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Access to care, patient safety focus of this year's Leadership Day

From the July/August 2000 ACP-ASIM Observer, copyright © 2000 by the American College of Physicians-American Society of Internal Medicine.

By Ingrid Palmer

WASHINGTON—Access to care, patient safety, patient rights legislation and a Medicare prescription drug benefit topped the agenda at this year's Leadership Day. More than 100 College leaders from 32 states traveled to the nation's capital to meet with lawmakers and talk about the College's stance on health care issues.

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This year's Leadership Day events, which took place May 16-17, started with a day-long briefing session to bring internists up to speed on health policy issues. The following day, College leaders visited lawmakers and their staff on Capitol Hill.

Here is an overview of some the issues they covered:

  • Access to care. In one briefing session, Sen. James M. Jeffords (R-Vt.), chairman of the Committee on Health, Education, Labor and Pensions, described his proposal to provide tax credits to help the uninsured pay for coverage. The proposal is similar to a plan the College unveiled last year that would include a refundable tax credit to make health coverage available to Americans with incomes of up to 150% of the poverty level.

During his briefing, Sen. Jeffords acknowledged the increasing importance of health issues in the national debate and praised the College for getting involved with the process. ACP-ASIM also supports a number of measures to improve access to care, including expanding federal programs like Medicaid and providing subsidies for those who are eligible for COBRA coverage but can't afford it.

  • Patient safety. Another hot topic at this year's event was reducing medical errors to promote patient safety. Since the Institute of Medicine (IOM) reported last November that up to 98,000 deaths each year are caused by medical errors, physicians and legislators have focused on how patient safety can be improved.

At the day-long briefing, analysts addressed concerns that the IOM's estimates of patient deaths may be exaggerated. "How many patients are killed by medical errors? I don't know, and it doesn't matter," said Gregg S. Meyer, ACP-ASIM Associate, from the Agency for Healthcare Research and Quality (AHRQ). "We all agree on one thing: It's too many."

During visits to Capitol Hill, three internists from the College's Minnesota Chapter spoke with Rep. Jim Ramstad (R-Minn.), who sits on the Ways and Means Committee, about the issue of medical errors. The internists, led by Governor Tanya L. Repka, FACP, explained the College's position on preventing medical errors, which includes the creation of a Center for Patient Safety within AHRQ. Mr. Ramstad told the internists: "These egregious errors that occur can't continue ... I want to take dramatic and corrective action."

During their meeting with Congressional staff, representatives from the College's Northern Texas Chapter also discussed the issue of medical errors. Dean Clancy, senior policy advisor to House Majority Leader Dick Armey (R-Texas) asked Lynne M. Kirk, FACP, Governor of the Northern Texas Chapter, why the College favors mandatory reporting rather than voluntary reporting of medical errors, like the AMA. Dr. Kirk explained that in states where reporting is currently voluntary, very few mistakes are reported.

  • Patient rights legislation. Dr. Kirk also spoke with Mr. Clancy about patient rights legislation. Mr. Clancy said that his office supports a patient's bill of rights and he is "hopeful" that an agreement between Democrats and Republicans will be reached this year.

Of the House and Senate versions that are being considered in the conference committee, the College supports the House bill because it more adequately addresses key issues. The House-sponsored bill would apply to all insured Americans--no matter what kind of insurance plan they have. The College also believes that physicians--not health plans--should decide who needs treatment and that health plans should be held legally accountable for medical decisions that result in death or injury to patients.

  • Medicare drug benefit. During briefings on the first day, policy analysts and legislators described the need for a Medicare prescription drug benefit--and the challenges in drafting legislation.

Though there is plenty of bipartisan support for a Medicare prescription drug benefit, analysts said that the devil is in the details. Elizabeth Fowler, staff member for the Senate Finance Committee, said that controversial points include whether the bill should be offered to all Medicare beneficiaries or targeted at low-income seniors, and whether HCFA should administer the benefit or a new agency should be created to handle it.

The College favors a Medicare prescription drug benefit as long as it doesn't financially weaken other Medicare services. The College also says that any benefit should target individuals who are most in need, regardless of income, and should not mandate the use of formularies.

For more information on any College policies mentioned in this story, visit ACP—ASIM Online at www.acponline.org/home/policy.htm.

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