NCMS Board Addresses Timely Issues

At its November meeting last weekend, the North Carolina Medical Society (NCMS) Board of Directors took up many timely issues including discussion of how to address the state treasurer’s cost containment proposal for the State Employee Health Plan; legislative priorities for the upcoming long session and progress on our strategic plan.

State Employee Health Plan

NCMS Senior VP for Advocacy and Advancement Chip Baggett, JD, offered the Board one cause for celebration on this issue – the state treasurer dropped his original plan to pursue a straight 15 percent cut on provider reimbursement. The treasurer’s new approach to cost cutting is to go to a reference based reimbursement model, pegging the fee schedule to 160 percent of Medicare rates. The Board discussed the various ramifications of this and agreed that tinkering with reimbursement rates ignores the systemic faults with our current reimbursement system. The treasurer’s plan is not a lasting and effective way to bring down health care costs. They strategized on how best to address the plan on behalf of NCMS members going forward.

Here is the NCMS’ official public statement issued Oct. 24, on Treasurer Dale Folwell’s proposal:

Physicians and hospitals are united in their opposition to the state treasurer’s proposal to implement radical cost-cutting measures that could negatively impact access to health care for state employees. We are seeking an opportunity to work with leaders of the plan to develop a sustainable approach that will save money and not compromise the health care services available to state employees.

“Over the past 40 years unilateral rate cuts to physicians and health systems have not worked to achieve long-term savings. Rather, rate cuts often result in reduced access to care for patients, particularly in rural areas, and jeopardize the financial stability of smaller physician practices and health systems,” said Robert W. Seligson, CEO of the NC Medical Society (NCMS). 

The NCMS and NC Healthcare Association (NCHA) are proposing various strategies to strengthen the State Health Plan. Since 2012, leading physician groups and health systems in North Carolina have been developing and implementing value-driven models of care that save money and improve the health of the populations enrolled in them. These strategies are being implemented by private payers, Medicare, and soon will be adopted by Medicaid.

We ask the state treasurer to work with physicians and health systems rather than to implement this tried and failed approach to reducing State Health Plan costs. 

Physicians and health systems support positive change in the State Health Plan to improve health and control spending.  NCMS and NCHA are offering their expertise to the State Health Plan to address these challenges.

Legislative Priorities

The Board accepted the Legislative Cabinet’s recommendations that the NCMS should take the lead in the following are areas when the General Assembly convenes for its long legislative session in January. As always, the NCMS tracks hundreds of bills as they are introduced during any session, but our top priorities is any legislative that would:

  • Fight for transparency and open access for patients to choose their doctor (e.g. updated network adequacy rule, balance billing defense, step therapy)
  • Increase access in rural NC with more investment in GME and rural residencies.
  • Defend against erosions to our medical malpractice reforms.
  • Protect patient safety by ensuring practitioners have proper training requirements (e.g. defend against scope of practice challenges; address naturopath licensure).
  • Confirm the process for a smooth transition to managed care for Medicaid beneficiaries and push for inclusion in funding for social determinants of health programs.

Strategic Plan Update

NCMS staff reported to the Board on progress in several areas of the strategic plan.

  • Physician wellness – October’s Summit on Physician Wellness was extremely successful, bringing together more than 60 health care leaders to discuss the issues surrounding and strategizing on how to ensure a workplace culture that promotes wellness. Plans also are being developed to acquire baseline data on the prevalence of burnout in our physician community.
  • Community and Patient Engagement – many initiatives are underway to engage community partners outside of the clinical setting to support patients and promote health outcomes. Highlights include NCMS programs like Project OBOT, which involves many stakeholders in addressing treatment for substance use disorder and the Health Initiative, which includes community organizations like the YMCA in getting patients the support they need to be healthy. The NCMS also is partnering with the NC Institute of Medicine in their Accountable Communities Task Force and has been a strong supporter of incorporating provisions to address social determinants of health into the state’s Medicaid managed care contracts.

The Board also agreed to have the Membership Committee research and make a recommendation on having a student and or physician assistant seat on the Board of Directors as was suggested at the Open Forum held at the NCMS’ Annual Business meeting in October.

 
 

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2 Comments

  • Charles Willson MD

    Strong work, Chip. Our most precious resource in NC is our children. We need to ask legislators to INVEST in their future by assuring access to high quality, cost-effective healthcare and top notch education.

  • Kerry A Willis MD

    So just wondering if for the average rural primary care Physician the 160% of Medicare would represent an increase in their reimbursement form State employees, How is this plan a threat to rural healthcare? It actually would seem to have the opposite effect by improving the financial standing of the rural areas to encourage Primary care physicians to enter those areas.

    Given that hospital employed physicians would be paid the same as private practice physicians under the RBP schedule, are we to believe that the position of the NCMS is that its fair to reimburse physicians differently for the same service based on employment type and ability to negotiate contracts based on market share?

    My second wondering is does the NCMS feel it is fair to have charges as a % of Medicare that range from 85% to 700% of Medicare for the same procedure?

    The new referenced based pricing proposal doesn’t represent across the Board cuts to Doctors. It does represent a fairer and better way of paying for a service funded mostly by taxpayers.

    It may need work to make it reasonable but then there isn’t anything reasonable about the current system at present. I understand that naysaying is popular these days but perhaps if the NCMS advanced an alternative idea that the State Treasurer might take them seriously. He has laid out his idea that is fairer and more equitable than the current system feel free to propose an alternative.

 
 

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