Doctors lobby at Leadership Day for better pay, access
By Phyllis Maguire
WASHINGTON-More than 140 College members from 34 states came to Capitol Hill for this year's Leadership Day event, speaking with their elected officials about problems affecting health care access at home.
At an early morning briefing, Rep. Michael Bilirakis (R-Fla.), vice chair of the Veterans' Affairs Committee, warned attendees that domestic spending prospects now differ radically from recent years. With the government's attention and funds focused on fighting terrorism, he said, the fate of physician-friendly reforms that seemed like a sure thing just last year—such as Medicare regulatory relief, a prescription drug benefit and a patients' bill of rights—is much more uncertain.
The funding crunch has already hit physicians who are struggling with a 5.4% Medicare physician fee cut enacted Jan. 1. While Rep. Bilirakis assured physicians that members of Congress are aware of the problems caused by the fee cut, "any fix to physician fees must now compete with a prescription drug benefit," he said.
Robert B. Doherty, the College's Senior Vice President for Governmental Affairs and Public Policy, asked attendees to urge officials to support a new proposal put forth by House leaders, including Rep Bilirakis. The proposal would replace the deep fee cuts projected over the next three years with modest increases.
Physician fee schedule
Rep. Nancy L. Johnson (R-Conn.), a member of the House Ways & Means Committee, is a key leader behind that proposal. Rep. Johnson's senior health policy counsel, Susan Christensen, told members of the College's Connecticut delegation that physicians "should expect nothing this year" to reverse the 5.4% cut, but that Congress would likely enact legislation to avert future cuts.
"We're shooting for increases next year of 2% to 2.5%," Ms. Christensen said, adding that she was not optimistic that CMS would move on its own to correct errors built into the payment update formula. It will fall to Congress to mandate needed changes, she said.
Another House member responsible for the leadership proposal is Rep. William M. Thomas (R-Calif.). His legislative assistant, James B. Min, told members of the California delegation that opposition to increasing physician fees is not coming from representatives, many of whom are convinced the cuts have been too deep. The problem, he said, is the Congressional Budget Office, which "claims that fixing the physician payment update formula could cost as much as $43 billion. That has House members worried."
Physician fees were also the lead item for the Florida delegation when it met with Jocelyn M. Moore, legislative assistant to Sen. Bob Graham (D-Fla.), a member of the Senate Finance Committee.
Frederick E. Turton, FACP, Governor for the Florida Chapter, pointed out that 40% of the state's physicians are now over 50. Shrinking Medicare payments might push those physicians toward early retirement.
That trend would be part of what Dr. Turton called "subtle changes" in health care access as a result of fee cuts. "Doctors won't flee the state en masse," he said. Instead, practices will quietly stop taking new Medicare patients, or will hire fewer staff to help process claims.
Ms. Moore mentioned the Medicare Reform Act of 2001, a prescription drug benefit bill that Sen. Graham has introduced that would preserve Medicare's fee-for-service structure.
"If we don't have enough physicians available to write prescriptions," replied St. Petersburg internist Michael A. Zimmer, FACP, whose patient base is 80% Medicare beneficiaries, "then a prescription drug benefit won't do much good."
Members of the Florida delegation meet with Rep. Dave Weldon (R-Fla., far left) to discuss tort reform, access and the Medicare fee schedule cut.
Liability insurance reform
The Florida delegation also discussed the state's growing liability crisis—a problem that Ms. Moore said is becoming national. College members are urging officials to consider the recently introduced HEALTH Act of 2002 (HR 4600) that would cap noneconomic damages and attorney's fees in malpractice cases.
Liability problems are already wreaking havoc on patient access in the state, said Saeed A. Khan, FACP, who practices in a rural area near Okeechobee.
"Cardiologists here won't do catheterizations," he said. "Patients who need the procedure have to be moved 60 miles."
Malpractice insurance was a major topic of the West Virginia delegation's meeting with Sen. John D. Rockefeller IV (D-W.Va.). Charleston internist Greg Rosencrance, FACP, told the senator that patients routinely go to Virginia or North Carolina for procedures that in-state specialists used to perform.
