2014 Advocacy program: Attendees learn about traditions that influence legislative outcomes

The American College of Surgeons (ACS) hosted its third annual Advocacy program during the 2014 Leadership & Advocacy Summit, March 29 to April 1, at the JW Marriott in Washington, DC. More than 280 people registered for the Advocacy program.

Payment issues at top of agenda

The Summit took place when Congress was debating the future of the Medicare physician payment system and the flawed sustainable growth rate (SGR) formula used to calculate physician fees. Physicians have long lobbied for Congress to repeal and replace the SGR with a bicameral, bipartisan payment system that rewards value and quality over volume, and provides high-quality, patient-centered care. However, the legislation that Congress passed before a more than 24 percent pay cut was scheduled to take effect on April 1 instituted another one-year SGR patch. On April 1, President Barack Obama signed the Protecting Access to Medicare Act of 2014 into law.^* (See related article.)

At the Advocacy program, Rep. Michael Burgess, MD (R-TX), Vice-Chairman of the U.S. House Energy and Commerce Subcommittee on Health, said, “This is not the end of my efforts. I will continue to work on this issue. We are farther than we’ve ever been toward repealing and replacing the SGR.”

Rep. Burgess also noted that the ACS Advocacy program offered a great opportunity for attendees to collectively learn about the issues facing surgery and take their message to Congress. More than 200 attendees from 44 states attended 229 meetings on Capitol Hill during Lobby Day on April 1, which concluded the Advocacy program. In addition to repealing and replacing the SGR, other topics discussed at congressional meetings included medical liability reform, research funding, the 96-hour rule, and trauma and emergency care, all issues that will become especially pertinent in the months ahead.^†

The Advocacy program began on Sunday, March 29, with a reception and dinner featuring guest speaker Thomas Goetz, author of The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine, and former executive editor of Wired magazine. Mr. Goetz’s presentation, The Invention of Innovation, centered on how invention and creativity have continued to help shape health care and other sectors. He spoke of several essential inventions, including the Kodak camera, the zipper, and the washing machine, and how they became increasingly more sophisticated over time.

For example, Mr. Goetz pointed to the discovery of the bacteria that causes tuberculosis (TB) in the 1800s as a groundbreaking finding that ultimately led to further important innovations. He spoke of how that discovery decreased mortality rates and the development of antibodies used to identify and neutralize foreign objects, and the progression of the various discoveries. “It’s not just about having an idea,” Mr. Goetz said. “It’s about the idea catching on and demonstrating enough progress that begs the attention of other inventors.”

The provider role in health care reform

In a presentation sponsored by the ACS Young Fellows Association, Thomas H. Lee, MD, chief medical officer at Press Ganey Associates, Inc., South Bend, IN, discussed the drivers of improvements in health care. Dr. Lee, who played a leadership role in the development and implementation of Massachusetts’ health care reform law, stressed the importance of strategy and tactics in health care advocacy. “The health care system is under duress, and some of the drivers are medical progress, an aging population, and the global economy,” Dr. Lee said. However, the true challenge in the health care system for providers and patients is that “there are too many people involved. There is too much to do; there is no one person with all the information; and there is no one to hold accountable,” Dr. Lee said, leading to gaps in the quality, safety, and efficiency of care.

How can physicians and patients improve the health care delivery system? At the core of the solution, said Dr. Lee, is maximizing value for patients. “Providers must lead the way in making value the overarching goal…since, after all, we are advocating for patients, not doctors,” he explained. The ability to segment patients and become more transparent and accountable are two key drivers for improving value—which may be achievable with the use of patient-centered systems, focused on value-based payment, patient satisfaction, and other methods that are aimed at improving outcomes.

How to hug a porcupine

Brad Fitch, president and chief executive officer (CEO) of the Congressional Management Foundation, a nonpartisan, not-for-profit organization dedicated to helping members improve congressional operations and enhancing citizen engagement, discussed the importance of building relationships with lawmakers and their staffs. Mr. Fitch said that he would imagine that for many health care advocates, developing relationships with legislators is akin to hugging a porcupine. Nonetheless, these kinds of relationships are vital for change. “Capitol Hill is much like the emergency room,” Mr. Fitch said. “[Legislators and their staffs] work long hours, and they work hard,” he observed. On average, each Congressional office receives about 6,000 pieces of constituent mail per month, yet there has not been an increase in staff size since 1974, and Congress has cut their budget by 20 percent, said Mr. Fitch. The average staff size is 18, so finding ways to capture their attention is important.

