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


ACP leaders find attentive audience at Leadership Day

With an important election year approaching, health care reform has become a hot topic on Capitol Hill

From the June ACP Observer, copyright 2003 by the American College of Physicians.

By Phyllis Maguire

WASHINGTON—When a record number of internists took to Capitol Hill for ACP's Leadership Day last month, they found lawmakers eager to talk about issues like access to care and medical liability insurance. With the economy in a slump and a critical election year ahead, health care is a hot topic on the Hill.

In the days before and after the event, several Democratic presidential candidates released plans to expand access to health care. And just a week before Leadership Day, Sen. Jeff Bingaman (D-N.M.) unveiled an access bill modeled on ACP's proposals.

At a breakfast briefing of the College's 200-plus delegates, Sen. Bingaman received a standing ovation after describing his plan, the HealthCARE Act of 2003 (S. 1030). He credited the College's seven-year plan as the basis for the bill, adding that the number of uninsured Americans is "a national disgrace" that legislators urgently need to address.

While he introduced his bill at the same time that many of the presidential contenders unveiled proposals to solve the access crisis, Sen. Bingaman seemed sanguine about his legislation's chances of standing out from the pack.

He pointed out, for example, that the recent flood of proposals would help develop "critical mass" for the access issue. He also added that his legislation should garner more bipartisan support. His bill includes no mandates that would force employers or individuals to pay for coverage. And it marries Republican and Democratic approaches to extend access, relying in part on tax credits as well as expanding existing programs like Medicaid.

(Later in the day, ACP hosted a press briefing with College officials and representatives from other national physician and consumer organizations, representing over 250,000 physicians and millions of consumers, announcing their support for the bill. A summary of the HealthCARE Act is online.)

Medicare funding

Physicians at Leadership Day heard different takes on Congress' interest in revisiting Medicare reimbursement relief for physicians.

A growing number of officials want to address geographical disparities in Medicare reimbursements, said Colin Roskey, JD, a majority health policy advisor to the Senate Finance Committee. But many Congressional leaders believe it's more important to preserve funding for a prescription drug benefit that, he said, Republican Senate leaders want to introduce by July 4.

Mr. Roskey admitted that any drug benefit proposal would have to clear some high partisan hurdles. Republicans want to expand the role of private health plans in providing prescription benefits, while Democrats favor enhancing the traditional fee-for-service Medicare program.

But in a message that clearly frustrated some College members, Mr. Roskey also predicted that Congress would be reluctant to revisit the issue of physician reimbursement, particularly because legislators recently pumped $54 billion more into physicians' Medicare reimbursements over the next 10 years.


Undaunted by Mr. Roskey's predictions, College leaders addressed issues like Medicare fees later in the day during visits to their legislators' offices.

During a meeting with Senate Minority Leader Tom Daschle (D-S.D.), David E. Sandvik, FACP, Governor for ACP's South Dakota Chapter, explained that Medicare access has become an increasingly acute problem as more physicians in the state refuse to take on new Medicare patients.

He recalled that his practice recently received $300 in the mail from a patient desperate to find a physician for his elderly father. The patient wanted $200 to go to the physician who agreed to accept his father; the other $100 was to go to the office manager who would convince the physician to take on a new Medicare patient.

"We enrolled the patient and sent back the money," Dr. Sandvik said, "but that's how bad it's getting."

During a meeting with Ray H. LaHood (R-Ill.), a member of the House Appropriations Committee, Stephen R. Goetter, FACP, Governor for the Illinois Downstate Chapter, and Cinthia Deye, ACP Medical Student Member, talked about the need to revisit the Medicare physician fee schedule. They gave Rep. LaHood a chart showing the decline in U.S. medical graduates interested in primary care specialties. With Medicare income dropping—60% of Dr. Goetter's patients are covered by Medicare, he said—students have a harder time getting education loans and paying them off.

During a meeting with leaders from ACP's Southern California Region II Chapter, a health care aide to Sen. Dianne Feinstein (D-Calif.) predicted that physicians may see another Medicare fee freeze again this year to avert predicted cuts. She also said that any Medicare reform package introduced in the Senate could address the underlying formula used to calculate physician fees.

And Dan Elling, a health care aide to Rep. James Ramstad (R-Minn.) told the College's Minnesota delegation that officials are also looking to a Medicare reform package to take up the issue of reducing geographical payment disparities. Kevin L. Larsen, ACP Member, reinforced the need to address that issue.

"We're at the lowest end of the fee schedule, so we have to rely on good state programs to make up the difference," Dr. Larsen said. "Now, as state programs are getting peeled away, it's really becoming a problem."

Tort reform

At the South Dakota delegation's meeting with Sen. Daschle, he discussed the mounting problems of liability insurance. Although the House of Representatives passed a tort reform package earlier this year, that legislation has bogged down in the Senate.

Members of ACP's South Dakota delegation meet with Sen. Tom Daschle (right) to discuss Medicare reimbursement and liability reform.

Sen. Daschle explained that he had "grave doubts" that growing premiums are caused directly by mounting lawsuits and the amounts for settlements or awards. He said he suspected that insurance companies hard hit by the weak stock market were "making up their investment capital" by boosting their premiums.

During her visit with the delegation, Mary T. Herald, FACP, Chair of ACP's Board of Regents, pointed out that liability insurance relief should involve more than caps on damages. She explained that malpractice litigation strongly required mechanisms to weigh the merits of suits.

"If we could use expert panels to limit the number of frivolous lawsuits brought against physicians," Dr. Herald said, "malpractice litigation might be restricted to valid cases, and costs could come down."

Drs. Goetter and Deye from the Illinois delegation also discussed liability during their meeting with Rep. LaHood.

The physicians thanked Rep. LaHood for his support for the House tort reform package, a vital issue for doctors in Illinois. Dr. Goetter pointed out that Decatur recently lost a key orthopedic surgeon who moved to another state because his liability insurance jumped from $18,000 to $80,000 a year.


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