October 31, 2022
Interview conducted by Holly Pisarik, Senior VP of Advocacy & Policy Counsel, SCMA, and Ben Homeyer, President, 1101 Public Affairs on Oct. 12, 2022.
About Representative Elliott:
Republican – Greenville
District 22 – Greenville County
Years in Public Service: 2017 – Present
Send an email to Representative Elliott
We anticipate there will be bills related to telemedicine this upcoming legislative session. Based on telemedicine utilization numbers over the last two years, I think it’s safe to say that we’ve all learned that there is a role for telemedicine. One concern for physicians is that parity in pay for telemedicine visits will not survive the pandemic. Do you have an opinion on this issue?
I supported expanding telemedicine prior to the pandemic. Telemedicine brings value to the patient by providing the opportunity for more choices. I support expanding patient choice.
I support parity in pay for telemedicine visits versus traditional office visits, although there might be specific instances that require a different payment structure. However, when utilizing regular physician services there should be parity in pay.
We should also continue to expand telehealth. Most people I’ve talked to around South Carolina have been pleased with the outcomes of their telehealth experiences and received the care that they needed.
Physicians aren’t going to continue offering this service if they don’t receive compensation that makes financial sense. A strong case can be made that by reducing the number of patients that show up in an office, that it frees up the availability of the doctors and staff to see the patients in person that require direct care, creating a situation that is more productive overall.
Expanded healthcare coverage will continue to be an issue. Republicans in NC were close at the end of their legislative session to passing Medicaid expansion. Do you foresee any similar efforts in SC this upcoming session? Do you have a position on this issue?
I assume that legislation expanding Medicaid will be introduced next year. We are getting away from the hesitation that existed initially, but it will still have a tough time getting it through the General Assembly. Hopefully, a strong case can be made through a cost/benefits analysis that expanding Medicaid will produce a cost savings, which would be persuasive. But it’s going to be a tough sell.
Now that the COVID pandemic is beginning to be in the rearview mirror (fingers crossed), how would you assess SC’s response to it? Do you think there are any lessons learned? Do you think we’ll continue to fund or work on increasing SC’s ability to respond to future public health events?
In hindsight, the state government’s response was more than sufficient. Overall, the state did a good job. It’s hard to measure because what seemed to be the prudent thing to do in one stage of the pandemic quickly became outdated, and we moved on to something else, so to judge how we reacted in any given point of time is challenging. The state adapted and did about as good of job as can be expected, especially compared to other states on both sides of the spectrum – states that had no restraints, and states that kept restraints for too long – so I give the Governor and DHEC good grades on that.
What did we learn? And what should we do with what we learned? My concern is that government is reactionary and not visionary by nature, so it’s very hard for government to stay focused on things for long once the crisis has passed.
Am I sure that we’re going to take what we’ve learned and prepare sufficiently for the future? I am pessimistic about whether we will stay focused and allocate the resources that are needed to be prepared as best we can. It will be important for us to use the federal resources that have been made available to us to prepare for future situations. DHEC will certainly have the institutional knowledge of what needs to be done to move forward, but it will be hard to remain focused enough to have us as prepared as necessary for the next challenge. While that seems like a criticism, practically that’s just the way government works because of competing priorities, and resources are often allocated to the squeakiest wheel at that time.
The SCMA obtained the most recent data on physician employment nationwide and in SC, and there has been a noticeable shift. In January 2019, 31.8% of physicians were independent in SC. By January 2022, that number had dropped to 20.7%. The article states, and we agree, that consolidated healthcare markets and less competition lead to increased healthcare costs. Do you have any concerns about how this trend may impact the practice of medicine or delivery of healthcare in SC?
It comes down to the personal preference of the physician. I support the physician or practice being able to decide how to operate their practices. If a doctor or group wants to be self-owned or self-directed, that’s the way they should operate. It should be a free market situation, where doctors are not compelled by a hospital system from a top-down structure.
If a doctor is satisfied with the practice structure and operation, then the result is better patient care because you have a physician who has a more rewarding work environment. This directly leads to patient satisfaction and a positive impact on patient care and services.
A concern is fewer entities owning practices leading to reduced availability of services and higher costs. There should be as much discretion and choice as possible on how a practice is managed. That’s better for the physician and it’s better for the patient.
