Last night, the NCMS Legislative Cabinet met to discuss the current political landscape and issues facing physicians and physician assistants during the legislative session set to begin next week. The Legislative Cabinet consists of 15 NCMS members from diverse specialty backgrounds with proven experience in the advocacy arena. They meet regularly in order to develop legislative strategy, analyze proposals in light of current NCMS policy and advise the NCMS Board on all matters related to political advocacy.

The Legislative Cabinet approved three key objectives as recommendations for the Society’s 2012 legislative priorities. The following recommendations will go to the NCMS Board for review:

1. Ensure continued access to high-quality care for Medicaid patients by defending against further rate reductions, cuts to essential medical services and further erosions to the mental health care system.
2. Defend the significant improvements to the medical liability reform system achieved in 2011.
3. Continue to protect our patients by opposing proposals by practitioners to be licensed, relax current regulatory safeguards, or expand licensure beyond their training and abilities.

As the NC General Assembly convenes, look for upcoming articles and action alerts to provide resources for you to connect with your legislators about these and other important medical issues being debated.

Your NCMS PAC has been hard at work raising money since the 2010 general elections to be ready to assist those legislators that would face primary challenges in 2012. We are pleased to announce that, through the generous support of members like you, your NCMS PAC was able to invest in 72 candidates for office this year. All but four of those candidates have now won their election or moved on to face a challenger in the general election this November. 

Even with this success, there is still more to do. The campaign season never ends and we have to gear up for an even bigger battle this fall. Your NCMS PAC was able to contribute more than $180,000 this spring and we will need to do that and more again in just a few short months. Please consider becoming a sustaining donor to the PAC by committing to $20 per month or making a one-time gift of $250. 

Your ongoing support enables the NCMS to continue to have strong advocacy programs on behalf of you and your patients. While the focus of many of our reports over the past year have been centered on tort reform, we have also had outstanding success with protecting Medicaid physician services rates, defending against lesser trained practitioners seeking the endorsement of the state through licensure, progress on workers compensation laws and improvements to the insurance regulations that cost your practice time, money and resources.

This success is only possible through your contributions to the NCMS PAC, your personal relationships with local legislators and ongoing communication about our goals and positions on bills of interest to you. NCMS staff will be organizing communication throughout the legislative session that begins next week and we will be doing elections briefings in early September to help you prepare for November.  We hope that you will choose to be part of this winning team and consider a contribution today.

Governor Bev Perdue released her budget adjustments yesterday for consideration by the NC General Assembly. The $20.9 billion budget includes a three quarters cent sales tax increase, restoration of education funds cut during the last year, salary increases for some state employees and a continuation of the many smaller cuts in Medicaid. There do not appear to be any additional across-the-board rate cuts proposed in the Governor’s budget. While the health and human services portion of the budget seems to be relatively untouched, your NCMS legislative team is working to analyze each line item to ensure no further erosions to rates and essential medical services. Further detail and a comparison to the House budget expected to be released next week will be posted online.

Are you looking to learn more about physician and patient advocacy? Do you have an issue that you would like to address with your legislators? Sign up today for White Coat Wednesdays, an NCMS program that gives its members the opportunity to advocate for their profession by speaking directly with legislators about current medical practice concerns. NCMS staff will prep participating members and provide tips on how to convey messages regarding pressing medical and patient issues. The next legislative session is set to begin next week.

This program is a great way for medical organizations across North Carolina to present a united front while advocating on behalf of their fellow physicians. The NCMS Leadership College, Academy of Family Physicians, North Carolina Orthopaedic Association, and the North Carolina Pediatric Society are just a few organizations that will be participating this session. On White Coat Wednesdays, members will visit and see the General Assembly in action, meet one-on-one with North Carolina legislators while also taking part in committee meetings. These interactions build relationships that will benefit the health care profession today and in the future. 

Grab your white coats and come to Raleigh and see what advocacy–on behalf of you and your patients– is all about. There are currently several openings on Wednesdays, May 23 and June 13, 2012. The NCMS can accommodate multiple groups at once so contact the Society for an updated schedule. For an agenda and to schedule a White Coat Wednesdays visit, contact Chip Baggett (cbaggett@ncmedsoc.org), NCMS Director of Legislative Relations, or Will Barnett (wbarnett@ncmedsoc.org), NCMS Assistant Director of Legislative and Political Action, at 800-722-1350.

