Advocacy at its Best

By Robert J. Summerer, DO
SDSMA President

Although there are many aspects to the South Dakota State Medical Association, I would consider advocacy to be its cornerstone. My involvement with the organization was birthed out of my desire to advocate for patients and physicians living in rural areas. I perceived that the SDSMA could help me achieve this goal. I have come to grasp the concept of organized advocacy and to find tangible ways that I can participate in the process of rule and law making that affects my patients, peers, coworkers, and community.
 
In February, as part of my role as President Elect in the organization’s Board of Directors, I had the opportunity to participate in the American Medical Association’s (AMA) annual Advocacy Conference in Washington, D.C. This advocacy on a national level revealed a sophisticated organization of physicians prepared with several topics relevant to the medical community. Our delegation, which also included Dr. Mary Carpenter, South Dakota’s AMA delegate, and Barb Smith, SDSMA CEO, listened to several speakers and successfully met with all three members of South Dakota’s Congressional delegation: Sens. John Thune and Mike Rounds and Rep. Dusty Johnson. 

Perhaps the most engaging speaker was Health and Human Services (HHS) Director Alex M. Azar II. Mr. Azar, the son of a physician, seemed to relay a passion for the plight of physicians and patients trying to find their way in the ever changing health care climate. He began with the following quote: “The first principle of our vision for value-based healthcare is about empowering patients – but we are fully aware this cannot be done without empowering physicians, too. So I want you all to imagine a system where patients are finally in the driver’s seat, free to work with physicians who have been empowered as navigators of the best options for their patient, rather than navigators of a sea of paperwork.” His four priorities include combating the opioid crisis, reforming the individual insurance market, lowering the price of prescription drugs, and transforming our healthcare system into one that pays for value. He discussed the complexity of prescription drug pricing, working with tier systems, and the frustrating lack of transparency for patients and their physicians. His department hopes to promote regulatory reform in order to relieve the provider burdens of time spent in prior authorization, quality reporting, and struggling with billing requirements. I was encouraged by his goal to make the documentation that we must do become that of a useful medical record rather than simply a box-checking exercise.  

Mr. Azar’s goals meshed well with the AMA’s top advocacy issues, and our delegation spoke to our senators and representative about various topics that relate to our South Dakota constituency. One concern is that of unanticipated medical bills and network inadequacy. These situations occur when patients are faced with a medical encounter in which multiple physicians and organizations may be involved, some of which are out of their insurance network. These patients are then faced with higher medical bills over which they had no control. We also lobbied for legislation that would bring sanity to prescription drug pricing. We hope to bring transparency to the complicated system of medication pricing in the US. Currently, pharmaceutical companies are using unique loopholes and manipulating patent protections in order to prevent generic manufacturing sales. Additionally, pharmacy benefit managers (PBMs) are benefiting from pharmaceutical discounts without passing them on to patients. In response to the ongoing opioid crisis, we also advocated for measures that would address substance use disorder with funding for multidisciplinary treatments including alternative medications, physical therapy, and mental health therapy. It was pointed out that it’s not enough to limit prescriptions. Alternative treatment modalities must also be in place to address pain. 

Our delegation treaded lightly on the issue of gun violence. The AMA supports universal background checks on gun sales. We concentrated on the need for research into the epidemiology of gun violence recognizing that without good research data, discussions are meaningless. Funding and encouragement of research has been stymied for nearly two decades. Conversely, the study of other public health issues, such as trauma, has continued much to the benefit of patients nationwide. 

Our final pitch was to discourage the nebulous concept of Medicare for All. I believe our Congressional delegation understands the folly of taking an already broken system and offering it to everyone. It was encouraging to see our senators and congressman engaged and interested in the topics we had to present. Their staffs accepted our materials and talking points. Yet, it is important that we, as a profession, continue to advocate our issues both individually and collectively to promote the changes needed to provide better patient care.