This is the first in a series of articles profiling the committees of the ACR.
The ACR Government Affairs Committee has a long list of accomplishments from the past year—renewing funding for the Centers for Disease Control lupus registry, gathering congressional support for the Arthritis bill, and advocating for a simplified Medicare Part D, to name a few.
The committee—a group of dedicated volunteers, ACR staff, and a professional lobbying firm—advances rheumatology through advocacy, including advocating for government legislation and policies.
The committee is led by Joseph Flood, MD, president of Musculoskeletal Medical Specialties, Inc., and a clinical faculty member at the Ohio State University College of Medicine and Public Health in Columbus. Dr. Flood has a long history of volunteering for ACR committees.
“In the early ’90s I spent five years on the Committee for Rheumatologic Care, and for four or five years I was the one-person Practice Advocacy Subcommittee, dealing with Medicare issues. This was replaced by the Regional Advisory Council,” he says. “I joined the Government Affairs Committee for a year as a member, and I just started my third year as chair.”
Dr. Flood says he joined the committee because of his interest in public policy. “I spent 10 years in Washington, D.C., during my internship, residency, and fellowship,” he recalls. “I’d always been interested in government, and being in D.C. for those years piqued that interest.”
What the Committee Does
The Government Affairs Committee was formed in 1995; prior to that, both the ACR Committee on Rheumatologic Care and the Committee on Research had legislative affairs subcommittees. “Our mission is to represent the college and its members to the federal government and its agencies,” explains Dr. Flood. “Those agencies include CMS [Centers for Medicare & Medicaid Services], the Food and Drug Administration, the National Institutes of Health [NIH], and others.”
The committee focuses on issues that affect physicians and their patients. “We have policy statements, including increased advocacy for improving reimbursement from both government and private payers,” says Dr. Flood. “We often work in collaboration with the American Medical Association and the American College of Physicians; we try not to duplicate efforts of other medical associations, and we have representatives in both these groups.”
The committee actively promotes ACR policy statements. “We lobby Congress,” says Dr. Flood. “We’re in our second year working with Patton Boggs, a powerhouse lobbying agency. There are three people on the healthcare team there that we work with.”
Advocating on Behalf of Members and Patients
One of the big issues for the Government Affairs Committee is increasing federal funding for organizations that contribute to medical research. “We also advocate for funding for research for NIH,” says Dr. Flood. “We support a substantial increase for their budget; during the last two years, this budget has been flat and the proposed budget would keep it flat.”
The ACR also lobbies for increased funding for the Veterans Administration and the Agency for Healthcare Research and Quality (AHRQ). “There are lots of other places we want to see increased funding for research,” says Dr. Flood.
The committee advocates for Medicare reform, including the simplification and re-evaluation of the prescription drug plan. “Part D benefits apply to our treatments, and we want to make sure that our patients are covered for those treatments,” says Dr. Flood. “Most of our patients fall into the donut hole. We also support the off-label use of drugs when it’s worthwhile. When pharmacy or insurance representatives make decisions, they want cost-only use of meds; we know what’s best for our patients.”
The committee continues to fight for a reversal of Medicare reimbursement cuts to both the technical and the professional components of dual-energy absorptiometry (DXA) testing of bone mineral density (BMD). “I don’t think the government really wants to prevent early warnings of fracture risk, but the overall costs to CMS of imaging went up 28% last year,” says Dr. Flood. “CMS is rightfully concerned about this, but I think we unfairly got swept up in their desire to cut back.
“We want to take the BMD issue head on,” he continues. “First, we’ll start a public relations campaign, perhaps including volunteer organizations concerned with osteoporosis. Second, we’d like to appeal to CMS at a higher level. Ideally, we’d like to have a meeting with the administrator.”
Dr. Flood and his committee members also keep an eye on quality-of-care issues such as pay-for-performance. “We believe those [measures] ought to include our input,” explains Dr. Flood. “The ACR has put together a starter set of 16 quality indicators….Any kind of performance indicators should be relevant and no further burden of time” to busy rheumatologists.
Arthritis Bill Highlights
If it becomes law, the Arthritis Prevention, Control, and Cure Act will support arthritis research and education. Here are some highlights from the bill.
