Legislature(2001 - 2002)
01/18/2001 09:05 AM Senate FIN
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
GENERAL SUBJECT(S):
Overview: Update on Federal and State Medical Issues
American Medical Association
The following overview was taken in log note format. Tapes and
handouts will be on file with the Senate Finance Committee through the
21st Legislative Session, contact 465-4935. After the 22nd
Legislative session they will be available through the Legislative
Library at 465-3808.
Time Meeting Convened: 9:05 AM
Tape(s): SFC-01 # 3, Side A
PRESENT:
x Senator Donley
x Senator Kelly
x Senator Austerman
Senator Green
x Senator Hoffman
x Senator Leman
x Senator Olsen
x Senator Ward
x Senator Wilken
ALSO PRESENT:
JIM JORDAN; Executive Director, Alaska State Medical Association
PETER LAWRASON, MD; President, Alaska State Medical Association
DONALD J PALMISANO MD, JD; Member, Board of Trustees, American
Medical Association
BECKY DADURA, Attorney, Advocacy Resource Center, American Medical
Association
LOG SPEAKER DISCUSSION
0 Co-Chair Kelly Introduction
Medical professionals in the capital, so I
invited them to update the Committee on the
status of medical issues
Noted that the entire membership of the
Senate Health and Social Services
Committee, which also have an interest in
this matter, also serve on this Committee.
34 Jim Jordan; Introduced speakers
Executive Director,
Alaska State
Medical Association
46 Peter Lawrason, MD; OB/GYN practicing in Fairbanks
President, Alaska Hoping the Committee will consider SB 37,
State Medical Physicians Negotiations With Health
Association Insurer.
Listed the credentials of Dr. Pamisano,
including law degree. General and vascular
surgeon in New Orleans, Louisiana, Member,
American Medical Association (AMA) Board of
Trustees, Member, AMA Executive Committee
and it's board, the finance committee and
Chair of its Compensation Committee. Former
president, Louisiana State Medical
Association and serves as AMA's point
person on privacy confidentiality as well
as anti-trust reform to allow negotiations
by self-employed physicians.
Listed credentials of Becky Dadura,
Attorney, AMA's Advocacy Resource Center,
who also testified before the Committee the
previous year.
95 Donald J Palmisano Discussed with medical students that this
MD, JD; Member, is an exciting time in medicine with the
Board of Trustees, gene projects and the potential for curing
American Medical many diseases during their lifetimes.
Association
118 Spoke of potential future system of
identifying and curing patient with cystic
fibrosis through gene technology
124 Technical advances allow us to diagnose and
cure conditions quicker as opposed to only
being able to offer comfort.
130 Other side is issues that impede the
process
On national level, there is an increase in
regulations and increased burdens on
practicing physicians
Interference with the patient/physician
relationship by many insurance companies.
AMA position on insurance is a "system of
plurality"
We are in favor of "letting the patients be
in control"
AMA favors letting them chose the doctor
and insurance companies
141 Have seen the rise in large companies that
have interfered and presenting "take it or
leave it "contracts to doctors.
Physicians look at the contracts and see
onerous problems, such as the different
types of offerings.
Insurance making the decision for patients
and doctors
148 Physicians are forced in the position to
have to deny care to patients when the
physician believes the patient needs care.
Physicians are finding they are not
effective patient advocates.
Insurance companies control so much of the
market place that a physician has no
choice.
If the physician quits the plan, the
physician is unable to care for his or her
patients.
160 Meanwhile, more regulations are coming out.
There is a big issue of privacy before the
US Congress currently.
AMA believes patients have a right to
privacy and they should control the
information that the physician has in his
or her chart.
We see wholesale transfer of this
information by insurance companies for
reasons other than health care.
170 Congress had to take action on this matter
by a certain date, but failed.
As a result, the regulatory branch issued
in December, 1535 pages, much of which is
commentary, but over 600 pages of
regulations, that we are studying to see
what affect it will have.
There are many entities that "escape".
Life insurance companies are exempt from
the privacy information requirement and can
still transfer information for marketing
purposes.
180 Patient safety issue - we want every
patient to be safe.
We founded the National Patient Safety
Foundation, with several other
organizations.
Has been very successful.
The Institute of Medicine report, "To Err
is Human" repeatedly mentions the good work
of the foundation.
Concerned about regulations that focus on
punishment of the physicians who cause the
errors. That will not work.
188 Need a culture of candor, truth and sharing
of information.
Over 20 states have mandatory reporting but
nothing is being done with that
information.
Not enough to collect information.
Need someone knowledgeable about the
analysis of that information to ask what is
the system that set the physician or nurse
up for that problem.
The Joint Commission on Accreditation of
Health Care Organizations, which the AMA
places seven members on, has come out with
standards for hospitals.
They are saying that regardless of whether
you have voluntary or mandatory reporting,
the information has to be confidential,
shared and analyzed properly.
202 Seeing a number of practices closing down
in California, which we told Congress when
we testified on HR 1304
210 HR 1304 passed with overwhelming bipartisan
support in the US House of Representatives
but couldn't get through the Senate
217 Things at national and state level affect
the treatment of the patient
222 AMA believes two things must happen at the
state and federal level
1. Meaningful patients bill of rights
We have hopes that such a bill will
actually pass this congressional session.
