Attendance was up approximately 20 percent for this year’s Day on the Hill, the annual one-on-one meeting in Nashville of legislators and physicians, nurses and healthcare administrators for the opportunity to exchange opinions and concerns about issues affecting healthcare.

The two chief issues for the physicians and administrators involved during last month’s gathering, according to Keith G. Anderson, MD, were Governor Bill Haslam’s failed Insure Tennessee effort and the Payor Accountability Act.

Anderson, a cardiologist with Sutherland Clinic and the new president of the Tennessee Medical Association (TMA), observed, “One of our priorities as a medical community has been to promote Insure Tennessee, but this year, since it’s already been voted down, we went with a ‘What happened? Can you give us the details of why Insure Tennessee did not pass?’ mindset.”

Anderson, a physician for 25 years, expressed his discontent that such an initiative is prohibited from coming up again for two years, leaving 200,000 to 300,000 lives uncovered.

“These people cannot qualify for traditional Medicaid or vouchers or buy insurance on the free market. Most are working part-time in service industries, are seasonal help, or are PRN in health care,” he said.

Anderson said they were not given a reason for the two-year window. He explained it might just be a political cycle. The reason given for the failure of the measure, he said, was discontent with the Affordable Care Act which is what was perceived as the driver of this plan, and that this was a statement from the local legislature. He cited a heavy, organized coalition against Insure Tennessee that had protested on the hill before the vote was taken.

“It was a very well-written plan and I commend Governor Haslam for his hard work on it. The time and effort put into creating it was tremendous. I’m just so sorry it failed so quickly in the legislature,” Anderson said.

The Payor Accountability bill, addressed in the 109th General Assembly, was promoted by physicians to legislators during Day on the Hill as well. The legislation was filed, heard and passed in numerous committees in 2014. Bill sponsors felt continued discussions were warranted and TMA staff and members spent the last half of 2014 meeting with insurers to try to reach a compromise. The bill requires the insurers contracting with physicians honor their financial commitments to those physicians for at least one year, allowing one fee schedule change.

The TMA’s position on the issue behind the bill is that the constant rule-changing has made it impossible for physician practices to run a sound business model.

“All providers have the right to be paid what they were promised when contracts were signed,” said Julie Griffin, director of government affairs, TMA.

The TMA’s position is that staffing and other financial decisions are based on the fee schedule and changes not only affect the way they do business but also affect patients.

“If that is changed 10 times, then it interrupts our business and can sometimes end our contracts prematurely, making patients sit out,” said Anderson.

Another priority, according to Anderson, was the introduction of a bill for Physician-Led, Team-based Care. The bill is a response to an opposing bill by the Tennessee Nursing Association (TNA) to change the scope of practice such that advanced practice nurses (APNs) could practice without physician supervision. He said there is strong research to support that patients like seeing nurse practitioners, but they want a physician available to head their care.

“We work very closely with mid-level practitioners and we feel they need to be part of a team with a physician at the head of it. In our bill, instead of calling it ‘supervisory,’ we are calling it physician-led,” he said.

One of the arguments for more independent nurse practitioners has been access to physicians. Anderson does not see this as a problem in Tennessee.

“In Idaho, where you might not have a physician within 400 miles, there is a problem,” he said. “In Tennessee, we need more primary care docs like everywhere else, and doctors are there and overworked, but they are there.”

A petition with approximately 200 supporters, says the opposite. The petition asks Senator Ken Yager and State Representative Dennis Powers to vote yes on HB456 and SB680 to allow full practice authority for nurse practitioners and no to HB861/SB521, which is the Physician-Led Team Based Care Act. Elizabeth Chadwell of Sharps Chapel, Tennessee, signed and said “I’m an NP and believe it’s time for change. Patients deserve better access to care and this change will help assure such access.”

Another nurse practitioner, Lucille Vara, of Knoxville, asserted that “Research shows patient outcomes under NPS are as good as, even better than under physicians.”

Wendy Owen, from Murfreesboro, claimed her APN saved her life on more than one occasion, as she is uninsured and was sent home from the hospital.

Doctors, nurses, and healthcare administrators can be involved in next year’s event in Nashville. To sign up for Day on the Hill 2016, contact the Memphis Medical Society at 901-761-0200