March Advocacy Recap 2023

Alec Bose:

Hello, and welcome to the CAP Advocacy Recap, a podcast dedicated to catching you up on the top news for pathologists. I'm Alec Bose, here with your March 2023 recap. This month we'll examine the White House budget proposal and what it means for the pathology workforce and pandemic preparedness, why the CAP and other organizations are calling for Congress to pass an inflation-based fix to Medicare payments, and more. Later, we will sit down with the president of the CAP, Dr. Emily Volk, to discuss a recent meeting with the Congressional Black Caucus, including key takeaways from our conversation and how the CAP can engage with policy to create a more equitable healthcare system. We begin today with policy news from the Biden administration. The White House introduced a proposed 2024 budget proposal, which focused on a number of healthcare issues.

According to the White House, this budget would institute several pandemic preparedness measures and expand patient access to health insurance. To prepare for future pandemics, the budget includes $20 billion in mandatory funding for HHS public health agencies, in support of the administration's pandemic prevention and preparedness and biodefense priorities, as outlined in the 2021 American Pandemic Preparedness Plan. Which includes ways to transform our capabilities, the 2022 National Biodefense Strategy, and an implementation plan for countering biological threats. The budget also calls for $400 million in new discretionary funding to prepare for pandemics and biological threats, as well as key investments for the Biomedical Advanced Research and Development Authority and the Strategic National Stockpile, to support advanced development and procurement of vaccines, therapeutics and diagnostic capabilities against known and unknown high priority threats. In addition, this budget also expands access to health insurance, as well as specific workforce provisions. In order to get more Americans' health insurance, the budget calls for premium cuts to purchase health plans under the Affordable Care Act through expanded premium tax credits.

In addition, the proposed budget would provide Medicaid like coverage to individuals in states that have not adopted Medicaid expansion under the ACA, paired with financial incentives for states to maintain their existing expansions. It would also allow $966 million in 2024 to expand the National Health Service Corps, which provides loan repayment and scholarships to healthcare professionals in exchange for practicing in under-served areas. This would allow $350 million to expand programs that train and support the nursing workforce and fund a program to train residents in community-based healthcare clinics in rural and high need areas. Each year, the president is required to submit a budget to Congress. The budget document lists the administration's priorities but Congress will ultimately determine how funds are appropriated and which programs get enacted into law. We will continue to keep you updated as Congress considers the president's proposal. In related congressional news, the CAP, AMA and over 130 medical professional societies asked Congress to pass legislation that provides an annual inflation based payment update based on the full Medicare Economic Index or MEI.

This legislation would be a solution to the ongoing problems plaguing the Medicare physician fee schedule and ongoing Medicare payment cuts to all physicians. The coalition, which represents over 900,000 physicians, sent a letter to congressional leaders urging both the House and the Senate to pass legislation providing an annual inflation based payment update automatically, averting the ongoing problem currently facing all physicians. While the groups noted that Congress has acted to mitigate Medicare payment cuts and healthcare access to patients, medical practice costs have outpaced these congressional actions. There have been other recommendations put forth, one of which would increase the 2024 Medicare physician payment rate above current law with an inflation based payment update tied to the MEI. This, however, would only address half the problem, as the practice expense component does not cover all practice costs. This is addressed in the coalition letter sent to Congress.

"Therefore, an inflation-based payment update is equally warranted for physician work and other aspects of total physician payment, all of which could be addressed by finalizing an update that is tied to full, rather than half, of MEI." The CAP continues to fight for fair pay for value pathologists provide. And we round out the recap with action to address health disparities in the United States. This month, CAP President, Dr. Emily Volk, met with the Congressional Black Caucus Health Brain Trust during a forum, to discuss strategies to address inequities that pathologists can take to use in healthcare. We had a chance to talk with President Volk after the meeting about her experience and the policies they discussed.

Dr. Volk, thank you for joining us for this podcast.

Dr. Emily Volk:

It's my pleasure. Glad to be here.

Alec Bose:

We really appreciate you being with us today. So just tell me briefly how did this meeting with the Congressional Black Caucus come to be and why did you meet with the CBC Health Brain Trust?

Dr. Emily Volk:

Well, we have worked very hard on Capitol Hill to establish the College of American Pathologists as an interested party in health equity and health equity conversations happening in Congress and throughout the government and really throughout the whole field. So we also have been working very hard to nurture relationships with interested congressional representatives. So Congressman Robin Kelly, Representative Kelly is one of our ... is a congressional representative that has been engaged with the college. One of our Board of Governor's members, Dr. Kalisha Hill, is in Dr. Kelly's ... excuse me, in Representative Kelly's district. And I really need to credit Dr. Hill for nurturing that relationship with Representative Kelly.

And in fact, Representative Kelly came to a PathPAC event last year at our Chicago 2022 meeting for CAP, our annual meeting. And that was delightful to have Representative Kelly there. So we are on her radar, and of course, Representative Kelly, being an important leader in the Congressional Black Caucus, she led this Health Equity Brain Trust meeting and invited the CAP to sit at the table with other organizations, which included the AMA, the American College of Obstetrics and Gynecology, organizations that represented osteopathic physicians, midwives, optometrists, physical therapists, and so on. So from all corners of the healthcare world, sat around the table together with Representative Kelly as she listened intently to the various concerns and solutions that these different organizations were bringing to the table.