231 2. There has to be an ability for
individual practitioners who are not
eligible to join a collective bargaining
unit on the National Labor Relations Act,
to get together to say "this is hurting my
patient, this is inappropriate and needs to
be changed" without the fear of anti-trust
239 Supreme Court in 1943 decided, "if the
state action doctrine, (if a state actually
passes a law allowing these negotiations,
and also actively supervising it) then the
matter doesn't fit under the national
Sherman/Clayton Act.
243 Long term solution is to make sure everyone
is insured, particularly children.
43 million people are not insured,
including 11 million children.
Our website details a system that changes
the framework of insurance.
Instead of the employer having to decide
between staying in business and converting
to offering managed care to their
employers.
Instead, we propose a system where the
employer makes defined contributions that
would allow individual employee to have the
choice to choose the type of insurance
policy.
Employee who pays more to get higher
coverage would get a tax credit.
273 Meanwhile problem with patients being
denied care by insurance company and
physicians having to go through hoops to
provide care.
We think SB 37 would give physicians the
opportunity to advocate for their patients,
which is their ethical obligation.
We think the bill would benefit the people
of this state and would be an example
around the nation.
Texas and Washington State have laws
similar to that we are proposing.
Washington DC almost had a bill, but ran
out of time and are reintroducing it again
this year.
Over a dozen states introducing similar
legislation.
289 Would like to get something done at
national level but we can't wait.
Patients are the ones suffering.
294 Co-Chair Kelly Texas legislation: we referred to that
several times last year. What is the status
of that law?
Explain bill before this legislature the
previous session that protected doctors
from some provisions of the anti-trust law
when negotiating with insurance companies.
304 Dr. Palmisano Texas law was passed but then ran into
obstruction in its implementation
308 Becky Dadura, Law passed then went through lengthy
Attorney, Advocacy regulatory process, completed last Spring.
Resource Center, Caused consternation because they are
American Medical onerous.
Association Potential for similar situation in other
states as well that adopt similar laws.
Oversight authority with attorney general
in Texas.
Political implications with last year's
presidential election.
Concern is that regulations would actually
serve as a deterrent with physicians who
may want to utilize the law.
The way the regulations are written,
applications would never be complete.
We are drafting revisions to the law to
streamline the regulations.
Will keep you apprised.
341 Co-Chair Kelly So the Texas law concept was not flawed but
rather conflicts between its legislature
and executive branch
345 Ms. Dadura Correct.
The bill sponsor and other Texas
legislators wrote a letter to the attorney
general stating, we think you are exceeding
the scope of your authority. Your
regulations go far beyond just implementing
the law and in fact are writing additional
law.
Regulations written do not allow physician
to use the law in the manner it was
crafted.
256 Senator Ward Is there already tightened language
proposed for the Texas law that we could
use here, to avoid having to go through the
same regulatory problems?
366 Ms. Dadura Intent of the legislation is very clear.
Texas legislature plan is to limit the
regulatory process to the language in the
statute.
Won't necessarily benefit other states,
rather a matter of the political dynamics
in that state.
More a reflection on how the regulatory
process works in that state
380 Senator Ward Any generalized language to keep that from
happening in the first place?
392 Ms. Dadura That has not happened yet.
They are considering vesting the oversight
authority of this law with a different
agency.
They have not considered any specific
language for this issue.
399 Co-Chair Kelly We will look to you to watch that case so
we can prevent similar problems here.
402 Ms. Dadura Have looked at other states and found it is
very specific to how each state handles its
regulatory authority.
411 Co-Chair Kelly Even though we do not have the legislation
before us, I did not want to miss the
opportunity to meet with you and have you
speak to the Committee.
414 Senator Hoffman Patient bill of rights - do you know what
Senator Hillary Rodham Clinton's position
is on your proposal?
420 Dr. Palmisano Our belief is that bill would have been
signed by the Clinton Administration.
Issue raised in presidential debate where
Al Gore challenged George W. Bush.
President-Elect Bush responded that he
signed the bill in Texas and would also
sign a national law.
Regarding Senator Clinton, we think she
would support, although she hasn't stated
such publicly.
Only opposition has been raised by the
insurance industry who has spent a lot of
money fighting this
439 Co-Chair Kelly 600 pages of commentary on one bill?
441 Dr. Palmisano Yes. There are different interpretations of
what they mean.
446 Co-Chair Kelly So the medical community is getting
overwhelmed with regulations?
449 Dr. Palmisano No question.
We have fought to have the fraud and abuse
statutes in the "American spirit of fair
play so the physician is not considered
guilty - people swoop into your office,
take your records. You would be astounded
that such things happen."
We are against fraud, but the regulations
have become so burdensome.
Relayed experience with own practice and
the amount of paperwork necessary to meet
regulations.
New physicians will be unable to afford to
establish their own practices.
Relayed instance of prohibition of waiving
co-payment for those patients who cannot
afford it. Physicians who do this are
accused of fraud.
Relayed instance of emergency situation
with a patient and the difficulty getting
insurance approval for hospitalization.
Difficulty in getting to speak to another
physician at the insurance company to fully
explain situation. If he went to the
patient telling of the insurance approval
difficulty, this would have caused more
stress leading to a possible stroke in this
instance.
516 Co-Chair Kelly
517 Dr. Palmisano Wish to leave written information that
further details.
520 Co-Chair Kelly Adjourn 9:44 AM
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