Let the Show Begin!Let the Show Begin!D.O. Day on the Hill 2007D.O. Day on the Hill 2007

Dana M. Block, OMS-IVDana M. Block, OMS-IV

SOMA National Director of Political AffairsSOMA National Director of Political Affairs

IntroductionIntroduction Purpose:Purpose: to inform osteopathic medical students to inform osteopathic medical students

of the specific issues, and respective background of the specific issues, and respective background information on the issues, we will be lobbying at information on the issues, we will be lobbying at D.O. Day on the HillD.O. Day on the Hill

This presentation is part III of III of the SOMA This presentation is part III of III of the SOMA Political Action Training Course (PATC), completion Political Action Training Course (PATC), completion of which is recommended for all D.O. Day on the of which is recommended for all D.O. Day on the Hill participantsHill participants

Completion of the SOMA PATC is one requirement Completion of the SOMA PATC is one requirement for induction into Omega Beta Iota (for induction into Omega Beta Iota (ΩΒΙΩΒΙ), the ), the national osteopathic political action honor society national osteopathic political action honor society (exceptions will be made for 2007 (exceptions will be made for 2007 ΩΒΙΩΒΙ inductees, inductees, as this is the first SOMA PATC to be given as this is the first SOMA PATC to be given

Presentation OverviewPresentation Overview

Act I: The IssuesAct I: The Issues Act II: SpecificsAct II: Specifics

Osteopathic MedicineOsteopathic Medicine Medicare Physician ReimbursementMedicare Physician Reimbursement Resident Physician ShortagesResident Physician Shortages State Children’s Health Insurance Program State Children’s Health Insurance Program

(SCHIP)(SCHIP) Act III: Grand FinaleAct III: Grand Finale

D.O. Day AgendaD.O. Day Agenda Your responsibilities prior to the eventYour responsibilities prior to the event

Act I: The IssuesAct I: The Issues Osteopathic MedicineOsteopathic Medicine

Inform your legislators of who we are and the D.O. Inform your legislators of who we are and the D.O. differencedifference

Medicare Physician ReimbursementMedicare Physician Reimbursement Encourage replacement of the current Medicare formula Encourage replacement of the current Medicare formula

used to calculate physician reimbursementused to calculate physician reimbursement

Graduate Medical EducationGraduate Medical Education Request support for increased access to residency training Request support for increased access to residency training

programsprograms

State Children’s Health Insurance Program (SCHIP)State Children’s Health Insurance Program (SCHIP) Suggest health coverage for more of America’s children Suggest health coverage for more of America’s children

through passage of SCHIP-related legislationthrough passage of SCHIP-related legislation

Act II: SpecificsAct II: Specifics

Osteopathic MedicineOsteopathic Medicine You are already experts on this topic!! That means You are already experts on this topic!! That means

you are inherently 25% prepared for the big day!you are inherently 25% prepared for the big day!

Potential items to discuss:Potential items to discuss: The principles of osteopathic medicineThe principles of osteopathic medicine Your training Your training The D.O. difference when it comes to provision of The D.O. difference when it comes to provision of

healthcarehealthcare

Do not spend too much time on this topic, as there Do not spend too much time on this topic, as there are three other topics to discuss in a short amount are three other topics to discuss in a short amount of time!of time!

Act II: SpecificsAct II: SpecificsMedicare Physician Medicare Physician

ReimbursementReimbursementMedicare Physician Reimbursement Medicare Physician Reimbursement

(MPR)(MPR)This topic has been EFFECTIVELY lobbied at This topic has been EFFECTIVELY lobbied at

the past few D.O. Days on the Hill! the past few D.O. Days on the Hill! Our efforts have helped secure reimbursement Our efforts have helped secure reimbursement

rates at those of 2001 instead of the rates at those of 2001 instead of the reimbursement rates dropping annuallyreimbursement rates dropping annually

However, the cost of healthcare provision However, the cost of healthcare provision continues to rise and there is a predicted continues to rise and there is a predicted 8-10% 8-10% REDUCTIONREDUCTION in Medicare physician in Medicare physician payment rates for 2008!payment rates for 2008!

