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TMA Releases 2015 Legislative Agenda Calling for Payer Accountability, Team-based Health Care Regs

Press release from the Tennessee Medical Association; February 17, 2015:

NASHVILLE – The Tennessee Medical Association, the state’s largest professional group for physicians with more than 8,000 members statewide, has announced its top priorities for the 2015 legislative session ahead of its annual Day on the Hill on March 3.

Atop the list of doctors’ legislative focus is a bill that would reduce health insurance companies’ ability to arbitrarily change reimbursement terms in the middle of a contract. TMA gained traction with its Payer Accountability bill in 2014 and has continued discussions with insurance companies during the past several months to try to reach a compromise. It will be the first law of its kind in the U.S. if TMA is successful this session.

“Our goal with Payer Accountability is the same as it was last year – stability and predictability for medical practices,” said Dr. Ron Kirkland, a Jackson physician and Chairman of TMA’s Legislative Committee. “In no other industry are contracts so lopsided toward one party to essentially allow them to change payment at any time, for any reason. We want to level the playing field, especially for smaller physician groups and solo practitioners, and prohibit insurance companies from using their typical ‘take it or leave it’ approach. It’s a pretty straightforward business issue.”

The TMA will also introduce the Tennessee Healthcare Improvement Act of 2015, which is designed to support the state’s vision for a more efficient and effective team-based healthcare delivery model. TMA is advocating for a physician-led, coordinated care approach that leads to high-quality patient outcomes at the lowest possible cost.

Other notable items on TMA’s legislative agenda:

  • TennCare Payment Reform – TMA has been actively engaged in TennCare payment reform since the state received its first grant in 2013 for the Tennessee Healthcare Innovation Initiative. TMA physicians and staff continue to work with the Haslam Administration and TennCare Bureau to advocate for fundamental improvements to the program implementation, specifically around episodes of care reporting, to help make the initiative successful.
  • Addiction Treatment Act of 2015 – For a number of years the legislature has tried to address Tennessee’s prescription drug abuse epidemic by placing regulations on those writing the prescriptions, without properly addressing issues related to appropriate medical intervention. TMA’s bill seeks to remove barriers to identifying those who need treatment and ensure that they have access to available treatment options.
  • Improving access to quality, affordable healthcare – TMA supported Governor Haslam’s Insure Tennessee plan and will continue to serve as a resource for legislators as the debate continues around how to best provide insurance coverage for the state’s working poor.
  • Telemedicine – A coalition of several interested parties, including the TMA, will continue to advocate for improved access to telemedicine services for Tennessee patients by filing a bill addressing telemedicine. The most recent iteration of draft rules from the Board of Medical Examiners significantly reflects TMA’s advocacy efforts during the past year.
  • Biosimilars – TMA is working with the pharmaceutical industry to make sure physicians’ concerns are addressed in a bill allowing for the substitution of biosimilar medications. TMA supports the allowance of biosimilars for drugs the FDA has deemed interchangeable, as long as there is communication back to the physician when a change is made.

These and other issues will be part of discussions between physicians and lawmakers during TMA’s annual Day on the Hill on Tuesday, March 3.

“It is important for legislators who make important decisions that affect healthcare in this state to hear directly from physicians. Our lawmakers need to know how their votes impact patient care, and no one is more qualified to educate them on the issues than the men and women who take care of patients every day. We hope to have a lot of white coats on Capitol Hill on March 3,” said Dr. Kirkland.

Physicians interested in participating in Day on the Hill can sign up online at tnmed.org/dayonthehill.

Visit tnmed.org for more information about TMA’s legislative advocacy.

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Featured

Improper Release of Health Info Highlighted in Federal Report

The private health information of more than 13,000 Tennessee Medicare recipients was released to the public by a state contractor — the most wide-ranging breach nationally uncovered by federal investigators.

A just-released report, from the Department of Health and Human Services Office of the Inspector General, found 14 breaches of protected health information between 2009 and 2011 by the federal agency that administers Medicare and Medicaid. The largest breach of records took place in Tennessee.

Those are exactly the kind of records that, if in the wrong hands, can lead to medical identity theft, a scam that hurts both those on Medicare and the taxpayer. Scams run the gamut from the simple, when thieves use someone’s medical information to get prescription drugs, to the complex, when sham doctors’ offices use the information to bill the government for quick cash.

“The information obtained can be used to file false claims under Medicare or TennCare,” Yarnell Beatty, the Tennessee Medical Association’s director of legal and government affairs told TNReport. TennCare is the state’s version of Medicaid, the healthcare program for the poor. “Even one breach is cause for concern.”

