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- Sandeep Kumar Krishnan, MD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Sandeep Kumar Krishnan, Cardiovascular Diseases, Cedars-Sinai Medical Center, Los Angeles, California.
Every time I walk between the U.S. Capitol and the Supreme Court in Washington, D.C., I feel inspired. Its magnificence, its place in history, and its importance to our everyday practice of medicine and cardiology: this is, after all, what our founding fathers intended. They wanted Americans to visit the nation's capital and have the opportunity to advocate for the organizations they represent. For the American College of Cardiology (ACC), this means working with legislators to make our health care system work better for both patients and cardiovascular teams around the country. As I gain more experience in the realm of advocacy, I realize just how vital it is for fellows-in-training to get and stay involved with the ACC’s efforts.
At the 2015 ACC Legislative Conference, we were charged with 4 “asks” for our congressmen and congresswomen: 1) thank them for passing the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) and urge Congress to work with medical specialty societies and federal agencies to develop alternative payment models; 2) increase pressure on electronic health record companies to help encourage them to improve interoperability between health record systems and promote transparency of vendor contracts by making nondisclosure clauses, now commonplace, illegal; 3) support new funding for the National Institutes of Health and U.S. Food and Drug Administration at the levels provided in the House-passed 21st Century Cures Act; and 4) cosponsor HR 3355/S 488, a bill to expand access to cardiac rehabilitation by allowing mid-level providers to directly supervise cardiac and pulmonary rehabilitation programs.
During my time on the Hill, I personally met with 2 congressmen from California (Representatives Brad Sherman and Ted Lieu of the 30th and 33rd Congressional districts, respectively) and a senior legislative aide from a third congressman’s office from California (Representative Adam Schiff from the 28th district). Although this was not my first time on the Hill (I worked as an intern in a congressional office during medical school and have been back several times for other medical advocacy activities), every time I visit the Hill, I feel like a child who just finished trick-or-treating and is returning home filled with elation and a jack-o-lantern full of candy. It is an honor to go to our nation’s capital and meet with our elected congressmen and congresswomen. I feel extremely grateful to live in a free society in which we, the citizens, wield control over the laws that govern us. It is our civic duty and responsibility to stay involved in the political process and have our voices heard to ensure that our government can live up to the ideals upon which it was founded—freedom, justice, and equality.
I feel privileged that our cardiovascular societies recognize the importance of advocacy and have worked over the past several decades to establish themselves as trusted and respected partners to Congress on health care issues. During my most recent visit to the Hill as a representative of the ACC, I had the opportunity to interact with many U.S. representatives and senators—many of whom mentioned their high regard for the College. This is a reflection of the years of hard work and dedication that prior generations of cardiologists have poured into the ACC and the ACC’s Political Action Committee (PAC).
Now, it is our turn as fellows-in-training to step up and build upon the foundation laid by our predecessors. As cardiologists, we are well-regarded on the Hill for staying engaged, being inclusive, and always putting our patients first. Thus, we should do everything we can to ensure that we continue to improve the stature of our profession in the eyes of our patients and our legislators. Our power as health care providers to help our patients is limited to the resources provided by the system in which we practice. We are concerned with our patients’ inability to afford and access cardiac rehabilitation; however, our means to solve this system-wide issue are limited without the help of state and federal legislation. If we band together and inform Congress about these issues, it is likely that we can create change. Sometimes, in our gridlocked political climate, it is hard to see any recognizable change from our efforts on the Hill; many often cite this as the reason for not being more involved. Yet, eventually change comes about. It is because of the efforts of the College and many other physician groups over almost 2 decades that the sustainable growth rate finally was repealed and replaced with a new reimbursement system to pave the way forward to a financially sustainable future in medicine.
