HOUSE BILL 1857--ANY WILLING PROVIDERS OF HEALTHCARE (Rep. Schaaf)

• Prohibits health insurers, the Missouri Medicaid Program, and the federal Medicare Program from discriminating against any provider located within the geographic coverage area of a health benefit plan who is willing to meet the terms and conditions for participation in the plan.

Current Status: In Rules Committee pending debate on the House Perfection Calendar.
 

HOUSE BILL 1880--HEALTH INSURANCE CONTRACTS (Rep. Schaaf)

Prohibits any agreement between a health insurance carrier and a licensed health care provider from containing a provision which:

• Prohibits a provider from contracting with another carrier to accept a lower reimbursement than the payment specified in the agreement;
• Requires the provider to accept a lesser reimbursement from the carrier if the provider agrees with another carrier to accept the lower reimbursement for services;
• Terminates or renegotiates the agreement if the provider agrees to accept a lower payment from a different carrier for services; or
• Requires the provider to disclose his or her contracted reimbursement rates with all contracted providers.

A violation of any of these provisions will make an agreement void and unenforceable.

Current Status: Heard in the House Committee on Healthcare Transformation on 2/20.
 

REIMBURSEMENT INCREASE FOR MEDICAID PHYSICIANS

The Governor's proposed budget includes a 10% increase in reimbursements for physicians who treat lower-income Missourians. Currently, physicians' rates are 55 percent of rates for the federal Medicare program for senior citizens and disabled. 

The proposed increase would raise MO HealthNet reimbursement rates to a minimum of 65 percent of the Medicare rates and would cost nearly $53 million.

MSOA Position: MSOA has consistently requested a moratorium on Missouri-based "pay-for-performance" until Medicaid reimbursement rates are at least 100% of Medicare or private insurance. MO HealthNet legislation calls for reimbursements rates to be brought up to 100 percent of Medicare rates in five years.

Current Status: Pending in the House Budget Committee and Senate Appropriations Committee.

PAC Contributors Board (PDF, 140K)

Missouri State Orthopaedic Association Issues of Interest (Word, 300K)

Missouri State Orthopaedic Association Position Paper: Pay for Performance Issues (Word, 32K)

May 3, 2007

National Orthopaedic Leadership Conference

On May 3, 2007, members of the Missouri State Orthopaedic Association lobbied their federal elected officials in Washington, D.C. as part of the AAOS' National Orthopaedic Leadership Conference (NOLC). MSOA members met with U.S. Sen. Kit Bond, U.S. Sen. Claire McCaskill, and U.S. Reps. Kenny Hulshof, Ike Skelton, and Russ Carnahan. The MSOA delegation also met with the healthcare staff of rep. Roy Blunt. Missouri lobbied on issues pertaining to pay-for-performance, physician reimbursement formula, orthopaedic trauma from Iraq and the importance of well-trained surgeons.

Representing MSOA at the NOLC were Dr. Dirk Alander, BOC member; Dr. Jonathon Grantham, BOC member, Dr. Matt Dobbs, MSOA member, Dr. Sonny Bal, MSOA member and MSOA staff Mary Phillips and Brian Treece.

April 4, 2007

Missouri Orthopaedic Lobby Day
Jefferson City

Leaders of MSOA came to the State Capitol in Jefferson City to lobby on behalf of issues important to Missouri orthopaedic surgeons. MSOA met with key members of the House and Senate to discuss pay-for-performance, Medicaid reform, scope of practice issues, and radiology concerns. Sen. Chuck Graham  presented MSOA with a Senate Resolution recognizing MSOA President Jason Calhoun in honor of the National Bone & Joint Decade. Pictured are: (L-R) Dr. Mike Grillot, Dr. Tom Reinsel, Sen. Chuck Graham, Dr. Jason Calhoun, Dr.Joel Jefffries,  and Dr.Greg Galakatos.

05.15.06

MSOA Representatives at NOLC

Members of the Missouri State Orthopaedic Association lobbied their federal elected officials in Washington, D.C. last week in conjunction with the AAOS' National Orthopaedic Leadership Conference (NOLC). MSOA members met with U.S. Sen. Kit Bond, Majority Whip Roy Blunt, and U.S. Reps. Kenny Hulshof, Ike Skelton, and Lacy Clay. The MSOA delegation also met with the healthcare staff of U.S. Senator Jim Talent. Missouri lobbied on AAOS' national medical liability reform solution and radiology scope-of-practice issues.

