Transcript Addressing Unmet Medical Need Through Changes in Medical Licensure Law Ramsay M.

Addressing Unmet Medical Need Through Changes in Medical
Licensure Law
Ramsay M. Hoguet, JD, MPH
Introduction
• The “medical mission” model alleviates some unmet
medical need by bringing together volunteer
dentists, doctors, optometrists and other providers.
• The state-by-state licensure system for health care
providers is a substantial barrier to volunteerism and
hampers the ability of medical mission organizers to
recruit volunteers.
• Several states have created volunteer licensure
mechanisms that ease the administrative burden of
volunteering across state lines.
• Ohio’s medically needy citizens, in both its rural and
urban areas, would benefit from increased medical
volunteers and medical mission style care.
Objectives
• Develop a volunteer licensure mechanism for
Ohio
• Gather input from relevant stakeholders,
negotiate details of the proposal, seek
supporters and discover sources of opposition.
• Address ethical, policy and political concerns
• Approach the Ohio General Assembly with a
legislative proposal:
• Start the legislative process
• Seek a legislative “champion”
• Draft legislative language
• Continue to advocate for passage of legislation
Background
Conclusions
• Unmet need for basic dental, optometric and medical care is a problem in Ohio, especially
in the southeastern part of the state
• Patience and persistence are key in advocacy
• Informing stakeholders of the issue, gathering
their input, and seeking consensus are verytime consuming
• The legislative process is very slow
• The “medical mission” model of care utilizes volunteer dentists, optometrists, doctors, etc.
during temporary events to provide free care, mainly consisting of:
• Oral hygiene procedures – cleanings, fillings, extractions
• Vision testing, prescriptions and free eyeglasses
• Limited medical diagnoses, treatment and Rx drugs
• A substantial amount of care has been provided in the US through medical missions. As of
Feb. 2012 one organization has had
• 660 missions
• 270,000 patient encounters
• Provided $52 million in charity care
• Legislation in several states creates a streamlined mechanism for out-of-state providers to
volunteer to needy people. The volunteer must:
• Prove to the sponsoring organizations or licensing board that she is licensed in a US
jurisdiction
• Not charge patients or 3rd parties
• Not regularly practice
Median income by county, 2009.
Medicaid members per provider, 2009.
• Be prepared for opposition
• Expected opposition from professional societies
and licensing boards has not yet materialized –
in fact, some support
• Opposition may arise from allies - concern
about the model of care and limited resources
for charities
• Volunteers, space medical equipment
• Media attention, funding sources
• Political action, attention from policy
community
• Legislators will not move until they know where
stakeholders stand
• Be prepared to negotiate details of the proposal,
keeping in mind broad goals
Results
• Developed general consensus among stakeholders
• The medical mission model could provide small but clear value to medically underserved people in Ohio
• Medical volunteerism is no substitute for more comprehensive reform
• Discovered sources of concern among stakeholders
• Volunteers must be screened in some way to protect public
• Medical missions must be planned and operated with community support and involvement
• Patients must be referred to permanent sources of care
• Medical missions may be more appropriate in rural areas than urban ones
• Advocated for passage of a volunteer licensure mechanism
• Built a coalition of advocates including some in public health, medical / dental / nursing / optometric
professions
• Presented the issue to Ohio legislature, licensing boards, professional societies
• Advocacy will continue in new legislative session after elections
• Drafted
•
•
•
•
the “Ohio Volunteer Health Care Provider Licensure Act” bill, which provides for:
Volunteer license mechanism for out-of-state providers
Requirement for medical mission to coordinate with local health dept., screen potential volunteers for discipline
Medical mission must refer patients to safety-net care in the area where the mission is held
Application of existing liability protections to volunteer licensees
References
Health Policy Institute of Ohio and Ohio Department of Jobs and Family
Services. (2010). 2010 Ohio Medicaid Atlas.
DeNavas-Walt, C., Proctor, B. D., & Smith, J. C. U.S. Census Bureau, Current
Population Reports, Income, Poverty and Health Insurance Coverage in the
United States: 2009. United States Printing Office, Washington, DC, 2010.
Tenn. Stat. §63-6-701 et seq.
20 Ill. Comp. Stat. §2105/2105-355
Okla. Stat. §59-493.5
Notes of author’s phone conversations with leaders of charitable organizations,
representatives of professional groups, and state officials, on file with author.
Acknowledgements and Contact
Thanks
Prof. Jessica Berg, JD, MPH
Dr. Willie Oglesby
Prof. Duncan Neuhauser
Dr. Scott Frank
Contacts
Ramsay M. Hoguet, JD, MPH - [email protected]
Dr. Robert Fulton, MA, DDS, FADI - [email protected]
Valerie Lindon Tracey, RN, BSN - [email protected]