Let the Show Begin! D.O. Day on the Hill 2007

1. Let the Show Begin!D.O. Day on the Hill 2007 Dana M. Block, OMS-IV SOMA National Director of Political Affairs

2. Introduction • Purpose: to inform osteopathic medical students of the specific issues, and respective background information on the issues, we will be lobbying at D.O. Day on the Hill • This presentation is part III of III of the SOMA Political Action Training Course (PATC), completion of which is recommended for all D.O. Day on the Hill participants • Completion of the SOMA PATC is one requirement for induction into Omega Beta Iota (ΩΒΙ), the national osteopathic political action honor society (exceptions will be made for 2007 ΩΒΙ inductees, as this is the first SOMA PATC to be given

3. Presentation Overview • Act I: The Issues • Act II: Specifics • Osteopathic Medicine • Medicare Physician Reimbursement • Resident Physician Shortages • State Children’s Health Insurance Program (SCHIP) • Act III: Grand Finale • D.O. Day Agenda • Your responsibilities prior to the event

4. Act I: The Issues • Osteopathic Medicine • Inform your legislators of who we are and the D.O. difference • Medicare Physician Reimbursement • Encourage replacement of the current Medicare formula used to calculate physician reimbursement • Graduate Medical Education • Request support for increased access to residency training programs • State Children’s Health Insurance Program (SCHIP) • Suggest health coverage for more of America’s children through passage of SCHIP-related legislation

5. Act II: Specifics • Osteopathic Medicine • You are already experts on this topic!! That means you are inherently 25% prepared for the big day! • Potential items to discuss: • The principles of osteopathic medicine • Your training • The D.O. difference when it comes to provision of healthcare • Do not spend too much time on this topic, as there are three other topics to discuss in a short amount of time!

6. Act II: SpecificsMedicare Physician Reimbursement • Medicare Physician Reimbursement (MPR) • This topic has been EFFECTIVELY lobbied at the past few D.O. Days on the Hill! • Our efforts have helped secure reimbursement rates at those of 2001 instead of the reimbursement rates dropping annually • However, the cost of healthcare provision continues to rise and there is a predicted 8-10% REDUCTION in Medicare physician payment rates for 2008!

7. Act II: SpecificsMedicare Physician Reimbursement • Background information • Timeline: • 1989: Omnibus Budget Reconciliation Act (OBRA) established a fee schedule for Medicare physician reimbursements (MPR) • 1992: OBRA went into effect • 2002: MPR cut 5.4% (due to incorrect estimates on future spending by the Centers for Medicare and Medicaid Services (CMS), a failing economy, etc) • 2003: Congress approved 1.6% increase in MPR • 2004 and 2005: Congress approved 1.5% increase in MPR • 2006 and 2007: 0% increase in MPR; Congress approved maintaining MPR at 2005 rate • 2008: Predicted decrease in MPR of 8-10%! This would place MPR at levels lower than in 2001!

8. Act II: SpecificsMedicare Physician Reimbursement • Background information cont’d • A fee schedule is used to determine Medicare payments for physician services • This fee schedule assigns relative values to services that reflect physician work, practice expenses, and medical liability costs; these relative values are then adjusted for geographic variations in cost • A conversion factor is utilized to assign a dollar payment amount to the adjusted relative values

9. Act II: SpecificsMedicare Physician Reimbursement • Background information cont’d: • The flawed conversion factor • The conversion factor used to designate dollar amounts to physician services is updated annually • The annual update to the conversion factor is dependent upon several factors: • Medicare economic index (MEI): measures inflation on the inputs needed to produce physician’s services • Sustainable growth rate (SGR): sets a target for Medicare spending growth for physician’s services • Performance adjustment factor (PAF): modifies the annual update by adjusting the MEI to account for the SGAR target

10. Act II: SpecificsMedicare Physician Reimbursement • Background information cont’d • The flawed conversion factor • Basically, if more services are performed in a year, the dollar amount reimbursed is reduced to account for the high volume in an attempt to restrain overall increases in Medicare spending for physician services • Obviously, there is a problem with this system! • If you are interested in more information on any of the topics briefly discussed above, visit the AOA’s DO Day Briefing Center online at www.do-online.or/index.cfm?PageID=gov_dodaybriefctr

11. Act II: SpecificsMedicare Physician Reimbursement • The “Ask” • Eliminate the use of the SGR in the conversion formula and replace it with a payment formula that accurately compensates physicians for their services, reflects actual costs of care, and is adjusted annually based upon inflation • If the SGR formula cannot be immediately repealed, then Congress must pass legislation to eliminate the SGR formula by a certain date and with a specific plan outlined

12. Act II: SpecificsMedicare Physician Reimbursement • Talking points • Improper reimbursement has prevented some physicians from making needed investments in staff and health information technology • Essentially punishes physicians for participating in initiatives that improve preventive care measures and reduce hospitalizations • Utilization of physician services grows more rapidly than the gross domestic product reflects (the GDP is one item used to calculate the SGR)

13. Act II: SpecificsMedicare Physician Reimbursement • Talking points cont’d • Access to care issue:IMPORTANT to legislators! • Increasing numbers of Medicare beneficiaries are having difficulty finding new primary care and specialist physicians • AOA surveys of D.O.’s have demonstrated that a majority will have to decrease or completely stop accepting new Medicare patients if additional payment cuts in the MPR are implemented • The Congressional Council on Graduate Medical Education is predicting a shortage of 85,000 physicians by 2020; Medicare cuts will exacerbate this shortage by making medicine a less attractive career • Do you have personal experiences or patient stories that are evidence of this issue? Think about it!

