The second legislative session of the 109th Tennessee General Assembly officially convened on Jan. 12, 2016. With lawmakers back in Nashville, the leadership teams representing the state’s physicians, nurses and hospitals are ready to share key priorities and make a case for a list of wants, needs and concerns impacting the delivery of care to Tennesseans.
TMA
The Tennessee Medical Association has outlined three key priorities for this legislative session: reimbursement stability, clarifying malpractice caps, and codifying the doctor as the team leader.
The Healthcare Provider Stability Act, sponsored by Sen. Bo Watson (R-Hixson) and Rep. Jon Lundberg (R-Bristol), would limit how often insurance companies could change fee schedules and payment policies and require adequate notice of those changes to make the process more transparent.
“It’s impossible for a physician to make sure the business side of a practice runs smoothly when health plans can cut reimbursement mid-contract with no recourse for the physician,” said TMA President John W. Hale, Jr., MD.
Hale said another priority for TMA in the upcoming session is to work toward a constitutional amendment clarifying the General Assembly has the authority to set the caps on noneconomic damages in cases including medical liability actions. Laws were passed in 2011 but are now being threatened by lawsuits. In order to make it to the ballot for a vote in 2018, the proposed amendment must pass two separate General Assemblies, which makes this session critical for TMA.
“The General Assembly needs to act now to prevent us from going backwards on the issue of a noneconomic damages cap,” said Hale, adding he was “confident Tennessee voters will support it if given the chance to have their voices heard.”
One of the key pieces of legislation on TMA’s list of priorities is the Tennessee Healthcare Improvement Act, which outlines a team-based healthcare delivery model with doctors as the team leader in patient care coordination. The TMA-backed bill is being offered as an alternative to the Nurse Independent Practice/Full Practice Authority Bill. The Tennessee Nurses Association has long advocated for legislation to remove scope-of-practice barriers, which has put the two major provider organizations at odds on this issue.
“Having the proper collaboration from a physician in diagnosing and treating a patient ensures the highest quality of care and patient safety,” stated Hale. “We want to knock down silos among providers, increase care collaboration and create a model that supports the best possible patient outcomes. The Healthcare Improvement Act will allow advanced practice nurses to use the full extent of their training but make sure that a physician is involved in the care of every patient. It’s in the best interest of all Tennesseans.”
TNA
The Tennessee Nurses Association disagrees with that assessment. For TNA Executive Director Sharon Adkins, MSN, RN, it comes down to improving access to care while decreasing costs to the system and individual patients.
“We certainly understand there are major changes going on in healthcare; and in Tennessee, we are consistently at the bottom of healthcare rankings,” Adkins said. “In order to address that, we’re concerned about providing access to quality, affordable care. Advanced practice registered nurses are positioned to provide that care, and so we will oppose any efforts to restrict their ability to practice to the full extent of their education, training, experience and certification.”
She continued, “Though the Tennessee Medical Association has introduced legislation to ‘improve healthcare,’ it essentially will restrict the existing practice of advanced practice registered nurses. Their bill would increase cost and decrease access.”
Adkins noted that while scope-of-practice issues are a major focus, there are a number of other bills that have been filed that could potentially impact the state’s healthcare landscape. To that end, TNA leadership is reviewing proposed legislation and will weigh in as necessary.
“We will support any legislation that is beneficial to the healthcare of the citizens of our state,” Adkins concluded.
THA
Although TMA and TNA might have to agree to disagree over practice authority, both organizations are united, along with the Tennessee Hospital Association, in supporting continued efforts to pass Insure Tennessee.
While hopeful the General Assembly once again will consider the proposal to extend healthcare coverage to more than 200,000 Tennesseans, THA Chief Executive Officer Craig Becker recognizes it will be difficult to gain traction on coverage expansion during a presidential election year.
Becker said there is work to be done even if legislators don’t formally take a look at Insure Tennessee this year. “We’re going to use this as an opportunity to provide more education to the Legislature and more public education, as well,” he said, adding there are lingering misconceptions about program.
Of key concern to THA is maintaining Tennessee’s Certificate of Need program. Becker said there have been discussions about eliminating the CON program with free market proponents opposed to government intervention in controlling healthcare supply.
“Those in favor of a free market say it controls costs, which would be true if there was a level playing field … but there’s not,” Becker stated. “We have to take all comers.”
Becker added the CON program helps control ‘cherry picking’ so that an ambulatory surgery center or imaging center doesn’t siphon off commercial pay patients without taking charity care patients.
Becker said not having a program in place “definitely poses a threat to hospitals in communities.” In addition to endangering access to care, Becker said eliminating the CON process would actually increase cost to the system.
Another area of emphasis this year is on telehealth reimbursement. “In 2014, we passed legislation that required insurers to pay for telehealth/telemedicine,” Becker said. However, he continued, the insurance industry “has come up with some loopholes so that they don’t have to pay in certain circumstances, which really guts the intent of the bill. In our opinion, it subverts the legislative intent.” Becker said THA is working with lawmakers to clarify the legislation with the strong support of hospitals and providers.
Also garnering broad support is the creation of a statewide stroke system. THA is working with TMA and TNA to replicate the success of the trauma system to ensure stroke patients receive the right level of care at the right time in the right setting. Launching a coordinated statewide stroke response system might even be feasible without requiring formal legislation, Becker noted.
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