Representing MSOA at the NOLC were Dr. Ken Yamaguchi, at-large member of the AAOS Board of Directors; Dr. Steve Morton, president of the Missouri State Orthopaedic Association; Dr. Dirk Alander, BOC member; Dr. Jonathon Grantham, BOC member and MSOA staff Mary Phillips and Brian Treece.

Pictured l. to r.--Dr. Ryan Nunley, Mary Phillips, Dr. Ken Yamaguchi, Sen. Kit Bond, Dr. Dirk Alander, Dr. Steve Morton, Dr. Jon Grantham, and Brian Treece.

04.18.06

Insurance Reform Legislation Still Progressing

The Missouri House has given first-round approval to House Bill 1837, sponsored by Rep. Brian Yates. The bill requires all medical liability insurers and self-insured entities to report detailed financial and claims and rate-making data to the Department of Insurance, requires Missouri medical liability rates to be based on Missouri loss-experience instead of the carrier's experience in other states, gives the Department of Insurance authority to reject rates that are excessive or inadequate, and requires insurers to give advanced notice to physicians before cancelling a policy.

The bill will now move to the Senate. Similar legislation has already passed the Senate and is awaiting a hearing in the House.

04.18.06

MSOA Opposes Blue Cross Blue Shield of Kansas City Imaging Privileging Program

Last month, Blue Cross Blue Shield of Kansas City (BCBSKC) announced new privileging guidelines for all providers that offer CT, MR, PET or plain film services. Beginning November 1, 2006, providers must employ a certified technologist (ARRT or other state recognized certification or licensure) on-site taking all films or must arrange for a BCBS-credentialed radiologist to over-read all films, at provider expense, within 5 business days from the date of service. And, BCBS providers would be required to offer all four modalities. In addition, all providers will have to complete the privileging program before the practice will be permitted to continue providing imaging services to BCBS PPO or HMO members.

BCBSKC has retained National Imaging Associates to manage the privileging program. According to NIA's website, NIA believes there is an "Imaging Problem" and that "about one third of advanced imaging tests are either inappropriate or do not contribute to the physician's diagnosis or ultimate health outcomes."

MSOA responded to BCBS with a detailed analysis (PDF, 264K) of the privileging plan along with a request to meet with BCBS. Within weeks, BCBS announced: "Given the feedback recieved from practioner groups... BCBS is re-evaluating certain privileging criteria and modifications to the current guidelines" including:

• Reducing the minimum modality requirement in a practioner officer from 3 imaging modalities to 2 modalities. Originally, BCBSKC would have required four modalities (CT, MR, PET and plain film).
• Offices with only a plain film modality will not be subject to the minimum modality requirement.
• In addition, the plain film technologist certification requirement will continue to be evaluated using "responses recieved on privileging applications to make the final determination."

MSOA had requested a carve-out for orthopaedic physician offices. BCBSKC "will not take action on any...imaging carve-outs until individual results are shared with each practioner's office."

MSOA will continue to keep you updated on our progress.

The Missouri Senate had a special guest in January. Newt Gingrich, former Speaker of the U.S. House, encouraged Missouri senators to overhaul the state's health system by taking a long-term approach that focuses on healthy habits and preventative care instead of crisis treatment. Gingrich was invited to speak from the Senate dais - an unusual move - by Senate President Pro Tem Michael Gibbons, R-Kirkwood.

The leader of the Republican takeover of the House in 1994, Gingrich spoke in his role as founder of the Center for Health Transformation, which advocates more individual responsibility, technology and the availability of health-care coverage to all. Republican legislators and Gov. Matt Blunt are exploring a similar revamping for Missouri's Medicaid program for the poor and the state's health-care system in general.

Gingrich encouraged lawmakers to consider a new model of health care that gives patients greater power to choose their own care, focuses on preventing health problems and managing chronic diseases, and reduces the use of paper in favor of electronic records. Doing so should save lives, improve the quality of life for others and ultimately cost less money, he said.

As an example of the need for a health-care system focused on improving individuals' health habits, Gingrich pointed to a "cultural epidemic" of childhood obesity, which can lead to early onset of diabetes and a lifetime of expensive treatments. "This is an epidemic caused by just two things: eating too much of the wrong food and not exercising," he said. AAOS promotes increased exercise and activity as part of several public awareness campaigns.

