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National Perspective on Policies Impacting Physicians
- 1. American Association of Clinical Urologists www.aacuweb.org A National Perspective on Policies Impacting Physicians and the Practice of Medicine Ross E. Weber Empowering Urologists to Advocate for their Patients, Practice and Profession
- 2. American Association of Clinical Urologists www.aacuweb.org Everything you always wanted to know… 1. About Health Care Reform 1912 – 1920 2010 – … 2. About Urology Joint Advocacy Campaigns SGR IPAB USPSTF GME IOASE 3. About Threats to Professional Standards 4. About Opportunities to Engage
- 3. American Association of Clinical Urologists www.aacuweb.org About the AACU • AACU has been a dynamic force for urologists across the country for over 40 years • Urologists increasingly realize state laws and regulations impact their practice; whether independent, employed or academic • AACU State Society Network supplies physician representatives with tools to advance the interests of their practice and patients The AACU is professionally-managed by
- 4. American Association of Clinical Urologists www.aacuweb.org Wilson Era Health Care Reform (1912-1920) • National health insurance proposed during the 1912 presidential campaign by Theo. Roosevelt • Wilson's first inaugural address (1913): Federal government should safeguard the nation's health – Never seriously pursued this issue • Other Priorities • Tainted because of its connection to Germany (1883), Trade Unions and Socialism
- 5. American Association of Clinical Urologists www.aacuweb.org Wilson Era Health Care Reform (1912-1920) • At present [Dec. 1916] the United States has the unenviable distinction of being the only great industrial nation without compulsory health insurance. Within another six months, it will be a burning question. – Yale economist Irving Fisher • 95 years later…The Patient Protection and Affordable Care Act
- 6. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) • Hospitals and Insurers Thrive – Tenet Healthcare Corp. • Patient volume +4% (2Q 2014) • Uninsured admin -22% (2Q 2014) – HCA Holdings • Revenue +9.2% (2Q 2014) – Aetna • Clients (Via Public Exchanges) +560,000 (2013-2014) • Stock price +30% (2014-2015) – UnitedHealth • Clients (Via Public Exchanges) +400,000 (2014-2015) • Medicaid Managed Care: +1 million • Physicians and Patients Thrive?
- 7. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) • Hospitals and Insurers Thrive • Providers exposed to “Grace Period” risk – ACA mandates 90-day grace period for subsidized Marketplace/Exchange plans • Most states/ins. companies grant 30-day grace period for non-ACA, private plans – 30 days: remains covered, insurer will pay for services rendered – 60-90 days: insurer will hold claims, paying only if account becomes current
- 8. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) • Hospitals and Insurers Thrive • Providers exposed to “Grace Period” risk – Law already REQUIRES insurers to notify providers • Specifics left unaddressed • States stepping in – Insurer must provide real-time info within 3 days – Prompt Payment Laws
- 9. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) Hospitals and Insurers Thrive Providers exposed to “Grace Period” risk Consolidation drives patients to higher-cost settings
- 10. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) • Hospitals and Insurers Thrive • Providers exposed to “Grace Period” risk • Consolidation drives patients to higher-cost settings • ER utilization unabated
- 11. American Association of Clinical Urologists www.aacuweb.org Obama Era Health Care Reform (2010 - …) • Hospitals and Insurers Thrive • Providers exposed to “Grace Period” risk • Consolidation drives patients to higher-cost settings • ER utilization unabated • King v. Burwell decision key to future of ins. market reforms – Not surprisingly, insurers filed a “friend of the court” brief in support of the law.
