WACEP President’s Message, Feb 2020
Ryan Thompson, MD, FACEP
Multiple WACEP members represented our specialty at this year’s Doctor Day, meeting with their legislators to discuss issues relevant to the house of medicine. We were also able to collaborate with physicians of all stripes from around the state. It’s such a pleasure to meet with other docs and discover that we are facing many of the same issues across the full spectrum of medicine and come together to advocate for the health of our state. This year, over 315 Wisconsin physicians met with their local legislators, covering 31 of 50 State Senators, and 57 out of 99 Assembly members.
One of the most popular breakout sessions at Doctor Day was a legislative update, and one of the most-talked-about topics was the CARES act. For those who are not aware, the CARES act was put forth by the Wisconsin Academy of Physician Assistants (WAPA) with the goal to improve parity with nurse practitioners in the state, who currently enjoy significantly more autonomy than PAs. The Wisconsin Hospital Association strongly supports the bill, as it makes it easier for hospitals to employee PAs. The bill removes the currently mandated ratios of physicians to PAs, changes the PA-physician relationship to one of “collaboration” rather than “supervision”, and allows PAs to work remotely from their collaborating physician. At the time of Doctor Day, several provisions in the bill were causing concern amongst physicians, including a titling change which would allow PAs to call themselves “Associate Physicians”, and the creation of an independent PA licensing board separate from the medical licensing board (NPs are licensed through the Nursing Board). Also controversial was the language surrounding the collaboration agreement between a PA and a physician.
The Wisconsin Medical Society (WMS) has been negotiating with WAPA and the bill sponsors to alter some of the more problematic portions of the bill. An updated version of the bill stripped out the title changes, and supports the creation of an associate PA board, underneath the state Medical Board – similar to how Podiatry currently has an associate board in the state. The associate board would not be permitted to expand the scope of practice of PAs without the approval of the Medical Board. The language around the collaboration agreement also was changed to ensure that a physician can provide collaborative care for a patient cared for by a PA within a medically reasonable amount of time. With these changes in place, WMS supported the bill, and it quickly passed both the Assembly and Senate, and awaits signature by Governor Evers.
In other legislative news, the US House of Representatives seems highly motivated to pass an Out-of-Network Bill this year. For some background, if this legislation ends up being unfavorable for EM physicians, it could cause the biggest disruption in Emergency Medicine since EMTALA went into place in the 80s! National ACEP has been working hard to push for fair compromise and promote negotiation between physician groups and insurers and avoid price-fixing. The insurance industry has been swinging their considerable political weight and lobbying coffers into this, so it is vital that EM physicians take a strong stand in response. If insurers get their way, we can expect EM compensation to drop considerably nation-wide, and the patient safety-net of Emergency Departments to disintegrate.
Several House committees have developed bills with various levels of favorability. First, the bad: The Education and Labor Committee has put forth a bill that sets the lower limit to allow arbitration between physicians and insurance companies at $750, far above most ED bills, essentially locking out emergency care from this solution. ACEP is understandably opposed to this bill. There is, however, a more promising bill coming from the Ways and Means Committee, known as “Consumer Protections Against Surprise Medical Bills Act of 2020”. This bill has no threshold, and is the most fair bill to EM physicians because it encourages robust insurance networks to help protect patients. ACEP supports this bill, and it moved out of committee on February 12th. Now the full House must reconcile these bills and amend them before going forward with a full House vote.
It is vital that our Wisconsin legislators hear from Emergency Physicians on these bills! Please write, call, meet with, or email your house legislator today, and let them know that you support the protections offered to patients in the Ways and Means Bill. In particular, ACEP is still pushing for some amendments to that bill, so it essential that Wisconsin representatives Ron Kind (WI 3 – Western WI) and Gwen Moore (WI 4 -Milwaukee) hear from their EM physician constituents. The only Wisconsin representative on the Education and Labor Committee is Glenn Grothman (WI 6 -Eastern WI) so if you are in his district, be sure to let him know the reasons you oppose the bill coming from his committee.
It has been a surprisingly busy winter in terms of legislation both at the state and federal level, but you can count on WACEP to keep you up-to-date on the issues that matter to you and your patients!