IMPAC Illinois State Medical Society Political Action Committee 2014 Legislative General Election Candidate Questionnaire Dear Candidate: Our member physicians and their families are interested in the views of candidates who hope to make the important decisions that will shape our future health care system. This questionnaire is designed to address key questions regarding issues important to Illinois physicians. Our positions and actions on legislative initiatives are designed to improve the practice of medicine, enhance patient safety, and increase access to quality care. Please return this questionnaire by Friday, August 22, 2014, to IMPAC, 20 N. Michigan Avenue, Suite 700, Chicago, IL 60602 or fax it to Erin O Brien or Kim Janas at (312) 782-2023. If you have additional comments regarding any of these questions, please attach a separate sheet. Should you have any questions, please contact Erin O Brien at (312) 580-6488 or Kim Janas at (312) 580-2450. We look forward to working with you. Position papers addressing issues included on this questionnaire and other topics that impact the practice of medicine can be found on the ISMS Legislative Action Hub at www.isms.org/governmental_affairs/legislative_action_hub/legislative_action_hub/ Jere E. Freidheim, M.D. Chairman, IMPAC CANDIDATE NAME: OFFICE BEING SOUGHT: DISTRICT: ADDRESS: PHONE#: FAX#: E-MAIL: WEBSITE: DO YOU HAVE RELATIVES WHO ARE PHYSICIANS? (If so, please provide names and relationship): 1
LEGISLATING MANDATES 1. During every legislative session, there are a number of bills introduced that attempt to dictate how physicians should communicate with and treat their patients. Most of these legislative mandates would require physicians to offer specific tests to certain patients, or require physicians to provide information on specific conditions or diseases. Many of these legislative mandates are based on medical guidelines established by medical specialty groups or government agencies, such as the Centers for Disease Control and Prevention (CDC). These guidelines, of which there are over 7,500, are meant to be used as references for physicians. Guidelines change as medicine changes, both of which change much quicker than state law. Guidelines are not written with the intent that they should be codified into law. Establishing public policy that allows non-medical third party groups to mandate how physicians treat and communicate with their patients will have adverse effects on the practice of medicine and patient care. Physicians, who honor the physician-patient relationship and the well-being of their patients above all else, should be trusted and allowed to treat their patients as they deem appropriate. Mandates chip away at the physician s ability to best treat his or her patient and in doing so sets a dangerous precedent by sending a signal that it is appropriate for the government to tell physicians how to practice medicine. Do you support or oppose measures that would mandate the use of particular practice guidelines? 2. Physicians in Illinois are currently required to complete 150 hours of continuing medical education (CME) credits during each three-year licensure cycle. This is the highest CME hour requirement in the United States. Physicians focus their CME hours based on the needs of their practice, which may include specific training that is also required to maintain their board certification in a specialty, such as pediatrics, dermatology, orthopedics, neurology, cardiology, obstetrics, or psychiatry. Mandating specific CME training, such as requiring all licensed physicians to take CME on how to properly prescribe opioids or other drugs treating specific diseases, prevents physicians from taking CME which is relevant to their practice. Mandated topic-centered CME would create situations where trained specialists would be forced to take CME that does not prepare them to provide quality medical care, such as requiring a radiologist who never prescribes medication to take training on prescribing opioids. In addition, mandated CME places an emphasis on specific topics to the detriment of other issues which may become more relevant as the practice of medicine and each of its specialties evolves. Do you support or oppose mandated CME for physicians on specific topics? 2
LICENSURE 3. ISMS has consistently worked in good faith with the Illinois Society for Advanced Practice Nursing (ISAPN) to ensure that our patients have access to a team of qualified health care professionals. Currently, advanced practice nurses (APNs) who practice outside of hospitals and ambulatory surgical treatment centers (ASTCs) must have a written collaborative agreement with a physician active in clinical practice to care for patients and prescribe certain medications. Those APNs who practice in hospitals and ASTCs are credentialed by the medical staff and work closely with the physicians of the medical staff of those facilities. Certified nurse anesthetists can order and administer anesthesia under the guidance of an anesthesia plan agreed to by an anesthesiologist or, in some cases the operating physician, who will be physically present and available on the premises during the delivery of anesthesia. The ISAPN supports initiatives that would remove physician collaboration for all APNs, including nurse midwives and nurse anesthetists. The ISAPN believes that APNs should be able to treat patients independent of a physician, thereby removing any collaboration in a hospital setting and removing the collaborative agreement process in an office setting. While nurses are essential in a patient s care and treatment, there is no substitute for a physician s education and training. Physicians must complete a formal institutional post-graduate residency program that, depending on specialty, can be as long as seven to eight years. APNs do not have this formal post graduate training and have less clinical experience than is obtained in the first year of a two-year medical residency that physicians must legally complete before they are allowed to independently practice. The belief that APNs can fill a health care void in areas that suffer from physician shortages is not accurate. Research shows that in states where nurses can practice independently, physicians and nurses continue to work in the same areas. Do you support or oppose allowing APNs to practice independently? 4. ISMS believes patients are best served when treated in a medical home by physician-led teams of qualified health care professionals. Pharmacists play a role in that team. Pharmacists are trained to monitor, evaluate, and implement prescription drug orders. They are charged with dispensing prescription drugs and can counsel the patient on the administration of drugs, drug to drug interactions, and provide other medication therapy management. Pharmacists can administer vaccines to patients 14 years and older pursuant to a valid prescription or standing order by a physician. Pharmacists can also administer vaccines for influenza and Tetanus, Diphtheria, and Pertussis (Tdap) to patients ages 10 through 13 pursuant to a valid prescription or standing order by a physician. 3
Last session, the Illinois Pharmacists Association introduced SB 3277, a bill to expand their authority to provide the meningococcal vaccine to patients ages 10 to 13. The bill did not advance. At age 11, most children in Illinois need their 6 th grade physical, with their Tdap, meningococcal, and HPV vaccines. Often, parents claim that their children have had their vaccines, but do not have documentation indicating when the vaccines were administered. This makes it difficult, if not impossible, for the physician to determine whether the appropriate vaccinations were given. The Affordable Care Act requires quality and outcome measurements of all physicians, clinics, and offices. Bills such as SB 3277 make it difficult for physicians providing care to children to maintain accurate records, and thus negatively impacts their measurements. Legislation that could be introduced next year to not only allow pharmacists to provide all vaccinations to patients of every age, but could allow them to therapeutically change a physicians prescription, write certain prescriptions, and provide clinical primary care services. Pharmacists, while trained in the science of drugs, do not go to medical school and do not continue onto a formal institutionalized medical residency program. These standards are only required of physicians, who are the only professionals trained to make a medical diagnosis and initiate treatment. Do you support or oppose allowing pharmacists to provide all vaccines to children? Do you support allowing pharmacists to change a physicians prescription, without the physician s permission? Do you support or oppose allowing pharmacists to provide clinical primary care services, such as ordering laboratory tests, making diagnoses and prescribing drugs? 4
5. The Illinois General Assembly has repeatedly rejected proposals to license naturopaths in Illinois. However, the naturopaths continue to push for licensure through the Illinois Department of Financial and Professional Regulation as they did this previous session by introducing House Bill 364, which did not advance. There is no comparison in the training of a physician and that of a naturopath. These individuals, who are not medically trained, want to act as primary care physicians, prescribe drugs, provide obstetrical care, and perform minor office procedures. Do you support or oppose licensure of naturopaths? 6. Currently, individuals who want to practice midwifery in Illinois can become advanced practice nurses certified as nurse midwives and work under a collaborative agreement with a physician or be credentialed and granted appropriate hospital staff privileges. Illinois does not license independent certified midwives. Bills have been introduced in the Illinois General Assembly to license these independent midwives to provide unsupervised prenatal, delivery, post-partum, and pediatric care including the administration of prescription drugs and the performance of surgical procedures like episiotomies without requiring the education and training required of certified nurse midwives. The education requirements for nurse midwives, which far exceed those required of certified midwives, protect patient safety. Physicians believe that licensure of independent certified midwives is a step backward in patient safety as it would allow the least trained individual to independently provide one of the most critical services to women in Illinois. Do you support or oppose licensing these independent midwives? 7. Physicians consider physical therapists essential in providing specific treatments for conditions of the musculoskeletal system. Current Illinois law dictates that patients must be seen by a physician first and referred to a physical therapist before a physical therapist treats a patient. Physical therapists want to remove this referral requirement and allow physical therapists to treat patients before a physician diagnoses them. Physical therapists are not able to order tests, nor are they trained to read X-rays or other diagnostic procedures. Physical therapists are also not permitted to prescribe drugs. Do you support or oppose removing the referral requirement for physical therapy? 5
8. Illinois physical therapists have been performing a procedure known as dry needling which involves the insertion of needles deep into muscle tissue. The Department of Financial and Professional Regulation has advised that dry needling exceeds the scope of practice for physical therapists. In particular, the Department noted that unlike dry needling, all procedures listed in the Physical Therapy Act are non-invasive procedures. In addition, because there are no standards or training for this practice, the Department has concerns about the ability of physical therapists to competently and safely perform dry needling. Do you support or oppose legislation expanding the ability of physical therapists to perform dry needling on patients in Illinois? PUBLIC HEALTH 9. The growing number of diagnosed cases of Hepatitis C in certain populations, such as the baby boomer generation, intravenous drug users, and those who have had a blood transfusion, tattoo, or piercing, have led to the issuance of guidelines by the CDC, which recommend screening for Hepatitis C. This testing proceeds in two phases, an initial test, which confirms the presence of the virus, followed by a confirmatory test. In Illinois, a legislatively created Task Force on Hepatitis C has convened to study and formulate ways to increase testing of the populations noted in the CDC guidelines. Undiagnosed Hepatitis C can remain undetected, as carriers have no symptoms for as long as 20 years, often only showing signs of the disease until the later stages of a chronic liver infection. Recently developed treatments for Hepatitis C have improved, but can cost as much as $80,000. Do you support or oppose mandating insurance coverage for the testing and treatment of Hepatitis C? Do you support or oppose funding for Department of Public Health education and outreach efforts to inform patients on the risk factors related to contracting Hepatitis C, the importance of testing, and the treatment options? 10. The Illinois Prescription Monitoring Program (PMP) is an electronic tool that collects information on controlled substance prescriptions. This data is reported on a weekly basis by retail pharmacies dispensing in Illinois. Physicians are able to view a patient s prescription history on the PMP, which allows the physician to review what medications the patient currently uses and who has previously 6
prescribed these medications. Besides improving the efficacy of treatment, the PMP can also prevent opioid abuse by patients seeking opioids from multiple physicians. Unfortunately, the PMP can be frustrating for physicians to use. The information in the PMP is not updated on a real time basis, thus allowing for an information lag of current prescription history. Technological limitations to its search capabilities require a patient s full date of birth. Currently, a physician is unable to delegate the search of the PMP to another staff member in their office. In addition, the Illinois PMP does not interface with other states which border Illinois, which is especially problematic in areas like the Metro East and Metropolitan Chicago. Do you support or oppose funding to improve the capabilities of the PMP, such as allowing for updates in real time and improved search capabilities? Do you support or oppose physicians having the authority to delegate use of the PMP to a physician s staff member? INSURANCE 11. Under the Affordable Care Act, any patient who purchased health insurance through the exchange and who is also receiving tax subsidies to offset the cost, is granted a 90-day grace period in which their coverage cannot be canceled for non-payment of premiums. Insurers are obligated to pay claims received during the initial 30 days of the grace period. But since they are not required to pay claims for services provided in the remaining 60 days of the grace period, the financial risk of the uninsured medical expenses is shifted to physicians and other health care professionals. Physicians and other health care professionals are often not notified that the patient has failed to pay his or her premium, and are not aware of the financial risks they are assuming when treating some patients. Do you support or oppose requiring health insurance companies to notify physicians and other health care professionals that the premium has not been paid and the physician or other professional may not be reimbursed for the services provided to the patient? 7