Improve patient access to quality care, DO Day participants tell Congress

For the first time in several years, DO Day on Capitol Hill did not concentrate on physician payment challenges, specifically the need to repeal the sustainable growth rate (or SGR) formula used to calculate Medicare reimbursement. Instead, the roughly 1,000 osteopathic medical students and DOs who participated in the March 8 event drew lawmakers’ attention to two broad issues: patient access to quality care and graduate medical education’s role in ensuring the future physician workforce.

“We have to remember that there are 310 million patients who are out there trying to access and take advantage of the U.S. health care system,” Shawn Martin, the AOA’s director of government relations, reminded the white-coated crowd during the DO Day breakfast briefing. “They face a lot of unique challenges and not just getting into a physician’s office.”

AOA leaders and staff asked attendees to push for four bills that would improve health care access:

• The Restoring Access to Medication Act of 2011 (S. 1368 and H.R. 2529) would repeal a recently enacted provision of the Patient Protection and Affordable Care Act of 2010 that requires prescriptions for most over-the-counter medications purchased with funds from flexible spending accounts and health savings accounts. Besides reducing patient access to medication, the provision adds to physicians’ administrative burden and potentially increases their liability.
• The Good Samaritan Health Professionals Act of 2011 (H.R. 3586) would improve access to physician services in times of emergency by providing civil liability protection to physicians and other health professionals who are volunteering their services during a declared national disaster.
• The Help, Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2011 (H.R. 5) would enact several reforms to the country’s medical liability system, including limiting the recovery of noneconomic damages to $250,000 and limiting attorney contingency fees.
• The Direct M.D. [Medicare Dual-eligibles] Care Act of 2011 (H.R. 3315) builds on the patient-centered medical home model of health care delivery, known as direct primary care in the private sector. The bill calls for a demonstration program in which the Centers for Medicare and Medicaid Services would pay primary care physicians up to $100 a month per Medicare beneficiary and up to $125 a month per Medicare-Medicaid dual-eligible beneficiary to coordinate the health care needs of these patients. The legislation would establish a fiduciary relationship between patient and physician, spurring primary care physicians to provide top-quality clinical care and friendly, efficient office staff, according to the bill’s sponsor, U.S. Rep. Bill Cassidy, MD, R-La., who was a keynote speaker during the breakfast briefing.

Making a difference

Well-versed on the issues, South Dakota’s lone representative, Seth W. Schmoll, OMS II, discussed every bill touted by the AOA with Jane B. Lucas, legislative assistant to U.S. Sen. John Thune, R-S.D. After noting his overall support for the insurance reforms in the Affordable Care Act, Schmoll observed that “there are always parts of every law that can be worked on and made better.”

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One aspect of the health reform law that should be changed, said Schmoll, is the OTC medication provision addressed by the Restoring Access to Medication Act. “Patients should not have to get a prescription to buy Tylenol. This results in frivolous spending on health care, wastes physicians’ time and may cause delays for patients who truly need to see their physicians,” Schmoll said.

Lucas responded, “We agree. That provision was included in the Affordable Care Act to boost tax revenues.”

The Good Samaritan Health Professionals Act “is another bill I consider common sense,” Schmoll said, noting that it would provide liability protections for physicians who volunteer at natural disaster sites. “Let’s say somebody scraped his knee and a physician doesn’t take care of him right away because of the need to treat more seriously injured patients. This bill would protect that physician volunteer from a negligence lawsuit,” he explained.

In the office of U.S. Rep. Shelley Berkley, JD, D-Nev., Ori DeVera, OMS I, a student at the Touro University Nevada College of Osteopathic Medicine in Henderson, broached the AOA’s support of the HEALTH Act and asked for the congresswoman’s position on this issue.

“She understands your concerns but believes the proposed cap on noneconomic damages is too low,” replied senior legislative assistant Carrie L. Fiarman.

Schmoll also voiced support for the HEALTH Act, which has been reintroduced in Congress multiple times. “I think medical liability reform needs to be national rather than state by state, just for the fact that when one state doesn’t have it and another state does, it creates health care access disparities, driving physicians away from certain places and to other places.”

In addition, he expressed his concerns about defensive medicine. “It is really sad to me that during my first two years of medical education, we’re being taught that if a patient comes in with a condition—even if you already know what it is because of your diagnostic skills—you need to order labs or run tests because if you don’t, you are liable. It’s absurd to me that if I know you have strep throat but I don’t have the labs to support that diagnosis, then I can get sued. It’s a big waste.”