Legislative Update

Charlton Coslett
by Lynne Coslett-Charlton, MD
Vice Chair, PA ACOG

ACOG’s 32nd Annual Congressional Leadership Conference (CLC) was held in Washington, DC on March 2-4, 2014.  The theme of this year’s conference was “Spotlight on the Center: Every Woman, Every Time,” recognizing Congressional leaders who have reached across the aisle to sponsor or support bipartisan, common-sense legislation that advances women’s health, regardless of party labels.

Once again, we marched on the Capitol with the request for a permanent fix for the fatally flawed SGR.  SGR Repeal and the Medicare Provider Payment Modernization Act of 2014 (HR 4015/S 2000) permanently repeals the SGR and provides modest annual updates of 0.5% for five years. Of note: there have been no updates, only temporary fixes, for the past several years. This bill also provides incentives and a pathway for physicians to participate in advanced practice models (APMs) with opportunity for merit-based incentive payment (MIPS) while also retaining the fee-for-service payment model with voluntary participation in APMs for smaller groups of physicians. Specialty societies such as ACOG will have a primary role in developing quality measures and APMs while ensuring that these quality measures or health care guidelines are not interpreted as medical standards of care in medical liability lawsuits. The primary obstacle to the passage of S 2000 is the pay forward. However, it appears that we have never been closer to a permanent SGR repeal and the house of medicine is uniformly supportive of this important piece of legislation.

For our patients, we advocated for support of the bipartisan Gestational Diabetes Act of 2013, HR 1915/ S 907.  The bill would provide funding and create a gestational diabetic research project within the CDC to expand public health research on GDM and improve methods of data surveillance. The occurrence of gestational diabetes in a pregnancy provides a unique opportunity of a window into the future for a patient’s increased risk of Type II DM. The hope is that with better surveillance of follow-up after pregnancy, preventative interventions will have positive public health benefits, reduce recurrence of gestational diabetes in future pregnancies, and improve outcomes for those at risk of developing Type II DM.

For the future of our specialty, we advocated for the Training Tomorrow’s Doctors Today Act of 2013, HR 1201.  This bipartisan legislation, introduced to Congress by Pennsylvania’s Allyson Schwartz, would create 15,000 new GME slots.  Although we have seen an increase in graduating medical students that addresses the predicted physician shortages, no intention exists for an appropriate corresponding increase in funding for hospitals in order to provide opportunities to complete training. HR 1201 would ensure that hospitals appropriately use the increase in GME funding through annual reporting to HHS.

Finally, we asked our Legislators to support HR 4106, the Saving Lives, Saving Costs Act, introduced by Reps. Andy Barr, R-KY (attorney) and Ami Bera, MD, D-CA.  This innovative legislation provides physicians subject to a medical negligence lawsuit the option of a “safe harbor” based on adherence to clinical practice guidelines.  A panel of qualified medical professionals (mutually agreed upon and paid for by both plaintiff and defense counsel) would review cases to determine adherence to practice guidelines set for by specialties such as ACOG, allowing physicians facing lawsuit to use the panel’s findings as an affirmative defense. The bill also accounts for the unexpected nature of the practice of medicine and the need for independent clinician decision making, and provides protection for physicians whose care varies from established guidelines so that they are not automatically held liable. Safe harbors provide an opportunity to promote adherence to quality-promoting guidelines, thus reducing the burden to the health care of the practice of defensive medicine, and will subsequently reduce the burden of frivolous lawsuits to our costly legal system.

Once again a successful Congressional Leadership Conference has recharged our state legislative efforts as we continue to advocate for our patients and our specialty.