weekly-rounds-march-31-2023-olympia-update-budget-proposals | Weekly Rounds: March 31, 2023 - Olympia Update: What the Legislative Budget Proposals Mean | Leadership | Shared_Content/News/Weekly_Rounds/2023/weekly-rounds-march-31-2023-olympia-update-budget-proposals | <div class="col-md-12">
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<h5>March 31, 2023</h5>
<h2>Olympia Update: What the Legislative Budget Proposals Mean for Physicians</h2>
<p>
Sean Graham, WSMA Director of Government Affairs
</p>
<p>
With less than a month remaining in the 2023 legislative session, lawmakers are turning their attention to budget negotiations. Against the backdrop of a <a href="https://erfc.wa.gov/sites/default/files/public/documents/meetings/rev20230320.pdf" target="_blank" rel="noreferrer">recently released, relatively foreboding state revenue forecast</a>, majority party Democrats in the Senate and House of Representatives rolled out their 2023-25 operating budget proposals over the last week, each advocating to appropriate around $70 billion over the two-year cycle.
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In broad strokes, the two spending plans are similar. Both prioritize addressing climate change, behavioral health, education, and housing and homelessness. And neither relies on significant new or increased taxes, including no new taxes on the physician community. But there are hundreds of wrinkles between the two budgets that will need to be ironed out before a final agreement is reached and session adjourns on April 23.
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<p>
WSMA's top budget priority for the 2023 session is across-the-board Medicaid rate increases for "professional services" delivered by physicians, physician assistants, and other health care practitioners. Our ask is to bump up rates to at least the equivalent paid by Medicare and adjust to inflation moving forward. Important for ensuring access to care for patients, it's been years since the state made broad investments in physicians' Medicaid rates.
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The House budget proposes to increase rates for professional services by a total of $67.8 million (inclusive of federal matching funds), with rate increases going into effect July 1, 2024. This only partially funds our request but would represent a positive first step. The Senate failed to fund this ask in their budget. We are disappointed that neither budget fully funded the ask in the interest of supporting physicians who deliver services in the Medicaid program and the patients they serve. The WSMA will advocate for the inclusion of rate increases at least at the proposed House level in the final state budget.
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<p>
Both budget proposals do fund Medicaid rate increases in other contexts, most notably for hospitals. In the case of hospitals, nursing homes, and ambulances, those increases are funded through "safety net assessments," or taxes, which are levied against the relevant entities to leverage increased federal funds. By comparison, WSMA's ask for a professional services rate increases was from the state's general fund revenue.
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<p>
Another priority funding area for the WSMA in the 2023 session is health care workforce. State funding for physician residencies is maintained in both budgets, with each proposing $2 million in new spending for residencies. There's a distinction in approach between the two budgets, however, with the Senate increasing investments in the state's Family Medicine Residency Network housed at UW Medicine, and the House proposing to run the increased funding through the Elson S. Floyd College of Medicine at Washington State University, designating it for "rural" residencies.
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<p>
Both budgets invest around $20 million in loan repayment programs for health care professionals, though there are some differences in how the funds are appropriated. In addition to existing programs, the Senate proposes to create a new $1.4 million loan repayment program for forensic pathologists. Significant new investments are also proposed for the education and training of nurses and behavioral health professionals, as well as support for apprenticeships.
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<p>
Public health is another bright spot in legislative budget proposals. The House sets a high-water mark of $340 million for Foundational Public Health Services in the 2023-25 biennium, representing a continued prioritization of public health. Both budgets also increase appropriations to the Office of Firearm Safety and Violence Prevention. And both propose new investments to address the opioid epidemic, with the Senate proposing to spend $1.8 million on opioid education, including expanding the Better Prescribing, Better Treatment safe-prescribing initiative jointly run by the WSMA and the Washington State Hospital Association.
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<p>
In other areas of the budget, WSMA staff continue their review and work with legislators and legislative staff to understand the implications of funding proposals. An example is abortion care access, where both proposals make investments short of the level requested by abortion access advocates. Another area where more review is needed is around the differing approaches for funding health care coverage options for undocumented residents of the state.
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<p>
Looking beyond the conclusion of the 2023 session, it's clear that more work will be needed in support of fully funding the state's Medicaid program to ensure access to care for patients and fair reimbursement for physicians. We're disappointed that despite our collective advocacy, with hundreds of WSMA members engaging their legislators from across the state, our ask likely will not be fully funded this year. Legislative advocacy is often a long game, however, and the WSMA is committed to making this our top budget priority until its resolved.
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</div> | 3/31/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
weekly-rounds-march-20-2023-remembering-tom-curry | Weekly Rounds: March 20, 2023 - Remembering Tom Curry, Former WSMA CEO | Leadership | Shared_Content/News/Weekly_Rounds/2023/weekly-rounds-march-20-2023-remembering-tom-curry | <div class="col-md-12">
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<h5>March 20, 2023</h5>
<h2>Remembering Tom Curry, Former WSMA CEO</h2>
<p>Jennifer Hanscom, CEO</p>
<p>
It is with a heavy heart that I share the news of the passing of Tom Curry. Tom was the executive director and CEO of the WSMA from 1986 to 2013, in addition to being a dear friend, mentor, and supporter not only to me, but to many in organized medicine and the physician community.
