College members arrive in force to lobby on Capitol Hill
From the July-August ACP Observer, copyright © 2004 by the American College of Physicians.
By Janet Colwell
WASHINGTON—A record number of internists came to Capitol Hill this spring for ACP's Leadership Day.
This year's annual event brought close to 220 members from more than 40 different states to Washington. Physicians were first briefed by government officials—including the administrator of the Centers for Medicare and Medicaid Services (CMS) and the newly appointed health care technology czar—before meeting with their legislators.
The need for physician payment reform, universal coverage and interoperable health care technology topped internists' agenda. While a tacit understanding emerged that little new legislation will pass in a presidential election year, College members were able to identify key legislative supporters and lay the groundwork for potentially significant change in the future.
Changing physician payments
College members were briefed by fellow internist and CMS administrator Mark B. McClellan, ACP Member.
In his address, Dr. McClellan described upcoming CMS plans to streamline payment review and claims processing. He also urged physicians to embrace technology, saying that the CMS intends to reward physicians who use e-mail to prescribe medications and consult with patients.
He also made it clear that physicians must get ready for pay-for-performance measures. Next year, he said, the CMS will launch a major pay-for-performance initiative, with 300,000 Medicare beneficiaries with chronic illnesses taking part in a disease management pilot program. The program, which aims to improve outcomes in chronic care, will in part link participating physicians' payment to their performance on quality measures.
And Dr. McClellan vowed to support physicians in their effort to increase Medicare payments. "The health care system faces ongoing cost pressures, but the solution shouldn't be to cut physician payments," he said. "We'll try not to do that."
Dr. McClellan's message about Medicare payments hit home with internists frustrated by yearly struggles to avert fee cuts.
Last year's Medicare Prescription Drug Improvement and Modernization Act gave physicians a two-year reprieve from fee reductions. However, as College members explained in their meetings with legislators, more cuts lie ahead unless Congress replaces the sustainable growth rate (SGR) formula used to set physician payment updates. That formula, they pointed out, links payments to changes in the gross national product, not to physicians' actual costs.
Many legislators and staff agreed that the SGR was deeply flawed. However, legislators also pointed out that they are troubled by the costs of SGR reform.
"It could cost upward of $100 billion to fix the SGR," said a health policy staff member during a panel briefing with College members. Because of those concerns, she said, Congress will likely continue to set annual stopgap measures rather than wrestle with an SGR redesign.
Members of the Alaska delegation, including this year's Key Contact of the Year, Richard L. Neubauer, FACP (second from left), meet with Sen. Ted Stevens (R-Alaska), center, to discuss the state's physician recruitment problems.
Physician fees were also a big topic of discussion for the College's Alaska delegation.
At Leadership Day last year, internists from Alaska were able to convince Alaska Sens. Lisa Murkowski and Ted Stevens to back a 50% increase in physician fees to address the state's severe access problem.
In the group's meeting this year with Sen. Murkowski, Alaska Chapter Governor Richard L. Neubauer, FACP, said that the increase—which took effect at the beginning of this year—is already improving access in the state for Medicare patients.
Despite those increases, however, "Anchorage needs 10 or more new general internists," said Dr. Neubauer, a general internist who practices in Anchorage.
Sen. Murkowski told College members that she would appear in a promotional video aimed at recruiting physicians to the state. She also pledged to sign a letter asking the CMS to update the SGR formula.
(The SGR sign-on letters, circulated in the House and Senate, ask the CMS to fix the SGR formula. For more information, visit the College's Legislative Action Center.
Universal health insurance
College members were also briefed by Rep. Marcy Kaptur (D-Ohio) who, along with Rep. Steve LaTourette (R-Ohio), has introduced a House version of the Health Coverage, Affordability, Responsibility and Equity Act (HealthCARE Act, H.R. 2402). The HealthCARE Act calls for several different mechanisms to extend coverage, including tax credits, broader safety net programs and purchasing arrangements to help small employers afford coverage.
The bill—which was first introduced in the Senate (S. 1030) by Sen. Jeff Bingaman (D-N.M.)—was modeled on the College's seven-year plan. Rep. Kaptur told College members that physicians need to collaborate with local small business groups to promote the College's seven-year plan and the House and Senate bills.
"This creates a real answer for small business," she said, "and that's where we should go for support."
