Mangla Gulati, MD, FACP, FHM, an academic hospitalist and medical director of clinical effectiveness at University of Maryland Medical Center in Baltimore, had never been involved in a lobbying trip before the waning days of last year. But then, just as members of Congress were wrestling with potential Draconian cuts to Medicare reimbursements and a $10 million slash in Medicare funding for the National Quality Forum (NQF), Dr. Gulati found herself on a daylong trip with SHM government guru Laura Allendorf and an NQF representative to make a series of in-person appeals to politicians in Washington, D.C. “When you’re a practicing physician, even though you know there’s regulation and compliance and mandates, you really don’t understand how they come to fruition and what the thought process is,” says Dr. Gulati, secretary of SHM’s Maryland chapter. “It was really interesting to see the other side of that and how people up on the Hill make a lot of decisions based on the information that’s given to them.”
The Hill she’s referring to is none other than Capitol Hill, and Dr. Gulati is making a return just a few months after her visit. And this time, she’s bringing a few hundred hospitalists with her. Hospitalists on the Hill 2013 (www.hospitalmedicine 2013.org/advocacy) is the annual trek made by SHM leadership and rank-and-file members to lobby legislators and federal staffers “on the way policies affect your practice and your patients,” SHM says on its website. This year, the showing in Washington is expected to be among the best ever, as the lobbying trip is May 16, just before HM13’s full program kicks off at the Gaylord National Resort & Convention Center in National Harbor, Md.
The all-day affair kicks off in the morning, as participants will receive briefings from SHM Public Policy Committee Chair Ron Greeno, MD, FCCP, MHM, and Allendorf, SHM’s senior advisor for advocacy and government affairs. Then comes a two-hour training course from Advocacy Associates (http://advocacyassociates.com), a boutique communications firm that helps organizations, such as SHM, tailor their message to policymakers. After that, it’s a six-hour whirlwind of meetings with home-state legislators, career administrators, and aide-de-camps that one former participant described as “almost like speed-dial dating with congressmen and -women.” Lastly, participants regroup at day’s end for a debriefing.
“I think what’s different at SHM is we go to Washington with an agenda of how we can improve patient safety and quality outcomes,” says Patrick Torcson, MD, MMM, FACP, SFHM, chair of SHM’s Performance Measurement and Reporting Committee. “We’re not there about just protecting our turf and making sure that our reimbursement stays at a reasonable level. We’ve been very clear to offer innovations about care transitions and Project BOOST, and different things that can be done to improve things like quality and service for Medicare beneficiaries.”
Dr. Torcson says congressional contacts he’s made in past years “always look forward to our visits, because we really do come with an attitude of how can we help fix a broken system.”
He counts several victories as fruit of the annual trip. First, he believes the trip has “clearly educated our politicians, congressional staffers, and CMS [the Centers for Medicare & Medicaid Services] that the predominant model of the way patients are taken care of in the hospital is by a hospitalist.”
Second, and more granularly, SHM really gets into the weeds. Take CMS’ Quality and Resource Use Report (QRUR), which is part of the rollout of its value-based purchasing modifier (VBPM). Dr. Torcson says SHM carefully reviewed the report to register its concerns about proper attribution, fair comparisons, relevant metrics, and other issues. In turn, CMS signaled its appreciation of SHM’s due diligence and has indicated a willingness to work with SHM to address its concerns.
CMS chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM, sees it from both sides of the equation. A pediatric hospitalist by training, he has been on trips to push federal officials to promulgate rules that make the most sense for HM. But in his current job, he’s often the one being pushed—and he welcomes the visits.
“We’re trying to partner up with physicians,” he says.
Dr. Conway believes lobbying trips like SHM’s are critical to informing both politicians and professionals on what physicians need or want most.
“People often think, ‘How could it matter?’ Sure, some of it will be hits and misses. But you’ll hit some key points that resonate,” he says.
Hospitalist Rick Hilger, MD, SFHM, director of resident education and adjunct associate professor of medicine at the University of Minnesota Medical School in Minneapolis, learned that lesson last year during his first Hospitalists on the Hill. A first-time member of SHM’s Public Policy Committee, he met with the legislative assistants for U.S. Sens.
Al Franken (D-Minn.) and Amy Klobuchar (D-Minn.), as well as had a face-to-face meeting with U.S. Rep. Allyson Schwartz (D-Pa.). The latter has been a staunch advocate of Medicare payment reform, sponsoring several bills—with SHM’s support—to repeal the sustainable growth rate (SGR) formula.
“It’s an investment in time, and especially for the senators and congressmen and -women from your own state, it’s more about trying to develop a relationship,” Dr. Hilger says. “I’ve already exchanged emails with the aides that I met that day concerning other healthcare issues. … I’m not sure I can completely answer for the long-term impact, but it definitely feels better than doing nothing.”
Richard Quinn is a freelance writer in New Jersey.