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Government AffairsUpdate

Tim Laing, MD

Chair, ACR Government Affairs Committee

Objectives

• Be informed on current issues and priorities for the rheumatology community

• Understand the ACR Government Affairs structure and activities

• Feel confident that it is important to be an advocate for your patients and for your profession

Thank You!

The Big Picture

The Big Picture

The most important time in the history of medicine.

• Breakthroughs in treatment options/outcomes

• Real crises in implementation

• Growing storm of regulation

• Insurance company practices

• Transformation of payment and delivery models

• FUD

Response to the Big Picture

• Direct advocacy efforts are essential to advancing rheumatology.

• We have seen a dramatic increase in ACR influence due to this engagement.

• Members of Congress are calling on the ACR for input into major policy proposals.

• Your engagement is the key to successful outcomes

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Opportunities - 113th Congress

• Non-election year; past major election that delayed legislative productivity

• Past landmark Supreme Court decision that increased partisan legislating

• Collaboration more possible on some issues

• Real momentum to repeal, replace SGR

• Congressional leaders continue to seek ACR input in developing payment reform proposals

Challenges - 113th Congress

• Legislative environment is still very difficult

• Zero-sum legislative politics still the norm

• Harmful approaches to payment reform still in play (MedPAC, grouping specialties together)

• Major systemic challenges – budget, spending, tax issues – still clouding environment and preventing much action

TargetsTop Priorities - 2013

• Permanent SGR repeal and replacement

• Physician payment reform that values and works for rheumatology

• Eliminate specialty tier barriers to treatment (H.R. 460/Patients’ Access to Treatments Act)

• Sustain levels of federal funding for research

• Stop ICD-10 implementation

• Increase influence of ACR/ARHP members; increase number of contacts with lawmakers

What is Happening?

• Sequestration Impacting Research and Practices

• Failure of Congress’ “Super-Committee”

• Statutory $1.2 trillion cuts across-the-board

– Cut annual funding for non-exempt domestic discretionary programs by 7.8 percent (in 2013) to 5.5 percent (in 2021)

– Cut annual funding for defense programs by 10.0 percent (in 2013) to 8.5 percent (in 2021)

Sequestration

Devastating impact over time for:

– Discretionary health care programs (NIH, CDC, FDA, VA, AHRQ, FDA, etc)

–Military medicine

–Medicare (2% provider cut, on top of 25% SGR; GME; hospitals cut)

Sequestration! Research Impact

Took effect March 1st:

• Sequestration cuts, Defense – $55 billion

• Sequestration cuts, Non-Defense – $55 billion

• 5.1% Cut to NIH, other agencies

• Cut agency budgets across the board, including cutting NIH funding by $2.4 billion

• Possibility of 2,300 fewer grants because of cuts

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NIH Response to Sequester

• NIH will reduce funding levels for continuing grants and make fewer competing awards:

• Cuts made at the level of Institutes and Centers

• Cuts represent devastating blow to research institutions and scientists, especially after years of stagnant funding.

Sequestration! Practice Impact

Took effect April 1st:

• Cut Medicare physician payments 2 percent

• Cut Medicare GME funding by 2 percent despite physician shortages

• Cut Part B drug reimbursements from ASP+6% to ASP+4.3%

FY 2014 Appropriations

• Process happening Now

• New Fiscal Year begins October 1

• ACR meeting with appropriators, sending letters, participating in coalition activities

SGR Reform – This is the Year (?)

• New CBO cost estimate plummets price!

Was $244 billion, now only $138 billion *

• Cuts will continue to threaten until addressed

� Last scheduled pay cut – March 1, 2013: 26.5%

� 10-Month SGR “patch” (until Jan. 1, 2014) means

� Jan. 1, 2014 Cut estimated at 24.4%

What is ACR Doing?

Government Affairs Committee (GAC)What is GAC?

• 19 member volunteers selected by ACR Committee on Nominations

• Broad and deep expertise levels

• Meet monthly via conference call and three times in person each year

• ACR and ARHP members

• 3 year terms

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Government Affairs Committee (GAC)Prioritizing issues and advancing legislation

• How do we choose issues?

• How do we prioritize issues?

