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- Mary Norine Walsh, MD, FACC, President, American College of Cardiology∗ ()
- ↵∗Address for correspondence:
Dr. Mary Norine Walsh, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
On Tuesday, September 12, 2017, more than 400 cardiologists, nurse practitioners, physician assistants, nurses, and other American College of Cardiology (ACC) members took time away from their practices to attend the ACC’s 2017 Legislative Conference. There were many first-time attendees, as well as many who returned to meet with their senators and representatives on Capitol Hill in Washington, DC, as they do year after year.
Fellows-in-training were well represented, with approximately 40 attending (Figure 1). FITs-on-the-Go documented the event, with multiple interviews with ACC leaders and conference presenters. (You can watch these interviews on the ACC’s YouTube channel.) The ACC’s state chapters were also well represented, although the delegations from Texas, Georgia, and especially Florida were under-represented compared with previous years due to hurricanes Harvey and Irma. The Legislative Conference began with a nod to those members who were in harm’s way and were unable to attend.
Legislative Conference attendees spent a full day in preparation for their meetings with lawmakers on the Hill. Issues such as prior authorization, the Medicare Access and CHIP Reauthorization Act, best practices for state advocacy, and social media as an effective tool for advocacy were highlighted. During my opening presidential address, I walked attendees through the process by which the ACC decides which legislation it will support. Attendees were reminded that the Health Affairs Committee, under the leadership of its chair, Thad F. Waites, MD, FACC, compares each piece of legislation proposed in Congress to the ACC Principles for Health Reform (Figure 2) and then makes a recommendation as to whether the College should support or oppose the legislation. Earlier this year, in anticipation of efforts to repeal or replace/reform the Affordable Care Act, the Health Affairs Committee and the Board of Trustees developed and approved these principles for health reform. These principles guide the Health Affairs Committee and staff as they evaluate new legislation. The ultimate authority for this decision to support or oppose legislation rests with the president of the College, but the expertise and careful consideration of the members of the Health Affairs Committee strongly inform the decision.
A real highlight of the conference was my interview with Francis Collins, director of the National Institutes of Health (NIH) (Figure 3). Among many other topics, Dr. Collins told the audience what it was like to succeed James Watson, PhD, one of the scientists who discovered the structure of DNA, as the director of what is now the National Human Genome Research Institute. He also discussed his view, detailed in his best-selling book, The Language of God: A Scientist Presents Evidence for Belief, that a belief in science and faith can be compatible. Dr. Collins also provided his perspective on the advancement of women in the biomedical fields and at the NIH. He discussed his appointment of cardiologist Hannah Valantine, MD, as the first chief officer for Scientific Workforce Diversity at the NIH. We also had the opportunity to discuss with him similar efforts that are ongoing at the ACC with our newly appointed Diversity Task Force. Dr. Collins spoke of ongoing requirements for NIH-funded research to include adequate enrollment of women in cardiovascular and other clinical trials, and he shared the work of his personal research laboratory on progeria and the discovery of the cause: a single-letter misspelling of the DNA code in a highly vulnerable place in the genome. We discussed the importance of increased funding for the NIH, one of the “asks” of our legislators this year, and he presented his views on the crisis of opioid addiction and overdose deaths. On a lighter note, Dr. Collins discussed his passion for music and told us of his experience playing guitar in a rock band of scientists that has performed at TEDMED and other conferences. He is a remarkable leader and scientist, and it was an honor to have him spend time with us in preparation for our visits to the Hill.
2017 Legislative Conference Talking Points
Each year prior to the Legislative Conference, the Health Affairs Committee determines which legislative issues should take priority as members meet with their legislators. Talking points are developed with input from a broad group of members. Sections, committees, and other membership groups make recommendations on potential additions or changes to the College’s advocacy agenda or specific positions on legislation or regulation. In close consultation with the Health Affairs Committee, ACC advocacy staff draft talking points of importance to the entire cardiovascular care team. The goal is to utilize the unique perspectives of all cardiovascular professionals during our meetings with members of Congress and their staff. This is a conversation in which all members should participate!
This year, ACC members met with their senators and representatives or their legislative aides and focused their “ask” on the following issues:
1. Cosponsor H.R. 1155/S. 1361, a bill that would expand access to cardiac rehabilitation by allowing physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs.
