Effective Advocacy for Hospice and Palliative Care Providers

1. Effective Advocacy for Hospice and Palliative Care Providers Judi Buckalew, BSN, MPH Principal & Director of Legislation & Policy Powers Pyles Sutter & Verville, P.C. AAHPM/HPNA Annual Assembly February 15, 2007 Powers Pyles Sutter & Verville, P.C.

2. It’s Been Awhile Since Civics Class. Founding Fathers Created A “Bicameral” Congress • United States House of Representatives • United States Senate Founding Fathers Envisioned A “Three-Legged Stool” To Balance the Power of Government • Congress • White House and Administration • Supreme Court and Court System Powers Pyles Sutter & Verville, P.C.

3. Roles of Congress • Work with White House/Administration to govern • Provide Oversight of the Federal Government • Create laws • Amend laws • Serve constituent needs • Pass Appropriation bills every year to fund the Federal Government • Approve Federal Judges and Political Appointees Powers Pyles Sutter & Verville, P.C.

4. Legislative Process: • Bill introduced in House and/or Senate • Bill referred to House and/or Senate Committee • Bill referred to House and/or Senate Subcommittee • Hearings held by House and/or Senate Subcommittee – Bill approved or defeated • Bill approved by House and/or Senate Subcommittee – referred back to Full Committee • Hearing held by Full House or Senate Committee and bill passed or defeated Powers Pyles Sutter & Verville, P.C.

5. Legislative Process: • Approved bill referred to House or Senate for floor action • Bill will not be debated in House without a rule by House Rules Committee – Senate does not have a Rules Committee • House Passes Bill – Senate Passes Bill • House and Senate Representatives conference the Bill • House-Senate Conference version of the bill sent to House & Senate Floor for approval • President signs or vetoes the bill Powers Pyles Sutter & Verville, P.C.

6. Legislative Process – How Does It Start? • 10,000 Bills introduced every year – only a handful become law • Bills Are introduced by Members of Congress • Many bills are introduced but Congressional Member has no intention of getting the bill to pass • If you want a bill to pass, you must find a Member of Congress who will be a relentlesschampion of your cause • Chance of success is enhanced if your sponsor is in the Leadership and on the Committee of Jurisdiction Powers Pyles Sutter & Verville, P.C.

7. Legislative Process – How Does It Start? • Process frequently starts with Congressional Staff • Meeting with the right Congressional staff is key • Insist on meeting with Legislative Assistant, Legislative Director or Chief of Staff, not Legislative Correspondent • Timing and place of meeting should be arranged to gain maximum benefit • Mondays and Fridays are best time to meet staff in Washington • Preferred place to become acquainted with Congressional Member is in the District Powers Pyles Sutter & Verville, P.C.

8. Legislative Process – How Does It Start? • Expect meeting with staff to be brief – 20 Minutes or less • Expect meeting with staff to be interrupted • Do not expect meeting with staff to be private • Anticipate that most Congressional Staff will be in early twenties with an undergraduate degree in political science and no experience with the health care system • Bring materials describing your concern to “Leave Behind” • Wait until your verbal presentation is over before you provide written materials • Tell staff as you begin presentation you have a written copy so they don’t need to take notes Powers Pyles Sutter & Verville, P.C.

9. Effective Advocacy • Prepare for your meeting – research the Congressional Member and Congressional staff – try to find common interests, hobbies, alumni, etc. • Google • Almanac of the Unelected • thomas.loc.gov • Know the Congressional Committees your Lawmaker is assigned to – if not a health committee, their ability to help you is limited or non-existent • Know the political affiliation of your Lawmaker – if they are not in the Majority Party, their ability to help will be limited or non-existent • Know the voting record and sponsored legislation of your Representative Powers Pyles Sutter & Verville, P.C.

10. Effective Advocacy • Plan on meeting both District and Washington Staff • District Office Staff Director can be important contact • Initiate request for meeting with Washington staff via phone and electronically. All electronic addresses follow same format • House of Representatives Firstnamestaff.lastnamestaff@mail.house.gov • Senate Firstnamestaff.lastnamestaff@lastnamesenator.senate.gov • Mention in your request for meeting that you will be representing the concerns of a 3,000 member national physician organization Powers Pyles Sutter & Verville, P.C.

