The Tennessee Medical Association (TMA) plans to tackle a number of legislative issues pertaining to physicians and the future operation of healthcare in the state during this month’s meeting of the 2016 Tennessee General Assembly.
The TMA, the state’s largest professional organization for physicians, has unveiled an agenda that includes:
- The limitation of how often an insurance company can change fee schedules and payment policies,
- Physician-led, team-based collaboration with practice nurse practitioners and
- Tort reform to cap non-economic damages in medical liability lawsuits.
“These priorities are about making improvement for Tennessee physicians and the patients they serve,” said John Hale, MD, TMA president. “We feel these legislative priorities benefit both physicians and patients.”
The association supports passage of the Healthcare Provider Stability Act, which would limit how often insurers could make changes to fee schedules and payment policies with providers. Currently, insurance companies can change the terms of agreements with providers in the middle of multi-year contracts.
According to Ron Kirkland, MD, and chair of the TMA legislative committee, the bill was drafted partly in response to Blue Cross Blue Shield of Tennessee’s changing the laboratory reimbursement rate in 2014. Blue Cross Blue Shield of Tennessee, the state’s largest health benefit plan company, notified providers in December 2013 that it would cover only 48 percent of what Medicare pays for laboratory tests instead of matching the Medicare reimbursement rate.
“Doctors had no choice but to accept the changes or be removed from the network,” Kirkland said. “As a result, they could have lost patients if they didn’t comply. Patients were locked into an insurance program where certain physicians who they thought were covered by the network initially, weren’t. There was no negotiation.”
The bill requires health insurance companies to honor reimbursement contracts with physicians for 12 months. If passed, Tennessee would be the first state in the nation to limit how often payment policies can be changed during a contracted period.
“Ideally, physicians want changes to payment policies prior to the time of negotiation, but we recognize this always isn’t the case,” Kirkland said. “This bill would allow for insurers to make changes to contracts with providers at certain times. Also, it would allow patients to receive notifications of changes ahead of time. We feel this bill levels the playing field and offers favorable options to the insurance companies.”
The bill is being held in the state Senate finance committee and the state House finance subcommittee. The Haslam administration added a $5-million fiscal note to the bill at the end of the pervious session.
“The TMA has asked for the current administration to make changes on the fiscal note to make it more reasonable,” Kirkland said.
Another key piece of legislation supported by the TMA is the Tennessee Healthcare Improvement Act. The bill would put in place a team-based approach with physicians leading the collaboration and coordination of patient care.
“A change is coming in the way healthcare is being delivered,” Hale said. “The government will mandate a primary care physician to coordinate care between hospitals and specialists and this bill is a proactive response to that future mandate. We want to add structure to a system that is unstructured.”
There is a competing bill being considered called the Nurse Independent Practice/Full Practice Bill, which would give advanced practice registered nurses the ability to treat patients and prescribe medication without a physician to supervise and provide consultation.
The Tennessee Nurses Association, which supports the bill, has a list of talking points on its website which include, “Numerous studies over many years have shown the care given by advanced practice registered nurses is as good as, and in some cases better, than care provided by a physician.”
According to Kirkland, Tennessee Healthcare Improvement Act will allow nurse practitioners to use the full extent of their training, while making sure that a physician is involved in the care of every patient.
“Nurse practitioners are highly valued and take good care of patients,” Kirkland said. “We need them, but there are limitations to their training. If a patient has a complex issue such as an acute heart attack or renal failure, those patients should be treated by a physician.”
The final legislative initiative for the TMA is the passing of a constitutional amendment clarifying the General Assembly can cap non-economic damages in cases including medical liability actions.
The Tennessee General Assembly approved the Tennessee Civil Justice Act of 2011 to cap non-economic damages in tort claims to $750,000, but a Hamilton County Circuit Court judge last March ruled the cap unconstitutional. The cap is being threatened by lawsuits.
A joint resolution must pass two separate General Assemblies before it is put on the state ballot for a vote in 2018. According to Kirkland, if the resolution does not pass this year’s session, the next opportunity to have the issue on the ballot would be 2022.
“This bill has had a positive impact on reducing the amount of frivolous lawsuits in the state,” Kirkland said. “Less money and time spent on filing these lawsuits lowers the cost of healthcare.”
In addition, the TMA hopes to have legislation drafted in 2017 that would increase funding for greater medical education in the state.
“State residency spots haven’t changed since the 80s,” Hale said. “Studies have shown that physicians relocate within 100 miles of their residency. We need physicians trained in Tennessee to stay in Tennessee. There aren’t enough residency spots for the number of medical students in school.”
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