AAHPM Fall Quarterly 2011 : Page 8

ADVOCACY UPDATE Member Survey Confirms Academy on Track with Advocacy Efforts Stephen A. Leedy, MD FAAHPM As I write this, sitting here in West Central Florida in August, it is hard to not think about water. It’s not just that I’m surrounded by it—the Gulf of Mexico to the west and Tampa Bay to the east—but it also falls from the sky nearly every day in ferocious, though briefly lived, tor-rents. Water strikes me as an excellent thematic format in which to discuss the current public policy climate for hospice and palliative medicine. We are at a watershed moment in the history of our spe-cialty. For hospice and palliative medicine, that is a good thing. Movements are created and initially sustained by visionary charismatic leaders. To survive long term, how-ever, movements need to become normalized and viewed as part of everyday practice. Attaining American Board of Medical Specialties subspecialty recognition was only the start of this transformation. It is imperative that we advocate for the incorporation of hospice and palliative medicine principles into any initiative aimed at reforming the healthcare system. Nothing normalizes a movement faster than having its core principles integrated into pub-lic policy. AAHPM understands the significance of this. In a spring 2011 member survey, just over 95% of respondents indi-cated that it was important or extremely important for AAHPM to amplify the voice of hospice and palliative medicine through advocacy and public awareness efforts. The Academy’s Public Policy Committee is tasked with coordinating this advocacy. Although we are flattered by the roughly 80% of survey respondents who indicated being satisfied or extremely satisfied with current advo-cacy initiatives, we are increasing our efforts in hopes of similarly impressing the 20% who were not. The size of the committee has recently been increased to better facilitate this, and two committee working groups, which I will describe further below, have been convened. It is also important that we ensure that this time of great change not become our Waterloo. As Napoleon discovered at that infamous conflict, one needs to pick one’s battles wisely. Many of the issues relevant to our specialty at this moment (eg, access to opioids, advance care planning) are also debated on much larger state and national political stages, with messaging quite different from ours. Repeated exposure of the general public to this so-called conventional wisdom—often a politically motivated substitute for real knowledge—eventually elevates it to the status of truth in the eyes of the public. A not-entirely facetious oversimplification of the current conventional wisdom would go something like this: opi-oids are bad, advance care planning discussions are bad, and hospice is bad. Stepping into the melee to disagree with these “truths” requires caution and careful planning. Addressing Key Issues AAHPM continues to engage the US Food and Drug Administration in an effort to ensure access to opioids for our patients in need, an advocacy issue that 69% of survey respondents considered important. Our communi-cations suggest that the Academy appreciates the need to address drug abuse/misuse but also stress the impor-tance of a balanced approach. At the same time, the Public Policy Committee is tracking related bills in the current session of Congress. We will continue to weigh in whenever appropriate to express concerns that multiple, overlapping initiatives do not serve to impede access to these medication for patients with legitimate need. Just about two-thirds of survey respondents indicated it was important for AAHPM to promote advance care planning, with more than 77% noting it was important to advocate for reimbursement for physician time spent in such patient/family consultation. After Oregon Congress-man Earl Blumenauer’s effort to provide for Medicare/ Medicaid coverage of voluntary advance care planning consultation was distorted during the healthcare reform debate, AAHPM offered advice and counsel on how he might craft a stand-alone bill that addressed this and other related matters. The “Personalize Your Care Act of 2011” was introduced earlier this year with the Academy’s endorsement. AAHPM also provided relevant testimony before the American Medical Association (AMA), which this summer adopted a resolution calling for a national dialogue by interested parties to redirect discussions of end-of-life issues and voted to encourage the Centers for Medicare and Medicaid Services (CMS) to designate voluntary discussions about end-of-life care as covered services in the 2012 Medicare Physician Fee Schedule. Former Public Policy Committee Chair Chad D. Kollas, MD FACP FCLM FAAHPM, is AAHPM’s representative in the AMA House of Delegates and champions our field’s causes before that body. It is imperative that we advocate for the incorporation of hospice and palliative medicine principles into any initiative aimed at reforming the healthcare system.

