March 12, 2010

As the final week draws to a close, the budget has been consuming everyone’s time.  Until Wednesday night, no real budget negotiations were occurring. Now, they are working furiously to finish by the last day of session, Saturday March 13.

VACEP has educated all the budget conferees, the money committee staff and VACEP members in the legislator’s districts about how the House and Senate budget cuts directly and disproportionally affect emergency physicians. Big thanks need to be given to our board members who spent last weekend and the beginning of the week calling their colleagues and asking them to contact the legislators.

Our lobbying and grassroots efforts, coupled with our media push, allow us to safely say that no one working on the budget has not heard the concerns facing the emergency physicians if they decide to cut Medicaid reimbursement rates. Last week, Dr. Wentzel’s op ed ran in the Virginian Pilot. This week, Dr. Tamera Barnes had an op ed run in the Richmond Times Dispatch (click here ).

Finally, SB 652, Senator Northam’s bill requiring the Board of Education to develop guidelines for dealing with suspected concussions of student athletes reached a compromise and was reported from committee and has passed the floor and is on the way to the Governor.

Thank you to everyone for all their help and support! We couldn’t have educated everyone like we did this session without all your hard work.

- Aimee Perron Seibert

March 5, 2010

This week was spent crafting talking points about how the House and Senate budget cuts directly and disproportionally affect emergency physicians. As you know, the DMAS PEND program already cuts ONLY emergency medicine claims, down coding at least 65,000 claims a year.  The proposed four and five percent cuts would be on top of our already low pay.  At the same time, we will see an increase in patients when primary care physicians stop taking Medicaid patients. We are educating the budget conferees about this disparity and sharing our concerns that the emergency departments could very well be crowded with new patients while the reimbursement cuts drive physicians to leave the Commonwealth or forces practices to cut physician hours.

Another aspect of our education has been a big media push around the Medicaid cuts. Dana Callahan, our media guru has been working on Op Ed’s, as well as pitching to reporters the emergency physician story. Last week, President Tamera Barnes appeared at three press conferences, was interviewed by two TV news crews.  Today, Dr. Carl Wentzel’s op ed appeared in the Virginian Pilot.

The only bill of interest that we are still following is SB 652, Senator Northam’s bill requiring the Board of Education to develop guidelines for dealing with suspected concussions of student athletes. It has gone through numerous re-drafts as we try to come to a consensus on language. The final hearing will be on Monday in House Education. 

After Monday night, all the committees will have completed their work and all that will be left will be bills on final passage, bills in conference committees to work out conflicting language and the budget. VACEP will continue to advocate and educate the conferees on the Medicaid cuts.  It is likely that you will be getting a phone call or email from a board member if you live in one of the conferees districts. PLEASE take action and call/email the legislators. It is so critical that they hear from emergency physicians that live and work in their district. We can’t do it without you!

  - Aimee Perron Seibert

February 26, 2010

The House and Senate budgets were released on Sunday, February 21 and both contained cuts to Medicaid physician reimbursements.  The House recommended 5% cuts in both years of the biennium, meaning the cuts would start on July 1, 2010. The Senate recommended 4% physician cuts in the second year of the biennium. They also included 4% cuts to the Medicaid Managed Care programs; the House did not.  But the most sobering difference between the two budgets was how they planned on spending the anticipated additional Federal FMAP Medicaid extension dollars—the Senate said they would use it to reinstate the provider cuts; the House said they would use it for state employee bonuses and replacing higher education and K-12 cuts, not for Medicaid provider cuts.

We are working as part of larger coalitions to fight the provider cuts and to ask for the Federal monies to be used to make Medicaid whole again. In addition, we are working to lessen the impact specifically to emergency medicine, potentially by eliminating the PEND program to put us on a more even playing field with all our physician colleagues before the cuts are adopted.

SB 675, Senator Wampler’s bill to mandate insurance coverage for telemedicine services, was reported out of House Commerce & Labor unanimously with no opposition from the health plans or the business community.  As we stated last week, it doesn’t add any new categories to be covered; rather, it just requires a consultation over video to be covered in the same manner as a face-to-face visit.  Thank you for all your calls and emails on this important bill!

