Published 7/26/2017 

Senate begins vote on Obamacare replacement

U.S. Senate Republicans, after passing the procedural motion needed to begin debate, have begun voting on legislation to repeal and possibly replace the Affordable Care Act. All 48 Democrats voted against the procedural motion, along with two Republicans, Sen. Susan Collins of Maine and Sen. Lisa Murkowski of Alaska. Vice President Mike Pence broke the tie for a 51-50 vote.

During the past months, the WSMA has raised significant concerns about efforts in Congress to repeal and replace the ACA, including the American Health Care Act that passed the House and the Better Care Reconciliation Act proposed in the Senate. For the WSMA, it comes down to the health of patients. It is clear these bills would reverse the substantial progress made in Washington state to reduce the number of people who are uninsured. Both bills would make affordable insurance unattainable for many. For those reasons, the WSMA cannot support either proposal. (At the time of this writing, the BCRA has failed to achieve the votes necessary to pass the Senate, but Republican lawmakers are continuing to seek consensus on legislation to repeal the Affordable Care Act.)

At the center of WSMA's principles for health care reform is access to comprehensive, affordable health care for all Washingtonians, including support for adequate funding of programs like Medicaid and Medicare and preservation of coverage attained through the Affordable Care Act. Our principles also call for stabilizing the health insurance market to ensure choice and insurer participation. Provisions under consideration by the House and Senate would greatly undermine these principles, exacerbating the problems with our health care system rather than improving them.

We at the WSMA urge Congress to put aside empty, partisan rhetoric and instead engage in bipartisan discussions with physicians and other health care organizations to improve the health care system to ensure access to high-quality, affordable care and coverage.


Published 7/26/2017

Published 7/26/2017 

WSMA prepares education around new prior authorization rules

As previously reported, after years of WSMA advocacy on the issue, the Office of the Insurance Commissioner has finalized rulemaking aimed at streamlining prior authorization of medical services. With most of the new requirements slated to take effect on Jan. 1, the WSMA now turns its sights to educating physicians and practices on the new rule, the pinnacle of WSMA’s Healthy Doctors, Healthier Patients initiative to reduce administrative burden and physician burnout.

The new prior authorization rule standardizes administrative practices, ensures transparency and mandates certain technological requirements across the health plans regulated by the OIC. (Note that the new rule does not apply to prescription drugs; the OIC conducted separate rulemaking in 2015 around prior authorization of pharmacy benefits.) Highlights of the new rule include:

  • Uniform timeframes for standard prior authorization (five calendar days maximum), expedited prior authorization (two calendar days maximum) and an extenuating circumstances provision for when the timelines are insufficient for a provider or facility to receive approval prior to the delivery of the service.
  • An online prior authorization process where critical information must be available to physicians prior to delivering a service, including clinical criteria that will be used to evaluate the request.
  • Communication requirements, including reasons for denials in clear language and the clinical criteria used to make the determination.
  • A secure online process for a participating provider or facility to complete a prior authorization request and upload documentation.
  • The rule applies to third party administrators.

The OIC has developed an FAQ document featuring answers to the most common questions from stakeholders on the rule’s implementation. The WSMA will be distributing physician- and practice-specific educational materials on the new rule in the weeks to come.

And be sure to mark your calendar for a free, lunchtime webinar on Wednesday, Nov. 15, for an explainer on the new rule, to help you adjust workflows and take advantage of these sweeping new requirements. The session will also cover the OIC’s previous rulemaking on pharmacy benefits. Registration details to come—for now, save the date.

Published 7/26/2017

Published 7/26/2017 

Free webinar on Washington’s new law to address the opioid crisis

Join us tomorrow (Thursday) at 1 p.m. to learn more about House Bill 1427, Washington state’s new law to address the opioid crisis through enhancements in the state prescription drug monitoring program.

HB 1427, passed during the 2017 legislative session, represents a successful joint effort by the WSMA, the Washington State Hospital Association and the Department of Health to support medical group practices’ ability to identify and help prevent drug abuse and overdose by leveraging data in the prescription drug monitoring program. Provisions of the bill include:

  • Issuing prescribing reports to physicians and other providers, which include a comparison of a clinician’s prescribing patterns with others from the same specialty and license type.
  • Issuing quarterly prescribing data to facilities and group practices with more than five prescribers for the express purpose of quality improvement.
  • Data sharing by the Department of Health with the WSHA Coordinated Quality Improvement Program for quality improvement initiatives.
  • Establishing an overdose notification system.

During this free, one-hour session, experts from WSMA, WSHA and DOH will provide physicians and practice managers an overview of the new law, how it will be implemented and how you can prepare your practice. Attendees will learn about the coming enhancements to the prescription drug monitoring program and how they can leverage prescribing reports to review prescribing practices and work on quality improvement initiatives.

Register for Addressing the Opioid Crisis, Thursday, July 27 from 1-2 p.m.

Published 7/26/2017

Published 7/26/2017 

Bad bills defeated; 2017 WSMA Legislative Report appearing in your inbox soon

Now that the Legislature has finally adjourned for the year—after a record-breaking 193 days of session—we can take final stock of new policies affecting health care and the practice of medicine. Yet, while legislative wins tend to command our attention, it’s worth noting that physicians frequently avoid adverse impacts to their practice when the WSMA defeats bad legislation.