- 12. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns SGR Repeal and Medicare Payment Reform House: 392-37; Senate: 92-8
- 13. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns SGR Repeal and Medicare Payment Reform • SGR repealed immediately • Annual 0.5% payment updates July 1, 2015 – Dec. 2019 • Quality Reporting Programs Streamlined: MIPS • Medical liability protections: Quality Measures ≠ Standard/Duty of Care • 5% Incentive for participation in alternate payment models (2019- 2024) • Fee-for service retained
- 14. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns SGR Repeal and Medicare Payment Reform • What does the bill say about the release of physician claims data? • Does the bill address private contracting? • Will Medicare’s plans to eliminate the 10-day and 90-day global surgical service bundles be addressed? • Myth: H.R. 2 mandates physician participation in Maintenance of Certification (MOC). • Myth: H.R. 2 sets a new requirement that the quality of physicians’ care must be compared with the quality of care by non-physicians Source: American Medical Association
- 15. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns IPAB Repeal • H.R. 1190: Protecting Seniors' Access to Medicare Act of 2015 – Introduced: Mar 2, 2015 – 210 cosponsors (192R, 18D) • Rep. Wittman, Robert J. [R-VA-1] • Rep. Rigell, E. Scott [R-VA-2] • Rep. Forbes, J. Randy [R-VA-4] • Rep. Hurt, Robert [R-VA-5] • Rep. Goodlatte, Bob [R-VA-6] • Rep. Brat, Dave [R-VA-7] • Rep. Griffith, H. Morgan [R-VA-9] • Rep. Comstock, Barbara [R-VA-10] • S. 141: Protecting Seniors' Access to Medicare Act of 2015 – Introduced: Jan 8, 2015 – 37 cosponsors (37R)
- 16. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns • USPSTF quasi-independent (i.e., unaccountable) • Members appointed by Agency Director • Does not meet with relevant stakeholders during review process • No medical specialists
- 17. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns • H.R. 1151: USPSTF Transparency and Accountability Act of 2015 – Introduced: Feb 27, 2015 – 3 cosponsors (2R, 1D) • Process improvements • Remove any tie to Medicare/Payer policy
- 18. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns Preserve the In-Office Services Exception to the "Stark" Law • Profession has taken significant steps to ensure that only medically necessary and appropriate ancillary services are performed. – training guidance, appropriate use criteria, practice guidelines, and decision support tools – complex billing, supervision, and location requirements.
- 19. American Association of Clinical Urologists www.aacuweb.org Joint Advocacy Campaigns Support Training of Tomorrow's Doctors Today • H.R. 1117: Creating Access to Residency Education (“CARE”) Act of 2015 – Introduced: Feb 26, 2015 – 5 cosponsors (3D, 2R) • H.R. 1006: Building a Health Care Workforce for the Future Act (Scholarship Programs) • H.R. 1272: Doctors Helping Heroes Act of 2015 (Visa Requirements) • H.R. 1707: Access to Frontline Health Care Act of 2015 (Loan Repayment)
- 20. American Association of Clinical Urologists www.aacuweb.org Professional Standards and Physician Training • Med school grads stuck in residency bottleneck granted 'Assistant Physician' license – 2014: Missouri – 2015: Ark., Kan., Okla. • Pay equality not sufficient for Oregon nurses – Authority to perform male sterilization procedures w/o supervision • Multi-state licensing compact to facilitate telemedicine usurps state authority to license physicians – Authority of legislators and licensing boards would be questioned, if not compromised
- 21. American Association of Clinical Urologists www.aacuweb.org Legislative Exports • Definition of Surgery – First approved in Va. 2012 – Under active consideration in Connecticut and Massachusetts • Medical Practice Freedom – No health care provider licensed by this state shall be required to participate in any public or private third-party reimbursement program as a condition of licensure. – 2011, VA HB 2218 – 2012, GA HB 785 – 2013, WA SB 5215 – 2014, AL SB 22 – 2015, AZ; MS
- 22. American Association of Clinical Urologists www.aacuweb.org Opportunities for Engagement Life does not consist in Thinking, it consists in Acting. - Woodrow Wilson (Lawyer, Academic, President of the United States)
- 23. American Association of Clinical Urologists www.aacuweb.org Get Involved! Be Heard! IPAB • Call to Action: Cosponsor and support consideration Protecting Seniors’ Access to Medicare Act of 2015 (H.R. 1190/S.141) •Rep. Scott, Robert [D-VA-3 (Richmond)] •Rep. Beyer, Don [D-VA-8 (Alexandria)] •Rep. Connolly, Gerry [D-VA-11 (Arlington)] •Sen. Warner, Mark [D-VA] •Sen. Kaine, Tim [D-VA] Physician Training/GME Funding • Call to Action: Cosponsor and support consideration Creating Access to Residency Education Act of 2015 (H.R. 1117)
