Steven Milesko, OMS I, speaks with Rep. Brett Guthrie, R-Ky., in his office.
Steven Milesko, OMS I, and Rep. Brett Guthrie, R-Ky.
Up the hill

White coats in Washington: DO Day attendees push SGR repeal, GME growth

“When there’s 50 or 60 physicians standing in a hallway outside of a senator’s office, it does have a massive impact,” says Teshina Wilson, DO.

Last week, more than 100 DOs and some 1,100 osteopathic medical students from across the nation journeyed to Washington, D.C., to advocate for the medical profession. A sea of white coats flooded Capitol Hill as students and DOs met with their senators and representatives. The turnout was the second-highest in DO Day’s history.

While meeting with members of Congress or their aides, attendees focused on repealing Medicare’s sustainable growth rate (SGR) formula and expanding graduate medical education.

DOs and students told their lawmakers that the U.S. physician shortage is poised to grow worse as millions of newly insured patients enter the health care marketplace under the Affordable Care Act. Limits on Medicare-funded graduate medical education positions haven’t changed since they were set in 1997, and they are inhibiting the training of new physicians.

However, the Affordable Care Act did establish funding to create residency positions in federal teaching health centers, but only through 2015. A Senate bill introduced late last year would both extend funding for existing positions through 2020 and provide money for new residency slots at teaching health centers.

Students encouraged their senators to co-sponsor that bill, the Teaching Health Center Reauthorization Act, and reminded them that residents who train in teaching health centers are more likely to practice in underserved communities, according to the Health and Human Services Department.

DO Day attendee Teshina N. Wilson, DO, the chief medical officer of a teaching health center in Wilmington, Del., says she’s seen the impact training in the center has had on her community. All of the nurse practitioners she trained stayed on to practice at the center.

“Teaching health centers offer invaluable education,” says Dr. Wilson, whose center does not yet have a residency program. “Every day, we’re learning something new. So I can imagine how enriching the experience would be for residents.”

Jeremy Berger, OMS II, is embedded in a Washington, D.C., teaching health center as part of his training at the A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA) in Mesa. During his meetings with aides for California’s two senators, the California native stressed that funding for the center needs to continue.

“We need to train residents in the environment that they’re going to practice in,” Berger says. “If you train in an academic center, you spend a significant amount of time learning how to best address the needs of the community you’re serving. And if you train there all along, you’re more likely to stay and work with the underserved.”

SGR repeal

For more than a decade, physicians have been encouraging lawmakers to repeal the SGR, the 1997 cost-control measure for Medicare spending. Year after year, the actual costs of practicing medicine have exceeded the SGR’s targets. So since 2003, Congress has spent more than $150 billion enacting 16 patches to prevent steep SGR-driven cuts to Medicare payments.

In 2014, the cost of fully repealing the SGR is estimated to be $116 to $130 billion—less than what Congress has already spent on patches. In the past year, Congress has made significant strides toward permanently repealing the SGR. Introduced last month in the House and Senate, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 would permanently repeal the SGR, provide 0.5% annual increases to Medicare payments, and encourage physicians to transition from a fee-for-service payment model by providing bonus payments for those using alternative payment models and meeting performance thresholds.

While the bills have bipartisan support in both chambers, politicians haven’t yet figured out how to pay for the repeal. When Timothy M. Lemaire, OMS II, encouraged Sen. Ron Wyden, D-Ore., to support SGR repeal, Wyden told the group that he agreed with the bill but that the offsets are still being worked out, Lemaire says.

“It was an interesting day because everyone was in agreement,” says Lemaire, who attends ATSU-SOMA. “I could see this happening a lot in Washington. People say, ‘This is a really great idea, but how are we going to pay for it?’ It made the challenge clear.”

Farrell Roseberry, OMS I, says Medicare reimbursement is the issue he’s most concerned about. He’s not a fan of the fee-for-service payment model.

“As physicians, if we’re paid fee-for-service, we’re not going to do what’s best for the patient. Typically, we’re going to be doing what’s best for our bottom line,” says Roseberry, who attends the Midwestern University/Arizona College of Osteopathic Medicine in Glendale. “Why not base payment off of outcomes instead of treatment or procedures?”

Roseberry also notes that the evolution of physician reimbursement will greatly affect his generation’s ability to practice in the future.

“We’re all going to be straddled with huge amounts of debt, and we need to earn enough money to be able to pay it off,” he says.

Cuts to Medicare reimbursement rates affect nearly all physicians, Dr. Wilson says.

“We get so busy in our own lives as physicians that we sometimes forget to take a step back and look at the overall picture,” she says. “Any threat to reimbursement for Medicare patients is a threat to any physician anywhere. No matter where you practice, it would be very difficult to maintain your practice if you lose a large percentage of your patient population, and most of our patient populations are Medicare-eligible.”

‘Get out and do something’

Because physicians are in an altruistic profession, they run the risk of shelving their own interests while they focus on their patients’ needs, Dr. Wilson notes.

“We have this expectation placed on us to do no harm and to take care of our patients to the best of our ability, but it sometimes feels like we’re discouraged from standing up for our own rights,” she says. “We’re putting our livelihoods on the line to take care of patients, yet we are expected to accept the fact that we might not get paid for it. That is just unacceptable.

“Look at DO Day as an opportunity to reiterate your needs to your own legislators. It’s important that they see this mass of white coats. It’s one thing if we do letters or phone calls, but when there’s 50 or 60 physicians standing in a hallway outside of a senator’s office, it does have a massive impact.”

Frustration with the health care system drove Roseberry, a former engineer, to switch careers and become a medical student. He’s hoping to do his part to enact change through his work as a physician, and he sees advocacy as an integral part of his mission.

“If you don’t vote, then you can’t complain about how your government’s run,” he says. “If you don’t advocate and do something about your concerns, sitting around and complaining is not going to fix them. Get out and do something. That’s why I got involved with the Student Osteopathic Medical Association, and that’s why I’m here at DO Day.”

3 comments

  1. Dear sttudent roseberry from AZCOM, payment based on outcome will be like insurance company judging what and how we do. Your vision is absolutely dangerous. Please be in hospital and treat patients with many comorbidities. Insurance can decide not
    To pay doctors if they decide not to pay. So if patient becomes hospice after many years of comorbidities, doctors should not be
    Paid???

  2. I could be completely wrong on this, I am trying to learn. Am I correct in thinking that payment based outcome is a concern more for the hospitals, that if they have poor outcomes, won’t receive incentive money. Which could theoretically trickle down to less physician pay, but I really don’t see this happening. OR, does it directly relate to patients and their physicians

  3. The only sensible method for physician reimbursement is to be paid for your time plus costs of materials. Couple that with transparency of pricing and you might get somewhere. Right now there is no pricing transparency, the economy and people will not tolerate more taxes and we are borrowing trillions to keep a Ponzi scheme afloat.

    Lawyers are paid on time and their rates reflect their perceived value.

    Until student physicians and practicing physicians understand that handouts and carve outs and flip flops on Medicare physician reimbursements are simply accounting tricks leveraged against unsustainable national debt and ” how you pay for it” is you charge patients directly for services at mutually agreed upon rates we have no hope of correcting any problems in the system.

    Better than DO day on the hill would be a massive movement of DOs electing to opt out of third party schemes and demonstrating to Congress that we are more capable of meeting patient needs by dealing directly with them rather than through third party bureaucracies which only increase overhead costs.

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