During the 2017 session, the WSMA defeated legislation that would have created additional administrative burden, facilitated inappropriate scope expansion, and infringed on patient and physician privacy, including bills that:

  • Would have created an inappropriate expansion of scope to allow naturopaths the authority to prescribe and administer Schedules III-IV controlled substances (SB 5369).
  • Would have prohibited balance billing and created numerous patient information disclosure requirements for physicians and facilities (HB 2114).
  • Would have placed a standard of care into state statute by limiting first-time, outpatient prescriptions for opioid drugs to seven days, and created additional administrative burden by mandating annual continuing education on prescribing opioids for physicians and other prescribers (HB 1339).
  • Would have created administrative burden by requiring patients with chronic medical conditions to obtain a signed exemption on business letterhead from a physician or other provider when seeking an exemption for the Interstate 405 express toll lanes when traveling to a medical appointment (HB 1269).
  • Would have created administrative burden by requiring physicians and other providers, before administering a vaccine, to review a patient’s full health history and the vaccine’s package insert with the patient to obtain informed consent (HB 2090).

For more bills the WSMA successfully opposed, be on the lookout for the 2017 WSMA Legislative Report, our published overview of the legislative session, including: a session overview, session facts, a list of budget and policy bills by subject, a list of new laws impacting practice management (and their effective dates) and the WAMPAC vote tracker—a look at lawmakers’ votes on a number of WSMA’s priority bills so you can easily see how your local legislators weighed in on the issues important to medicine.

The WSMA Legislative Report will be mailed to members by mid-August. For more information on our legislative and regulatory advocacy on behalf of physicians, practices and patients, visit the WSMA Legislative Action Center.

Published 7/26/2017

Published 7/26/2017 

Free MQAC-approved suicide prevention training prior to WSMA Annual Meeting

In its final rule on the suicide prevention training requirement for physicians and other providers released earlier this year, the Medical Quality Assurance Commission clarified specific compliance requirements, allowing, as the WSMA strongly recommended, exceptions for physicians who have no, or limited, contact with patients. For those physicians providing direct patient care, the WSMA has joined with Physicians Insurance to offer in-person, suicide prevention training directly preceding the WSMA Annual Meeting in Seattle. Completion of this activity will meet the new Washington state requirement, providing the requisite training in recognizing and responding to these at-risk patients.

Assessment, Treatment and Management of Suicide will be held on Friday, Oct. 13, from 10 a.m. to 5 p.m. at the Hilton Seattle Airport & Conference Center, with lunch provided. The training is free for WSMA members and PI insureds. The training is also free for members of the Washington State Radiological Society, which holds its annual meeting on Saturday morning, Oct. 14, concurrent with the WSMA meeting.

Register for the free training when registering for the WSMA Annual Meeting, Oct. 14-15, also at the Hilton Seattle Airport & Conference Center in Seattle. The Annual Meeting is the association’s premier policy-making event, and features a full weekend of activities, including policy discussions, educational sessions and networking opportunities. The meeting is free for WSMA members, members of MGMA Washington, as well as residents and medical students. Learn more about the WSMA Annual Meeting on the WSMA website.

For a complete list of Medical Commission-approved suicide prevention trainings available to physicians and other providers, visit the Department of Health website.

Published 7/26/2017

Published 7/26/2017 

DOH sunrise review considers creation of new profession; could result in independent PA practice

The Washington State Legislature has requested that the Department of Health consider a sunrise review proposal to regulate a new health profession in Washington. If approved, a physician assistant would be able to practice medicine independently as a “Doctor of Medical Science.” DOH is currently accepting comments on the proposal.

The Doctor of Medical Science program would be a two-year degree program for physician assistants run by Lincoln Memorial University, a for-profit online college based in Tennessee. From the sunrise review hearing notice: “The Doctor of Medical Science program is a doctoral medical program that trains physician assistants in advanced clinical medicine and prepares them for clinical practice equivalent to a medical doctor in the practice discipline of primary care.”

The WSMA has major concerns with the proposal, foremost being the apparent equivalence of the advanced degree program’s Doctor of Medical Science with that of a Doctor of Medicine and Doctor of Osteopathic Medicine. The program would also be costly (LMU estimates tuition at $50,000) and yield little discernable benefit to either applicants or patients. We will include these elements, among other concerns, in our comments to DOH.

Comments on this sunrise review proposal are due Aug. 9 by 5 p.m. and a hearing is scheduled for Aug. 15. For more information on the Doctor of Medical Science sunrise review, please visit the DOH website. If you have any questions, please contact Trevor Justin at

Published 7/26/2017

Published 7/26/2017 

Reducing unnecessary care in Washington state: The 2017 Choosing Wisely Summit, Friday, Oct. 27

Join health care leaders, stakeholders and national Choosing Wisely® representatives in Seattle on Friday, Oct. 27 for a day-long, in-depth look at how the Choosing Wisely initiative in Washington state is moving from education to implementation. If your practice or organization is working to integrate Choosing Wisely recommendations into daily operations, this conference will give your team the tools and inspiration to implement change within your care setting. Learn more about the Choosing Wisely Summit and register on the WSMA website. This activity has been approved for AMA PRA Category 1 Credit™.

