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There is still time for Congress to take healthcare action


Bob Doherty, senior vice president of governmental affairs and public policy with the American College of Physicians, spoke to Medical Economics on his healthcare legislative outlook for the year.

Physicians and others in healthcare are facing a legislative environment in Washington, D.C., unlike any they’ve seen in the past decade, says Bob Doherty, senior vice president of governmental affairs and public policy with the American College of Physicians. And it’s not just because the November elections effectively shorten the legislative year for Congress.

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Rather, he points to Congress last year finally solving the Medicare Sustainable Growth Rate (SGR) problem that had vexed it for so many years as being the game changer for healthcare this year. Solving SGR “paved the way for Congress to look at other issues. A lot of those wouldn’t have gotten on Congress’s agenda this year,” if lawmakers once again had to wrestle with a temporary SGR “doc fix” as they’d done in the past, he says.

Chief among the issues Doherty sees Congress addressing this year are opioid painkiller abuse and incentives in the area of chronic care management. Final legislation may be difficult to pass in an election year, he concedes, but that doesn’t mean Congress won’t make progress on major issues that could result in future legislation, Doherty contends.

Doherty recently spoke to Medical Economics on his healthcare legislative outlook for the year.

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Medical Economics: Can Congress do much more than study and educate itself about healthcare issues in an election year?

Bob Doherty: I think education and study doesn’t really give enough credit to what’s going on. If you can actually get a committee to report legislation out on whatever issues you want to talk about, that is something. You’ve succeeded in getting it through all the partisanship and next year it will put us in a far more advantageous position to move those pieces of legislation forward. I think such efforts this year will lay the groundwork for it to bloom next year.

Next: The healthcare issues Congress will look at this year


ME: What do you see as the healthcare issues Congress will look at this year?

BD: Opioid abuse and chronic care management are at the top of our list right now. On opioid abuse, there’s a great sense of urgency in having Congress pass legislation that would provide for funding to cover recovery and treatment options. Unlike other issues, I think you’re likely to see some legislation signed into law on the opioid abuse issue.

ME: What are prospects for legislation addressing the need for incentives for chronic care management?

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BD: That’s one area where medicine has a tremendous opportunity to bring about bipartisan improvements that would reduce many of the barriers to managing patients with multiple complex diseases. The Senate Finance Committee created a bipartisan working group which released a paper last year that included options they are considering. Our most recent conversations with the committee suggests they are still in that process of reviewing options to release a list of policies they are committed to moving forward through the legislative process.

ME: What about the 21st Century Cures Act? Is it being broken apart, with pieces of it being considered separately?

BD: The House wants to do as a comprehensive bill, [but] the Senate seems more inclined to break it up, partly because there are funding issues for NIH and others. There also are a lot of policy issues in that legislation that divide the patient community. I think it may move forward as a package in the House. The Senate seems less inclined to take it up as a whole.

ME: You’ve blogged about the need to integrate behavioral health with primary care, what are prospects for legislation in that area?

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BD: Both the House and Senate have been working on behavioral health and mental health legislation for over a year now. Because mental health, the opioid abuse issue and chronic care are so tightly tied together as issues, if Congress moves forward on opioid abuse legislation, then you may be able to take pieces from all those areas and bring them together in one bill under the opioid abuse umbrella.

Next: What about Meaningful Use?


ME: Do you expect any action from Congress in the area of meaningful use regulations in light of CMS’ January announcement on the program?

Bob Doherty: Meaningful use is now in the regulatory arena, but Congress is watching meaningful use with considerable interest. My expectation is that Congress is going to use its oversight authority to see what CMS does, just as they did last year. We’re moving out of [stage 2 of] meaningful use  and into something else. Congress will be putting a watchful eye on the regulatory process in this area. They don’t want people unfairly penalized.

ME: Do you see any likelihood of Congressional action in the area of prescription drug pricing?

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BD: There’s going to be a lot of hearings about it and I can tell you the ACP will be coming out with a major position paper on it soon. I think you’re going to see a very strong advocacy effort by us and others. Both Republicans and Democrats see this as an issue, but there are philosophical differences on how to fix it. The Democrats favor regulatory approaches that go directly after the drug industry to require greater transparency in their pricing, for example. Republicans tend to say there’s not enough competition, so let’s speed up the FDA approval process for more drugs, generic drugs, etc. So there is a philosophical gap. We believe you need both. You need some greater regulation but we also believe there are market-based approaches that can be effective in driving down prices.

Next: Any GME reforms?


ME: Do you expect Congress to pass any significant graduate medical education (GME) reforms this year?

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BD: I don’t expect a lot happening on that this year. We’re always watchful to see if there are cuts in Medicare to GME payments that might come up in the budget process but I think that’s unlikely in an election year. We would like to see increased funding for medical education …  It’s imperative it gets done but I’m somewhat skeptical it actually gets done this year. Any measure that puts more money into GME is going to be expensive and that extra money has to come from somewhere else.


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