- 24. American Association of Clinical Urologists www.aacuweb.org Get Involved! Be Heard! USPSTF Transparency & Accountability • Call to Action: Cosponsor and support consideration USPSTF Transparency & Accountability Act of 2015 (H.R. 1151) – Rep. Wittman, Robert J. [R-VA-1] – Rest of the delegation, as well • Call to Action: Reconsideration Recommendation – Call on USPSTF to reconsider the prostate cancer screening recommendation ASAP – www.bit.ly/uspstf-reconsider
- 25. American Association of Clinical Urologists www.aacuweb.org Share Your Experience, Learn What Works
- 26. American Association of Clinical Urologists www.aacuweb.org Collective Action
- 27. American Association of Clinical Urologists www.aacuweb.org Education and Relationship Building www.uropac.org
- 28. American Association of Clinical Urologists www.aacuweb.org Get Involved! Be Heard! • Action Items: – Join the AACU – Contribute to UROPAC – Engage as a State Society Network Physician Representative – Keep Up-to-Date: AACU and the News; Urology Times; AACU Sentinel – AACU State Advocacy Conference; Sept. 18-19; Metropolitan Chicago
Editor's Notes
- In the next few minutes, I look forward to Sharing a bit about the AACU Highlighting a few high-profile issues related to the Affordable Care Act Diving into Urology’s Joint Advocacy Campaigns As time permits – Addressing emerging threats to Professional Standards Issuing specific calls to action
- Background about the AACU and State Society Network. Founded in 1968 by Drs. Charles “Carl” Hoffman of West Virginia and Russell “Russ” Carson of Florida, the AACU is the only national organization to serve urology with the sole purpose of promoting and preserving the professional autonomy and financial viability of each of its members. These men determined that urologists must have a say in socio-economic matters and legislative proposals impacting the practice of medicine. The AUA was prohibited from doing so and many of its members looked down on political activity. I know pride is one of the seven deadly sins, but I would be remiss if I didn’t tell you that I’m proud to work with the AACU and urologists across the country. The AACU’s resources are dedicated to INFORM members of the socioeconomic issues affecting their practice and profession, and then to work directly to INFLUENCE the resolution of these issues More and more, the AACU seeks to impact public policy at the state level. These efforts take the form of supporting state societies’ organizational development, collaborating with other medical societies and patient advocacy groups and grassroots mobilization of the urologic community.
- A rush of newly insured patients using health services has boosted hospital operators’ fortunes. People are getting more back surgeries, seeking maternity care and showing up at emergency rooms more frequently, executives say, boosting income for hospital operators. At Tenet Healthcare Corp., patient volumes rose 4% in the second quarter compared with a year earlier, while uninsured inpatient admissions slid 22%. The biggest publicly traded hospital company, HCA Holdings Inc. HCA, reported a 9.2% increase in second-quarter revenue. Hospital leaders estimate one-third to one half of their gains are due to the law itself. Nationwide, the cost of uncompensated care dropped by one-fifth in 2014. Nearly 70 percent of those savings came from states that have expanded the eligibility for Medicaid under ObamaCare. The 29 states with Medicaid expansions saved a total of $5 billion last year, compared to the $2.4 billion saved in states that did not expand the program. The fortunes of health insurers began to improve in 2013, the year before major portions of the ACA were implemented, because the rise in health care costs slowed dramatically. Then, in 2014, the individual mandate that requires most Americans to have health insurance took effect, resulting in a “burst of new revenue,” The dire predictions by insurers that new ACA fees and restrictions on their medical loss ratios would hurt health insurers were exaggerated. Indeed, earlier this year, Aetna reported adding 1.1 million new health insurance clients between 2013 and 2014, with 560,000 coming through the 17 state exchanges Aetna participates in. Aetna shares rose nearly 30 percent last year, hitting several all-time highs, but so did the stocks of rivals UnitedHealth Group Inc. and Anthem Inc.
