Editor’s note: Dr. Hudis hosts the ASCO in Action Podcast, which focuses on policy and practice issues affecting providers and patients. An excerpt of a recent episode is shared below; it has been edited for length and clarity. Listen to the full podcast online or through iTunes or Google Play.
I am really pleased to have as my guest Melissa S. Dillmon, MD. She is the chair of ASCO's State Affiliate Council and a hematologist/oncologist at the Harbin Clinic in Rome, Georgia, as well as a remarkably active ASCO volunteer and contributor. We are going to examine how state-level health care policy may impact the care that we deliver to our patients with cancer, why it's important for us to pay attention to and help shape bills and regulations moving in states, and what ASCO is doing to partner with state affiliates to advance policies that will ensure that our patients are able to access the highest quality cancer care possible.
CH: When most people think about health policies, they often picture activities that are occurring at the federal level, either through Congress or from the administration. Yet so much happens at the state level that is critically important to our members. Can you help us start to understand the specific role that states play in setting health care policies? Specifically, those policies that might impact cancer care and our patients?
MD: Most recently, one good example is the opioid crisis. This has come up at the state level because state legislators often regulate the rights of health care providers to provide narcotic prescriptions. The startling number of our American population dying of legal or illegal narcotic overdoses has really brought this issue forward. While some state Congresses have crafted laws, sometimes these bills can have many untoward consequences, specifically in our cancer care population, because often our patients with cancer have significant pain needs. It's very important to watch those state legislative actions because they could significantly hinder our ability to take care of our patients.
CH: Do you think that the states will in fact serve as a laboratory? Do you see a federal level rollup of some of what the states are offering in terms of legislation?
MD: I think so, and I am fearful. In our state, the law that was originally put forward in was going to significantly limit the ability of oncologists to provide pain medication to a 5-day first-time fill. You know that for a patient with cancer, the pain doesn't go away in 5 days. This was going to be a hardship for our patients, making them come back in for that second fill. It also was a hardship for physicians because if they did not check the data registry to see if a patient was already on pain medication, or filled more than 5 days, they could be charged with a felony and put in prison for 1 to 5 years or get a $50,000 fine.
That kind of state legislation is not what we want to see modeled in federal legislation. It's important for oncologists to get involved and help craft their state legislation, because it may be something that is looked at on a federal level. [In Georgia] we were successful in getting many of those parts of the bill taken out, and we also got an exemption for our patients with cancer so that we are not limited in our ability to get them the pain medicines they need.
One of the services that ASCO provides through the State Affiliate Council is the ability for us to talk to other state affiliates about what's going on in their state legislatures. One of the hottest topics on our Listserv is opioid legislation in different states. We share pending legislation and rules and regulations as a regular part of that communication.
CH: Can you talk in a little more detail about how the State Affiliate Council works? What is its role within ASCO? How does it partner with ASCO on state legislative activities?
MD: The State Affiliate Council is a relatively new council within ASCO. It was created because there is a sense that there are unique state issues that could help ASCO and that ASCO could help those states. It has been a very effective and well-received council and has been a way for the Government Relations Committee to get a view of what is bubbling up in the states and may become federal legislation that we need to address.
ASCO helps support a twice-yearly State Affiliate Council meeting. The Listserv allows us to communicate and provide resources to our members. We can send a legislative question or a bill to ASCO staff and ask for input on language. We get very rapid turnaround, which we often need because things in the state legislature move a lot faster than they do in the federal government. ASCO has a great resource called the ACT Network, which is an easy way for physicians to reach out to their representative.
CH: I'll inject a little personal note here. Part of the reason that I'm here at ASCO is that in the advanced years of my career, my cynicism about government, and policy, and having an impact actually went down, not up. I saw that while progress can be slow, progress is actually possible; however, it takes expertise, clarity of vision, and commitment for us to have an effect. So I'm asking you this question: What have you personally gotten out of your participation in state advocacy? What are some of the big lessons that you've learned?
MD: I am a frustrated political science major from my college days, so I always liked the process of making legislation. I like the process of debating. When I went into medical school I thought I had left my political science years behind—little did I know that they would become very important. I have always believed that you can't complain about something unless you seek to change it. If I sit back in my chair comfortably and complain about the legislation that prohibits me from being able to get a medication for a patient, then I should do something about it.
And I have seen change, exactly as you said, on a personal level. For instance, there was a bill in our state that looked at compounding. There was one word in there that would have effectively stopped all compounding, as they called it, which was mixing of chemotherapy drugs in any infusion center in the state. If we had not caught that and then sent that legislation to ASCO and had them reply back, all chemotherapy care would have been halted across the state. It was an accidental insertion of a phrase in a bill that could have stopped cancer care for days, weeks, or until the next legislation a year later. A legislator was happy to take that language out and so I saw a change immediately effected.
CH: It sounds to me like you could say, "One person can make a difference." If listeners are convinced, what are some of the specific ways that they might get involved in state advocacy on cancer-related policy developments?
MD: Find out who your legislators are that serve on important committees within the state legislature. If they're not in your own community but you know an oncologist in a neighboring town they represent, then that's the person you call or write to and say, "Would you mind going and meeting with your state senator? There's a big bill coming up and we want him to understand what this means to our patients with cancer."
Get involved with your state Medicaid director. Tell them the story of why it's important to have a mammogram or why it's important to have a Pap smear or why it's important to have a genetic counselor and what difference this makes.
CH: For those of you who want to get involved—and I hope it’s a lot of you—I would encourage you to visit the State Advocacy page on ASCO.org. You can learn much more about the state legislative process and about legislative activity in your state, and it will enable you to send messages directly to your state representatives.