Government Affairs Committee2012-2013 GAC Members

Tim Laing, MD, Chair, Ann Arbor, MI

Deborah Desir, MD, Hamden, CT

Michael Henrickson, MD, MPH Cincinnati, OH

Joseph Huffstutter, MD, Hixson, TN

Sharon Kolasinski, MD, Camden, NJ

Matt Mundwiler, MD, Rockford, IL

Geeta Nayyar, MD, Miami, FL

Anu Sharma, MD, Bethesda, MD

Arielle Silver, MD, Voorhees, NJ

Monica Snowden, MD, Los Alamos, NM

Barton Wise, MD, Davis, CA

- continues -

Government Affairs Committee2012-2013 GAC Members

- continued -

Kimberly Kimpton, PT, Centennial, CO (ARHP Representative)

Jennifer Trizuto, MPT, San Mateo, CA (ARHP Representative

Annelle Reed, MSN, CRNP, Birmingham, AL (ARHP Representative)

Lisa Shanahan, BS, Raleigh, NC (ARHP Representative)

Candace Feldman, MD, MPH, Boston, MA (Fellows Subcommittee Representative)

Michael Ombrello, MD, Bethesda, MD (COR Representative)

Rebecca Shepherd, MD, Lancaster, PA (CORC Representative)

David Goddard, MD, Brooklyn, NY (RheumPAC Representative)

Adam Cooper, MS, Director, Government Affairs (ACR Staff)

Meredith Freed, Sr. Specialist, Government Affairs

(ACR Staff)

ACR Staff – At Your Service

• Adam Cooper: Director, Government AffairsACooper@rheumatology.org

• Meredith Freed: Sr. Specialist, Gov’t AffairsMFreed@rheumatology.org

• ACR Government Affairs (404) 633-3777

Additional Lobbying Resources

• Boots on the ground:

Dickstein Shapiro, LLP

• Senator Tim Hutchinson (R-AR)

• Congressman Albert Wynn (D-MD)

• Eyes and ears in Washington, DC

• Unparalleled access and inside intelligence

Key Issues

• Access to Rheumatology

• Access to Treatments

• Funding for Research

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Legislative Focus Areas

• Patients’ Access to Treatments Act (H.R. 460)

• SGR Repeal and Replacement Efforts

• Sequestration cuts and Medicare Part B reimbursement (H.R. 1416)

• Funding for NIH Research

• ICD-10 Implementation (H.R. 1701/S. 972)

• RBRVS

Access to Treatments – H.R. 460

Access to Treatments

• “Specialty tiers” require insured patients pay percentage of drug cost – 25% to 33% or more – rather than fixed co-pay

• No generic equivalents

• Co-insurance placing necessary treatments out of reach of insured Americans

• Increasing disability and costs to the health care system

Access to Treatments

PATA = Greater Access to Necessary Treatments

• Limits cost sharing for specialty drugs (Tier IV) to the cost sharing required for non-preferred brand drugs (Tier III).

• Limited number of people have these conditions -when risk is spread out to entire pool (insurance), any premium increases should be minimal.

• Would change lives for rheumatology patients and others who need “specialty drugs” to avoid disability, death

Access to Treatments

• Patients’ Access to Treatments Act of 2013

(H.R. 460) – reintroduced February 5th byReps. McKinley (R-WV) and Capps (D-CA)

• 45 Cosponsors currently -

• Coalition for Accessible Treatments working together to build support, move the bill

• Working for U.S. Senateintroduction and hearing

• American College of Rheumatology (Co-Chair)

• Arthritis Foundation

(Co-Chair)

• American Academy of Dermatology

• American Academy of Neurology

• American Academy of Pediatrics

• American Autoimmune Related Diseases Association

• Crohn's and Colitis Foundation of America

• Colon Cancer Alliance

• Hemophilia Federation of America

• Immune Deficiency Foundation

• Leukemia & Lymphoma Society

• Lupus Foundation of America

• National Hemophilia Foundation

• National MS Society

• National Psoriasis Foundation

• National Organization for Rare Disorders

• Patient Services Incorporated

• Sjögren's Syndrome Foundation

• Spondylitis Association

• US Hereditary Angioedema Association

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SGR ReformGoal: Permanently repeal SGR and replace it with a payment system with multiple options that takes into account the specialized care rheumatologists provide

Medicare patient access at risk aspractice margin shrinks to zero

Deficit in supply of rheumatologistsis projected to grow

SGR Reform - ACR Involvement

• House Energy & Commerce Committee

• House Ways & Means Committee

• Senate Finance Committee

• Multiple, comprehensive comment letters

• Energy & Commerce draft legislation

• Actual legislation before August

• Ongoing meetings with committee members and staff

Sequestration Cuts and Part B Reimbursement

• 2% Medicare Sequestration cut =

Disproportionate effect on reimbursement for Part B drugs, lowers rate from ASP+6% to ASP+4.3%

• H.R. 1416 by Rep. Renee Ellmers (R-NC) would exempt physician-administered drugs under Medicare part B from sequestration.

