MSMA Advocacy Training Federal Advocacy and Lobbying on a National Level David Barbe, MD MHA...

MSMA Advocacy Training

Federal Advocacy andLobbying on a National Level

David Barbe, MD MHAChair-elect, Board of TrusteesAmerican Medical AssociationMSMA Vice Councilor 9th DistrictJanuary 19, 2013

© 2012 American Medical Association. All rights reserved.

The AMA – A Unifying Voice for Physicians• 186 state, specialty and sub-specialty societies

– the voice of >650,000 physicians• Multiple life-cycle stages – student, resident,

young physician, mature physician, retired• Multiple practice settings – independent solo,

small group, large group, employed, integrated group practices, academic

• No other organization is better positioned to unify – and advocate for physicians, the profession, and our patients


AMA Reach: The AMA Equation

33

House of Delegates

Members PracticeTools

Research & Education Advocacy

AMA

Voice of physician

organizations

Direct personal

engagement

Expertisein managing

practice

Career,clinical, and

practice enhancement

Authoritativeadvocate forphysicians in

Washington, inthe courts, and to

the public


AMA – Our People

• Membership – >220,000 students, residents and physicians, > 3% increase in 2012

• House of Delegates – 520 state and specialty society representatives

• Board of Trustees – 21 members– 3 Presidents– Speaker and Vice-Speaker House of Delegates– Student, Resident, Young Physician– 12 At large members– One public member

• AMA management – James Madara, MD CEO


What unites us

• Our diversity – our strength, our challenge• Most issues in common

– Medicare payment / SGR reform– Medical liability reform– Payment and delivery system reform– Scope of practice– Regulatory and administrative burdens

• Most others if not in common, not in conflict• Reframe the issues and reject the forces that

threaten to divide us

The 2013 Federal Landscape


The 112th Congress

• Recap:– Least productive Congress in U.S. history

• About 220 Acts of Congress signed into law– 104th Congress produced 333 new laws

• 33 House votes on ACA repeal• No budget passed• US credit rating downgraded• Economic recovery slowed• Missed deadlines and opportunities


2012 highlights

• Medicare payment and delivery reform:– Improved framework for developing Medicare shared

savings programs (ACOs and others)– Preserved physician favorable parts of ACA– Proposed concepts for transition to new Medicare

physician payment system– Reshaped dialogue – physicians as part of solution

• Administrative burdens eased:– eRx requirements, EHR Meaningful Use rules,

PECOS enrollment burdens, PQRS and Physician Compare web site improvements, ICD-10 delay


Avoiding the fiscal cliff• Physician provisions:

– Extended 2012 Medicare payment rates through Dec. 31, 2013 (stopped 26.5% cut)

– Extended 1.0 GPCI “floor” on work RVUs

– Deferred 2% sequester for Medicare (larger cut in other health programs) for 2 months

– Expanded quality reporting programs to include clinical data registries

– Called on HHS to develop strategies for timely, confidential quality data feedback to physicians

H.R. 8The “American Taxpayer Relief Act” Signed into law Jan. 2


The fiscal cliff, continued

• Budget offsets did not:– Eliminate enhanced Medicaid payments for primary

care services– Eliminate the ACA prevention fund– Eliminate physician in-office exemption for imaging

services– Impose new penalty programs

• Health provisions totaled about $30 billion– Higher utilization assumptions for advanced imaging

services offset accounts for $300 million– Hospitals absorbed about half the offsets

• E&M payment rate cuts in HOPDs avoided


The 113th Congress

• New members: 84 in House, 14 in Senate

• 90% running for re-election returned

• More diverse membership

• Still relatively old (58 in House, 61 in Senate)

© 2012 American Medical Association. All rights reserved.12

2012 House Elections

158 19

2

2013 House of Representatives By Party ID

2012 House of RepresentativesBy Party ID

28

190

240

218 seats needed for a majority

2012 = 242 R - 193 D

2013 = 233 R - 200 D196 233

GOP Maintains Control

218 seats needed for a majority


2012 Senate Elections

13

2012 SenateBy Party ID

2013 SenateBy Party ID

5147

2 Independents

84 5 10

1 5

30 37

2012 = 53 D – 47 R

2013 = 55 D – 45 R

Democrats gain seats/retain majority, but GOP retains filibuster leverage

45532 Independents


The 113th Congress

• Physicians in Congress – unchanged at 20

• Physicians in House– 4 Democrats– 13 Republicans

• Physicians in Senate– 3 Republicans


AMPAC and the 2012 Elections• In all, AMPAC invested over $3.1 Million in the 2012 cycle.• More than $1.8 Million contributed to physician-friendly

candidates for U.S. House and Senate from both political parties.

