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ACP’s Washington office reviews its own ‘seven days in May’

From the July/August ACP Internist, copyright © 2013 by the American College of Physicians

By Robert B. Doherty

ACP members sometimes ask me what ACP’s Washington office actually does. They have a vague idea that we are lobbying on their behalf but are unsure of what that really means.

One recent week provides a great example of the Washington office’s efforts to support College advocacy. Our own “seven days in May” (not counting the weekend!) may not measure up to the intrigue of the classic 1960s novel and movie about an attempted U.S. military coup—we weren’t trying to overthrow the government, just influence it—but our week had its own share of drama.

May 20

On Monday, the College’s Health and Public Policy Committee met to make recommendations to the Board of Regents on three provocative public policy issues.

The first discussion reviewed the causes of and potential solutions to firearms violence. The committee had a spirited discussion of studies, summarized by the Washington policy staff, on the relationship between firearms ownership and preventable injuries and deaths, especially when children, the mentally ill, and persons with substance and alcohol abuse problems are present in the home; on the effectiveness of banning assault weapons and high-capacity magazines; and on universal background checks. ACP staff will next create a policy paper for the Regents to review later this year.

The second discussion reviewed immigration reform legislation that would create a pathway to legal residency and citizenship. The committee, working from a 2011 ACP position paper on national immigration policy and access to health care, guided the Washington office regarding ACP’s position on proposals that would restrict undocumented persons’ access to health care services and benefits as they move toward permanent legal residency.

The third discussion involved final approval of a position paper, drafted by ACP staff on the committee’s behalf, about the roles of physicians, nurse practitioners and other clinicians in delivering team-based care. The paper, which the Board of Regents will review in July, will recommend policies that are intended to help create good working relationships among all clinicians involved in the care of patients.

May 20-21

On Tuesday, some 350 internist and medical student members from 47 states, the District of Columbia and Puerto Rico came to the College’s annual Leadership Day on Capitol Hill. They were briefed by ACP staff, administration officials, congressional staff and two physician members of Congress on the current political environment as it affects health care issues. On Wednesday, they pressed lawmakers to support the College’s four top legislative priorities: repealing the Medicare sustainable growth rate (SGR) formula, replacing “sequestration” cuts to critical health programs with responsible alternatives to achieve savings, protecting and reforming graduate medical education payments and enacting legislation to fund a pilot test of no-fault “health courts” to consider malpractice claims as an alternative to jury trials. Throughout the day, they met with ACP staff lobbyists to report on the results of their visits.

May 23

On Thursday, ACP’s Medical Practice and Quality Committee (MPQC), which shares responsibility for policy development with the Health and Public Policy Committee but with a special focus on payment and regulatory issues, met to provide policy direction on several ongoing issues as well as discuss an urgent request from lawmakers to consider a new proposal to repeal the Medicare SGR formula.

The committee discussed ideas for improving Medicare payments for internists’ services, including new codes and relative value units for coordination of care for patients with chronic illnesses. They discussed a proposed framework, developed by the Washington policy staff, for identifying administrative requirements and other hassles that undermine the patient-physician relationship and contribute to physician burnout. This initial discussion is the first step in developing proposed policies, which will be considered in more depth by the committee later this year, to reduce unnecessary administrative tasks.

The most urgent issue considered by the committee, though, was a bipartisan request from the U.S. Senate Finance Committee for ACP’s views on a proposal to repeal the Medicare SGR and reform physician payments. The College was asked to provide the senators with specific recommendations, no later than May 31, to improve the accuracy of Medicare’s relative value units, to reduce overutilization in the fee-for-service system and to enable physicians to transition to new models based on the value of care provided. The committee reviewed a paper, developed by its policy staff, which proposed options that would serve as the basis of the College’s response to the senators.

May 24-29

Over the next several days, with some needed time off for the Memorial Day weekend, ACP staff drafted a detailed letter to the Senate Finance Committee to help the senators develop the SGR repeal legislation, based on the MPQC discussion, and considered a new request from the House Energy and Commerce Committee for the College’s views on its own draft bill, released May 28, which has a similar goal of repealing the Medicare SGR formula and transitioning to value-based payments. Staff also followed up on the intelligence gathered from the Leadership Day visits to lawmakers in support of ACP’s priorities.

Not every week, of course, includes two policy committee meetings, congressional visits by hundreds of ACP members, and two urgent congressional requests for ACP input on major legislation. But our seven days in May illustrate the breadth of what ACP’s Washington office does to advance the College’s advocacy agenda.

We help inform policy. We then help get that policy accepted by Congress and federal officials. Above all, we share the ACP physician leadership’s fierce commitment to making American health care as good as it can possibly be.

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