Strategy session

Saturday, November 01, 2014 12:34 PM

CMS delegates hold scope of practice strategic discussion

by Kate Alfano, CMS contributing writer

The House of Delegates held a strategic discussion on scope of practice at the 2014 annual meeting in Vail. The CMS Board of Directors, as the body charged with implementing CMS policy, brought this issue to the HOD to gather members’ thoughts on whether the society should reassess the traditional issue-by-issue approach to dealing with scope of practice and look for effective, alternative strategies.

There are three things that triggered a review of scope of practice issues, explained Joe Gagen, JD, the discussion’s facilitator and veteran of the realm of legislative and organizational strategy.

The first came about as a result of a meeting of national specialty and state medical society CEOs. The American Medical Association convened the group, which included CMS CEO Alfred Gilchrist, to examine the effects and costs associated with the current strategies dealing with scope of practice. The group commissioned an environmental scan that uncovered a skyrocketing number of legislative and regulatory proposals related to scope across the country and the growing state lobbying expenditures on this issue. “The vast majority of state medical societies are spending between 50 and 85 percent of their total lobbying budget on scope issues,” Gagen said.

Second was the awareness that, in line with a national trend, there will be several scope of practice issues brought forward by allied health professionals and other groups and likely debated by the Colorado legislature in 2015.

Third was a lawsuit before the United States Supreme Court, North Carolina Board of Dental Examiners v. Federal Trade Commission, through which the FTC has challenged the ability of that board to regulate dentists on the basis that – in this case – the board is nominated by the dentists themselves. The FTC doesn’t think it is appropriate for an official state licensing board that regulates scope of practice to be controlled by the individuals who perform that practice.

“Those are three things that led us to the desire to be proactive rather than reactive, to look at the issue ourselves as part of a deliberative process, and get feedback from the Council on Legislation and our House of Delegates,” Gagen said.

The changing landscape
Much has changed over the course of the career of Jerry Johnson, longtime CMS lobbyist. “Doctors are no longer seen as the dominant authority figures on health care at the Capitol, and while physicians continue to hold the respect of legislators, it is a shared respect with other providers, especially advance practice nurses.”

At the same time, much has stayed the same, Johnson said. “I cannot recall a year when we did not have to fight at least one scope battle and while we win almost all of them, they are always difficult fights and the battles are not well received by members of the General Assembly.”

“The most consistent dynamic that I have observed over the past 20 years is this: Legislators hate scope battles,” he said. “They feel trapped in the middle and would prefer that the warring professions work out their differences without involving the legislature. The reality is this: We will face these same fights over the next 20 years without the same level of success we have enjoyed in the past without a change in our strategy that takes into account the changing perspective of the General Assembly.”

Council on Legislation survey
The CMS Council on Legislation was asked to complete a survey on scope of practice in advance of their July meeting. Gagen presented a few of the questions and their answers. First, the COL was asked to what extent they believe changing health care economics and market forces have impacted broader political support for expanded scope of practice for allied health professionals and others. Eighty-five percent answered either high or very high.

Another question asked them to choose the major factors that influence the legislature’s decision-making on scope of practice issues. In order of significance:

• Lobbying efforts
• The perception of the impact of expansion of scope in improving access to and delivery of health care
• Not quality of care issue at all, but rather “how you slice the health care dollar pie”
• Campaign funds and campaign support
• Public support or opposition
• Merits of the scope issue
• Possible harm to patients

In response to a question on whether past specific expansions of scope have impaired the quality of care to patients, the answers were split nearly evenly. To another question on whether past expansions have affected the financial viability of physician practices, 37 percent said “yes” and 63 percent said “no.”

Finally, after reviewing the environmental scan, COL members were asked whether some past and current legislative strategies have not been particularly effective in limiting scope expansion, have undermined legislative respect for physicians as quality of care advocates and as a political force, and have impacted legislative effectiveness on other issues important to organized medicine. Every single respondent answered “yes.”

Members in the audience then shared their perspective on scope of practice, in the context of the environmental scan, Jerry Johnson’s comments and the survey results.

Gagen summarized: “The overwhelming theme I heard very clearly is the Colorado Medical Society should not abandon its role to ensure that patient safety is put first and that there is accountability for skill and competency when people treat patients. I did hear that overwhelmingly you believe that it is, in fact, appropriate to reexamine the tactics that are implemented consistent with that overarching principle.”

The Board of Directors will continue to go through this dynamic process to look at new tactics to address the issue, and should any fundamental change be proposed, it will come back before the House of Delegates. All CMS members are encouraged to share their thoughts with CMS staff or officers.