US Rep. Schrier meets with PCMS

PCMS Executive Director Bruce Ehrle met with US Representative Kim Schrier at her district office in Issaquah on Saturday, September 28.  As a physician, Rep. Schrier understands the federal advocacy issues of the Society very well.  Her Congressional District includes portions of east and mid Pierce County.  Bruce was able to raise several priorities with her that include major initiatives that might be possible in the coming years as well as more immediate oversight opportunities. 


Not much legislating is expected to be done for the remainder of this Congress through next year but one health care topic where there remains hope for bi-partisan agreement is in combating the practices of the prescription drug sector.  So far this year, the House of Representatives has passed a bill that would curtail some of the worst practices in the generic drug industry such as receiving payments by the major drug companies for delaying the introduction of generic versions of certain drugs.  Senators Grassley and Wyden have introduced a bi-partisan bill that would cap out of pocket drug costs for Medicare beneficiaries and increase transparency of drug pricing decisions as well as the behavior of pharmacy benefit managers among other provisions.  Negotiations may take place next year between Congress and the White House on a package broader than either of those proposals.  In that event, Bruce encouraged Rep. Schrier to support legislation that would allow CMS to firmly negotiate lower drug prices for the Medicare and Medicaid programs and to allow American consumers to reimport prescription drugs from pharmacies in the other G7 nations, especially Canada, at the prices those drugs are sold for in those nations.  He also referred to the generic drug company that several health systems including CHI Franciscan have formed to produce drugs most needed in their hospitals that the drug companies have curtailed production of and increased the cost of substantially.  Bruce noted that their action, born of necessity, should serve as a template for the federal government to require the drug companies to produce those drugs in sufficient quantities at capped prices. 


Bruce also encouraged Rep. Schrier to consider lowering the bar that patients must hurdle in order to qualify for federal assistance for health insurance premium payments and for Congress to consider also providing deductible assistance.  Bruce referred to a just published analysis of employer based insurance premium and deductible costs over the past decade conducted by the New York Times and the Kaiser Family Foundation that show that while inflation has risen a bit over 20 percent in the last ten years and wages have risen 25 percent, employer based policy premiums have increased over 50 percent and deductibles for those policies have increased over 150 percent in ten years, frequently making health insurance unaffordable for patients to use.  Even Medicare patients have recently reported deferring care due to cost concerns and the rate of the uninsured has begun to climb again.  Additionally, Bruce and Rep. Schrier discussed how mandating to the insurance industry that all preventive and primary care outpatient visits be deductible-free with affordable co-pays (at least for the core portion of the visit, not including imaging, labs, and other treatments) would encourage the insured to establish relationships with primary care to help reduce the development of expensive chronic conditions, ER utilization, and hospitalizations.  Rep. Schrier noted that she favors policy movement in all these areas to foster improved access to care that also lowers costs. 

Bruce noted the need for HIPAA reform to modernize a law and its associated regulations that was developed at a time when fax machines were viewed as a marvel.  He stressed that it is time for a full re-examination of HIPAA requirements in light of 21st Century technologies to reduce the amount of faxing going on in the medical sector.  Bruce also pointed out that providers such as physicians and PAs need to be able to partner with first responders such as EMTs and paramedics in the field so that patients are less frequently transported in the most expensive mode to the most expensive care setting when such patients might get better outcomes in behavioral health facilities or outpatient settings.  That would require HIPAA reforms to allow first responders to have wider access to medical records. 


Barring a lot of health care legislation on the immediate horizon, Bruce asked Rep. Schrier for assistance in three oversight areas that can be conducted immediately. 


First, tasking CMS and HHS with giving more information to the provider community regarding a detailed roadmap with realistic deadlines of how to achieve interoperability of Health Information Technology given that most Electronic Health Records remain in the silos of individual provider systems, adding tremendous burdens for physicians to exchange medical records or be aware of the full treatment picture for a patient.  Bruce noted that for nearly 20 years CMS allowed a patchwork of systems to be installed around the country and only recently has declared that interoperability is “Priority 1”.  Rep. Schrier agreed that the full realization of EHR goals hasn’t been met because if a patient is admitted to an ER in another provider setting, the caregivers treating that patient are often working in the dark as far conditions, medications, and medical history because their system doesn’t communicate with others.  Bruce stressed that providers operated in good faith to install EHR systems and that if there are costs and practice disruptions associated with now fixing the massive deficiencies that the federal government allowed to develop with interoperability, providers should not be the ones to be forced to pay them. 


Second, working with the chairs of the House Ways and Means Committee and Energy and Commerce Committee to request aggressive, televised, public oversight hearings of the private health insurance industry, compelling the testimony of leaders of those companies to disclose under oath why their business practices so often differ from the image they present in their promotional materials.  Such hearings could examine why it seems that so many insurance companies spend more time than anything else looking for ways to deny payment for needed care as well as for prescription drugs that providers such as physicians and PAs deem necessary, even at times when those prescriptions are for less expensive generics. 


Third, pressing CMS to continue the work that the agency is doing to reduce administrative burden on providers.  Bruce noted that while the medical community is appreciative for CMS efforts to reduce the amount of documentation that is required for outpatient office visits as well as for how the agency has listened to concerns about how payment might be significantly impacted for some practitioners in a negative manner, that initiative needs to be viewed as just the start of combating some of the root causes for physician burnout and depression. 


PCMS will continue to work with Rep. Schrier on these and other issues on behalf of the membership.