Leadership Day launches push for primary care

Whether they were catching a Congressman in the hallway or pleading their personal stories to legislators, participants in ACP's annual Leadership Day were united in the message to their state representatives: save primary care.

More than 400 ACP members gathered in Washington, D.C., on May 20 to lobby their senators and congressional representatives on behalf of internal medicine. They found an especially receptive audience this year, thanks to the administration's current push for health care reform.

“This is a fantastic time to be in Washington,” said Molly Cooke, FACP, chair of ACP's Board of Governors.

Internal medicine advocates hoped to take advantage of the timing to garner support for primary care payment reform. At an afternoon press conference on Leadership Day, Rep. Allyson Schwartz (D-PA) announced her sponsorship of the “Preserving Patient Access to Primary Care Act of 2009.”

The bill, which has more than 100 co-sponsors, calls for increased Medicare payments for primary care and care coordination, as well as loan repayments, new residency slots and other incentives to attract medical students to primary care. ACP was heavily involved in crafting the bill, and College members made it the focus of their conversations with elected representatives.

Eight other physician and nurse organizations have endorsed the bill, and representatives from these groups, including ACP President Joseph W. Stubbs, FACP, spoke at the press conference.

“We don't want health care in America to be like a weak cell phone signal—patchy and intermittent,” said Ari Silver-Isenstadt, MD, of the National Physicians Alliance. “This is the beginning of making primary care cool again.”

During meetings with members of Congress, ACP's student, associate and young physician members took the lead in explaining why primary care is currently so unpopular among the new generation of physicians.

Matthew E. Johnson, ACP Member, told his personal story to Sen. Ben Nelson (D-NE). A Nebraska native, Dr. Johnson spent several years as a rural general internist, but he was overwhelmed by patient volume, paperwork, educational loans and the impossibility of finding other physicians to join his practice. He is now training in Omaha to become a cardiologist.

“I grew up on a dairy farm. It wasn't the time and commitment. It was what was coming down the road,” Dr. Johnson said.

His story appeared to hit home with Sen. Nelson. “If you could see the future being brighter, you wouldn't have come back to Omaha, right?” he asked. Dr. Johnson agreed, and then he and the other Nebraska physicians explained how incentives for primary care will be even more critical if health care reform expands the covered patient population. (That theme was also emphasized in an ad ACP ran in the newspaper Roll Call on May 20 with the headline “Giving everyone an insurance card doesn't ensure care for everyone.”)

“If you don't have access, the system implodes,” Sen. Nelson agreed.

Many of the legislators had their own ideas to offer about payment and health care reform. Rep. William M. Cassidy, FACP, a first-term representative from Louisiana, spoke to Leadership Day attendees before they went to Capitol Hill and described his ideal model—a version of concierge medicine in which insurance would be used only for major health care expenditures. “I would like it if we acknowledged that primary prevention services are different from traditional insurance,” he said.

Although it was a popular topic among legislators, ACP representatives tried to steer away from the hot-button topic of coverage reform. The Schwartz bill was put forward by Democrats, but preserving primary care and internal medicine should be a bipartisan concern, the doctors said.

“I'm a conservative Republican and I like this bill as the best alternative out there,” Vincent E. Herrin, FACP, told staff members working for Sen. Thad Cochran (R-MS).

Cost was another issue frequently raised by the politicians and the physicians had ready responses on that topic, too. Fixes for payment cuts instituted by Medicare's sustainable growth rate (SGR) formula have become an annual routine, but this year, the internists-as-lobbyists could offer a new financial scenario.

ACP's proposed legislation calls for breaking up the divisions between Medicare Parts A, B and D, and using savings from reduced hospital admissions to pay for the primary care that keeps people out of the hospital.

“It's not just the SGR,” said David M. Borne, FACP, in a meeting with Sen. David Vitter (R-LA). “We're pushing to break the silo.”

Cost concerns should be a reason for legislators to join her and Sen. Maria Cantwell (D-WA) in sponsoring the primary care legislation, Ms. Schwartz said. “To me, health care has always been a moral imperative. It is now also a financial and economic imperative,” she told ACP members before sending them out to gather support.

That message, along with ACP's tagline for the day—primary care is the best medicine for better health and lower costs—would be repeated again and again as the doctors made their rounds on the Hill.