We tend to be fairly subdued at the MSA, but this time we will make an exception. We had an incredible legislative session this year aided by some excellent strategic lobbying, hard work by our Anesthesiologist member experts who advocated and testified in Annapolis, as well as help from Congressman Andy Harris, MD. Now our physician colleagues are coming to us for leadership to help create a new bill to expand collaboration and avoid destructive self-referral/company model arrangements!But we are not done….we still need your time, interest and involvement!!! Read below to find out more about the session and why we need you.
Attend our annual meeting in Washington, DC May 14-15, 2016 (1st Annual Mid Atlantic Societies of Anesthesiologists (MASA) Conference ). This will be a critical time to learn about health reform and what we have been doing in Maryland to negotiate and preserve quality and reimbursements.
We need to hear what is going on in your practices. What is happening with your volume, reimbursements, and collections? Let’s discuss together and learn from your colleagues what works and doesn”t. If your hospital asks you to bundle your service, what will you do? If a surgery center asks you to lease the preop area at an exorbitant rate, will you do it? Where did that come from? (Hint- it’s from a practice by a national group as well as others who are being sued by the Florida Society of Anesthesia).
Anyway, here is what we worked on this session and information about what is coming next year! Stay tuned and get active…..
The MSA is actively involved at the highest levels as the federal and state governments implement laws and regulations changing the health care delivery landscape. This year, more than ever, we relied on the concrete advice and strategic actions of our lobbying team to successfully surmount the challenges of this Session.
First, broad changes in law were proposed to allow for new levels of value based care at the expense of the valuable protections of Maryland’s self-referral law which could have expanded company model type practices. Second, Maryland’s nurse anesthetists launched an effort to redefine and essentially eliminate their required collaboration with physicians and undo the anesthesia care team model.
We moved quickly to take action. A thorough and targeted outreach effort was conducted by MSA members from across the state. Members spoke openly and honestly with key legislators about the concerns inherent in a move to nurse anesthesia independent practice and abandonment of the ACT model; as well as the types of deceptive business arrangements that could become valid under a weakened self-referral law.
MSA has reason to be proud of what was accomplished this year. We’ve also started looking at State and Federal Data to evaluate volume trends and readmission patterns to better help practices like yours prove the value of good anesthesia care. We began a program to educate referring primary care physicians about sleep apnea for earlier intervention. More remains to be done. We need your help to continue this great work!
Thank you in advance for your continued time, attention and involvement in the MSA.
Preservation of Maryland’s Self-Referral Law:
Senate Bill 886 (Sen. Middleton) / House Bill 1272 (Del. Pendergrass) “Health – Collaborations to Promote Provider Alignment”
STATUS: Bills were withdrawn
MSA POSITION: OPPOSE UNLESS AMENDED
The transition from the fee for service model to a risk-sharing, outcome based, outcome-oriented model of care is underway. MSA agrees with the principles of value based care, physician cooperation, and improvements to care outcomes.
Our team worked throughout the legislative session to guard against any problematic changes to the self-referral law.
We had serious concerns about the financial incentives created by SB886/HB1272. We were opposed to the bills unless they were amended to protect against the company model and against compensation arrangements that resulted in financial incentives that unnecessarily increased utilization of professional services for profit.
MSA proposed amendments providing that any changes to the self-referral law must include oversight and review of new delivery models to ensure transparency and appropriate utilization. This primary concern was shared by the Maryland Attorney General’s Consumer Affairs Division. They were waving red flags about the potential for misaligned incentives promoting profit driven utilization; and insisting on amendments to protect patients in these models.
MSA raised these concerns with the Maryland Insurance Administration. They quickly got into the action when it became evident that the potential risk bearing nature of these entities violated existing law and encroached on the MIA’s authority in this space. Health insurers raised similar questions and concerns directed to the lack of detail and structure of these models.
In the end key members of the House Health and Government Operations Committee supportive of our concerns intervened and opted not to move forward on the bills this session. It was clearly stated by them to the many stakeholders the need to continue discussions to try and find a path forward.
