April 2023 Advocacy Recap

Alec Bose:

Hello and welcome to the CAP Advocacy Recap, a monthly podcast dedicated to catching you up on the top news for pathologists. I'm Alec Bose here with your April 2023 recap. This month, we'll be looking at the FDA's newest proposal on blood donations as well as plans from the CMS to improve hospital equity. Later, we will be sitting down with Dr. Victoria Jones and Dr. Eric Loo of Dartmouth Health to talk with them about their experience at this year's Pathologist Leadership Summit. We start our recap with news from the Food and Drug Administration. Under draft recommendations, the FDA announced monogamous gay and bisexual men would be allowed to donate blood and eligibility would be determined using individual risk-based questions. The proposal, if enacted, would eliminate time-based deferrals for men who have sex with men and women who have sex with men who have sex with men.

In comments submitted to the FDA Commissioner, the CAP expressed its support for the proposed changes, quote the proposed recommendations are more inclusive and more objective blood donor screening criteria, which expand opportunities for many prospective donors who have been excluded and potentially increases the blood supply while maintaining the high level of safety for life-saving blood transfusions in medical community and the public experts. The CAP encourages the FDA to continue monitoring blood donor and donation safety. The CAP also urged the development of public information and education to promote blood donations from everyone who is eligible, including partnering with the LGBTQ plus community for messaging to ensure the new policy becomes widely communicated. We will keep you updated as this issue moves forward.

In other news, the CMS proposed new regulations promoting equitable care in hospital systems. The 2024 inpatient prospective payment system and long-term care hospital prospective payment system regulation aims to advance health equity and support underserved communities. According to the CMS, if implemented, the proposed regulation will update me Medicare payments, hospital policies and hospital quality measures to foster safety and equity, while reducing preventable harm in the hospital setting. The proposal also recognizes homelessness, a social determinant of health, as an indicator of increased resource utilization in the acute inpatient hospital setting, which may result in higher payments for certain hospital stays. Another aspect of the proposal calls for health equity adjustments in the hospital value-based purchasing program by incentivizing hospitals to perform well on existing measures and those who care for high proportions of underserved individuals as defined by dual eligibility status. The CAP applause this move from the CMS as we continue to advocate for health equity and eliminating disparities in care.

And finally, we wound out the day with a debrief from the 2023 Pathologist Leadership Summit. PLS is one of the biggest advocacy events the CAP holds every year in Washington DC, where participants attend a number of information sessions culminating in a trip to Capitol Hill to lobby on behalf of their specialty and their region of the country. We sat down with two PLS attendees, Dr. Victoria Jones and Dr. Eric Loo of Dartmouth Health in New Hampshire to discuss their Hill Day experience. So Dr. Jones, Dr. Loo, thank you so much for joining us on the podcast. We really appreciate your time today.

Dr. Victoria Jones:

Thank you for having us.

Dr. Eric Loo:

Yep. Happy to be here.

Alec Bose:

So I'm really excited to talk to both of you today, but I want to start out with you, Dr. Jones. This was your first time at the Pathologist Leadership Summit, was it not?

Dr. Victoria Jones:

Yes, very first time. So I'm a pathology resident at the Dartmouth Hitchcock Medical Center. And I would say as far as background, I had limited knowledge of policy, but in our program, we were exposed to these policies through Dr. Loo. He would give some lectures to us during our conferences. And then back in January, he was invited to speak to the California CAP Delegation about how to get involved in advocacy. And it was there, I attended virtually in support, and it was there that they mentioned this conference. And so I was really excited to register, which I did. And I would just say that leading up into the conference, I just expected that they would prepare us well, go over all the policies, everything that we needed to know, and even though it was my first time, that we wouldn't be alone. And especially having Dr. Loo there as well, I knew that I would be in good hands.

Alec Bose:

Yeah. So those are some of your expectations coming into it. Now that you are on the other side of it, so to speak, what are some of your thoughts about it now? How are you feeling now?

Dr. Victoria Jones:

I feel that they exceeded all my expectations. There were so many different sessions at the conference as far as telling us what to expect. There were a lot of different panel discussions going over the different issues that we'd be presenting. Even down to the app, there was an app that I downloaded on my phone, which had all the talking points and issues that we would be presenting as well as information about our senators and representatives. And I felt pretty comfortable that everything went as they told us it would.