Senate Minority Leader Tom Daschle (D-S.D.) also praised the College's universal health care plan in his meeting with College leaders and the South Dakota delegation, led by former Chapter Governor David E. Sandvik, FACP.
"The College has been very forceful and clear," said Sen. Daschle, who called the College's plan "a good compromise" for addressing one of the country's biggest challenges.
He also underscored the link between the health care coverage crisis and the trend toward outsourcing jobs. Employers are exporting jobs overseas to avoid paying health benefits, he said—a growing problem that universal access would solve.
While "interoperability" is an unlikely buzzword, internists found that it's quickly gaining currency in Washington.
The term refers to the massive effort now underway to create a technology infrastructure that would allow electronic information to be shared among health care payers and providers.
In a position paper approved by the Regents in April 2004, the College called on Congress to pass a bill to ensure that interoperable networks will be in place by the end of this decade.
That call was strongly endorsed by David J. Brailer, MD, HHS' new national health information technology coordinator. In an address to College members, Dr. Brailer claimed that technology can simplify physician workflow and improve patient care.
He also encouraged physicians to seize the technology initiative rather than letting vendors or insurers set the technology agenda. "Physicians need to step up and take the lead," he pointed out, "or others will."
How technology will be financed, however, is a major concern. The College's Missouri delegation discussed those concerns with an aide to Sen. James Talent (R-Mo.).
Patrick F. Garrett, FACP, a general internist practicing in St. Louis, made it clear that his 35-member group will not make any further investments in information technology until universal standards for data and clinical "vocabulary" are adopted.
"We've been through three computer conversions," Dr. Garrett said. "Each system cost us between $25,000 and $50,000."
While the delegation asked for the senator's support in getting federal funding for electronic information technology, aides promised only to review the College's position paper, which asks Congress to fund demonstration projects and provide incentives for physicians to invest in health care information systems.
The Missouri delegation did, however, garner support from Sen. Talent's staff on encouraging—not mandating—physician adoption of information technology.
When Richard L. Neubauer, FACP, set out last year to boost the number of ACP Key Contacts in his home state of Alaska, only 17 of the chapter's 150 members were enrolled. Two months and dozens of phone calls later, that number had jumped to 108-almost three-fourths of the chapter's entire membership.
That persistence was Dr. Neubauer's response to a call from ACP's Washington office to increase the number of Key Contacts, College members who regularly communicate with their members of Congress about issues important to internists. Currently, nearly 3,000 College members are enrolled in the Key Contact program.
"When I started making calls, I had a goal of doubling the number of contacts," said Dr. Neubauer, Governor for the Alaska Chapter. "But it proved so easy to convince members to become Key Contacts that I was encouraged to continue."
That recruiting effort led to Dr. Neubauer being named Key Contact of the Year at this year's Leadership Day.
Another deciding factor was Dr. Neubauer's extensive discussions with legislators about Medicare reimbursement. As part of last year's Medicare reform, Alaska received a two-year, $53 million influx of federal dollars that increased physician reimbursements for office visits by 50%—a victory partly due to lobbying by Dr. Neubauer and members of the Alaska Chapter.
That increase is already improving access for seniors, many of whom had been unable to find doctors, Dr. Neubauer said. The chapter's next challenge is to recruit more doctors.
"Over the past decade, the number of general internists in private practice has declined to a critically low level," said Dr. Neubauer, who may convene a state summit on recruiting. During this year's Leadership Day, Alaska Sens. Lisa Murkowski and Ted Stevens both said they would participate in such a summit.
Other Key Contacts recognized at Leadership Day this year included:
Dawn E. Clancy, FACP (Johns Island, S.C.)
Steven R. Craig, FACP (West Des Moines, Iowa)
S.A. Dean Drooby, FACP (Oklahoma City)
Jacqueline W. Fincher, FACP (Thomson, Ga.)
Robert M. McLean, FACP (New Haven, Conn.)
Rolf P. Paulson, FACP (Grand Forks, N.D.)
Susan E. Sprau, FACP (Santa Monica, Calif.)
Robert G. Strickland, FACP (Albuquerque, N.M.)
Sara E. Walker, MACP (Columbia, Mo.)
Ernest L. Yoder, FACP (Huntington Woods, Mich.)
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