Advocacy Update

Aug. 25, 2023: State Advocacy Update


Virginia’s health systems continue to revise their credentialing applications to remove stigmatizing questions about mental health and substance use disorders. Valley Health, which serves the Northern Shenandoah Valley of Virginia, the Eastern Panhandle and Potomac Highlands of West Virginia, and western Maryland, recently made the revisions following discussions with the AMA and Dr. Lorna Breen Heroes’ Foundation.  

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“We have made physician health and wellness a priority for our system,” said Iyad Sabbagh, MD, MPH, Valley Health’s chief physician executive. “Changing our credentialing application is part of our work—we are now committed to communicating the changes to our physicians and other health care professionals to help them know we support them if they need care for health or wellness.”

Among the helpful changes Valley Health made was to remove a question requiring disclosure of medication being taken and to add two questions per a new Viriginia statute, Senate Bill 970, which was enacted earlier this year and supported by the Medical Society of Virginia and the AMA. The bill required that health regulatory boards include two questions on their applications, but Valley Health used the questions to replace its formerly stigmatizing questions. The questions required by SB 970: 

(i) Do you have any reason to believe that you would pose a risk to the safety or well-being of your patients or clients? and (ii) Are you able to perform the essential functions of a practitioner in your area of practice with or without reasonable accommodation? 

If you are interested in learning more about AMA advocacy to help health systems revise their credentialing applications, please contact [email protected]

Facing a number of concerning proposals, the Washington State Medical Association (WSMA) saw a very successful legislative session when it comes to scope of practice this year. 

WSMA received grant funding from the Scope of Practice Partnership (SOPP) to bolster their scope of practice advocacy and defend against legislation proposing inappropriate scope expansions. Up against scope bills impacting advanced practice registered nurses, optometrists, psychologists, naturopaths, pharmacists, physician assistants and other nonphysician practitioners, and facing significant turnover in Washington’s state legislature and increasing pressure around access to care, WSMA confronted a challenging scope of practice landscape. Still, in short order WSMA defeated at least seven concerning scope of practice bills this legislative session—nearly all of those introduced in the legislature.  

One defeated bill would have authorized pharmacists to diagnose and treat patients over the pharmacy counter. Pharmacist “test and treat” bills like this one exploded across the country in 2023. These bills typically involve authorizing pharmacists to prescribe medications based on the result of certain CLIA-waived tests. They are of grave concern as pharmacists are not trained to diagnose patients and not equipped to take on the role of primary care provider. Washington’s law was one of the more expansive of the test and treat bills proposed in state legislatures this year: it would have allowed pharmacists to prescribe for “short-term health conditions” including but not limited to urinary tract infections and unspecified “respiratory illness, condition, or disease.” The bill died in Washington. Nationally, only a few of more than 20 test and treat bills introduced this year have passed. 

Notably, another bill proposed in Washington would have removed physician supervision requirements for physician assistants, establishing collaborative practice instead. As is the case with the pharmacist test and treat bills, state legislatures also saw a sharp uptick in legislation to weaken supervision requirements for physician assistants this year, with at least 22 such bills introduced across the country. WSMA’s advocacy helped to defeat this bill in Washington. 

Among other legislation defeated by WSMA were bills to extend prescribing privileges to certain psychologists, to increase the prescriptive authority of naturopaths, and to establish equal reimbursement for APRNs and physicians. A bill expanding scope of practice for optometrists passed in Washington over the objections of WSMA, the AMA (view letter of opposition (PDF) ) and the physician community, however the bill was successfully amended to remove the ability of optometrists to perform laser procedures. 

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