HD64 - Annual Report of the Joint Commission on Health Care

Executive Summary:

Authority for Study

The Joint Commission on Health Care was created by the 1992 Session of the Virginia General Assembly, pursuant to Senate Bill 501 and House Bill 1032. This sixteen-member legislative commission, with a separately staffed agency, continues the work of the Commission on Health Care for All Virginians (Senate Joint Resolution 118, 1990 Session).

1994 Commission Activities

The Joint Commission held nine meetings in 1994, as well as two additional meetings in January, 1995, prior to the 1995 Session of the General Assembly. All meetings were held at the General Assembly Building in Richmond. In addition to the agenda items identified below, monthly staff reports were presented at each meeting.

At the May 2nd meeting, the current status of Joint Commission on Health Care initiatives, as well as the status of the Joint Commission's 1994 legislation, was reviewed. Additionally, the workplan for 1994 and the 1993 Annual Report were presented and reviewed.

The May 23rd meeting included an interim report on the feasibility of implementing a health insurance purchasing cooperative in Virginia. Follow-up reports on organized health services delivery systems, specifically solvency requirements for Community Health Networks, and anti-trust immunity for health care providers were presented. A case study of TENNCARE, a Medicaid capitation program in Tennessee, was also presented.

A new Chairman and Vice Chairman were elected at the June 27th meeting in accordance with a policy to rotate these positions among the House and Senate every two years. Delegate Jay W. DeBoer was elected Chairman and Senator Elliot S. Schewel was elected Vice Chairman. ·A summary of the public comments received on the issues presented at the May 23rd meeting was provided. In addition, an analysis of indigent hospital care in Virginia and a case study of Maryland were presented. F. Reid Cushman, Senior Associate of the Virginia Health Policy Research Center, presented an interim report on hospitals' contribution to the community.

The August 1st meeting included reports on: (i) the impact of the "any willing provider" statute on the cost and quality of health care in Virginia; (ii) the impact of managed care practices on independent medical laboratories; (iii) the impact of defensive medicine; and (iv) the optimum use of nurse practitioners.

A summary of the public comments received on the four studies presented at the August 1st meeting was provided. John E. Jones, M.D., Vice President for Health Sciences at the Medical College of Virginia (MCV), presented a status report on the MCV Hospital Downsizing Initiative. Lastly, an overview of key health care issues was presented, including information regarding: (i) the current trends in health care financing and delivery; (ii) the major national health care reform proposals; (iii) the Commonwealth's various health care roles; and (iv) the goals for health care reform in Virginia.

At the September 26th meeting, status reports on regulations governing neonatology units and child health initiatives were provided. In addition, a report on school-based health insurance programs was presented as well as an overview of health insurance reform issues and information regarding access to care for the uninsured.

A summary of the public comments received on the reports presented at the previous meeting was provided during the October 24th meeting. Ms. Margaret E. O'Kane, President of the National Committee for Quality Assurance (NCQA), gave an overview of the quality assurance efforts of NCQA, and suggested ways in which states can measure and improve the quality of health care plans and services. Finally, summaries of key cost and quality issues and health workforce issues also were presented.

The November 7th meeting included a presentation by Kay Coles James, Secretary of Health and Human Resources, and Robert C. Metcalf, Director of the Department of Medical Assistance Services, on the reorganization of long-term care services. Mr. Metcalf also presented a report on incentives to .purchase long-term care insurance and an update on the implementation of PACE (Program of All-Inclusive Care for the Elderly) pilot programs in Virginia. Paul E. Parker, Director of the Office of Resources Development in the Department of Health, presented a study of the moratorium on the issuance of certificates of public need for nursing home beds. Lastly, Mr. Metcalf and Carol A. Brunty, Commissioner of the Department of Social Services, presented a status report on past long-term care initiatives.

During the November 28th meeting, a summary of the public comments received on the long-term care reorganization plan was presented. In addition, Joseph M. Teefey, Deputy Director of the Department of Medical Assistance Services, and Barbara S. Brown, Director of Clinical Information Systems with the Virginia Hospital Association, presented a report on the "Medicaid Hospital Length of Stay" initiative. A summary of each issue studied by the joint Commission during 1994, along with a recap of the options presented for addressing each issue, was provided.

A report on hospitals' contribution to the community was presented at the January 9, 1995 meeting. Recommendations regarding each of the various issues studied by the joint Commission throughout 1994 as well as potential legislation to be introduced during the 1995 Session of the General Assembly also were presented. At the January 16, 1995 meeting, the public comments received on the hospital study were summarized. Also, final decisions regarding potential 1995 legislation were made.

Individual Study Reports Published by the Joint Commission on Health Care

The Joint Commission conducted numerous studies throughout 1994. In past years, the joint Commission incorporated the written reports from each study into the annual report. However, in 1994, the joint Commission prepared a separate report on each study that was conducted pursuant to a study resolution. These reports, called "issue briefs," were presented to the Joint Commission at its monthly meetings.

Copies of each issue brief were distributed to persons attending the meeting at which the study was presented to the Joint Commission, as well as other interested parties who requested a copy. Public comments were received on each issue brief and presented to the joint Commission at the next monthly meeting. Following the public comment period, each issue brief was finalized and printed as either a House or Senate Document. Figure 1 identifies each of the Joint Commission's studies which were printed as separate documents.