Alec Bose:

So Dr. Loo, you've been involved in advocacy for a long time, and so while this wasn't your first Pathologist Leadership Summit, I know that the last few years have been tumultuous, to say the least. How did this year's summit differ from others and other previous advocacy events that you've been to and how might it have been a little bit the same?

Dr. Eric Loo:

Sure. Well, let's see. The overall structure of the meeting was fairly similar to prior meetings in that it started with the House of Delegates meeting and it included forums for the pathologists running for office within CAP to introduce themselves and that type of stuff. It also had all the educational content and round table discussions that we've had in previous years. And of course, finished up with the Hill Day visits.

In the way that it differed from the prior meetings, I feel like in general, they've just been getting better. The educational content seems to be getting better and better. The topics are more timely, the people that are presenting, not to say that the ones a few years ago were bad, but I just feel like the topics and the presentations have been really excellent this past time. It was a hybrid meeting, which hadn't been done prior to COVID, and it just went very well. They allowed people that were participating from home to ask questions. And I just think that it was a very well-run meeting.

Alec Bose:

I'm sure the CAP staff are happy that it all went well and we're grateful that you all could attend. So this is a question for both of you, but Dr. Jones, let's hear from you first. What were some of the policies that you were advocating for and how were these issues presented and discussed prior to your Hill Day visit?

Dr. Victoria Jones:

Sure. So we had three asks if you'll, that we presented to our representatives and senators. And prior to then, they were discussed throughout the conference as far as panel discussion, there were different lectures and Q&A sessions, and we were even presented with these folders of information and packets that we could leave with them. So those were all great for outlines. But I'll go over the first two, let's say.

The first one that we lobbied for revolved around the fiscal challenges related to Medicare cuts, which are largely in due to the reimbursement increases for primary care. And so that resulted in some specialties such as ours, pathology, experiencing payment reductions to offset costs to these physicians who deliver more office-based visits. And so without Congressional action, pathologists in particular face Medicare cuts of 6.5% in 2024. And just to share, pathology and the rest of the laboratory workforce, we have a lot of pressures, a lot arose from the pandemic, but also preparing for future pandemics. There are a lot of workforce shortages, a lot of increased demands, and there's just a critical need to invest in our infrastructure, not necessarily eroded. So that's what we were lobbying for. We were urging Congress to pass legislation to provide additional relief from these Medicare cuts scheduled to take place next year. And that will hopefully provide some short-term financial stability.

And then the second ask that we had centered around the Resident Physician Shortage Reduction Act, and this was introduced by Senators Menendez and Guzman from New Jersey and Arkansas, Majority Leader Schumer and Representative Sewell from Alabama and Fitzpatrick from Pennsylvania. And so this act would provide 14,000 new Medicare supported graduate medical education positions, residency positions, over the next seven years. And that's critical because the United States is facing a shortage of up to 124,000 physicians by the year 2034. And so there are a lot of factors that exacerbate that, such as the aging physician population, rising rates of burnouts, people are retiring earlier. And then also not everyone who completes a pathology residency goes on to practice full time. We have people who go into research or industry or even rely on a J-1 Visa, they're international medical graduate, have to go back to their country. So all that to say is very important that we invest in these training positions because that would really help our specialty in particular.

Alec Bose:

Yeah, no, Dr. Loo, I would love to hear from you about the last ask.

Dr. Eric Loo:

Oh, yeah. Let's see. Just to add on a little bit for the Medicare cuts, that's not something new, right, we've been dealing with that for the last few years. And hopefully at some point in the near future, we'll get a good action item on that that Congress can agree on and everything will be fine and dandy in the future, in my dreams. And then the physician workforce shortages are again something that we've been dealing with for quite a long time. If you look at physician growth since the 1970s, it's been abysmal. And most residency programs, if you're a program director, know about the cap. So back under the Clinton administration, they passed the Balanced Budget Act of 1997, which put a cap on the number of GME positions that are funded through Medicare. And we've been kind of stuck at that cap without any meaningful change since 1996 or 1997, when it went into effect. So that's been very problematic. So I'm glad that this is something that the CAP is advocating for and hopefully it'll get congressional support and go through.

