1. 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

2. © 2012 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved. AMA Reach: The AMA Equation 33 House of Delegates Members Practice Tools Research & Education Advocacy AMA Voice of physician organizations Direct personal engagement Expertise in managing practice Career, clinical, and practice enhancement Authoritative advocate for physicians in Washington, in the courts, and to the public

4. © 2012 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved. The 112 th Congress Recap: –Least productive Congress in U.S. history About 220 Acts of Congress signed into law –104 th 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 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved. The 113 th 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 American Medical Association. All rights reserved. 12 2012 House Elections 158 192 2013 House of Representatives By Party ID 2012 House of Representatives By Party ID 28 190 240 218 seats needed for a majority 2012 = 242 R - 193 D 2013 = 233 R - 200 D 196 233 GOP Maintains Control 218 seats needed for a majority

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

14. © 2012 American Medical Association. All rights reserved. The 113 th Congress Physicians in Congress – unchanged at 20 Physicians in House –4 Democrats –13 Republicans Physicians in Senate –3 Republicans

15. © 2012 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved. 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. © 2012 American Medical Association. All rights reserved.

22. 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 www.patientsactionnetwork.org 1-800-833-6354 www.ama-assn.org/go/medicarepayment Select “Medicare Physician Payment Advocacy Documents”

23. © 2012 American Medical Association. All rights reserved. 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

24. © 2012 American Medical Association. All rights reserved. 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

25. © 2012 American Medical Association. All rights reserved. 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

26. © 2012 American Medical Association. All rights reserved. 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

27. © 2012 American Medical Association. All rights reserved. Get Involved! National Advocacy Conference Grand Hyatt, Wash DC February 11-13 Hill visits – see Pat Mills http://www.ama-assn.org/go/nac

28. © 2012 American Medical Association. All rights reserved. The AMA is working on your behalf. Great changes equal great opportunity. Medicine needs a collective voice – we need yours. Join the AMA!

29. © 2012 American Medical Association. All rights reserved. 29 Thank you ! ! Happy New Year! Discussion… David Barbe, MD MHA Chair-elect AMA Board of Trustees