HB 11, a bill streamlining the reconsideration and appeals process for utilization reviews, was reported out of Senate Education and Health unanimously on Thursday and should face no opposition on the Senate floor.

Finally, VACEP had their lobby day and annual meeting on Thursday. It was a successful day, highlighted by visits to the budget conferees, Dr. Tamera Barnes being interviewed for TV and print as a member of the Healthcare for All Virginians Coalition and how the Medicaid cuts will impact emergency physicians and the new Secretary of Health and Human Resources, Dr. Bill Hazel, speaking to the group. We really appreciate everyone who took time off to come to the Capitol. It is so beneficial to have emergency physicians visible and walking the halls and talking to legislators. Please consider joining us in 2012 at our next legislative day.

 - Aimee Perron Seibert

February 19, 2010 End of the Week Update: Crossover                                     

One of the last bills to get a committee hearing this week was SB 675, Senator Wampler’s bill to mandate insurance coverage for telemedicine services. It doesn’t add any new categories to be covered; rather, it just requires a consultation over video to be covered in the same manner as a face to face visit.  For the first time, the health plans didn’t oppose the bill, nor did the business community. It was reported from the Senate Commerce and Labor committee unanimously, as well as the Senate floor. We expect it to be up for a hearing on Tuesday afternoon in the House Commerce and Labor committee, a much less receptive committee for mandated benefits.  Look for an action alert on this bill this weekend.

One of the biggest events this week was Governor McDonnell releasing his budget recommendations.  He did not recommend reducing physician reimbursements, but there were a substantial number of cuts that will have an impact on emergency medicine, including:  further cuts to free clinics and community health centers, changes in Medicaid eligibility, a freeze on enrollment in the FAMIS program, cuts to Medicaid provider payments for dentists, community mental health services, and indigent care funding to the UVA and VCU health systems. Click here for more details on the Governor’s recommendations. 

It’s important to note that the recommendations he released are just that: recommendations to the legislature. The real work will begin on Sunday, Feb. 21 when the House Appropriations and Senate Finance Committees will announce their budget proposals. We have been educating the legislators about the importance of emergency medicine as part of the healthcare safety net and how the PEND program disproportionally affects EM when compared to other specialties.

We will monitor the budget this weekend and continue to advocate for VACEP priorities in the coming week. I hope all of you not working on Thursday, February 25th, will join us in Richmond for White Coats On Call to visit members of the General Assembly, participation in VACEP Annual Meeting and our Legislative Reception!

 - Aimee Perron Seibert

February 12, 2010

We just completed the last full week before Crossover when each house has to complete work on their bills. It was a busy week, with lots of long committee meetings as they raced to complete their dockets by Friday. SB 263, the bill according nurse practitioners independent practice, was officially killed in full committee ending this attempt for the year. 

After much negotiating and redrafting, HB 11, Delegate Marshall and Delegate O’Bannon’s bill requiring peer review during reconsideration, was reported out of House Health, Welfare and Institutions.  After all the redrafting, the bill now allows a physician to go from reconsideration to the appeal process, with a peer of their specialty, and without having to resubmit all the necessary paperwork.   It’s not all we had asked for, but we do believe it will have an impact on the current, problematic process.

Finally, Senator Northam’s SB 652 requiring the Board of Education to develop guidelines for dealing with student athletes was reported from Education and Health unanimously. It will likely face a less friendly in the Republican House who tends to shy away from guideline mandating bills.

The upcoming week will bring very long floor sessions on Monday and Tuesday with few committee meetings. This week is also typically the week that the budget finally starts to take shape, so we will continue to advocate for no cuts to physician reimbursements for Medicaid. 

 - Aimee Perron Seibert

February 5, 2010

In an unprecedented move, both houses of the General Assembly cancelled committee meetings and floor session this Friday because of the impending snowstorm. In the last 45 years, no one could ever recall the legislature cancelling for weather. To make up for the missed day, they will be holding session next Saturday, as well as additional committee meetings. 