2. Foster innovation and research through increased funding for the NIH, the Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC).
3. Ease administrative burden on clinicians by exercising oversight of Quality Payment Program implementation, streamlining electronic health record (EHR) requirements, and facilitating a smooth transition to new payment models.
H.R. 1155/S. 1361 would not alter the requirement for “medical direction” of these programs—it would expand access to these essential programs by allowing nonphysician practitioners to meet the “direct supervision” requirement. Nonphysician practitioners already meet this requirement for many other outpatient services in accordance with scope of practice and state licensure laws. Direct physician supervision requirements limit access by making it challenging for rehabilitation programs to operate in areas where physicians are scarce, and impose unnecessary costs in both rural and urban areas.
Regarding increased research funding, we asked members to acknowledge the Senate Appropriations Committee proposal to increase discretionary FDA funding by $1 million in fiscal year 2018, to encourage the Senate to provide increased funding for the NIH and CDC, and to ensure tobacco use prevention is a funding priority. And, when meeting with members of the U.S. House of Representatives, we encouraged ACC members to thank their Representatives for proposing to increase NIH funding by $1.1 billion in fiscal year 2018 and urge them to support level funding of $205 million for the Office on Smoking and Health within the CDC.
In addressing the increasing administrative burden of all clinicians, we encouraged legislators to exercise oversight of Quality Payment Program implementation and to streamline requirements for EHR use. Specifically, we asked for support of H.R. 3120, a bill to amend title XVIII of the Social Security Act to reduce the volume of future EHR-related significant hardship requests. Our other “asks” were to ensure consistency of EHR requirements across care settings and to facilitate smooth transition to new payment models by relying on clinician feedback, removing barriers, and aligning new requirements with existing regulations.
2017 President’s Award for Distinguished Service
Fully prepared with these talking points, Legislative Conference attendees met for breakfast on Capitol Hill and had final debriefings before going to meet with their representatives and senators. Each state chapter organized their team and then fanned out to the various offices. Prior to these meetings, I had the privilege of presenting Rep. John Lewis (D-GA) with the 2017 President’s Award for Distinguished Service (Figure 4). Rep. Lewis has represented Georgia’s fifth congressional district since 1987 and is the dean of the Georgia congressional delegation. He has served as a chief deputy Whip since 1991 and senior deputy Whip since 2003. He serves on the House Ways and Means Committee and is the ranking member of the Oversight Subcommittee. Since 2015, he has been the lead Democratic cosponsor of a cardiac rehabilitation bill, strongly supported by the ACC. Rep. Lewis has also played many roles in the civil rights movement, including being one of the “Big Six” leaders who organized the 1963 March on Washington and spearheading the march across the Edmund Pettus Bridge in Selma, Alabama, on March 7, 1965, in demonstration of the need for voting rights in the state. He is a personal hero of mine, and he was warmly received by ACC members; he graciously spent time with many individuals and chapter delegations after the award presentation.
Rep. Lynn Jenkins (R-KS-2) was unable to attend the award ceremony, but she was also presented with an award later in the day by ACC Vice President C. Michael Valentine, MD, FACC, and Sandra Lewis, MD, FACC, vice chair of ACC’s Political Action Committee. Like Rep. Lewis, Rep. Jenkins has played a lead role as the Republican cosponsor of cardiac rehabilitation legislation in the House. Rep. Jenkins has represented Kansas’ second congressional district since 2009. As of the 114th Congress, she is the senior member of Kansas’ House delegation and the Vice Chair of the House Republican Conference. A certified public accountant by training, Rep. Jenkins serves on the House Ways and Means Committee and is an active member of the Subcommittee on Health. In addition to being a member of the Republican Study Committee, the Republican Main Street Partnership, and the Team Party Caucus, she is also a founder of Maggie’s List, a political action committee designed to increase the number of conservative women elected to federal public office.
In total, ACC members paid visits to the offices of nearly 300 senators and representatives throughout the day, ensuring that our messages were heard. New friendships were made, follow-up visits to local legislators’ offices were planned, and offers of ACC help and expertise in issues of health care were extended. The momentum from this year’s conference will carry us throughout the year as we advocate at both state and national levels. Hopefully, the value gained over the 3-day meeting will make participation in next year’s 2018 ACC Legislative Conference a priority for members new and old.
- 2017 American College of Cardiology Foundation