- Enhance the National Arthritis Action Plan;
- Develop a National Arthritis Education and Outreach Campaign;
- Organize a National Arthritis and Rheumatic Diseases Summit;
- Support juvenile arthritis research; and
- Encourage health professionals to enter the field of pediatric rheumatology.
2007 Budget and Legislative Issues
Most recently, the ACR added its voice to other organizations that insisted on restoring continued funding to the Centers for Disease Control lupus registry that collects data and provides a basis for future research. “We were successful,” says Dr. Flood. “The government re-instituted funds for that, and the research is continuing.”
Another important lobbying effort is still underway. Dr. Flood says, “under the general rubric of increasing funding, we pushed for the Arthritis Prevention, Control, and Cure Act, or ‘the Arthritis Bill,’ which calls for increased research for arthritis, primarily pediatric rheumatology training and research, including federal funds for paying the medical educational bills for this specialty.”
The bill also calls for a summit of all federal agencies involved in such research, along with leaders from the Arthritis Foundation, rheumatology community, and other stakeholders. “It has important provisions for pediatric rheumatology including the forgiveness of student loans for those who choose this subspecialty,” notes Dr. Flood. “It also promotes community awareness of arthritis and how people can potentially prevent arthritis and become involved in effective self-management of arthritis.”
The ACR was the major supporter of this bill, which was initiated by the Arthritis Foundation. The Arthritis Bill was introduced in Congress in 2005 and re-introduced in 2006, when it gained considerable sponsorship—nearly 50% of each chamber. Because the bill was not acted on during 2006, it must be re-introduced this year. “We’ll be seeking sponsors to reintroduce the bill in the new Congress,” says Dr. Flood, “and we anticipate its passage, since most of our sponsors were either re-elected or held seats not up for election in November. We can’t take [its passage] for granted, though, and will be working hard to see it to fruition.”
ACR Members as Advocates
The Government Affairs Committee doesn’t work alone. “We recruit members and patients to become advocates,” says Dr. Flood. “We take groups to visit Congress each spring for an ACR Advocacy Day.” This event includes brief training and a keynote speaker covering three or four of the most important issues. Last year, participants focused on increased funding for NIH and a permanent fix for the sustainable growth rate. Participants then visited their own members of Congress. This year, ACR members paid Congress a visit on March 13. (Look for coverage of Advocacy Day in an upcoming issue of TR.)
The Government Affairs Committee plans another annual event: “Each autumn, we hold a legislative reception,” adds Dr. Flood. “Our board and committee, as well as members and patients, invite members of Congress to a reception to discuss issues and meet us. It’s a relaxed atmosphere, with opportunities for photos and to thank representatives for their support.”
In addition to activities on Capitol Hill, the committee communicates important issues to the ACR membership. The committee produces the monthly Public Policy Monitor, which is distributed to ACR leadership and posted on the Web site.
“We send out blast faxes or e-mails to ACR members when we think they need to be rallied to action,” says Dr. Flood. “There’s also a new list serve that allows conversation on issues.”
2007 Committee Priorities
- Medicare reform, including improvements to the Part D prescription drug benefit and changes to the physician reimbursement formula;
- Increase federal funding for rheumatology research;
- Reverse cuts to dual-energy absorptiometry tests; and
- Support passage of the Arthritis Prevention, Control, and Cure Act.
Committee Strengths
The Government Affairs Committee is a “widely disparate group of people,” says Dr. Flood. It includes representatives from solo practice, group practice, and fellows in training, as well an ARHP representative.
Committee member William Palmer, MD, head of the rheumatology care team at Westroads Medical Group in Omaha, Neb., agrees: “We have a good mix from various disciplines and geographic regions. And Joe Flood is definitely the man for the job.”
The committee works closely with ACR staff members, including Tiffany Schmidt, JD, MBA, vice-president for socio-economic affairs; Kristin Wormley, senior specialist of government affairs; and Aiken Hackett, government affairs specialist.
“Without ACR staff, we’d never get our work done,” says Dr. Flood. “Most members don’t know what a terrific staff we have.”
Jane Jerrard is writing the series on ACR committees.
