ACP presses its case on the Hill
“Who’s taking care of America?” Sen. John Kerry (D-MA) joked upon entering his Capitol Hill office on Wednesday and finding it crowded to capacity with internists.
The College’s annual Leadership Day, held for the first time during Internal Medicine week, brought more than 500 physicians to Capitol Hill on Wednesday to lobby their elected representatives in person. It was the College's largest Leadership Day ever, with physicians coming from all 50 states and Puerto Rico to encourage their elected officials to support the College’s legislative priorities.
Requests focused on three major areas: preventing pending Medicare physician payment cuts, funding pilots of the patient-centered medical home, and expanding access to primary care. The doctors told real-life anecdotes to convince politicians of primary care’s precarious situation.
“I’m $60,000 in debt. I live with four people. I don’t go out that much,” University of Washington medical student Gabriel Fine told Sen. Maria Cantwell (D-WA). He went on to explain how the prospect of declining reimbursements is pushing many students toward careers in more lucrative subspecialties over general internal medicine.
Sen. Kerry: “We’re looking for ideas of what will attract people to primary care … so you don’t have to become a boutique dermatologist with your own line of skin care.”
Ms. Cantwell was one of the most sympathetic ears that the internists found. Just before Leadership Day, she agreed to sponsor legislation proposed by the College. The “Patient Access to Primary Care Act” would expand scholarships, provide payment for care coordination, and institute loan-forgiveness programs for young physicians who practice primary care in underserved areas.
Ms. Cantwell, along with many of her colleagues, also expressed support for the College’s efforts to halt the Sustainable Growth Rate cuts scheduled for July 1, 2008. Legislators from both sides of the aisle assured the internists that Congress was working hard to avert the cuts, but expressed less certainty about whether they would be halted for a full 18 months, as the ACP is urging.
“It’s not a foregone conclusion that we can get this done, so the physician community really needs to get active on this,” said Chris Dawe, a legislative aide to Mr. Kerry.
Legislators and their aides also repeatedly asked the visiting physicians for their help crafting more comprehensive reforms of the U.S. health care system. “We really need your input. We need your help to do a reality check about the things that look good on paper,” said Sen. John Cornyn (R-TX).
“We’re looking for ideas of what will attract people to primary care … so you don’t have to become a boutique dermatologist with your own line of skin care,” said Mr. Kerry.
The physicians urged legislators to support just such a real-world test of proposals for improving primary care, by approving $500 million to fund a Medicare pilot of the patient-centered medical home. It was one of the toughest sells of the day, as legislators were reluctant to commit the financially strapped federal government to a new expenditure.
The physicians emphasized how the outlay of money could be recouped by the cost savings provided by comprehensive primary care—such as regularly consulting with a diabetic patient about his diet to avoid an amputation.
“Recognizing that there are budget issues, what would the cost be if we don’t do something? We’re looking at a pound of prevention,” said Washington internist Carrie A. Horwitch, FACP.
The politicians supported the College’s ideas about funding medical homes and education, but were consistently pessimistic about the money. Rep. Louise McIntosh Slaughter (D-NY) noted the difficulty that Congress has faced even over funding of higher education for veterans.
“This is a government that’s broke,” she said. “I imagine that it would be harder to get loan forgiveness for people with the possibility of good income.”
ACP members were unwavering in their focus on the importance of these issues for society as a whole, as well as physicians, however. “The patient-centered medical home is a last-ditch effort to save primary care from oblivion and destruction,” said New York Upstate Governor Edward A. Stehlik, FACP.
It was just that sort of intensity which ACP executive vice-president and CEO John Tooker, FACP, praised at the White Coat Rally that ended the day. After the group gathered outside the Capitol building finished some demonstration-style cheering (“When do we want SGR fix? NOW!”), Dr. Tooker encouraged the attendees to continue their efforts to persuade legislators beyond Leadership Day. “Wear them down until they give you their commitment,” he said.
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