On the evening of June 4, State Sen. Jeannie Darneille of the 27th District that includes most of Tacoma, a majority member of the State Senate's Behavioral Health Subcommittee, met with the PCMS Board of Trustees and Executive Director Bruce Ehrle for 90 minutes.
The discussion focused primarily on behavioral health issues at a time when primary care physicians are being tasked with behavioral health care integration, when pediatricians and family practitioners are spending more time than ever on behavioral health issues in a challenging reimbursement environment, and when ER physicians are still dealing with patients who would be better off getting care in more appropriate and cost effective settings. Sen. Darneille briefed the Board about further measures that the state legislature took during this year's session to address the behavioral health access crisis in the State of Washington.
The lengthy discussion included points about how as behavioral health issues are increasingly detected as more is known about conditions and as substance abuse problems especially relating to opioids remain high, capacity shortcomings become even more acute--and that even with measures passed thus far and new facilities either being opened or planned, much remains to be done to reach a point where providers have the referral resources they need to provide fully integrated care for their patients. The Board noted that some practices have reduced their referral times for behavioral health to 10 days or less as part of their integration efforts but that has been done in some instances through extraordinary measures with those referral sources increasingly reaching capacity if they are not there already.
Sen. Darneille commented that even with the work that the legislature has pursued in the last two sessions, additional resources would also be obtained if the leaders in Pierce County would agree to the permitted 0.1% sales tax increase to earmark funds for mental health and substance abuse treatment. She urged PCMS to have a voice along with other community based organizations in pressing for those needed funds to help address the care crisis.
The PCMS Board asked Sen. Darneille and her colleagues to be aware of the high stress levels that the provider community is facing during an era of increased patient volume, added administrative burdens, and adjusting to massive payment reforms. It was stressed that when physicians are being tasked with new areas of care such as behavioral health integration and addressing social determinants of health, having the legislature target a B&O tax increase at doctors and increasing their liability as was done in this most recent session makes succeeding at those new areas of care more difficult--and seems to send a message to the physician community that the legislature feels that the profession is not facing those immense challenges.
Sen. Darneille responded that she had a positive history with PCMS when she was a leader at the Pierce County AIDS Foundation and that what physicians and PAs do along with other providers to heal patients can't be appreciated enough. The Board encouraged her to spread that message in Olympia as we seek partnership with elected officials to address care issues in a way that permits the physician profession to be robust in to future years.
On another topic, PCMS Members should be aware that beginning yesterday, June 6, the rules relating to VA patients changed to permit enhanced access to private care. VA beneficiaries may now seek care for acute illness or injury at a private urgent care facility. Additionally, the distance and wait-time guidelines concerning when they may seek care in the private provider community changed as of yesterday too. Now, veterans who drive more than 30 minutes to a local VA care facility (this was changed from a miles-based rule to acknowledge traffic congestion) or are made to wait more than 20 days (the old rule was 30 days) for a primary care or mental health appointment at a VA facility may be eligible to seek private care. If they drive more than 60 minutes to a VA facility or are made to wait more than 28 days for a specialty appointment, they may be eligible to seek private care.
While PCMS applauds this latest effort to help our nation's patriots receive the care they deserve, the Society has noted to policymakers that in a locale such as Pierce County with its large veteran population, civilian capacity is also stretched so there may be no magic in scheduling appointments when compared to the VA, that the exchange of medical records between civilian providers and the VA remains a tremendous challenge that needs to be fixed, and that VA reimbursement rates and timeliness of payment are such that many providers will simply not take VA Choice patients on--and those rates need to be increased and those payment delays need to be reduced if these measures to enhance veteran access to care are to be fully successful.