WHITE SULPHUR SPRINGS -- Doctors must be involved in developing West Virginia's health insurance marketplace, the president of the American Medical Association said Saturday.
"The AMA has been very vocal in how we want health insurances exchanges to work," Dr. Ardis Hoven, president of the national physician's organization said at a meeting of the state medical association. "One of the important elements is that physicians have to be directly involved in the government structure of the exchange.... Nobody else can do it. We know how to do it."
Hoven, of Lexington, Ky., spoke at the WVSMA's Healthcare Summit Saturday at The Greenbrier resort in White Sulphur Springs.
Hoven said the Affordable Care Act is not perfect, but "it was the only available vehicle to reach some important goals in health care."
The law promotes coordination of care, improving quality and investing in prevention, Hoven said.
Hoven said the AMA is available to assist physicians in states like West Virginia that have chosen to expand Medicaid. In those states Medicaid will be available to those who earn less than 133 percent of the federal poverty level, currently about $28,000 for a family of three.
Gov. Earl Ray Tomblin announced the Medicaid expansion in May. Officials estimate that 91,000 state residents will gain access to health care under the expanded Medicaid program.
"We're working with physicians and states that want to expand Medicaid through our advocacy resource center at the AMA," Hoven said. "If states are interested and physicians are interested we will come. We will work with you, boots on the ground, to help with the Medicaid program as well."
Hoven said she's optimistic about a bill that would revamp the way that physicians are paid for Medicare patients.
"Getting [the Medicare sustainable growth rate formula] repealed is something for physicians that is a very big deal," Hoven said. "I will tell you that I am the most optimistic I have ever been about us being able to get SGR repealed."
If not reformed, the sustainable growth rate formula threatens to cut physician reimbursements for Medicare patients by 25 percent beginning in 2014.
Congress has consistently passed short-term fixes to override the formula and keep reimbursement rates relatively stable.
The bill, called the Medicare Patient Access and Quality Improvement Act of 2013, recently passed the House Energy and Commerce panel, according to the Medical Association's website.Reach Lori Kersey at lori.ker...@wvgazette.com or (304) 348-1240.