Yes, this article will be touching on the upcoming presidential election, but don’t worry. There will be no mention of penis size, attacks at campaign rallies, that time someone almost knifed a guy, or any theories on how the pyramids were made. (Seriously, we have heard almost everything this campaign season.) Instead it will focus on the other side of politics. You know, like actual political issues. Or more specifically, just one in particular: Healthcare.
Recently, Healthcasts, a leading digital educational resource for physicians, released the results of a survey that asked 165 healthcare providers (HCPs) from across the U.S. for their take on the current presidential race as well as the healthcare issues that are most important to them in this election. Overall, physicians aren’t thrilled with what they have been hearing from either party. Forty-three percent of respondents either felt that neither party would have a more positive impact on the U.S. healthcare system or they just weren’t sure at the time. Only 36% favored a Republican president while 21% are hoping a Democrat wins the election.
The healthcare issues that physicians would most like to see either party address include physician reimbursement, concern about the Affordable Care Act’s (ACA) impact on medical practices, and fears about the rising costs of prescriptions. Among the three, the ACA is the top concern for 68% of respondents, with more than 40% hoping it is either scaled back or eliminated in the future. Nearly half (49%) feel the ACA has negatively affected their practice, and the same percentage of physicians is also looking for candidates who are willing to reform Medicare.
In addition to a less than ideal perception of the current presidential race, physicians also don’t have a very favorable view of the pharmaceutical industry. Nearly 62% reported feeling that pharmaceutical business practices are worse today than three years ago.
“It’s no surprise that the industry is dealing with negative perception issues,” Denis Wyrwoll, Healthcasts’ Director of Market Research, said in a statement. “That’s why it is so important for pharmaceutical marketers to educate physicians in a way that they find useful.”
At PM360’s request, Healthcasts asked two KOLs within their physician network to dive a little deeper into the issues brought up in the survey, including the impact of the ACA, the issues they want the next president to address, and the relationship between physicians and the pharma industry.
Impact of the ACA on Physicians
Paul Doghramji, MD, Attending Physician at Collegeville Family Practice and the Medical Director, Health Services at Ursinus College says that initially the ACA seemed to be helping his practice. It increased his patient load “by a good bit” as suddenly patients who previously didn’t have health insurance were starting to get medical care.
“But as patients found out what a high deductible they have, it became frustrating for them and me,” Dr. Doghramji explains. “It also increased patient outstanding balances to a very concerning degree.”
Ultimately, Dr. Doghramji feels the ACA has been effective in helping new patients get access to medical care, and he likes that patients have a choice of which insurance to get. But he still believes that “high deductibles are the worst” and need to be lowered, because at their current rates they impede medical care and raise his accounts receivable.
Ara Dikranian, MD, a Rheumatologist at the San Diego Arthritis Medical Clinic, also says he has seen an increase in volume of patients since the ACA, including the return of some of his previous patients who had lost insurance. But he says there is a clear distinction about the necessity of insurance to care for chronic conditions, such as most rheumatic diseases, and the different need for catastrophic care and primary care.
“Though patients are relieved and reassured they are now insured, anything other than the basic necessities is difficult to access,” Dr. Dikranian adds. “Specialty medications or testing requires cumbersome and tedious authorization processes that can last many months, as compared to days for private insurances. This, coupled with exceedingly low reimbursement rates, has created significant frustration among both healthcare providers and patients, leading to delays in therapy and basic therapy that often does not measure up to the standard of care accustomed to traditionally insured patients.”
Additionally, Dr. Dikranian feels that even though volume and quantity have increased for practices in areas with high rates of exchange-related insurance, quality and satisfaction have actually decreased. On the positive side, he says that the ACA has helped in three ways:
- The incentives and support for broad implementation of electronic health records and ability to network with other electronic systems to potentially avoid duplication of tests and improve overall quality of care.
- The push to healthcare provider competition by paying for quality of care rather than simple potentially wasteful spending.
- The basic, primary, and catastrophic care coverage for more patients than would be able to afford insurance otherwise.
But he also understands why some still have an issue with the law.
“There are political and ideological issues with the ACA, including the individual mandate that many object to,” Dr. Dikranian says. “Many will also argue about the logistical details of the law, including the sizes of small businesses exempt from requirements. There is also a fear that the data gathering and the implementation of ICD-10 are moves toward an eventual single payer system.”
However, if it was up to him, he would focus on addressing three main areas in order to improve the ACA, rather than completely get rid of it:
- Allow for CMS to negotiate drug prices with manufacturers.
- Educate public about healthcare financing and medical economics.
- Increase funding for pharmacoeconomic research to assess value of new therapies and encourage innovative R&D by the pharma industry.
What Physicians Want the Next President to Address
When it comes to healthcare policy, Dr. Doghramji favors a presidential candidate who is able to solve the following three issues:
1. Prior authorizations for treatments and tests MUST GO: “They dramatically hinder good care,” he explains. “A good compromise between this arduous process as well as insurance concerns over ‘unnecessary’ tests, meds, and services is to have some kind of software in our EHR that prompts the provider on what is needed to get the service/medication approved.”
2. Generic vs. brand name prescribing: “The government has to step in and put a ceiling on brand name prices just as it is done in every other country in the world,” Dr. Doghramji says. “This must be accompanied by raising generic prices so that a part of it is kicked back to brand name companies for R&D. Also, there must be a set profit margin for pharmacies so that they don’t have such a huge incentive to switch patients from brand name to generic meds—in fact, many offer bonuses to pharmacists when they can convince a patient to make a switch.”
3. Law suits have to stop: “They raise cost of medicine,” Dr. Doghramji simply puts. “I am in favor of districts in every state that take on application for malpractice and process them without court cases.”
Dr. Dikranian has his own to-do list for the next president, including:
- Reconcile the need for quality measures with the extra burden this places on (uncompensated) physician time.
- Reign in on narrow network plans which restrict access to care for unsuspecting people.
- Ease restrictions on managed Medicare plans requiring extra physician and staff time.
- Not encouraging the development of a single payer system.
- Not doing away with the ACA but rather involving a task force of all stakeholders to recommend smart changes to it.
Physicians Relationship With the Pharma Industry
Neither doctor thinks very much of the current relationship that most physicians have with the pharmaceutical industry. Dr. Dikranian, for one, feels that the relationship has become so highly regulated that it is nothing more than a glorified sales call. He compares it to a vacuum salesman going house to house attempting to convince unsuspecting people of the need to buy a new vacuum. He adds that both educational services for physicians and the provision of samples have eroded over the last few years. But not everything has gone downhill.
“Patient education and counseling to help navigate the needed steps to qualify for specialty medications has improved, and will likely continue to improve with the advent of potentially cheaper biosimilar medications,” Dr. Dikranian explains. “The industry needs to be able to continue spending large resources for innovative R&D, so tax breaks to encourage this should be strongly considered.”
Dr. Doghramji also believes that government regulation has put a wedge between physicians and the pharma industry.
“It is ridiculous that legislators are allowed to accept tons of money from lobbyists, with guaranteed persuasion to vote in their favor, yet a pen with a drug name on it is not allowed as it is thought to surely sway a doctor to prescribe that med unnecessarily,” Dr. Doghramji exclaimed. “I have no problem keeping that wedge where it is as long as legislators are not allowed to take money from any special interest groups.”
But Dr. Doghramji would be in favor of allowing the pharmaceutical industry to put money in a pot—with the ability to earmark it for specific topics—that can be used for CME. Just add it to the list of suggested healthcare policy changes that the next president should look at in 2017.
