US Rep. Heck meets with PCMS

PCMS President Aaron Pace, MD and PCMS Trustees Nicholas Rajacich, MD and Dina Titova, MD as well as PCMS Executive Director Bruce Ehrle met with US Representative Denny Heck for nearly an hour in his district office in Lakewood on Tuesday, October 1 to advocate on behalf of the Society’s membership.  Rep. Heck’s Congressional District includes West and Mid Pierce County from Lakewood and University Place over to Puyallup.  He has been in the US House of Representatives since 2013. 


PCMS raised many of the same issues that were discussed with US Representative Kim Schrier this past Saturday in her district office including challenges for patients regarding access to care and prescription drugs while emphasizing the need for both the insurance and pharmaceutical industries to receive strong oversight from Congress.  Potential upcoming legislation relating to prescription drugs was discussed during the meeting.  Many details will still have to be worked out over the coming year. 


With Joint Base Lewis/McChord in Rep. Heck’s district, PCMS stressed the need to work on providing greater access to care, especially access to behavioral health, for troops in the civilian provider sector.  With the military suicide rate continuing to climb, PCMS leaders strongly stated that as long as any member of the military reaches out to receive help from civilian behavioral health specialists and can’t be seen in an immediate manner, we have collectively failed that patriot.  Due to intense peer pressures, remaining stigma in the armed forces about seeking behavioral health resource utilization (or admitting the need for health care of any kind), and concerns on the part of members of the military that they will not be trusted with responsibility again if they seek such help, it is vital that we pursue having the civilian provider capacity for them at the same time as we pursue expanding capacity for everyone else in our community.  PCMS suggested to Rep. Heck that a caucus of Members of Congress who represent large military bases with medium to large numbers of civilian providers nearby be formed to consider such measures as decoupling the Tricare reimbursement rate from Medicare rates—and increasing Tricare rates--as well as looking at how transferring medical records for military patients and care coordination between providers could be streamlined and expedited. 


PCMS leaders encouraged Rep. Heck and his colleagues in Congress to think in innovative ways to assist providers improve patient outcomes, maintain high quality of care, and reduce costs by pursuing policies that cut the development of chronic or acute conditions in all patient populations.  Recommendations from PCMS included investing now to save money later with three important initiatives. 


First, funding a massive national field force to coordinate care and do the needed follow-up in the most important care setting for the 21st Century to reduce hospitalizations, cut readmissions, and improve outcomes—the home.  This field force would include a wide range of community health workers, nurse practitioners, PAs, and physicians depending on the case complexity of each patient.  Such coordinators funded by the federal government would work for and/or in partnership with that patient's providers such as their primary care physician or the hospital that discharged them with occasional visits to the home setting to assist with patient compliance with proper care and prescription drug usage, monitor the patient for changes in condition, and perform necessary follow-up with things such as closing the loops on referrals to organizations or agencies for help with social determinants of health such as getting access to nutritious food or getting new housing if they’re an asthma patient living in moldy conditions. 


Second, increasing funding for the social determinants of health such as housing, food assistance, transportation for medical care, and economic opportunity among others to improve population health, reduce health disparities, and reduce expensive chronic and acute conditions—thereby helping to achieve the goals laid out for providers to meet in the new decade with the movement away from fee-for-service toward payment for value, quality, and outcomes. 


Third, re-focusing the American health care system to emphasize establishment and maintenance of primary care through a variety of measures including mandating to all payers that all primary and preventive outpatient visits be deductible-free with very low co-pays at least for the core visit codes, providing direct loan repayment grants to new physicians who choose primary care or behavioral health to help alleviate critical shortages, permitting new doctors (especially those going in to primary care and behavioral health) to have no interest accrue on their loans during the years that they are in residency, and changing HIPAA to allow first responders to be in a better position to route some patients to primary care and behavioral health settings rather than the ER. 


PCMS noted that all of these initiatives would reduce hospital ED utilization with the result of improved access to the ER for patients who really need it and cost reductions. 


As with Rep. Schrier, PCMS encouraged Rep. Heck to lean on CMS to provide details about a process to achieve interoperability of Health Information Technology so that Electronic Health Records are not siloed by providers. 


Rep. Heck was very engaged in the lengthy conversation and listened intently to PCMS suggestions.  He expressed admiration for what doctors do with their talents to heal people with all types of conditions in all types of care settings. 


PCMS will continue to work with Rep. Heck on behalf of the physician and PA membership of the organization on these and many other topics that require attention in a complicated health care system.