With only half an hour until close, I quickly walked through the National Archives in Washington, D.C. Along with the small crowd around me, I gazed at our country’s founding documents: the Declaration of Independence, the U.S. Constitution and the Bill of Rights. The surrounding interpretive texts recounted the process of discussion, deliberation and, finally, creation of these documents. I was reminded that even today, it is the thoughts and opinions of citizens who create our laws. In fact, I was in our nation’s capitol to meet with members of Congress and their staff as part of the ACR’s Advocacy Leadership Conference.
In our practice as physicians, we encounter endless, seemingly nonsensical laws and rules dictating how we practice medicine, what tests we can order and what medications we can give patients. As a medical student, an internal medicine resident and now a rheumatology fellow, I would sometimes imagine lawmakers sitting in a faraway room and making up these policies. Surely many were created with good intentions, but perhaps without an understanding of the impact on the reality of clinical work. As we’ve all seen, good intentions don’t translate to perfect policy.
What’s at Stake
Dr. Liu
Throughout the Advocacy Leadership Conference, ACR advocacy staff and other ACR leaders shared background on the legislative process, the role of advocacy and the key bills we would be speaking about with legislators, emphasizing why we were having these meetings. Rep. Larry Bucshon, MD (R-Ind.), also addressed attendees on the first day of the conference and spoke about how our meetings could help influence real change. As a cardiothoracic surgeon, Dr. Bucshon is one of 19 physicians in Congress and understands the challenges of both practicing medicine and passing good laws. We then broke into groups with others from our states. For several of us, it was our first time speaking with our legislators in person, and we were excited and nervous about how the meetings would go. We ended the day by reviewing our schedule for the next day—when we would speak directly with our elected officials.
On the second day, we set out in the morning to Capitol Hill, starting at the Senate buildings. Along the way, I noted other health-related advocacy groups, including a dialysis patient group and a brain tumor awareness group. There was no shortage of passionate folks who wanted the ears of legislators. The appointments would be short, about 15–30 minutes, so we had to make our asks succinct and convincing. Thankfully, our team included a couple of experienced members, including Government Affairs Committee Chair Christina Downey, MD. She took the lead in the early conversations and eloquently laid out our requests.
During the meetings, we discussed two separate bills. The first, the Strengthening Medicare for Patients and Providers Act (H.R. 2474), would tie physician payments for treating Medicare patients to inflation by adding a permanent inflationary update to the Medicare Physician Fee Schedule (MPFS). For context, other healthcare sectors, such as skilled nursing facilities and hospitals, already have this inflationary update built into their payments. Ironically, physicians, who are arguably the core of healthcare delivery, are the only sector that does not currently have this update. The measure was introduced by four physicians serving in Congress who have been joined by 129 co-sponsors.
We also advocated for the Provider Reimbursement Stability Act (H.R. 6371). This bill would raise the budget neutrality trigger from $20 million to $53 million. Right now, when the Centers for Medicare & Medicaid Services (CMS) estimates pricing increases to the MPFS of greater than $20 million, it triggers a requirement for the CMS to reduce Medicare physician services by an equivalent amount. Often this cut comes at the expense of physician payment, typically via a reduction in the Medicare conversion factor. The budget neutrality trigger level was set in 1989 and reflects the cost of healthcare delivery from that era, a figure that is long overdue for an update. This bill would allow more flexibility when adjusting prices of individual services without defaulting to blanket Medicare cuts.
The Human Face of Medicine
During our training the previous day, we learned that sharing our personal stories helps policymakers better understand our asks, and in meetings, our team delivered. One physician shared a story of how, as a small business practice, they were able to move more nimbly to see an urgent elderly patient with knee pain and an effusion. They evaluated and treated the patient with arthrocentesis and glucocorticoids, thereby preventing a costly trip to the emergency department that would also have left the patient waiting all day in pain.
Several members of our group shared the financial challenges of covering the cost of rent, utilities, support staff wages, electronic medical records software, billing and medications because lower reimbursement rates haven’t kept up with inflation. They are now being forced to consider such options as limiting Medicare patients, selling their practices to a bigger health group or private equity, or even closing their doors entirely. That could mean a whole community would lose access to rheumatologists.
In one impactful moment, a member of our team asked the Capitol Hill staff member if they’d heard constituents complaining about the difficulty of getting to a doctor. When they told us they had, we explained that we are seeing the consequences of past legislation not only on how we deliver care but, increasingly, on whom we can deliver care to.
Over the course of the day, everyone on our team had the opportunity to take the lead, and I could see everyone’s confidence grow with each meeting. Over the course of one day, I felt I gained so much. It felt good to turn the regular frustrations of the clinic and hospital into productive conversations with those with the power to turn bills into laws.
Now, I feel empowered with the skills I need to reach out, set up my own meetings and bring others into advocacy. Like the mantra in medicine, “see one, do one, teach one,” I’m hoping to pay it forward!
Audrey Liu, MD, is a first-year rheumatology fellow and serves as the fellow-in-training (FIT) member of the ACR Government Affairs Committee.
