American College of Physicians: Internal Medicine — Doctors for Adults ®

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Internists make case for access, policy issues during this year’s Leadership Day activities

From the June 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

Key Contact of the Year

Washington—During this year’s Leadership Day, 120 internists from 35 states converged on Capitol Hill to talk to their senators and representatives about policy issues like patient protection legislation, access to care, patient safety and regulatory relief.

College President William J. Hall, FACP, told internists gathered for the two-day event that they have a unique opportunity to participate in the political process. Because power and resources are split in the Senate and new leaders are chairing key Congressional committees, he explained, new opportunities exist for health care issues to be heard.

Robert B. Doherty, the College’s Senior Vice President for Governmental Affairs and Public Policy, told internists that their involvement is particularly important because of the coming tax cut. Federal spending will have to be slashed to fit the constraints of the largest tax cut in 20 years, he said. While the full effects of the tax cut may not be felt for four or five years, he said, physicians need to make their views heard now to get the legislation that patients need funded.

Rep. Dave Weldon (R-Fla.), ACP-ASIM Member, (left) discusses health care legislation with College President William J. Hall, FACP, (right) and the College’s Florida delegation.

In a morning briefing, Sen. Bill Frist, MD, (R-Tenn.), the only physician now serving in the Senate, told College members that meeting with elected officials and their aides gives an important perspective. “That’s the only way we get real information from the field, through anecdotes and real stories,” Sen. Frist said. “Those ultimately influence the way people vote.”

In visits with elected officials, College representatives spent much of their time focusing on the following six key health care issues.

Patient protection

During a meeting with Sen. Max Cleland (D-Ga.), the College’s Georgia delegation focused on patient protection legislation. Sen. Cleland supports the Bipartisan Patient Protection Act of 2001, which would give patients the right to appeal care denials and sue health plans. The College has endorsed the proposal.

While the Georgia delegation thanked the senator for supporting the bill, some members expressed concern that its momentum seems to be slowing. Sen. Cleland said that while the bill has a good chance of passing in the Senate, he expects it to be “buried in the House.”

He explained that while polls in his state say that citizens value a patient bill of rights and a Medicare prescription drug plan more than a tax cut, members of the House aren’t listening. “The HMOs are in the saddle,” he said, “and they’re ‘riding herd’ on the House leaders.”

The College’s delegation from Texas heard a similar message about the bill’s likely fate from Dean Clancy, senior policy advisor to House Majority Leader Richard K. Armey (R-Texas). He told College representatives that Rep. Armey expected the bill to get stuck in “classic textbook gridlock.” Mr. Clancy explained that President Bush’s promise to veto the bill had eroded support.

The College’s New York delegation, including former Regent Faroque A. Kahn, MACP, (right) and Martin Lee, FACP, (center) tell a legislative aide to Sen. Charles E. Schumer (D-N.Y.) about the need for regulatory reform.

Mr. Clancy noted, however, that alternative patient protection legislation is being introduced by Sens. Jim Jeffords (R-Vt.), John Breaux (D-La.) and Frist. (That bill was introduced at press time.) He said that Rep. Armey would wait to see the Jeffords-Breaux-Frist bill and might support it.

Access to care

Lynne M. Kirk, FACP, Chair of the College’s Board of Governors and a member of the Texas delegation, talked about the College’s support of legislation to improve access to care. The College supports the Relief, Equity, Access and Coverage for Health (REACH) bill, which would create refundable tax credits to help Americans without insurance to get coverage.

Mr. Clancy said that Congress is currently very interested in extending coverage to the uninsured. He also pointed out that several different tax credit plans have been proposed.

While Mr. Clancy said that Rep. Armey “could cheerfully vote for REACH,” he said that the House majority leader is sponsoring an access bill in the House that would extend tax credits to an even greater number of the uninsured.

Dr. Kirk assured him that the College would consider any access proposal, as long as it was administratively simple enough to not burden low income workers.

Patient safety

Several College delegations talked to their elected officials about the College’s support for the Center for Quality Improvement and Patient Safety within the Agency for Healthcare Research and Quality (AHRQ).

College members explained that ACP–ASIM supports a voluntary error reporting system that protects the confidentiality of physicians and other health professionals. In a meeting with Sen. Patty Murray (D-Wash.), Bruce C. Smith, FACP, and David C. Dale, FACP, said that without confidentiality protections in place, physicians in their state worry that they’ll “find themselves on the front page of the Seattle Times” if they report problems.

