PAC Progress and Challenges

In 2007, the ACR established a political action committee, known as RheumPAC. Three years later, the PAC has raised more than $130,000, contributed to the campaigns of dozens of senators and congress-people who support legislation that could benefit rheumatology, and attended countless meetings, fundraisers, and one-on-one discussions with federal elected officials and their staffs.

Genesis of the PAC

Before RheumPAC’s founding, and to begin to address the many legislative issues that could affect the practice of rheumatology, “the ACR Government Affairs Committee [GAC] had developed a legislative agenda that was vigorous and required an audible voice in Congress,” which the ACR did not have at the time, says Joseph Flood, MD, who was the GAC chair when the agenda was developed, and is a rheumatologist in solo practice and clinical assistant professor of internal medicine at the Ohio State University College of Medicine and Public Health in Columbus.

One agenda item was the Arthritis Prevention, Control, and Cure Act, a bill that would provide patient education, loan forgiveness for pediatric rheumatologists as an incentive to encourage new doctors to enter the field, and many other benefits for patients with arthritis and the subspecialty of rheumatology. The need to enact such legislations is pressing: in the United States, there are only about 237 pediatric rheumatologists, including those who work in research and academic settings. In contrast, there are nearly 300,000 children who need rheumatologic care, says Aiken Hackett, director of government affairs for the ACR. Until recently, eight states had no pediatric rheumatologists; this year Montana, a state that stretches roughly 700 miles by road east to west, lost its lone pediatric rheumatologist, raising the state total to nine. Specialist care is needed because “many of the medications we give have fairly severe side effects and must be monitored regularly,” says Maura Iversen, PT, DPT, SD, MPH, the ARHP representative on the RheumPAC committee, and assistant professor of medicine at the Harvard Medical School, professor and chair of the department of physical therapy at Northeastern University, and clinical researcher in rheumatology at Brigham and Women’s Hospital, all in Boston. Specialists such as rheumatologists are trained and experienced in managing long-term medications for chronic conditions such as rheumatoid arthritis and lupus.

Increasing the budget of the National Institutes of Health (NIH) is also a priority for medical specialty societies, says Dr. Flood. Over the last several years, the NIH’s budget had flatlined, “threatening our members who had ongoing grants and making it harder for new rheumatology investigators to get any grants,” says Dr. Flood.

Then there is the Medicare Fraction Prevention and Osteoporosis Testing Act which addresses dual-energy Xray absorptiometry (DXA) scans, among other things. “Our members who performed bone density measurements in their offices were being forced out of that part of their business by the Draconian decreases in reimbursement for that very important test,” says Dr. Flood. Reimbursement was set to plummet year by year from $140 in 2006—about $5 more than the cost of providing the service—to $53 in 2010. The DXA bill would reinstate the 2006 reimbursement rate.

“Our members’ and our patients’ welfare was at stake, and congressional leaders held our fate in their hands,” says Dr. Flood. “We needed to make sure they would hear us. At the same time, all of medicine was threatened by the intrinsic flaw in the Sustainable Growth Rate (SGR) formula, a formula for Medicare reimbursement which Congress passed into law in 1997, which each year leaves practices both private and academic scrambling to project budget shortfalls for the next year if a Congressional band-aid were not bestowed upon us.”

With such issues pressing, in 2005, the ACR had hired a Washington, D.C.–based lobbying firm, Patton Boggs, LLP, to help broadcast the ACR’s message. Martha Kendrick, the ACR’s point person with Patton Boggs, pointed out that the ACR needed a way to reach members of Congress who had jurisdiction over the relevant legislation, says Dr. Flood. One good way to do that, she suggested, is through a PAC.

Additionally, says Neal S. Birnbaum, MD, who was president of the ACR at the time RheumPAC was established, “we had a presentation from the American College of Physician’s PAC, and after that deliberation, we decided to go ahead.” In the end, says Dr. Flood, most of the board members supported establishing the PAC. Those who disagree, he says, “help us maintain strict, ethical standards.”

RheumPAC: Helping Docs and Patients

Exactly what the RheumPAC has accomplished is hard to quantify, partly because it is one small player, many of whose goals coincide with those of larger medical associations, and partly because a PAC’s success can’t be measured in the manner of a randomized, controlled clinical trial. Nonetheless, the ACR is clearly gaining influence through the RheumPAC.

For example, with help and support from the RheumPAC, the ACR played a role in getting the Arthritis Prevention, Control, and Cure Act, passed by the House last year, says Sharad Lakhanpal, MD, chair of the GAC and clinical professor of medicine at the University of Texas Southwestern Medical School in Dallas. Unfortunately, it never came up for a vote in the Senate because the presidential election distracted that body from so much of its business, he says. But it has been reintroduced this Congress.