CRNA Independence and the Anesthesia Care Team:
Senate Bill 30 (Sen. Conway) “Maryland Anesthesiologists Assistants Act”
MSA POSITION: SUPPORT
Simultaneous to our defense of self-referral MSA battled on two fronts: maintaining the scope of practice for nurse anesthetists and reinforcing the anesthesia care team through the licensure of AAs. The Maryland State Board of Nursing proposed regulations in the fall of 2015 that would redefine collaboration and remove the supervision requirement for nurse anesthetists. MSA legal counsel articulated a strong and persuasive argument against the proposed regulations. The MSA successfully enlisted support of the legal counsel for the State Board of Physicians and the State Medical Society in opposing the regulations. Our team worked with key leaders on the General Assembly’s committee of jurisdiction for state regulations, the Joint Committee on Administrative, Executive, and Legislative Review (AELR). The regulations were held for a period of time. The regulations remain under review.
The proposed regulations would essentially dismantle the current anesthesia care team model in Maryland. Legislation was brought forward to allow for Anesthesia Assistant (AA) licensure in Maryland. The inclusion of AAs into the anesthesia provider landscape would allow those groups who practice with the care team model to continue in that manner.
Senate Bill 30 had a great hearing a number of MSA members spoke to the benefits of AAs in strengthening and preserving the care team model. There was strong support in the Senate committee and the Chair felt it was a good start for any efforts in the future on the bill.
Other Major Legislative Issues
Payment & Network Adequacy
Senate Bill 335 (Sen. Kelley) / House Bill 1505 (Del. Hayes) “Health Insurance – Assignment of Benefits and Reimbursement of Nonpreferred Providers – Modifications”
Status: SB 335 was heard by the Finance Committee on February 10. HB 1505 was been referred to the House Rules Committee.
MSA POSITION: OPPOSED
Given the implications of this bill for physicians and consumers of health care, we have actively engaged to defeat the legislation. The bill as introduced would have established a strict balance billing prohibition in the PPO market that currently doesn’t exist. This bill would have undone the compromise achieved with the passage of the Assignment of Benefits law in 2010. We met with the Sponsor of the bill, joined by MedChi and the MHA, to illustrate the negative consequences the bill would have on fair payment. We were successful in stopping this bill from moving forward.
Specifically, this bill would expand provisions of law regarding assignment of benefits (AOB) and reimbursement of non-preferred providers, including consumer protections against balance billing, to apply to all non-preferred on-call and hospital-based “health care practitioners” rather than only to physicians. The bill removes the requirement that on-call and hospital-based providers obtain an AOB and notify the insurer that they have obtained and accepted the AOB in order for balance billing provisions to apply. A non-preferred provider seeking an AOB must provide specified information to the insured, except in emergency circumstances, at least 24 hours prior to performing a health care service. A heath care practitioner who fails to comply with this requirement is prohibited from billing the insured more than the allowed amount for the covered health care service.
House Bill 800 (Del. Hammen) “Health Insurance – Payments to Non-contracting Specialists and Non contracting Non physician Specialists”Status:
The bill was withdrawn
MSA POSITION: SUPPORT W/ AMENDMENT
We brought the historical background and essential arguments to the discussion with regard to pegging any commercial reimbursement solely to Medicare as a benchmark for reimbursement.
This departmental bill would have required a carrier to pay a specified rate for covered services provided to a member by a non-contracting specialist or non physician specialist because a network provider is not available. An insurer, nonprofit health service plan, or dental plan organization must pay at least 140% of the Medicare rate for the same covered service provided by a similarly licensed provider in the same geographic area. A health maintenance organization (HMO) must pay the greater of this amount or the amount specified for non-contracting providers under current law.
Senate Bill 929 (Sen. Klausmeier) / House Bill 1318 (Del. Kelly) “Health Benefit Plans – Network Access Standards and Provider Network Directories”
Status: Both SB 929 and HB 1318 passed and await the Governor’s signature
MSA POSITION: SUPPORT
This bill will establish uniform standards for all commercial carriers in Maryland, which does not currently exist. We actively sought support from legislators and successfully worked against provisions that would have financially penalized providers who did not update their provider directory information in a timely manner. With our involvement regulations will be developed over the summer to establish the actual standards.
The bill has been amended from its original form. However the goals remain the same. Specifically, this bill requires the Insurance Commissioner, by December 31, 2017, to adopt regulations to establish specified quantitative and, if appropriate, non-quantitative criteria to evaluate the network sufficiency of health benefit plans. By July 1, 2018, and annually thereafter, an insurer, nonprofit health service plan, or health maintenance organization (collectively known as carriers) that uses a provider panel for a health benefit plan must file a specified network access plan with the Commissioner for review and approval. A carrier must also develop and make available to enrollees and prospective enrollees an accurate provider network directory for each health benefit plan.