#166 Advocacy and Hot Topics in Healthcare Policy with Robert McLean MD, FACP

August 14, 2019 | By Matthew Watto, MD

Featuring ACP President Dr. Robert McLean and Policy Wonks, Drs. Fatima Syed and Deep Shah

Join us for this roundtable discussion of advocacy in healthcare and a rundown of hot topics: coding and billing, the Affordable Care Act, universal healthcare, gender equity, women’s health, gun violence and more! Returning guest, Dr. Robert McLean (@rmmclean84), current president of the American College of Physicians, helps us answer questions like, What is advocacy in healthcare? What are the issues that are impacting your profession? What can your medical home do for you? He’s been heavily involved in advocacy throughout his career including testifying before Congress. Guest hosts Drs. Fatima Syed MD, MSc and Deep Shah MD, MSc join! 

Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and Produced by: Fatima Syed, MD, MSc; Matthew Watto MD, FACP

Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP; Fatima Syed, MD, MSc; Deep Shah, MD, MSc

Editor: Matthew Watto MD, FACP

Guest: Robert McLean MD, FACP

Time Stamps

• 00:00 Intro, disclaimer, and guest bios
• 03:22 How can new docs in practice get involved in advocacy and shaping healthcare policy
• 11:30 Medicare’s proposed changes to billing and documentation
• 13:40 Who’s involved in changing Medicare policies?
• 16:09 What’s the purpose of policy papers? How are they written?
• 19:12 Getting involved in local and national councils as a student or resident
• 25:22 The Affordable Care Act and Universal coverage
• 29:25 What’s the risk of non-ACA approved insurance plans?
• 31:40 Why do people oppose the ACA?
• 34:40 Universal healthcare defined
• 40:23 The gender pay gap; Shout out to ACP’s CEO Darilyn Moyer MD, FACP
• 45:10 Women’s health policy paper
• 47:40 Gun violence and how advocacy issues take off
• 55:00 Take home points; Plug for Bob Doherty’s blog
• 60:36 Outro

Advocacy Take Home Points

Dr. Robert McLean

1. Advocacy is taking a position in the public space on behalf of a meaningful issue.
2. Effective advocacy is trying to figure out how to make an impact by getting involved with legislatures and policymakers at the state level and national level.
3. Read Bob Doherty’s ACP Advocate blog to get a sense of what’s going on with healthcare policy in Washington D.C. Follow him on Twitter @BobDohertyACP.
4. The ACP’s compendium of policy papers is also a nice resource.
5. Advocacy is “burnout prevention”.

Dr. Deep Shah

1. Legislatures want to hear from doctors and value our input at the local, state and federal level. 
2. Physicians are trying to protect patient’s health and maintain their own autonomy and sanity. Most of ACP’s policy papers address one or both of these issues.

Dr. Fatima Syed

1. Physicians are a diverse group with diverse opinions. Don’t be discouraged if you’re not always in agreement with your colleagues or professional organization.
2. Get involved at your local organization or chapter as a starting point.

HCP and Advocacy Show Notes

What is advocacy and what is the process for determining what topics matter?

• Grassroots involvement from ACP members.  Members highlight what issues matter.
• These issues go up the organizational chain and are studied by staff and discussed in committees
• Final approval for stances come from membership level efforts, through the Board of Governors and the Board of Regents.

What are important advocacy issues for the internist?

Patients above paperwork

Administrative burden.  EMR. Note writing. All things that you are not trained in residency but have a lot to do with clinical practice in the real world.  ACP recognized this issue as important to its members. Through its research efforts, ACP put together a policy paper called Patients Before Paperwork (https://www.acponline.org/advocacy/where-we-stand/patients-before-paperwork).  CMS put together an initiative called Patients Over Paperwork.  CMS is the Center for Medicare and Medicaid Services and is a national governmental body that has everything to do with Medicare, Medicaid, and the Affordable Care Act.  Its policies impact physicians nationally. CMS plans on changing coding and note writing requirements. This poses challenges related to reimbursements for physicians.

Social Determinants

Social determinants are the non medical factors that impact health.  More can be found on this here. https://annals.org/aim/fullarticle/2678505/addressing-social-determinants-improve-patient-care-promote-health-equity-american 

Women in Medicine

Women have unique medical needs and we live in a time where access to certain care for women is being limited.  ACP weighs in here. https://annals.org/aim/fullarticle/2678505/addressing-social-determinants-improve-patient-care-promote-health-equity-american 

Evolution of the healthcare system

Does ACA need to be undone?  Can we expand on ACA? Robert and Deep discuss this further on the episode.  Read more about ACP’s policy here https://annals.org/aim/fullarticle/2731120/improving-patient-protection-affordable-care-act-s-insurance-coverage-provisions 

How can you become involved?

• Institutional level: get involved in committees in your medical organizations and employers
• Local level: get involved with your local ACP chapter, state medical boards.
• National level: attend leadership day events for ACP, join other organizations, meet with your legislators.

Goal

Listeners will be able to define advocacy, describe ways to get involved and be familiar with recent hot topics in healthcare policy and advocacy.

Learning objectives

After listening to this episode listeners will…  

1. Define advocacy
2. Explain how one might become involved in advocacy as a physician
3. List recent hot topics in healthcare policy and advocacy that matter to internists
4. Describe how CMS is changing paperwork and administrative burdens 
5. Explain how non medical factors impact healthcare
6. Learn how advocacy can impact women’s health needs
7. Learn how to get involved in one’s own medical community

Links

1. ACP’s recent position paper commenting on ways to improve the Patient Protection and Affordable Care Act https://annals.org/aim/fullarticle/2731120/improving-patient-protection-affordable-care-act-s-insurance-coverage-provisions
2. ACP’s recent position paper on Women’s Health https://annals.org/aim/fullarticle/2682682/women-s-health-policy-united-states-american-college-physicians-position
3. ACP’s recent position paper on Social Determinants of Health https://annals.org/aim/fullarticle/2678505/addressing-social-determinants-improve-patient-care-promote-health-equity-american
4. ACP’s recent position paper on Reducing Firearm-Related Injuries https://annals.org/aim/fullarticle/2709820/reducing-firearm-injuries-deaths-united-states-position-paper-from-american 

Disclosures

Drs. Mclean, Syed and Shah report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

McLean RM, Syed F, Shah D, Brigham SK, Williams PN, Watto MF.. “#166 Advocacy and Hot Topics in Healthcare Policy with Robert McLean MD, FACP”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/episode-list. August 14, 2019.