Balance Billing: HB 1065 / SB 5031

This is a hot-button issue for the general public and legislators. When a patient visits an in-network hospital, often for an emergency, they may receive services for physicians that work at the hospital, but are not covered by the same network. These physicians charge the patient separately, and the cost is not met by the patient’s insurance. The bill originated with the Office of the Insurance Commissioner and aims to remove patients from the situation, leaving providers and insurance companies to come to terms on reimbursement. The bill as written will create an arbitration process for providers and healthcare networks. With proposed amendments, the bill may help providers and networks avoid unnecessary costs and come to an agreement on reimbursement. Legislators were receptive to our comments on this bill, and amendments that would help arbitrators reach an equitable compromise have been proposed in the Senate.

Wrongful Death HB 1135 / SB 5163

Background: In brief this legislation resulted from the 2015 “Ride the Ducks” accident on Aurora Bridge that killed 4 people and injured many more. There were issues with obtaining reasonable compensation for those who died or were injured in the accident. The bill as written may have unintended consequences that impact physician malpractice in our state. We approached legislators with the points listed below:

WSRS opposes the joint severable liability provisions and recommended that it be removed. The language would hold a party responsible for making a plaintiff economically whole for damages even if the party is found only partially liable for the wrongful death. This bill is an incentive for predatory litigation, expands liability and inappropriately increased damages. WSRS opposes the joint severable liability provisions in HB 1135/ SB 5163 and recommend it be removed.

The bill is opposed by many including schools and local governments amongst others, but has strong support from attorney groups which must be countered. There is no indication at this time that the bill will be amended.

The WSRS Executive Committee, and our lobbyist Jim Hedrick will continue our efforts to track relevant legislation that affects patient care and Radiologists.

WSRS Regulatory Advocacy Efforts, 2016

On October 14, 2016,  the  American College of Radiology and the WSRS submitted a joint comment to the Washington State Office of the Insurance Commissioner (OIC) regarding prior authorization and transparency. To read the comment, click here.

On September 2, 2016, WSRS submitted a statement of support for proposed rules to the Washington State Department of Health regarding safe and effective use of computed tomography (CT) systems for diagnostic purposes. To read the statement, click here.

On June 16, 2016,  the WSRS submitted its own letter to the OIC regarding the prior authorization issue. To read that comment, click here.

Thank You Regarding Dunnington Case From WSMA

Dear WSRS leaders and members,

I have good news! The Washington State Supreme Court published its opinion in the Dunnington case last week – unanimously, the Court sided with our position!

On behalf of the WSMA, thank you for your support in the amicus brief submitted in the case Dunnington v. VMMC. To our great relief, the Washington State Supreme Court handed down a unanimous 9-0 ruling agreeing with our position. You may recall that the attorney who drafted the brief for us, Greg Miller, also appeared at oral arguments when the case was heard, and articulately presented our brief’s points and answered the justices’ questions. We are pleased to see the Court agreed to keep the established burden of proof in medical malpractice loss of chance cases, rather than lowering that burden of proof, as the plaintiff patient in the case wanted. Additionally, the Court agreed with our argument that, when a defendant physician asserts an affirmative defense of “contributory negligence,” the jury should be able to hear and consider evidence that the patient failed to comply with the physician’s follow-up instructions.

This is a great victory for physicians in Washington. A decision from the Court on either of those issues had the potential to drastically increase medical malpractice suits brought against physicians. We are pleased to see the Court deliver such a well-considered opinion, which will constrain burgeoning health care costs and pressure to practice defensive medicine, while encouraging patients to take responsibility in following their physicians’ instructions.

Our brief was stronger, and indeed – financially possible – thanks to the participation of groups like the Washington State Radiological Society, and we sincerely appreciate your assistance in this legal effort.

Please do not hesitate to let me know if you have any questions about the case or the decision.

Thank you so much,

Tierney Edwards, JD
Associate Director of Legal and Federal Affairs
Washington State Medical Association

Note: a copy of the amicus brief and the decision are linked below:

Motion of Amici Curiae submitted by WSMA, WSRS and other specialty societies

Washington State Supreme Court’s Decision in the Dunnington Case

WSRS leaders recently evaluated the two rulemaking proposals being considered in May 2016 by the Washington State Medical Quality Assurance Commission (MQAC) regarding continuing medical education for physicians:

  • WSR 16-08-106 seeks to clarify which physicians may qualify for an exemption to the new law which requires physicians and certain other health professionals to take a one-time, six-hour training in suicide assessment, treatment and management.
  • WSR 16-08-107 would, in part, allow physicians to meet their re-licensure CME requirements by participation in their specialty board’s maintenance of certification program.

After analyzing the impact of the proposed changes on radiologists in the State of Washington, WSRS submitted official comments to provide input prior to the Commission’s hearings on these issues on May 11, 2016.

The MQAC Rule Hearing Notices which detail the proposed changes and the two WSRS comments to the Commission are available by clicking on the links below. Our lobbyist, Brad Boswell, will be representing WSRS at the hearings where these proposed rule changes will be discussed on Wednesday, May 11, 2016.

If you have any questions about WSRS’ advocacy activities, feel free to contact Executive Director Debra Alderman at 206-956-3650 or debra@wsrs.org and she can put you in touch with the legislative advocacy committee.

MQAC Rule Hearing Notice on WSR 16-08-106
WSRS comment to MQAC on WSR 16-08-106

MQAC Rule Hearing Notice on WSR 16-08-107
WSRS comment to MQAC on WSR 16-08-107

WSRS Teams with WSMA for Successful Certificate of Need Decision

On July 9, 2015, the Washington State Supreme Court unanimously decided that the Department of Health had exceeded its scope of authority when it promulgated a 2013 rule that would have dramatically expanded the purview of the certificate of need (CON) program in Washington State. WSRS financially supported the amicus curiae brief in this case (initiated by WSMA) which highlighted the potential adverse implications of the now-invalid rule.

Background: DOH had adopted the rule following a directive from Governor Inslee in June 2013 for the department to modify the CON process to take into account transactions other than “sale, purchase, or lease” by which hospitals and hospital systems change control, including “affiliations, corporate restructuring, mergers, and other arrangements.” While the intent of the new rule was to protect the delivery of reproductive services following changes in control of hospitals, the language DOH used in the rule was exceedingly broad.

The WSRS, WSMA and other parties expressed concern that the rule might require a CON review for arrangements such as new alignments between physicians and medical practices with hospitals, exclusive contracts between physician specialty groups and hospitals, and any other type of joint services agreements with hospitals. The amicus curiae brief argued that this could impede the development of Accountable Care Organizations and other integrated forms of health care delivery, and could result in significant financial and administrative burdens on physicians, their practices, as well as hospitals. The Supreme Court decision leaves it up to the legislature to determine when a business transaction between hospitals will trigger the need for the CON process, rather than allowing the department to unilaterally expand the CON process through rule changes.

Thanks to the WSMA for providing material for this article. For further information on this case, please contact WSMA staff members: Denny Maher, JD, MD at dpm@wsma.org or Tierney Edwards, JD at tee@wsma.org.