Act II: SpecificsAct II: SpecificsMedicare Physician Medicare Physician

ReimbursementReimbursement Background informationBackground information

Timeline:Timeline:1989: Omnibus Budget Reconciliation Act (OBRA) 1989: Omnibus Budget Reconciliation Act (OBRA)

established a fee schedule for Medicare physician established a fee schedule for Medicare physician reimbursements (MPR)reimbursements (MPR)

1992: OBRA went into effect1992: OBRA went into effect2002: MPR cut 5.4% (due to incorrect estimates on 2002: MPR cut 5.4% (due to incorrect estimates on

future spending by the Centers for Medicare and future spending by the Centers for Medicare and Medicaid Services (CMS), a failing economy, etc)Medicaid Services (CMS), a failing economy, etc)

2003: Congress approved 1.6% increase in MPR2003: Congress approved 1.6% increase in MPR2004 and 2005: Congress approved 1.5% increase in 2004 and 2005: Congress approved 1.5% increase in

MPRMPR2006 and 2007: 0% increase in MPR; Congress 2006 and 2007: 0% increase in MPR; Congress

approved maintaining MPR at 2005 rateapproved maintaining MPR at 2005 rate2008: Predicted 2008: Predicted decreasedecrease in MPR of 8-10%! This in MPR of 8-10%! This

would place MPR at levels lower than in 2001!would place MPR at levels lower than in 2001!

Act II: SpecificsAct II: SpecificsMedicare Physician Medicare Physician

ReimbursementReimbursementBackground information cont’dBackground information cont’d

A fee schedule is used to determine A fee schedule is used to determine Medicare payments for physician servicesMedicare payments for physician servicesThis fee schedule assigns This fee schedule assigns relative valuesrelative values to to

services that reflect physician work, practice services that reflect physician work, practice expenses, and medical liability costs; these expenses, and medical liability costs; these relative values are then adjusted for relative values are then adjusted for geographic variations in costgeographic variations in cost

A A conversion factor conversion factor is utilized to assign a is utilized to assign a dollar payment amount to the adjusted dollar payment amount to the adjusted relative values relative values

Act II: SpecificsAct II: SpecificsMedicare Physician Medicare Physician

ReimbursementReimbursement Background information cont’d:Background information cont’d:

The The flawedflawed conversion factor conversion factorThe conversion factor used to designate dollar The conversion factor used to designate dollar

amounts to physician services is updated annually amounts to physician services is updated annually The annual update to the conversion factor is The annual update to the conversion factor is

dependent upon several factors:dependent upon several factors: Medicare economic index (MEI): measures inflation on Medicare economic index (MEI): measures inflation on

the inputs needed to produce physician’s servicesthe inputs needed to produce physician’s services Sustainable growth rate (SGR): sets a target for Sustainable growth rate (SGR): sets a target for

Medicare spending growth for physician’s servicesMedicare spending growth for physician’s services Performance adjustment factor (PAF): modifies the Performance adjustment factor (PAF): modifies the

annual update by adjusting the MEI to account for the annual update by adjusting the MEI to account for the SGAR targetSGAR target

Act II: SpecificsAct II: SpecificsMedicare Physician Medicare Physician

ReimbursementReimbursement Background information cont’dBackground information cont’d

The flawed conversion factorThe flawed conversion factorBasically, if Basically, if moremore services are performed in a year, services are performed in a year,

the dollar amount reimbursed is the dollar amount reimbursed is reducedreduced to account to account for the high volume in an attempt to restrain overall for the high volume in an attempt to restrain overall increases in Medicare spending for physician servicesincreases in Medicare spending for physician services

Obviously, there is a problem with this system!Obviously, there is a problem with this system!

If you are interested in more information on If you are interested in more information on any of the topics briefly discussed above, visit any of the topics briefly discussed above, visit the AOA’s DO Day Briefing Center online at the AOA’s DO Day Briefing Center online at www.do-online.or/index.cfm?PageIDwww.do-online.or/index.cfm?PageID==gov_dodaybriefctrgov_dodaybriefctr

Act II: SpecificsAct II: SpecificsMedicare Physician Medicare Physician

ReimbursementReimbursement The “Ask”The “Ask”

Eliminate the use of the SGR in the conversion Eliminate the use of the SGR in the conversion formula and replace it with a payment formula formula and replace it with a payment formula that accurately compensates physicians for that accurately compensates physicians for their services, reflects actual costs of care, and their services, reflects actual costs of care, and is adjusted annually based upon inflationis adjusted annually based upon inflation

