programs with potential medical risks to student athletes, public health, safety, and welfare of the entire school community in infectious disease outbreaks including during Pandemics, Public Access Defibrillator Programs, emergency medical sites for widespread community disasters, as well as daily and emergency care and medication delivery systems, and

WHEREAS,   The American Academy of Pediatrics and the American Medical Association support that a registered professional nurse (RN) should be present in all schools with coverage supported by the National Association of School Nurses, and be it therefore

RESOLVED, The Medical Society of Virginia supports registered professional nurses (RN) to be present in all schools as recommended by the National Association of School Nurses.

Fiscal Impact: None

Existing Policy: None

Resolution to End Handcuffing, Shackling, and Tasering of Children During a Mental Health Crisis

WHEREAS,              mentally ill and developmentally disabled children in crisis are often transported by police in handcuffs and sometimes leg shackles to hospitals or other facilities for further psychiatric evaluation, and

WHEREAS,              these children frequently have experienced psychological and physical trauma and this experience increases their trauma burden, criminalizes mental illness and dehumanizes them, and

WHEREAS,              this experience frequently occurs at school in front of their peers, increasing their shame and social isolation and further stigmatizing these children, and

WHEREAS,               this experience is not warranted, and

WHEREAS,              this experience can lead to further trauma for the child, and

WHEREAS,              the Commonwealth of Virginia has allocated 10 million dollars and identified an agency to transport mentally ill adults in similar situations as an alternative to police transportation. However, there has been no such action taken to protect minors, and

WHEREAS,              this population of children is even more fragile than adults, as trauma can actually alter brain development and result in long-lasting changes, therefore be it

RESOLVED,             that the Medical Society of Virginia work with the Virginia Department of Behavioral Health and Developmental Services and other appropriate officials to develop alternatives to handcuffing, shackling, and tasering for the transport of mentally ill and developmentally disabled children.

 

Support for Increased Broadband Access and Health Technology Literacy

WHEREAS,               Telemedicine has evolved significantly through the course of the COVID-19 pandemic and became a lifeline for patients seeking care in ways that could minimize infectious exposure; and 

WHEREAS,              Telemedicine visits have been embraced as a welcome alternative to in-person care by patients and physicians, with research supporting the desire for continuing virtual access; and

WHEREAS,              Physicians embraced and utilized telemedicine to care for their patients as well as generate revenues for their practices during a time when visits dropped dramatically, and elective procedures were suspended; and

WHEREAS,               A significant proportion of patients want to continue to receive care through telemedicine and many physicians have started to implement practice redesign to integrate telemedicine into their routines and care paradigms, and

WHEREAS,               The public health emergency (PHE) caused by the COVID-19 pandemic led to executive and legislative mandates that reduce regulatory and payer burdens and expanded the scope of care permitted; and

WHEREEAS,            The state of Virginia has a baseline  of regulations supporting the use and payment for telemedicine and embraced the federal deregulation of constraints and protections to increase access to care for patients in a variety of ways that include adding preventive care codes as well as the originating and distant site care locations; and

WHEREEAS,            Many of these enhancements are likely to expire as the pandemic recedes, to the detriment of patients and physician practices, and will need both consumer and physician advocacy to become permanent; and

WHEREEAS,            It will be important for our MSV to have the appropriate policy and informed advocacy to support and preserve the progress made in telemedicine; andi

RESOLVED,             MSV supports increasing broadband access and health technology literacy throughout the Commonwealth, especially to underserved populations.

