North Carolina Medical Society (NCMS) staff briefed the crowd of physicians, physician assistants, lobbyists and health care association leaders on the state’s proposal for Medicaid reform; scope of practice issues; health plans’ tiering of specialists; the NCMS’ efforts to provide information and resources on accountable care; the importance of the NCMS PAC in upcoming elections and certificate of need legislation. Lobbyists and specialists then gave more detailed information on the status of various bills, which generated some lively discussion.
Chip Baggett, NCMS Director of Legislative Relations, outlined the Medicaid reform issue that will be considered by the General Assembly this spring. He praised the state’s latest proposal, which builds on the state’s current medical home model and uses accountable care organizations as a foundation, describing it “as the best alternative.”
“This is not just an opportunity to put lipstick on a pig,” he said. “This is a whole cloth change in the delivery of care.” He emphasized that physician leadership is a key feature of the proposal, and that primary care as well as specialties are all “out on the tightrope together.”
Speaking on behalf of Coastal Carolina, an accountable care organization in New Bern, Stephen Nuckolls, Coastal Carolina’s CEO, and Kenneth Wilkins, MD, its Medical Director, described their experience implementing an ACO model in North Carolina.
“No other Medical Society in the country has done as much as NCMS to help,” Nuckolls said. Dr. Wilkins conceded that the start-up and culture change has been difficult, but that “the first win is for our patients – they have better access [to care] and we’re keeping them out of the hospital.”
Lobbyist for the North Carolina Obstetrical and Gynecological Society, Jessica Middlebrooks spoke about the proposed legislation that would allow certified nurse midwives (CNM) to practice without physician supervision, as is now required. Several physicians in the audience clarified that doctors and CNMs currently enjoy good collaborative relationships, but that physicians need to continue to lead the team to ensure patient safety.
Amy Whited, NCMS Director of Public Policy, noted the NC Coalition to Protect Patients as a great source of information on various scope of practice issues being considered by the legislature. View the Coalition’s website here.
North Carolina Dermatology Association lobbyist Rob Lamme updated everyone on the status of HB18 – the Ban the Tan bill, which seeks to prohibit use of tanning beds to anyone under 18. Learn more about this issue at preventskincancernc.org.
The final topic of the meeting was on certificate of need. Physicians representing specialties of urology, orthopaedics, anesthesiology and eye surgeons presented their case for changing the law as it currently stands to allow more ambulatory surgery centers to perform procedures outside of hospital facilities that are often more expensive. John Bode, lobbyist for the radiologists, argued that the CON requirements should remain as is, citing problems with self-referral to physician owned surgery centers and that any changes to the law would come at a bad time for physicians who are already dealing with massive change in the health care system.
Grace Terrell, MD, CEO of Cornerstone HealthCare, the state’s largest accountable care organization based in High Point, suggested that ACOs may offer a solution to the divisive debate over CON. With a full-fledged ACO, all doctors and the hospital “takes total ownership for cost and quality of care,” she said.
Watch the NCMS website in the weeks ahead for video of summit highlights and on-going updates on legislative issues.