- Essentially, this law means that any patient who purchased health insurance through the state exchanges AND who is receiving tax subsidies to offset the cost, is granted a 90-day grace period in which their coverage cannot be canceled for non-payment of premiums. For comparison purposes, insurance companies have traditionally allowed up to a 30-day grace period when premiums went unpaid. By lengthening this timeframe and imposing restrictive mandates, insurers have seemingly shifted the majority of financial risk to providers. Why is the grace period risky for providers? As with any legislation, it’s all in the details. Here’s the highlights that you need to know. Insurers are obligated to pay claims received during the initial 30 days of the grace period. That’s good news for providers, at least temporarily alleviating most financial risk. However, during the remaining 60 days of the grace period, providers will potentially bear the brunt of the financial burden since insurers are not required to pay claims for those dates of service. Even worse, insurers have the right to hold claims incurred during the final 60 days of the grace period. Basically, they can wait it out to see if policyholders will pay their premiums. If premiums aren’t paid, coverage will be canceled and then all pending claims can be retroactively denied. Plus, if any payments have already been made for services rendered during the same period, insurers can recoup those as well. As you can imagine, this could prove detrimental to a practice’s revenues and wreak havoc with their billing. In large part, it’s a lack of information that is at the core of the problem. Currently, no fail-proof system exists to help providers identify: Which patients are receiving government-subsidized healthcare (i.e. tax subsidies) Which patients receiving subsidies are within the grace period – particularly the latter 60 days Without this critical information, physicians are going out on a financial limb. They will continue to treat patients, assuming premiums have been paid and expecting reimbursement from insurers. In reality, they may actually be underwriting the cost of those services themselves.
- Issuers must also notify HHS of such nonpayment and notify providers of the possibility for denied claims when an enrollee is in the second and third months of the grace period. There is no requirement on when this notice must be sent to a physician, although CMS has subsequently said it expects providers to be notified within the first month. Some states have taken action to enact additional requirements on health plans for grace-period purposes. Louisiana Gov. Bobby Jindal signed into law on May 22 certain provider notification requirements. The law says that if a provider requests information regarding an enrollee about eligibility, benefits, or claims status, and the request or service is for a date within the last two months of the grace period, the issuer is required to clearly identify that the enrollee is in the grace period. Information provided about the enrollee’s grace-period status is binding. If the insurer does not tell the provider that the enrollee is in the grace period, the plan must pay claims for covered services, and it is precluded from trying to recoup payment. Washington Gov. Jay Inslee signed a bill last year that addresses provider notification. That statute says that for an enrollee who is in the last sixty days of the grace period upon provider request the insurer must provide real-time information regarding that person’s status and notify the provider that an enrollee is in the grace period within three business days after a claim is submitted. Legislation has also been introduced in at least 6 other states this year. Many states have “prompt payment” laws that set timeframes for insurers to reimburse providers for claims. In an August 2013 American Bar Association newsletter article, California Medical Association official Brett Johnson wrote, “States currently require health insurers to pay clean claims within anywhere from 15 to 45 days, depending on the means of submission (e.g., electronic or paper), and impose penalty interest where insurers fail to pay within the prescribed time period. Such payment requirements would certainly inhibit an issuer’s ability to hold claims over a two-month period.”
