AAHPM — Summer Quarterly 2012
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Stephen A. Leedy

Together We Are Stronger: Amplifying the Voice of AAHPM in the Public Policy Arena

Teamwork is essential in the field of hospice and palliative medicine. Working collaboratively as part of an interdisciplinary team provides patients and families with optimal care. Collaboration is similarly important in advocacy—few entities have the power and numbers to effect change on their own. For a smaller medical specialty society such as AAHPM, collaboration and strategic alliances are critical to advancing our policy agenda, affording opportunities to amplify hospice and palliative medicine’s voice in the health policy debate.

In recent years, AAHPM has aligned with the American Geriatrics Society, American Cancer Society, AMDA – Dedicated to Long Term Care Medicine, American Academy of Pediatrics, and Association of American Medical Colleges to bring common concerns to policy makers’ attention. Typically, one group will take the lead in identifying an advocacy opportunity, drafting a proposed initiative or response, and seeking stakeholder support to move it forward. AAHPM’s membership in the National Coalition for Hospice and Palliative Care, the American Medical Association (AMA) House of Delegates, and the Council of Medical Specialty Societies allows for regular, formal joint advocacy efforts.

Advancing Hospice and Palliative Medicine Originally established as the Hospice and Palliative Care Coalition, the National Coalition for Hospice and Palliative Care (NCHPC) was founded in 2001 when AAHPM, the Hospice and Palliative Nurses Association, and the National Hospice and Palliative Care Organization began meeting regularly. Three others organizations have since joined: the Center to Advance Palliative Care, the National Palliative Care Research Center, and the National Association of Social Work. In addition to monthly conference calls (which include the chief executive officers, volunteer leadership, and key staff), in-person meetings are held at least twice yearly. Legislative and regulatory developments are standing agenda items for the NCHPC.

AAHPM has joined its NCHPC partners to submit joint comments on proposed regulations, such as electronic health record meaningful use requirements for Medicare and Medicaid incentive programs and the definition of accountable care organizations under the Medicare Shared Savings Program. Coalition partners have also come together to nominate hospice and palliative medicine leaders to serve on bodies established to guide federal policymaking, such as the National Health Care Workforce Commission and the National Advisory Council for Healthcare Research and Quality.

When the Congressional Joint Select Committee on Deficit Reduction—the so-called Super Committee—was charged with issuing recommendations for trimming the deficit by at least $1.5 trillion over 10 years, the NCHPC sent a joint letter to committee members to protect hospice and palliative care funding. The letter suggested that lawmakers include in their recommendations policies to expand access to hospice and palliative care for all Americans, explaining how we deliver both higher quality and lower cost.

This year, the NCHPC commented on a US Department of Health and Human Services (HHS) bulletin regarding the development of healthcare insurance exchanges, which are required under the Affordable Care Act (ACA). Hospice and palliative care was not among the 10 “essential benefits” that exchange plans are required to include. NCHPC members submitted a joint letter urging the HHS Secretary to incorporate hospice and palliative care services in all future guidance and rulemaking around essential health benefits.

In March, AAHPM joined its NCHPC colleagues in submitting comments on the Patient-Centered Outcomes Research Institute’s (PCORI’s) draft National Priorities for Research and Research Agenda. Congress created PCORI in 2010 to fund research directed at providing patients, caregivers, and clinicians with evidence-based information needed to make better-informed healthcare decisions. The Coalition urged PCORI to focus on palliative care research in four key areas: knowledge gaps in pain and symptom management, knowledge gaps in the relationship between psychosocial and spiritual care interventions and outcomes, improving communication between patients and providers around goals of care and treatment choices in serious illness, and developing new models and evaluating existing models of palliative care delivery. Additional research to support patient and caregiver decision making was also recommended.

Speaking for Medicine
AAHPM’s involvement in the AMA—viewed by Congress and the Administration as “the voice of medicine”— provides additional advocacy opportunities. AAHPM has one seat in the AMA House of Delegates and our delegate, Chad D. Kollas, MD FACP FCLM FAAHPM, is also the elected chair of the Pain and Palliative Medicine Specialty Section Council, helping to guide overall AMA policy in these areas.

AMA membership also allows AAHPM to join with state and specialty medical societies in communicating concerns to policy makers. The Academy can be heard on issues that may not be the primary focus of AAHPM’s advocacy agenda, but where member interests can still be advanced. For example, AAHPM has been part of AMA-led efforts to repeal the flawed Sustainable Growth Rate (SGR) formula for Medicare physician payment. The SGR formula has called for yearly cuts in Medicare physician reimbursement for the past decade. Each time, Congress voted to push those cuts down the road. (The SGR prescribed a 29.4% cut to take effect in January 2012. Congress passed a 10-month “fix” in February.) These wranglings contribute to Medicare program instability and compromise patients’ access to care. The stop-gap measures also produce steeper future cuts and have increased the cost to repeal the formula by more than 500% over the last few years.

AAHPM has also weighed in on proposed federal regulations through AMA-led efforts, recently signing on to joint comments on a proposed rule the Centers for Medicare & Medicaid Services (CMS) issued for Conditions of Participation related to critical access hospitals. State and specialty medical societies expressed concern that the rule would give too much discretion to the hospital/health system and diminish medical staff influence, including their clinical decision making. Particularly concerning to Academy leaders were the implications for our rural members. AAHPM also joined in commenting on a CMS rule regarding reporting and returning of physician overpayments. Physicians are currently obliged to return overpayments under provisions of the ACA. The Academy signed on to a letter that highlights ways the proposed rule fails to clarify key elements of the obligation and contravenes other existing CMS overpayment initiatives. The signatories also pointed to requirements, such as a 10-year look back period, that place an undue burden on physicians.

AAHPM is a newer member of the Council of Medical Specialty Societies (CMSS), founded in 1965 as an independent forum for discussion by medical specialists of issues of national interest and mutual concern. Today, CMSS represents 38 societies with aggregate membership of 700,000 US physicians. AAHPM was among the CMSS members to sign a joint letter to CMS commenting on a proposed rule to implement the Physician Payments Sunshine Act (PPSA). The PPSA is intended to provide transparency in reporting of payments or gifts to physicians and physician ownership and investment interests. CMSS is supportive of the legislation, having provided important input into the original legislation, but signatories asked for clarification and modification of the rule to avoid unintended consequences in areas that relate to accredited and certified continuing medical education (CME), including direct physician compensation for serving as CME program faculty and indirect payments through third parties (such as grants from applicable manufacturers to CME providers). In addition, member societies are developing a joint strategy to protect graduate medical education funding from cuts during the lame duck Congress later this year.

Participation in CMSS not only advances the interests of AAHPM’s physician members, but it also brings attention to the needs of patients with serious illnesses. When late last year AAHPM submitted its comments on a US Food and Drug Administration (FDA) draft blueprint for opioid prescriber education, the Academy relayed its feedback to CMSS. CMSS incorporated many of AAHPM’s points in its own letter to the FDA, including suggesting that the agency require a basic curriculum to address differences in the care of special populations, including those with cognitive impairment and end-of-life patients, who are frequently managed by practitioners without specialist-level training.

Leadership, group process, and decision making are key considerations in determining how well any group functions, whether it is an interdisciplinary care team or a large coalition working to advance public policy goals. Together, the group can accomplish much more than any one member alone. You, too, can play a role in that advocacy. AAHPM members are encouraged to visit aahpm.org to access AAHPM’s 2012 policy priorities and learn how they can amplify the voice of hospice and palliative medicine.