If the SGR formula cannot be immediately If the SGR formula cannot be immediately repealed, then Congress must pass legislation repealed, then Congress must pass legislation to eliminate the SGR formula by a certain date to eliminate the SGR formula by a certain date and with a specific plan outlinedand with a specific plan outlined

Act II: SpecificsAct II: SpecificsMedicare Physician Medicare Physician

ReimbursementReimbursement Talking pointsTalking points

Improper reimbursement has prevented some Improper reimbursement has prevented some physicians from making needed investments in physicians from making needed investments in staff and health information technologystaff and health information technology

Essentially punishes physicians for participating Essentially punishes physicians for participating in initiatives that improve preventive care in initiatives that improve preventive care measures and reduce hospitalizationsmeasures and reduce hospitalizations

Utilization of physician services grows more Utilization of physician services grows more rapidly than the gross domestic product reflects rapidly than the gross domestic product reflects (the GDP is one item used to calculate the SGR)(the GDP is one item used to calculate the SGR)

Act II: SpecificsAct II: SpecificsMedicare Physician Medicare Physician

ReimbursementReimbursement Talking points cont’dTalking points cont’d

Access to care issue:Access to care issue: IMPORTANTIMPORTANT to legislators! to legislators! Increasing numbers of Medicare beneficiaries are having Increasing numbers of Medicare beneficiaries are having

difficulty finding new primary care and specialist difficulty finding new primary care and specialist physiciansphysicians

AOA surveys of D.O.’s have demonstrated that a majority AOA surveys of D.O.’s have demonstrated that a majority will have to decrease or completely stop accepting new will have to decrease or completely stop accepting new Medicare patients if additional payment cuts in the MPR Medicare patients if additional payment cuts in the MPR are implementedare implemented

The Congressional Council on Graduate Medical Education The Congressional Council on Graduate Medical Education is predicting a shortage of 85,000 physicians by 2020; is predicting a shortage of 85,000 physicians by 2020; Medicare cuts will exacerbate this shortage by making Medicare cuts will exacerbate this shortage by making medicine a less attractive careermedicine a less attractive career

Do you have personal experiences or patient stories that Do you have personal experiences or patient stories that are evidence of this issue? Think about it!are evidence of this issue? Think about it!

Act II: SpecificsAct II: SpecificsMedicare Physician Medicare Physician

ReimbursementReimbursementTalking points cont’dTalking points cont’d

Access to physicians improves quality of Access to physicians improves quality of lifelifeMedical advances added approximately 6 Medical advances added approximately 6

months to senior’s life spans between 1999 months to senior’s life spans between 1999 and 2002 aloneand 2002 alone

Deaths from heart disease and CVAs have Deaths from heart disease and CVAs have been falling by about 3% per yearbeen falling by about 3% per year

Cancer death rate over last decade has Cancer death rate over last decade has decreased by 1% per yeardecreased by 1% per year

Cost of care vs. benefits of the care receivedCost of care vs. benefits of the care receivedCuts in physician payments are not the way to Cuts in physician payments are not the way to

improve Medicare’s financial sustainability!improve Medicare’s financial sustainability!

Act II: SpecificsAct II: SpecificsResident Physician ShortagesResident Physician Shortages

Resident Physician ShortagesResident Physician Shortages Senate Bill 588, “Resident Physician Shortage Senate Bill 588, “Resident Physician Shortage

Reduction Act of 2007” (bipartisan bill)Reduction Act of 2007” (bipartisan bill)

House Resolution 1093, “Resident Physician House Resolution 1093, “Resident Physician Shortage Reduction Act of 2007” (bipartisan bill)Shortage Reduction Act of 2007” (bipartisan bill)

This Act will increase federal funding for This Act will increase federal funding for residency training programs in states with a residency training programs in states with a shortage of residents to meet their healthcare shortage of residents to meet their healthcare needsneeds

Act II: SpecificsAct II: SpecificsResident Physician ShortagesResident Physician Shortages

Background informationBackground informationTeaching hospitals rely on federal Teaching hospitals rely on federal

government reimbursements (Medicare) government reimbursements (Medicare) to train residents to train residents

