During my term as President of the Virginia Society of Plastic Surgeons, I have been exposed to how new health care related regulations are developed in Virginia and it has been an eye opener. Let’s take a look at the current effort to produce limits on physician healthcare practices in Virginia as a case study. This will show us the steps and the time course of this process.
The current proposal for regulatory change seeks to:
• Establish a volume level of local anesthetic above which the anesthetic regulations would apply.
• Modifications of limits on lidocaine use for tumescent liposuction and removal of supernatant fat.
• A limit on the maximum duration of combined surgical procedures.
• Defining a reasonable proximity to a transfer facility to a specific transport time.
• Improved transparency requirements for the physician’s training and certification status.
The proposal was made by the Richmond Academy of Virginia (RAM) to the 2011 Medical Society of Virginia (MSV) legislative session in the spring of that year. The legislative session of the MSV has representatives from the breadth of physicians in Virginia, primary care and specialists. They saw merit to the proposal and convened a task force to examine issues related to the office based surgeries. Having the support emanate for the RAM helped to successfully win approval for the proposal but a proposal could have come from almost any source.
After several meetings which included the MSV staff and physicians representing plastic surgery, family medicine, pediatrics, anesthesiology, otorhinolaryngology, and orthopedic surgery it was agreed that several recommendations be presented to the MSV Board.
This approval of the MSV board took place in 2013. Although some of the delay from 2011 till 2013 was consumed in gaining consensus of the taskforce, most of the delay was related to other political issues that consumed the MSV’s attention. The proposal was placed on the back burner to allow the MSV to focus on health related issues deemed to be of more immediate importance to members of the MSV.
A comment on the role of the MSV is needed here. MSV support is almost essential to successfully achieving health care related regulatory change in Virginia. Without the mark of approval of the MSV, the commonwealth is less apt to enact change. The commonwealth looks to the MSV as spokesman for the majority of physicians in Virginia. If the majority of physicians are seen as supporting healthcare related regulatory change then governmental support is more likely.
The next step in the process is the presentation of the recommendations for regulatory change by the MSV to the Board of Medicine (BOM). If accepted by the BOM, the promulgation of regulations will begin. This includes the issuance of a Notice of Intended Regulatory Action and the ability of the public to offer comments to the Board. The Board will then draft proposed regulations, comment will be received on them and the Board will vote as to whether they want to adopt the draft. Our society will be involved in shaping the details as much as the system will allow. Once the draft is adopted it is sent to the Office of Planning and Budget, the Attorney General, and then finally the Governor for approval. It should be noted that this can be a lengthy process.
Regulatory change is a lengthy process. Multiple parties with different viewpoints are involved. The only alternative to this lengthy process is being satisfied with the status quo.
I would like to see our next effort for regulatory change to begin this spring at the 2014 legislative session of the MSV. Limitations in the use of “Board Certification” in advertising by physicians would protect the citizens of Virginia from being misled. The American Board of Medical Specialties (ABMS) has required a rigorous process of review and testing be carried out before awarding “Board Certification” to a physician for many years. . This mark of approval and accomplishment is being usurped by organizations offering board certification with significantly reduced standards.