Page 17 - Delaware Medical Journal - July-August 2018
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ADVOCACY
much as a state for health care. We’re not getting good results.”
He and his new Health and Social Services Secretary, Kara Odom Walker, MD, chose a course of action: a benchmark that seeks to create transparency mechanisms, ascertain our total cost of care, set a growth rate goal of that cost between 2 and 5%, and then put downward pressure on the system to slow its growth. A plan that immediately caught the attention of Delaware’s hospitals, which, looking
at Massachusetts, engaged in the conversation with a healthy dose of skepticism.
Still not included in the public-facing part of the discussion was action on community primary care. The yellow
In January 2018, physicians were pulling
they were getting paid the same amount. Medical residents refused to enter community primary care practice, calling it unaffordable. Nurses, PAs, and other staff were leaving for higher-paying jobs; practices were drowning in debt, laying off staff, and operating beyond capacity for patient load.
The yellow light turned red.
Primary care physicians turned to the Medical Society of Delaware for help. MSD reached out to Rep. David Bentz and Sen. Bryan Townsend, the chairs of their corresponding health committees in the General Assembly. Rep. Bentz met with a group of primary care physicians. Hearing their story, he agreed that the time to act was now and agreed to carry the banner. Soon thereafter, a similar
meeting with Sen. Townsend took place. He, too, understood the urgency.
MSD crafted legislation with two goals: (1) quickly give relief to practices to allow them to subsist, and (2) start a methodical shift of resources into the larger primary care system to build out Delaware’s foundation.
For procedural and tactical purposes, Sen. Townsend agreed to start it in his chamber. The elements were:
1.
for all primary care providers — doctors, nurses, PAs, and anyone else on the frontlines — and chronic care management payments.
2. A shift of 1% a year in our larger Delaware health care spend into primary care, to 12% of total spend by 2025, with requirement that the spend be split between community and hospital primary care.
The plan was kept broad, with a clear
answer. Medicare is the very bottom of
practice, and certainly isn’t enough to
The 12% spend needed strong regulatory guidance to ensure it was invested appropriately and effectively and not to the detriment of independent specialty care. But the legislation would stem the tide of imminent practice closures and leave room for payment innovation.
Senate Bill 199 immediately drew the attention of regulators and the ire of insurers and hospitals. With time short, Sen. Townsend quickly pulled the
bill into his committee for a hearing.
Primary care physicians and MSD members broadly swung into action.
A grassroots petition collected thousands of signatures and heartfelt comments. Phones rang constantly in Dover with constituents voicing their support. Dozens of white coats — from physicians Senate Health Committee. In the face
of near-overwhelming opposition from insurers and hospitals, they told their stories and presented the urgency of the situation: primary care couldn’t wait. The bill came out of Committee.
Over a legislative break, MSD hosted
a stakeholder meeting where Sen. Townsend and Rep. Bentz collected input. Senate Bill 199 became Senate Bill 227. The hospitals joined with the other providers, leaving only insurers in opposition. By June 28, the bill received unanimous votes in the House and Senate. It headed to the Governor’s desk for signature.
chronic care management, but with a sunset of three years to make it clear that we are driving the conversation forward, not stopping at this point. It created a path for the long term (but not too long), instructing the Health Care Commission, the state’s nonpartisan health care
policy arm, to develop the primary care investment strategy, borrowing lessons from Rhode Island and Oregon.
Delaware will have a strong primary care system; it starts with SB 227. None of this could have been done without the advocacy of the primary care physician community through the Medical Society of Delaware. Advocacy matters!
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