We had a great visit to Washington DC on March 22 to meet with members of Congress to discuss the American Academy of Neurology 2009 issues. Elaine Jones, Peter Bellafiori, and I attended. Here is a summary (actually a mish-mash recording of the days events)...
At the start of the day, during breakfast, we heard a speech by a former cardiac surgeon- now congressman (from LA) on the House Ways & Means Committee, Charles W. Boustany Jr. who emphasized a stronger patient-physician relationship as a means to tackle costs/quality issues. Also endorsed the concept of a "medical home". Went on to comment on items already passed in the stimulus bill that are keystones to Obama's health care reform effort, including:
(1) Electronic medical records (already passed in stimulus bill) - there will be a penalty of 1%/yr on SGR payment if not implemented by a certain time: "another example of pressure to adopt health information technology that doesn't work with a penalty on the back end."
(2) A board to decide which technology is appropriate & cost effective (already passed in stimulus bill) - this is a "cost cutting measures in place of what is effective". Mentioned the White House Budget Director, Peter Orzak's comments that this measure "put in effect a value on you life". Also commented that by placing costs above effectiveness it intrudes on the pt-ph relationship, citing legal cases in Great Britain where there are allegations around withholding proper care.
(3) Public (nonprofit) plan option to compete with private insurance (not passed but considered) - comments: "you don't compete with the Federal government - you take it or leave it"; smaller insurers disadvantaged not able to compete in this system; this appears to be another form of Medicare & "a back door to single payor system."
Questions to the Congressman emphasized cost again with comments that Louisiana may have highest per capita expenditures on health care, linked primarily to inefficient use of the emergency room (after a question on variation in health care study (dartmouth). And, after a question on single payor system: Medicare and Medicaid are on an unsustainable path to 100% of the federal budget with no mechanism for effective cost containment with Obama's public plan: "We need more transparency in present system with more competition to reduce costs" (see my prior post on private insurers ability to reduce costs).
Then we had a chance to listen to Senator Charles Grassley briefly (as we were the first to leave to meet with Senator Jack Reed). Senator Grassley gave a nod to neurologists saying that "for the patients you deal with, if cures are found, you will empty out the nursing homes." Also: "health care reform is the issue of the year," and because of the economic crisis and opportunities for change, "these are the best of times and worst of times."
We were followed by a one-person paparazzi into Senator Reed's office. We have a chance to meet with a legislative aide for about 20 minutes and then we were joined by S. Reed for about 10 minutes. Several issues were discussed:
- Pay for Performance: we mentioned that it has been difficult getting information about the program from CMS let alone bonuses. The aide mention
ed you likely won't get penalties if done and had no comment on bonus structure. - Reed's office likes the ideas of a medical home, but after hearing our comments on the importance of neurology's role in chronic-primary care states that maybe the idea should include a place for chronic care.
Although not able to meet with other members, we were able to sit down with staff from other RI offices, including:
- Congressman Langevin's office where we connected with several accounts of personal health experiences that required neurological care.
- Congressman Kennedy's office where we learned about Kennedy's strong interest in mental health care reform, and about a bill the Congressman is supporting regarding the use of medical devices in neurological care.
- Senator Whitehouse's office where we had a candid discussion of many topics with a legislative aid including Tort Reform with the Senator supporting present system with more transparency on the part of medical providers. In discussing measures to reduce costs, aid mentioned that even discussing limiting costs at the beginning and end of life bring strong opposition from conservative right. In our discussion of the neurologists role in health care reform, specifically regarding the medical home, the aid remarked that she has never heard a reform idea stating that there were not enough referrals, but rather discussions about reform often talk about limiting unnecessary referrals - a possible area in which the AAN message may be misconstrued. Reports during a recent the AMA visit, the AMA advocated to increase supply of specialists - "they have to get on board with the reform effort emphasizing medical home, or get left behind".
