Indiana House committee trims down Senate health care process bill

A Senate proposal with multiple provisions to ease the health care process looks a lot simpler following a flurry of House committee amendments.

As passed by the Senate chamber, Senate Bill 400 included an alternative licensing path for students who don’t match with a residency and revoked a dental compliance fee – the latter of which is moving in a separate House motion.

The bill still includes a pilot program for state employees that eases the prior authorization process for certain health services as well as a requirement for emergency departments to have a physician on site when open. Current law allows for a physician to be on call, rather than physically present. 

The proposal, authored by Sen. Liz Brown, R-Fort Wayne, passed out of committee unanimously.

What’s changed in the bill?

Public Health Committee Chair Brad Barrett, a retired physician from Richmond, introduced five amendments to the bill and praised the cooperation between various health care factions to negotiate a middle ground. 

Barrett, a Republican, noted that the removal of the associate physician language, which created a new license for medical students who don’t match with a residency, occurred at the same time that many students “matched” with their various residency programs.

“In the event that students don’t match, this was to create a category for them to get clinical experience,” Barrett said. “But now that we vetted this with many of the providers, it’s come to a realization that it’s not quite the format we’d prefer at this time.”

Additionally, the committee opted to add language to require insurance policies to cover wearable cardioverter defibrillators – an external version of a device that allows patients to go home while they wait to get the internal version placed.

Manesh Parikshak, a cardiovascular surgeon practicing at Franciscan Health, said there are 500,000 sudden cardiac deaths annually in the United States where one’s heart abruptly stops.

He used the recent and highly publicized collapse of Buffalo Bills player Damar Hamlin, who had a cardiac event on live television. Parkishak said most, between 85-90% of Americans, who suffer similar health emergencies don’t survive.

“It was witnessed, there was immediate CPR and he was defibrillated and that’s why he’s alive,” Parikshak said. 

Patients, after a set period of observation, can go home with a wearable defibrillator – a vest that has electrodes to monitor the heart. After 90 days or so, patients can get an internal defibrillator placed. 

“Patients will pass out (from a sudden cardiac death) but the vest will take over and basically defibrillate and bring them back. And it’s highly successful at doing that,” Parikshak said. “It’s peace of mind for me… but also peace of mind for the patient and their family.”

But Parikshak said that some insurance plans don’t cover the treatment, meaning patients spend that time in a hospital instead.

What’s still in it?

One area that’s attracted much attention is the portion on prior authorization, a process in which an insurer guarantees payment for a service to a provider. But both sides agree the time-consuming process needs to be reformed.

Brown’s bill initially included a set of Current Procedural Terminology (CPT) codes that all insurers were required to cover without utilizing the prior authorization process, including some prescriptions. But amendments on the Senate side limited that to a pilot program for certain health services – such as dermatology and imaging scans – for state employees.

Physicians – both those testifying and those serving on the committee – highlighted the inclusion of prior authorization language, which they say has burdened doctors and taken them away from patient care.

“Prior authorization… is a constant hurdle and barrier to care and getting care in a timely fashion,” said Dave Welsh, a Batesville surgeon speaking on behalf of the Indiana State Medical Association. “From a workforce perspective, prior authorization is one of the major causes of physician burnout. This is a serious problem.”

Earlier this month, the American Medical Association released survey results from its members documenting several negative impacts of the process, including patients who abandoned their care or had to be hospitalized due to delays. According to the organization, the average physician spends 14 hours, nearly two weekdays, completing prior authorizations.

Many health care systems hire separate staff members solely to handle prior authorizations, something they say increases their payroll costs.

The bill also includes a process for provisional credentialing, meaning newly employed physicians can get their accreditations with insurers sooner, while awaiting a permanent version, and start practicing medicine. 

The bill now moves to the full chamber for further consideration.