Regulatory relief

Dr. Smith, a geriatrician who sees only Medicare patients, also urged Sen. Murray to become a co-sponsor of the Medicare Education and Regulatory Relief Act (MERFA). The bill, which the College supports, would streamline Medicare by changing how HCFA audits and penalizes physicians over billing matters. The bill would also give physicians more time to appeal denied claims.

However, Sen. Murray warned Dr. Smith that changing Medicare regulations would require “a delicate balancing act.” She explained that because Medicare overpays providers about $11 billion a year, the government has an obligation to eliminate overpayments and fraud.

Dr. Smith assured Sen. Murray that the College is fully committed to ferreting out overpayments and fraud. He also emphasized that fraudulent providers would not be protected under the MERFA bill.

Instead, he said, the bill would ease physicians’ administrative burden. He noted that in part because of the Medicare hassle factor, physicians in several parts of Washington state now refuse to accept new Medicare patients.

The College’s New York delegation also worked to generate support for the MERFA bill. Martin Lee, FACP, told Tom Coffey, legislative aide to Sen. Charles E. Schumer (D-N.Y.), how a local laboratory he had long used in Brooklyn had recently shut down. The problem? The lab was unable to survive a HCFA-imposed payment freeze. The current Medicare system, Dr. Lee explained, favors large companies that can weather indefinite payment suspensions.

“All of us are ‘little guys’ with no trustees to bail us out,” Dr. Lee said. “Medicine is practiced in little platoons. Once those groups are shattered, there isn’t any continuity left in communities.”

Medicare reform

College representatives urged their officials to oppose a Senate bill that would convert Medicare from a defined benefit to a defined contribution program. They also encouraged their representatives to establish and fund a Medicare drug benefit, an idea that Sen. Murray said she was surprised to find had “died the day after the election.”

Dr. Smith told Sen. Murray that without the enactment of a drug benefit, he will continue to send patients to Canada to buy prescription drugs, a trip that saves them hundreds of dollars.

Appropriations

College representatives asked their elected officials to support bills that would expand health care program funding, particularly for the AHRQ; for health professions and nursing education programs; and for the VA medical and prosthetics research program.

Paul A. Gitman, FACP, Governor for the New York Downstate II Chapter, reminded Sen. Schumer’s aide that health education funding was crucial to New York state, where 15% of the nation’s physicians are trained. He added that several of the state’s teaching hospitals were either closing or financially distressed.

And College representatives from Vermont met with Paul J. Harrington, the health policy director of the Health, Education, Labor and Pensions Committee, which is chaired by Sen. Jeffords. Mr. Harrington asked the internists how they would be financially affected by newly enacted Health Insurance Portability and Accountability Act (HIPAA) regulations.

Burlington internist Frank J. Landry, FACP, explained that he was concerned that the regulations would increase overhead costs for the state’s physicians, most of whom maintain small practices. He claimed that some physicians spend up to 60% of their practice revenues on overhead and can’t easily absorb any new costs.

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Key Contact of the Year

At this year's Leadership Day events, College leaders acknowledged the work of the College's Key Contacts, ACP-ASIM volunteers who keep in touch with federal officials to advocate for issues important to physicians. While 10 Key Contact members received special recognition awards at this year's event, Mahendr S. Kochar, FACP, a College Regent and former Chair of the Board of Governors, was honored as the College's Key Contact of the Year.

Dr. Kochar received the award for his consistently thoughtful and thorough communication with members of Congress on a range of issues, including graduate medical education, access to care, regulatory relief and affordable medications for the elderly.

"Democracy is not a spectator sport," Dr. Kochar told College members when he received the award. "It requires everyone of us to be involved in electing politicians and supporting leaders whose ideas we value and ideals we share." Having grown up in the world's largest democracy—India—and immigrating to what he called "the greatest democracy," Dr. Kochar said he was very familiar with the democratic process. But Dr. Kochar, senior associate dean of graduate medical education for The Medical College of Wisconsin in Milwaukee, said the need for advocacy has become acute in the last several years.

"Graduate medical education is being threatened by all the cutbacks in Medicare funding," he said. "By necessity, I've had to become more active."

Dr. Kochar said he is concerned that "the best and the brightest" may soon stop choosing medical careers. "It's important that we maintain a climate that will be conducive to young people entering the profession," he explained. "That can be done only by advocating for the practice of medicine."

For more information on the College's Key Contact grassroots program, call Jenn Jenkins at 800-338-2746, ext. 4536.

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