Why do we advocate? The short answer is because it works. But, how do we know it works? How do we really know? Beyond the relationships, recognition from lawmakers and staffers, and hearty greetings each time we walk into an office on Capitol Hill or visit a local office, are we getting somewhere?
To answer that question, let me tell you about the last time I visited Capitol Hill in May with the ACR Board of Directors and committee chairs.
I have been on dozens of Capitol Hill visits on behalf of rheumatology, so I pretty well knew the routine. When I am getting ready for a day of meetings on Capitol Hill and I put the Simple Tasks bent fork on the lapel of my suit, I psych myself up by telling myself that I’m doing the best thing I can be doing that day to make an impact for rheumatology and our patients. The evidence to support this attitude will come later in the day.
Inspiring Speakers to Start the Day
First, the ACR advocates for this visit—board members, committee chairs, and staff—gathered in the hotel lobby, all of us with our bent forks, and made our way to Capitol Hill for a breakfast meeting to hear from the speakers the ACR had lined up to jumpstart our day, before our Hill meetings. The meeting room is a majestic committee hearing room, with a soaring ceiling and imposing chairs for members of Congress, but it seemed almost intimate that morning. We were extremely fortunate that day to hear from congressmen who are actually sponsoring bills that address two of our major issues. Our first speaker was Congressman David McKinley, a Republican from West Virginia, who sits on the powerful Energy and Commerce Committee that handles much of the healthcare legislation that affects rheumatologists and their patients every day.
Bill St.Clair, MD, ACR/REF treasurer and a native of West Virginia who is now settled in at Duke University in Durham, N.C., makes the introduction. Rep. McKinley provided an update on healthcare policy and discussed his bill, the Patients’ Access to Treatments Act (H.R. 4209), which he introduced with Rep. Lois Capps, a Democrat from California. It already has the support of 22 of his colleagues in the House, from both parties. It is the first federal legislation specifically addressing the problem of excessive cost sharing in specialty tiers. It is a major breakthrough for the ACR and for our patients, most of whom can’t afford hundreds—let alone thousands—of extra dollars each month in cost sharing for their necessary, life-changing treatments. It is not likely to make it through Congress this year, but it is an excellent start.
Following Rep. McKinley was Congressman Joe Heck, DO, a Republican from Nevada. I introduced Rep. Heck, and sat down to listen to a detailed, nuanced discussion of healthcare policy, focused on the Medicare physician payment system, where it’s gone wrong, and how to fix it. Part of Rep. Heck’s focus is replacing the Sustainable Growth Rate (SGR). I know, how many times and for how many years have we talked about getting rid of the SGR? So often that now I find that, frequently, the first thing Congress members or staffers will say in meetings is, “I know about the SGR problem, we’re working on it.” That’s encouraging, but it is not enough. It is not enough to just talk about it, and it is not enough to replace the SGR unless it is replaced with the right “fix.” It is refreshing that at least members or staffers are candid and acknowledge right away that it is a tough year for agreements—especially the kind needed to find $300 billion to repeal the SGR. We have been told to expect another SGR patch, for now, but we are appeased that repeal may truly be possible next year.
New Legislative Efforts Support Rheumatology
Rep. Heck has introduced pertinent and groundbreaking legislation: the Medicare Physician Payment Innovation Act (H.R. 5707), cosponsored by Rep. Allyson Schwartz, a Democrat from Pennsylvania. Not only does it repeal the SGR, but we believe it also has an excellent chance of replacing it with something that would help advance rheumatology! Part of what the bill does is stabilize payment rates for a period, during which multiple payment and delivery models can be tested. One size will not fit all practices and geographic areas in this country, and this multimodel approach is something the ACR has been advocating. But, the most important part for us is that his bill also implements temporary pay increases for those who mostly provide primary-care services—defined as physicians billing at least 60% E/M—and it does this regardless of specialty. In other words, it recognizes the critical role of specialists like us who spend time with patients. Rheumatologists would be eligible for increases and are recognized for our role in care and coordination. Dr. Heck has provided a blueprint for doing payment reform in a way that advances rheumatology.
In fact, H.R. 5707 represents the first time rheumatologists and other cognitive specialists have been included in efforts to incentivize and reward primary-care services. We are recognized for delivering the critical face-to-face, hands-on care we provide every day for patients with arthritis and rheumatic diseases. This truly is progress!
There is another area where I can see the progress our advocacy is making. It’s an area near to my heart, in particular because of my time as president of the ACR Research and Education Foundation. Federal funding for research is something we have to continue to push because of the precarious budget situation in Washington, D.C., and the crucial difference funding can make in the lives of patients—and members of Congress are getting the message. I can tell you that, in my meetings on Capitol Hill, after the members or staffers tell us that, yes, they know, they’re going to get rid of the SGR, usually the second item they will bring up—sometimes before I get to it—is that they support research. In fact, we are hearing nearly universal support for medical research—we just need to make sure they follow through with the dollars. Usually there are caveats and recognitions about the budget situation in Washington, but the message about research funding is crystal clear.
However, it is not just talk or telling us what we want to hear. While partisan politics and the competition between the parties, each controlling its own chamber of Congress, has resulted in deadlocks and bad deals between the Senate and House, and in an environment where cuts in funding are the norm, members of Congress consistently propose either keeping NIH funding steady or providing increases—not cuts. Why? Because it’s the right thing to do for patients and for keeping the U.S. at the forefront of cutting-edge research? Yes, of course. But, just as in the cases of the two issues we heard about that morning at the Capitol, it also has a lot to do with the fact that they have been asked by advocates and constituents to take that stance.
We are advocates because advocacy works. When your colleagues were in Washington this month at Advocates for Arthritis, or when you participated in the virtual Advocates outreach to your members of Congress, or when you reach out to your representatives in Washington or at their home office at any point during the year, you will know that we are making a difference.
It was especially gratifying in May to have so many of the elected officials or staffers identify us by our ubiquitous forks—they are starting to know who and what rheumatologists are. Let’s be proud of what we have accomplished and commit to staying involved so we can make even more progress together for our profession and our patients. If we build the relationships, and take thoughtful and credible positions on issues that are important for our patients—Congress’s constituents—we will continue to make a difference. So put on that fork—there is no time like today and there is no year like this year for advocacy!
Dr. O’Dell is director of the Internal Medicine Residency Program and division chief of rheumatology at the University of Nebraska, Omaha and the Omaha VA medical centers. Contact him via e-mail at [email protected].
Questions About Simple Tasks?
To learn more about Simple Tasks, visit www.SimpleTasks.org, and make a plan to visit the ACR Simple Tasks booth in the exhibit hall at the annual meeting in Washington, D.C., this November to get your fork.
