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President's Message

legislative update


This month Robert C. Bernstein, MD, FACC, Advocacy Chair from Norfolk, updates us about federal and state issues.

Dear Colleagues:

The 2023 congressional and state advocacy updates are summarized below. I am happy to provide additional details, respond to any questions, and welcome your input on issues you feel are important to address on a national or state level.

First, a couple take-aways from the past year:

You can have an impact

  • Individual voices matter. When you reach out to your state and congressional representatives, they do hear your voice. Particularly at the state level, small numbers can leave an outsized impression. 
  • Societies matter. Professional societies, both individually and banding together with other groups with common interest(s) to support an issue(s) speak with a large voice. 
  • VCACC represents you. Make your concerns known. If you have an issue you feel passionately about, bring it forward. Chances are many of us share the same concern. Also, if you have a proposal to address a problem, please bring that forward as well.

Frustrating process

  • The bills and budget amendments supported (or opposed) by the ACC and MSV detailed below enjoy society constituency consensus. But a proposal that seems like a slam dunk to many of us can have a strong counter argument limiting an individual representative’s support. Reaching out to representatives earlier in the process may help with that discussion.
  • Despite most of our targeted bills enjoying bipartisan support, for some legislation the level of support was still insufficient. Bills died in both House and Senate Committees. (As a benchmark, less than 10% of congressional bills become law). 
  • We had a better batting average on the state level. Most of our practice level issues are statewide concerns (except Medicare).

Proactive voice/Patience

  • This process takes time. Please submit any comments or proposals as soon as possible. Advocacy is a yearlong activity. Our national and state societies are already discussing proposals for the 2023 and 2024 legislative sessions.
  • Reach out to VCACC members who serve on committees with opportunities to propose ideas for advocacy efforts and impact society legislative agendas:

Benjamin Galper, MD, MPH, FACC - ACC Health Affairs Committee

Robert Bernstein, MD, FACC - MSV Advocacy

Resources

  • The ACC website has a robust advocacy section - explore!

Anticipated issues for 2023-2024

  • Restrictive covenants
  • Prior authorization
  • Long term fixes to Medicare reimbursement
  • Medicare formula adjustments
  • Alternative payment models
  • Medicaid provider reimbursement
  • Certificate of Public Need
  • Advanced practice provider scope of practice
  • Clinician well-being
  • Cardiovascular disease GME positions 

Please contact me with any questions, comments, ideas: Rob Bernstein, MD, FACC advocacy@vcacc.org

    2022 SUMMARY

    VCACC Congressional Advocacy Update

    VCACC members met with staff from 8 of 11 Virginia US Representatives and both Senate offices.

    Thank you to participating VCACC members - Annette K Ansong, MD, FACC; Ian Burrows, MD; Linda Hart, DNP, FACC; Christopher M Kramer, MD, FACC; Victor Soukoulis, MD, PhD, FACC; and Robert C Bernstein, MD, FACC

    SCORE CARD

    ACC Legislative Conference 10/2022 

    Six bills - 4 died 1/3/2023 (new Congress), One was altered then incorporated in another bill - now law, one now law

    Congressional advocacy on behalf VCACC constituents (pursued separate from ACC effort).

    One bill - died 1/3/2023 (new Congress)

     

    SUPPORTED BILLS SUMMARIES/ACTIONS

    Increasing patient access to care

    Supporting Medicare Providers Act of 2022HR8800/Senate supporting letter

    Address Medicare cuts. Bipartisan support.

    Status: Bill held in House Committee then included in 2023 omnibus spending bill (passed 12/2022). Bill reduced but did not eliminate overall cuts scheduled for 1/2023. Overall 8.5% cut not addressed. Instead of 4.5% reduction physician reimbursement, expected 2% cut 2023, circa 3% 2024.

    Remaining concerns: 1) long term planning for Medicare budget not addressed; 2) lack of an annual inflationary factor not addressed; and 3) flawed reimbursement formulas such as assigning atrial fibrillation ablation same work value as peripheral vascular intervention remain problematic.


    Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021. HR 1956/S1986. PAs/NPs and CNS to supervise day-day CR/PR in 2023 rather than 2024 and newly authorize APPs to order/refer pts for cardiac and pulmonary rehab. House and Senate:  in committee.

    Status: Dead 1/3/2023

    Improving clinician well-being/Increasing patient access to care

    Improving Seniors’ Timely Access to Care Act of 2021.HR3173/S3018

    Streamline prior authorization practices. Also requested support Gold Card ACT HR 7995

    Passed House 9/2022. Senate: sponsored by 53 senators. Remained in committee

    Status: Dead 1/3/2023

    Improving clinician well-being

    Safety from Violence for Healthcare Employees (SAVE ACT) HR 7961/ Senate no bill. Creates federal penalties for knowingly committing violence or intimidation toward healthcare workers, hospitals and offices. House vote: in committee 11/2022.

    Status: Dead 1/3/2023

     

    Developing public health initiatives

    South Asian Heart Health Awareness & Research Act of 2022. HR 3771/Senate no bill. Funds heart disease research and addresses health equity. 