The last act is SALSA, which stands for Saving Access to Laboratory Services Act. And hopefully this passes too because it will fix a lot of the problems that we've been facing in relation to reimbursement for services provided on the clinical laboratory fee schedule. So those are those technical only services like CBCs, BMPs, liver function tests, microbiology testing that don't have a professional component. We started having big problems related to CLFS reimbursement after another act went into effect, called PAMA. PAMA was Protecting Access to Medicare Act, that got passed in 2014 and went into effect in 2018. And because of a very, very flawed data collection methodology, reimbursement on the clinical laboratory fee schedule was going to be slashed horrendously.

Alec Bose:

Right.

Dr. Eric Loo:

And that would definitely impact most clinical laboratories. At Dartmouth, for example, the CLFS or reimbursement for the CLFS really accounts for like 70% of our revenue. And so it's a very important thing that we have to keep an eye on.

Alec Bose:

I think it's very important that these issues also get brought up in a local context. It can get lost in the national spotlight, in a national conversation, but it does impact people on a local and regional level. Dr. Jones, just going back to you for a quick moment, what was it like to lobby your congressperson during your first Hill Day and how did it compare to what you expected it to be?

Dr. Victoria Jones:

It was very exciting. I felt proud to be part of the movement. And there were actually so many other different groups on the hill, even the surgeons, they were there for a meeting and they were staying in our same hotel. But Dr. Loo and I were the only ones from New Hampshire represented from the CAP. And so everything went exactly as they told us it would. We met with the staffers of Senator Maggie Hassan, Representative Ann Kuster and Senator Jeanne Shaheen. And so they gave us some tips beforehand of how to conduct the meetings. So we started with introductions and then we had a discussion of what pathologists do because these offices meet with so many different groups, so I feel that that was helpful. And then we presented the three asks that we just talked about.

And then I just wanted to say that it wasn't just saying, "We need you to do this. We need this. We can't afford for you to do X, Y, Z." It was also a lot of the conversations stemmed from just a simple thank you, recognizing what they've already done. So thank you for supporting or co-sponsoring this bill already. Thank you for the 2021 Consolidated Appropriations Act that already provided 1,000 new Medicare supported GME physicians. Things like that, I think that goes a long way as well and makes for respectful conversations and productive conversations. Anyway, at the end, we also invited them to come to Dartmouth so we could give them a personal tour of what we do in the lab, and so they can see firsthand where their support is going.

And I will just say in general, that practice does make better. I know the first session, the meeting that we were in, there are a few things that I forgot to say. It's like, "Oh man, I meant to say this." But it was nice to have Dr. Loo there to be able to interject and add in other things, and it really was a team effort. And also, one of the staffers, she offered advice for the next session, which we welcomed. So she was saying, "It might be helpful that for the legislation who actually sponsored or introduce the bill, and tell the senators and representatives in their states because that's helpful for them."

And so for the next meeting, I made a note to do that. So it was a lot about improvement and growth, but I learned a lot in the process and it was just an empowering experience I was very proud to be a part of.

Alec Bose:

Fantastic.

Dr. Eric Loo:

She did fantastic.

Alec Bose:

I think you hit on something...

Dr. Eric Loo:

Sorry.

Alec Bose:

Oh, sorry.

Dr. Eric Loo:

No, no. She did an excellent job. So I just wanted to get that in there.

Alec Bose:

And I think you touched on a very interesting point, Dr. Jones, which is that practice makes better advocacy. Like everything else, it takes time and sometimes people can get intimidated to get involved because it's sort of like, "Where do we begin?" But it is important to recognize that once you start, you can get better and much better. And next thing you know, you're in Dr. Loo's position or a CGPA position or just as a lot of our other CAP leaders have become a part of. I wanted to touch on something else. So were there any issues that either of you felt were particularly important to the state or region that you were both representing? Dr. Loo, you alluded to this earlier in your answer in terms of what specifically matters in the state of New Hampshire, was there anything else that was particularly interesting or that meant a little bit more in terms of the interest of New Hampshire?