The primary election is scheduled for next Tuesday, May 8.  Early voting continues through this Saturday. The NCMS encourages you to uphold your civic duty by making sure that you vote. Consider this is your first act of advocacy on behalf of your profession and your patients. 

Many of the races on Tuesday will be the determining race, since they have no further challenge in the fall. Others are merely a stepping stone to the next challenge as the parties choose their candidates. Either way, your vote counts and your vote is needed.

The NCMS has highlighted a number of races over the last few weeks. We would like to again recognize three NCMS members in primary races that have a strong chance of winning, but continue to need your help in these final days leading up to next Tuesday.

Eric Mansfield, MD (Democrat Candidate for Lt. Governor)

Dr. Mansfield is an ENT physician from Fayetteville. He is currently serving his first term in the North Carolina Senate. He was a strong supporter and key vote during the medical malpractice reform debate during the 2011 session. Dr. Mansfield has proven himself to be a strong advocate for bipartisan consensus during his short time in the North Carolina Senate. This is his first attempt at statewide office. He is running in a close Democratic primary against former Rep. Linda Coleman. You can find more information about Dr. Mansfield by clicking here to go to his website.

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Jim Fulghum, MD (Republican Candidate – NC House District 49 – Wake County)

Dr. Fulghum is a neuro surgeon in Raleigh. He is running in his first bid for elected office against former Rep. Russell Capps in the Republican primary. This new district was added during the remapping process this year. It is a leaning Republican district though Dr. Fulghum would still face a Democrat challenger in the general election. Dr. Fulghum has made healthcare and the economy his leading campaign issues. His voice as a practicing physician will be important with the loss or retirements of all three of our physicians in the North Carolina Senate this year. You can find out more about Dr. Fulghum by clicking here to go to his website.

 

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Mark Hollo, PA (Republican Incumbent – NC House District 73 – Alexander County)

Rep. Hollo is serving in his second term in the North Carolina House. He is a physician assistant in Taylorsville. He currently serves as one of the House Health Committee Chairs and was another strong voice for tort reform this past session. He has also been instrumental in writing the Medicaid portion of the state budget. Rep. Hollo is currently double bunked with Rep. McCormack (R) who filed for office but has subsequently withdrawn from the race. Even so, Rep. Hollo will still have to collect the majority of votes next Tuesday since Rep. McCormack’s name could not be removed from the ballot after filing. Rep. Hollo will then move on to take on a Democrat challenger in the leaning Republican district during the fall election. Click here to learn more about Rep. Mark Hollo.

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Other NCMS members on the ballot include Bruce Blackmon, MD (Democrat Candidate for Governor) and Eric Troyer, MD (Republican Candidate – NC House District 76 – Rowan County). Please make sure that your voice is counted next Tuesday, if not before. You can click here to go to the NC Board of Elections website to find your sample ballot, early voting locations and your precinct voting site for next Tuesday. Go Vote!

Earlier this week the North Carolina House Appropriations Subcommittee on Health and Human Services (HHS) met to continue its discussion of the upcoming short session. General Assembly leaders have indicated a desire for a quick session, lasting a number of weeks rather than months. This means budgets are being discussed now and votes will take place very early in the session.

At Wednesday’s HHS Subcommittee meeting it was determined that the Health and Human Services spending target for FY 2012-2013 is $4,392,302,749. Among the parameters set by the House leadership for developing the HHS budget are the following:

• Funding restorations may be considered but no expansion of current programs or services.
• No fee increases.
• No substantive policy in special provisions.
• Additional Medicaid funds for growth and certain non-recurring liabilities are excluded from the spending target; funds will be held in reserve until further notice.
• The HHS Subcommittee is encouraged to continue funding programs previously supported by the Health and Wellness Trust Fund.

The subcommittee continues its work today to finalize its recommendations for the FY 2012-2013 HHS budget, with the Full House Appropriations Committee Chairs meeting next week to finalize the recommendations. According to a calendar distributed this week, the House plans to introduce its Budget Bill on Wednesday, May 16 – the first day of the 2012 short session. Final approval of the House Budget is expected to come the following week, as early as Wednesday, May 23.

Your NCMS legislative team is actively engaged in HHS Budget discussions and will keep members updated via the Bulletin and the NCMS website. Click here to review the budget handouts from this week’s HHS Appropriations Subcommittee.

