ACP members tell Congress their views on SGR, health reform

Internists descended on Capitol Hill to explain how the legislative process impedes good clinical care. The legislators agreed with the doctors on that. But disagreement on health care reform left physicians and politicians with a cynical view.

Darin Lang, FACP, got right to the point when talking to a legislative assistant for Rep. Rick Berg (R-North Dakota). “The SGR. Can we eliminate it? Get rid of it?” Dr. Lang asked at the start of his meeting. But just as politicians have during every Leadership Day in recent memory, the staffer declined to offer a definitive answer.

Yet a fix for the sustainable growth rate (SGR) formula currently has a better chance than usual of making legislative progress, according to Robert B. Doherty, ACP's senior vice president of governmental affairs and public policy.

At left Thomas Bledsoe FACP explains the concerns of Rhode Island ACP members to Sen Sheldon Whitehouse Photos by Rick Reinhard
At left, Thomas Bledsoe, FACP, explains the concerns of Rhode Island ACP members to Sen. Sheldon Whitehouse. Photos by Rick Reinhard

“There is a difference this year. There is at least a glimmer of hope that Congress might really be interested in a permanent solution,” Mr. Doherty said during a speech to Leadership Day attendees about the political landscape and ACP's priorities on May 24.

The next day, more than 350 ACP members took those priorities to Capitol Hill, where they paid about 400 visits to the offices of senators and representatives from their home states. The doctors told the politicians about the problems posed by the SGR for their states of mind as well as their incomes.

“It's like you come into your job every six months wondering if there's going to be a pay decrease,” Ryan D. Mire, FACP, told an aide to Rep. Marsha Blackburn (R-Tennessee).

The internists didn't get any disagreement from legislators about the need for a fix. “It's always been kicked down the road as emergency spending. For doctors like you who are busy worrying about people's tumors, you're not supposed to have to be an expert in this,” said Sen. Sheldon Whitehouse (D-Rhode Island).

But physicians did recently bring their expertise to the problem of payment. At the request of the Energy and Commerce Committee, the College and other medical organizations proposed a plan to eliminate the SGR and replace it with five years of stable payment updates (including higher payments for evaluation and management services) while at the same time piloting alternative models of payment. Then in 2015, a new payment model or models would be selected and physicians could begin transitioning. “We're asking for stability. We're asking to transition to new models,” said Mr. Doherty.

In addition to the replacement of the SGR, Leadership Day attendees had a few other “asks” on their agendas, mostly related to the politically delicate subject of health care reform, known as the Affordable Care Act (ACA). Repeal of the act is a major component of the Republican platform, but lacking the votes to accomplish that, Republicans have focused on putting less popular parts of the law up for repeal votes, Mr. Doherty explained.

A legislative assistant to Rep. Connie Mack (R-Florida) confirmed his analysis. “They're trying to pick some of the weaker parts of Obamacare out right now,” he told members of ACP's Florida chapter.

The mission of the ACP representatives was to make sure that some key primary care programs didn't end up in that category. “We want to give the messages that the programs are important for both parties to support. Make sure the Democrats don't trade them, and the Republicans exempt them from cuts,” said Mr. Doherty.

The programs on which the internists focused their efforts include the National Health Service Corps, Section 747 Training in Primary Care Medicine, and the National Health Care Workforce Commission. All of these programs, designed to increase the primary care workforce, were included in the ACA, but will require appropriations from Congress.

Student and associate members of the College explained to legislators how these programs are needed to encourage young physicians to enter primary care.

“I'm very interested in primary care but I worry a lot. I'm at this conference and it's very pro-primary care, but I'm hearing these things [about reimbursement],” Jennifer E. Zora, ACP Student Member, told Rep. Tom Price (R-Georgia).

Jacqueline Lynn Green, ACP Associate Member, supported her argument. “It's so hard coming out of training with all the debt. Whether we want to think about those things or not, they're in our minds,” she said. “Anything you can do to continue funding of these programs will help myself and my colleagues.”

The internists also pressed for funding of ACA programs to compare the effectiveness of different practice models and treatments: the Center for Medicare and Medicaid Innovation and the Patient-Centered Outcomes Research Institute.

Jacqueline W. Fincher, MACP, governor of ACP's Georgia chapter, explained the value of comparative effectiveness research to Rep. Price. “As an internist in a rural area, anything that walks through the door is mine. Anything that helps me determine the best way to treat that patient is helpful,” she said.

Jennifer E Zora ACP Student Member tells Rep Tom Price about primary cares importance as other members of ACPs Georgia chapter look on Center is former ACP president Joseph W Stubbs MACP
Jennifer E. Zora, ACP Student Member, tells Rep. Tom Price about primary care's importance as other members of ACP's Georgia chapter look on. Center is former ACP president Joseph W. Stubbs, MACP.

The visits also touched on another perennial issue, malpractice reform. The College representatives encouraged legislators to co-sponsor an existing bill to cap awards for noneconomic damages, but also asked them to consider supporting legislation to fund state pilots of health courts, a no-fault system in which liability claims would be heard by expert judges instead of lay juries.

That request attracted more support from Republican legislators. Rep. Price, who practiced as an orthopedic surgeon before entering politics, told the Georgia delegation that he was currently working on a health court bill, which would also allow physicians sued for malpractice to use specialty guidelines as an affirmative defense. “I think that caps are a simplistic way to look at things. They don't give physicians any comfort,” he said.

Whether their legislative visits gave comfort to Leadership Day attendees was also uncertain. Despite the ACP representatives' requests for bipartisanship, the greatest point of agreement between the two parties seemed to be on the dim outlook for health care legislation.

“Don't have too much faith in this town,” Rep. Price told the Georgia internists.

While Sen. Whitehouse expressed enthusiasm about the continuing implementation of the ACA (which he will be involved in overseeing), he was not very encouraging about the other legislation hoped for by physicians. “The likelihood of anything that relates to health care passing in the near future is very, very slim,” he said.

But Rhode Islander Thomas A. Bledsoe, FACP, found a way to look on the bright side anyway. “We're lucky that the system's so screwed up there are so many ways to improve it,” he told Sen. Whitehouse.