11. Effective Advocacy • If you are seeking appointment with Member of House of Representatives, you may not get if you don’t live in that District • www.Nationalatlas.org • www.Congress.org • www.Senate.gov • www.House.gov • Be prepared to be surprised – your meeting may end up being a meeting in a crowded waiting room, cafeteria or standing in the hall – Think: Drug rep! • Follow the basics – make eye contact, shake hands, have a business card ready as meeting starts • Explain you are a Doctor who provides Hospice and Palliative Care and where you provide these services • Staff will not understand the difference – explain what Hospice & Palliative Care is and why it matters. Emphasize Quality of Life and Cost Savings. Powers Pyles Sutter & Verville, P.C.

12. Effective Advocacy • Move quickly to “The Ask” • AAHPM has three priority requests • Increased funding for Palliative Medicine Research • Palliative Medicine Quality Measure and Pay-for-Performance • Enhanced graduate medical education - CMS recognition and expanded Medicare payments for resident and fellowship programs - Pass legislation to create Palliative Academic Career Award program Powers Pyles Sutter & Verville, P.C.

13. Effective Advocacy • Briefly describe all AAHPM Issues • Emphasize AAPHM Issues based on the Committee assignment of the Lawmaker you are meeting with • Ex: If assigned to the Ways & Means or Finance Committee, a Lawmaker can help on Medicare and P4P • Ex: If assigned to the Appropriations Committee, a Lawmaker can increase research funds • Ex: If assigned to Senate HELP Committee or House Energy & Commerce, a Lawmaker can help on Career Awards Powers Pyles Sutter & Verville, P.C.

14. Effective Advocacy • We are interested in establishing long term relationship with members and staff • Be prepared to follow up with calls and E-mail messages to stay in touch • Letters only effective if attached to E-mail to appropriate Congressional Staff, preferably someone you’ve met • Objective is to be recognized on sight by all elected officials • Meet elected official in District at office, town hall meetings or tour of your facility • Consider supporting lawmakers at political events; either as guest or host • Know or develop shared interests Powers Pyles Sutter & Verville, P.C.

15. Effective Advocacy • Know Your Topic • Avoid details, minutiae & medical terms • Be clear & accurate • Never mislead & correct any misconceptions • Practice Your Presentation • Logical flow • Informative • Interesting (stories, studies) • Brief – be able to adjust for 1, 5, 10, 20 minute presentation “on demand” • Know Your Audience • Early twenties, undergrad degree in political science, on job less than one year & will only stay about 3 years Powers Pyles Sutter & Verville, P.C.

16. Effective Advocacy • Not about politics • End of Life or Palliative Medicine resource • Practicing expert and community resource • Constituent “if you don’t vote, you don’t count” • Most effective if this is not a crisis, either yours or theirs • Requires a constant effort – the grass must be watered for the roots to grow Powers Pyles Sutter & Verville, P.C.

17. Effective Advocacy • Build the Relationship – • Invite staff and Lawmaker to events • Engage in written or electronic dialogue • Send relevant articles • Add Washington and District staff to AAHPM mailings and press releases • Provide Congressional staff with relevant journal or media articles and publications • Engage your patients, families and volunteers Powers Pyles Sutter & Verville, P.C.

18. Key Congressional Committees • Medicare and P4P • Senate Finance Committee • House Ways & Means Committee • House Energy & Commerce Committee • House & Senate HHS Appropriation Committees • Increased Research Funding • House & Senate HHS Appropriation Committees • Palliative Medicine Career Award • Senate HELP Committee • House Energy & Commerce Committee Powers Pyles Sutter & Verville, P.C.

19. Advocacy Messages • Hospice is high quality, cost effective care • Hospice and palliative care is what patients and families want • Palliative medicine is not provided only at the end of life • Oppose proposals to reduce Medicare payments for hospice and physicians • Increase funding for hospice and palliative medicine research • Provide incentives to increase the number of faculty and residency opportunities in palliative medicine • Support Medicare recognition of palliative medicine • Create a Palliative Medicine Career Award Powers Pyles Sutter & Verville, P.C.