So of course, CAP was there, and I had the honor of representing CAP there, to talk about the work that we have been doing as far as end stage kidney disease definitions and the use of the adjusted calculations for estimated glomerular filtration rate. Removing that race-based adjustment factor that we now understand was non-scientific and did prevent some black patients from getting on transplant lists and getting earlier diagnoses of end stage disease and really preventing some earlier intervention for end stage kidney disease. We are also able to talk about the work that we're doing in the transgender space, where we're looking at do we need to have recommendations around reference ranges for folks who are transgender individuals for some laboratory values and the other work that we're doing to identify where the lab can drive health equity. And not just the lab, but where pathologists too can drive health equity.

Alec Bose:

What were some of the specific topics that you discussed and were there any issues that you discussed that had any policy solutions in the possible future?

Dr. Emily Volk:

Well, again, we certainly covered the race-based EGFR calculations and how many laboratories across the country have adopted the more modern protocols, but recognizing that about 30% of laboratories have not been able to do so yet. We talked about some of the barriers to adoption of those guidelines too, that some laboratories have to face because of shortages with IT resources and so forth in the environments that they work. The EMR has to be manipulated in order to change these things in the computer, and so if you don't have the personnel, you don't have access to the resources that you need, getting that changed for a health system or a hospital can be next to impossible. So we talked about those kinds of barriers.

We also talked about, again, what is the role of laboratory testing in just the foundation of caring for people? So if the diagnosis isn't correct, if the laboratory results that are used to inform diagnostic and therapeutic decisions are not accurate and reliable, everything falls apart from there. So again, having the opportunity to remind, not only the congresswoman but also the other members of the Caucus, that pathologists or physicians, that the work that we do is clinical and it's not different than or separate from other clinicians. We are part of the clinical universe, and in fact, we're a critical part of the clinical universe. And so getting the opportunity to tell that story again was also, I think, a benefit of being at that table.

Alec Bose:

Yeah, I think that makes a lot of sense in terms of just making that case that pathologists are just like other doctors and belong in this space as well. Lastly, I just wanted to know if you had any takeaways that you had personally from the meeting, and if there are any ways that the CAP can engage on these issues further?

Dr. Emily Volk:

Well, a couple of things come to mind. First of all, I think it's important for members to realize that we have a team of just shy of 40 in Washington DC working on behalf of pathologists in Washington, DC right now, and how unique that is for pathology organizations. We are really the best positioned pathology organization from an advocacy perspective. We're the best resource and we're the best positioned. And we have experts working on our behalf in Washington. We also have a number of volunteers who engage with these folks in Washington, and again, we're unique in the depth and breadth of those resources. The other thing that I would say is, that just strikes me yet again, is how important the relationships can be between a citizen and their congressional representative.

The fact of the matter is Representative Kelly wants to hear from her constituents, just like every other congressman in the country wants to hear from their constituents. So she welcomed Dr. Hill reaching out to her and developing that relationship. So we have Representative Kelly understanding what it is pathologists do. We need more of those kinds of relationships developed with members of Congress. There are only a handful of congressional representatives who are actually physicians or who are maybe married to a physician or have their partner who is a physician. So the majority of folks in Congress really do not have an intimate look on what it is like to devote yourself to medicine. And so the more we can develop the relationship with our representatives and tell the story of what it's like to deliver care to patients as a physician, as a pathologist, the more influence we're going to have on the Hill.

And the more they're going to be able to help us when budget cuts are looming, when we're facing significant payment cuts around Medicare or Medicaid, and other issues that impact the ability to practice pathology. So that's super important. The other thing that struck me about the experience is, whenever I get to go to Capitol Hill, it is such a patriotic and moving experience for me. Again, it was such a privilege to go with one of our CAP staff, Darren Fenwick, one of our lobbyists, to the Congressional Black Caucus meeting on Capitol Hill in the Rayburn Building, and walk those hallowed halls and exercise my full rights as a citizen. It just blows my mind. And the setting is absolutely stunning. The enthusiasm and the interest in learning about what we do as physicians is truly there but we have to show up to tell that story.

So that brings me to the Pathologist Leadership Summit. What I'd really like our listeners to hear is, if you're listening to this before the 2023 Pathologist Leadership Summit, which is from April 15th to the 18th, please consider joining us, either virtually or in Washington DC. It is a member benefit to attend. Folks who attend are almost universally thrilled with the experience that they have. First timers I always hear say things like, "Wow, I didn't think it would be this much fun. I didn't think it would be this easy. I didn't think I could do it but now I see that I can." And so I just really encourage folks who've been before or who have never gone to consider going. If you're hearing this recording after April 18th, 2023, then I would say put it on your calendar to join us next year. But the Pathologist Leadership Summit gives you the tools that you need to represent yourself as a physician and our specialty where it matters the most.

Alec Bose:

Again, thank you Dr. Volk, for joining us. We really appreciate your time.

Dr. Emily Volk:

Thank you.

Alec Bose:

That's all for this edition of the Advocacy Recap. Thank you so much for listening. For more information on any of the stories that you heard today, be sure to subscribe to our weekly advocacy newsletter and follow us on Twitter @CAPDCAdvocacy. Again, that's @CAPDCAdvocacy. Once again, for CAP DC advocacy communications, I'm Alec Bose, and we'll see you next month.

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