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The Budget Control Act of 2011 cut Medicare physician payments by 2% across the board. The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law in 2020, suspended this sequester (i.e., a cut in government spending) between May 1 and Dec. 31, 2020. In the Consolidated Appropriations Act, signed into law in December 2020, Congress postponed Medicare sequester reinstatement until March 31. The Medicare Sequester COVID Moratorium Act (H.R. 315) would extend this relief to the end of the public health emergency.
Urging legislators to support H.R. 315 is just one of the important actions your Government Affairs Committee (GAC) is taking this year. Other ACR legislative priorities include:
- Asking Congress to address arthritis’ impact on our military;
- Urging legislators to fund a pediatric subspecialty loan repayment program; and
- Supporting COVID vaccination for the immunocompromised.
As ARP representatives on the ACR Government Affairs Committee, we are passionate about these issues, because of the impact they have on our patients and the profession. We also get a tremendous amount of personal satisfaction from the work and wish to share our volunteer experiences with you, in the hope you will join us.
From State to National Advocacy
Dr. Frie
“My first exposure to advocacy on a state level was through my job as an assistant professor in the Graduate Occupational Therapy Program at St. Catherine University in St. Paul, Minn.,” says Brenda Lee Frie, EdD, OTR/L, CHT, an assistant professor at St. Catherine University, St. Paul, Minn. and an occupational therapist at M Health Fairview Hand Center, Minneapolis. “As part of our activities each year, we held an occupational therapy day at our state capitol, where we organized students and practitioners across the state by representatives to advocate for upcoming legislation that supported practice and patient access to services.
“I am a new member of the Government Affairs Committee and look forward to advocating on a national level.”
Be Prepared to Learn
Mr. Loggins
Brian Loggins, BA, BS, is the practice administrator for Arthritis Associates, San Antonio, Texas. He has served on the GAC for more than two years, and says, “As a member of the GAC, I have been actively involved with advocacy for our patients and practicing rheumatologists. To me, advocacy involves an active attempt to persuade those with authority to make changes that we want. Advocacy takes training, effort and work, but it can also be rewarding and fun.
“My first experience with advocacy on the Hill in Washington, D.C. was about five years ago, when one of our physicians, who was a member of the ACR Affiliate Society Council, could not attend the Spring Advocacy Leadership Conference in D.C. I agreed to go in his place, but I had no idea what to expect or what was expected of me.
“The few days that I was in D.C. were very well organized by the ACR. We spent the first day in training, going over the topics we were to discuss with the legislators and role playing. The next day, we were off to meet with, and hopefully persuade, the congressional members who control the levers of power [to support issues of importance to rheumatology]. A mobile phone app told us everything we needed to know—like who was on our team, who we were to meet with, when and where.
‘I learned that many members of Congress & their staff have no idea what a rheumatologist is or what we do.’ —Brian Loggins, BA, BS
“That day on the Hill was very enlightening. I learned that you don’t always meet with the actual member of Congress, but sometimes with a member of their staff. I learned that just because you have a meeting scheduled does not mean it is going to happen as planned. I learned that many members of Congress and their staff have no idea what a rheumatologist is or what we do. I learned that physicians, academicians, and scientists are not always the best at persuading.
“I also experienced great satisfaction when the member or staff person listened, understood and agreed to support whatever issue or bill we were in support of. It is always a long, busy and tiring day, but well worth it.
“Since my first trip to the Hill, I have gone back five times to D.C. and have participated in virtual trips to the Hill twice. I really enjoy doing it and would encourage anyone who might be interested in advocacy to contact the ACR and volunteer.”
The ACR Makes Advocacy Easy
Ms. Robbins
Lisa Robbins, BSN, RN, CPN, is a clinical care manager in pediatric rheumatology, Penn State Health Children’s Hospital, Milton S. Hershey Medical Center, Hershey, Pa. “Patient advocacy has never been more convenient in the world of rheumatology,” says Ms. Robbins. “The ACR offers many opportunities for advocacy engagement, ranging from simple letter writing, through the Voter Voice app on the website, to interacting with our legislators directly during a Hill visit.
