President of the Harris County Medical Society
Internal Medicine Physician
Editor's Note: This article was first printed in the Harris County Medical Society's Physician Newsletter.
Watching the election coverage last week, I was distressed by the fact that government gridlock is certain unless someone blinks. Reporters were surprised and excited about the new Republican majority in the House and in the Senate and their affect on President Obama and the Affordable Care Act (ACA), immigration reform, etc. Election results reflected a discontent with the direction Washington is moving or not moving, whatever your viewpoint.
For medicine, health care is at a crossroads and important decisions need to be made. However, it is uncertain if there is a real willingness for the President and Congress to work together. We cannot continue under our present situation. Knowing that we have been working on repealing Medicare’s SGR for over 10 years without any success, does not make me hopeful about any changes that we need for the ACA. Not wanting to feel helpless, I wanted to write a letter to Washington to tell them how we feel. I know, it’s another letter. When we have a sick patient and are unsure how to proceed, we consult with our colleagues to find answers on the best plan of care for our patient. We never give up on our patient. As our health care system needs healing, we want to be consulted by Congress on making improvements. We cannot give up here either.
Here’s my letter:
Dear President Obama and members of Congress,
I am writing you to express the concerns of the more than 11,700 physicians of the Harris County Medical Society. I want you to know that while we do appreciate your willingness to lead our country, we also feel great disappointment due to your inability to work together and move our country forward. There are many complicated issues that require attention. We physicians stand willing to help provide guidance in the area of health care. As physicians, we live these issues daily. We can speak of our experiences and what we have learned. Through our national, state and local medical associations, we have tried to provide alternatives to problems of the SGR and Medicare, health information technology (HIT), fraud and abuse and the Affordable Care Act (ACA), to name a few. It is not possible to legislate good medicine, but as physicians, we work fervently to practice good medicine. And, neither we nor our patients are robots willing or able to follow recommendations without question or thought. We must provide personalized medicine to our patients and do what we do best, which is to help them make decisions based on their individual health care risks and needs. We cannot force patients to change, but only do our best to educate them about their illnesses and give them tools to effect changes to their habits and lifestyles. We do not ask our patients about their political affiliation, only offer to help them with their health care needs. We ask that you set aside your political differences and focus on getting our patients the health care they need and deserve. This is not about who wins or loses in the political arena. This is about creating good public policy that helps people who are sick or injured. When a family member is ill, no one is thinking about who their senator or congressman is. All they want to know is where they can go to get medical care. We have to work together with insurance companies, hospital systems, long-term care facilities, and other allied health professionals to continue providing comprehensive medical care.
Repeal SGR formula
Through the work of Congressman Kevin Brady and others, we came very close to repealing SGR with bicameral and bipartisan support. Don't let the last few months of this year go by without finally repealing this costly and flawed formula. We need to find ways to finance a rational Medicare physician payment system with a fair and stable funding formula. Due to our senior patient population’s rapid growth, we need to have adequate physician access. As patients’ choice of their physicians is important, increased Medicare flexibility would also improve access, especially if physicians were allowed to directly contract with Medicare patients, even when they opt out of Medicare.
ACA-Keep what works, add what's missing and fix what's broken
The Affordable Care Act (ACA) has been a lightning rod for politicians - pro and con. After evaluating the new law, the Texas Medical Association (TMA) recommended some parts be kept, some be fixed and other things be added. That sounds like a reasonable approach to me and many of my physician colleagues. It's important that patients with pre-existing illnesses be able to get insurance coverage or that patients not lose insurance coverage due to "honest mistakes" on insurance forms. Patients should be able to understand their insurance coverage with easily readable health insurance labeling and be able to easily compare coverage options offered by different insurance companies. Finally, it is vital that health insurers use a consistent reporting formula for their medical loss ratio. Purchasers of insurance need to know how much their premium dollars are being applied to covering the cost of medical care and how much is going toward insurance company profits.
We need to repeal the Independent Payment Advisory Board (IPAB), which is charged with reducing Medicare spending and can ONLY do this by reducing payments to physicians and a few other groups. If decisions are needed to limit funding for health care services, then Congress needs to be accountable for these decisions for the Medicare system. Also, if patient access to care is to be maintained, it is important to support expansion of graduate medical education (GME) funding through Medicare or consider alternative methods for GME funding to assure adequate physician availability.
Overbearing fraud and abuse
Reducing health care costs is a laudable goal, but creating laundry lists of rules and regulations does not necessarily stop fraud and abuse. It causes an undue amount of needless paperwork for physicians who are working hard to take care of sick patients. Auditing medical offices that have invested a lot of time and money achieving meaningful use (MU), only discourages others from even attempting MU, as the tedious documentation is daunting. The use of recovery audit bounty hunters further discourages physician participation in the Medicare program. We need to remove language from the ACA health care fraud statute, stating "a person need not have knowledge of the law or intent to commit a violation," meaning physicians could be charged for honest mistakes or errors.
Health information technology
Despite the fact that many physicians have adopted electronic health records (EHRs), there remains a significant percentage of physicians who are unable to afford the systems. The cost of maintaining an EHR also remains an issue and evidence of return on investment (ROI) continues to be unproven for most physicians. The time investment for EHR is also very high and cumbersome. Additionally, meaningful use criteria are proving to be overwhelming for many physicians. While physicians do appreciate being able to have health care information readily available for review, this idea remains elusive as there is very limited health information exchange (HIE). Also, as many EHR systems are incompatible with each other, most health information remains in the silos of each physician’s office and each hospital. Until uniform standards for EHR compatibility are created, HIE will continue to be difficult. As physicians work to adopt EHRs, it is important to extend the provisions of the HITECH act to provide additional funding and monetary incentives, rather than punitive penalties, for meaningful use adoption. Slowing down time for adoption of EHRs allows time for EHR vendors to improve their product for different specialties and create compatibility standards. We need to determine which MU standards are important and contribute to improved medical care, not just useful for actuarial use or data mining.
Whatever our political affiliations, we physicians share a commitment to advocate for our patients, to provide the best medical care possible and to foster collegial partnerships with all members of the health care team. Mr. President and members of Congress, we need you to take this same approach and work with us to address the problems in our health care system that are reducing people’s access to care. Everyone has a need for medical care at some time in his/her life. It's that common need that should drive us to foster a robust health care system for the future. As physicians, we will continue lifelong learning, improve the quality of care, and provide value for our patients. We physicians are prepared to advise you on health care issues, just as we are prepared to advise our patients on their health care needs.
E. Torres, MD
Harris County Medical Society President