2022 Legislative Priorities for TMA/Memphis Medical Society/MGMA 2022 will be a year of implementing what C-19 has taught us and cleaning up some of the messes it has left us.
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? Tennessee Medical Association, 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 and physician assistant groups feel that advanced practitioners' scopes must 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, 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 2020, 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.
Many of us have already used telehealth as a provider and patient. That utilization has stabilized at levels still thirty-eight times higher than pre-pandemic metric, according to McKinsey.
Yet, equitable reimbursement still remains a challenge for providers. TMA is working with several stakeholder groups to amend or add laws that allow for continued and equitable telehealth reimbursement. This will allow our state to continue its increased access to vital healthcare services.
There will be plenty of other bills to watch for that will impact healthcare, including COVID-19 rules and regulations for businesses and providers, the professional privilege tax, increased coverage to age 35 for breast examinations, and many more. Stay tuned to communication from all of our organizations throughout the session. We will need you!
Clint F. Cummins is the Chief Executive Officer/Executive Vice President of the Memphis Medical Society.