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MSMA Advocacy Training Federal Advocacy and Lobbying on a National Level

MSMA Advocacy Training Federal Advocacy and Lobbying on a National Level. David Barbe, MD MHA Chair-elect, Board of Trustees American Medical Association MSMA Vice Councilor 9 th District January 19, 2013. The AMA – A Unifying Voice for Physicians.

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MSMA Advocacy Training Federal Advocacy and Lobbying on a National Level

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  1. MSMA Advocacy TrainingFederal Advocacy andLobbying on a National Level David Barbe, MD MHA Chair-elect, Board of Trustees American Medical Association MSMA Vice Councilor 9th District January 19, 2013

  2. The AMA – A Unifying Voice for Physicians • 186 state, specialty and sub-specialty societies – the voice of >650,000 physicians • Multiple life-cycle stages – student, resident, young physician, mature physician, retired • Multiple practice settings – independent solo, small group, large group, employed, integrated group practices, academic • No other organization is better positioned to unify – and advocate for physicians, the profession, and our patients

  3. House of Delegates Practice Tools Research & Education AMA Members Advocacy AMA Reach: The AMA Equation Direct personalengagement Expertisein managingpractice Career, clinical, and practice enhancement Voice of physician organizations Authoritativeadvocate forphysicians in Washington, inthe courts, and to the public 3

  4. AMA – Our People • Membership – >220,000 students, residents and physicians, > 3% increase in 2012 • House of Delegates – 520 state and specialty society representatives • Board of Trustees – 21 members • 3 Presidents • Speaker and Vice-Speaker House of Delegates • Student, Resident, Young Physician • 12 At large members • One public member • AMA management – James Madara, MD CEO

  5. What unites us • Our diversity – our strength, our challenge • Most issues in common • Medicare payment / SGR reform • Medical liability reform • Payment and delivery system reform • Scope of practice • Regulatory and administrative burdens • Most others if not in common, not in conflict • Reframe the issues and reject the forces that threaten to divide us

  6. The 2013 Federal Landscape

  7. The 112th Congress • Recap: • Least productive Congress in U.S. history • About 220 Acts of Congress signed into law • 104th Congress produced 333 new laws • 33 House votes on ACA repeal • No budget passed • US credit rating downgraded • Economic recovery slowed • Missed deadlines and opportunities

  8. 2012 highlights • Medicare payment and delivery reform: • Improved framework for developing Medicare shared savings programs (ACOs and others) • Preserved physician favorable parts of ACA • Proposed concepts for transition to new Medicare physician payment system • Reshaped dialogue – physicians as part of solution • Administrative burdens eased: • eRx requirements, EHR Meaningful Use rules, PECOS enrollment burdens, PQRS and Physician Compare web site improvements, ICD-10 delay

  9. Avoiding the fiscal cliff Physician provisions: Extended 2012 Medicare payment rates through Dec. 31, 2013 (stopped 26.5% cut) Extended 1.0 GPCI “floor” on work RVUs Deferred 2% sequester for Medicare (larger cut in other health programs) for 2 months Expanded quality reporting programs to include clinical data registries Called on HHS to develop strategies for timely, confidential quality data feedback to physicians H.R. 8 The “American Taxpayer Relief Act” Signed into law Jan. 2

  10. The fiscal cliff, continued • Budget offsets did not: • Eliminate enhanced Medicaid payments for primary care services • Eliminate the ACA prevention fund • Eliminate physician in-office exemption for imaging services • Impose new penalty programs • Health provisions totaled about $30 billion • Higher utilization assumptions for advanced imaging services offset accounts for $300 million • Hospitals absorbed about half the offsets • E&M payment rate cuts in HOPDs avoided

  11. The 113th Congress • New members: 84 in House, 14 in Senate • 90% running for re-election returned • More diverse membership • Still relatively old (58 in House, 61 in Senate)

  12. 2012 House Elections GOP Maintains Control 2012 House of Representatives By Party ID 240 190 218 seats needed for a majority 2012 = 242 R - 193 D 2013 = 233 R - 200 D 2013 House of Representatives By Party ID 28 196 233 158 218 seats needed for a majority 192

  13. 2012 Senate Elections Democrats gain seats/retain majority, but GOP retains filibuster leverage 2012 Senate By Party ID 47 51 2 Independents 2012 = 53 D – 47 R 2013 = 55 D – 45 R 2013 Senate By Party ID 10 5 5 4 1 8 45 53 2 Independents 37 30 13

