LMS President’s Message, March 2019
AMA National Advocacy Conference and a Special Visit
Charles L. Papp, MD
I recently had the wonderful opportunity to participate in the AMA National Advocacy Conference in Washington, D.C. This is an annual conference that gives physicians from across the nation an opportunity to hear updates on bills, proposals and ideas that relate to our practices and our patients. One of the best parts of the conference is the opportunity to visit our Kentucky senators and members of the House of Representatives in their offices. The other participants from the LMS included Dr. Mamata Majmundar, our president elect, and Chris Hickey, our CEO.
As many of you know Chris Hickey was a colonel in the United States Army and served in Iraq during Operation Iraqi Freedom. While in D.C, he wanted to visit one of his former soldiers. Specialist Hoby Bradfield served under Colonel Hickey in Iraq. He was a cavalry scout of Grim Troop, 2nd Squadron, 3rd Armored Cavalry Regiment. He was seriously wounded in a daring dismounted cordon and search in the narrow winding alleys in the old city of Tal Afar. When Chris said he wanted to visit him we all decided to go with him. Since we arrived on a Monday morning and the conference started that afternoon, we decided to go Wednesday afternoon after the conference was over.
The conference began with the President’s Lecture given by Dr. Indu Subaiya a physician who works as an entrepreneur and consultant in healthcare technology. She clearly was excited about the promise of the many technology startups relating to healthcare and shared details about some of them. A few of the attendees, however, had questions about the amount of data these apps might produce and the possibility that they will take up more time instead of saving time. We shall see.
Following this there were several briefings on policy and pending bills. Last year the biggest priority was the opioid epidemic. Although this is still a critical issue, this year’s priority was unanticipated medical bills. Health insurance plans are narrowing and changing their networks such that even a diligent patient who researches his provider list can find himself with an unanticipated bill. One example would be a patient who selects a network surgeon. The surgeon then operates on the patient, but the anesthesiologist or the pathologist is not in the network. The patient is then presented with a bill the insurance company will not adequately cover. This is especially troublesome when a patient seeks care in an emergency room. The AMA’s position includes making the insurer accountable to provide robust networks and up-to-date directories, as well as transparency in what the actual out-of-pocket expenses will be if a patient goes out of network. The AMA also wants benchmarks for physician payment that are not based on a percentage of Medicare or a percentage of the insurers fee when a doctor treats an out-of-network patient. It is also essential to ensure all changes are extended to ERISA plans as well. Most importantly, patients should be left out of the equation. They should only be responsible for in-network cost-sharing rates when they receive an unanticipated out-of-network bill. The battle for rates should be between the insurer and the doctor.
Other policies that we advocated for include increasing pharmaceutical market competition and reducing the burden of prior authorizations for medications and procedures. Many times, an insurer will insist that certain medications need to be tried before a physician can prescribe the medication the patient actually needs. This often results in prolonging a patient’s illness or symptoms. In my practice insurers often require a patient to fail two older drugs for Crohn’s or ulcerative colitis before allowing the patient to be treated with a biologic that was needed all along. The AMA is pushing for relief from this practice.
On Tuesday and Wednesday morning we headed to the Capitol to meet with our legislators. Dr. Majmundar visited Senator Mitch McConnell and I visited Senator Rand Paul. We all went to see Representatives Andy Barr and Brent Guthrie. Our representatives were very welcoming and friendly, but what stood out to me is that they seemed genuinely interested in our thoughts and ideas. They asked pertinent questions and gave us more time than I expected. We may not have moved the needle very far with this one meeting, but I am encouraged that we were able to have a voice. In order to make a difference we all must get involved. The more of us who call write or text the bigger the influence. Your email will be magnified because the legislator feels that for everyone who emails or calls there are dozens more who share the same opinion who don’t. Contact the LMS office to get the latest update on what the legislature is debating and whom to call with your thoughts. The website will have links to what is happening in Frankfort and Washington. Feel free to email me as well.
On Wednesday, after our last appointment, we returned to the hotel, changed clothes and went to Arlington National Cemetery to visit the grave of SPC. Hoby Bradfield. After he had been shot that fateful day in Tall Afar, SPC. Hoby Bradfield was put in an armored ambulance and evacuated. In transit, the vehicle was hit by an IED. SPC. Bradfield was killed July 9, 2005 two months before his daughter was born. He was 23. As I stood there in Arlington National Cemetery my mind swirled with feelings of sadness, respect, and gratefulness. I turned to Chris and thanked him for letting me come with him to visit his soldier. He looked at me and said he was not his soldier, he was our soldier– all of ours.
It was then that I realized this visit was the most significant of the entire trip. Without the sacrifices of Hoby and all the other service members throughout the years, I would not be coming to Washington as a member of a successful private practice representing an independent medical society. I would not be openly discussing and debating governmental policies and legislation, and I wouldn’t be meeting with freely elected legislators. As I walked away from Hoby’s grave I realized that I would never be called to serve others as he did. I have been given a calling to serve though. All of us have. As physicians we have been given resources, knowledge and skill beyond what we deserve. With these we have been asked to heal when we can and comfort when we can’t. I now leave Washington with a renewed commitment to serve my community, my profession, and my patients. Thank you Hoby.