Doctors, physician and nursing assistants would pay more to practice under new Washington rules

Washington state regulators plan to increase the fees doctors and physician assistants must pay to renew their license to practice, citing increased costs tied to discipline as the primary cause of double-digit hikes.

The increases are among the first revisions to licensure fees for health care professionals in a phased approach that could affect the tens of thousands of health care workers in Spokane County. The state Department of Health will hold a public meeting on the fee increases in Tumwater next week, amid pushback from the trade group representing the state’s practicing physicians who say the agency hasn’t yet made its case that the hikes, between 54 percent and 96 percent, are urgently needed.

“What we’re really trying to do is become a lot more open about how we’re doing business,” said Martin Pittioni, director of the Office of Health Professions at the Washington Health Department. “We’re trying to have a conversation before we actually file the formal rules document.”

The department has given notice that the renewal fee for medical doctors would increase to $1,012 for two years beginning in October, up from its current level of $657. That’s an increase of 54 percent in a fee that has remained flat since 2012, and was just $400 in 2005. For physician assistants, the increase is even greater, jumping to $396 from $202, an increase of 96 percent.

At the region’s largest health service providers, that cost will be borne by the institutions, not the doctors themselves. Providence Medical Group fully covers the licensing costs of the health care providers it employs, said Liz DeRuyter, director of external communications at Providence in Spokane.

Those providers that operate independently, but are credentialed to practice at Providence facilities, would be responsible for paying the increased fee themselves.

The proposal raised eyebrows at the Washington State Medical Association, the professional organization representing 11,000 physicians, physician assistants and medical students throughout the state. In November, their organization submitted a letter to the Health Department questioning the need for the fee hikes.

“We would like to see something predictable and understandable,” said Katie Kolan, director of legislative and regulatory affairs for the association. “There may be reasons why they need a fee increase, we just have questions about the amount and the timing of it.”

The request to increase fees not only for physicians and physician assistants, but also nursing assistants, chiropractors, massage therapists and animal massage therapists comes a few months after the Washington State Auditor’s Office released a report indicating that the regulatory fees collected from members of some health professions were subsidizing the costs of others in violation of state law. The Health Department sets the licensing fees for dozens of different professions and collects that money in the same account, which is supposed to cover the cost of credentialing new professionals and investigating complaints tied to care.

Fees collected from each profession must cover the costs of policing that profession. What medical doctors pay to keep their license active must go, under state law, to policing all other medical doctors. Likewise for registered nurses, chiropractors and orthopedic surgeons.

The audit showed a deficit of $16 million that auditors expected to grow without some revisions to licensing fees for some professions, calling into question the long-term plans for maintaining oversight of the industry.

“The Department of Health can make changes to address this issue, but the Legislature should consider a broader policy question as well,” the audit concluded, noting that state law allows for waivers of certain fees to ensure care providers aren’t scared away from some jobs because of high regulatory costs. But there’s no process laid out in the law to create such a waiver, and there is also no legal way for the Health Department to try to recoup waived fees from another source.

Those professions targeted in what Pittioni described as a “first phase” of fee adjustments were among those with the largest projected deficits in the state audit. While all fees are collected in the same pot, known as the “Health Professions Account,” different commissions are tasked with regulating specific professions, such as the Nursing Quality Assurance Commission for registered nurses and the Dental Quality Assurance Commission for dentists and those providing sedation for dental procedures. The oversight of both of those commissions are projected to run multimillion dollar surpluses through 2023, based on projections of licensing fees collected and the cost of investigating complaints.

But the Medical Quality Assurance Commission, which is tasked with regulating physicians and physician assistants, has seen drastically increasing costs tied to litigation of complaints brought by patients, according to the Health Department. Its deficit is predicted to reach $3.4 million this year, and $27.8 million by 2025.

Those increased costs have not been offset by more collected in fines and penalties paid by doctors found to have violated state laws and policies, Pittioni said, and the primary purpose of the investigative arm of the commission is not to generate revenue.

“From a patient safety perspective, your obligation is to investigate complaints that come in the door,” he said. “We need to find out if there’s evidence that would support if there is actually a violation that occurred.”

The nursing assistants program at the department is expected to reach a deficit of $6.8 million this year, with its costs ballooning due to high turnover in the profession and the associated costs with credentialing new providers, according to the department.

“At a high level, this is not exactly the same story for each profession,” Pittioni said. “It is a profession-specific analysis, what specifically the dynamics are for each profession.”

Kolan said her organization was concerned that, on an individual level, physicians may choose to practice elsewhere if regulatory fees become too high. And if an organization is responsible for paying the fees, like Providence, they may make decisions about employment or services based on a bottom line that’s shrinking due to the new fees.

“It’s like a death by a thousand cuts,” Kolan said.

Pittioni said the agency takes into account factors that include potential physician loss as a result of rate increases, but pointed to the auditor’s conclusion that the agency was operating contrary to state law as the main reason they’re considering fee adjustments.

“I think that, quite frankly, the sensitivity needs to be making sure that we do comply with the law, that the profession is self-sustaining and that we do our work as efficiently as possible,” he said.

The Health Department will hold a public workshop about the fee increases Thursday that will be telecast statewide online. The department hopes to have an official proposal addressing fees in March, with the new prices in place by October.