The legislature is near mid-session and their accomplishments are beginning to materialize, somewhat earlier than traditional general assembly’s. There are many key issues facing Emergency Medicine, therefore my overview of other highlights of this session will be brief.
But First…. Breaking News! It is an election year, which means candidates are filing for office, and you heard it here first, our very own Dr. Randy Jotte just filed for the 1st Senatorial District (South St. Louis County). Since this is an association newsletter, I cannot suggest that you assist Randy with his efforts.
On to legislative hot topics…. First, Ethics reform – on the ropes (House and Senate have different views); Transportation funding – struggling – key conservatives dislike, no, actually despise, increased taxes; Budget – Legislature says Governor overstated revenue picture to fund his last hoorah! And finally yet another legislator submitted his “I quit” letter due to his, well, again this is an association newsletter and therefore you fill in the blank; a lobbyist was issued a restraining order due to inappropriate interaction with interns and medical marijuana will go no where this year, but the hearings are entertaining as everyone piled in the room and brought their snacks. However, while this sounds like business as usual at the Capitol, this legislature is far from it.
The Senate has passed tort reform; not one but two major proposals, both of which will help Emergency Physicians. The House seems to be on a similar pace, and we are very optimistic on both proposals. Expert Witness, which is a complicated bill that says in order to testify as an expert witness you actually have to be an expert on the issue about which you are testifying. Huh? That sounds complicated to me.
The second bill is actually complicated. It is the Collateral Source rule. It says that a plaintiff can recover the amount they had to pay for the medical care they received. The courts are actually awarding an amount greater than the actual cost, and attempt to award the “value” of the medical care. This bill tells the court that the “value” = actual cost. Seems like simple algebra.
Instituting a Prescription Drug Monitoring Program in Missouri continues to struggle, and remains stalled on the House, where it has its best chance. The Senate remains the tougher hurdle, where ironically two physician Senators lead the charge to block the bill. But before you get too mad, remember in politics, your enemy on one issue is your best friend on the next.
The Helmet repeal legislation is the perfect example. While this bill makes its annual trek through the House, our two foes on the PDMP are our friends by blocking a vote on the repeal legislation.
Medicaid and controlling the cost is a perennial issue. One goal each year is to impose cost shares on Medicaid recipients to ensure they have skin in the game. Obvioulsy, if you impose a cost share for primary care visits, recipients will simply visit the ER for their primary care acute issues. Senator Sater has passed out of the senate a bill which imposes a copay for ER use buy Medicaid enrollees. The bill originally required a $5 copay, which would have reduced by the same amount the reimbursement you receive from the State Medicaid program. He later amended his bill to ensure the copayment supplements the MoHealthNet reimbursement and does not supplant it.
During the debate on that bill, the Senate added two health care transparency proposals, which will need an exemption for Emergency Medicine. The bills require a physician to give a patient an estimate, or bid, on the cost for procedures. I think everyone can think of their own example on why this would not work in an Emergency Room.
Nurses are back! Actually, they never left. I could write a thesis on the nurse’s advocacy techniques and why that continues to render few results. Here is the theme – we don’t need doctors telling us what to do. The APRN’s have filed legislation to allow them full controlled substance prescription authority, full separate licensure and elimination of the requirement to enter into a collaborative agreement. They want the last piece of the pumpkin pie too.
As you can imagine, the physician community does not even know where to start with that proposal. Their request is like the physician community countering by requesting that they go to medical school and only have the scope of practice of an LPN. This will continue to simmer….and then boil.
Health Insurance reforms have been floated in various designs this year, however their momentum has stalled due to multiple reasons including the traditional insurer/provider fight, but this year has an added obstacle; most of the bills filed are by the legislator that recently resigned as noted in the opening paragraph. The one hot item was allowing for a higher cost share for HMO plans. Current law precludes a higher than $50 copayment, and therefore the premiums for the plans are too high to meet the Health Exchange requirements and hence not sold.
Finally, the Department of Health and Senior Services continues to struggle with a solution for medical education requirements for Emergency Medicine physicians working in a Stroke, Trauma or Stemi designated hospital. We may need to file legislation, similar to what the air ambulance industry has done to repeal a DHSS TCD rule regarding helicopter pads.
Finally, if you are still reading, then I know you are committed enough to our legislative effort to receive the following message and act upon it. Visit your legislator and invite them to your Emergency Department and show them what you do. It is as simple as that, no need to talk to them on legislative issues now, but instead establish a relationship – schedule the meeting TODAY!