Athol MD helped shape Affordable Care Act
Fighting for better care for her patients, Dr. Heidi Foley ends up on presidential panel
ATHOL — Dr. Heidi Foley knew she wanted to become a doctor ever since she was a little girl. What she didn’t realize was that the hard work and schooling she went through to fulfill that dream would be nothing compared to the battles she would face advocating for patients and dealing with health insurance as a family physician. When Dr. Foley realized that truly helping people was being hindered by health insurance companies, she knew she had to do something about it.
And that effort, in turn, led her to participate in crafting the nation’s new Affordable Care Act, also known as Obamacare.
“It all started with a patient with pneumonia who had Medicaid. I didn’t want her to end up at the hospital with unnecessary costs. I brought her into the office where I evaluated her and discerned she needed an injection, which was administered,” Foley recalls.
When her office billed Medicaid for the injection and office visit, the bill was rejected. Medicaid would only pay for the shot, but not the office visit. Foley’s husband, Dennis Foley, who is the practice manager, re-submitted the bill. That resulted in the claim being approved for payment of the office visit, but not the shot or the administration of the shot. Six months later, the claim went to an insurance adjuster who overturned that payment decision.
“This one bill for service went on like that for over a year without payment,” Dennis Foley said.
The straw that broke the proverbial camel’s back came the month when the practice billed $4,000 in legitimate services and received payment of $17.
“At that point, I had had it,” Dr. Foley said.
The couple contacted their state representative at the time, Christopher Donelan, for a meeting. When he arrived at their practice, Donelan made it clear that his schedule was tight and he had limited time to speak with them.
“We immediately told him that we didn’t want to talk about getting paid, we wanted to talk to about patient advocacy and how we could make the process better,” Dennis Foley said.
That caught Donelan’s attention. What began as a short meeting turned into a major discussion ending in Donelan telling Dr. Foley that she had to go to Washington ,D.C. So, that’s just what she did. She signed up as a member of The American Academy of Family Physicians on her first day in D.C. and learned the laws. On the second day, she was out and about, talking to people and trying to get them to see that change in the health care system was crucial.
Dr. Foley made several visits to Capitol Hill and that’s where she encountered Dr. Kavita Patel, who was interested in what Dr. Foley had to say and coincidentally formed a committee for health care reform not long after their meeting. She invited Dr. Foley to join.
“I’m nobody,” Dr. Foley remembers saying.
That very reason was exactly why Dr. Patel told her she was needed. Shortly after Dr. Foley accepted the position on the committee, Dr. Patel became the health care adviser to the Obama administration.
“I remember there were so many committee emails and we had Monday night phone meetings. Then all of the members of the committee were asked to write bios,” Dr. Foley says. “While the other members had credentials filling a page with medical accomplishments and distinguished titles, ours was a paragraph about family life with our son, Timothy, and how we enjoy going to Patriots games.”
During this time Dr. Foley continued to visit Capitol Hill, going around to representatives and staff members with her stories of how health care needed to change.
An example she remembers vividly is a situation where a sick newborn in her office needed a formula change. The Women, Infants and Children nutrition program was not going to be able to provide it for a week due to the process and paperwork. Obviously, a newborn could not wait a week without ending up in the hospital. So Dr. Foley rallied her office staff and was able to get Catholic Charities to donate some money to purchase some of the new formula as well as placing a call to the formula company, who provided the balance for free.
The Foleys say they work well together as a team. Working toward the goals of the Health Care Reform Committee, they made several road trips to Washington and were able to accomplish much.
“I would come up with ideas and Dennis would write. On one occasion we were a ways into the trip to D.C. when we received an email from the committee regarding questions on H.I.P.A.A. law. So, we rerouted back to the house to get a copy and researched and emailed the rest of the way,” Dr. Foley says.
Their teamwork and passion for patient rights and reform led them to help write the landmark Affordable Care Act with the committee headed by Dr. Patel and eventually led Dr. Foley to attend luncheons with both President Obama and the First Lady.
“People who fell through the cracks before will now have the health insurance they deserve and need. In addition, people who won’t be subsidized have the opportunity to shop for a possible lower-priced plan without sacrificing quality. The ACA is also going to expand Medicaid and help the state out because the costs will be aided by the federal government,” Dr. Foley says about the positives the ACA has to offer.
Dr. Foley urges the public to give the bill a chance, explaining that there are many chances for kinks to be worked out, as with any new venture.
Another move forward is the Patient Centered Medical Home Initiative. Its purpose is to find efficient and effective ways to deliver health care providing positive results. Doctors participating in this initiative have lengthy checklists for each and every patient. Eventually, this initiative will be standard for all medical practices. Foley Family Practice has been a P.C.M.H. member since October 2010 and was chosen as one of only 45 practices in the state to participate.
“A large portion of this initiative is to put the patient, physician and staff together as a team,” Dennis Foley says.
“It’s a family business,” Dennis Foley says, going on to explain how involved their 7-year-old son is in the day-to-day. “We had a flu clinic and Timothy drew pictures for everyone receiving their shot; he even held the hands of some patients he thought needed it.”
Find out more
Find out more about Dr. Foley and her family practice as well as the Affordable Care Act and the Patient Medical Home Initiative by visiting the websites below.
Foleyfamilypractice.com – Click on the services page for several local area resources
Mahealthconnector.org – Find the right health insurance plan for you
Kff.org – The Henry J. Kaiser Family Foundation, a resource for information on health issues
Westernmasswomen.com – Issues including healthcare, lifestyle, business and education for women
Procon.org – A nonpartisan, nonprofit charity organization presenting the pros and cons of controversial issues