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| ASSEMBLY EDITION • ORLANDO, FLA |
Patient advocacy takes many forms. Just look at the background of some resolutions the AAFP Congress of Delegates approved Tuesday and Wednesday.
When Georgia physicians saw the plight of pregnant women who were dropped from Medicaid rolls because the state changed its eligibility from 225 percent of the poverty level to 200 percent, the physicians decided to act.
"This is called abandonment," said Georgia delegate Roslyn Taylor, M.D., of Savannah, describing the pregnant women's dilemma. She spoke in support of a resolution directing AAFP to seek a CMS mandate preventing states from removing pregnant Medicaid recipients from eligibility until their postpartum periods are completed. The resolution also calls for CMS to pay physicians and hospitals for recipients whose hospitalizations are in progress on the day they lose Medicaid eligibility and for CMS to pay for medications, durable medical equipment and post-hospital rehabilitation for 30 days after discharge. "If a patient is in the hospital, the hospital should be paid, as should anything that goes along with that hospitalization. If the patient is pregnant, the pregnancy should be covered," said Taylor.
The delegates agreed and approved the resolution.
Ensuring care for low-income communities
The Congress moved to preserve patient access to care by approving a resolution that instructs the Academy to "find ways to protect professional liability coverage for teaching hospitals."
The resolution reflects a growing number of teaching hospitals whose medical liability insurers have cited teaching activities as a reason for dropping coverage. Liability insurers have completely dropped policies, leaving teaching hospitals to scramble for coverage, said Rhode Island delegate Arnold Goldberg, M.D., of Pawtucket.
Insurance companies' actions adversely affect not only residents and students, but also patients, said Christina Kelly, M.D., alternate resident delegate from Tacoma, Wash. She recounted a situation in which rising medical malpractice premiums prompted a supporter to drop his financial assistance to a community health clinic where residents provided care to low-income residents. The clinic closed.
"The residents were able to finish their training at the main (health center) campus," she said. "But that community lost its medical home."
Keeping patients' drug costs down
Minimizing patients' drug costs was the goal behind a COD-approved resolution that calls for AAFP to ask the FDA to require average daily wholesale prices to be advertised whenever pharmaceutical companies market directly to consumers.
"Our delegation found this to be one of the more compelling and important resolutions to come before the Congress of Delegates," said Oregon delegate John Saultz, M.D., of Portland. "It's high time the profession take a stand on the issue of high drug costs. When patients are told the cost of (highly promoted new) drugs, they have no idea how expensive they are."
Cost awareness will reinforce physicians' message that many of the medications advertised directly to consumers were formulated for patients whose conditions are more serious than just a little fatigue or minor indigestion, said Mary Elizabeth Roth, M.D., AAFP delegate to the AMA.
Despite delegates' interest in teaching patients about the likely higher cost of medications promoted in television, radio and print advertisements, they acknowledged that some patients required the new drugs.
"We need to ask, 'Does the patient need that drug? If they need it, whether it costs $1 or $100 is less of an issue," said Florida delegate Alma Littles, M.D., of Tallahassee, during committee hearings.
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Copyright © 2003 by American Academy of Family Physicians.