 

i https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

https://www.healthleadersmedia.com/clinical-care/patients-eager-embrace-telemedicine-new-survey-finds

https://evisit.com/state-telemedicine-policy/virginia/

A Resolution to Amend 10.9.16 Reimbursement of Telemedicine and Addressing Barriers to Telehealth Care

WHEREAS,              MSV Policy 10.9.16 states- The Medical Society of Virginia supports the following principles and will pursue appropriate strategies to enact these principles, including but not limited to direct negotiation with third party payers, regulation through the Board of Medicine, or, if necessary, through state legislation:

  1. 1. Physicians should receive appropriate reimbursement for telemedicine encounters for patients with whom they have an established physician-patient relationship.
  2. 2. Any financial or equity arrangements between insurance companies and direct-to-consumer telemedicine companies should be fully disclosed to patients; and 

WHEREAS,               Telemedicine has evolved significantly through the course of the COVID-19 pandemic and became a lifeline for patients seeking care in ways that could minimize infectious exposure; and 

WHEREAS,              Telemedicine visits have been embraced as a welcome alternative to in-person care by patients and physicians, with research supporting the desire for continuing virtual access; and

WHEREAS,              Physicians embraced and utilized telemedicine to care for their patients as well as generate revenues for their practices during a time when visits dropped dramatically, and elective procedures were suspended; and

WHEREAS,               A significant proportion of patients want to continue to receive care through telemedicine and many physicians have started to implement practice redesign to integrate telemedicine into their routines and care paradigms, and

WHEREAS,               The public health emergency (PHE) caused by the COVID-19 pandemic led to executive and legislative mandates that reduce regulatory and payer burdens and expanded the scope of care permitted; and

WHEREEAS,            The state of Virginia has a baseline  of regulations supporting the use and payment for telemedicine and embraced the federal deregulation of constraints and protections to increase access to care for patients in a variety of ways that include adding preventive care codes as well as the originating and distant site care locations; and

WHEREEAS,            Many of these enhancements are likely to expire as the pandemic recedes, to the detriment of patients and physician practices, and will need both consumer and physician advocacy to become permanent; and

WHEREEAS,            It will be important for our MSV to have the appropriate policy and informed advocacy to support and preserve the progress made in telemedicine; andi

RESOLVED,             that the Medical Society of Virginia amend Policy 10.9.16 to be the following:

The Medical Society of Virginia supports the following principles and will pursue appropriate strategies to enact these principles, including but not limited to direct negotiation with third party payers, regulation through the Board of Medicine, or, if necessary, through state legislation:

  1. 1. Physicians should receive appropriate reimbursement for telemedicine encounters for patients with whom they have an established physician-patient relationship.
  2. 2. Any financial or equity arrangements between insurance companies and direct-to-consumer telemedicine companies should be fully disclosed to patients.
  3. 3. All private and public health plans, including self-insured, fully insured, and Medicaid recognize and pay for telemedicine using equivalent service elements for all E&M, preventive, emergency, and chronic care CPT codes
  4. 4. All payers/plans pay for the comparable telemedicine codes at par for face-to-face visits providing they include the same standardized elements.
  5. 5. That the “originating site” for patients and “distant” site for the physician can be at their office, home or any other location providing there is an established patient-physician relationship in place or one that is established through an initial encounter.
  6. 6. All forms of health information technology used to facilitate, support, and record patient care be interoperable and that all EMR platforms integrate telemedicine into the patient record.
  7. 7. Regulatory or legislative barriers that disrupt the continuity of care between a patient and a physician should only exist if they serve the patient.

 

i https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

https://www.healthleadersmedia.com/clinical-care/patients-eager-embrace-telemedicine-new-survey-finds

https://evisit.com/state-telemedicine-policy/virginia/

Expansion of Telemedicine and Telephone Visit Coverage and Pay Parity

WHEREAS,    MSV Policy 10.9.16 states “The Medical Society of Virginia supports the following principles and will pursue appropriate strategies to enact these principles, including but not limited to direct negotiation with third party payers, regulation through the Board of Medicine, or, if necessary, through state legislation:

1. Physicians should receive appropriate reimbursement for telemedicine encounters for patients with whom they have an established physician-patient relationship.

2. Any financial or equity arrangements between insurance companies and direct-to-consumer telemedicine companies should be fully disclosed to patients.”

