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Leadership Day attendees push legislators to finish SGR fix

From the July/August ACP Internist, copyright © 2014 by the American College of Physicians

By Stacey Butterfield

A year ago, the internists who visited Capitol Hill for ACP’s Leadership Day were especially optimistic. It seemed promising that after years of last-minute temporary patches, Congress might finally fix the sustainable growth rate (SGR) formula that continually threatened to cut Medicare payments.

The doctors’ hopes seemed justified as bipartisan legislators came together to develop a fix earlier this year. But in April, over the objections of the College and other medical societies, Congress passed yet another patch, largely due to disagreement between Democrats and Republicans over how to pay for a permanent fix.

Sen. Jeff Flake greets ACP members from Arizona du...

Sen. Jeff Flake greets ACP members from Arizona during a Leadership Day visit. Photo by Rick Reinhart.



“I urged our leadership not to make it partisan ... We ran out of time,” Rep. Charles Boustany (R-LA) told attendees at this year’s Leadership Day, held in Washington, D.C., on May 22.

He urged the internists not to give up hope, however. “We need all of you and physicians back home to put pressure on the Senate. Tell them there’s broad agreement on the policy and we can fix this,” said Rep. Boustany, who practiced as a cardiovascular surgeon before he was elected to Congress in 2004.

His advice echoed that given to the physicians (and soon-to-be physicians—a number of medical students were among the almost 350 participants of Leadership Day) during advocacy training sessions by ACP leaders.

Members of the Arizona delegation for ACP’s...

Members of the Arizona delegation for ACP’s Leadership Day included (left to right): Shakaib U.R. Rehman, MD, FACP; Pratik B. Shah, MBBS, ACP Resident/Fellow Member; Samuel B. Carli, MD, ACP Resident/Fellow Member; Juhyung Sun, ACP Medical Student Member; and Ateefa Chaudhury, MD, ACP Resident/Fellow Member. Photo by Rick Reinhart.



“A patch was unnecessary and counterproductive, but it doesn’t have to be the end of the line,” said Robert B. Doherty, ACP’s senior vice president for governmental affairs and public policy. “Ask [legislators] to complete work on the bill they’ve already produced.”

ACP President David A. Fleming, MD, MA, FACP, offered some tactical advice for the physicians’ lobbying efforts. “Bring your wisdom. Bring your practical experience that will help you inform them as to what you do as physicians, as learners, and as leaders,” he said. “Legislators want to hear your stories about real patients and your concerns.”

During a visit with a staffer for Sen. Lisa Murkowski (R-AK), Kristin M. Mitchell, MD, FACP, followed his instructions. “I’m part of the only practice of internists on the Kenai Peninsula seeing patients with Medicare coverage,” she said. “I have patients who come in every week and say ‘Will you still be my doctor? Will you still take Medicare?’”

The staffer expressed sympathy but little certainty that an SGR fix would be completed during the current congressional session.

(From left) Amanda Makki, a legislative assistant ...

(From left) Amanda Makki, a legislative assistant from the office of Sen. Lisa Murkowski, meets with Kristin M. Mitchell, MD, FACP, a rural physician practicing in Soldotna, Alaska, and ACP Medical Student Members Erik Woelber and Aaron M. Johnson from the University of Washington School of Medicine. Photo by Rick Reinhart.



Doctors from the New Mexico chapter received a more positive response from Sen. Tom Udall (D-NM), however. “We need a permanent fix on the SGR, right?” he said. “This is the time to take action.”

Given the senator’s support for an SGR fix, the physicians took the opportunity to talk about ACP’s other priority issues, including extension of the law that increased Medicaid payments to parity with Medicare rates for designated primary care services and immunizations. Without an extension, the parity program will end on Jan. 1, 2015.

“It needs to be renewed,” Samuel D. MacBride, MD, ACP Member, told Sen. Udall. “It makes it financially viable for rural providers.”

The delegation also pushed the senator to support programs to grow the physician workforce. Darshan Nilesh Patel, an ACP Medical Student Member who had previously interned for Sen. Udall, talked about the importance of graduate medical education (GME) and other pipeline programs, which have been impacted by sequester cuts. “Right now, the National Health Service Corps is up for continued funding and we’d appreciate your support,” he said to Sen. Udall.

The senator was receptive, noting that he had sponsored a bill to increase funding for GME programs providing primary care access.

Leadership Day attendees met another supporter of workforce programs earlier in the day, when Mary Wakefield, PhD, RN, administrator of the Health Resources and Services Administration, was presented the College’s Joseph F. Boyle Award for Distinguished Public Service.

“Our Affordable Care Act-funded efforts to further strengthen the production, skill set, and distribution of the primary care workforce are a high priority,” she said. “We really rely on pipeline programs like [the National Health Service Corps] to expand the number of physicians and other health care professionals who are committed to delivering primary care, particularly in underserved areas. These programs train many internal medicine specialists.”

The physicians urged legislators to help train more internists by increasing residency slots to match growing medical school graduate populations. “You can create as many medical schools as you want, but if you don’t create more adequately funded residency positions, you won’t get more doctors,” S. Clark Fincher, MD, FACP, ACP Governor for Arkansas, told a staffer for Sen. Mark Pryor (D-AR).

The internists also urged their representatives to help physicians use their resources more efficiently by enacting medical liability reforms—creating a safe harbor from medical malpractice litigation for physicians who document adherence to guidelines and piloting a health court model of resolving contested cases of medical negligence.

Shakaib Rehman, MD, FACP, told Sen. Jeff Flake (R-AZ) the story of a patient who had been unnecessarily passed from specialist to specialist after she presented to the emergency department for chest pain, palpitation, nausea, and sweating. After a cardiac catheterization and an endoscopy, she was finally sent to a primary care physician who took a careful history. “After a $50,000 workup...it turned out she was having panic attacks and anxiety,” Dr. Rehman said, noting that this anecdote shows the need to increase primary care and reduce unnecessary costs.

“I certainly agree with the premise we’re spending far too much on defensive medicine,” said Sen. Flake.

In what Mr. Doherty described as “one of the most polarized Congresses in history,” agreement on a premise was a promising start.

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