This past week I had the pleasure of spending some time in our Nation’s capital. I say pleasure, but this was not a journey to visit the museums and, of course, the cherry blossoms vanished many months ago. The principal purpose of my visit was to spend time on Capitol Hill discussing the potential devastation that the recently proposed 12% cut to dialysis payments would have upon patients with dialysis-dependent renal failure. How we got here is beyond my understanding (and those who do understand tell me it would be difficult to convey in a blog post). Suffice it to say the magnitude of this cut caught a well-informed renal community off guard.
The community responds
The renal community, which includes patients, providers and vendors involved in the delivery of care to this vulnerable patient population, has responded with a vigorous effort to convince CMS of the direct and collateral damage that will ensue should such a Draconian cut occur. A small but important part of that effort includes convincing members of Congress that CMS has gone a bit too far. My trip to Washington, DC, was part of this effort.
For those of you who have not been involved in such endeavors, I’d like to provide a peek inside this process from my vantage point. This was not my first opportunity to participate in direct advocacy efforts, but each time I do so, I am impressed at the remarkable complexity of this important process, which lurks beneath the hood of our democracy.
“Targets”
As I am sure you recall from your government civics class, there are 100 Senators and 435 congressional members of the House of Representatives. One might imagine the place to start is with your specific member of the House and your two Senators. While this is true in many instances, all members of Congress are not created equal. There are important committees in both bodies of the Legislative Branch of our government that exert control over a variety of issues. Advocating for change with a member of the Committee on Transportation and Infrastructure, for example, is less likely to return dividends for a Medicare issue than spending the same amount of time with someone on the House Committee on Ways & Means.
Gaining entry
Orchestrating your visit requires quite a bit of advanced planning. While anyone can enter the buildings where the offices of the Congressional representatives are housed (make sure to bring your ID if you wish to knock on the door of one of your Senators’ offices), these folks are very busy. You need to have an appointment and your appointment needs to be with the appropriate individual in that member’s office.
Congressional staffers
When I first made this journey some years ago, I was Chief of Medicine at our local hospital. The Chief of Staff, hospital CEO and I hopped into a very small plane and, dressed to the nines, made our way to DC. Somewhat naively, I was under the impression that we would come face to face with our two Senators and our member of the House. Imagine my surprise when I discovered our audience that day consisted of Congressional staffers in their 20’s, dressed in golf shirts and slacks (as Congress was not even in session). The eye opener for me is just how important these folks are. They serve as very well-informed intermediaries, if you will, and often have specific areas of expertise. I have made a few of these trips since then, and while I have had the opportunity to speak directly with a member of Congress, let me assure you, such opportunities are not common.
10-minute pitch
In addition to gauging expectations about whom you’ll be talking with, you’ll need to meet the expectation to clearly articulate your position in a very short period of time. You and I bandy about all sorts of renal-related jargon, which is part of our daily lexicon. You need to check that language at the door. Do not assume the folks sitting (or standing as the case may be) across from you know what ESRD, ESCO or even hemodialysis means. In addition to a simple message, make sure you can effectively deliver it in a brief period of time. We had several visits that day, including a few that occurred while standing in a hallway. I think the longest conversation lasted 15 minutes. For each of our visits, a folder containing information of specific interest, not only to the issue at hand, but more specifically identifying the potential impact upon the particular member’s district. This material serves as a future reference for the folks on the receiving end of the 10-minute pitch.
It takes a team
At the end of the day we were able to see and speak with a large number of folks on the Hill. If the above discourse has left one point unclear, let me emphasize the importance of the infrastructure and resources necessary to coordinate these visits. Getting in front of members of Congress is only one part of an effective advocacy program. Bottom line, it takes a dedicated team, and that team needs not only the assistance of people in the field, but appropriate financial resources as well. Advocacy—whether expressed through an email, a personal visit to a member of Congress or financial contributions to a Political Action Committee—is an extremely important cog in the wheel of progress. Without it, one’s interests are significantly disadvantaged within the context of our government.
Do you have experience or perspective to share about advocacy? If so, drop us a comment and join the conversation.
RG says
Interesting. I always wondered how all of that worked. Here is a question for you. Our new doc starts on Nov 1, 2013. She attested for her old practice in 2012 (90 day, program year 1). She has not registered for program year two yet with her current practice. We are thinking it is too much trouble to combine numerators and denominators from two practices. Thus, we would like to start fresh on Jan 1, 2014 for this new physician. How would this work since she “skipped” a year and did not attest? Are we at stage 2 criteria now? Or, are we still at stage 1 criteria? Is there a change in the incentive amount for skipping a year? I like the idea of having her not attest for 2013 because her old practice may not have the compliance program that we have. (Also, I found the FAQ question on the CMS website that addresses this. It is question number 3609. You can search by question number, and voila! Enjoy M.U. enthusiasts). Thanks in advance for helping us sort out this question.
Terry Ketchersid, Vice President and Medical Officer at HITSG says
Thanks for the comment RG. Our Nation’s capitol is certainly an interesting place. The news for your new doc is not so good. Assuming she is taking the Medicare path to certification, 2014 will be considered year 3 for her. By starting in 2012, in year 3 she will face the Stage 2 objectives. As she is “skipping” year 2, her incentive in 2014 will be $8,000 (she will miss out on the $12,000 year 2 incentive). If there is a silver lining it is the fact that in 2014 she will only report the MU objectives for a calendar quarter (or her choosing) and will not be required to report the entire calendar year. One other bit of bad news is the penalty she will face in 2015. If she does not attest in 2013 and if she does not qualify for a hardhsip exception she will face a 1.0% penalty in 2015. Take a close look at the recent hardship exception post to determine if she meets one of these.