ADVOCACY UPDATE

Stephen A. Leedy

Member Survey Confirms Academy on Track with Advocacy Efforts As I write this, sitting here in West Central Florida in August, it is hard to not think about water. It’s not just that I’m surrounded by it—the Gulf of Mexico to the west and Tampa Bay to the east—but it also falls from the sky nearly every day in ferocious, though briefly lived, torrents. Water strikes me as an excellent thematic format in which to discuss the current public policy climate for hospice and palliative medicine. We are at a watershed moment in the history of our specialty. For hospice and palliative medicine, that is a good thing. Movements are created and initially sustained by visionary charismatic leaders. To survive long term, however, movements need to become normalized and viewed as part of everyday practice. Attaining American Board of Medical Specialties subspecialty recognition was only the start of this transformation. It is imperative that we advocate for the incorporation of hospice and palliative medicine principles into any initiative aimed at reforming the healthcare system. Nothing normalizes a movement faster than having its core principles integrated into public policy. AAHPM understands the significance of this. In a spring 2011 member survey, just over 95% of respondents indicated that it was important or extremely important for AAHPM to amplify the voice of hospice and palliative medicine through advocacy and public awareness efforts. The Academy’s Public Policy Committee is tasked with coordinating this advocacy. Although we are flattered by the roughly 80% of survey respondents who indicated being satisfied or extremely satisfied with current advocacy initiatives, we are increasing our efforts in hopes of similarly impressing the 20% who were not. The size of the committee has recently been increased to better facilitate this, and two committee working groups, which I will describe further below, have been convened. It is also important that we ensure that this time of great change not become our Waterloo. As Napoleon discovered at that infamous conflict, one needs to pick one’s battles wisely. Many of the issues relevant to our specialty at this moment (eg, access to opioids, advance care planning) are also debated on much larger state and national political stages, with messaging quite different from ours. Repeated exposure of the general public to this so-called conventional wisdom—often a politically motivated substitute for real knowledge—eventually elevates it to the status of truth in the eyes of the public. A not-entirely facetious oversimplification of the current conventional wisdom would go something like this: opioids are bad, advance care planning discussions are bad, and hospice is bad. Stepping into the melee to disagree with these “truths” requires caution and careful planning. Addressing Key Issues AAHPM continues to engage the US Food and Drug Administration in an effort to ensure access to opioids for our patients in need, an advocacy issue that 69% of survey respondents considered important. Our communications suggest that the Academy appreciates the need to address drug abuse/misuse but also stress the importance of a balanced approach. At the same time, the Public Policy Committee is tracking related bills in the current session of Congress. We will continue to weigh in whenever appropriate to express concerns that multiple, overlapping initiatives do not serve to impede access to these medication for patients with legitimate need. Just about two-thirds of survey respondents indicated it was important for AAHPM to promote advance care planning, with more than 77% noting it was important to advocate for reimbursement for physician time spent in such patient/family consultation. After Oregon Congressman Earl Blumenauer’s effort to provide for Medicare/ Medicaid coverage of voluntary advance care planning consultation was distorted during the healthcare reform debate, AAHPM offered advice and counsel on how he might craft a stand-alone bill that addressed this and other related matters. The “Personalize Your Care Act of 2011” was introduced earlier this year with the Academy’s endorsement. AAHPM also provided relevant testimony before the American Medical Association (AMA), which this summer adopted a resolution calling for a national dialogue by interested parties to redirect discussions of end-of-life issues and voted to encourage the Centers for Medicare and Medicaid Services (CMS) to designate voluntary discussions about end-of-life care as covered services in the 2012 Medicare Physician Fee Schedule. Former Public Policy Committee Chair Chad D. Kollas, MD FACP FCLM FAAHPM, is AAHPM’s representative in the AMA House of Delegates and champions our field’s causes before that body. Seventy-five percent of survey respondents felt that increasing funding for graduate medical education and faculty development in palliative care and hospice was essential, and more than half cited advancing a palliative care training bill as key. AAHPM has been working closely with Senator Ron Wyden of Oregon to craft such a bill and is now seeking a potential cosponsor to help introduce the Palliative Care and Hospice Education and Training Act. This measure would establish a palliative care academic career award and create palliative care education centers through the US Health Resources and Services Administration. The highest rated public policy concern on AAHPM’s member survey was ensuring that palliative care and hospice are represented in emerging healthcare payment and delivery models, with more than 91% of respondents marking this as significant. With this in mind, I liken us to surfers, up early and the first to paddle out on a calm sea, waiting patiently on our boards. But it’s later now, and the sea is crowded, and a big wave is coming in. Are we positioned to catch it? Being here first does not necessarily guarantee our success. If our vigilance wanes, the wave could easily pass us by, propelling many of the latecomers to glory as we float again on an empty sea, alone and wondering what happened. The Public Policy Committee has a task force focused on this matter. The Emerging Payment/Delivery Models Working Group, chaired by Phil Rodgers, MD FAAHPM, remains abreast of developing federal initiatives, including those related to accountable care organizations (ACOs) and the patient-centered medical home. Their charge is to advocate for palliative care and hospice care to be recognized and included in the laws and regulations defining these new models — to make sure that we catch this particular wave. (See the summer 2011 issue of the Quarterly for an overview of the Academy’s comments to CMS regarding the proposed rule defining ACOs.) State-Level Advocacy Of course, state-level policy developments are increasingly impacting members and their patients, so it is no surprise that half of the member survey respondents said they would appreciate resources to tackle these issues. The Public Policy Committee has established a State Policy Issues Working Group, chaired by Gregg VandeKieft, MD MA FAAHPM, to help identify areas of synergy across states so that best practices can be shared or advocacy efforts combined. Defending the Medicaid Hospice Benefit and ensuring ongoing patient access to opioids in the face of prescription drug monitoring programs are two key issues followed by this group. In October, Dr. VandeKieft and I will represent AAHPM at the annual meeting of the State Hospice Organization Executives Roundtable. We will make a presentation and investigate opportunities to collaborate on state-level advocacy efforts. But, next on the agenda is the Academy’s Capitol Hill Days—a fly-in to Washington, DC, that will provide an opportunity for participating AAHPM members to liaise with members of Congress and other federal officials to champion the Academy’s priorities. They’ll be looking to catch the healthcare reform wave and advance our specialty by having our core principles incorporated in public policy. In the interest of space—it is a fly-in, after all— we’ve asked them to leave their surfboards at home.

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