The Balanced Budget Act (BBA) of 1997 The Balanced Budget Act (BBA) of 1997 placed limits (“caps”) on the number of placed limits (“caps”) on the number of physician residents who are eligible for physician residents who are eligible for reimbursement under Medicarereimbursement under Medicare

Hospitals are therefore not reimbursed Hospitals are therefore not reimbursed by the federal government for training by the federal government for training any residents above the allotted “cap”any residents above the allotted “cap”

Act II: SpecificsAct II: SpecificsResident Physician ShortagesResident Physician Shortages

Background information cont’dBackground information cont’dThe Act would provide additional The Act would provide additional

Medicare funding to expand the number Medicare funding to expand the number of approved residency positions in of approved residency positions in states with a shortage of residentsstates with a shortage of residents““Shortage” is defined as the ratio of Shortage” is defined as the ratio of

enrollees in all approved medical residency enrollees in all approved medical residency training programs within the state per training programs within the state per 100,000 people being less than the national 100,000 people being less than the national median level of residents median level of residents

The AAMC defines the national median level The AAMC defines the national median level of residents currently as 25 residents per of residents currently as 25 residents per 100,000 people100,000 people

Act II: SpecificsAct II: SpecificsResident Physician ShortagesResident Physician Shortages

Background information cont’dBackground information cont’dThe Act would increase the number of The Act would increase the number of

new resident positions eligible for federal new resident positions eligible for federal Medicare funding in qualified states over Medicare funding in qualified states over the course of 5 yearsthe course of 5 years

Each state, overseen by the US Secretary Each state, overseen by the US Secretary of Health and Human Services, is of Health and Human Services, is responsible for allocating residency responsible for allocating residency positions based on the needs of the positions based on the needs of the communitycommunityPrimary care, preventive medicine, and Primary care, preventive medicine, and

geriatrics in particulargeriatrics in particular

Act II: SpecificsAct II: SpecificsResident Physician ShortagesResident Physician Shortages

The “Ask”The “Ask”Encourage your legislators to cosponsor Encourage your legislators to cosponsor

S. 588/H.R. 1093S. 588/H.R. 1093

Act II: SpecificsAct II: SpecificsResident Physician ShortagesResident Physician Shortages

Talking pointsTalking points The “caps” placed on physician training programs by the The “caps” placed on physician training programs by the

Balanced Budget Act of 1997 do not adjust for Balanced Budget Act of 1997 do not adjust for population growthpopulation growth

Physician shortages are occurring or are threatening to Physician shortages are occurring or are threatening to occur in many states as populations continue to grow occur in many states as populations continue to grow and as the general population agesand as the general population ages

Physicians have a tendency to remain in the area in Physicians have a tendency to remain in the area in which they complete their medical training, therefore which they complete their medical training, therefore increasing the size of residency programs within increasing the size of residency programs within particular states should ensure an adequate physician particular states should ensure an adequate physician workforce for that state’s populationworkforce for that state’s population

Again, do you have any personal stories to share?Again, do you have any personal stories to share?

Act II: Specifics Act II: Specifics State Children’s Health Insurance State Children’s Health Insurance

Program (SCHIP)Program (SCHIP)State children’s Health Insurance State children’s Health Insurance

Program (SCHIP)Program (SCHIP)

Senate Bill 895Senate Bill 895

House Resolution 1535House Resolution 1535

Basic principle is to provide more Basic principle is to provide more children with access to healthcarechildren with access to healthcare

Act II: SpecificsAct II: SpecificsSCHIPSCHIP

Background InformationBackground Information Amends portion of the Social Security Act to Amends portion of the Social Security Act to

grant states the option to expand health grant states the option to expand health coverage of children belonging to families with coverage of children belonging to families with income up to 400% of the poverty lineincome up to 400% of the poverty line

Provides subsidies for employment-based Provides subsidies for employment-based coverage of eligible childrencoverage of eligible children

Authorizes states to offer purchase of coverage Authorizes states to offer purchase of coverage for ineligible childrenfor ineligible children

Requires coverage of screening, diagnostic, Requires coverage of screening, diagnostic, and treatment services and treatment services

