The Good That We Can Do Depends On You
Tom Hermann, MD

This new year brings with it new leadership as President-elect Donald Trump and the Republican party assume control in the U.S. Senate and House of Representatives. And while the details and/or means by which it will be accomplished, President-elect Trump and his team have vowed to repeal the Affordable Care Act and the provisions by which Medicaid has been expanded. 

 At the same time, we in medicine face new rules and reporting requirements passed by Congress when they replaced the SGR with MACRA and its emphasis on health care quality and measurable metrics, evolving EHRs, and new Medicare payment provisions. Some would say much is lost, while others, much is gained. The case for health care reform is undeniable as we continue to see growth in the rise of health care costs and the many who remain without insurance coverage. As advocates for patients and physicians of South Dakota, the SDSMA believes in a health care system that provides the greatest possible access to basic quality health care that is affordable for all South Dakota citizens; cost management by all stakeholders – patients, providers, and payers – to ensure a workable, affordable, and sustainable health care system; and the development of a health care system that can provide effective, efficient, and appropriate health care without administrative barriers and unreasonable overhead costs. Lastly, let’s not forget our belief in the role that we as physicians must play in determining health care policy. As providers of health care, we must fulfill our role in medicine as protector and advocate for the health of our patients. In doing so we thereby also protect what we envision as the profession of medicine. We must continue to speak out for those ideals, and remember, together we are stronger.

Our own American Medical Association (AMA) delegate Mary Carpenter, MD, and alternate delegate Rob Allison, MD, along with many of our SDSMA Executive Committee members can share with you specific examples of how our national AMA advocacy efforts have stood for the principles of our profession and by their efforts have made a difference in our executive and legislative branches of government in Washington. I am proud to say that our Executive team and SDSMA staff have excellent relationships with our congressional delegation. 

We have a significant impact at the state level as well. Over the years, our SDSMA Executive, Council and district members have voiced concerns, provided guidance, and demonstrated leadership in promoting the art and science of medicine, and protecting and improving the health of the public. I am confident that just about every physician within our state can think of a patient care or administrative issue in which advocacy efforts of the SDSMA have had a positive impact. While you as a member may not always agree with each and every decision of the Association, I assure you that we listen, try to understand and try to represent our membership as well as our profession. 

For fiscal year 2018 Gov. Dennis Daugaard has proposed a 1 percent increase in Medicaid provider reimbursement and a continuation of funding for his Provider Enhancement Program (PEP). The PEP is a three-year initiative that aims to increase Medicaid provider reimbursement to a minimum of 90 percent of provider cost. While we appreciate the governor’s ongoing efforts to increase Medicaid provider reimbursement, the bottom line is that an overwhelming number of physicians in South Dakota lose money when providing care to Medicaid patients and their inability to meet overhead costs has a negative effect on the provider community and the ability to meet the health care needs of the public. We are also concerned about the individuals who remain without health insurance coverage because our legislature has yet to expand Medicaid eligibility. I reassure you, your SDSMA will again be proactive and vigilant in advocating for medicine as the legislature reconvenes this month. 

Our service to our profession begins will you, our members. We as an organization are only as strong as your participation in this organization allows us to be. Therefore, I encourage you to continue to be a part of the SDSMA and to renew your membership if you haven’t already done so. Remember, the good that we can do depends on you.