Published 7/26/2017

Published 7/26/2017 

WSMA proposes Clinical Data Repository summit to resolve concerns

As part of our ongoing efforts to monitor the state’s implementation of the Washington Link4Health Clinical Data Repository, WSMA and MGMA Washington leadership have provided feedback to the Health Care Authority and OneHealthPort, noting that physician practices and other providers are still faced with numerous technical and operational issues regarding the CDR and have many unanswered questions about the status, progress and problem-solving mechanisms available to provider organizations of all sizes.

As a constructive suggestion, our organizations have proposed that a “summit” be convened to give provider organizations an opportunity to meet with leadership from the Health Care Authority and OneHealthPort and reach an understanding of the status of the CDR and how to move forward. The format would be substantive, not merely informational presentations, to allow for problem-solving discussions that address the barriers being encountered in moving clinical data to the CDR. Participants would include clinical and administrative leadership from provider organizations as well as their HIT experts to address technical concerns. The proposed forum would also offer the opportunity to review concerns and potential risks of violating “privacy” and “confidentiality” protections when provider organizations submit clinical data.

Reaction from HCA leadership to convening the proposed forum has been very positive. We’ll keep you apprised. For questions, contact Bob Perna, director of the WSMA Practice Resource Center at or 206.441.9762.

Published 7/26/2017

Published 7/26/2017 

Volunteers needed for WSMA Judicial Council

The WSMA is accepting applications to fill two positions on the WSMA Judicial Council, the standing committee that meets as needed to interpret the medical ethics of the WSMA and to offer opinions to the WSMA House of Delegates. Terms on the council are for five years and members are limited to one term. Applicants must be current active members of the WSMA and must have been active members for 10 or more years. Applications can be sent to Shannon Bozarth ( at the WSMA Seattle office or faxed to 206.441.5863 no later than August 31. A curriculum vitae must be submitted with each application. For more information about the work of the council, contact Denny Maher, MD, JD, in our Seattle office at 206.441.9762 or

Published 7/26/2017

Published 7/26/2017 

CMS proposes changes to MACRA’s Quality Payment Program

The Centers for Medicare & Medicaid Services has released a proposed rule to update MACRA’s Quality Payment Program for 2018 and beyond, with the goal of simplifying the program, decreasing administrative burden and increasing flexibility, particularly for small, independent and rural practices. To help physicians and practices provide feedback to CMS, the WSMA is offering education on the proposed rule and the changes under consideration.

The proposed rule would amend some existing requirements and introduce new policies that would encourage participation in either of MACRA’s two payment pathways: advanced alternative payment models or the Merit-based Incentive Payment System. One key proposal is the introduction of “virtual groups” as a participation option, composed of solo practitioners and groups of 10 or fewer eligible clinicians who come together “virtually” with at least one other solo practitioner or group to participate in MIPS for a performance period of a year. WSMA staff is currently preparing a summary of these proposals for members’ review.

To help you understand the changes being proposed by CMS, WSMA has partnered with the Oregon Medical Association, the Idaho Medical Association and CMS Region 10 to present a free, one-hour webinar on Tuesday, Aug. 1 at noon. Dr. Nancy Fisher, chief medical officer of CMS Region 10, will be the lead presenter. Register online for this event.

Comments on the proposed rule are due to CMS by 5 p.m. on Aug. 21. For further guidance, be sure to review WSMA’s other MACRA resources, available on our dedicated MACRA webpage.

Published 7/26/2017

Published 7/26/2017 

HCA releases annual value-based payment survey

The Health Care Authority is requesting the participation of physician practices and other providers in a brief survey to assess how much revenue is currently being received through value-based payment arrangements. The survey will give the HCA insight into the challenges physicians and providers face as they consider adopting new payment arrangements and guide its health care purchasing strategies in support of overcoming those challenges.

The provider survey refers only to the 2016 calendar year. Completion of the survey should take no more than 30 minutes. HCA is seeking only one response per organization. Find the survey on the HCA website or download directly (submission instructions are included at the bottom of the survey). Survey responses are due by 3 p.m. on Friday, Aug. 25.

Regarding the survey, WSMA raised these points with HCA staff:

  • The term “value-based payment” should be more explicitly defined. HCA agreed to add a further description.
  • Regarding HCA’s use of these data and confidentiality, HCA commented:
    • “Section III.A includes the statement, ‘If you select "No" your responses will only be disclosed in aggregate or in accordance with public disclosure request laws.’
    • “The name of the Reporting organization is not next to the individual’s name but it is the very first question on the survey (I. A).”

Regarding the disclosure of revenue data, WSMA also commented that many health care organizations that are engaged in some form of shared savings models will likely have contracts with payers that include a condition of maintaining confidentiality of payment arrangements. HCA commented: “Since we are not asking for information by payer, we’re hopeful that that won’t impede the response.”

Published 7/26/2017