“Many years ago, as a novice pediatric rheumatology nurse, I first became involved in advocacy efforts in partnership with the Arthritis Foundation. I recall volunteering at an AJAO [American Juvenile Arthritis Organization] meeting, which was in D.C. that year, in the late 1990s. We attended pre-arranged meetings with our legislators, followed by a picnic on the Hill with patients and their families, along with rheumatology health professionals and legislators. The idea that ‘kids get arthritis too’ was novel to many of the legislators. How powerfully these kids could communicate the needs of this particular population.
“Fast forward to September 2020. With the pandemic precluding face-to-face visits for anyone on Capitol Hill, the idea of a picnic together was impossible.
“As an ARP representative on the GAC, I continue to be involved in sharing our patient’s needs with our legislators. September is an important month for ACR advocacy, because we get to interact with our legislators as representatives of the rheumatology care community alongside patients.
“Our ACR staff work year-round to develop relationships and advocate for the issues prioritized by the GAC. We receive coaching on how best to share our concerns and eloquent written information to provide to our legislators.
“This past year, the ACR pivoted to virtual visits, so we were still able to interact with our legislators and share information about our advocacy priorities. Our patients’ stories continue to be very impactful.
“I invited a 10-year-old patient to join us and speak to our legislators about why pediatric rheumatologists are needed. This healthy child had fallen into some pool-side landscaping in 2019 and suffered a nasal fracture. He developed a fever and was sent home from his local emergency department (ED) with antibiotics. He presented to our ED and was diagnosed with strep pneumonia meningitis and bacteremia.
“His course was complicated by seizures, bilateral MRI changes consistent with ischemia and narrowing of internal carotid arteries, so a rheumatology consult was requested. The child was [diagnosed with CNS vasculitis,] ultimately discharged from the pediatric intensive care unit (PICU) 19 days later, and the rehabilitation hospital a week after that, to continue his outpatient care with a pediatric rheumatologist.
“He has recovered from this secondary CNS vasculitis with just some residual unilateral sensorineural hearing loss and focal epilepsy. He doesn’t recall much from his time in the PICU or the rehabilitation hospital, but told the legislators that his rheumatologist, embodying ‘cognitive care specialists,’ helped him get back into life, school and onto the baseball field again. The patient and his family were incredibly thankful to have a pediatric rheumatology team available.
“This child helped make real and memorable the idea of why the ACR was advocating around workforce issues to have rheumatologists available when needed, evaluation and management code increases for cognitive care management and, even, parity for telehealth visits. (The patient’s family had shared their concern about immunosuppression from steroids and their son’s COVID-19 exposure risk.)
“The work of the ACR—including the staff, the GAC and other engaged providers—and our patients in advocacy for issues important to the practice of rheumatology is imperative, and I am thankful for the opportunity to continue to participate.”
Virtual ≠ Unreal
Ms. Sampson
Laura Sampson, PA-C, a physician assistant at Orthopaedics and Rheumatology of the North Shore, Skokie, Ill., says, “I joined the GAC in 2019 to help guide legislation affecting our profession and patients. I was looking forward to the ‘Hill Days’ that I’d heard so much about—the organized advocacy meetings with members of Congress in Washington, D.C., that were energizing, positive and a great way to get to know colleagues across the country. However, like so many things in 2020, expectations changed with quarantine.
“I was apprehensive that a ‘virtual advocacy day’ would not be quite as effective, but I am so grateful that I was able to participate in this unique experience.
“Virtual advocacy gave me the opportunity to talk to my representatives about urgently relevant issues, like telemedicine. I felt the impact of those discussions when I was able to treat my patients safely from their home.
“I was also able to learn from peers and patients. One of my patients joined our group during the Advocates for Arthritis meeting in September. She is a sommelier who could not open a bottle of wine because of her rheumatoid arthritis until we treated it. Listening to her describe her rheumatoid arthritis journey with our representative gave me a refreshed appreciation for how the work we do truly affects patients’ quality of life.
“There are silver linings to be found everywhere, especially in this pandemic. It is rare that the entire world and, specifically, medicine can change so quickly, and I am excited to be a part of this process.”
Get Involved
If you, too, are interested in helping patients and the profession while making meaningful connections, visit the Legislative Action Center on the ACR’s website.
