A Quick Lesson on #Radvocacy
A Rutherford Fellow finds out how the government relations team works directly for radiologists and patients on pertinent issues that will affect your practice.
Daniel Ortiz, MD, with Martin Heinrich, Senator from New Mexico
This September, I had the honor to be sponsored by the ACR to serve as a Rutherford-Lavanty Fellow in government relations (GR). The fellowship offers a week-long comprehensive experience encompassing introduction to many of the facets of the incredible ACR GR team that works tirelessly to represent the interests of the radiology community and our patients.
The ACR GR office, located just one mile from the U.S. Capitol Building, in Washington, D.C., houses a robust team of experienced experts in government relations, congressional affairs, state affairs, and legislative/regulatory affairs. Prior to my experience, I had no idea the degree of flexibility the various executive branch agencies have on implementing legislation that is often left intentionally vague: thus leaving ACR GR a chance to educate these agencies to interpret and apply legislation in the most favorable way to the radiology community. Therefore, a major takeaway for me is that for a successful GR team, not only do you need members with in-depth expertise in their respective focus, but also a cohesive network that is in frequent communication with each other. Very often, an issue cannot be compartmentalized into a single section of the office.
This point was made evident quickly with the pressing issue during my time in the District — namely, an Anthem policy that gave itself (through its radiology benefit manager, AIM Specialty Health) the ability to deny patients the freedom to choose where their imaging is performed. This is being implemented currently in nine states and is expanding into at least 13 states, including my state, Virginia.
A brief lesson in outpatient imaging reimbursement: Medicare outpatient imaging performed at a hospital is reimbursed using the Hospital Outpatient Prospective Payment System (HOPPS). And at free-standing imaging centers, reimbursement is obtained using the Physician Fee Schedule (PFS). Due to a congressional directive a few years ago and various factors including operating costs, the HOPPS payments are reimbursed at a higher rate than the PFS. One driver for this was to consolidate care to encourage compliance with MACRA legislation for reporting, quality improvement (QI), formation of accountable care organizations (ACO), and other reasons.
Now, in an apparent reversal of that drive, and a race to the bottom for imaging payments, Medicare is discussing “site neutral” payments, which would pay hospital outpatient imaging at the PFS rates, which are substantially lower and calculated using factors not accounting for the unique challenges of a hospital outpatient center. Anthem is taking this a step further and denying outpatients the ability to get imaging in hospital outpatient imaging centers all together.
With this historical context provided by the congressional affairs experts and their state-level knowledge of certificate of public need laws (which are counter to the spirit of the Anthem initiative policy), we were able to take the case to the offices of my U.S. senators, Tim Kaine and Mark Warner, and my federal representative Scott Taylor.
A brief aside: a certificate of public need program (COPN) limits the number of health care facilities on the basis of geographic factors and population need, as determined by the state’s health commissioner. The COPN program states it “seeks to contain health care costs while ensuring financial viability and access to health care for all Virginia at a reasonable cost.” The COPN attempts to do this by limiting the number of facilities. Anthem’s new policy, to the contrary, states it is attempting to accomplish this same goal in a method completely counter to COPN, by encouraging decentralization of imaging. There are reasonable arguments and proponents for both consolidation and decentralization, but my state’s COPN significantly limits the number of offerings for patients in the outpatient facilities that Anthem is trying to shift patients towards.
Anthem is scheduled to roll out their new policy in Virginia in March 2018. This leads to another takeaway: sometimes you will be the first source of information for a Congressional office, as was the case in each of these three encounters. Although, there is limited ability for Congress to “legislate away” this issue, we asked their support by having them pen letters to the state insurance commissioners, who have regulatory authority to prohibit such a policy.
This awareness effort was extended to the state level. I had the fortune of being present when the GR office had phone conferences with various state hospital associations and state radiology societies. The GR office put together resources to empower state chapters to take action. A full public relations blitz with social media and local news outlets was also organized. Only with an established team of highly skilled and experienced professionals who have developed a large network of relationships with various stakeholders can such an effort be performed. Incredibly, all of this was done in just about a week or so.
I strongly encourage all residents and fellows to be actively involved in #radvocacy, nationally, and frequently more importantly, at the state level. State RFS leaders should talk to their state chapter leadership about sponsoring a resident each year to serve as a state chapter-funded Rutherford Fellow and/or fashioning a state legislative experience emulating the Rutherford-Lavanty fellowship, as Florida has done. You should speak to your programs about dedicating conference time to talk about the current issues facing radiology locally and beyond. Also, I encourage everyone to read the Advocacy-in-Action eNewsletter and follow the various radiology accounts on social media such as @ACRRAN and @RADPAC for the most up-to-date information. Only through awareness can the voice of radiology become stronger.
The final takeaway from this experience is this: radiology as a specialty is a heterogeneous group, and there will be times when an individual radiologist or practice may not agree with a position that the College takes or a particular congressional campaign to which RADPAC contributes. This is by no means a reason to not be involved or to not donate. In fact, this should make you more engaged, as member engagement is the only way for the GR team to get a true pulse on how various policies, legislation, and regulations impact your practice. Take part in the various RADPAC donation drives including RADtoberfest as well as “Lobby days” nationally and in your state.
Individual issues aside, there is no stronger force or louder voice on the Hill with a clear focus to ensure that radiology can continue to successfully provide the best care possible to our patients.
Daniel A. Ortiz, MD
Chief Resident, Eastern Virginia Medical School
Vice Chair, ACR Resident and Fellow Section