Given these constraints, how do you get Congress to listen, and who is most likely to attract Congress’ attention? According to Mr. Fitch, legislators listen to expert constituents, passionate constituents, angry constituents, influential constituents, and their own conscience. Although e-mail and the Internet have made it easier for constituents to become involved in the public policy process, research shows that old-fashioned grassroots advocacy is still tried and true. In-person visits, followed by telephone or e-mail contact, and personalized letters are the three most proven ways to communicate with representatives and senators. “The most effective way to influence a lawmaker is for a constituent to talk to a legislator about how the policy will affect the person or a particular group,” said Mr. Fitch. He also suggests constituents participate in town hall meetings, as they provide a platform for voicing opinions  that hundreds of other constituents will hear.

A house divided

David Wasserman, house editor of The Cook Political Report, was the keynote speaker at a luncheon sponsored by the ACS Professional Association’s political action committee (ACSPA-SurgeonsPAC). Mr. Wasserman discussed The Cook Political Report’s 2014 Election Road Map, highlighting some of this year’s congressional candidates and then providing his views on the current state of American politics.

In a presentation that sometimes bordered on satire, Mr. Wasserman pointed to some of the more unusual, recent political developments. One example is the candidacy of Clay Aiken, a Democrat running for Congress in North Carolina’s second congressional district. Mr. Aiken is best known as the 2003 runner-up in the television singing competition and reality show, American Idol.

The second example is Republican candidate Milton Wolfe, MD, who is running for Congress in Kansas. According to his website, “Milton Wolfe is a doctor, not a politician. He believes America must re-embrace the Constitution and the divinely inspired American idea of individual liberty, limited government, and free-market values. Want to drive Barack Obama crazy? Send his very own fearless conservative cousin, ‘the next Ted Cruz,’ to the United States Senate!” Whereas the two candidates seemingly have widely opposing political views, they serve as an example of the vast division of today’s U.S. government.

On a more serious note, Mr. Wasserman examined the current demographics of the Republican and Democratic parties, and indicated which races each party was likely to win. Factors that he said affect elections range from the types of retail stores—high end versus moderate— in a particular neighborhood to the level of education of a geographic area’s population. He also discussed some of 2013’s triumphs and failures and how each played a huge part in where both parties stand today.

Be brief, be clear

One of the most effective, time-honored ways of communicating with elected officials is through face-to-face contact. To ensure that the right message is presented at the most opportune time, it is essential that organizations sponsoring lobby days plan and prepare well in advance of scheduled visits. Between February and April, members of Congress and their staffs can expect as many as 10,000 to 15,000 advocates in Washington per week, so brevity and clarity are vital.

To help prepare participants for the ACS Lobby Day, several advocacy and health policy experts participated in the advocacy program. These advocates spoke on key issues and provided details on what attendees could expect before, during, and after Lobby Day.

Sara Rosenbaum, JD, founding chair of the department of health policy at George Washington University, Washington, DC, presented details about aspects of the Affordable Care Act (ACA) that affect surgery and surgical patient care.

After providing a brief overview of the ACA, Ms. Rosenbaum spoke about specific provisions in the act, including the establishment of state health care exchanges, the preservation of employer-based coverage, and how cost is a major driver for families and providers. The overarching goal of the legislation is to ensure that patients have access to high-quality and safe health care services and affordable health insurance coverage, Ms. Rosenbaum said. Accessing affordable insurance plans is of particular concern to families living in costly areas such as Northern Virginia. She indicated that if surgeons and health care proponents want to change the health care system, then more needs to be done to control costs, such as increasing health care interventions and creating new delivery systems.

Next at the Summit, ACS advocacy staff briefed attendees on the key issues affecting surgical practice. The full list of issues on the ACS legislative agenda at the time of the meeting can be accessed at http://www.facs.org/ahp/summit/congressional-asks.pdf.

