Source: https://wmc.wa.gov/rule_making_2019/renewal-fee-increase-allopathic-physicians-and-physician-assistants
Timestamp: 2020-06-04 00:21:40
Document Index: 631349770

Matched Legal Cases: ['ART403', 'art403', 'art403', 'art403', 'art403', 'art403', 'ART403', 'art403', 'art403', 'art403', 'art403']

Renewal fee increase for allopathic physicians and physician assistants | Washington Medical Commission
Home » Renewal fee increase for allopathic physicians and physician assistants
Renewal fee increase for allopathic physicians and physician assistants
Code Reviser (CR) Link:
RCW-WAC:
WAC 246-919-990
WAC 246-918-990
Christian M Gua... (not verified)- May 02, 2019 08:11 AM Reply
Writing to object the increase in license renewal fee. The fee will be a burden on me and colleagues, specially since my salary will remain the same and is not going to offset the increase in license renew fee that is proposed. I support WSMA which is deeply concerned regarding the ability to absorb such dramatic increase,in particular, clinicians that work in primary care and those serving in professional shortage areas whose salaries are not high enough to begging with. Melanie DeLeon, Director Washington Medical Commission, Department of Health P.O. Box 47866 Olympia, WA 98504-7866 Dear Members of the Washington Medical Commission: On behalf of the Washington State Medical Association (WSMA) and our more than 11,000 physician and physician assistant members, thank you for the opportunity to provide comment on the Medical Commission's CR-102 for an increase in renewal fees and late renewal penalties for allopathic physicians and allopathic physician assistants. While the WSMA understands a need for a self-sustaining program budget, the Washington Medical Commission’s (Commission) basis for a fee increase does not appear to be justified or sufficiently supported. Furthermore such a dramatic increase will financially impact the physician community, particularly on the heels of a legislative session that increased the B&O tax private practice physicians by 20%, further expanded liability laws, which may result in more litigation and an increase in professional liability coverage, and imposed costly IT mandates on medical practices. We must vigorously oppose this fee increase. Specific to the CR-102, the Commission fails to provide sufficient evidence and data to analyze and evaluate whether the fee increase is needed. In the fee narrative, the Commission asserts that the funding deficit is due to increased costs over time for credentialing, case management, discipline, call center functions, and a significant increase in disciplinary and litigation related costs over the last few years that “appear to now be normalized ongoing costs.” The information in the cost drivers, however, does not reflect a breakdown of data sufficient to verify the need for increased fees (e.g., actual cost for services, hours worked by number and type of employee, or actual number and type of cases processed, investigated, and litigated). Without this information, it is unclear where monies are being allocated and for what purpose, and the cost drivers do not provide sufficient evidence to demonstrate a clear need for increased fees. The Commission also fails to provide sufficient justification for the increase in costs for Attorney General (AG) services. The basis for the rise in AG costs is unclear. The Commission indicates that the cost for AG services has increased at an overall rate of 21 percent from FY 2015 to FY2018, and that it accounts for 59 percent of disciplinary spending. Disciplinary actions, including those that require AG services, have remained stable over the last four years.1 Without evidence of increased AG fees for service, or evidence demonstrating the basis for an increase in spending despite a stable workload, the need for a fee increase does not appear to be justified. Moreover, based on the information provided in the cost drivers, there also does not appear to be an increase in other costs sufficient to warrant the need for such a substantial fee increase. The Commission fails to show that its other revenue is insufficient to cover costs and fails to justify a fee increase. The evidence used to demonstrate budget deficit does not reflect monies from other sources that offset costs. By our read, the 2017-18 state budget provided a special allocation for the Commission in the amount of $2,604,000 for increased workload, and the 2019-21 budget allocates $2,151,000 for AG legal services and increased billing costs as a result of increased discipline and litigation costs. Additionally, the evidence does not reflect cost recovery, which was enacted to, “level out discipline costs, which makes them more sustainable, predictable, and can mitigate the need for larger fee increases over time.” 2 The WSMA recognizes that cost