Yesterday, the Senate subcommittee on health licensing heard SB 263, a bill the nurse practitioners put forward asking for independent practice. We were opposed to the bill, joining with all other specialties and MSV to fight it.  Four emergency physicians took time out of their days to come to the hearing: president-elect Dr. Tamera Barnes, Dr. Shawn Borich, Dr. Mark Rausch and resident Dr. Keel Coleman. They listened to testimony on both sides of the issue and watched as the committee failed to even make a motion on the bill, which sends it to full committee with no recommendation (essentially killing the bill soundly).

VACEP also opposed Delegate Massie’s HB 597 that would have required doctors to have additional CME training on death certificates if they had three complaints was laid on the table in subcommittee. As a compromise with the funeral directors, the chair of the subcommittee will be writing to the Board of Medicine to convene a small task force this summer to look into the issue to even see if it’s a problem. The funeral directors had indicated that Emergency Physicians and Family Physicians are most likely to be reluctant to sign death certificates.

We had some other victories as well, killing HB 35, a bill requiring the reporting of all surgical complications to the Board of Health in subcommittee; killing HB 512, a bill that would have put a specific treatment for Lyme disease in the Code of Virginia; and Delegate Phillip’s bills requiring CME’s on pain management and addiction (HB 1169) and HB 1170 requiring random urine screenings for prescriptions.

Upcoming Issues for the Week

HB 11 (Marshall, R.) Health services; peer utilization reviews. This bill is up on Tuesday in House Health, Welfare and Institutions. VACEP is joining with the other medical specialties on this issue at the request of the patron and chief co-patron, Delegate O’Bannon. While this doesn’t often directly affect emergency physicians, it is our position that peer to peer review, especially when health plans reject payment for services, should always be the standard of practice. The health plans are fighting this bill hard and we will be doing the same on Monday. If you can take the time to email your legislator if they are a member of HWI and ask them to vote in SUPPORT of the bill, that would be a big help.

VACEP supports this bill.                                  

SB 652 (Northam) Concussions; Board of Ed to develop guidelines dealing with student athletes. This bill was put forward by the Pediatricians and because students who suffer possible concussions usually end up in the emergency department, VACEP requested to be added to the list of experts developing the guidelines. The patron agreed and we will now be listed in the bill. SB 652 will be heard in subcommittee on Thursday afternoon. VACEP supports this bill.

Thank you for your interest and your help on these important bills.

- Aimee Perron Seibert

January 29, 2010

We had a big victory this week, killing HB 1069 that would have required any person employed in an emergency department to report to adult protective services every “serious bodily injury” case when the patient was unable to explain the cause of such injuries.  While we are certainly support protecting the safety of incapacitated adults, we think this bill would have led to over-reporting of injuries unrelated to real abuse and neglect cases. Special thanks to Dr. Jake O’Shea for quickly drafting up some real life examples of when this would apply in the emergency department, which helped us kill the bill!

Other actions this week on bills we were opposing included the death of HB 465 (Herring) that would have allowed the court to change the damage amount awarded if the jury returned a verdict for MORE than the plaintiffs requested.  This would have had a serious impact on medical malpractice cases that fell below the current cap. 

Another interesting occurrence this week was Delegate Morgan’s HB 1136 to expand the scope of when medical marijuana can be prescribed by a physician beyond the current cancer and glaucoma.  VACEP had no position on this bill, but a retired member, Dr. Gaylord Ray, spoke passionately for the bill (representing himself), but the subcommittee recommended laying it on the table, essentially killing it for the year.

Next week will be a busy week with SB 263, a bill to allow nurse practitioners to practice independently up in subcommittee. When we send out an action alert early next week, please take a minute to email the senators on the subcommittee.

Upcoming Issues for the Week

SB 263 (Whipple) Nurse practitioners; licensure. This bill is up in Senate Ed & Health- Health Licensing subcommittee on Thursday afternoon. VACEP is following the lead of MSV on this issue, but generally, we do not support independent practice for nurse practitioners and we certainly do not support dissolving the joint board that oversees NP’s and put them back under the Board of Nursing. VACEP actively opposes this bill.                               

