Courtesy of Keith vom Eigen, Health and Public Policy Committee Chair
We have been addressing several health policy issues at both the state and national levels that are of interest to ACP and its members.
State Level Issues
The state legislature has completed its session. The governor signed some significant bills:
1. APRN Independent Practice – This issue came up again after multiple failed attempts by the Nurse Practitioner organization to get approval for practice independent from physician supervision. ACP, CSMS and other physician groups opposed this legislation, as they have in the past. ACP policy favors APRN participation in physician led team based care, rather than independent practice, which could affect patient access to physician expertise. It is unclear whether NP independent practice will increase access to primary care or help keep costs down. One possible outcome is excessive referral to specialists, and further reductions in physician availability for primary care. The impact of this bill remains to be seen, but we should continue to track this.
2. For-Profit Hospital Ownership – Previously state law did not allow for-profit hospitals to employ physicians which has hindered major for-profit hospital purchases in the state so far. The legislature passed and the governor signed legislation that would make these conversions easier. At this point, Sharon Hospital is the only for-profit hospital in the state, however there are several proposed for-profit conversions. Tenet is moving ahead with plans to purchase Waterbury and Bristol Hospitals, as well as Eastern Connecticut Health Network (Manchester and Rockville Hospitals). Tenet and Yale made an agreement for Yale to provide physician services to ECHN. A public meeting has been announced regarding the ECHN purchase.
State SIM Grant – Connecticut has submitted its State Innovation Model (SIM) grant proposal, which could provide approximately $50 million in funding for transformation of the health delivery system in Connecticut. Currently the steering committee is putting together an implementation grant request. Former chapter governor Robert McLean is serving on the steering committee for the proposal development, and several other ACP members are serving on other advisory committees. CSMS is coordinating physician members on these committees. There was a meeting earlier this evening of the steering committee at which they discussed several issues of interest to us. One issue of direct interest is the standard for designation of Medical Homes under state programs, and the conversion of practices to the PCMH model of care.
There have been ongoing services cuts around the state. St. Francis has been cutting various primary care services. Institute of Living is eliminating its schizophrenia program. Hartford Health is cutting 350 positions around the state. These staffing cuts are generally explained as efforts to control costs while maintaining services, however they may have effects on access to care, especially for low income, vulnerable populations. With ongoing consolidation there are threats to access as hospitals and systems focus on high profit services and markets consolidate. We need to keep an eye on this. Members can contact us if they are aware of other potential access issues that arise.
ACA implementation – Several of the Exchange plans have asked for rate increases next year, while one has proposed a decrease (Healthy CT). The OHA has asked for public hearings on the issue. There was a recent data breach from Access Health CT, but it appears accidental and low impact. They are making changes to prevent further breaches.
At the national level, there are several health policy issues of ongoing interest, although partisan gridlock and budget constraints continue to dominate the political process in Congress. We had a successful Leadership Day on 5/22/14, with several students accompanying our group in meetings with Congressional staffers. The key issues we discussed include:
1. Medicare Payment/SGR Issue – The SGR was pushed out again to the end of the year (after the election) ACP and other groups advocating for elimination of the SGR are hopeful that it may finally be possible this year. The budget cost is projected to be lower than in previous years, and the involved committees have been able to work towards legislation needed to replace the SGR with an alternative payment plan. However, there has been no agreement on budget offsets that will be needed to eliminate the SGR. So even if there is bipartisan agreement to eliminate the SGR, it may be put off yet again. ACP favors elimination of the SGR and transition to a new payment system that will reward high value care.
2. ACA implementation – The ACA (“Obamacare”) is still drawing opposition from Republican legislators despite ongoing implementation. After initial problems with enrollment websites, especially on the federally run exchange, enrollment has been picking up. Implementation of the Connecticut exchange has been relatively smooth. Lack of Medicaid expansion in some states (mainly Republican controlled) will be one of the significant factors hindering more universal insurance coverage. There are continuing legal challenges, and future political campaigns are likely to raise it as a major issue. A shift to Republican control of Congress or the Presidency may pose a threat to ongoing implementation. Going forward, the cost of policies on the exchanges and in the private market may determine whether this program can provide sustainable near-universal health insurance coverage. ACP favors extension of the Medicaid pay parity for primary care services through at least 2016.
3. GME Funding – Graduate Medical Education funding may become a more contentious issue this year. The President’s recently released budget proposes additional funding for primary care residency slots and other primary care training programs, with some funding being shifted from current hospital based GME funding. Physician groups, such as AAFP and ACP have come out in support of the increased funding for primary care training, and better alignment of GME funding with workforce needs. However ACP and other organizations such as AAMC and hospital associations are opposing cuts to hospital based training programs. Although it is unlikely that the divided Congress will pass the President’s proposal as it is, GME funding may be subject to other legislative action going forward.
4. Medical Liability Reform – The current medical liability system is failing to meet its goal of compensating patients when they are injured due to negligent care, and reducing the need for compensation by incentivizing physicians and systems to provide better care. Although medical liability systems are controlled at the state level, ACP supports national legislation to provide funding to states to implement and test alternative strategies such as Health Courts, and to promote Safe Harbor laws that protect physicians who can document that they are following guidelines in providing care. In Connecticut, ACP is working with CSMS and other organizations to promote patient safety measures and a more effective system for compensating injured patients.
If you want to get more involved in health policy, let us know!