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 December 2007
Note: Questions relating to state legislative activity or any of the items noted in ACS Cross Country may be directed to Mindy Baker, State Affairs Associate, at mbaker@facs.org. State Legislation 2007
Included in the November issue of the Bulletin of the American College of Surgeons is the 2007 State Legislative Wrap-up. To read it online, visit: http://www.facs.org/fellows_info/bulletin/2007/baker1107.pdf AMA House of Delegates Adopts Health Policy
A number of issues came to the fore during the November 2007 meeting. One dealt with improving abdominal aortic aneurysm screening, and called on Congress to extend a one-time screening to all Medicare beneficiaries between the ages of 65 to 75. The HOD adopted this policy, as well as others focused in improving reimbursement for physicians, encouraging child restraint use on school buses, and supporting efforts to extend the State Children’s Health Insurance Program (SCHIP). In addition, the Surgical Caucus, which is composed of all surgeons participating in the HOD, sponsored an education session dealing with The Joint Commission – Making Sense of the TJC. For further information on the AMA HOD and surgical involvement in this meeting, contact jsutton@facs.org.
Public Hearing Emphasizes Support for General Surgery in GeorgiaThe Georgia Board of Community Health sponsored a public hearing on November 28 to receive oral and written testimony on a series of proposed amendments to various aspects of the state’s Certificate of Need (CON) program. Of particular interest was an amendment that would recognize general surgery as a single specialty for purposes of the single specialty exemption from the CON program for ambulatory surgery centers. Currently, other surgical specialties such as orthopedic and plastic surgery can request the exemption, but general surgery is defined as a multispecialty, which prevents general surgeons from applying for it. Testimony during the hearing was impassioned and overwhelmingly in favor of recognizing general surgery as a single specialty. Over 25 general surgeons, other surgical specialists, patients, and representatives of Georgia medical organizations and the American College of Surgeons made the trek to Atlanta and filled the room to lend their support for general surgery. In addition, more than 150 Georgia Fellows sent letters to the board in support of general surgery through the Surgery State Legislative Action Center. The very few opponents in the room focused their remarks on legal and constitutional arguments--that is, the board does not have the authority to change the rule because the legislature intended for general surgery to be defined as a multispecialty. The rules, which were unanimously accepted by the board in October of this year, will be considered for a final vote on December 13. Illinois' 2005 Cap on Noneconomic Damages Headed for the State Supreme CourtOn November 13, Cook County Circuit Judge Diane Larsen ruled Illinois’ 2005 cap on noneconomic damages unconstitutional. The 2005 law contained a firm $500,000 cap on noneconomic damages for physicians (and a $1 million cap for hospitals); an "I'm Sorry" provision; expansion of the Good Samaritan law to include retired physicians providing free care and for free care provided in the home; stronger standards for expert witnesses; and improvements to the affidavit of merit. Judge Larsen ruled that the cap on damages was unconstitutional due to the issue of separation of powers—essentially ruling that the legislature had no right to limit the damages awarded by the judicial branch. Because the ruling was that the law was unconstitutional (as opposed to a technical problem with the procedure) the matter will go directly to the Illinois Supreme Court. Judge Larsen’s ruling mirrors a 1997 Illinois Supreme Court decision that overturned the1995 law implementing caps on personal-injury cases. A Look Ahead to 2008
Various issues arise in state legislatures every year that are of interest to surgery. Following are a few highlights of topics on which surgeons can expect to be involved in advocacy initiatives.
Medical Liability Reform In addition to court battles in Illinois, several other states caps on noneconomic damages will be tested in the courts during 2008. Legislative battles over liability reforms are expected in New York and Tennessee. Virigina’s cap on noneconomic damages is set to expire in 2008, and the medical community is expecting an increase. An increase is also expected in New Jersey. Trauma Trauma funding could be greatly influenced by a pending case in Virginia challenging the constitutionality of additional fines and fees on traffic violations. Although the VA law only applies to in-state drivers (unlike most fees) and does NOT pay for trauma care, there may be some impact. States looking to raise any fines or fees during 2008 to pay for trauma care should be aware of this issue. Also, Connecticut and Michigan are revising their Trauma Systems in 2008. The American College of Surgeons continues to support the Uniform Volunteer Emergency Health Care Practitioners Act. This act allows state governments during a declared emergency to give reciprocity to other states’ licensees on emergency services providers so that covered individuals may provide services without meeting the disaster state’s licensing requirements. (NCCUSL) Scope Because the College joined the Scope of Practice Partnership (SOPP) in 2007, it is expected that there will be an increase in the number of Scope bills monitored. This “all for one, one for all” approach makes it contingent on SOPP members to work together on scope of practice issues, and the College looks forward to working with surgical specialty societies and state medical associations to achieve positive state legislative outcomes through a variety of advocacy initiatives. The SOPP is a coalition the AMA formed to assist various physician organizations facing scope of practice “battles.” The SOPP also plans to fund studies to (a) determine whether “allied health professionals” truly fill health care voids in rural and other underserved areas; and (b) examine the education and training of “allied health professionals” with the goal of providing this information as a “point of comparison” to legislators. The SOPP is continuing to publish comprehensive reports on many of the allied health professions. The data series for psychologists has been published, podiatry should be completed soon, and the series for naturopaths should also have been completed by early 2008. In addition, the SOPP has funds available to state coalitions fighting scope battles in their state. North Carolina expects to see the optometrist/ophthalmologist issue heat up in 2008; Virginia expects legislation to be introduced regarding the use of lasers; and Missouri is expecting scope battles regarding both lay midwives and podiatry.
Reminders Now is the time for chapters and others to begin preparing for next year. State Affairs staff can assist with planning a Day at the Capital; address advocacy planning/strategy issues (including development of a Chapter Advocacy and Health Policy Committee); and help develop testimony for presentation at state legislative committee hearings. In addition staff would be delighted to participate as speakers for any chapter event or for other stakeholder groups. Past Issues of ACS Cross Country:
Revised December 10, 2007
by the American College of Surgeons, Chicago, IL 60611-3211 |
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