recovery and funding provided by the legislature is not as predictable as revenue raised by application and active renewal fees; however, the WSMA is concerned that the exclusion of this information results in an incomplete financial picture and raises concerns about the validity of the Commission’s predicted budget deficits. More broadly, given the considerable recent special appropriations from the Legislature for the Commission, if the Commission’s financial picture is as bleak as it’s portrayed, we would question the prudence of its budgeting practices. The Commission has not demonstrated that fees are being increased no more than necessary. In addition to our concern about the physician and PA communities’ ability to absorb such a dramatic increase in their fees, we take issue with the statement that such an increase would obviate the need to revisit fees for ten years. Increasing fees to satisfy projected needs for a period of ten years suggests that initially the fee would generate more revenue than is actually needed to accommodate the Commission’s current needs. We acknowledge that raising licensure fees is a difficult endeavor, but expediency is not a valid rationale for developing budgeting policy. We question the need for the Commission to advance such a dramatic increase and advise that the approach be reconsidered. The increase also runs contrary to the best practices outlined by the State Auditor’s Office (SAO) Performance Audit – Aligning Healthcare Professional Fees with Licensing Costs, which specifically advised the Department of Health to, “review and adjust fees for each profession with sufficient frequency to ensure they fully cover costs that provide sufficient but not excessive reserves, and that they do so for that profession only.” Raising more revenue than needed could put the Medical Commission in a compromised position. As the SAO report iterates to the agency, RCW 43.70.250 “prohibits DOH from using one profession’s fee revenues to pay for another professions’ costs.” The WSMA has deep concerns that such a fee increase could put the Medical Commission in the position of subsidizing the costs of other professions if it has healthy reserves; a very real possibility for the first few years that the fee is enacted. Finally, it isn’t clear what role the expenses associated with the “Healthcare Enforcement and Licensing Modernization Solution” play in the fee increase. If that cost is a part of this fee increase proposal, we need more transparency to understand what role it plays and what steps the Commission is taking to ensure that our members are paying only their fair share. We appreciate your consideration of these comments. For questions, please do not hesitate to contact Katie Kolan, Senior Director of Government Affairs and Policy at kak@wsma.org. Sincerely, Tom Schaaf, MD, MHA WSMA President
DEEPSHIKHA DATT... (not verified)- May 03, 2019 01:15 PM Reply
I would like to express my strong opposition to the proposed license renewal fee increase. If accepted this measure will make WA State less attractive for incoming physicians and will definitely have large impact on providers practicing in the state. I hope that commission will reconsider this proposal.
Leslie E. Waters MD (not verified)- May 03, 2019 02:18 PM Reply
While I appreciate the difficult work of the Medical Commission, I cannot support a fee increase of this magnitude. Every branch of medicine and every department involved in medical care delivery has been called upon to tighten their belts, provide more care for less reimbursement, and do more work (documentation, meaningful use, prior authorizations) while still needing to spend money on requirements such as CME, DEA, professional organizations and licensing. WMC should likewise keep expenses in line with revenues. A surprise doubling of fees (including renewals, which should cost less, not more than the original application) reflects a lack of attention to the bottom line over the last few years. The startling lack of a cost-benefit analysis is unacceptable in the face of such a large increase. I recommend a much more modest increase in fees, especially renewals; a transparent cost-benefit analysis; aggressive cost-control within the WMC; and if an increase is still required, it should be factored in over several renewal cycles, not imposed suddenly and without warning. Large fees such as these are part of our overhead and need to be budgeted like any other expense. Respectfully submitted, Leslie E. Waters M.D.
SAUMYAJIT DATTA (not verified)- May 03, 2019 08:47 PM Reply
Why are physicians being picked on. Are you also increasing the licensing rates for accountant, dentist, lawyers among other professionals. I would oppose this rate increase.
achart (not verified)- Nov 07, 2019 06:01 AM Reply
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