At the same time, he said that West Virginia's medical students "are voting with their feet." Many of Charleston Area Medical Center's senior residents plan to leave the state to practice.
Sen. Rockefeller, who tried to get tort reform legislation passed several years ago, was blunt about the chances of seeing liability insurance reform in an election year: "There is 0% chance of getting a federal liability bill passed." At this point, he said, physicians' best bet is to lobby for state tort reform measures.
John D. Holloway, FACP, another member of the West Virginia delegation, outlined the College's seven-year plan to extend coverage to most uninsured Americans by the end of this decade. (See www.acponline.org/hpp/afford_7years.pdf for more information.)
Sen. Rockefeller said that while Congress may have the goodwill to help the uninsured, it does not have the funds. With the government "husbanding its resources to fight terrorism," he said, the most effective way to tackle the problem of lack of coverage is "in little pieces."
Mark Liebow, FACP, who practices at the Mayo Clinic in Rochester, Minn., also discussed universal coverage with Robin Goracke, legislative aide to Rep. Collin C. Peterson (D-Minn.). Dr. Liebow pointed out that many small businesses in Rep. Peterson's district are particularly vulnerable to losing health care benefits. The first step, he said, is to get a resolution passed in Congress, committing the federal legislature to extending coverage.
Ms. Goracke said that Rep. Peterson does not think that funds are available to both extend health care coverage and increase provider payments, which he thinks are necessary to safeguard the rural state's supply of physicians. With such a tight federal budget, she continued, "we have to make hard choices. She suggested that funds now going to the Medicare+Choice program might be better spent elsewhere.
"The Medicare+Choice program doesn't seem like a viable solution," Ms. Goracke said. "We don't know how much we want to continue funding a program that doesn't help seniors in our district."
Prescription drug benefit
Dr. Liebow also raised the issue of a prescription drug benefit. The need for prescription drug relief is obvious, he said, given the number of chartered buses filled with seniors traveling from Minnesota to Canada for better drug prices.
Ms. Goracke pointed out that while the congressman supports drug reimportation "as a short-term solution," he is in favor of a prescription benefit. How that benefit should be designed, however, remains controversial. The congressman wants to see a package that would give Medicare the same kind of drug price discounts that the Veterans Health Administration now receives.
Antitrust legislation and Medicare regulatory reform
Yul D. Ejnes, FACP, Governor for the Rhode Island Chapter, and R. Scott Hanson, ACP-ASIM Member, met with Sen. Jack Reed (D-R.I.), who sits on the Senate's Health, Education, Labor & Pensions Committee. Dr. Ejnes said that if the Health Care Antitrust Improvements Act of 2002 (H.R. 3897) passes in the House, the College would appreciate Senate support for the bill. The bill would allow physicians in small or solo practices to collectively bargain with health plans.
Yul D. Ejnes, FACP, (left) and R. Scott Hanson, ACP-ASIM Member, discuss Medicare reform with Kimber Colton, legislative aide to Rep. Patrick Kennedy (D-R.I.)
Antitrust protections are particularly needed, Dr. Ejnes said, in a state where small physician practices are the norm and "a single payer system gives physicians only a 'take it or leave it' option."
Sen. Reed also raised the issue of the patients' bill of rights. (Last year, the House and the Senate passed different patients' rights bills that have not yet been reconciled.) The senator's aide, Lisa German Foster, pointed out that HMO liability provisions have been a sticking point, and said she was not optimistic about the bill's fate.
Dr. Hanson raised the issue of Medicare regulatory reform, which the House passed unanimously last year as the Medicare Regulatory and Contracting Reform Act of 2001 (MERFA). The senator said that the bill has stalled in the Senate but he is hopeful it will be assigned to a committee for study soon.
"Regulatory reform is a cornerstone of access," Dr. Hanson said. "It's just as important an access issue as payment, so making the system more provider-friendly is key."
Chances are, local print or broadcast reporters have already approached you to explain the latest clinical breakthrough. Increasingly, however, they are also asking physicians to go on record to defend their advocacy efforts for Medicare reform or to sort out the local impact of state liability problems.