- Despite efforts to steer some new enrollees to less expensive places for care emergency room use continues to grow. Many of the hospitals with the busiest ERs in 2013 are reporting even higher volumes in 2014 despite the nation's declining uninsured rate. Indeed, ER visits increased 8% at Tenet and 5.7% at HCA for the quarter of 2014. Although ACA supporters expected ER utilization to fall immediately, they're now trying to explain away these findings by pointing to: Urban and rural areas of the nation lack primary health care providers Declining funding for mental health services causes mentally ill people to be "boarded" in ERs Hourly wage earners cannot take time off during standard hours Integration of Retail Health Clinics into the delivery system may address Incentivize ERs to address full range patients' needs Increase the number of primary care physicians in the workforce, will take years to work,
- At 5 years and 1 month old, the ACA remains in existential jeopardy. The Supreme Court is considering whether the law, as drafted, permits payment of tax credits in the 34 states that use HealthCare.Gov as their administrative agent. These credits make insurance affordable and the law sustainable. Should the Court rule that these credits cannot be paid, millions will find insurance unaffordable. Insurance markets in most of those states will be thrown into chaos. Congress could easily amend the law to prevent these consequences. Alas, partisan gridlock makes such legislative action unlikely. A Supreme Court decision disallowing the tax credits would threaten the law’s survival. Most recently America’s Health Insurance Plans, the trade organization for the nation’s major health insurers, filed a friend-of-the-court brief bolstering the Obama administration's defense of the ACA against a legal challenge to the tax credits given to some individuals and families to help them buy policies in the exchanges. AHIP says pulling subsidies from those states would destabilize the system because many of those receiving subsidies are young people and young families who tend to be healthier than the population at large but would be likely to become uninsured without financial help.
- Here are some of the highlights of what's included in this historic legislation: The SGR formula is repealed immediately. The 21 percent payment cut scheduled to take place April 15 was halted, and a positive payment update of 0.5 percent will take effect July 1. The 0.5 percent payment update will be applied through 2019. Claims that were held for the first half of April will be processed and paid at the rates that were in place before the 21 percent cut was scheduled to take effect. Medicare's current quality reporting programs will be streamlined and simplified into one merit-based incentive payment system, referred to as "MIPS." This consolidation will reduce the aggregate level of financial penalties physicians otherwise could have faced. Protections are included so that medical liability cases cannot use Medicare quality program standards and measures as a standard or duty of care. This provision will stop plaintiffs from using a doctor's quality improvement performance as the sole basis for a medical liability lawsuit or to prove negligence. Language in the law states that "the development, recognition, or implementation of any federal health care guideline or standard shall not be construed to establish a duty of care in medical malpractice claims."[1] Before the law was passed, medical leaders worried that guidelines and quality criteria could be used in new legal actions against physicians. For example, plaintiffs won't be able to include in a lawsuit the fact that a doctor didn't earn an incentive under the Physician Quality Reporting System (PQRS), or if a preventive care service covered under the Affordable Care Act (ACA), such as screenings, isn't performed and the patient is ultimately diagnosed with a disease. The fact of ACA coverage of the service can't be used to demonstrate malpractice or negligence. 5% incentive payments will be available for physicians who participate in alternative payment models and meet certain thresholds. Technical support will be provided to help smaller practices participate in alternative payment models or the new fee-for-service incentive program. While the bill supports physicians who choose to adopt new payment and delivery models, it retains Medicare's fee-for-service model. Participation in new models is entirely voluntary.
