Last Updated: Oct 31, 2018
Physician advocacy is alive and well in Pennsylvania, as more than 200 physician and medical student delegates came together for the 2018 House of Delegates (HOD) meeting in Hershey, Pa. on Oct. 26-28. Pennsylvania Medical Society (PAMED) delegates representing counties, specialties, and member sections engaged in spirited debate on many of the pressing issues affecting health care today.
The HOD approved a breadth of resolutions, including ones that addressed rising prescription drug prices, reaffirmed PAMED's support for the physician-patient relationship, and called for PAMED to support a repeal of the Merit-based Incentive Payment System (MIPS).
Here's a look at some of the resolutions that physicians either adopted or directed PAMED's Board to study further. (Important Note: This is not an exhaustive list. PAMED will soon share final versions of the 2018 resolutions adopted or recommended for further study online, and we will provide monthly updates on progress concerning each resolution.)
Health Care Legislation & Regulations
In their daily practice, Pennsylvania physicians must navigate an ever-growing number of laws, policies, and regulations. Delegates addressed legislative and policy issues such as:
- Defending the Physician-Patient Relationship – PAMED will continue to recognize, support, and lobby for the need for physician oversight, whether by direct supervision or a written collaborative agreement, of all non-physician practitioners who deliver care as part of a physician-led care team.
- Maintenance of Certification (MOC) – PAMED will strongly encourage organizations such as hospitals, network employers, and insurance companies to recognize multiple qualified board organizations when credentialing physicians. Further, at the HOD's direction, PAMED will share more information from a September 2018 Department of Justice letter containing MOC guidance.
- Clarifying State Legislation on Ambulatory Surgery Centers (ASCs) – The Pa. Dept. of Health has ruled that a 2017 state law intended to increase the allowable time of care in ASCs to 23 hours, 59 minutes did not specifically address Pennsylvania code which prohibits overnight stays. As a result, current Pa. code prevents care in an ASC to last up to 24 hours except in "extreme circumstances." The delegates voted to work with stakeholders to ensure that the intent of the law is executed and, if necessary, seek a legislative remedy.
- Maternity Leave Equity – The delegates directed PAMED to support the elimination of punitive salary policies on the career opportunities of women physicians who become mothers, and, with guidance from the Women Physicians Caucus, develop best practice guidelines for physician employers.
- School Resource Officer (SRO) Training – In light of the multiple incidents of school violence, PAMED will advocate for legislative initiatives to implement minimum standards of training for SROs to include topics like conflict resolution and cultural competency.
- PAMED Support of Local Legislative Efforts – PAMED's Board will study ways to increase the grassroots involvement of physicians statewide. They will explore whether to create a council or committee that would coordinate advocacy initiatives at the state and county level.
Public Health & Education
Delegates explored issues that affect the health and well-being of Pennsylvania patients, including:
- Improving Health Care in Correctional Institutions – The delegates directed PAMED to address a range of public health issues in the U.S. prison system. They approved resolutions on issues affecting individuals in the prison system including: improving treatment of depression in older adults, support of medication-assisted treatment (MAT), health education programming, and prevention of hygiene-associated and sexually-transmitted infections. The PAMED Board his directed to study the issue of funding for disease prevention programs, including vaccinations, in the prison system.
- Immunization – PAMED will promote American Academy of Family Physicians and/or Pennsylvania Academy of Family Physicians outreach campaigns to educate health care providers about immunization platform visits at 16 years of age that can enhance the well-being of older adolescents.
- Firearms Safety Education for Physicians – The delegates directed PAMED to explore partnerships with other stakeholders to provide physicians with comprehensive educational resources on firearms safety.
- Promote Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline – PAMED will continue to promote awareness of the SAMHSA national helpline, 1-800-662-HELP (4357).
- Social Determinants of Health (SDOH) – PAMED will support addressing SDOH to provide comprehensive care to patients. We will also encourage primary care providers to recognize the correlation between adverse childhood experiences and chronic disease to appropriately tailor care to the patient.
Practice Issues & Reimbursement
Skyrocketing drug prices, the accelerating transition to value-based payment models, and patient access to care are major concerns for all Pennsylvania physicians. Delegates addressed practice and reimbursement issues such as:
- Out of Network Balance Billing – PAMED will support state legislation to get patients out of the middle of billing disputes between insurers and providers that result from "surprise" insurance gaps, out of network emergency services, or other situations where patients do not have the ability to select their provider. We will also oppose initiatives that base the benchmark or default payment rate for non-contracted physician services on Medicare rates.
- Support for Repeal of Merit-based Incentive Payment System (MIPS) – PAMED will support the repeal of MIPS and petition the American Medical Association (AMA) to support the repeal and to oppose any federal efforts to implement pay-for-performance programs unless they do not add significant regulatory or paperwork burdens to the practice of medicine and have been shown by evidence-based research to improve quality of care.
- Corporate Practice of Medicine – PAMED will commission a study to determine the current extent of corporate ownership of physician practices in the state, which will include physician and patient feedback.
- Health Insurance Parity – The delegates directed PAMED to advocate for essential health benefits, seek legislation to ensure Pa. consumers are protected, and ask the Pa. Insurance Department to provide resources to consumers seeking comprehensive health insurance.
- Physician Credentialing – PAMED will advocate that physician credentialing by insurance companies be based on professional training and licensure rather than solely on employment status or hospital affiliation. We will also advocate to payers that, once credentialed, physicians be listed as equal-tiered providers to those employed by the hospital or health insurer.
- Drug Shortages and Drug Prices – Delegates voted to directed PAMED to support evidence-based policy to address drug shortages and drug prices, advocate for increases to supply chain transparency and pharmacy choice, and advocate for effective implementation of pharmacist gag clause legislation. Additionally, PAMED will provide member education on the safe harbor exemption to the anti-kickback statute.
The delegates in attendance discussed numerous strategies to strengthen state and county medical societies and enhance the member experience:
- Find Methods to Increase Communication and Transparency – The HOD recommended a variety of strategies to effectively communicate with members. One such strategy recommended by delegates is an "Ask the Board Chair" website providing members and opportunity to submit questions for physician leadership. This new feature will be available soon. Note that PAMED members can currently access Board of Trustee and Executive Committee meeting minutes here.
- Role of County Medical Societies – The HOD reaffirmed that county medical societies are integral components of the state medical society.
- Update to PAMED's Bylaws – The HOD adopted several bylaws amendments that will (1) clarify dues for medical staff coordinators, (2) give county medical societies increased flexibility in setting their own dues, (3) streamline PAMED's membership categories, (4) update provisions regarding the Early Career Physicians and Medical Student Sections; and (5) create a new Women Physicians Section and Board of Trustees seat.
- Regionalization of County Medical Societies – PAMED will form a task force to create a grant process through which county medical societies who wish to participate in the process of regionalization can apply for assistance.
- PAMED's Care Centered Collaborative – The Collaborative, PAMED's for-profit subsidiary, will continue to share information about its activities to PAMED members on a regular basis. You can find the Collaborative's quarterly reports at www.pamedsoc.org/CCC.
- Explore Options for Making the HOD Virtual – A task force will be created to explore the incremental virtualization of the HOD as a means to increase member participation and engagement.
Thank You to This Year's HOD Delegates and Attendees!
PAMED thanks the physician and medical student leaders who attended this year's House of Delegates.
We will soon share final versions of the 2018 resolutions adopted or recommended for study online, and we will provide monthly updates on progress concerning each resolution. We will also continue to share updates via the website at www.pamedsoc.org
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