PUBLIC POLICY

PUBLICPOLICY

// GOVERNORS' VANTAGE PINT

INVITATION ACCEPTED

From Capitol Hill to Oklahoma City, Senator Inhofe's Staff Visits Saint Anthony Hospital

By Tauseef Ali, MD, FACG, ACG Governor for Oklahoma, Saint Anthony Hospital and the University of Oklahoma

BACK IN APRIL, I joined more than 50 ACG Governors and members of the ACG leadership to advocate on Capitol Hill on your behalf at the 2018 ACG Board of Governors Legislative Fly-In. During the Fly-In, I had the opportunity to meet with Senator Jim Inhofe’s (R-OK) staff, and invited them to come have a personal tour of our endoscopy lab back home in Oklahoma. I recognized the mutual importance in this opportunity for both ACG members and his staff: they could learn more about colonoscopy from our perspective, and meet with the endoscopy nurses and team in order to gain first-hand knowledge and to better understand and advocate for GI-related issues in Washington, DC.

In June, Senator Inhofe’s staff graciously toured our facility. During our meeting together at lunch, we sat down and discussed the issues I and other ACG leaders highlighted in April: colon cancer screening awareness, establishing exemptions for insurer step therapy, and the negative impact of prior authorization regulations. We discussed the “Removing Barriers to Colorectal Cancer Screening Act (S. 479/H.R. 1017),” which fixes a Medicare coverage quirk by waiving Medicare beneficiary cost-sharing when screening colonoscopies turn therapeutic. I also addressed the “Restoring the Patient’s Voice Act of 2017 (H.R. 2077),” 

Top left: Dr. Tauseef Ali addresses the ACG Governors during the ACG Board of Governors Legislative Fly-In. Photo in the top right and on page 13 courtesy of Dr. Ali.

which allows for exemptions for step therapy requirements in health plans regulated by federal law. Step therapy entails the “fail first” drug therapy requirements, in which patients are forced by insurers to try and fail with one or more medications before the insurer approves the cost of the medication which ACG members originally prescribed.

Senator Inhofe’s staff also had the opportunity to meet directly with the staff member of our clinic who is in charge of handling our prior authorization requests, and heard the details of our daily difficulties with this process. ACG Governors and members continue to express their frustration over the amount of time and resources GI practices spend dealing with insurers and prior authorizations, to the detriment of patient care. These policies are not rooted in clinical evidence, and ultimately take valuable time away from treating patients. In a recent study by the American Medical Association (see bit.ly/AMAStudy) surveying 1,000 physicians, 92% of participants stated that prior authorization issues delayed their patients’ access to necessary care, and carried an overall negative impact on patient outcomes. Senator Inhofe’s staff expressed their appreciation for the College, its mission and for the opportunity to be educated on these issues. They plan on visiting again in the near future to sit in on a colonoscopy and to listen to more of these concerns.

This is just one example of how my role as an ACG Governor on behalf of the College can be impactful at the federal, state and local level. The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows who are elected by the membership of their particular state or region. There are currently 77 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at large. This helps the College make certain it is meeting the evolving needs of the membership.

I welcome you to reach out to your ACG Governor to bring to light any other issue at the local and state level that is important to you, your practice and your patients. We recognize the significance and power of advocacy at the local, grassroots level. It not only helps to resolve the issues impacting your state, but also sends a message to representatives on Capitol Hill by creating a larger voice and momentum for federal GI-related legislation and concerns.

“In a recent study by the American Medical Association surveying 1,000 physicians, 92% of participants stated that prior authorization issues delayed their patients’ access to necessary care, and carried an overall negative impact on patient outcomes.”

We would like to hear from you. Contact your Governor today: gi.org/governors

Taking the LEAD

Dr. Wilmer Rodriguez Recognized for Leadership on Hurricane Relief

 In the days leading up to the June 2018 American Medical Association (AMA) Annual Meeting of the House of Delegates, AMA Wire published an article— “Physicians helped boost aid for Puerto Rico, U.S. Virgin Islands”—recapping the steadfast efforts of ACG Governor for Puerto Rico Wilmer Rodriguez, MD, FACG, to secure aid for Puerto Rico and the U.S. Virgin Islands in the wake of the 2017 hurricane devastation.