I hope that I have provided more than a few reasons to encourage participation. Every year that I participate in advocacy activities, I work with someone who has never previously been to the Hill. The prevailing attitude I hear from these newcomers is how easy and rewarding it is to get involved; once involved, they realize the importance of staying involved. Regardless of your level of prior advocacy experience, I would strongly encourage my cofellows in the United States to learn about the issues and find ways to get involved at the local, state, or national levels. Finally, as Dr. Eugene Sherman, during the ACC's Annual Legislative Conference in October 2015 said, “If you are not at the table, you will be on the legislative menu.” I think that a seat at the dinner table is worth your time and commitment for the sake of our patients and our profession; do you?
- Ralph G. Brindis, MD, MPH ()
RESPONSE: Cardiovascular Advocacy
Its Role and Importance for the Cardiovascular Professional
Cardiovascular professionalism encompasses medicine’s long-standing social contract focusing on the primacy of patient welfare, patient autonomy, and social justice, which is increasingly reflected in a commitment for a just distribution of finite resources. Our responsibilities also center on professional competence, improving quality of care, and expanding scientific knowledge (1). By putting the interests of patients before personal financial gain, we will be rightfully perceived as champions of patients and respected advisers on health care policies that affect public health (2). Dr. Krishnan’s rallying call for fellows-in-training to become involved in cardiovascular advocacy is indeed 1 additional “North Star” for rounding out cardiovascular professionalism for a new cardiologist or specialist. Given the importance of advocacy in shaping public policy and patients’ experiences, it is noteworthy to review the wide variety of advocacy roles that the American College of Cardiology (ACC) has pursued in its commitment to its professional mission.
The ACC’s advocacy team has been particularly effective when firmly focused on the welfare of patients and in eliminating discrimination in health care due to sex, socioeconomic status, or race. Advocacy can be perceived as self-serving when the efforts are focused on financial payments/reimbursements and can be viewed by external stakeholders as a “guild-like” response. Certainly, advocacy for financial gain for its individual members should not be the motivator of the cardiovascular professional “knight in shining armor” (3).
In contrast, over the past decades, ACC advocacy has played important roles in promoting funding for National Institutes of Health/National Heart, Lung, and Blood Institute research; use of registries and appropriate use criteria; and implementation of cardiovascular clinical practice guidelines, performance measures, and data as well as information technology standards. The ACC had created its own document for principles of health care reform and advocated strongly for the incorporation of these principles in the Affordable Care Act. The recent successful effort to eliminate the Sustainable Growth Rate also highlights the ACC’s advocacy efforts. Work by the ACC advocacy staff, along with advocacy and officer volunteer leaders, led to incorporation of many of the ACC’s cardiovascular quality principles with Congress’s creation of MACRA (Medicare Access and CHIP Reauthorization Act) as the Centers for Medicare & Medicaid Services (CMS) moves from a “volume to value” environment. The College offered sage input for the recent House bill “The 21st-Century Cures Act”—a transformative approach to health reform that seeks better, faster, safer, and more innovative approaches to treat diseases and medical conditions that currently lack effective therapies.
ACC advocacy is not only involved with both national and state legislative efforts, but also firmly rooted in fruitful interactions with the CMS, the Food and Drug Administration, payers, purchasers, patients, and consumer groups. Testimonies by ACC volunteers continuously occur at FDA and CMS hearings covering topics related to cardiovascular drugs and devices, research study design, post market surveillance, Medicare national coverage decisions/coverage with evidence development along with cardiovascular-related CMS Advisory Committee panel topics.
I share Dr. Krishnan’s enthusiastic “rallying call” and encourage our fellows-in-training, cardiac care associates, and fellows of the ACC to become actively involved in the noble mission of advocacy. It is a particularly powerful and effective advocacy strategy when the full complement of the cardiovascular team appears at their congressman’s office sharing personal stories surrounding patient care.
Professional cardiologists are best suited to share insights as to how services that affect cardiovascular disease can be improved to advance national health goals. Given the evolving health care system, the need for supporting advances in scientific discovery, along with the needs of our patients, opportunities are ever expanding for cardiovascular professionals to fulfill their advocacy responsibilities.
- American College of Cardiology Foundation