    Passed House.  Senate: still in committee

    Status: Dead 1/3/2023

     

    Cardiovascular Advances in Research and Opportunities Legacy Act. HR1193/S1133

    Supports valvular heart disease, research and awareness. Note, currently no screening recommendations included as part of Medicare annual wellness visit or general preventative task force recommendation. Passed House 9/2022. Passed Senate 12/2022

    Status: Became law 12/2022. Of note, bill sponsor was House Representative who lost spouse to valvular heart disease at age 39.

     

    Congressional advocacy on behalf VCACC constituent - Increasing patient access to care

    Access to Genetic Counselor Services ACT of 2021. HR 2144/S1450. Note, not specifically cardiac legislation. Requesting Medicare access/reimbursement for Genetic Counselors (despite possessing Masters or Doctorate degrees and national society certifications, genetic counselors are not reimbursed by Medicare (they are covered by Virginia Medicaid and private insurers). House and Senate - no action.

    Status: Dead 1/3/2023

     

    Additional Congressional legislation

    Budget Winners: Veterans Administration; Behavioral Health; Substance Abuse; Maternal Fetal Medicine; NIH; Health Equity, and Biosecurity

    PAYGO Sequester: Delayed for two years (end of 2024). This prevents $38 billion in Medicare cuts 1/2023.  (PAYGO - Congress must pay for legislative package by either reduction in entitlement spending or increasing revenue).

    Graduate medical education: Beginning 2026, additional 200 Medicare-funded GME residency positions. At least half dedicated to psychiatry and psychiatry subspecialty training. At least 10% of positions to be distributed to rural hospitals, hospitals operating above their cap, hospitals in states with new medical schools, and hospitals that serve health professional shortage areas.

    Conrad 30 Program: Extends program that allows states to request J-1 visa waivers for foreign born physicians who have completed US residency training programs to work in federally designated shortage and underserved areas.

    Telehealth Extension: Extends support through 12/2024. Expands originating sites, eligible practitioners, and duration of service without in-office recertification. Also extends audio only Telehealth reimbursement.

    Hospital at Home- Extended 2 years


    STATE ADVOCACY UPDATE

    Met with multiple House Delegates and a State Senator.

    Participating VCACC member - Robert C Bernstein, MD, FACC 

    SCORE CARD

    MSV Legislative Conference 1/2023.

    Four bills - 0 died; 2 remain in committee; 2 passed legislature; signed by Governor

    Two budget amendments - 0 died; 1 approved full funding; 1 approved funding below target

    BILLS AND BUDGET AMENDMENT SUMMARIES/ACTIONS

    Increasing underserved patient access to care

    Support Medicaid Reimbursement - Budget Amendment

    Target increase reimbursement rate for non-primary care physicians to 80% Medicare rate. Target increase reimbursement rate for primary care physicians to 100% Medicare rate. Tie rate increases to inflation.

    Status: Approved funding below target. Approved increase to 80% Medicare rate for physician (but not 100% target for primary care physicians)

    Support Expansion Virginia Mental Health Access Program - Budget Amendment

    Target expands existing mental health resources from 6-18yo to add 0-5yo (complex developmental disorders) + perinatal maternal mood and anxiety disorders

    Status: Approved funding at target

    Oppose HB2183 - Nurse Practitioner to Practice Independently Immediately Upon Graduation.  Current Virginia law requires NPs have 5 years supervision before transition to autonomous practice. Pro Rationale - Add providers to underserved areas sooner. Problem - NPs have not relocated to underserved areas. Current 5 year restriction is in line with minimal total hours for post graduate physician training.

    Status:  Remains in committee - Amendment anticipated

    Improving clinician well-being

    Support HB1573/ SB970 - Mental Health Question for Physician licensure Bill directs Dept of Health Professions to amend licensure, certification, and registration applications to remove direct mental health questions which force many physicians to then avoid seeking diagnosis and care due to fear of stigma or threat of license.  Question change to “Do you have any reason to believe that you would pose a risk to the safety or well-being of your patients?  Are you able to perform the essential functions of a practitioner in your area of practice with or without reasonable accommodation?”

    Status:  Passed legislature; signed by Governor

    Support HB1835 - Threats Against Providers

    Current law protects healthcare workers from threats of violence in hospitals and ERs

    This law extends protections to providers in physician offices, urgent care centers, health clinics, pharmacies, or when treating patients in the field. Class 1 misdemeanor.

    Status:  Passed legislature; signed by Governor

    Improving patient access to care/Business of medicine

    Support HB1600 - Expedite COPN process.

    Allows for existing practices to expand services and build more healthcare facilities more quickly and affordably.

    Status:  Remains in committee


    VCACC is proud be the official international exchange partner with the British Cardiovascular Society (BCS).

    BVS and VCACC leadership

    VIRGINIA CHAPTER OF THE AMERICAN COLLEGE OF CARDIOLOGY

    Our purpose is to contribute to the prevention of cardiovascular diseases, to ensure optimal quality of care for individuals with such diseases, and to foster the highest professional ethical standards.
     

    The Virginia Chapter ACC supports the American College of Cardiology’s statement of support for the Ukrainian people; see this link for the full statement.



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    Mid-Atlantic Women Cardiologists Seminar:

    Renegotiation: Rethinking Your Next Contract


    Date: March 13

    Time: 7:00pm-8:00pm

    Click here for additional information and registration.


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