In addition, John Hedstrom, JD, Deputy Director, ACS Division of Advocacy and Health Policy, interviewed Beltway insider Brian Gavitt, MD, a Resident Member of the College and a former Senate staffer. Dr. Gavitt said that a typical day on Capitol Hill can involve a number of obligations, such as fielding phone calls, learning about new legislation and policy, meeting with constituents, and serving as a liaison with federal agencies to resolve constituent issues. Given their busy schedule, congressional staff are more receptive to individuals who are well-prepared for constituent meetings.

Because 2014 is an election year, candidates and members of Congress may be listening more intently to the needs of their constituents, according to Christopher Kush, grassroots expert and CEO of Soapbox Consulting, Washington, DC, which helped the College make arrangements for Lobby Day. Mr. Kush guided attendees through the process of preparing for Lobby Day, which involved setting up individual meetings with members of Congress and their staffs, analyzing state and federal level issues, examining each state’s tracking map and its political parties, and, most importantly, analyzing the 113th Congress by party.

Mr. Kush also discussed techniques that attendees could use to help lawmakers and candidates view issues from a surgeon-patient viewpoint. He explained that surgeon advocates should work to grab the attention of a senator or representative and to build relationships. He also provided tips for how to handle push-back (see graphic).

Fundraising: Asking without fear

Fundraising is vital to support the candidacies of individuals who support the surgical profession. “Asking for money is one of the most notable opportunities on earth,” said Marc Pitman, “The Fundraising Coach.” He said that fundraising is not about “the money,” but rather the opportunity to take part in solving a problem of great magnitude.

The first steps in fundraising are to be realistic and do the research. If the goal is to raise $100,000, said Mr. Pitman, don’t expect 10 peers to give $10,000 each. Mr. Pitman further suggested that PAC members:

• Conduct face-to-face meetings with potential donors, a time-honored tradition still favored among contributors
• When contacting donors via telephone, use a natural tone
• Get to know potential donors ahead of time and learn what matters to them
• Let your donor know what is unique about your organization
• Be clear. Do not confuse the donor by providing too many options

Such suggestions are especially useful for Fellows interested in helping to increase ACSPA-SurgeonsPAC dollars by participating in various state and federal level activities—or hosting their own event in their home state. Understanding how to fundraise increases the PAC’s chances for making a noticeable impact in the advancement of the practice of surgery and quality of life for patients.

Vehicles for surgeon advocacy

ACSPA-SurgeonsPAC provides the tools necessary to help reach the College’s advocacy goals and increase the profile of surgeons and surgical patients on Capitol Hill. The ACSPA-SurgeonsPAC enables the College to develop relationships with representatives and senators to educate them about the issues that affect the surgical practice environment. The ACSPA-SurgeonsPAC contributes to incumbents and candidates who act as champions for surgery, regardless of their party affiliation.

The ACSPA-SurgeonsPAC hosted several fundraising events at the Summit, raising more than $60,000 during the conference. Awards were also given to Fellows for their philanthropic efforts to help sustain ACSPA-SurgeonsPAC. The list of awards can be viewed in the sidebar.

One ACSPA-SurgeonsPAC event took place at the International Spy Museum. Attendees were able to tour the museum and hear an introduction from its founding executive director, Peter Earnest, a 35-year veteran of the Central Intelligence Agency (CIA). The event provided an opportunity for attendees to meet with members of Congress and discuss important advocacy issues currently affecting surgery.

Another advocacy resource available to ACS members is SurgeonsVoice, a nationwide interactive program that provides surgeons with the tools they need to influence federal and state legislation. Each Advocacy program attendee received a copy of the “SurgeonsVoice Advocacy Handbook,” a guidebook that describes how Washington works, surgical advocacy, getting involved, taking advocacy to the next level, and planning and staging successful meetings with elected officials. Fellows can log on to www.SurgeonsVoice.org for more information and to get involved.

The 2015 ACS Leadership & Advocacy Summit will take place April 18–21 at the JW Marriott, Washington, DC.

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*Govtrack.us. Protecting Access to Medicare Act of 2014. Available at: https://www.govtrack.us/congress/bills/113/hr4302. Accessed April 10, 2014.

†The Centers for Medicare & Medicaid Services. 96-hour rule. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Downloads/IP-Certification-and-Order-09-05-13.pdf. Accessed April 10, 2014.