‘Hill Trip’ Connects Legislators to Hospitalists, Health Care Issues


New York City hospitalist Dahlia Rizk (left) speaks to legislative staffers in D.C.

A veritable perfect storm of relationships brought hospitalist Jairy Hunter, MD, MBA, SFHM, to “Hospitalists on the Hill 2013,” a daylong advocacy affair that preceded HM13 last month.

First, Dr. Hunter was born and bred—and now lives—in South Carolina, a close-knit state where leaders across industries tend to run in the same circles, or at least have relatives who do. Second, Dr. Hunter’s father, Jairy Hunter Jr., is the longtime president of Charleston Southern University, where Sen. Tim Scott (R-S.C.) earned his undergraduate degree when it was still called Baptist College at Charleston. And three, Dr. Hunter is associate executive medical director of one of the state’s flagship health-care institutions, Medical University of South Carolina in Charleston.

So it was that SHM set Dr. Hunter up in meetings with the offices of Scott, Sen. Lindsey Graham (R-S.C.), and Rep. Jim Clyburn (D-S.C.), and—for the day at least—made Dr. Hunter the voice of hospital medicine.

“It was a little bit demystifying of an experience to be able to know there’s actually people you can talk to and you can develop a relationship with,” says Dr. Hunter, who also serves on Team Hospitalist. “I thought that was very rewarding.”

The connections made by Dr. Hunter are the point of the annual trek made by SHM leaders and members to lobby legislators and federal staffers “on the way policies affect your practice and your patients,” SHM says on its website (www.hospitalmedicine.org/advocacy). This year’s volunteer effort was by far the largest ever, says Public Policy Committee chair Ron Greeno, MD, FCCP, MHM. More than 150 hospitalists participated in training, 113 hospitalists visited Capitol Hill, and scores more had to be turned away. All told, hospitalists held 409 individual meetings with legislators and staff members.

“Quite frankly, if we’d have had the budget, we could have had another 100 to 150 people come,” Dr. Greeno says. “That’s how many people wanted to go.”

Dr. Greeno attributes the interest to two factors. One, having the annual meeting at the Gaylord National Resort & Convention Center, just outside Washington, D.C, makes the Hill trip a natural extension. Two, the current landscape of health-care reform has motivated many physicians to become more involved than they might otherwise be. One challenge of having so many first-timers making this year’s trip was making sure they were properly prepared. To hone the message, SHM gave the group a few hours of education by former legislative staffer Stephanie Vance of Advocacy Associates, a communications firm that helps organizations, such as medical societies, tailor their message to policymakers. Vance told hospitalists a personal visit with a constituent often becomes the most influential type of advocacy.

“That’s why it was easy to make an initial connection, because these staffers are from where I’m from, friends with people that I’m friends with,” Dr. Hunter says.

Hospitalist Jack Percelay (center) discusses issues during HM13’s Hill trip.

Unique Approach

SHM CEO Larry Wellikson, MD, SFHM, says the society tries to differentiate itself from other organizations through its grassroots approach to advocacy. More important, the society refrains from giving a long list of legislative requests that are self-serving.

“We’re someone they want to talk to because we’re not coming there to just say, ‘Here’s a power play for hospitalists,’” Dr. Wellikson says. “We come and try to provide solutions.”

To that end, this year’s lobbying effort was targeted to topics important both to HM and the health-care system:

  • Repealing the sustainable growth rate (SGR) formula for Medicare payments, specifically via the proposed Medicare Physician Payment Innovation Act of 2013 (H.R. 574);
  • Solving the quagmire of observation status time not counting toward the required three consecutive overnights as an inpatient needed to qualify for Medicare benefits at a skilled nursing facility, by supporting the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569); and
  • Getting the federal government to commit to providing $434 million in funding for the Agency for Healthcare Research and Quality (AHRQ) in fiscal 2014.

“The message that we’re sending resonated with the people we met with on both sides of the aisle,” Dr. Greeno says. “The SGR, for instance, they know there needs to be a fix. We want to serve as a resource for them as they start to figure out the answer to the question: What are we going to replace it with?

“What we want to do is make everybody on the Hill understand that we can be relied upon as a resource when they’re looking for solutions,” he says.

Focused on Follow-Up

And that’s where rank-and-filers, such as Dr. Hunter, have to take charge. So for his Hill Day visits, he tried to stand out. Everyone he met with got a lapel pin in the shape of a South Carolina state flag, which has become a popular fashion statement in recent years. And Scott also got a pin from Charleston Southern University, his alma mater. The gestures were small, but they served as icebreakers and reminders that Dr. Hunter and the people he met are bound by service to the residents of the Palmetto State.

Dr. Hunter also hopes the small token will be that little extra that makes him memorable enough that the next time a Congressional staffer has an SGR question, they’ll ask him and not a doctor from another specialty.

“I’m interested to see how much feedback I get back from them,” he says. “I can feed them all day long, but I don’t want to be that crazy guy bugging them. If they respond back to me, I can hopefully make more inroads.”

He certainly would if Dr. Greeno gets his way. Moving forward, SHM hopes to be able to rely more on local advocates pushing for reform than just a once-a-year major event and formal positions drafted by SHM’s staffers or the Public Policy Committee. Dr. Greeno says the physicians who participated in this year’s Hill trip are likely to find they will be asked to be the first cohort of a grassroots initiative meant to deliver the society’s message more routinely.

“These are not easy things to change because there are not easy solutions,” Dr. Greeno adds. “If you have just one meeting on the Hill, you’ll have no impact at all. You have to follow up. You have to do it consistently. And you have to have a consistent message. And we will.”

Richard Quinn is a freelance writer in New Jersey.

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