by Tabitha Mueller, The Nevada Independent, February 23, 2023
In a letter obtained by The Nevada Independent, Gov. Joe Lombardo’s office said it does not support two bills proposed by the Patient Protection Commission and is evaluating a third piece of legislation proposed by the commission, which was created under the Sisolak administration.
One measure the Republican governor’s office said should not move forward is AB6, which would establish into law an executive order former Gov. Steve Sisolak signed in 2021 requiring a health care cost benchmark. The benchmark is aimed at capping health care cost increases; the state’s goal is to keep growth under 3 percent in 2023. The 2021 order is in place unless Lombardo issues a separate executive order rescinding it.
Another bill the governor’s office said they would not support is AB11, which would prohibit a hospital or psychiatric hospital from employing a full-time physician for the purpose of practicing medicine. Many doctors practice as independent contractors. The law would not apply to community hospitals or academic institutions.
“We are asking that you and other members of the Commission do not work to advance those two bills during the Legislative session,” Chief of Staff Ben Kieckhefer wrote to members of the commission.
The letter from Kieckhefer did not detail issues with the legislation or the governor’s concerns. In an email Wednesday, a spokesperson for Lombardo’s office said the proposals were created under Sisolak’s leadership and “did not align with Governor Lombardo’s health care policy priority of ensuring that Nevada has a robust and growing health care workforce to serve its citizens.”
Both pieces of proposed legislation have been opposed by the Nevada Hospital Association. Patrick Kelly, president and CEO of the association, said that with a shortage of physicians, the state should not be eliminating employment opportunities for doctors wanting to work in Nevada.
Kelly said Nevada ranks lowest in access to health care, and argued that capping health care cost growth would hurt communities lacking access.
“In a state with low access, we can’t cap expenditures because we can’t expand access without being able to spend more money,” he said.
The Legislature formed Nevada’s Patient Protection Commission during the 2019 session after Sisolak promised the concept during his 2018 campaign. It exists within the Department of Health and Human Services and consists of 12 members representing health care professionals, advocates and industry leaders. Under Nevada law, the commission may request the drafting of three bills in a legislative session.
Over the last two years, the commission has worked to establish a benchmark aimed at limiting health care cost growth by a certain percentage each year as determined by the director of the Department of Health and Human Services.
The bill submitted by the Patient Protection Commission does not include penalties for costs exceeding the benchmark, and a brief on health care cost benchmarks says the policy is a way to track increases and promote accountability. Following the implementation of Sisolak’s executive order, members of the commission participated in the Peterson-Millbank Program for Sustainable Health Care Costs to design the benchmark policy.
It wasn’t immediately clear whether Nevada would continue participating in the program if the health care cost benchmark is not codified into law.
At a June meeting of the commission, members said the proposed legislation prohibiting hospitals from hiring doctors addresses a lack of clarity in statute and aligns with a 2010 opinion written by then-Attorney General Catherine Cortez Masto.
“It has been the longstanding practice in Nevada that physicians only work as contractors for private hospitals, and not as employees,” Cortez Masto wrote in the opinion. “To depart from this practice would mark a significant change that would be tantamount to a change in state public policy, best accomplished by either statutory or regulatory revision.”
In an August discussion about their bill draft request, members of the commission said hospitals have been hiring physicians, which reduces the number of independent doctors working at multiple hospitals. They said retaining a specific provider could also exacerbate a shortage of specialized care providers. Employing doctors also means patients are directed to specific hospitals, reducing consumer options, they said.
In the letter sent to the commission, Kieckhefer said the governor’s office was reviewing AB7, a third measure proposed by the group that would seek to expand immunity from certain liability for health care providers who use a health information exchange, or an exchange allowing health care professionals and patients to securely share and access a patient’s medical record.
“We appreciate your work and look forward to having conversations regarding protecting patients in Nevada in the future,” Kieckhefer wrote.
Members of the commission could not be immediately reached for comment.
Disclosure: This story about the Patient Protection Commission was edited by Assistant Editors Michelle Rindels and Tom Tait. Sara Cholhagian Ralston, a commission member, is married to Nevada Independent CEO Jon Ralston.