In February, the NCMS provided information about General Statute 90-106.1, the law passed by the NC General Assembly during the 2011 Legislative Session that requires photo identification prior to the dispensing of certain controlled substances. Pharmacies began requesting identification on March 1, 2012.

At the request of the NCMS House of Delegates at the 2011 Annual Meeting, the Society will continue to educate members about General Statute 90-106.1. Below are a few resources that will provide updates on the law:

• The North Carolina Board of Pharmacy (NCBOP) released frequently asked questions pertaining to the requirement for photo identification prior to dispensing certain controlled substances updated in early March 2012. This document addresses how dispensing physicians and physician assistants must comply with identification check requirements.
• The NCBOP also provides updated memos about the controlled substances identification requirement. Click here to view the memos.
• WRAL reported on the law and its importance.
• WSOC-TV also reported on what the new law will bring. Click here to read the article.

 Refer to future Bulletin articles for updates on this statute and other House of Delegates actions.

Earlier this year the North Carolina Senate’s Judiciary I Committee appointed a subcommittee to discuss potential changes to the state’s laws regarding pharmaceutical manufacturer liability. Senator Thom Goolsby (R – New Hanover) chaired three meetings of this subcommittee, with the final meeting taking place earlier this week.

As in past meetings, members of the subcommittee heard testimony from stakeholders on both sides of the debate this week:

• Roland Larino, Finance Director, GlaxoSmithKlein
• Kim Wilson, Lewis & Roberts
• Mary Bethel, AARP Associate State Director for Advocacy
• Paul Schmidt, Covington & Burling, LLP
• Eddie Kirby, Civil Chief, NCDOJ Medicaid Investigations Unit
• Doug Kenyon, Hunton & Williams
• Kevin Anderson, Chief, NCDOJ Consumer Protection Division
• Burton Craig, Legal Affairs Counsel, NC Advocates for Justice

No action was taken by the subcommittee at this meeting. You can find all of the past agendas and handouts from the subcommittee’s proceedings by visiting the NCGA website here.

The North Carolina General Assembly (NCGA) convened earlier this week in a skeletal session in which no votes were taken and floor sessions adjourned within minutes. The mini-session had been scheduled in order to address potential action on redistricting, however such work became unnecessary.

The regularly scheduled short session of the General Assembly will begin on May 16 and focus primarily on budget-adjustments. In the meantime, appropriations subcommittees have continued to meet in order to identify areas of concern and possible solutions to impending shortfalls – including those within the Medicaid budget.

Your legislative team is already hard at work to prepare for a very short session with goals to protect Medicaid reimbursement and services, defend hard-won medical liability reforms, protect against half a dozen scope of practice threats and address needed legislation regarding insurance regulation.

With so much to discuss in such a short period of time, it is important for our members to build relationships with legislators and play an active role in advocating for your profession. Watch upcoming issues of the Bulletin and for information on the NCMS website regarding the latest developments on the many issues facing the medical community this year.

With the 2012 Short Session quickly approaching on May 16, legislators and staff are busy wrapping up interim study committee work, preparing bills for introduction or further action and developing the fiscal adjustments for the second year of the biennium budget. 

The budget is expected to be the primary focus for legislators when they return next month. Though they are awaiting the arrival of the Governor’s budget adjustment proposals, they have wasted no time in coming up with their own solutions.  Appropriation subcommittees have continued to meet throughout the interim to watch for trends, identify problem areas and develop possible solutions so that the short session can really be just that… short.

NC General Assembly leadership from both chambers are suggesting that this session will be out by the end of June. That gives us just six weeks to accomplish our goals of protecting Medicaid reimbursement and services, defending hard won medical liability reforms, protecting against half a dozen scope of practice threats and addressing needed legislation regarding insurance regulation.

The work that is being done now through lobbying activities, grassroots and legislative committee work will be foundational to our success. We encourage you to continue to host legislators for meetings in your offices so that they can understand your patients, your profession and your business better.  We encourage you to be active participants in the primary elections that are going on right now through May 8. Your vote is essential to guarantee that those legislators that support you return to office in 2013. Finally, we encourage you to give to your NCMS PAC so that we can continue provide fundamental resources to those physician friendly candidates seeking elected office.

The NCMS will keep its members informed during the session. Watch upcoming issues of the Bulletin and the NCMS website for the latest developments. Members are also encouraged to follow Chip Baggett, NCMS Director of Legislative Relations, on Twitter at @doclobbyist.

