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In a letter to Congressional Representative Charles Rangel, Chairman of the House Ways and Means Committee last week, the AMA voiced it's support for HR 3200 "America's Affordable Health Choices Act of 2009". This apparently near blanket support surprised many and spurred efforts of a handful of state medical associations to voice their dissent. AMA representatives have articulated that the letter of support was designed to help push the legislation out of committee while they are still actively trying to get some components of the bill changed. The strategy is to place the AMA in a stronger negotiating position when the bill gets to conference committee to work out differences between the House and Senate versions. The Senate is restrained by the requirement to pass a bill that is "fully paid for", thus will likely only have a one year SGR payment fix. The House bill includes a permanent SGR payment fix.
Yesterday, the AMA released a video from their President J. James Rohack, M.D., regarding the health system reform bill in the U.S. House of Representatives and the position the AMA has taken. Click here to watch the video. Additionally the AMA released a Frequently Asked Questions document yesterday explaining why they took the action they did.
Other national associations and specialty societies also voiced their support and endorsement of the legislation in letters to Congress including: American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, and the American College of Surgeons. (Click on the organization to read their letter.)
The American Osteopathic Association, American College of Physicians and the American Psychiatric Association all wrote letters saying they support numerous provisions of the legislation and want to work for further revisions.
The American Association of Neurological Surgeons has written a letter to Congress opposing HR 3200.
The legislation, drafted by the tri-committee group in the US House of Representatives, had passed out of two of the three committees (Ways and Means Committee and Education and Labor). The third and final committee, Energy and Commerce, should mark up their bill sometime this week.
Politico Newspaper reports that House Speaker Nancy Pelosi has said that she will continue to push for more concessions from hospitals, pharmaceutical companies and health insurers. On that note, the insurance industry is on the airwaves starting today with a seven-figure, national cable television ad campaign on health system reform. The 30-second spot pushes for bipartisan reform that includes affordable coverage for everyone, and doesn't deny insurance to those with pre-existing health conditions. Industry insiders view covering pre-existing conditions as a significant, but needed, concession that, combined with a requirement that individuals own insurance, will ensure that everyone gets affordable coverage. |
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Since the end of the legislative session rumors have been flying about who would be appointed to serve as the Director of the newly created Governor's Office of Health Enhancement and Lifestyle Planning (GO HELP). In a surprising press release issued late last week by Governor Manchin he announced that West Virginia Department of Health and Human Resources (DHHR) Secretary Martha Yeager Walker will become the acting director of GO HELP effective Sept. 1. The GO HELP office was established with the passage of Senate Bill 414, this past session to oversee the state’s health care reform initiatives and collaborate with all state agencies to coordinate the delivery of health care in West Virginia.
Governor Manchin then appointed Patsy Hardy to replace Walker as Secretary of DHHR. Hardy is a resident of Parkersburg and has more than 24 years of health care management and operations experience, including serving as CEO of St. Joseph’s Hospital in Parkersburg and CEO of Putnam General Hospital in Hurricane. She also was the chief operating officer for St. Francis Hospital in Charleston.
The WVSMA congratulates both women for their appointments and looks forward to working with them in their new roles. |
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The WV Legislature got down to work last week researching and discussing a number of issues. Many of the issues were carried over from legislation that failed to pass during the session instead being wrapped up into study resolutions. The Legislature will meet monthly for three days throughout the summer and fall. |
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Members of the legislative Government Organization Subcommittee A discussed the scope of practice of optometrists at their interim meeting last week. Representatives of the WV Optometric Association presented their suggestions to the subcommittee on how they would like the legislature to expand their scope of practice.
This issue is being discussed following the very hotly debated legislation which the medical community (Academy of Opthalmology and the WVSMA) worked to defeat last Session.
The committee heard from a handful of optometrists and optometric students on how the statute should be rewritten to grant the Board of Optometry full control to determine the scope of practice of optometrists in West Virginia. One of the presenters Tom Griffith, OD said “Our goal is to do what it takes to take care of patients”. They want to allow the Board of Optometry to allow optometrists to "perform any procedure that is taught at any optometry school in the United States." Megan Elkins is a fourth year student in optometry school in Memphis and she said she wants to “slice away bumps and do injections” on patients. When asked by committee members exactly what they are trained to do they stated that they are taught for example to do injections and to use lasers to reduce eye pressure in a patient with glaucoma for example. When asked specifically whether they are hoping to be able to do injections directly into the eyeball there was no direct answer given. No specific list was distributed for legislators to respond to.
The WV Academy of Ophthalmology has been asked to present to this Subcommittee their perspectives on this subject in August. |
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Delegate Craig Blair received a lot of attention this past legislative Session when he introduced legislation that mandated drug testing of persons receiving assistance from state and federal welfare assistance programs including the Temporary Assistance for Needy Familys (TANF) program, Aid to Families with Dependent Children (AFDC) the food stamp program and unemployment compensation.