Gingrich also suggested lawmakers analyze the costs and benefits of health-care expenditures on a five- to 10-year budget cycle. Annual budgeting tends to lead to decisions that cost less in the short term but more in the long run, he said.

"The current model is stunningly stupid," Gingrich said, comparing it to a stage coach operator who saves money by not feeding the horses. "Every year we do what's technically smart for one year but is stupid in the long run."

Legislative Update

Legislation affecting the Missouri State Orthopaedic Association as of February 8, 2006 (Word, 96K)

The Missouri General Assembly reconvened September 6 for the first day of the 2005 special session. The special session, called by Governor Matt Blunt, could last until September 16, and will deal with abortion legislation, as well as minor technical fixes to several bills that passed during the 2005 regular session. The House will convene in technical session through Monday, September 12, 2005, with full sessions beginning on Tuesday, September 13. The full sessions will run concurrently with the annual veto session which begins on Wednesday, September 14.

Gov. Blunt is asking state lawmakers to approve pro-life legislation, to address conflicting language in four recently enacted alcohol-related laws including one with a section dealing with prescription drugs at schools, to correct drafting errors in the new workers' compensation law, to remove provisions prohibiting the posting of personal information of elected officials on the Internet by state and local government offices, and to consider a concurrent resolution in opposing the U.S. Army Corps of Engineers' spring rise plan of the Missouri River.

The special session will be held concurrently with the constitutionally mandated veto session scheduled for Sept. 14 and allots time needed for the issues to move through the legislative process. Blunt vetoed two bills that would have restricted the public's access to information on lobbyists and used his line-item veto authority to balance the state's $19.2 billion budget.

The Missouri General Assembly will reconvene on January 4, 2006 for the regular legislation session.

Medical Liability Reform on the front burner of issues facing Missouri General Assembly

Meaningful reform of Missouri's medical liability system remains a high priority for MSOA and the Missouri General Assembly. Legislation will soon be introduced to lower caps on non-economic damages. Missouri's current "limit" on non-economic damages has increased every year since 1985, and as of Feb. 1, 2004 the cap was $565,000. Moreover, a 2002 court decision allows plaintiffs to seek multiple caps from the same defendant.

Missouri's new Governor Matt Blunt, along with leaders of the Missouri House and Senate, have publicly pledged their support for medical liability reform. "I have never equivocated on this subject," said Blunt. "I promise that responsible tort reform, primarily focused on protecting health care workers, will be one of the first efforts of my administration."

Hospitals launch grassroots appeal on Limited Service Providers

The Missouri Hospital Association (MHA) has launched a communications campaign including direct mail, paid phone calls, and a website to promote new restrictions on free-standing health care facilities. MHA wants so-called "limited service providers" to have a state license if more than half of the facility's revenue or services are derived from surgical procedures, childbirths, diagnostic imaging, cardiac catheterization, lithotripsy, Gamma knife, radiation therapy, or endoscopy. Every licensed facility would be required to maintain an agreement with at least one nearby hospital to handle emergency care.

The license would require an annual inspection by the state, and detailed reporting including patient abstract data, annual financial statements, and charges for certain procedures and diagnoses. The proposed bill also requires the Board of Healing Arts to promulgate quality assurance "guidelines and standards" for all office-based surgery. Free-standing facilities would also be taxed if the total of the facility's Medicare, Medicaid, and uninsured patient revenue is less than 30% of its total patient revenue.

Medical imaging licensure bill introduced

Legislation has been introduced in the Missouri House of Representatives to require licensure and inspection of medical imaging and radiation therapy services. House Bill 61, sponsored by Rep. Robert Schaaf, MD, requires all persons administering medical imaging and radiation therapy procedures to be licensed. Physicians, dentists, chiropractors, podiatrists, registered nurses, certain qualified persons currently practicing medical imaging and radiation therapy are exempt from licensure. Medical imaging and radiation therapy in medical facilities, dental facilities, educational institutions, or other public or private institutions would be required to be certified.

House Bill 109 allows referral to physician-owned PT services

Physicians who have a financial interest in entities providing physical therapy services would be required to provide a written disclosure of that fact to their patients and inform them that they may obtain a prescription for physical therapy services elsewhere. House Bill 109, sponsored by Rep. Rob Schaaf, lifts Missouri's prohibition of physician-owned PT services if disclosure is made to patients. All disclosures must be signed by the patient and kept as part of their medical record.