The North Carolina House Select Committee on The Certificate of Need (CON) Process and Related Hospital Issues has been meeting since September 2011 to address issues raised in two bills filed in the House during the 2011 Long Session (i.e., H743 and H812). The Committee’s authority arguably included the ability to scrutinize all aspects of the CON program, but specifically included a provision in the CON law that exempts academic medical center teaching hospitals from the generally applicable “need” limitations of the CON program. As a practical matter, anyone can seek an exemption from these limitations on a case-by-case basis through the petition process, but the academic centers enjoy a standing, statutory exemption from the General Assembly. Also included in the Committee’s authority was scrutiny of the role of publicly-owned hospitals, the certificate of public advantage (COPA) program, and any related matters or matters raised in the legislation noted above. There has been extensive discussion of possible recommendations, but ultimately the Committee determined that continued study of these issues is appropriate. Some action is expected in the General Assembly’s 2013 Long Session. Watch upcoming issues of the Bulletin for details. Click here to view the approved 2012 Legislative Session report.

As the next legislative sessions approach, members are encouraged to sign up for White Coat Wednesdays, a NCMS program that gives its members the opportunity to advocate for their profession by speaking directly with legislators about current medical practice concerns. NCMS staff will prep participating members and provide tips on how to convey messages regarding pressing medical and patient issues.

This program is a great way for medical organizations across North Carolina to present a united front while advocating on behalf of their fellow physicians. On White Coat Wednesdays, members will visit and see the General Assembly in action, meet one-on-one with North Carolina legislators while also taking part in committee meetings. These interactions build relationships that will benefit the health care profession today and in the future. 

Grab your white coats and come to Raleigh and see what advocacy–on behalf of you and your patients– is all about. For an agenda and to schedule a White Coat Wednesdays visit, contact Chip Baggett, NCMS Director of Legislative Relations, at cbaggett@ncmedsoc.org or 800-722-1350.

As reported in the past, the North Carolina Department of Health and Human Services (DHHS) has been working to manage cash flow within their approved budget while juggling a number of fines, penalties and lawsuits. This external pressure along with increased enrollment led to the announcement yesterday, April 4, 2012, at the North Carolina General Assembly (NCGA) that DHHS, and more specifically the Division of Medical Assistance (DMA), will likely run out of money at the end of this month to pay for services for Medicaid patients.

Governor Beverly Perdue’s Budget Director, Andy Willis, testified before the Joint Legislative Oversight Committee on Government Operations during a meeting dedicated to the Medicaid budget. Mr. Willis reported that money would run short at the end of this month but that DHHS had found $45 million within their state appropriation to continue to reimburse for services until the NCGA reconvenes on May 16. 

Senator Pete Brunstetter (R-Forsyth), one of the Appropriations Chairs for the North Carolina Senate said, “This is something that we are going to have to address quickly, in the first few days when we return in May.” 

The problem that he refers to is a limitation in the DHHS Budget that says the department must balance within its’ own budget. That provision essentially means that no money can be shifted from any other general funds (i.e., Transportation, the Rainy Day Fund) to balance Medicaid. The provision was included by budget writers in part because of a history of problems like this where overspending required the State Office of Budget Management to redirect additional general fund dollars to cover Medicaid overages.

Even with the various overages experienced this year, Medicaid is within three percent of the budgeted target for the roughly $12 billion program, of which the state funds about $3.4 billion. Many legislators agree that is a significant improvement over previous years. Lawmakers continue to look for ways to better predict these health care expenditures, which is difficult because of varying enrollment, fluctuating utilization and additional burdens steadily flowing down from the Federal Government due in part to the health reform law.

Your NCMS continues to work with legislators and other health care partners to identify savings opportunities without jeopardizing access to care for your Medicaid patients or payment reductions. While lawmakers still view rate cuts as a possible solution, Wednesday’s conversation revealed that this initial budget problem would be handled with money from other sources in the state budget. At the same time, we will be facing budget corrections for the remaining biennium budget year.

Watch the Bulletin and other action alerts for opportunities to communicate with your legislators about this issue in the coming month.

Last weekend, leaders in the physician community came together to discuss the issues they will be facing during the upcoming legislative short session and in the future. The NCMS hosted the event at its headquarters in Raleigh. More than 70 physicians and advocates from a wide range of specialties attended, including representatives from 24 various organizations.   