Two things that impede doctors from being able to choose the work environment that best suits them are the CON and the applicability and availability of non-competes.
You were a co-sponsor of H.3775, which if it would have passed as introduced, would have prevented health benefit plans from requiring step-fail edits for cancer drugs for patients with stage-four metastatic cancer. The oncology members of the SCMA believed that would have been a beneficial bill. It had significantly changed by the time it passed to be less meaningful. Do you still believe in the bill as it was introduced? And do you think that a bill closer to the original would be passed?
We need to keep pushing. I can tell you a little about the genesis of this bill … There was a lady in the Greenville community what had metastatic cancer. She was a well-known acquaintance with many House members. Unfortunately, she recently passed away, but she was a great advocate for patient care and awareness of this issue.
I support refiling the bill. The idea that someone battling stage 4 metastatic cancer must first try a less-effective drug before being prescribed a drug recommended by their doctor is beyond frustrating. It impedes patient choice and freedom at a most critical time when any delay can have a very negative outcome.
On your website, your Pro-Life stance on abortion is listed as one of your key issues. What are your thoughts on the abortion debate/H.5339 in the House and Senate over the summer?
I’m Pro-life, and I’m going to vote for Pro-life legislation. The legislative effort needs to focus on the doctor-patient relationship. When the heartbeat bill was passed, few people envisioned that it would become the law of South Carolina. The implementation of it was so immediate that necessary protocols were not in place. Some physicians had to consult with lawyers before providing care to their pregnant patients. Having lawyers in the middle of the doctor-patient relationship is not the preferred method.
The House passed bill was a step in the right direction over the Heartbeat Bill as it relates to the health and safety of the mother. Please prepare for a day in South Carolina when there’s a ban on abortion, with exceptions for the life and health of the mother and rape and incest.
I don’t envy a doctor having to consult a legal team before deciding on patient care, especially in emergency situations. We need to make sure that the law does not impede women from receiving the care that they need to protect their lives and the lives of their unborn children.
You have one of the largest health care providers in the state right in your backyard in Prisma Health, do you often talk to physician constituents? If so, what concerns do they share they have with you?
I do hear from physicians, but I don’t hear from them regularly as it relates to professional issues impacting the healthcare industry.
I take the opportunity to reach out to doctors if I have questions. On the Pro-life legislation that was recently debated, it was particularly helpful for me to interact with physicians on the topic. Those doctors were gracious with their time and knowledge and were very helpful to me and other legislators. The head of Prisma OB/Gyn spent a lot of time interacting with me and several other SC House members. I am very appreciative when doctors can help me better understand an issue.
Is there anything specific that you would like to say to SC physicians?
I’m appreciative of the SC Medical Association, for both the services that individual members provide and collectively improving health care in SC.
I encourage your members to find a way to have conversations with and to get to know their House Members and Senators. Reaching out and developing a relationship before you have an ask is important. It will go a long way and will be impactful when it comes time to discuss legislative priorities with a House Member or Senator. The overwhelming majority of legislators will take the text or call, will read the email, and set up a time to talk on the phone or meet in person. It is often more effective to do so in the home district than at the State House. If the average legislative member heard from a handful of physicians on any issue, it would be very impactful.
Out of all the professions in America, physicians are still at the top. Legislators will want to hear directly from physicians as it relates to healthcare issues. Developing a relationship prior to the time that is necessary to discuss legislation can only be a positive thing. It’s much easier to allow a random number to go to voicemail than if that name is already in my phone. When time is critically important, that rapport or pre-existing relationship could make things as simple and efficient as sending a text.
Also, be sure to vote in your primaries. That’s where at least 95% of the races are decided, so it’s critically important. And when we have a 10-15% turnout of registered voters, you’re getting a very small percentage of people deciding elections, and that’s not good for the process.
Beyond what we’ve talked about, what are your top legislative priorities this year?
Is there anything with which the SCMA can assist you?
Continue providing knowledge and expertise on complicated healthcare issues. Legislators are generalists, and very few of us have medical backgrounds. A legislator who is educated on a particular issue is going to be a more effective legislator. Knowledgeable legislators generally produce better legislation. SCMA is a resource for information and expert knowledge for legislators.