NHMS Membership - Two More Please

Our practices are attached to the swinging pendulum of healthcare debt, reimbursement and corporate drivers.  This blog is not intended to highlight the potential trends of ACOs, hospital mergers and acquisitions, or the impact they will have on the quality of physicians’ professional practices and our patients.  After all, so many providers are well aware of the changes on the horizon.  Many more healthcare professionals are intimately aware of business practices and much more willing to partner with or be employed by healthcare organizations than to weather it alone.  This, too, is part of the swinging pendulum that physicians should be mindful of.  There can be some very positive outcomes for all, but it is important to remain at decision tables and as proactive stakeholders.  To do so, it is essential for physicians to grow more robust and cohesive groups in order to be proactive agents of change.

NHMS Physician Opinion Survey

Last week you received an email from me announcing the NHMS physician opinion survey and yesterday, we launched it.

For NHMS to better represent its members and carry-out its mission -- to bring together physicians to advocate for the well being of our patients, for our profession and for the betterment of the public health – we need your input.

NHMS Supports Important Health Policy Areas.

A central role of NHMS is to work on policies to enhance the public's health and the practice environment.  At our most recent executive council meeting, we voted on two important health policy areas:  

1.  The New Hampshire Society of Eye Physicians and Surgeons brought forth an issue that some hospitals were not open to negotiating their service call relationships with specialty providers.  Following a spirited discussion of the nature of service call and our professional obligations, we unanimously voted to support physicians as they seek to pursue meaningful negotiations in providing service coverage. 

Moving Towards Medicaid Expansion

Because of our hard work on expanding coverage to the uninsured in New Hampshire, I was asked to serve on the Medicaid Expansion Study Commission and I wanted to share some updates from this.  The Commission was set up to give the State more time to study expansion so that the Legislature can possibly come back for a special session this fall so that we can take full advantage of federal funds.  So far we have met three times and have been given background information on the Medicaid program, what it costs and who it serves, and options for expansion.  In NH, Medicaid is a 50-50 partnership between the federal and state governments.  Under expansion, the newly covered population would be 100% financed by the federal government for 3 years and then would titrate down to 90% by 2021 and the state would be responsible for 10% into the future. 

MLPs – Current State vs. Future State: What to do with mid-level providers?

While I was recently speaking with a group of physicians, a comment was made regarding mid-level providers.  Somewhat succinctly and pointedly, it was mentioned that the direction of health care is such that patients are more frequently unable to see a physician in primary care settings, specialty clinics and emergency departments.  This is not a new circumstance, but a growing and developing integral transformation in health care occurring over several decades.  Interestingly, the same physician’s practice has MLPs as part of the staffing model, with a very large patient base and a well-regarded reputation.  What is paradoxical is that over the years many patients have commented that they have not seen their PCP at all within that practice, they are seen exclusively by a midlevel in the office who they have come to accept as the provider who knows them better than anyone else in the group, and they are quite satisfied with their PA-C/APRN relationships. 

NHMS Testifies in Support of Raising the Tobacco Tax

Yesterday, I testified on behalf of NHMS in support of HB490, a bill to change the tax rate on tobacco products -- other than cigarettes -- to a price which is equivalent to the tax rate on cigarettes. The bill also proposes to establish a tobacco use prevention and cessation program.

I went through a few familiar points such as tobacco being the only legal product that kills 1/3 of its users; and 31,000 of children in New Hampshire today will die from a tobacco related illness.

Medicaid Expansion Part 2: Understanding the Health Insurance Premium Payment Program

Two weeks ago I wrote about the work that I am doing on the Medicaid Expansion Study Commission and mentioned the Health Insurance Premium Payment Program, or HIPP Program. Since I received a number of emails from you asking for more information about the program and what role it may play in Medicaid expansion, I am writing about it today.

The Medicaid expansion population includes adults with or without children who make 0-138% of the federal poverty level (FPL), meaning individuals who earn less than $15,500 annually. Many people in the expansion population work in low-paying jobs, often doing seasonal work or in the hospitality industry. Currently, only parents who make less than 54% of FPL (earning less than $6,300 annually) are eligible for Medicaid. So, childless adults and parents making more than 54% of FPL define the expansion population.

Medicaid Expansion - Now What?

On March 27, 2014, New Hampshire became the 26th state to pass legislation allowing for Medicaid expansion under the Affordable Care Act.  Gov. Maggie Hassan signed Senate Bill 413 into law in front of a bipartisan gathering of legislators and supporters at the State House, including NHMS Past President Dr. Travis Harker, NHMS EVP Scott Colby and myself.  Read the Boston.com story here.

Not Alone

Now that the summer is in full swing, one of the classic phases of parenting begins for those whose children are entering senior year of high school: the college application discussion and visits.  This summer may be slightly different, however, due to a report released earlier this year by the White House that addressed head-on the issue of college sexual assault

March Madness

As you read this, I imagine many of you will spend the remainder of today looking at the infamous NCAA March Madness brackets, filling in the teams that you hope will win each game and hoping that you win the $1 billion prize from Warren Buffet.  Some teams have been affected by injuries and may not be as capable as you remember them from earlier in the season.  One of these teams is the Kansas Jayhawks, whose 7-foot center, Joel Embiid, recently suffered a spinal stress fracture and will miss the first week of the NCAA tournament.  Read the KUSports.com article here.