Leadership Day 2017 prioritizes patient protection

All the health-policy themes that emerged during ACP's 25th annual Leadership Day in Washington, D.C., boiled down to a single goal: protecting patients.

“Believe it or not, we do have experience in this. In the hospital and in our practices, we have to be our patients' agent and ensure they get the best possible care that our system can provide,” ACP President Jack Ende, MD, MACP, told attendees on May 23, one day before they ventured to Capitol Hill to meet with their states' congressional representatives. “So now, we just go one step further, and we move from being an agent to an advocate.”

He said he is quite concerned that the American Health Care Act (AHCA), which passed the House in May, will be associated with great harm for the most vulnerable patients, as tens of millions of people stand to lose coverage if the legislation becomes law.

In fact, the day after Dr. Ende addressed ACP members, the nonpartisan Congressional Budget Office released its official estimate that 23 million more individuals would be uninsured in 2026 under the AHCA relative to current law. “The College opposes the AHCA, and we intend to do everything we can to ensure that it does not advance in the Senate,” Dr. Ende said.

But ACP members advocated for more than preserving health insurance for their sickest, poorest patients. During the event, ACP unveiled a policy agenda, “A Prescription for a Forward-Looking Agenda to Improve American Health Care,” that includes seven elements of an effective health care system, such as reducing administrative burdens and increasing the nation's dwindling cache of primary care physicians.

“We didn't want to send you in there just playing defense,” Robert B. Doherty, Senior Vice President for Governmental Affairs and Public Policy for ACP, told attendees. “We wanted you to feel empowered to say, ‘Yes … we oppose this and that, but we have ideas on how to make health care better.’ I think that's a much more credible position to take than simply just being against things.”

On May 24, about 400 Leadership Day attendees from 47 states and Washington, D.C., met with 107 members of Congress and their staffs during more than 400 meetings on Capitol Hill. Medical students, residents, and fellows in training represented more than one-third of all attendees.

Seated in front of a large depiction of Mount Rushmore, representatives from ACP's South Dakota Chapter explained their wishes and fears about the future of health care to Sen. John Thune (R-SD).

“In 10 years, my vision is a little apocalyptic,” said Robert L. Allison, MD, FACP, painting a future where there are no primary care internists. Physician interest in primary care has dropped sharply over the last 20 years, he said, and he foresees nurse practitioners and physician assistants becoming the primary care clinicians while hospitalists and subspecialists handle the referrals. “The costs are going to be astronomical,” Dr. Allison said.

Residency slots have been capped at a certain number since 1996, noted ACP Medical Student Member Samuel Jensen. “It's obvious to me that we as a nation need to realize the lack of residency programs,” he said. ACP supports increasing the number of graduate medical education slots by at least 3,000 per year over five years for specialties that are facing shortages, such as internal medicine.

Dr. Allison thanked Sen. Thune for taking part in introducing the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, a bipartisan Medicare reform bill supported by ACP and intended to improve quality of care for patients with multiple chronic conditions. However, the College recommends that the bill take additional steps.

For instance, although CMS now pays for chronic care management services that are not face-to-face, Medicare patients with multiple chronic conditions are still responsible for copayments on these services. An $8 monthly copay may be a modest figure, but it should be removed because it is often a barrier to care for these patients, Dr. Allison told Sen. Thune.

The CHRONIC Care Act also came up at the Nebraska Chapter's meeting with Sen. Deb Fischer (R-NE). “We're asking the Senate to support that legislation,” but without the monthly copays, said Richard Seitz, MD, FACP. For instance, some patients with serious infectious diseases need IV antibiotics at home, blood draws, and lab tests, he noted. “They're not used to paying for services that aren't face-to-face.”

The bill would also expand telehealth options for Medicare patients, including telehealth for stroke, which Dr. Seitz said he is particularly interested in because he practices in Fremont, Neb., where there is no neurologist to provide early treatment for patients.

Another issue that arose again and again is the wild upward spiral of prescription drug prices.

Part of the problem, Dr. Seitz said, is that drug companies can delay the process of an off-patent drug becoming generic by preventing other companies from obtaining samples for necessary testing. He expressed support for a Senate bill introduced last year, the Creating and Restoring Equal Access to Equivalent Samples Act of 2016, because it “prevents manufacturers from not giving the samples to the generic manufacturers.”

ACP supports another Senate bill, the Medicare Prescription Drug Price Negotiation Act of 2017, that would allow the Secretary of Health and Human Services to negotiate Medicare prices with drug manufacturers.

Prices directly impact patients, some of whom now can't afford inhalers and insulin that used to be affordable, Dr. Seitz said. “We all have stories of prescription drug prices getting out of control,” such as colchicine, he said, which “used to be literally pennies. It's been out forever.”

Sen. Fischer asked whether shortages of medications are also an issue, and the answer is “constantly,” such as the national shortage of certain antibiotics to treat syphilis, said ACP Nebraska Chapter Governor Marvin J. Bittner, MD, FACP. “There are definitely some distortions in the system,” he said. “Unacceptable.”

Meanwhile, during a brief standing meeting with Washington Sen. Patty Murray (D-WA), 18 ACP members from the Washington Chapter (including 10 trainees) thanked the senator for her work on increasing access to health care and expanding Medicaid, “which we need to maintain,” Sen. Murray replied. “And expand further in states that haven't,” added Carrie A. Horwitch, MD, FACP, who is an ACP Regent.

Sen. Murray said stopping the AHCA in its tracks is a top priority and appears to be a promising one from her purview. “Now is the time to really raise our voices because this is not acceptable,” she said.