HB 1304 (Nutter) Workforce Development Authority; created. This bill creates the Virginia Workforce Development Authority to take over the duties of the Statewide Area Health Education Centers Program. The mission of the Authority is to facilitate the development of a statewide health professions pipeline that identifies, educates, recruits, and retains a diverse, appropriately geographically distributed and culturally competent quality health workforce. This bill is in the House HWI committee. VACEP actively supports this bill.

Thank you for your interest and your help on these important bills.

- Aimee Perron Seibert

January 22, 2010

This first week of session, following the swearing in of our new Governor, Lieutenant Governor and Attorney General, brought the quick demise of bills in the House banning texting while driving and a bill to require helmets on motorcycles with 8” wheels. In stark contrast, the Senate passed bills tout of committee o make wearing your seatbelt a primary offense and to require children under 12 to wear personal floatation devices.

Next week will be a busy one opposing the nurse practitioner’s bill to expand their scope of practice and to remove them from the oversight of the joint board and continuing our work against Athey’s bill to expand emergency personnel’s reporting of adult abuse to “serious bodily injury.”

Early Victories:

SB 9 (Blevins)/SB 518 (Norment) Safety belts; makes nonuse a primary offense. This bill passed Senate Transportation on a 10-Y 4-N. Every year we support these bills and they pass the Senate easily and are summarily killed in a House subcommittee.  We will keep a close eye on the bill, but do not foresee it surviving in the House. VACEP actively supports this bill.                     

SB 275 (Whipple) Advance medical directives; clarifies authority.  This bill clarifies last year’s new law to help medical providers and consumers better understand and implement the law. It was requested by the Supreme Court’s Mental Health Commission. VACEP is in favor of this bill.

Thank you for your interest and we look forward to a lot of action in the upcoming week!

 - Aimee Perron Seibert

January 15, 2010

We are embarking on the start of a new legislative session, but more importantly, are in a time of transition as Governor Tim Kaine ends his four year term and Governor-elect Bob McDonnell prepares to take office on January 16. In addition, twenty new delegates and two new senators have been sworn in to begin the 2010 session. 

As everyone already knows, Virginia is facing the largest budget shortfall since the Great Depression.  The most recent estimates put us in the position of having to cut an additional 4 billion dollars from the two year budget. Governor Kaine presented his suggested budget in December where he cut 2 billion dollars and, to the dismay of the new Governor and the House of Delegates, backfilled the other 2 billion dollar with a local one percent income tax increase.  His cuts were significant and will bring hardship to many Virginians, but luckily he spared physician Medicaid reimbursements.  However, with the House of Delegates and Governor-elect McDonnell vowing to defeat any and all tax increases, we know that the legislature has the task to cut an additional 2 billion dollars out of the budget. It is unlikely we will be spared in the second phase. 

We are bracing ourselves for a potential 5%-15% across the board cut in Medicaid payments to providers.  We have already been educating the members and new administration about our message: emergency departments are the safety net for our health care system, yet emergency physicians have the lowest Medicaid reimbursement rates when you factor in the PEND program. The connection between the current reimbursement level and the crisis in the access to emergency care is undeniable.

We will continue to talk about how detrimental such cuts will be, not just to emergency medicine, but as part of a larger system where other specialties, who are not bound by EMTALA, could choose to decline Medicaid patients who would then use the ED as their chronic medical conditions turn into urgent and emergent care needs.  This puts all Virginians at risk for receiving life-saving emergency care.

Every year, we monitor and advocate for and against over a hundred bills dealing with health care reform, insurance coverage, mandatory seat belt laws, scope of practice and mental health reform. This year will be no different. VACEP is your eyes and ears at the legislature, but we can’t do it without you.  President-elect Tamera Barnes attended three pre-session legislative receptions with me and her interactions with the delegates and senators were invaluable. The legislators are truly interested in hearing from practicing emergency physicians and the challenges they face in the emergency department. Never question if your participation matters- it does and it’s critical to VACEP’s success.

Please join us for our ‘Members Only’ conference call at 3pm on January 29th to hear about VACEP’s legislative priorities and the bills we will be following along with Q & A with your lobbying team. Notify Gwen Harry to receive the conference call instructions by email gwenh@vacep.org.

Thank you for your help! 

- Aimee Perron Seibert