At the 2017 Congress of Delegates (COD), held here from Sept. 11-13, family physicians discussed a number of hot-button issues that were referred to the Reference Committee on Advocacy.
Pennsylvania alternate delegate Kevin Wong, M.D., of Jeanette, speaks in support of a resolution on tort reform. He told the Reference Committee on Advocacy there is considerable variability among states when it comes to malpractice awards. Pennsylvania is the third highest in payout amounts per year, while neighboring Ohio sits in the low forties on that list. "The difference is in state laws, it's not the way we practice medicine," said Wong.
During the COD business sessions, delegates addressed the issues by adopting resolutions or substitute resolutions, or referring them to the AAFP Board of Directors for further discussion. In some cases resolutions were not adopted, or were reaffirmed as current AAFP policy or as already being addressed by Academy leadership. What follows is a brief overview of some the reference committee and COD work.
A resolution introduced by the New York State chapter asked for support of "loser pays" tort reform for medical malpractice and personal liability cases. The resolution asked that the plaintiff and the plaintiff's attorney both be held liable for the defendant's legal fees and related costs with a cap established by legislation.
Wayne Strouse, M.D., of Newfield, N.Y., spoke strongly in favor of the measure as a way to deter nuisance lawsuits. "It's time to play offense. It's time to put lawyers on the hook for frivolous lawsuits."
- The AAFP 2017 Congress of Delegates acted on a number of resolutions that were referred to the Reference Committee on Advocacy.
- The reference committee discussed a number of issues at length including tort reform, the opioid crisis and compound topical medications.
- Other issues the Congress considered included elimination of the hospital three-day rule.
Member constituent alternate delegate Kristi VanDerKolk, M.D., of Kalamazoo, Mich., testified that her delegation opposed the resolution.
"Specifically, our fear is that marginalized populations, who truly may have been harmed, will be dissuaded from moving forward with lawsuits knowing that they may be held liable for the cost of that lawsuit, and they surely can't afford it."
Georgia delegate Bruce LeClair, M.D., M.P.H., of Evans, supported the resolution but suggested holding only the plaintiff's attorney accountable, reasoning, as the member constituency did, that otherwise plaintiffs would be less likely to bring a valid suit forward.
"The attorney is responsible for giving good advice to his or her client and should be responsible for legal fees if the case is lost," LeClair said.
The reference committee advised referring the matter to the Board of Directors, and the delegates voted to do so.
A resolution introduced by the Mississippi chapter titled "Stop the 'Blame the Doctor' Game: Evidence Says Physicians are not the Cause of Opiate Crisis" grabbed the attention of family physicians.
The resolution included a resolved clause that asked the AAFP to engage in a public relations campaign to "dispel the myth that places the blame on physicians for the current opiate epidemic."
Mississippi delegate Timothy Alford, M.D., of Kosciusko, said his chapter very much appreciates the AAFP's work on the issue of opioid abuse and misuse.
He said the mainstream media and the DEA often confuse opiates with other controlled substances such as amphetamines and benzodiazepines. "This issue has become a lot more complicated because the drug panel is a lot more complicated," and there are implications that local law enforcement and even some drug agency directors don't understand, said Alford.
"We have good physicians who are out in rural America, right in the wheelhouse of what we do, where this problem is very pervasive, and they're getting thrown under the bus," he added.
Maine alternate delegate Elisabeth Mock, M.D., M.P.H., of Holden, said her state had passed the most restrictive opioid prescribing legislation in country. While she respected the intent of the resolution, she had reservations about language that held physicians blameless.
"I don't think there is clear agreement that we had no responsibility in this crisis. I work to teach prescribers across the state that we do have some responsibly, and we also have a responsibility to try and act to try to implement solutions such as medication-assisted therapy and other treatments," said Mock.
Jun David, M.D., of Albany, N.Y., said his state has programs that aid in the provision of medication-assisted treatment like Suboxone (naloxone and buprenorphine). "The problem we have right now is we can prescribe it, but the insurance will not approve" what patients require, said David. Instead, they are offered a five-day supply when a one-month or a one-year supply is what's needed.
