2021 will be a doozy of a year for healthcare legislation in our state. I wonder why?
Writing this is a challenge, as we know that these priorities can change and shift at a moment's notice based on politics, hidden agendas, covert tactics, and the ever-present pandemic. So, as of about mid-March, here are the priorities for our organizations this year.
Scope of Practice
This issue is expected to rear its head once again this year, as it has every year since 2014. What is the beef? TMA, Memphis Medical Society and many other physician groups feel that a physician-led team is still the best environment for patient care in our state because it does not compromise patient safety or quality of care. Furthermore, silos and fragmentation are one of the greatest issues in healthcare today, creating unnecessary waste and fostering poor communication in healthcare systems. Nurse advocacy groups feel that APRN scope should be expanded to allow for no physician oversight, allegedly allowing those providers to open practices in rural areas. The current laws require physician oversight of any medical clinic opened in our state. Physician groups counter that there is no evidence that expanding scope will prompt any healthcare discipline to move to a rural area and patient safety could be compromised, particularly in more complex cases.
Balance Billing
Balance billing, or surprise medical billing, has been an ongoing issue for years. Each one of us has probably received a "surprise" bill from an ED visit, ambulance ride, anesthesia administration, and other sources. Hopefully, we are turning a corner. Around that corner should be a new healthcare environment that protects our patients and fairly reimburses providers.
As you likely saw at the end of year, the federal government passed the No Surprises Act as part of the year-end omnibus legislation package. So, why do we need further legislation at the state level? The federal legislation only covered those enrolled in plans covered by ERISA (federal law that establishes minimum standards for federally administered health plans). We need a more comprehensive solution for Tennessee that covers non-ERISA (private) health plans.
TMA leads a coalition of hospital-based physician specialty organizations in protecting patients from narrow networks created by health insurance companies. State-wide listening sessions are being hosted with SB 001/HB 002 sponsors, Sen. Bo Watson and Rep. Robin Smith, as they offer a physician-friendly balance billing solution. Their bill would only require patients to pay according to their in-network responsibility if they receive a surprise medical bill and would allow out-of-network physicians to pursue fair payment from health insurance companies through an independent arbitration process if the initial payment was unsatisfactory.
Graduate Medical Education (GME)
Graduate medical education is a term used to reference residency training for medical school graduates in our state. That training was funded through a formula that provided a 2:1 funding match to state dollars by The Centers for Medicare and Medicaid Services (CMS) From 1997-2019, that funding was not increased one dollar. That means no new doctors trained in our state via government funding. Hospitals carry the burden of funding any additional training spots.
As you may recall, the fight for increased GME funding in Tennessee started right here in Memphis in 2019 with MMS's Legislative Committee and a passionate group of medical students that soon enveloped the entire state. TMA took the reins and partnered with other groups to increase the number of residency training slots in the state.
Unfortunately, that amazing work showed a light on another unbeknownst issue. CMS ruled last summer that Tennessee must scratch its longstanding formula to fund graduate medical education slots through TennCare. It places millions of dollars and all of Tennessee's residency programs at risk. You have to love federal red tape!
This initiative is vitally important to maintaining and growing the physician talent pipeline in our state that will ultimately lead to better care of our citizens.
There will be plenty of other things to watch that will impact healthcare, including laws addressing health department authority, COVID-19 rules and regulations for businesses, licensure for nursing and medical assistants, and many more. Stay tuned to communication from all of our organizations throughout the session. We will need you!
Clint Cummins is the CEO of the Memphis Medical Society.