WCMS Legislative Priorities, June 2015
June 4, 2015
Based on multiple discussions with NCMS, meetings with legislators, and Board review, WCMS is currently focusing on these legislative priorities, which may change in the ensuing weeks as these issues are moving targets. Please contact Miriam@mywcms.org if you have questions or if you would like to get involved in advocacy.
On 5/6/15, seven board members (Drs. Henderson, Read-Smith, Jaben, Buie, Shillinglaw, McLean and Verrastro) spoke briefly with NCMS staff (Chip Baggett) regarding key legislative issues from NCMS' perspective. The group also reviewed the memo from Chip Baggett to WCMS dated May 6, 2015 "NCGA 2015 Crossover Briefing" and an undated document from NCMS entitled "NC Provider Community Medicaid Reform Proposal." A full discussion of these materials ensued after the call, culminating in the group making the following recommendations to the full WCMS Board on May 11. The Board made a few wording changes and approved the following:
1. Medicaid Reform
REQUEST FOR WCMS ACTION FROM NCMS: "This is an ongoing and constantly evolving priority. Regular communication with your local delegation about your desire to see a fix this year rather than face additional rate cuts, your desire to retain a leadership role in whatever solution is decided and your support for our negotiated solutions is greatly appreciated. We have already established a regular weekly call with WCMS staff to keep up to date on the most current happenings regarding this legislation."
WCMS RESPONSE: Having talked with key legislators and NCMS staffers in Raleigh recently, it is clear that Medicaid will move from fee-for-service to a capitated payment. It is also clear that provider-led entities will be expected to assume full financial risk. There is no debate any longer about these two issues. Therefore, WCMS agrees with NCMS' request for action as stated above and strongly supports North Carolina-based, provider-led entities (PLEs) for the future of Medicaid, assuming that the following principles are upheld:
PLEs will keep dollars in-state and use for the patient's benefit rather than for shareholder profit.
PLEs will keep physicians and other front-line medical providers in the driver's seat in terms of decision-making.
PLEs will promote creative collaboration, efficiencies, and integration with local health systems, mental/behavioral health providers, long-term services, and both traditional and non-traditional community partners.
PLEs will achieve budget predictability by delivering evidenced-based medicine within the resources allotted.
PLEs will achieve the Triple Aim of reducing the per capita cost of health care, improving the health of the population, and improving the patient experience of care including quality and satisfaction.
PLEs will define the parameters and measures for successful delivery of high quality patient care.
Physicians participating in PLEs will base their decision-making through the foundational framework of strengthening the physician-patient relationship.
2. Professional Regulation
APRN Independent Practice and Supervision of CRNAs
According to NCMS, Bills S695 and H807 would make significant changes to the regulation of nursing by categorizing NPs, Nurse MidWives, and others as Advanced Practice Registered Nurses (APRNs) and then restructuring the makeup of the Nursing Board to reflect such changes. Additionally, the bills as drafted would eliminate completely the current supervision requirement for all newly titled APRNs as well as RNs depending on the draft one reads. Supervision is a fundamental patient protection and public function that physicians have provided to the citizens of NC for years. Supervision provides a vital public function that allows nurses to practice to the top of their supervising physician's confidence in their abilities.
There are no studies showing that nurses will move to rural communities to address access to care issues or that nurse-only practices could be viable in Medicaid dominant geographies if they were to relocate. There are no studies demonstrating that nurses practicing without physician supervision can save money for the health care system.
REQUEST FOR WCMS ACTION FROM NCMS: "This is a top priority for the NCMS. We oppose both S695 and H807. Please contact your local delegation and ask them to oppose the bills."
WCMS RESPONSE: WCMS agrees with NCMS' request for action as stated above for both APRN and CRNA issues. The value of physician supervision and the contributions to patient safety made by physicians are being questioned. It is important that WCMS physicians contact legislators and tell them the important role of physician supervision in protecting patients in our healthcare system. We will be sending out an action alert to WCMS membership shortly asking physicians to contact their legislators about both the APRN and CRNA issues. (Action Alert sent on 5/14/15)
3. Bills impacting the physician-patient relationship/governmental intrusion into the exam room
We understand and respect the wide range of personal opinions on the topics of abortion and guns. Our focus here is specifically on the intrusion of Government into the exam room.
HB 465 regulating physician/patient communication about abortion has been modified (sections restricting state-funded medical education training and scope of practice have been removed) and version 2 has been sent to the Senate for consideration. Physicians, or a qualified professional, are mandated to explain by phone or in person to the patient at least 72 hours prior to the abortion, a long list of alternative services that may or may not be available to the woman should she opt to keep her baby.
Update 6/1/15: Senate passed second reading of their version of the bill this week, "An Act to Enact the Women and Children's Protection Act of 2015." The Senate version still has the 72 hour waiting period, the list of mandated alternatives providers must share with the patient, but they also put back in the “ob-gyn only” provision that has been removed from the House version. The provision is on Page 10, lines 21-23. Monday, 6/1/2015 will be the 3rd reading, then Senate votes again.
HB 562 regulating physician/patient communication about guns in the home restricts the ability of a physician to utilize questionnaires including questions about firearms in the home or document verbal communications with patients about the same. Furthermore, it would allow for strict disciplinary action and fines for any physician or other provider found to have violated the proposed law.
WCMS RESPONSE: WCMS stands against HB 465 v.2 and HB 562 Section 15 pp. 9-10 as these bills represent an intrusion of Government into the privacy of the patient and the physician-patient relationship. It is important that WCMS physicians contact legislators to tell them that Government intrusions into the exam room are an attack on patient privacy and freedom, are potentially dangerous to the patient's health, and erode the sanctity of the physician-patient relationship.
4. Medicaid Expansion
The WCMS board had endorsed at the February 2015 board meeting the launch of a grassroots Medicaid expansion effort engaging both physicians and their patients. Comments from legislative team at NCMS regarding the effort were that timing is not good with the legislature focused entirely on Medicaid reform. The legislature will not entertain such pleas for expansion.
WCMS Response: The Board has decided to put the expansion effort on hold until after reform is resolved, and then complete the project and press the issue when the legislature is open and receptive to seriously considering expansion.
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