AGA Washington Insider

A policy blog for GIs

A Day on Capitol Hill: Loren Laine Goes to Washington

Loren Laine and Frank PaloneLast week, right before attending our AGA Governing Board meeting in Washington, DC, I spent the day on Capitol Hill. I met with seven representatives and senators, as well as the staff members responsible for health affairs of three other legislators. My goal was to discuss subjects of importance to gastroenterology and gastroenterologists with members of Congress and their staffs, hopefully learning from them, but also having them learn from me about some of our key issues. I was accompanied (and guided) by our extremely able and expert AGA Government Affairs staff members Michael Roberts and Kathleen Teixeira. I wanted to let you know about some of the highlights of my day.

I started the day meeting with the only gastroenterologist in Congress, Rep. Bill Cassidy, R-LA. This was especially enjoyable for me, because I knew Bill when he was a resident and fellow at U.S.C. during my days as a young junior faculty member there. It was nice to reminisce with him about the old days at U.S.C. and Dr. Telfer “Pete” Reynolds, a mentor and pioneer in hepatology, and more importantly, to hear his perspective on issues important to gastroenterology. We first discussed NIH funding, which I think most will agree is critical to preserving the current and future generation of researchers, to improving both the science and practice of gastroenterology, and to maintaining the economic and scientific competitiveness of the U.S. Dr. Cassidy stated that he strongly supports the NIH and its mission, but believes that NIH’s funding should be based on factors including the impact of disease and state of the science rather than which group has the strongest lobby. For example, he pointed out that the NIH provides proportionally far less support for Alzheimer’s than for HIV. Rep. Cassidy was interested to hear about the AGA’s work on the National Commission on Digestive Diseases, which examined the burden of GI diseases in our nation and how they are funded.

We also spoke about the broken Medicare physician payment system and the need for a permanent solution to the sustainable growth rate (SGR) process. This was great timing, because later that morning, Dr. Cassidy chaired a hearing on the sustainable growth rate in Medicare for the Health subcommittee of the House Energy and Commerce Committee. I pointed to the numerous quality initiatives and tools that the AGA has developed over the years to prepare our members for the inevitable arrival of a value-based payment system. The AGA wants gastroenterologists and our professional GI societies to be the ones developing practical, evidence-based quality and performance measures rather than having measures imposed on us by others. Dr. Cassidy was extremely interested in AGA’s work on developing a colonoscopy bundle and pointed to a similar bundle that was developed in Louisiana by the VA. It’s a real asset to have a gastroenterologist in Congress who understands medicine and is working on our behalf.
Loren Laine and Tom Coburn

I also met with Sen. Tom Coburn, R-OK, (pictured right) another physician member. He expressed sentiments similar to Rep. Cassidy’s regarding the NIH and was concerned that Congress dictates to them which diseases they should fund. Sen. Coburn, like most of the legislators I met with, believed that the sequester will occur, but indicated that Congress should provide some flexibility in its implementation to allow funding of essential programs and personnel.

I also talked to Sen. Coburn about the Medicare screening colonoscopy cost-sharing problem. Although the Affordable Care Act (ACA) provided preventive services such as colonoscopy screening at no cost for Medicare beneficiaries, CMS has interpreted the legislation to mean that when a screening colonoscopy becomes “therapeutic” because a polyp is found, the patient’s co-pay is no longer waived. Sen. Coburn, himself a colon cancer survivor, stated that he was sympathetic, but suggested that, in the current period of fiscal constraints, a compromise might be to have the patient responsible for the co-payment on the differential in cost between the screening and therapeutic charges.

My marathon day on the Hill also included meetings with the offices of legislators from Connecticut including Rep. Rosa De Lauro, D-CT, Sen. Richard Blumenthal, D-CT, and Rep. Joe Courtney, D-CT. All of the legislators from Connecticut are strong supporters of NIH funding, especially given the impact funding has on the state of Connecticut. Rep. Courtney is a strong supporter of correcting the Medicare screening colonoscopy cost-sharing problem and was the lead Democratic sponsor of the Removing Barriers to Colorectal Cancer Screening bill. During my visit with Rep. Courtney, we also discussed his recent national fame: he pointed out the inaccuracy of Steven Spielberg’s movie Lincoln, which depicts representatives from Connecticut voting against the 13th amendment.

Loren Laine and Charles DentMy meeting with Rep. Charlie Dent, R-PA, (pictured left) a key moderate in the House who is a member of the Appropriations Committee and serves as the co-chair of the House Biomedical Research Caucus, was very productive. Rep. Dent was co-sponsor of the Removing Barriers to Colorectal Cancer Screening bill, which was introduced last year, and we discussed the potential timing of re-introduction of the bill during this year’s Congressional session. In addition, I introduced the subject of the gut microbiome and its likely great importance in health and a host of GI and other conditions. The AGA and I believe this may be one of the most important research areas in recent history, and have made this a key research and education initiative for our organization. Rep. Dent suggested conducting a congressional briefing to the House Biomedical Research Caucus on this topic and we will follow up with his office to plan the briefing.

I also had a very pleasant meeting with Sen. Tim Johnson, D-SD, who expressed support for the NIH, the VA and an SGR fix. Sen. Johnson mentioned that as the Chair of the Senate Appropriations Subcommittee on Military Construction, VA and Related Agencies, he is extremely supportive of the research that the VA is conducting and can be helpful in ensuring that the VA continues to have the resources necessary to support its mission. I ended my day meeting with Rep. Frank Pallone, D-NJ, (pictured above left) who serves as ranking member of the House Energy and Commerce Health Subcommittee which has jurisdiction over Medicare Part B, NIH and other public health programs. Rep. Pallone is a veteran New Jersey congressman who also has strongly supported the NIH and an SGR fix. He sponsored legislation in the past commemorating the 50th anniversary of the NIDDK. He and his chief of staff also seemed fascinated hearing about the gut microbiome.

All in all, the day was educational for me and hopefully productive for gastroenterology. We made inroads by discussing the AGA’s development of tools for the future of practice, such as quality measures, clinical service lines, and a colonoscopy bundle in the context of the current debate around an SGR fix; we sparked interest in an important area of research, the gut microbiome, which hopefully will lead to a congressional briefing on the topic; and we re-kindled interest in the colonoscopy cost-sharing issue and re-introduction of a bill designed to remedy the problem. I’m hopeful that my visit will help strengthen GI’s voice on Capitol Hill.

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1 Comment

  1. As a funded state with CDC’s Colorectal Cancer Prevention Program and as the Program Manager of the FITWAY Alabama Colorectal Cancer Prevention Program, I am searching for information about how the ACA and the resolution of the Medicare screening colonoscopy cost-sharing problem will be further interpreted for positive fecal immunochemical tests that require a diagnostic colonoscopy. Our goal is to increase screening rates to 80% by advocating and educating for screening according to the USPSTF screening guidelines. For a rural state with larger portions of underinsured and uninsured, that is not expanding Medicaid, we need information about diagnostic colonoscopy cost sharing for patients whose first test is a FIT/iFOBT/HSguaiac. Can you speak to this?

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