Associations, Providers Weigh in with Their Agendas
Of all the healthcare issues on the table at Tennessee's legislative session currently taking place in Nashville, the stunning rise of opioid abuse is dominating the discussion.
The facts, supplied by the Tennessee Department of Health, are hard to ignore: Drug abuse claims at least three lives every day in Tennessee and 1,600 residents died from drug overdoses in 2016, mainly due to opioid abuse. Understandably, lawmakers wasted little time focusing their attention on the crisis as soon as the session opened last month.
Gov. Bill Haslam and Tennessee lawmakers unveiled a $30 million legislative and executive plan. Dubbed "TN Together," the plan, announced during the last days of January, will be funded with federal and state money and consists of three components - prevention, treatment and law enforcement. A large portion of the plan is focused on treatment and recovery programs.
The plan was designed in partnership with the Tennessee General Assembly through its Ad Hoc Opioid Task Force, which was established last year and announced its recommendations in September, based on feedback from state healthcare experts and public officials.
Nita W. Shumaker, MD
According to Nita W. Shumaker, MD, president of the Tennessee Medical Association (TMA), the state's largest professional organization for physicians, it's too soon to tell how the proposed legislation will affect Mid-South physicians, hospitals and patients. She said the organization is reviewing the proposed legislation and will base its position on how the proposed legislation will impact physicians and patients in the state.
"We have made some progress in reducing initial opioid prescriptions but still have a long way to go," Dr. Shumaker said in response to the governor's proposed legislation. "We must continue to promote alternative pain management treatments that do not involve opioids while ensuring that treatments are covered by health insurance. We do need to reduce supply and dosage, particularly for new patients and acute episodes like the hospital ER.
"At the same time, we want to make sure that any law(s) limiting physicians' ability to prescribe have reasonable exceptions to continue giving relief to patients in legitimate need, such as chronic pain, oncology or hospice patients."
Legislation in the proposal, which was recommended by the task force and is of particular interest to Mid-South physicians, pharmacists and hospitals, includes limiting the supply of an initial opioid prescription to five days. According to several Mid-South medical professionals, many hospitals in the area follow this practice currently.
Carla Kirkland, NFP
Carla Kirkland, NFP, president of District One of the Tennessee Nurses Association, which includes Shelby and Fayette counties, said, "Many emergency rooms in the Mid-South are doing this already. Some ERs limit prescribing opioid medications to three days or less for patients with acute issues. Hospitals are taking the initiative already."
Keith Norman, vice president of government affairs for Baptist Memorial Health Care, said the goal of many hospitals in the near future will be to become opioid free, except in acute cases when an opioid medication is deemed necessary for the patient.
"This is an important issue which affects everyone in healthcare in Tennessee," Norman said. "You will see hospitals enact 'opioid free' policies and help patients seek alternative pain management."
Additionally, various state healthcare associations, such as the Tennessee Hospital Association (THA), Tennessee Nurses Association (TNA) and the TMA have announced their legislative agendas and plan to tackle a number of healthcare-related legislative issues during the 2017 Tennessee General Assembly.
Some of the key issues are:
Maintenance of Certification
The TMA plans to file legislation for the second year in a row to prohibit hospitals and health insurance companies from requiring maintenance of certification (MOC) for physician credentialing for network participation. Currently, physicians must be board-certified through the American Board of Medical Specialties, the nation's largest physician-led specialty certification organization, to receive privileges to practice at area hospitals.
According to Clint Cummins, executive vice president of The Memphis Medical Society, physicians must spend "thousands of dollars of their own money" to travel to take the exam, creating the additional problem of losing time with patients.
Additionally, the MOC exam covers areas of medicine that do not necessarily pertain to the physicians' current specialties. Cummins compared the MOC exam to an attorney who practices criminal defense law and must take an exam for real estate law.
"It has become cumbersome and expensive to maintain the requirements," said Dave Chaney, vice president for the TMA. "Right now physicians are forced to participate in the certification because hospitals require it for the physician to have privileges. This has become a revenue building operation, and we want physicians to have more options and other measures that aren't generic and have more value to their current specialties."
The THA contests the TMA's legislation because it "restricts or dictates the process hospitals use for granting privileges to physicians."
"We oppose this legislation and think the decision should be made by the local governing board of hospitals and not be placed in the legislative arena," said Tish Towns, chief administrative officer for Regional One Health.
Cummins said there isn't another board-certification option for physicians currently, and he hopes that physicians, hospitals and insurance companies can agree on a solution.
Balance billing, also known as extra billing, is the practice of a healthcare provider billing a patient for the difference between what the patient's health insurance chooses to reimburse and what the provider chooses to charge. Balance billing occurs when an out-of-network provider bills a patient separately, even when a patient receives treatment at an in-network hospital. Rarely is the patient told that the provider is out-of-network and he or she receives a "surprise bill" from a provider that contracts with the hospital.
Farm Bureau Insurance of Tennessee has filed proposed legislation that would mandate that the hospitals or physician notify the patient ahead of a scheduled procedure that a provider is out-of-network or accept the in-network negotiated rate.
The TMA wants a proposal that doesn't place the responsibility on the provider, who may not have immediate access to the patient's insurance information. The TMA opposes the legislation, which the organization sees as giving insurance companies more leverage to force providers to accept unfair contractual terms.
Extension of HSDA
The Health Services and Development Agency (HSDA), which oversees Tennessee's certificate of need (CON) program, is set to expire at the end of the fiscal year. The THA wants a three-year extension of the agency and hopes to preserve the CON program for the state.
According to the HSDA, a certificate of need is granted when a project will be deemed necessary to provide healthcare, will be profitable, will provide healthcare that meets appropriate quality standards, and will contribute to the orderly development of adequate and effective healthcare facilities in an under-served area.
Baptist's Keith Norman said he would like to see clarification from the agency on the definition of a free-standing emergency department.
"We have been denied twice by the state for free-standing emergency departments in East Memphis and Arlington," he said. "We feel there is a need in these locations, and we don't feel there is enough clarity on the definition now. These are not hospitals, but eight to 10 emergency room centers which can treat up to level two trauma."
School Nurse Requirements
The TNA has proposed legislation for a minimum mandatory school-nurse-to-student ratio of one nurse to 750 students in all public schools in the state. Currently, according to the TNA, there is one school nurse for every 3,000 students.
"The Centers for Disease Control recommends a nurse-to-student ratio of one to 750," the TNA's Carla Kirkland said. "Tennessee doesn't meet the standards of the CDC, and we want this to change."
Legislation has been filed to prohibit minors under the age of 18 in the state from using indoor tanning facilities. The bill has received much support from the medical industry, including the TNA, THA, TMA, The Tennessee Dermatology Society and Le Bonheur Children's Hospital.
"This bill has a lot of support from various associations in the industry and state hospitals," the Medical Society's Clint Cummins said. "If passed, Tennessee will join 20 other states banning minors under 18 from indoor tanning."
There are other issues the healthcare industry hopes the General Assembly will address.
Norman said it is unclear how many issues the General Assembly will tackle.
"This is an election year, so we don't know how many bills will come to a vote," he said. "I suspect this session will be short."