Act II: SpecificsAct II: SpecificsSCHIPSCHIP

The “Ask”The “Ask” Has not officially been provided by the AOA at Has not officially been provided by the AOA at

this point in time, but will most likely this point in time, but will most likely encourage support and/or co-sponsorship of encourage support and/or co-sponsorship of the legislationthe legislation

Talking pointsTalking points Again, have not officially been provided by the Again, have not officially been provided by the

AOA at this point in time; should be included in AOA at this point in time; should be included in information distributed at D.O. Dayinformation distributed at D.O. Day

Act II: SpecificsAct II: Specifics

For additional, more detailed information For additional, more detailed information on any of the topics we are scheduled to on any of the topics we are scheduled to discuss at D.O. Day, please visit:discuss at D.O. Day, please visit: www.do-online.org/index.cfm?PageID=gov_dodaybriefctrwww.do-online.org/index.cfm?PageID=gov_dodaybriefctr

To learn about your legislator’s stance on To learn about your legislator’s stance on the slated issues, visit the online DO the slated issues, visit the online DO Advocacy Action Center:Advocacy Action Center: http://capwiz.com/aoa-aoia/issues/http://capwiz.com/aoa-aoia/issues/ Enter your zip code (where you are registered Enter your zip code (where you are registered

to vote) on the website to find your respective to vote) on the website to find your respective legislators!legislators!

Act II: SpecificsAct II: Specifics

You will have an opportunity to become You will have an opportunity to become reacquainted with these issues on at least reacquainted with these issues on at least two other occasions prior to lobbying:two other occasions prior to lobbying:

Student informational session by the AOA Student informational session by the AOA Department of Government Regulations, the Department of Government Regulations, the evening of Wednesday, April 25, 2007evening of Wednesday, April 25, 2007

Held at the Embassy Suites, where the SOMA Held at the Embassy Suites, where the SOMA Convention is being heldConvention is being held

Policy Briefing on Thursday, April 26, 2007Policy Briefing on Thursday, April 26, 2007

Act III: Grand FinaleAct III: Grand Finale

D.O. Day Agenda: Thursday, 4/26/07D.O. Day Agenda: Thursday, 4/26/07

6:30 and 6:45 am: buses depart Embassy 6:30 and 6:45 am: buses depart Embassy Suites for AOA hotelSuites for AOA hotel

7:00 am: registration and breakfast7:00 am: registration and breakfast

8:00 am: welcome, opening remarks, keynote 8:00 am: welcome, opening remarks, keynote speakerspeaker

9:00 am: program overview and briefing 9:00 am: program overview and briefing packet reviewpacket review

Act III: Grand FinaleAct III: Grand Finale

D.O. Day Agenda cont’dD.O. Day Agenda cont’d

9:20 to 10:20 am: policy briefing (a.k.a. review #3 of 9:20 to 10:20 am: policy briefing (a.k.a. review #3 of the issues to be lobbied)the issues to be lobbied)

10:30 am: leave for Capitol Hill10:30 am: leave for Capitol Hill

12:00 to 6:00 pm: meetings with legislators and staffers12:00 to 6:00 pm: meetings with legislators and staffers

Anytime: lunch (vouchers can be used in any House Anytime: lunch (vouchers can be used in any House cafeteria)cafeteria)

6:00 to 7:00 pm: D.O. Day reception at Renaissance 6:00 to 7:00 pm: D.O. Day reception at Renaissance Washington HotelWashington Hotel

Act III: Grand FinaleAct III: Grand Finale What to bring to D.O. DayWhat to bring to D.O. Day

White coat!! (this usually indicates that there will be a White coat!! (this usually indicates that there will be a press conference)press conference)

Comfortable shoes!!Comfortable shoes!!

Professional outfit (i.e. pantsuit)Professional outfit (i.e. pantsuit)

Pen and paper to take notes during meetingsPen and paper to take notes during meetings

CameraCamera

SmileSmile

Act III: Grand FinaleAct III: Grand Finale

To prepare mentally for the lobbying To prepare mentally for the lobbying experience, please review part II of experience, please review part II of the SOMA PATC, which is available the SOMA PATC, which is available online at online at www.studentdo.comwww.studentdo.com

Remember to write your thank-you Remember to write your thank-you notes to your legislators at the end of notes to your legislators at the end of the daythe day

The End!!!The End!!!

THANK YOU FOR YOUR ATTENTION!!!

QUESTIONS?