The efforts can be traced back to last fall when, at Rodriguez’s suggestion, ACG submitted an emergency resolution to the November 2017 AMA Interim Meeting of the House of Delegates. Resolution 235 urged the AMA, the House of Medicine, and U.S. policymakers to provide more support for hurricane disaster relief efforts for Puerto Rico and the U.S. Virgin Islands. Through the leadership of Rodriguez and ACG Delegates R. Bruce Cameron, MD, FACG, and March E. Seabrook, MD, FACG, the resolution passed with overwhelming support, which made advocating for Medicaid funding and regulatory waivers a part of AMA’s public policy objectives.

Ultimately, the Bipartisan Budget Act of 2018 provided $143 million for the U.S. Virgin Islands and $4.8 billion in Medicaid funding for Puerto Rico. Medicaid funding for Puerto Rico was especially important because, even before the hurricanes, 49% of U.S. citizens on the island were enrolled in its Medicaid program, 46% of Puerto Ricans were below the federal poverty level, and annual federal funding for Puerto Rico is capped, unlike the 50 states and Washington, DC.

In speaking with AMA Wire for the article, Rodriguez expressed his sincere gratitude for the resolution passing, while also cautioning that more will likely need to be done.

“‘It solved the problem for now,’’’ he said, “‘But it won’t solve the problem forever.’”

During a meeting at the 2018 ACG Board of Governors’ Spring Meeting and Washington, DC Fly-In, Rodriguez presented to the Governors about the devastation in Puerto Rico, the efforts to get the resolution passed, and evolving concerns in Puerto Rico including, among other issues, a physician shortage, as many physicians have moved or plan to move to the mainland United States following the devastation.

ACG is grateful to Dr. Rodriguez, Dr. Cameron and Dr. Seabrook for the time and effort they dedicated to this important initiative. This is a pivotal example of the role that the ACG Board of Governors can play in serving as a two-way conduit between College leadership and the membership, quickly acting to meet the evolving needs of the membership.

Remember to contact your ACG Governor on important state and local issues impacting you and your practice.

BIPARTISAN BUDGET ACT OF 2018 BY THE NUMBERS

MEDICAID FUNDING

$143 Million

FOR U.S. VIRGIN ISLANDS

$4.8 Billion

FOR PUERTO RICO

BEFORE THE HURRICANES...

49%

OF U.S. CITIZENS ON PUERTO RICO ENROLLED IN MEDICAID

46%

OF PUERTO RICANS WERE BELOW FEDERAL POVERTY LEVEL

Contact your ACG Governor:

gi.org/governors

READ the AMA Wire story: bit.ly/WRodriguez

The information you need to improve your practice.Accessible. Relevant. Practical.

The ACG Practice Management Committee’s mission is to equip College members with accessible tools to overcome management challenges, improve operations, enhance productivity, and support physician leadership in their private and physician-led clinical practices. Learn from practicing colleagues through monthly articles on topics important to you. Articles include a topic overview, suggestions, examples, and a list of resources or references.

Toolbox topics will include

•Alternative Payment Models (APMs) •Merit-Based Incentive Program Systems (MIPS) •Medicare Compliance & Preparation for RAC Audits •Reviewing & Maximizing Revenue Cycle E orts •Reviewing & Negotiating Insurance Contracts •Patient Satisfaction Surveys & Engagement •Reviewing & Updating Informed Consent •Developing an Infection Control Plan •Professional Society Opportunities & Involvement •Quality Improvement Projects in Your Practice

"Pressures are high as gastroenterologists make important management decisions that profoundly a ect their business future, their private lives, and their ability to provide care to patients." —Louis J. Wilson, MD, FACG