• 12 AMA-hosted fundraisers and meet-and-greets for supported candidates.

• AMPAC contributions created more than 365 opportunities for lobbyists to attend events with key Members of Congress in Washington, D.C. in addition to hundreds more around the country for physicians and state medical society staff.

• Partisan Communications mail program delivers over 100,000 mail pieces to physicians in support of 66 House candidates and 9 Senate candidates, specially identified as important allies for medicine.


The road ahead

• February 2013:– Obama budget proposal for 2014 released– Two month sequester delay expires– Debt limit ceiling will be reached– Expiration of continuing resolution for 2013 funding

imminent• Coverage provisions of ACA imminent

– Expect new regulations, oversight hearings• Focus on deficit reduction:

– Time to address spending (vs. taxation) side of the deficit equation

– Entitlement reform will be part of the conversation


Entitlement reform must include physician payment reform

SGR patches: 15 since 5.4% cut

Average update: 0.3% per year

Inflation/ update gap: 20% since 2001

Combined patch costs: $92.6 billion

10-year freeze cost: $271 billion (July)

Total physician spending: $67.3 billion (2011)

SGR Facts


Key elements of AMA transition payment proposal• Multi year period of stability• Positive incentives for participation in new

models– Incentives scaled to “accountability”

• New models can be developed and administered in private sector– Better fit across specialties, communities

• Transition can be gradual (e.g., one procedure or condition)


Federal legislative and regulatory priorities for 2013

• Advance Medicare physician payment reform– Continue easing regulatory burdens, stabilize

payment rates, align quality improvement/ reporting programs

• Maintain federal support for key health programs– Graduate Med Ed grassroots campaign

• Address public health concerns– Advance AMA health outcomes strategy– Address drug diversion/ opioid abuse, drug shortages– Support violence prevention, mental health, veterans’

issues


AMA – Broad scope of issues• ACA

– IPAB repeal or reform– Modify “Anti-discrimination” provisions– Modify Cost/Quality/Value Index– Physician Hospital Ownership options– Allow HSA / High-deductible health plans

• SGR fix / Medicare Physician Payment • Medicare Patient Empowerment Act• ICD-10 repeal or delay• Medical Liability Reform


We Need Your Help• Use our template to email your

Congressmen

• Use our toll-free number to call them

• Encourage your patients to get involved

• Access variety of advocacy materials

www.ama-assn.org/grassroots

www.patientsactionnetwork.org

1-800-833-6354

www.ama-assn.org/go/medicarepaymentSelect “Medicare Physician Payment Advocacy Documents”


Tips on Lobbying

• Relationships develop over time– Be persistent and be patient

• Influence increases over time– Relationships not transactions

• Contributions help – but NOT on government property!– Go through campaign org – candidate will

know


Tips on Lobbying

• Schedule time for Hill visit / in district visit– Both are important and relate to #1 and #2

• Don’t overstay your welcome– Schedules are tight, respect their time

• Meet with legislative health aide if legislator not available– Can be as effective in discussion of issues


Tips on Lobbying

• Legislator deserves and expects respect– Even when you disagree, do so agreeably

• Never threaten

• Do not be too familiar, unless you are– First name ONLY when your relationship

justifies it– You are ‘doctor’, they deserve similar

recognition of their role / rank


Tips on Lobbying

• When presenting your issues:– Make case clearly, know the facts– Explain positive and/or negative impact –

problems it corrects or that it creates– Use stories / examples, make it personal– Leave fact sheets / materials, when

possible

• Always follow up with email or fax


Get Involved!

• National Advocacy Conference

• Grand Hyatt, Wash DC

• February 11-13

• Hill visits – see Pat Mills

http://www.ama-assn.org/go/nac


The AMA is working on your behalf.

Great changes equal great opportunity.

Medicine needs a collective voice – we need yours.

Join the AMA!


Thank you ! !

Happy New Year!

Discussion…David Barbe, MD MHAChair-electAMA Board of Trustees

MSMA Advocacy Training Federal Advocacy and Lobbying on a National Level David Barbe, MD MHA...

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