  14. The 113th Congress • Physicians in Congress – unchanged at 20 • Physicians in House • 4 Democrats • 13 Republicans • Physicians in Senate • 3 Republicans

  15. AMPAC and the 2012 Elections In all, AMPAC invested over $3.1 Million in the 2012 cycle. More than $1.8 Million contributed to physician-friendly candidates for U.S. House and Senate from both political parties. 12 AMA-hosted fundraisers and meet-and-greets for supported candidates. AMPAC contributions created more than 365 opportunities for lobbyists to attend events with key Members of Congress in Washington, D.C. in addition to hundreds more around the country for physicians and state medical society staff. Partisan Communications mail program delivers over 100,000 mail pieces to physicians in support of 66 House candidates and 9 Senate candidates, specially identified as important allies for medicine.

  16. The road ahead February 2013: Obama budget proposal for 2014 released Two month sequester delay expires Debt limit ceiling will be reached Expiration of continuing resolution for 2013 funding imminent Coverage provisions of ACA imminent Expect new regulations, oversight hearings Focus on deficit reduction: Time to address spending (vs. taxation) side of the deficit equation Entitlement reform will be part of the conversation

  17. Entitlement reform must include physician payment reform SGR patches: 15 since 5.4% cut Average update: 0.3% per year Inflation/ update gap: 20% since 2001 Combined patch costs: $92.6 billion 10-year freeze cost: $271 billion (July) Total physician spending: $67.3 billion (2011) SGR Facts

  18. Key elements of AMA transition payment proposal • Multi year period of stability • Positive incentives for participation in new models • Incentives scaled to “accountability” • New models can be developed and administered in private sector • Better fit across specialties, communities • Transition can be gradual (e.g., one procedure or condition)

  19. Federal legislative and regulatory priorities for 2013 • Advance Medicare physician payment reform • Continue easing regulatory burdens, stabilize payment rates, align quality improvement/ reporting programs • Maintain federal support for key health programs • Graduate Med Ed grassroots campaign • Address public health concerns • Advance AMA health outcomes strategy • Address drug diversion/ opioid abuse, drug shortages • Support violence prevention, mental health, veterans’ issues

  20. AMA – Broad scope of issues • ACA • IPAB repeal or reform • Modify “Anti-discrimination” provisions • Modify Cost/Quality/Value Index • Physician Hospital Ownership options • Allow HSA / High-deductible health plans • SGR fix / Medicare Physician Payment • Medicare Patient Empowerment Act • ICD-10 repeal or delay • Medical Liability Reform

  21. We Need Your Help • Use our template to email your Congressmen • Use our toll-free number to call them • Encourage your patients to get involved • Access variety of advocacy materials www.ama-assn.org/grassroots 1-800-833-6354 www.patientsactionnetwork.org www.ama-assn.org/go/medicarepayment Select “Medicare Physician Payment Advocacy Documents”

  22. Tips on Lobbying • Relationships develop over time • Be persistent and be patient • Influence increases over time • Relationships not transactions • Contributions help – but NOT on government property! • Go through campaign org – candidate will know

  23. Tips on Lobbying • Schedule time for Hill visit / in district visit • Both are important and relate to #1 and #2 • Don’t overstay your welcome • Schedules are tight, respect their time • Meet with legislative health aide if legislator not available • Can be as effective in discussion of issues

  24. Tips on Lobbying • Legislator deserves and expects respect • Even when you disagree, do so agreeably • Never threaten • Do not be too familiar, unless you are • First name ONLY when your relationship justifies it • You are ‘doctor’, they deserve similar recognition of their role / rank

  25. Tips on Lobbying • When presenting your issues: • Make case clearly, know the facts • Explain positive and/or negative impact – problems it corrects or that it creates • Use stories / examples, make it personal • Leave fact sheets / materials, when possible • Always follow up with email or fax

  26. Get Involved! • National Advocacy Conference • Grand Hyatt, Wash DC • February 11-13 • Hill visits – see Pat Mills http://www.ama-assn.org/go/nac

  27. The AMA is working on your behalf. Great changes equal great opportunity. Medicine needs a collective voice – we need yours. Join the AMA!

  28. Thank you ! ! Happy New Year! Discussion… David Barbe, MD MHA Chair-elect AMA Board of Trustees

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