I have the honor of working with 3 brilliant neurologists developing their advocacy projects - Eseosa Ighodaro MD PhD (her project is reducing medical racism by training medical students in neurology and in racial disparities), Sara Pavitt MD (her project is changing high school start times in Texas to after 8:30 am to prevent migraine and other issues), and Masoom Desai MD (her project is improving epilepsy treatment and access to care for all patients in NM).
Dear Governor Michelle Lujan Grisham,
I have been a neurologist in NM since graduating from medical school here in 1994. I voted for you. For the past 13 years I ran a successful solo practice. I won the Top Neurologist in Albuquerque award the past 4 years and was honored by the AAN to win the 2022 award of Top General Neurologist (out of 14000 neurologists worldwide). I have had to close my practice in June 2022 after providing patient centered care for less cost than large groups or hospitals (I did not charge a facility fee which they charge). Putting me out of business actually costs the community. I write in order to explain ten issues that resulted in my closure, many of them directly due to your administration.
As you may know, our brains develop until our mid-20s, then remodel after that. Young Adults are particularly affected by cannabis use. New Mexico already has one of the worst records for violent crime, poverty, education, high school dropout rate, illiteracy, economy, and suicide. All of these statistics are already getting notably worse as the result of legalization of recreational cannabis. Research shows that young adults are more likely to have lower IQ, worse school performance, to drop out, become addicted and to become homeless. They can’t hold jobs and are more likely to be suicidal. They are more likely to commit violent crime as a result of cannabis induced psychosis, anxiety, and paranoia. Research shows that the use of cannabis is directly related to the use of heavier illicit drugs including opioids and stimulants, as well as tobacco due the effect of cannabis in the developing brain. All of these proven facts result in worsening crime, illiteracy, economy, education, high school dropout rates, and suicide rates. Cannabis is dangerous for our patients and for our state.
Because our NM state education system is poor and literacy rates have been so low, the Medical Assistants that I hired to work with me often could not read directions, explain things to patients, complete forms, address envelopes, do arithmetic, or record messages for me. A high school diploma or GED in NM guarantees third grade literacy. Over 60% of our state reads at second grade level or below so they cannot read prescription bottles or directions I typed out for them. My staff can’t read these directions either. Another result of illiteracy is that most patients have no idea about their insurance, and the time required to explain what they don’t know increases my cost of business.
New Mexico is one of 2 states that charge GRT on medical copays and deductibles. The insurance market has changed over the past 13 years so that copays have gone from average of $10 in 2009 to up to $120 currently per visit, and deductibles have gone from $2000 to $5000. This increases my cost of business.
The recent increased medical malpractice insurance cost was more than I could afford as my revenues declined due to increasing costs and declining reimbursement. This increases my cost of business.
Last year you passed a law requiring providers to use e-prescriptions for controlled substances. The software I needed was several hundred dollars that I could not afford. Although I never prescribed opioids, some of the epilepsy, sleep, and wakefulness medications needed by my patients were classified as controlled, such as Vimpat, lacosamide, modafinil, armodafinil, clonazepam, temazepam, methylphenidate, and others. Because I was unable to purchase this software, I needed to refer maybe a hundred patients to other providers to get the drugs I wanted them to have. This affects patient care, was a burden on my time, and increases my cost of doing business.
They newly required sick leave law made additional administrative burden that took time and effort from my provision of medical care. I already paid employees for time off to use at their discretion but now I have to require proof that they are sick and keep track of what they accumulated and what they used. In the past I allowed them to take whatever paid time off they wanted whenever they needed it regardless if they were sick. Employees disliked your law also because now they have to be sick to use time off. This increases my cost of doing business and staff turnover.
Telemedicine has been an important aspect of my care since Covid started in 2020. Because NM is so large, many of my outlying patients prefer to use this now. Continuing coverage for telemedicine is threatened creating another stressor that cannot be predicted as the rules change constantly. This affects patient care and increases my cost of business.
The newer and very effective medications for migraine and for multiple sclerosis are all step therapies, meaning one has to have tried several other treatments and failed them before they are allowed to try the newer ones. Forcing my patients to try treatments I don’t agree with or believe won’t work can cause added cost of care, delay of successful care, decline in patient’s job performance and increased absences, decreased quality of life, increased unemployment, increased burden to the community. This affects patient care and increases my cost of doing business.
Medicare reimbursement decreased again this year, and the 2% sequestration was reinstated resulting in a 5% cut of revenue. Most neurology patients end up on Medicare as a result of age or disability. The result was another decline in collections. This increases my cost of business.
I accepted Presbyterian insurance which I considered to be a statewide community service . Presbyterian does not allow their patients to go to UNM (with the exception of a small UNM only Presbyterian health plan). So when I needed a patient to see a UNM subspecialist, for example a complex patient with ongoing seizures, or ALS (Lou Gehrig’s Disease needing the MDA clinic help), or an advanced MS patient with medical complexity requiring an MS subspecialist, I had great difficulty sending them. When I told the Presbyterian medical director that I had 31 MS patients with Presbyterian insurance that needed to see a UNM MS specialist, they told me I had to complete a hand written 2 page report for each one detailing the case, and then supply medical records for each so they could determine on a one to one basis whether the patient deserved that kind of care. This took me hours to complete, time I did not have, and then Presbyterian did not allow all my patients to be seem at UNM. This affects patient care and costs me time.
My patients have been adversely affected and my costs have increased as a result of your administration with legalization of cannabis, increased malpractice insurance cost, controlled substance prescribing software, impaired workforce, and mandated sick leave. I would be happy to discuss any of these with you any time.
Sally L Harris MD MS FAAN firstname.lastname@example.org