Mississippi alternate delegate Susan Chiarito, M.D., of Vicksburg, speaks in favor of a resolution asking the AAFP to support inclusion of a health impact assessment in all federal environmental impact statements. "We all have patients in our communities who have high rates of cancer because of their exposure to industrial sites, children playing on fields built over trash dumps and industrial waste ponds, and asthmatics who have poor lung function due to the poor air quality," she told the Reference Committee on Advocacy. Delegates voted to refer the resolution to the AAFP Board of Directors.
Nebraska delegate Dave Hoelting, M.D., of Pender, opposed the resolution, saying it was ignoring the real problem. "The thing that's killing people is that we have a large volume of people that are addicted right now, and we simply don't have treatment facilities that are cost-effective and readily available."
Furthermore, if patients do get into rehab, they're kicked out the first time they make a mistake. Those people end up buying fentanyl off the street, "and two weeks later they overdose and they're dead," said Hoelting.
Massachusetts delegate Dennis Dimitri, M.D., of Worcester, described how his state implemented a public relations campaign that garnered good results.
"It wasn't aimed at trying to buff the reputation of physicians but rather worked to educate the public -- our patients -- about why there was an opioid crisis, how they could address it, and how they could be more careful about their own use of opiates," said Dimitri. The effort changed the perception of physicians and the role they might play, he added.
Ultimately, the Congress agreed with the reference committee's recommendation to refer the resolution to the AAFP Board for more scrutiny.
Compound Topical Medications
The reference committee also heard testimony on a resolution offered by the Virginia chapter that addressed the topic of unsolicited requests for compound topical medications.
Virginia delegate Sterling Ransone Jr., of Deltaville, told the reference committee that he's been dealing with unsolicited requests for durable medical equipment for years but only recently was made aware of a similar problem with compound topical medications.
He noted that in some cases, the cost to a pharmacy to compound eight to 10 drugs is $10-$15, but they charge $2,800 for a 30-day supply.
"We're asking for transparency for our patients -- what they might have to pay and what the government is paying," said Ransone.
Texas AFP President-elect Janet Hurley, M.D., of Whitehouse, testified that she'd had similar experiences related to the cost of compounded drugs.
She said some low-risk patients in her organization's employee health plan had a high pharmacy output. "We found patients who had $9,000 to $14,000 (in charges) for medications that our local compounding pharmacy would charge $50 for," said Hurley.
"For some of our patients, the pharmacy cost is exceeding the cost of their hospital admission," she added.
Patricia Sereno, M.D., of Stoneham, Mass., also supported the measure. "I've gotten several of these -- my most expensive one was $5,000. I now call the patients and say, 'Do you even know what was asked for?'" Most of the time the patients have no idea what's going on, she added.
New Jersey delegate Mary Campagnolo, M.D., M.B.A., of Bordentown, put it this way: "This is really Medicare fraud and should be called out and stopped. These are unsolicited requests to patients."
The Congress adopted a substitute resolution that directs the AAFP to develop policy describing best practices pertaining to compounded medications, including cost transparency.
The Congress also decided the outcomes of a number of other measures that were discussed by the reference committee. For instance, delegates voted to adopt resolutions or substitute resolutions asking the AAFP to
- argue for the elimination of the hospital "three-day" rule in certain cases,
- develop a policy statement in support of a publicly funded universal primary care system,
- recognize health as a basic human right for every person,
- advocate for marketplace solutions including giving public health programs such as Medicare and Medicaid the ability to negotiate prices,
- support funding for Medicare and Medicaid in Puerto Rico and the U.S. territories equal to that in the 50 states and District of Columbia, and
- issue a statement of support for the protections afforded by Deferred Action for Childhood Arrivals.
A complete report of the work of the 2017 COD is available online, where AAFP members can read reports from all five reference committees in their entirety.
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