Minutes of the Health & Public Policy Committee
November 21, 2000
Carmen Anthony's Restaurant, Waterbury
Present: Drs. McLean, Bernene, Granata, Miner, Mickenberg, Misiak, and guests Dr. Steve Zebrowski from ProHealth, Ms. Mag Morelli from CSMS, and Ms. Robin Krugman lobbyist from ProHealth
1. Review of CSMS legislative agenda:
There was an extensive discussion of the following topics with much insight provided by Ms. Morelli.
- Increase priority to aim for systemic reform through Medicaid provider rate increases and funding for dual eligible patients. With increasing numbers of patients needing this "safety net" due to inability to afford commercial insurance or it not being provided by employers, the Medicaid system is an already existing program which needs to have greater support so that doctors will willingly participate (and can afford to do so). To have greatest chance at success, any increases in funding need to get into the Governor's budget in January. This is the challenge, and the CSMS is sponsoring a state-wide "call in to the Governor" on December 12.
- Managed care issues: major topics on which there will be focus are fairness in contracting because that gets at the key inequity between doctors and insurance plans. Many other problems arise from unfair terms which doctors have signed on to in a contract. CSMS overall felt that focus on bigger issues would be lost if there is too much attention paid to smaller managed care issues which have little likelihood of passing with strong insurance lobby opposition.
- Several scope of practice issues are expected from the fields of Physical Therapy, pharmacists, and naturopaths. The issue of direct access to PTs was felt by the group to not be an internist issue (rather largely orthopedists, who frequently have in-house PT), and so our chapter would have no opinion on this issue. Pharmacist collaboration with doctors in such conditions as anti-coagulation and glucose monitoring and medication adjustment has apparently been effective in the hospital setting. However, expanding this into the outpatient setting and allowing pharmacist reimbursement is quite a different matter. The group felt strongly that this should be opposed for several reasons: having pharmacists making adjustments to medications and dosages will lead to more disjointed care (unlike the hospital where there's a single common chart containing all care), physicians are not currently being reimbursed for the specific tasks of coumadin monitoring or glucose monitoring, and the simple definition of what physicians (and non-physicians) are adequately trained to do. Legislators have apparently heard the positive side from hospital doctors but need to hear the other side from physicians in the community.
- Smoking cessation. The MATCH coalition will be focusing on improving funding for comprehensive anti-tobacco programs (the State is LAST in a ranking of amount of funding from the tobacco settlement dollars which actually went to such programs), working toward smoke-free workplaces and restaurants, and increasing the cigarette excise tax. There is now an Alliance for a Healthy New England, created by the joining of forces of several state medical societies and other voluntary health organizations. The goal is to increase tobacco taxes in each of the six New England states in order to decrease tobacco use and improve health access. We strongly support these goals and will look to work with this alliance (and possibly even join it!).
2. Organize grassroots contacts
There was an extensive discussion on how we as a chapter can be more effective politically in having our voice heard. Possible mechanisms include all of the following which the group felt would have utility and which Dr. McLean will be pursuing.
- Individual member of the H&PP committee will be designated as the official contact in each congressional district and will be asked to regularly call/write that representative on topics as they arise.
- E-mail network for prompt action when needed: This was extremely effective for the R.I. Chapter, and we will ask all H&PP and Governor's Council members to forward pertinent e-mails to all other ACP members in their address books.
- Chapter members to write congratulation letter to reps and show presence of physicians. We will look into sending a letter to each November election victor. Also, the H&PP members and any others will be asked to write specific letters on topics of Medicaid support and pharmacy collaboration—there will be a skeleton letter on web site to use.
- The chapter will look into creating a waiting room display to involve patients and have issue oriented postcards which patients can check off and easily send to their reps.
3. Scorecard on legislator votes in D.C.:
Nay on Campbell bill: Shays, Johnson, Larson; Nay on patient bill of rights: only Johnson. These votes should be mentioned in letters to these reps to remind them that we do watch them.
4. Legislator of the year award
The utility of this award was reviewed, and the group's feeling was to recognize Rep. James Maloney for his efforts in supporting health legislation. Dr. McLean will contact his office and try to arrange for Rep. Maloney to attend the next H&PP Committee meeting in February.
5. Reimbursement for time spent testifying or time away from office
In an effort to make it easier for physicians to spend time away from the office and not incur excess personal expense (overhead expense despite being away from office), we discussed developing a policy to reimburse physicians when embarking on politically-related activity. It was anticipated that this might be one use of the CSIM's Legacy Fund, and the figures discussed were $500 per day (or half-day). Such a policy should be discussed at the Governor's Council.
6. Web site design/content review and suggestions
Dr. McLean distributed the current content of the H&PP portion of the web site. The group was asked to review it and notify him of any suggestions when he updates it for both content and layout. He will try to make it a cornerstone of efforts to improve grassroots communication with the Chapter's members.
Submitted by Robert McLean, M.D., FACP