At a workshop held during Leadership Day, Maryland-based media consultant Frank Whyte gave internists tips on how to get their points across more effectively in the media.
What reporters want
Mr. Whyte claimed that reporters are interested in only two things: background and quotes. "Background is the 'who, what, when, where and why' of an issue," he explained. "Quotes are those nuggets of expert opinion or insight that reporters use to punctuate and structure their stories."
When reporters contact you, find out which of the two they need. If they say they're looking for background, "supply them with paper," Mr. Whyte said. Fax them a press release on the issue from the College or the state medical association, for example.
At the same time, Mr. Whyte said, "try to sell them quotes" by telling them that you're willing to put the background into perspective. Pass along your sound bites, even if reporters say they're looking only for background. If you give them a few good quotes, chances are reporters will include them. With quotes, you get your name in the paper or your face on the news, and gain more power to shape the final story.
Crafting sound bites. Good sound bites have several features in common, Mr. Whyte said. First, they are planned. If you expect a reporter who wants quotes to raise five different issues during an interview, create five "quote" index cards, each with a sound bite response. Rehearse them to achieve a comfort level, but don't memorize them, because it gives your delivery a "canned" quality.
Second, sound bites are short, consisting of no more than two or three declarative sentences. They should use words geared to an 8th-grade vocabulary and "relate to the folks back home," Mr. Whyte said.
"Nobody cares about your profession, political philosophy, religion or dog's name," he said. "What matters is how the issue affects the people reading or watching the story."
When crafting quotes, consider techniques that can make them more colorful and convincing. Mr. Whyte recommended using analogies or comparisons, parallel imaging, very short anecdotes, relevant quotes and if it's appropriate, humor.
Sizing up your reporter. In addition to preparing quotes, try to get a sense of the reporter's "angle" on the topic you'll be discussing. Casual questions such as "What have you heard so far about this?", "What caused you to be interested in this topic?" or "Are you talking to anybody else about this?" can give you an idea of whether the reporter is planning a friendly feature piece or a hard-hitting expose. It always helps to know ahead of time how aggressively reporters may pitch questions—and how well informed they are about the topic.
If you're unfamiliar with a reporter's work, search the Internet for samples or ask acquaintances who work in public relations about the reporter's work or reputation. And if you're unfamiliar with the organization that a reporter works for, research that group before the interview to find out its agenda.
Fielding tough questions
Even a friendly local reporter with whom you already have a relationship may throw you some curveballs. When an answer requires a defensive response, Mr. Whyte suggested the following:
Avoid the first person. Instead of defending yourself individually, speak about groups of people, such as patients or physicians in the state.
Don't repeat the "bad" words. Don't respond with, "Of course I want to squeeze more money out of Medicare, but I want to help patients too!" Only the first half of that quote may make it into the evening news.
Use body language to your advantage. Look directly at the reporter, and don't cross your arms, "fig leaf" or point. Don't frown or force a smile, and avoid leaning away from the reporter. Instead, when you want to make a point, be sure to lean toward him or her.
Don't say "no comment." You'll just sound like you have something to hide. If a question seems out-of-bounds, respond instead with, "I'm not the expert on that, and I don't want to misstate the situation" or "I wish I could discuss that, but it wouldn't be appropriate."
Avoid becoming hostile. Even if questions become hostile, maintain your composure. You can try to "spin" the question—supplying a positive response to an adverse question—by reverting to your list of sound bites and focusing on relaying your message rather than rising to the reporter's bait. Or you can call the reporter's bluff by saying, "That's not a fair or appropriate question" or "That's irrelevant. Can we stick to the subject?"
Since your interview will be cut up into snippets of quotes, repetition is OK. "If you have a handful of great sound bites," said Mr. Whyte, "don't be afraid to use the same one twice."
You can ask to see your quotes before they're published, but don't expect to review the entire article unless it's a personal profile. And until you have a relationship with a reporter, avoid going "off record."
"Private information," Mr. Whyte said, "should stay private."
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