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What have we done for you lately in Washington?

From the April ACP-ASIM Observer, copyright 2002 by the American College of Physicians-American Society of Internal Medicine.

By Robert B. Doherty

When College members call the Washington Office, they often ask a simple question: "What have you done for me lately?"

Internists understandably want some assurance that the College is effectively addressing the issues that concern them most today. Just as understandably, talking about past advocacy triumphs doesn't always satisfy them.

We can almost always show, however, that our current advocacy agenda is addressing members' concerns. Our agenda is broad enough—and representative of the views of enough practicing internists who establish our policies—that very few members raise an issue that we are not already addressing.

Unfortunately, however, many ACP-ASIM members are unaware of what we are doing for them. While publications like ACP-ASIM Observer and ObserverExpress, the College's weekly e-mail newsletter, cover ACP-ASIM's advocacy activities, there is a limit to how much can be reported, particularly given the breadth of our advocacy efforts.

As I prepared to write this column, I perused the advocacy section of the College's Web site (www.acponline.org/advocacy) to see what issues we've addressed over the past four months. The volume and scope of the topics surprised even me—and I have overall responsibility for implementing the College's advocacy agenda! The topics we've focused on provide a persuasive answer to skeptics who want to know what we are doing for practicing internists.

Fair payment

From Oct. 31, 2001, to March 1, 2002, ACP-ASIM sent 20 separate letters, press releases and reports on Medicare physician payment, coding and billing issues. Much of this communication addressed the need for Congress to halt a 5.4% cut in Medicare payments and permanently change the formula used to update physician pay to avert further cuts.

Other efforts, however, called for better payment policies for palliative care, vaccinations, care plan oversight and geriatric assessment and management services, as well as improvements in the relative values for physician services.

In December, ACP-ASIM authored a letter that 17 other medical organizations co-signed. We urged Medicare to live up to its commitment to "provide adequate reimbursement to providers for the cost of vaccine and vaccine administration by all publicly funded and private health insurance programs." The letter directly addressed internists' frustration with Medicare policies that tout the benefits of vaccinations but fail to provide sufficient reimbursement for administering them.

Reducing regulations

Over the same four-month period, the College issued 18 letters, position papers and reports on reducing unnecessary Medicare red tape and hassles. We have advocated for reforms in Medicare carrier performance, alternatives to onerous evaluation and management documentation requirements, and elimination of a proposed mandate requiring physicians to hire translators for patients who are not fluent in English.

We have also proposed changes in more than a dozen specific regulatory requirements that are being evaluated by the Practicing Physicians Advisory Council to Reduce the Medicare Regulatory Burden. HHS Secretary Tommy Thompson created this group to advise him on ways to reduce Medicare hassles.

We have sent several letters to the Senate urging lawmakers to enact a House-passed bill to mandate improvements to Medicare carrier performance, to make the Medicare audit process more fair, and to require Medicare to test alternatives to onerous documentation requirements.

Other issues

What else has the College been working on? We authored a letter, co-signed by dozens of other medical organizations, urging HHS to change the confidentiality rules that are part of the Health Insurance Portability and Accountability Act (HIPAA). The rules would hold physicians liable when business associates acting outside of doctors' direct control unintentionally release privileged information.

We submitted written and oral testimony to an HHS advisory committee on the HIPAA privacy rule, urging legislators to eliminate loopholes that would allow consumer health product marketers to use patients' confidential health information without prior consent to market products. We successfully asked legislators to give physicians more time to comply with HIPAA rules that regulate electronic exchanges of medical information.

The College critiqued model state legislation on emergency quarantines that would give government authorities unprecedented power to restrict patients' movements and seize private health care facilities. We also endorsed a new bill that would allow physicians to negotiate collectively with health plans without breaking antitrust rules.

Numbers don't tell the whole story, but in the past four months alone, we have written 32 letters calling for Medicare policy changes, 15 letters on HIPAA requirements, seven letters on access to care for the uninsured, and 17 letters on reducing or improving government regulations. These are a good indication of the scope of issues the College is addressing, but they are just one part of a multi-faceted advocacy effort that includes lobbying, coalition-building, grassroots advocacy and media relations.

Learning about College activities

As much as we are doing, I want more internists to be aware of the full breadth of our public policy agenda. That's why we have created a new online members-only service, the Public Policy Virtual Library (PPVL).

This service allows ACP-ASIM members to review past and present public policy statements by entering a keyword or topic. For the first time, you can look up any topic and see what the College has been saying about it, the source of the policy, the date the letter or position paper was issued and the document's author.

I realize that even with new resources like the PPVL, some internists will inevitably continue to question the College's effectiveness. But the next time members ask, "What has ACP-ASIM done for me lately?" I hope they'll check out the Public Policy Virtual Library. I think they'll be impressed.

Robert B. Doherty is ACP-ASIM's Senior Vice President for Governmental Affairs and Public Policy.

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