The report stated that medical identity theft “can lead to erroneous entries in beneficiaries’ medical histories and even to the wrong medical treatment” and “may also lead to significant financial losses for the Medicare Trust Funds and taxpayers.”

Beatty also noted that given the millions — and perhaps billions — of Medicare transactions each year, some breaches are to be expected.

If the breaches are a concern, so was how federal officials’ reacted in wake of those breaches, according to the report. Medicare recipients at risk of having their medical information stolen were notified, but it appears those notifications left much to be desired.

From the report:

The notifications for these breaches often were missing required information. Notably, the notification letters for six of the breaches did not explain how the contractors were investigating the breach, mitigating losses, or protecting against further breaches. … Moreover, notification letters for half the breaches, including the largest breach [in Tennessee], were missing either the date the breach occurred or the date it was discovered.

Many times, the information inadvertently released included beneficiaries’ names, Medicare identification numbers, dates of birth, diagnoses and services received.

The Tennessee breach affected 13,412 beneficiaries. A printing error by a Medicare contractor caused the notices to be sent to incorrect addresses, according to the report.

Most of the breaches, including the one in Tennessee, were accidental, according to the report, but one of the 14 breaches was found to be criminal in nature.

“You can’t totally eliminate human error, although you strive to,” Angie Madden, the director of eHealth Service at the Tennessee Medical Association, said.

But Madden pointed out a silver lining. She said that the Centers for Medicare & Medicaid Services — the federal agency that oversees both those entities and was the subject of the report — “have done a fairly good job of education the public and beneficiaries” when it comes to fraud.

Click here to find out more about Medicare fraud.

Editor’s Note: This story was updated on Oct. 25 to make clear that the printing error leading to the data breach was made by a Medicare contractor.

Trent Seibert can be reached at Trent@TNReport.com or on Twitter at @trentseibert.

Categories
Featured Health Care News

Lawmakers Refereeing ‘Turf Battle’ Over Pain-Management Care

The question of who exactly should be legally authorized to shoot powerful medications into easily injured areas of the body, like a patient’s spine, dominated talk on Capitol Hill Thursday.

Lawmakers heard testimony from the medical community about rules governing the tricky job of pain management.

Members of a House Health and Human Resources subcommittee are studying the implications of HB1896, a bill that limits when nurse practitioners and other caregivers with advanced training can administer “interventional” pain medications, which are injected within a half-inch of the spinal cord.

Under the proposal, which won committee approval in the Senate but stalled in the House, these nurses would only be able to perform the procedures under the supervision of specialists.

Lawmakers walked away from their four-hour discussion generally in agreement to add government mandates for better training of nurse practitioners, assistants and physicians alike as they try to defuse a war among the competing health care occupations.

“Sometimes though, these are turf battles, and money’s involved. And it’s whether which side is going to end up with the most procedures to make the most money,” said Rep. Mike Turner, the House Democratic Caucus chairman and a member of the panel examining who can perform the pain-management procedures.

“We have to determine which is which, whether this is the best medical procedure or we’re just settling a dispute between two or three occupations,” Turner said. The debate among the medical professionals is “pretty volatile,” he added, with physicians on one side and the nurse practitioners and physician assistants on the other.

“We do not believe that a few weeks of training can possibly equate a three-year residence and a year of fellowship in training,” said Dr. Joe Browder, speaking for the Tennessee Medical Association. The TMA argues that the procedure should be done by doctors, not nurses or assistants.

Opponents of HB1896, including state associations of physician assistants and nurse anesthetists, argue that restricting non-physicians from performing the procedures is anti-competitive and unnecessary. Opponents believe such a move would reduce options for patients at a time when more people will begin seeking health care as Baby Boomers age and the Patient Protection and Affordable Care Act is scheduled to start taking effect.

“This bill is a solution to a problem that doesn’t exist,” said Sharon Adkins, executive director of the Tennessee Nurses Association. “Our focus needs to be on access to the provision of quality patient care, not the pocketbook of the provider.”

The nursing industry is no stranger to debates on Capitol Hill. Last year it went to blows with the Legislature after the state Nursing Board refused to implement new laws regarding lower-level nurses issuing medications in the way the General Assembly intended.

Rep. Matthew Hill, who chaired the subcommittee meeting, called Thursday’s discussions a “starting point.” The Jonesborough Republican said he expects to amend the original bill with an eye toward requiring more extensive training for anyone performing the procedures while hoping the two sides will seek to meet each other halfway.