- What does the bill say about the release of physician claims data? Starting in 2014, CMS began to publicly release physician-identified Medicare claims data on an annual basis. The bill would continue to allow the public release of these data. The bill retains provisions that the AMA has supported that allow the sale of non-public data and analyses by Qualified Entities, with certain safeguards. Does the bill address private contracting? Physicians who choose to opt out of Medicare to engage in private contracting could elect to automatically renew their status; they would no longer be required to renew their opt-out status every two years. The bill also requires regular reporting about physicians who choose to opt out of Medicare. Will Medicare’s plans to eliminate the 10-day and 90-day global surgical service bundles be addressed? The decision by the Centers for Medicare & Medicaid Services (CMS) to eliminate bundled payments for 10-day and 90-day global surgical services has been reversed; instead, CMS will collect data on these services beginning in 2017 to determine the accuracy of payment rates. These data will be collected from a sample of physicians, rather than from all who bill global surgical services. To encourage participation, a 5 percent payment withhold may be applied until the required data are submitted. Myth: H.R. 2 mandates physician participation in Maintenance of Certification (MOC). False. Nothing in H.R. 2 mandates maintenance of certification, nor does it penalize physicians for not participating in MOC. Myth: H.R. 2 sets a new requirement that the quality of physicians’ care must be compared with the quality of care by non-physicians. False. PQRS currently does not differentiate in its assessment of physicians and non-physicians, although all eligible professionals (EPs) are allowed to select their own quality measures. The same will be true for the MIPS program. The MIPS requirements will apply to a wide array of non-physicians—dentists, podiatrists, optometrists, chiropractors, physician assistants, nurse practitioners, clinical nurse specialists, and nurse anesthetists—who are not currently subject to MU and VBM requirements. Both physician and non-physician EPs will be assessed against the same MIPS “performance threshold.”
- The IPAB will require a board of non-elected government officials to recommend Medicare cuts when spending exceeds a targeted growth rate. These recommendations automatically go into effect unless blocked by a Congressional three-fifths supermajority. Although hospitals and long term care facilities comprise over one-third of Medicare spending, they are exempted from IPAB cuts until 2020. This means that a disproportionate share of the burden will fall onto physicians, who make up less than 10 percent of total Medicare expenditures. Unless/Until the IPAB is empanelled, sole authority rests in the Sec. of Health and Human Services
- REQUEST U.S. urologists urge Congress to require that the U.S. Preventive Services Task Force (USPSTF) have greater accountability and transparency. We urge representatives to be an original cosponsor of the “USPSTF Transparency and Accountability Act of 2015” RATIONALE Currently, the USPSTF has little accountability. The Task Force members are appointed by an unelected official, and it does not meet with relevant stakeholders during their review process nor do medical specialists serve on the Task Force. Although recommendations are intended for a primary care audience, they impact patient access to appropriate specialty care.
- BACKGROUND The “USPSTF Transparency and Accountability Act” would include critical reforms that would require the USPSTF to: publish research plans to guide its systematic review of evidence and new science relating to the effectiveness of preventive services; make available reports on such evidence and recommendations for public comment; codify the grading system so it cannot be changed without appropriate review; and establish a stakeholders board to advise it on developing, updating, publishing, and disseminating evidence-based recommendations. the bill would ensure that Medicare or other payors cannot deny payment for a preventive service solely based on the Task Force grade.
- BACKGROUND The in-office ancillary services exception (IOASE) to federal self-referral regulations allows physician practices to provide critical services including radiation therapy, diagnostic imaging, pathology and physical therapy in an integrated and coordinated fashion within their respective practices. The medical profession has taken significant steps to ensure that only medically necessary and appropriate ancillary services are performed. development and implementation of training guidance, appropriate use criteria, practice guidelines, and decision support tools that assist physicians in delivering the most appropriate care. Physicians and group practices relying on this exception also must meet complex billing, supervision, and location requirements. Urology urges Congress to view any proposal promising simple solutions to increased diagnostic imaging costs with great skepticism. The timely provision of needed ancillary services often prevents unnecessary treatment and associated expenses. Reducing healthcare costs is a priority for physicians and patients alike, but restricting patient access to treatment options is not the answer.
