GIs In and Out of Congress Advocate for Fair Payment
Several weeks ago, I participated in the Alliance of Specialty Medicine’s annual legislative conference and attended on behalf of the AGA. It had been a few years since I had attended, and I was impressed with the number of members of Congress who came to address us. Rep. Tom Price, MD, R-GA; Sen. Rand Paul, MD, R-KY; Rep. Raul Ruiz, MD, D-CA; Rep. Michael Burgess, MD, R-TX; and other physician members of Congress spoke of the need to find legislative solutions that are evidence-based. All shared a common theme ― physicians and patients should be making informed decisions regarding their health care, not the federal government.
As in past years, the issue of reforming the Medicare physician payment system was a top priority of the members of Congress and the alliance. Everyone agreed that the payment system is broken, that we need to change the way that physicians are paid, and that payment should be more incentive and value-based. But how do we do that? How can physicians who have been practicing in a fee-for-service model be accommodated in the newer payment models?
During my visit to Washington, DC, I was fortunate enough to meet personally with Rep. Bill Cassidy, MD, R-LA. I have known Dr. Cassidy for almost three decades, dating back to when I was a GI fellow and he was a resident at LA County — USC Medical Center. Rep. Cassidy is a hepatologist who still sees patients at LSU—Baton Rouge, and he understands these complex issues from both a clinical and policy perspective.
I met with Rep. Cassidy to discuss several of the quality improvement initiatives that the AGA has undertaken in the past few years to help our members survive and thrive in the changing health-care landscape. I discussed the AGA’s work on bundled payment for screening colonoscopy to improve patient outcomes, a concept that Dr. Cassidy is very familiar with and very supportive of. He spoke of his legislative initiative, the Small Group Practice Preservation Act, which he wants to include in a larger SGR reform package to ensure that small group practices are able to participate in shared savings models. Dr. Cassidy and I discussed that nearly 40 percent of GIs practice in groups of one to five physicians, a statistic that he has used to advocate for his initiative since new payment models must be applicable to small practices to protect their viability and ensure patient access, especially in rural communities.
After our meeting, I had the opportunity to follow up with Dr. Cassidy and his staff on his proposal and offered some comments and concerns regarding how this proposal would work for GI. I was pleased that I received answers to my questions from Rep. Cassidy himself via email. I’m not sure how many members of Congress actually give out their personal email addresses, much less are able to understand double sided risk and attribution, but it was refreshing working with a Congressman who truly does get it.
Equally important, I was able to meet with Brett Baker, staff of the Ways and Means Health Subcommittee, about Medicare payment reform and share some of AGA’s initiatives. Mr. Baker, the staff member responsible for SGR reform, is someone with whom the AGA worked closely when he worked on regulatory issues for the ACP. We discussed the bundled payment concept with Mr. Baker, who noted that a colonoscopy bundle could be designed to pay physicians for the E/M visit prior to a screening colonoscopy and how this initiative could fit into the version of payment reform that they are crafting. It was a pleasure to meet with informed staff who understand the complexities of the physician fee schedule.
I also had the pleasure of speaking with Sen. Ron Wyden, D-OR, a senior member of the Senate Finance Committee who is equally knowledgeable on Medicare reform issues and has introduced legislation, the Medicare Better Health Rewards Program, to encourage seniors to get and stay healthy by providing shared savings to them if they make improvements in six key areas of health: tobacco usage, body mass index, diabetes indicators, blood pressure, cholesterol, and up-to-date vaccinations and screenings. Sen. Wyden introduced this bill with Sen. Rob Portman, R-OH, and spoke of the importance of working collaboratively in a bipartisan manner. I was able to share with Sen. Wyden some of AGA’s initiatives around colorectal cancer screening, obesity and quality improvement and to thank him for his support of our specialty given his sponsorship of the ASC Quality and Access Act (S. 1137).
All in all, it was a hectic two days, yet a successful trip to Washington. I was pleased to convey to lawmakers the investments that AGA has developed over the years to help our members transition to new payment models that will improve patient outcomes. I hope that the next time I am advocating on behalf of my colleagues and my profession, the SGR is truly behind us and that we can speak to our lawmakers about other issues aside from payment.