Addressing Unmet Medical Need Through Changes in Medical Licensure Law

1. Addressing Unmet Medical Need Through Changes in Medical Licensure Law 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. Introduction Objectives Unmet need for basic dental, optometric and medical care is a problem in Ohio, especially in the southeastern part of the state 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 Background 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 Results Conclusions Patience and persistence are key in advocacy • Informing stakeholders of the issue, gathering their input, and seeking consensus are very-time consuming • The legislative process is very slow 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 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 - hoguetr@gmail.com Dr. Robert Fulton, MA, DDS, FADI - norway330@windstream.net Valerie Lindon Tracey, RN, BSN - lindontracey@gmail.com 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, policyand 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 Ramsay M. Hoguet, JD, MPH Median income by county, 2009. Medicaid members per provider, 2009.