- The United States will face an overall shortage of more than 130,000 physicians by 2025 and one-half of this shortage will come from specialty physicians such as urologists. Urology has seen a greater than 10 percent decline in the number of urologists per capita over the past 20 years. In 2009, there were only 3.18 urologists per 100,000 population, which marked a 30-year low in the labor force for our field. The average age of a urologist is 51 years, with more than 38 percent of urologists age 55 or older, making our specialty the second oldest only to thoracic surgery. More than a half dozen studies project, by 2030, urology will face a shortage of nearly 4000 providers. The CARE Act will provide much-needed reforms to improve the nation’s graduate medical education (GME) system and help to preserve access to specialty care by increasing the number of GME residency slots by 15,000 over the next five years; directing half of the newly available positions to training in shortage specialties such as urology; specifying priorities for distributing the new slots (e.g., states with new medical schools); and studying the needs of the U.S. healthcare system in order to allocate residencies accordingly. H.R. 1006: Building a Health Care Workforce for the Future Act: The Secretary shall award grants to eligible States to enable such States to implement scholarship programs to ensure, with respect to the provision of health services, an adequate supply of physicians, dentists, behavioral and mental health professionals, certified nurse midwives, certified nurse practitioners, physician assistants, and pharmacists or other health profession as determined by the Secretary.
- Med school grads stuck in residency bottleneck granted 'Assistant Physician' license Legislators in Arkansas and Oklahoma are considering measures to create a new provider license category for medical school graduates who do not matriculate to a residency program. AR HB 1162 and OK SB 712 were inspired by Missouri's 2014 "Assistant Physician" law, which drew the ire of the physician assistant community. Physician assistants argued that creating "assistant physicians" would confuse patients and undermine the non-physician providers' successful patient education efforts. Both Arkansas and Oklahoma legislators seem to have heard that message loud and clear. In Arkansas, the new class of providers would be named "Graduate registered physicians." Oklahoma, meanwhile, chose to classify the medical school graduates as "training physicians.” Each state proposes similar qualifications for such a license, including, but not limited to: graduation from an accredited U.S. medical school; successful completion of Steps 1 and 2 of the U.S. Medical Licensing Exam (or an approved equivalent); entering into a physician supervision protocol (Arkansas) or physician collaborative practice agreement (Oklahoma) within 6 months of licensure. Pay equality not sufficient for Oregon nurses After securing "equal pay for equal work" in Oregon, nurse practitioners are seeking to increase the number of health care procedures they are eligible to perform. Current law prohibits nurse practitioners from executing voluntary sterilization procedures, regardless of gender. Introduced Jan. 12, 2015, by Rep. Rob Nosse and Sen. Michael Dembrow, a noted anti-integrated care lawmaker, HB 2678 amends the law to allow nurse practitioners to perform male sterilization. AACU Distinguished Leadership Award honoree, Sen. Alan Bates, DO, testified in support of the measure, but, according to the Lund Report, recommended that its scope be narrowed so nurse practitioners can only perform simple vasectomies in an outpatient setting. Telemedicine compact usurps state authority to license physicians More than three dozen states have introduced the Federation of State Medical Board’s (FSMB) Interstate Medical Licensure Compact. The general view extolled by news outlets and medical associations belies the fact that if a sufficient number of states approve the measure, the authority of legislators and licensing boards would be questioned, if not compromised. When questioned about the authority of states to require benefit managers' decisions to be made by a physician licensed in that state (WA HB 1471 / SB 5560), FSMB Senior Director for Legal Services Eric Fish responded: The Compact is designed to facilitate the granting of a full and unrestricted medical license. Once granted, physicians are bound to the laws of the state where the patient is located. This applies both to standard of care issues as well as any other requirements for medical care necessitated by that state's laws. While the legislation referenced here may be of varying degrees of concern to urologists, a number of positive work force measures are under consideration, including state-funded residency programs in Georgia and Idaho, as well prohibitions on tying licensure to meaningful use of electronic health records and maintenance of board certification.
- Definition of Surgery A modern definition of surgery is important because how surgery is defined has implications on scope of practice laws in addition to other laws and regulations that use the term surgery. The establishment of a precise definition of surgery in statute would provide clarity and transparency to the public, thereby preventing misrepresentation of the seriousness and potential risks of lasers and the other procedures listed in the definition.
- The AACU’s preeminent and growingly influential state advocacy conference is a highlight of the urologic calendar. This year’s event is scheduled for Sept. 18-19 in metropolitan Chicago. We’ll be announcing early details in just a couple weeks. No matter your level of current knowledge, this conference will both inform and inspire.
- How can you get involved?