Protecting our patients and protecting our profession A call to action for all physicians

1. Protecting our patients and protecting our professionA call to action for all physicians Russell Libby, M.D. MSV President

2. Virginia General Assembly • Session length: • 45 days in odd numbered years • 60 days in even numbered years • 14 – 15 White Coats on Call days each session • Committee meetings and floor sessions daily • 2,500 bills in 2013 • 185 health care related bills • Bills passed during session take effect on July 1

3. MSV legislative process Legislative Summit – issues proposed Legislative Committee – issues evaluated Board of Directors MSV House of Delegates

4. Collaboration and strategy Meet with relevant stakeholders Meet with key legislators before session Map out strategy Work with local medical societies and specialty societies to ensure physician presence during MSV’s White Coats on Call days Regularly communicate with other health care partners during session

5. 2013 Issues: Budget and Medicaid MSV sought a physician reimbursement increase and inflation adjustment formula Neither included in final budget Physician and managed care liaison committee established MSV supports fiscally-responsible expansion

6. 2013 Issues: Liability reforms Backed by MSV, passed nearly unanimously, signed by governor Expert witness certification in med mal cases Use of health records by providers to corroborate testimony in wrongful death cases Recovering expert fees for non-suits taken during trial

7. 2013 Issues: Workers’ comp reforms Workers’ compensation (WC) reforms Virginia’s WC premiums for employers are 4th lowest in U.S. VA has better than average return to work rates. MSV supports efforts to ensure providers receive timely payment for their services. MSV and others oppose a statutory fee schedule where government determines how much physicians can charge for care. Bills tabled; process established for deliberation this year.

8. Other bills PMP and substance abuse Physicians gain access to their profiles to detect fraud—PASSED Mandatory use—DEFEATED Mandatory CME to prescribe controlled substances—DEFEATED Completion of death certificates Authority to sign expanded; proposed language stricken that would have made failure to sign and return w/in 24 hours reportable to BOM. Pharmacy collaborative practice agreements Physician-led team care; pharmacists may conduct post-diagnostic “implementation” of a drug therapy pursuant to written or electronic protocols.

9. MSV Position: Patient-physician relationship MSV will oppose or work to favorably amend legislation, regardless of its primary intent, that interferes with or jeopardizes the sanctity of the patient-physician relationship or is in conflict with or contrary to broadly accepted, evidence-based standards of care identified by credible medical organizations such as the American Medical Association or the specialties and sub-specialties recognized by the American Board of Medical Specialties.

10. Applying the policy: 2013 GA session Policy used to establish MSV’s positions on: Penalty for sex-selective abortions Ultrasound mandate repeal Lyme disease testing notice

11. Legislating standards of care: How it happens Constituency and/or advocacy groups Emotionally charged and often anecdotal Well-developed strategies to influence legislators Sometimes fueled by partisan social agenda

12. What’s the problem? Interferes with patient-physician relationship Results in mandates that are inflexible and do not change when the science changes Little opportunity for repeal or alternatives once law enacted Sets dangerous precedent for other advocacy groups

13. What’s the problem? Patient safety can be affected Potential effect on access to care Cost to provider, patient and overall health care system Can create patient expectations for treatment Patient confusion Questions about legal implications and liability

14. Speak out against legislation that: Interferes with communication between patient and doctor Prohibits physicians from asking patients about risk factors Mandates physicians to discuss practices that may not be necessary or appropriate Imposes non-guideline standards or procedures Requires HIPAA-violating reporting of encounter information

15. Speak out against legislation that: Requires physicians to provide, and patients to receive, tests or medical interventions not supported by evidence Limits information that physicians can disclose with patients

16. What can physicians do? Establish relationships with legislators and be present to provide input Help legislators identify non-evidence based assertions Help legislators understand unintended consequences Give real examples of how patients will be impacted Create solutions consistent with standards of care Connect with stakeholders

17. Connecting: Shared values • Evidence based care • Safety • Privacy (HIPAA) • Sanctity (privilege of the exam room) • Cost consciousness • Risk management (liability)

18. Process going forward • Monitor proposed legislation • Identify potential problems • Convene stakeholders • Establish a common theme and consistent messaging • Develop a SWAT team to engage legislators

19. What you can do • Join us on White Coats on Call Days • Meet with your legislators and be ready with a clear message • Look for action alert e-mails and other calls for action • Check the MSV.org Web site, especially during the General Assembly • Support MSVPAC