The controversial legislation failed to pass last Session, however the legislature did decide to have the Select Committee on Health study the issue this interim.
Delegate Blair presented the issue to the Committee and was met with as litany of tough questions regarding the extent of the mandate and why certain things were included or excluded. Delegate Blair stated that the question he received over and over again during the Session was why did his bill not mandate publically elected officials be subject to mandatory drug testing? He stated that he thought "we should lead by example" and he would include that requirement in his bill that he plans to reintroduce next year.
He stated that he understands that 1 in 12 West Virgninans has a drug habit. With the savings from kicking people off public assistance programs who test positive for drug use, the State could reinvest the money in programs for kids and for substance abuse treatment. When questioned by Senator Evan Jenkins about why he targeted these specific populations, persons on public assistance, with this bill he answered that they're unemployed and are "the children of the state so to speak" and that "it's an insult to the working man going into the coal mine who has to be tested" while these persons arent. He also explained that these populations are just the starting point.
Delegate Charlene Marshall told Blair that many working persons actually receive food stamp benefits even those who work for the DHHR, the department which administers the program.
Senator Ron Stollings, MD questioned the impact this bill would have on the children if their parents benefits were taken away.
Following the long questioning of Delegate Blair, Franklin Crabtree with the ACLU spoke against the idea. And Stated that random drug testing of recipients of public assistance is costly, inefficient and likely unconstitutional.
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The legislative interim Judiciary Subcommittee B heard presentations from Brenda Dawley, MD an OB/GYN at Marshall University School of Medicine and Co-chair of Perinatal Partnership Committee on Unplanned and Teen Pregnancy and Michael Vernon, PhD, Chair OB/GYN department WVU School of Medicine on the need for insurers to provide contraceptive and maternity coverage for their policy holders' dependent children.
PEIA currently does not cover contraceptives or maternity care for the dependent children of policyholders. Some commercial insurers do not provide such coverage either. Dr Dawley explained that these arbitrary policies force otherwise insured persons to receive their care from a provider who is not their medical home and who does not have a relationship with the patient or their parents. Additionally, the lack of coverage for dependent maternity care actually could perpetuate poor outcomes by forcing a delay in receiving obstetrical care. Young women under 20 reportedly have the poorest outcomes in terms of infant mortality and pregnancy complications.
The Committee approved the funding of a study to be performed by the Perinatal Partnership and the Marshall University Center for Business and Economic Research to look into the economic impact of PEIA and commercial insurance of not covering dependent minors compared to the cost of covering them. Click here for information presented to the Committee from the Perinatal Partnership. |
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Ted Cheatem, Director of PEIA, reported that effective December 31, 2009, Coventry Advantra Freedom will no longer be offered in WV. PEIA has released an RFI for coverage beginning January 1, 2010. Reportedly Blue Cross/Blue Shield, Humana, Aetna and CIGNA are interested in submitting bids for the WV retirement coverage. They have projected an additional $6-8 million savings. Cheatem announced that effective July 1, 2010, PEIA will have a new drug plan for retirees. |
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Members of the Legislative Oversight Commission on Health and Human Resources Accountability (LOCHHRA) heard from Tara Buckner, CFO for the WV Department of Health and Human Resources. She provided an update on the amount of stimulus funds (American Recovery & Reinvestment Act 2009—ARRA) available to DHHR.
$2.5 million Foster Care & Adoption
$1.2 million Food Stamps
$12 million TANF
$6.5 million Child Care
$9.2 million Public Health
$2.1 million Part C Disability—for early intervention
$5.2 million Child Support
$116 million Medical Services
In response to questions, Buckner said that it is a common practice for DHHR to keep an administrative fee for specific line items appropriated by the legislature but they do not have a specific formula. Of specific concern was the line item for the Free Health Clinics for which $3.7 was appropriated. DHHR kept $30,000 for a specific cost the agency incurred. |
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The legislative interim Select Committee on Children, Juveniles and Other Issues was presented with information about the problems West Virginia is experiencing with substance abuse during pregnancy. Dr. Stefan Maxwell Chief of pediatrics and Director of Neonatal Intensive Care Services at CAMC spoke to the committee about the work the Perinatal Partnership has been doing on this issue. Results from a key informant survey of the Partnership showed that 50 percent of West Virginia obstetrical providers believe that the increased use of illicit drugs and legal drugs (alcohol, tobacco) is a major factor in this state's poor perinatal outcomes. Click here for more information from the Perinatal Partnership's work on this issue.