• ACR-ASCO initiative; 88 cosponsors

Rep. Renee Ellmers (R-NC)

Lead Sponsor of H.R. 1416

Sequestration Cuts and Part B Reimbursement

H.R. 1416

• 2% Medicare Sequestration cut had disproportionate effect on reimbursement for Part B drugs, lowering the rate from ASP+6% to ASP+4.3%

• H.R. 1416, introduced by Rep. Renee Ellmers (R-NC), would exempt physician-administered drugs under Medicare part B from sequestration.

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Funding for Research

• Almost all acknowledge importance of medical research, particularly NIH

• Inadequate funding threatens: jobs, investment, U.S. status as leader in innovation, life-saving research, progress toward improved treatments

• Our Goal: At Least $32 billion in NIH funding for FY 2013

Funding for NIH Research

Funding for Research

• Meeting with congressional Appropriators

• Assisting with congressional sign-on letters

• Interfacing with NIH director and Congressional leaders

• Asking for $32 billion for NIH 2014

RBRVS

Need to Better Value Specialty Care

• System rewards volume and procedures

• Face-to-face care not appropriately valued

• Not included in efforts to help primary care, E/M

• Practice viability questions; recruitment challenges

• Sent letter to RAND with suggestions

Select Legislative Victories

• Worked with AF to introduce legislation prohibiting coinsurance and excessive Tier IV cost sharing for biologics Patients’ Access to Treatments Act

• Built large coalition to promote PATA:Coalition for Accessible Treatments

• Mobilized to communicate effect of a 27% SGR cut in Medicare physician reimbursement

• Congress included SGR patch for 2013 and 2 month patch for 2% decrease for sequestration (but this is now in effect)

• Congress working on SGR replacement – soliciting ACR input in iterative process, ACR continually providing comments

• Blocked efforts to group rheumatologists with procedural-based specialists for Medicare reimbursement purposes. Legislation modified.

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RheumPACWhat is it? How does it work?

• Non-partisan political action committee

• Increase access to Congress and educate lawmakers

• Contributions approved by RheumPAC committee

• Ensures those who support rheumatology are elected and remain in Congress

Ed Herzig, MD

RheumPAC Chair

RheumPACAnnual Growth

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

2007 2008 2009 2010 2011 2012

RheumPAC Growth 2007-2012

Receipts

Disbursements

RheumPAC2012 Accomplishments

• Exceeded fundraising goal by raising a record $128,341

• Contributed a record $108,500 to congressional candidates – nearly 50/50 bipartisan contributions

• Over 90% of candidates supported in 2012 cycle won their elections

Why is RheumPAC So Important?

• Face-to-face meetings with lawmakers who have jurisdiction over our issues

• Opportunities to educate lawmakers

• Build and maintain key relationships

• Support candidates who support rheumatology so they remain in Congress

What Can YOU Do?

We (You) Must Lead

• In uncertain times, physician leadership is imperative to chart the right course

• Medical profession can’t control Washington

• We can influence public policy

• We can show leadership on key issues

• We can offer our ideas

• The public and decision makers will listen

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Constituents Hold the Power

• Members of Congress are constantly campaigning

• Lawmakers listen and respond to constituent interests in order to win re-election

• They are hearing from other constituents –are they hearing from YOU??

Engagement with Policy Makers

ACR/ARHP Member Engagement

• We need you to coordinate Meetings In-District in August / any time your members of Congress are at home

• Grassroots OutreachDirect member communicationSupplementing ACR staff contacts and meetings on Capitol Hill

• Coordination with RheumPAC/Events

• Fly-In Initiatives

122

111

117 117

145

2008 2009 2010 2011 2012

Number of Advocates

Advocates for Arthritis

Fly-In

Washington, D.C.

34

37

32

35

44

2008 2009 2010 2011 2012

States Represented

Advocates for Arthritis

ACR Advocacy Fly-In Takes Off

Advocates for Arthritis

Advocates for ArthritisSeptember 9-10, 2013

Applications open now!

Visit www.rheumatology.org/advocacy

Becoming an Advocacy Leaderis Easy and Very Rewarding

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Tim Laing, MDChair, Government Affairs Committee

Questions?