Notes September 11, 2017 Legislative Update  

Washtenaw County Medical Society (WCMS) – Legislative Update

 Monday, September 11, 2017, 7:30 a.m. – 9:00 a.m.

The WCMS Legislative Committee met at WCMS offices. Attending the meeting were Reps. Donna Lasinski (D-52nd) and Adam Zemke (D-55th) in addition to Colin Ford from MSMS.  Jim Mitchiner, M.D., chaired the meeting.

  1. Maintenance of Care Update
  • Maintenance of certification costly.
  • Doctors within specialty areas find very expensive
  • Propose the organization who administer the tests to provide metrics; does it improve the quality of care if the doctors take the test?
  • Understand the competency measures and how the information and testing is different from the already mandatory 150 hours of continuing education every three years.
  1. Prescription Drug Diversion
  • 13 bills and more in the next few weeks addressing mostly the opioid dispensing
  • Bills 274 and 166 – take a look at closer:   SB274 intent to curtail surplus supply of opioids,  SB166 Mandatory MAPS check for all controlled substances
  1. Auto No-Fault
  • MSMS against - concern patients will not get care needed. Propose amendment, not removal of no-fault insurance. In 6-8 days there will be two new plans presented
  • Take a closer look at how people are being rated, ex: single women and people who drive low miles.
  • Duggan getting around opposition through hospital boards. Eliminate or lessen the catastrophic vs. personal injury.
  1. Female Genital Mutilation Legislation – SB 338
  • Penalty – it is now a felony
  • State penalty and Federal penalty – more likely to be enforced at the local/state levels.
  1. Pending Gun Legislation
  • Removes the need to be trained to use the guns that are concealed
  • Safety and responsibility- Republicans, sheriffs and police officers are against
  1. Healthcare Bill of Rights – essential benefits
  • Single payer Medicare
  • Policy that all primary care visits be $5.
  • Affordable care
  • Representative Lesinski’s office to hold a town hall with Chelsea hospital in 3 weeks…more information to come.

Maintenance of Certification

This is an issue across the country, as physicians raise complaints about hospitals and insurers essentially mandating MOC as a prerequisite to renewing hospital privileges and/or being reimbursed for services. Physicians, particularly those in Internal Medicine, believe that recertification as presently directed by the American Board of Medical Specialties is burdensome, expensive, and unproven as a means of assuring quality of care. They are particularly annoyed that the ABMS advertises MOC to the public as a guarantee of higher quality without evidence to prove it. In Texas, the legislature recently passed, and the governor signed, SB 1148, “Relating to Maintenance of Certification by a Physician or an Applicant for a License to Practice Medicine in This State.”  This Act stipulates that hospitals “may not differentiate between physicians based solely on a physician’s maintenance of certification.” [This controversial issue was discussed in a Viewpoint piece recently published in JAMA, which commented on some of the implications of the Texas law.]

State law in Michigan has never required board certification for licensure and is silent on how insurance companies and health care organizations choose to use MOC in their businesses. No one is arguing that initial specialty board certification is not an important component of assuring quality. The focus is on what role, if any, recertification should play. In addition, not all specialists are complaining. Some specialty boards, recognizing that they have a problem with the way in which recertification is being viewed, have begun to look at ways to make the process more user-friendly and beneficial, rather than burdensome and expensive. Any legislation is unlikely to distinguish among these. A one-size-fits-all solution for either side in this controversy is unlikely.

The bottom line seems to be that monitoring of health care quality should be left to the appropriate medical specialty societies rather than the state legislature, and that both medical licensure and participation on health insurer panels should not be tied to MOC.

Prescription Drug Diversion

Two bills have been introduced in the Senate aimed at reducing the availability of opioid drugs. These are Senate Bills 274 and 166. At least 11 more bills are in the works, all related to opioid dispensing. The intent of SB 274 is to reduce the surplus of unused opioids stored at home (which promotes illicit use and diversion) by placing restrictions on prescribing of all Schedule 2 through 5 drugs, not just opioids. It states, among other things, “the prescriber shall not prescribe the patient more than a 7-day supply of an opioid within a 7-day period.” SB 166 would call for mandatory MAPS inquiry before any opioid could be prescribed. Neither bill offers a good solution to the many problems underlying the “opioid crisis,” and both would create significant obstacles for practicing physicians.

Members of the committee praised the state’s updated MAPS program, which is a significant improvement over the older version, which had become quite antiquated. They also agreed that the legislature should stop trying to practice medicine, as reflected in the provisions in these bills.

Auto No-Fault

This comes up every year. Once again, Detroit Mayor Mike Duggan has targeted this as a way to reduce auto insurance premiums in Detroit, which are beyond the reach of many residents. Mayor Duggan has been lobbying hospital board members in an attempt to bend their minds toward his position on reducing premiums by capping coverage for catastrophic injuries. While it is true that Detroit has a problem with auto insurance rates, No-Fault is not the source of its problem.

As a member of the House Insurance Committee, Rep. Lasinski offered her insight into the issue, with emphasis on abuse by some insurers and some physicians, who seek to capitalize on the open-ended nature of Auto No-Fault insurance benefits. As a member of the Coalition to Protect Auto No-Fault (CPAN), MSMS is opposed to any legislation that would block injured individuals from getting medically necessary care.

Female Genital Mutilation

Rep. Lasinski was instrumental in passing recent legislation that would make female genital mutilation a felony in Michigan, with enhanced enforcement at the state level.

Pending Gun Legislation

Legislation [House Bill 4416] is being considered that would allow a citizen to carry a concealed pistol without a permit, eliminating the requirements for firearms training and for disclosure to police that one is carrying a concealed weapon. Rep. Lasinski reported that responsible gun owners and local gun club leaders she has talked to oppose this bill. Nevertheless, it passed the House by a vote of 59-49.  The only good news is that Senate Majority Leader Arlen Meekhof, who has a concealed carry permit, has been quoted as saying “the time isn’t right” for this legislation.

Healthcare Bill of Rights

Rep. Lasinski said that she and others are considering introducing a Health Care Bill of Rights for the state, which would guarantee the essential benefits that are currently part of the Affordable Care Act.  Another proposal being considered is to impose a small ($5) co-pay for all primary care visits to address the “skin-in-the-game” concern that would purportedly mitigate frivolous office visits without discouraging visits that are medically necessary.

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