AGA Washington Insider

A policy blog for GIs

GIs: “Be at the Table Or…Be On the Menu”

I recently participated in the Alliance of Specialty Medicine’s annual legislative conference, which was a great meeting on “the hill.” As a member of the AGA’s Public Policy & Advocacy Committee, I was invited to attend the alliance’s conference and thankfully made time in my schedule to attend. The alliance, of which AGA is an active member, is comprised of 13 medical specialty societies that collaborate on common public policy goals and priorities.

I’ve never considered making such a trip and, frankly, never considered giving up three days of patient or family time for such a thing. But, I am so glad that I did, as I felt as though I was advocating not only for my fellow gastroenterologists, but for my profession as a whole. Here are a few highlights and reflections:

  1. Our leaders in DC are very clear about two things. First, there really isn’t great logic when it comes to health-care legislation. Second, if we as physicians aren’t sitting at the table, decisions will be made for us. After hearing several of our representatives on both sides of the aisle, there is a clear call for physician involvement.
  2. As a rookie on the hill, it is quite intimidating to meet with legislative aids, our Representatives and Senators. That being said, one quickly realizes that they are human too and interested in hearing physicians out. Rep. Michael Coffman, R-CO, spent time with Dr. Larry Kim and me on Tuesday afternoon and demonstrated interest in hearing our front-line experiences in hospitals (VA, academic and private). He is new to VA issues, as he is a member of the Veterans’ Affairs Committee, and clearly he is struck by the inefficiencies in the VA health-care system.
  3. Health-care reform is complex. Identifying the problems is somewhat easy. I bet 90 percent of physicians can rattle off five problems in health care. The real issue is finding solutions that fit the needs of a diverse patient population and health-care delivery system. I encourage anyone to sit down and start mapping a plan.
  4. Sen. Rand Paul, R-KY, is clearly interested in generating competition in health care. As you may know, he is an ophthalmologist and saw how competitive pricing for Lasix procedures eventually drove down the cost.
  5. Sen. Roy Blunt, R-MO, voiced his concerns about the pace at which change is being implemented. Both moving too fast or too slow is dangerous. The right speed may never be reached.
  6. Rep. Kevin Brady, R-TX, who chairs the Ways and Means Health Subcommittee, which has jurisdiction over Medicare, stressed that members of Congress hear from every interest group out there and that “someone is telling your story. Don’t you want to be the one? There is no better messenger than you.”
  7. Rep. Raul Ruiz, D-CA, is a freshman member of Congress who is also an emergency physician. He voiced concerns over Medicaid expansion, specifically in that it involves expanding a system in which there are already physicians who are not accepting Medicaid or Medicare. He represents the Coachella Valley in California, which already has a severe physician shortage, and is concerned about the impact of access to providers.
  8. Rep. Bill Cassidy, R-LA, is a hepatologist and a staunch advocate for our profession. This guy gets it! He understands the risk of “clickin” away to meet quality/meaningful use, while omitting the most important issue, i.e., the patient. He stressed the importance of putting the patient first and building models of care surrounding the patient. We also had a one-on-one meeting with Rep. Cassidy earlier in the day and Dr. Joel Brill did a knock-out job presenting the concerns of the AGA and reviewing our efforts at developing our own quality registry.

All in all, the alliance meeting was a success and it stressed the need for physicians to be involved in the legislative process. More and more decisions are being made in Washington that impact our practices, our patients and our bottom lines. As they say, physicians must be at the table or we’ll be on the menu.

To learn more about how you can get involved, contact Navneet Buttar, AGA government and political affairs manager, at

Dr. Carreira is pictured above with Dr. Joel Brill and Sen. Ron Wyden, D-OR, member of the Senate Finance Committee and  lead sponsor of the ASC Quality and Access Act.


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