The sustainable growth rate (SGR) formula has drawn seemingly limitless criticism from cardiologists and other physicians, but it may have a silver lining of sorts. It has served as a persistent reminder that physicians or their representatives need to be involved in the shaping of legislation that affects reimbursement and patient care. To be effective, cardiology’s advocates must choreograph and execute a delicate dance between persuasion, politics and what could be seen as self-interest.
Turn the calendar back several years, to the time when the Centers for Medicare & Medicaid Services (CMS) unveiled what cardiologist M. Eugene Sherman, MD, likened to “ripping the guts out” of the specialty. Rule changes ranged from 10 percent to 40 percent phased-in reductions in reimbursement for cardiovascular services, with imaging taking an especially hard hit. The cuts precipitated the movement from private to employed practice and altered the way patients received care.
Sherman, chair or the American College of Cardiology’s (ACC) Advocacy Steering Committee and a physician at the Aurora Medical Association in Colorado, had before then been involved in other committee activities. “But at that point I became clearly dedicated to that professional organizations should advocate on behalf of their members and equally on behalf of their patients,” he says. “In terms of cardiac imaging, this is critical [for] patient access to timely care.”
Physicians have served as advocates for the profession for decades, but their participation may have gained urgency in recent years as the practice and payment of medical care are in transition. Cardiologists who have been insulated from the vagaries of Washington in the past now wrestle with the consequences of policy decisions. Those pain points may vary from time-consuming preauthorization for tests to shrinking payments tied to readmissions or performance measures.
“This has a lot more traction and will get a lot more attention as we see declining revenue and increasing expenses and a smaller operating margin for healthcare facilities and for practices,” says Peter Duffy, MD, co-chair for the Advocacy Committee for the Society for Angiography and Interventions (SCAI) and director of quality for the cardiovascular service line at FirstHealth of the Carolinas Reid Heart Institute at Moore Regional Hospital in Pinehurst, N.C.
High-profile issues like calling for the repeal of the SGR also helped raise awareness but may have blunted cardiologists’ impulse to act because few believed the perennial threat of draconian pay cuts would be enforced. “There was a lot of disbelief when we said you have to write letters to Congress,” Duffy says. “They said, ‘Why bother? They will change it anyway. It doesn’t matter if I write letters or not.’ To some degree, while it was positive because it got attention, their feeling was that what is going to happen will happen regardless. Our job is to make sure they don’t feel that way.”
Communication & messaging
Society-affiliated advocates’ responsibility to their members is to educate key decision makers about cardiology practices and explain issues from the cardiologist’s perspective, according to those at the front lines. That requires advocates first understand the fine points of legislation, agency proposals and regulatory processes such as approvals and reimbursement for new devices or therapeutics. For instance, it is important that facilities are adequately remunerated for services or patients won’t reap the benefits, Duffy says, and advocates can help make sure CMS staffers and policy makers realize that potential barrier.
“No one who has the responsibility for policy making or coverage decisions wants to make the wrong decision,” Duffy reasons. “They just want to have the right facts in front of them.”
Members also have a responsibility to inform societies of concerns, listen and provide feedback. “Physicians have to realize they need to speak up and tell their professional organizations,” Sherman says. “In the other direction, [organizations] need to keep their members informed as to what is going on so they can all work together.”
Advocates speak with members to bounce off ideas in a back-and-forth process that refines dialog into clear talking points. The goal is to distill often complex concepts into a cohesive and unified message that can be presented to lawmakers, congressional aides, FDA officials, staffers at federal funding agencies