A new year is underway and physician advocacy efforts at the state level will continue to have an impact on the health care system. A survey of more than 65 state and specialty societies revealed the top issues to be addressed in 2017 include Medicaid, the nation’s opioid epidemic, private payer reforms, and numerous public health issues.
The annual AMA State Legislative Strategy Conference was held last week in Amelia Island, Fla., where physician leaders met to discuss state legislative and regulatory issues that will occupy their efforts in the months to come. Five issues rise to the top of the queue.
Strengthening Medicaid
Many states are preparing for debates this year over the future of Medicaid expansion. Also, on the agenda for state medical associations will be advocating for responsible Medicaid reforms that improve patient access and quality of care. Alabama, Delaware, Massachusetts, Maryland, Nebraska, Nevada, Rhode Island and Vermont will address accountable care organizations; Connecticut, Massachusetts, Maryland, Nevada and Kentucky are working on Delivery system reform incentive payments (DSRIP) programs.
Maintaining adequate payment rates continues to be a top priority as it is critical to ensuring patients have access to high-quality care, and 20 states will consider this issue in the coming year. Alabama, California, Illinois, Michigan, Mississippi, Ohio, Oklahoma, Oregon and Wyoming are a few of the many states contending with budgetary shortfalls that threaten Medicaid funding.
Reducing the nation’s opioid epidemic
Physicians across the nation will keep up their efforts to reverse the opioid misuse, overdose and death epidemic. Much of the legislation focuses on mandated prescription drug monitoring program (PDMP) use, physician education, substance-use disorder treatment, guidelines or restrictions on prescribing controlled substances.
As in previous years, many states will focus on PDMPs. States also will continue to consider proposals to increase access to naloxone and pursue stronger Good Samaritan policies for anyone who assists a person experiencing an overdose.
Advancing physician-led team-based care
The AMA’s Advocacy Resource Center tracked more than 450 scope-of-practice bills last year and included in those bills were provisions to establish a framework for physician-led team-based care. Health care teams in all states are moving away from fragmentation and toward care coordination to ensure that patients are provided the highest quality care at the lowest cost possible while improving patient outcomes.
Several states will consider AMA model state legislation, which encourages flexible, innovative health care teams under a framework of physician leadership. The AMA’s STEPS Forward™ collection of practice improvement strategies offers several modules to help physicians move their practices toward physician-led team-based care, including instructions on the implementation of team meetings, team documentation and strengthening team culture.
Provider network issues
As provider networks continue to narrow and patients’ financial responsibility for their health care continues to increase, the issues of network adequacy and out-of-network care will continue to be a focus in many state legislatures in 2017. Physicians are having discussions with key stakeholders across the country about how to ensure access to quality and affordable care for their patients while maintaining their ability to enter into fair contract negotiations.
More than two-dozen state medical societies anticipate proposals to address out-of-network billing this year, specifically in the hospital-based setting. And in almost as many states, proposals to address the adequacy of these provider networks to offer access to network providers could be introduced.
Improving public health
State legislatures continue to debate highly politicized issues, such as vaccines, firearm safety, reproductive health and many others. Assaults on the patient-physician relationship will continue in many states with legislation that attempts to decide what can and cannot be discussed in the exam room.
A number of states, including Iowa, Indiana, South Dakota, Vermont and Washington, aim to join California and Hawaii in raising the minimum purchasing age for tobacco products to 21. Missouri will attempt to ban texting while driving and fight against a repeal of the state’s helmet laws.
State and national medical societies will be targeting a long list of additional issues such as diabetes prevention, decreasing cardiovascular disease, infectious disease prevention, obesity, student-athlete concussion and cardiac laws, women’s reproductive rights, tanning restrictions for minors and many others.