In the case of the DXA bill, Dr. Lakhanpal notes that RheumPAC supports Rep. Shelley Berkley (D-Nev.), a member of the Ways and Means Subcommittee on Health and sponsor of the bill. “Rep. Berkley has stated that this issue is one of her top priorities in healthcare reform,” says Hackett. Rep. Berkley has osteoporosis and has firsthand experience with the importance of access to DXA screening for women’s health. Additionally, her husband, a physician, had to stop performing DXA scans in his office because of the low reimbursement. Dr. Lakhanpal also notes that a study by the Lewin Group found that the legislation could save Medicare more than $1 billion over a five-year period by reducing the number of hip fractures by screening for and treating osteoporosis.¹

Regarding the SGR, “physicians haven’t had a raise in 10 years,” says John Goldman, MD, a solo practitioner in Atlanta, who supports RheumPAC. Without congressional “band-aids” that have been applied on an annual and then biannual basis to the SGR calculations, physicians would have faced sharp reductions in reimbursement. Those reductions would have amounted to 10.5% in the summer of 2008, when President George W. Bush vetoed the congressional SGR fix. Dr. Lakhanpal credits the ACR and RheumPAC with contributing to a congressional override of that veto.

Although RheumPAC has been an active advocate for legislation that could positively affect rheumatologic care, it may be too early to know whether it has changed the practice environment for the individual rheumatologist, says Dr. Birnbaum. “This is only its third year of business,” he says, adding that, “PACs are a long-term investment.”

Nonetheless, “supporting candidates fosters relationships and ensures that the ACR is at the table when discussing important healthcare issues,” says RheumPAC Chair Gary L. Bryant, MD. “RheumPAC makes these opportunities possible, which is especially key at this important time in history as significant healthcare reform is being debated.” Dr. Bryant is professor of medicine in the division of rheumatology at the University of Minnesota in Minneapolis–St. Paul.

How RheumPAC Works

The RheumPAC committee works closely with the ACR Governmental Affairs Committee, and the lobbying firm Patton Boggs to review issues affecting rheumatology and set priorities among them, focusing on the top four or five issues, says Dr. Bryant. (See “RheumPAC Committee” for a list of the committee members.)

RheumPAC is strictly nonpartisan—just like arthritis. Decisions to sponsor legislators are based largely on whether a member has sponsored or cosponsored legislation of importance to rheumatology, and whether a member sits on a key committee or holds a leadership position in the House or Senate, says Dr. Bryant. Furthermore, because RheumPAC is a federal PAC, by law it may only donate to federal legislators, not state or local candidates. Members of the ACR and the ARHP can suggest legislators for support via a link on the RheumPAC page of the ACR Web site.

As per federal law, RheumPAC uses contributions from ACR members to contribute directly to campaigns, says Dr. Bryant. The ACR covers only the cost of administration, and cannot endow the PAC.

Besides deciding how to use RheumPAC’s funds, the nine members of the PAC committee attend fundraisers for candidates, which are frequently small events that afford committee members time to discuss rheumatology issues directly with legislators and their staffs. They also participate in several lobbying sessions on Capitol Hill each year that are attended by other physicians, rheumatology health professionals, and, often, patients. Recently Dr. Iversen described a fairly typical lobbying experience.

Lobbying in Action

Accompanied by a rheumatologist, a nurse, and a young woman with juvenile arthritis (JA), Dr. Iversen recently visited with congressional staff. In this particular case, the legislative assistant was not convinced by the rheumatologist’s analysis, despite the latter’s articulate advocacy, says Dr. Iversen. Patients, those whom rheumatologists and health professionals are trained to treat, have a great impact in advocacy. They can pull at the heartstrings. The young woman shared her story. It began one morning when, at age four, the girl woke up with severe pain in her legs, unable to stand. She was hospitalized and underwent bilateral hip aspirations. This was followed by similar episodes in her knees and ankles, and the JA diagnosis.

The young woman then recounted the difficulties of attending public school. “The stories continued,” says Dr. Iversen, “each more heart wrenching than the previous one. At a break in her captivating story, I looked from the young girl to the legislative assistant and noticed that the man was enthralled with her. He began asking her pointed questions about what had motivated her to come to Washington, D.C. She said she thought she could help others with arthritis. When the meeting adjourned, the legislative assistant promised to discuss the Arthritis Prevention, Control, and Cure Act with his congressman. Within a week, the congressman had cosponsored the bill.”

RheumPAC and the ACR advocacy program compliment each other in increasing the ACR’s visibility on Capitol Hill and influencing policies that affect the rheumatology community—physicians, health professionals, and especially the patients. As RheumPAC matures and builds more relationships with elected officials, the effects of this “long-term investment” on healthcare policy and the rheumatologic practice environment will become more apparent.

David Holzman is a freelance writer based in Massachusetts.

Reference

1. The Lewin Group. Assessing the costs of performing DXA services in the office-based setting. Published October 31, 2007. Available at: www.iscd.org/Visitors/pdfs/DXAFinalReportfromTheLewinGroup10-31-07.pdf. Accessed October 16, 2009.