Dr. Maxwell educated the committee about the teratogenic effects that many commonly used drugs have on a fetus. He reported that the problem with drug use during pregnancy is statewide and is not regionally concentrated. Twenty-six of the thirty one birthing hospitals in state reported drug/alcohol treatment of a pregnant woman coming in for birth.
Dr. Maxwell announced that he is partnering with Dr Robert Nerhood at Marshall and Dr Michael Stitley at WVU to conduct a study to determine the extent of the drug use during pregnancy problem in West Virginia. The study will test a sample of umbilical cords of babies born in ten hospitals over a month long period and will test for eight substances. This study will indicate the prevalence of specific drugs used by pregnant women over up to approximately 45 days prior to delivery. The Perinatal Partnership will then determine next steps in addressing the issue. |
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In 1995, the WV Legislature established the Rural Health Education Partnerships Program (RHEP) to achieve a greater retention of WV trained health science graduates in underserved, rural West Virginia communities by creating partnerships of community, higher education, health care providers and governmental bodies. A recent audit for 2005-2007 by the Post Audit Division of the Office of the Legislative Auditor found some problems with the management of the state funds. They found the Higher Education Policy Commission does not have effective procedures to monitor grant agreement expenditures. There appears to be some ambiguity in the structure of the multiple levels established for the program. A report by Suttle and Stalnaker, CPAs offers three scenarios to better protect the state and federal funds.
- Make grants to lead agencies and make them responsible for carrying out the program including managing the consortia network of preceptors and training providers.
- Make grants to consortia boards expanding the board to be fully responsible for carrying out all aspects of the program at the community level.
- Manage funds directly from the state level. This would make the HEPC fully responsible for carrying out the program.
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The AMA today announced the new results from its second annual National Health Insurer Report Card. The report card diagnoses the strengths and weaknesses of the claims processing systems used by the nation’s largest health insurers.
As reported in an AMA news release, the inefficient and inconsistent claims process adds as much as $200 billion annually to the health-care system. One recent study estimated physicians spend the equivalent of three weeks annually on health insurer red tape. To keep up with the administrative tasks required by health plans, physicians divert as much as 14 percent of their revenue to ensure accurate payments from insurers.
Key findings from the 2009 National Health Insurer Report Card include:
- Denials. The inconsistency found among health insurers in 2008 continues to be demonstrated in 2009. The wide variation in how often health insurers deny claims, and the reasons used to explain the denials, indicates a serious lack of standardization in the health insurance industry.
- Timeliness. Prompt pay laws continue to appear effective in encouraging insurers to respond to physician electronic claims with relatively quick payment transmittals. Five of eight insurers showed a slight improvement from last year in reducing the median time necessary to respond to a physician claim.
- Accuracy. While there remains room for improvement, health insurers made progress in eliminating unnecessary reporting discrepancies from the payment process. Private health insurers correctly acknowledged the expected contracted rate to physicians upon fee 72 to 93 percent of the time in 2009, compared with 62 to 87 percent of the time in 2008.
- Transparency. Payers have made improvements since 2008 in their efforts to disclose vital policies and information to physicians through their Web sites. Almost every insurer provides physicians with at least some access to a range of payment policies, with the notable exception of policies related to prior-authorization of services.
Also today, the AMA announced a new white paper urging the administration, Congress and health insurers to consider five recommendations for bringing transparency, simplicity and consistency to the nation’s multi-payer system.
To view the complete findings, or to listen to a webinar on the 2009 report card, please visit the AMA Web site at: http://www.ama-assn.org/go/reportcard
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In a press release issued yesterday evening Governor Joe Manchin announced he was named the 2009-2010 vice chair of the National Governors Association (NGA) during the organization’s annual meeting. Gov. Manchin becomes the first West Virginia Democratic governor to serve in that position. Manchin will replace Vermont Gov. Jim Douglas, who now serves as chair of the group of gubernatorial leaders.
"I am truly honored to serve and represent the National Governors Association as vice chair,” Gov Manchin said. “I am eager to continue my service as a member of this very progressive, bipartisan group. I look forward to working diligently and collectively with our nation’s leaders to help solve many of our respective states and our nation’s most pressing issues, in the months and years ahead.”
As vice chair of the NGA, Gov. Manchin serves as chair of the NGA Center for Best Practices, chair of the NGA Finance Committee and works collaboratively with NGA Chair Vermont Gov. Jim Douglas to provide leadership on implementing NGA policies.
Founded in 1908, NGA is the collective voice of the nation’s governors and one of Washington, D.C.’s, most respected public policy organizations. Its members are the governors of the 50 states, three territories and two commonwealths. NGA provides governors and their senior staff members with services that range from representing states on Capitol Hill and before the Administration on key federal issues to developing and implementing innovative solutions to public policy challenges through the NGA Center for Best Practices.
For more information on the National Governors Association, visit: www.nga.org.
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July 21, 2009
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