Dr. Eric Loo:

So the first and third acts, the Medicare cuts and SALSA, they're of course important and they're important everywhere because if you can't keep your lights on, if there's no margin, there's no mission, right, you can't take care of patients if you can't keep your lab operational, and that's critical. So that kind of goes for itself. In terms of the second ask or increasing the residency spot, that probably does have some direct impact to New Hampshire. We are a more rural state in general with an aging population and people aren't necessarily moving to the state proactively. And as such, a resident physician shortage really impacts New Hampshire because we don't have that many new talent moving into fill missing positions. And when we're able to train people here, they actually see that it's a very decent place to live where you can raise a family and have a good lifestyle. And so being able to train physicians here in New Hampshire means we get to keep more of them in state as well, and that definitely will help the state in the long run.

Alec Bose:

Definitely. Definitely. Dr. Jones, was there anything you wanted to say on that?

Dr. Victoria Jones:

I know for the Medicare cuts, when you have workforce shortages and reagent shortages, we can see it as far as delays and turnaround times. Even the weather up here can affect, if you can't afford to have in-house laboratory testing, you have to send it out, I've seen firsthand, even just FedEx delays. So regardless of all the factors, the patients and their treating physicians are relying on our services and expertise. And so we need relief from any cuts to our pathology services.

Dr. Eric Loo:

It's truly an access to care issue, especially for states like ours, which have very large areas that are rural. If you lose access to care in a rural area and patients end up having to drive two or three more hours or whatever to get care, that's going to hurt the overall health of the society. And healthcare, from what I understand, is one of the largest national security interests our country's facing. If the government can't finance itself and healthcare is the largest expenditure right now that we're facing and it's not slowing down in terms of the amount of dollars going towards healthcare, it's going to be a problem. And if people can't get access to care, that impacts the financial viability of a region, that impacts the amount of crime that you see in that region. It's one of those things that is going to be a tipping point for whether or not people trust our democracy and whether or not we still have a free society for our children and stuff. So I don't know. Sorry for getting philosophical.

Alec Bose:

No, I think that's a great answer. And I think that does speak to more of a overarching theme of healthcare. I think it's not something that's slowing down anytime soon and so it's important to stay actively involved in this type of advocacy. Finally, I just wanted to be able to get your advice for anyone who is thinking about going to the Pathology Leadership Summit or maybe somebody who just participated virtually. What advice would you give them or specific types of words that you would share with them in terms of what to expect and what they can do to sort of be prepared for it?

Dr. Victoria Jones:

I'll say my advice is to come join us. And I say us like I'm already going next year, but I do want to go again next year as well. And I understand if you do have to do it virtually for any other reason, just know that we did prioritize all the virtual people's questions, so we would read them out loud and hopefully they felt just as a part of the conference. But there is something about being in person, an energy, just being able to meet different people during the sessions, networking, even down to taking pictures. And then I met so many people from residence to, I believe some might've been retired, people who work in large academic hospitals to smaller private practices and then varying subspecialties within pathology.

And so also, it's good to be there in person so you can meet with your legislators in person and go about all the issues. And it's very rewarding. And I just want to say to the people who've never done this before, don't let that intimidate you, that you won't be alone, they will prepare you about all the issues and you'll have all the necessary supports that you need. So it's truly a great experience and I hope to see you next year.

Dr. Eric Loo:

I guess in terms of advice on my end, I'll echo that. The CAP really doesn't just let you fend for yourself. The first year that I went, I was the only person from New Hampshire that went, and they made sure a CAP staff member that was well-versed in the issues attended along with me. So hats off to Darren Fenwick, he was fantastic and really taught me a lot on my first Hill Day visits. So really, don't worry about it. To quote a very wise Muppet, do or do not, there is no try. Just go. It's a fantastic experience and just very rewarding to be part of our democracy and the whole process.

Alec Bose:

Well, thank you, Dr. Loo. I think that's a fantastic note to leave it on. Thank you both so much for joining me today. I really appreciate it.

Dr. Victoria Jones:

Thank you.

Dr. Eric Loo:

Thank you.

Alec Bose:

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

Download Transcript