</p>
<p>
During his 27 years at the WSMA, Tom had many achievements that centered on building a forward-leaning and progressive professional society. From working with the Legislature in the 1990s to help create the Basic Health Plan, to being the voice for needed tort reform in the early 2000s, Tom was an ardent supporter of Washington state physicians and patients. He helped incorporate and secure stable funding for the Washington Physicians Health Program and supported Physicians Insurance's evolution into a national professional liability insurance company leader.
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<p>
During his tenure at the WSMA, Tom served as a member of the board of directors of Physicians Insurance a Mutual Company, the state's largest professional liability insurance company. He was also a member of the board of directors of the Washington Physicians Health Program, the Association of Washington Business, the Washington Health Care Forum, and the Foundation for Health Care Quality.
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<p>
Prior to joining the WSMA, Tom was the executive director of the Pierce County Medical Society and manager of corporate relations at Blue Cross of Washington and Alaska.
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<p>
Tom was deeply respected by all in organized medicine-both within Washington state as well as throughout the U.S. His charming wit and engaging sense of humor will be deeply missed.
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<p>
On behalf of all of the staff and members of the WSMA, we extend sincerest condolences to Tom's wife, Deedle, sons Ian and James, daughter Jennifer, and grandchildren.
</p>
</div> | 3/20/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
death-comes-to-us-all-prepare-now | Death Comes to Us All: Prepare Now | Leadership | Shared_Content/News/Latest_News/2023/death-comes-to-us-all-prepare-now | <div class="col-md-12">
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<h5>March 17, 2023</h5>
<h2>Death Comes to Us All: Prepare Now</h2>
<p>
By Joanne Roberts, MD</p>
<p>
Having practiced palliative medicine most of my career before I retired in mid-2021, I have been involved in thousands of deaths and sat vigil with hundreds of families. I know a thing or two about the end of life. Or so I thought.
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<p>In October 2021, I had a routine exam that included basic blood work. A few hours after the draw, the results dropped into MyChart: neutrophils 700; hemoglobin 9.2; platelets 108,000. A week later, a bone marrow biopsy showed 14% myeloblasts.</p>
<p>
"What do you think of the biopsy results?" asked Brian, my hematologist, letting me take the lead in recognizing this as a high-risk myelodysplastic syndrome. "I think I would have liked to have lived to be at least 80," I replied. He wisely let silence fill in the next few moments.
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<p>
We know that from the moment we're born, we are dying. But as another patient with a terminal diagnosis said: "We all see the exit sign, but I see it more clearly than you do." Indeed, little in my life has focused my brain more than being within sight of my death.
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<p>
Once I got through the first month of shock, every day of the last 17 months has been among the best of my life. I've intensified my meditation alone and in groups, reflected on my life, spent more time talking with friends and daughters, ridden my bike more than 7,000 miles, and, generally "gotten my affairs in order."
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<p>
My biggest worry was for my young adult daughters. Both live far from me, so I set up a Zoom call to share the news of diagnosis, chemotherapy plan, and prognosis. When my older daughter, a nurse and my health care agent, blurted out, "Does this mean we'll get a bigger inheritance?" we all wept with laughter, and I breathed easier. I know from my practice that when families laugh together, grief is easier to bear.
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<p>
For my friends, CaringBridge is a lifeline to scores of people I know and love around the world, and I've hired a doula to help me build a support team for my daughters, my friends, and me.
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<p>
Working in palliative medicine for decades, I failed to appreciate the intensity and richness of life that exists between diagnosis and hospice. Part of that richness is the accomplishment of the "logistics" of the end of our lives. As we come up to the annual Healthcare Decisions Day this April, my plea to you is to focus on yourself-and your own mortality. Don't put it off. As they say on every flight, "Put your own mask on first." This year, tend to yourself first and your patients second.
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<ul>
<li>Havetheconversationwithyourfamilyabout your values and the care you hope to have when you are struck by disease, frailty, or another cause of death that is daily closer.</li>
<li>Designate a health care agent, and make sure everyone in your family knows who that is.</li>
<li>Complete your will so your family won't suffer over your "stuff."</li>
<li>Decide what you want done with your body. It will help you all acknowledge that death comes to us all.</li>
<li>Write your obituary. It will help you clarify what is most important to you in the life you have.</li>
</ul>
<p>
Death is the most natural thing in the world, particularly among those of us over 50 or 60. It is the one event that we all share. Imagine yourself as having a year to live, and then live as if you do. I suspect you'll be surprised at what you and your loved ones-and your patients-will discover.
</p>
<p>
<em>Joanne Roberts, MD, MHA, is an emeritus member now retired and living in Minnesota.</em>
</p>
<p>
<em>This article was featured in the March/April 2023 issue of WSMA Reports, WSMA's print magazine.</em>
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</div> | 3/17/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |