SD Medical Association President: Physicians must focus on patient care, not politics



By Nathan Johnson

While there are a lot of politics surrounding the health care industry, the president of the South Dakota State Medical Association (SDSMA) believes physicians needs to stay focused on what is best for patients.

“I think that physicians in South Dakota are much like the political spectrum of the country,” said Dr. Daniel Heinemann, who became the 2013-2014 SDSMA president in June. “You’ll hear from physicians who are vociferous supporters of the Affordable Care Act (ACA), and those who think it’s terrible. It’s more about the politics of the ACA. I think physicians, in general, support the idea of getting more patients covered with health insurance. Health insurance is the ticket you need to access our healthcare system. Without it, it’s very expensive and almost unmanageably so.”

Heinemann practiced family medicine in Canton for 20 years and is currently a chief medical officer for Sanford Health Network and Sanford Clinic.

He met with the Yankton District Medical Society at Valiant Vineyards in Vermillion earlier this month as part of a tour to visit with members of all 12 of SDSMA’s districts around the state. He visited with the Press & Dakotan prior to the meeting.

During the attempt to reform health care by President Bill Clinton and his wife, Hillary, in the 1990s, Heinemann said he witnessed a phenomenon similar to what is occurring today. At the time, he was president of the South Dakota Academy of Family Physicians.

“If you asked physicians at that time what they would support in health care reform, they would come up with many of the things the president and Hillary were coming up with,” Heinemann said. “But when you mentioned it, it was very political.”

The ACA is not perfect, he stated.

“There are things in the ACA that physicians are concerned about, and the Independent Payment Advisory Board (IPAB) is one of them,” Heinemann stated.

According to the White House, the IPAB will have 15 experts, including doctors and patient advocates who are nominated by the president and confirmed by the Senate. It will recommend policies to Congress to help Medicare provide better care at lower costs. This could include ideas on coordinating care, getting rid of waste in the system, incentivizing best practices and prioritizing primary care.

The harshest critics of the ACA have referred to the IPAB as a “death panel,” even though it is specifically prohibited by law from recommending any policies that ration care, raise taxes, increase premiums or cost-sharing, restrict benefits or modify who is eligible for Medicare.

Healthcare entities such as the American Medical Association, the American Hospital Association and the pharmaceutical lobby have called for the IPAB to be repealed, arguing that it could cut providers’ pay arbitrarily.

Heinemann said that he doesn’t want perfect to be the enemy of the good when it comes to the ACA.

“The system we have now is broken,” he stated. “We need to fix it. This is at least an attempt to lead us in a direction that we can fix it. I hope that we’re heading in the right direction, and it will only get better. Only time will tell.”

Among the SDSMA’s 2014 advocacy agenda items is the expansion of Medicaid.

The state has so far declined to expand Medicaid eligibility to an estimated 48,500 people, mostly adults without children.

According to The Associated Press, people earning up to 138 percent of the federal poverty level — $15,451 for a single person or $31,809 for a family of four — would be covered by an expansion. The federal government would fully cover spending on the extra people through 2016, and the state’s contribution would rise in stages to 10 percent of the medical costs by 2020.

“I think it comes down to a worry about paying for it. It would be incredibly expensive to expand Medicaid,” Heinemann said. “But our organization looked at this as a way to get more people covered. It’s very apparent that a lot of the people we’re talking about adding to the Medicaid rolls are working people, but they’re not working at a job that gives them enough expendable income to be able to go out and buy insurance.”

Other SDSMA advocacy agenda items for the year include improving public health, expanding access to health care, improving quality and patient safety, reforming medical liability, reforming Medicare, enforcing scope of practice and supporting increased funding for medical education.

Heinemann acknowledged that the health care industry is undergoing a lot of change.

“I want the people of South Dakota to know that their physicians are ready to help sort all of this out,” he said. “We want to provide the care that they need.”


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