WHEREAS,    The COVID-19 pandemic has caused an unexpected drop in outpatient clinic volumes for primary care and specialty practices across the country, creating financial stress that in some cases led to permanent practice closures, physician and support staff unemployment, and decreased access to care for patients;

WHEREAS,    Expansion of telemedicine and telephone visit coverage and pay parity have mitigated this financial strain for physician practices and access issues for patients; and

WHEREAS,    Projected in-person clinic volumes will continue to be lower for the foreseeable future given patient fear of contracting COVID-19 in a clinical setting, especially given the inevitably of infection surges until viable vaccine is available; and

WHEREAS,    Premature expiration of these expansions will lead to potential financial ruin to practices and decreased access to care for patients; and

WHEREAS,    Flexibility for patients to access their physician via telemedicine or telephone when an office visit is not feasible, especially for those who are homebound or have difficulty arranging transportation, have resulted in more reliable access to care; andi

RESOLVED, that the Medical Society of Virginia amend Policy 10.9.16 to the following:

The Medical Society of Virginia supports telemedicine and telephone visit coverage and pay parity to assure physician practice viability and improve patient access to care.

The Medical Society of Virginia supports the following principles and will pursue appropriate strategies to enact these principles, including but not limited to direct negotiation with third party payers, regulation through the Board of Medicine, or, if necessary, through state legislation:

1. Physicians should receive appropriate reimbursement for telemedicine encounters for patients with whom they have an established physician-patient relationship unless a public health emergency has been declared by state or federal Executive Order, and an exception for new patients shall be permitted.   

2. Any financial or equity arrangements between insurance companies and direct-to-consumer telemedicine companies should be fully disclosed to patients.

 

i https://www.statnews.com/2020/04/29/save-primary-care-devastation-covid-19/

Advocations of a Safe Working Environment for Health Providers with the Provision of Personal Protective Equipment (PPE)

WHEREAS,       According to the Washington Post, approximately 77,800 health care workers have tested positive for the coronavirus[1], but data collected by the Centers for Disease Control and Prevention suggests higher rates of infection for HCP’s at 142,946 cases and 705 deaths as of August 23, 2020[2]. The nation’s largest nurses union, National Nurses United, puts the total much higher: 939 fatalities among health-care workers, based on reports from its chapters around the country, social media, and obituaries; and

WHEREAS,      The shortage of personal protective equipment, as a contributing factor to the infection and deaths of frontline workers, has been noted on multiple occasions. Occurrences where organizations and hospitals have disciplined health workers for failure to comply with restrictions on the use of PPE mandated by limited supply have also been documents in multiple cases including in Virginia. In the absence of adequate supplies of PPE health care workers are struggling with ethical decisions about how to provide safe care for their patients, themselves, their families and their communities, and

WHEREAS,      The individual provider interfaces with, and is dependent on organizations such as hospitals and health plans that provide supplies and dictate standards for distribution.  The organizations are, in turn, dependent on governmental structures that establish legislation and public health policy that can facilitate, or limit, the clinician’s ability to provide necessary and safe care to the patient and the community, and

WHEREAS,      CDC provided guidelines for optimizing supply in a period of shortage but logistics and supply lines were not in the purview of this agency.  There was discussion of enactment the Defense Production Act without action.  It is to be hoped that policies would be scientific and ethical as well as coherent, however, uncoordinated policies across multiple agencies have failed to provide required equipment and services.  Physicians have had to resort to personal appeals for donations of equipment; therefore be it

RESOLVED,     The Medical Society of Virginia urges federal, state, and local authorities to ensure adequate resources for medical emergencies including supply and distribution of personal protective equipment (PPE) for frontline health care workers. The Medical Society of Virginia supports physicians and health workers use of their own PPE when other resources are not provided, but does not obviate the institutions responsibility for adequate workplace protections.

The Medical Society of Virginia supports a uniform coordinated mechanism for health care facilities to report their resource needs including PPE for optimal distribution in emergency situations.

Fiscal Impact: none

Existing Policy: none

 

1 https://www.washingtonpost.com/graphics/2020/health/healthcare-workers-death-coronavirus/

2 https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html