The agenda covered a broad range of issues affecting the daily practice of medicine and the changing health care environment. The purpose of the meeting was to generate a dialogue among physicians about the effects of legislation, payor issues, and mutual short- and long-term goals. Discussion focused on the following issues expected to surface during the legislative session convening in May:

• Budget/Medicaid – Preservation of Medicaid provider rates, Community Care of NC (CCNC) savings
• Mental Health – Management, reimbursement issues, lack of options for patients, transition from local management entities (LMEs) to managed care organizations (MCOs)
• Reimbursement / Insurance Regulation – The establishment of a state-run health benefits exchange,  fair contracting between payors and providers, necessary steps to amend contracts
• Accountable Care – The movement toward accountable care models, shared savings, and the new frontier of physician payment structures
• Scope of Practice – Licensure efforts by naturopathic medicine, lay midwives, and pharmacist injections
• Public Health – Tanning bed bill, nurse whistleblower bill
• Certificate of Need – NCMS policy in changes to Certificate of Need (CON)
• Medical Liability Reform – Importance of protecting 2011 reforms, expectation for activity in this area

Many physicians used this opportunity to recruit their peers to assist different specialties on issues not commonly addressed by others.  This important partnership opportunity is foundational to the overall goal of presenting a unified physician voice at the General Assembly.  Attendees were especially engaged in the conversation about moving health care delivery toward accountable care since this is timely and has a dramatic impact on reimbursement.  For more information on NCMS efforts in accountable care, click here.

The meeting was moderated by NCMS President Robert Monteiro, MD, who applauded the efforts of physician groups to work together (see the video below).

For more information about any of these topics or similar meetings, contact the NCMS Government Affairs Department.  We would be happy to hear from you and to speak with your medical practice about these issues and how you can get involved.

Just days after the second anniversary of the passage of the Patient Protection and Affordable Care Act (PPACA), the US Supreme Court heard more than six hours of oral arguments challenging the new law.  The challenges revolved around four distinct questions:

• Can the court hear the case right now since the individual mandate has not yet taken effect and no one has technically been harmed by the new penalty/tax for non-compliance?
• Is the individual mandate unconstitutional?
• If the individual mandate is struck down, what other sections of the bill must also be struck down?
• Is the ACA’s mandatory expansion of Medicaid enrollment an undue burden on the states that wish to continue to have a Medicaid program?

Speculation is rampant about the expected outcomes of these questions.  News sources are analyzing every word of the 421 pages of transcripts trying to identify the tell-tale signs as to which way the Justices will vote.  At this point, the Court has no deadline for releasing their decision.  Many argue that the longer it takes for them to complete their work, the more likely they are to find against the President’s plan.

The debate on Wednesday was especially interesting during the argument about what other provisions of PPACA should be dropped if the mandate is declared unconstitutional.  Justices on both sides of the political spectrum pressed hard to get the lawyers being questioned to identify the textual correlation between the mandate and other portions of the massive 2700 page law.  The questions gave rise to the theory that the more liberal Justices recognize that the mandate is likely to be struck down, so minimizing the down-stream effects would be important.  Even so, many of the questions from more conservative members of the Court indicated that they too were looking for some clear delineation so as to not be forced to strike down the entire law.

Many in the medical community believe that the mandate is likely to be found unconstitutional.  Only two elements of PPACA were explicitly identified as being bound to the mandate through the language of the bill itself.  They are the community rating improvements and preexisting condition coverage.  In addition, these portions of the law were most often discussed as linked to the mandate in some way:

• Coverage for individuals with pre-existing conditions
• Community rating adjustments
• Tax credits for purchasing health insurance
• Medicare disproportionate share funding
• Medicaid enrollment expansion
• Health Insurance Exchanges

The NCMS will continue to report on this historic debate as further analysis and more information becomes available.  The transcripts for each of the three days of testimony can be found below.

No matter the outcome, there remains a heavy burden on everyone involved in medicine to find ways to further improve quality outcomes while lowering costs within the system.  This debate centers on a topic that will be defining for generations to come.  We continue to look to you, the members of the NCMS, for guidance and participation in the programs that will set the course for the future of your profession.

Court Testimony

• Monday transcript (PDF)
• Monday audio
• Tuesday transcript (PDF)
• Tuesday audio
• Wednesday a.m. transcript (PDF)
• Wednesday p.m. transcript (PDF)