14. Act II: SpecificsMedicare Physician Reimbursement • Talking points cont’d • Access to physicians improves quality of life • Medical advances added approximately 6 months to senior’s life spans between 1999 and 2002 alone • Deaths from heart disease and CVAs have been falling by about 3% per year • Cancer death rate over last decade has decreased by 1% per year • Cost of care vs. benefits of the care received • Cuts in physician payments are not the way to improve Medicare’s financial sustainability!

15. Act II: SpecificsResident Physician Shortages • Resident Physician Shortages • Senate Bill 588, “Resident Physician Shortage Reduction Act of 2007” (bipartisan bill) • House Resolution 1093, “Resident Physician Shortage Reduction Act of 2007” (bipartisan bill) • This Act will increase federal funding for residency training programs in states with a shortage of residents to meet their healthcare needs

16. Act II: SpecificsResident Physician Shortages • Background information • Teaching hospitals rely on federal government reimbursements (Medicare) to train residents • The Balanced Budget Act (BBA) of 1997 placed limits (“caps”) on the number of physician residents who are eligible for reimbursement under Medicare • Hospitals are therefore not reimbursed by the federal government for training any residents above the allotted “cap”

17. Act II: SpecificsResident Physician Shortages • Background information cont’d • The Act would provide additional Medicare funding to expand the number of approved residency positions in states with a shortage of residents • “Shortage” is defined as the ratio of enrollees in all approved medical residency training programs within the state per 100,000 people being less than the national median level of residents • The AAMC defines the national median level of residents currently as 25 residents per 100,000 people

18. Act II: SpecificsResident Physician Shortages • Background information cont’d • The Act would increase the number of new resident positions eligible for federal Medicare funding in qualified states over the course of 5 years • Each state, overseen by the US Secretary of Health and Human Services, is responsible for allocating residency positions based on the needs of the community • Primary care, preventive medicine, and geriatrics in particular

19. Act II: SpecificsResident Physician Shortages • The “Ask” • Encourage your legislators to cosponsor S. 588/H.R. 1093

20. Act II: SpecificsResident Physician Shortages • Talking points • The “caps” placed on physician training programs by the Balanced Budget Act of 1997 do not adjust for population growth • Physician shortages are occurring or are threatening to occur in many states as populations continue to grow and as the general population ages • Physicians have a tendency to remain in the area in which they complete their medical training, therefore increasing the size of residency programs within particular states should ensure an adequate physician workforce for that state’s population • Again, do you have any personal stories to share?

21. Act II: Specifics State Children’s Health Insurance Program (SCHIP) • State children’s Health Insurance Program (SCHIP) • Senate Bill 895 • House Resolution 1535 • Basic principle is to provide more children with access to healthcare

22. Act II: SpecificsSCHIP • Background Information • Amends portion of the Social Security Act to grant states the option to expand health coverage of children belonging to families with income up to 400% of the poverty line • Provides subsidies for employment-based coverage of eligible children • Authorizes states to offer purchase of coverage for ineligible children • Requires coverage of screening, diagnostic, and treatment services

23. Act II: SpecificsSCHIP • The “Ask” • Has not officially been provided by the AOA at this point in time, but will most likely encourage support and/or co-sponsorship of the legislation • Talking points • Again, have not officially been provided by the AOA at this point in time; should be included in information distributed at D.O. Day

24. Act II: Specifics • For additional, more detailed information on any of the topics we are scheduled to discuss at D.O. Day, please visit: • www.do-online.org/index.cfm?PageID=gov_dodaybriefctr • To learn about your legislator’s stance on the slated issues, visit the online DO Advocacy Action Center: • http://capwiz.com/aoa-aoia/issues/ • Enter your zip code (where you are registered to vote) on the website to find your respective legislators!

25. Act II: Specifics • You will have an opportunity to become reacquainted with these issues on at least two other occasions prior to lobbying: • Student informational session by the AOA Department of Government Regulations, the evening of Wednesday, April 25, 2007 • Held at the Embassy Suites, where the SOMA Convention is being held • Policy Briefing on Thursday, April 26, 2007

26. Act III: Grand Finale • D.O. Day Agenda: Thursday, 4/26/07 • 6:30 and 6:45 am: buses depart Embassy Suites for AOA hotel • 7:00 am: registration and breakfast • 8:00 am: welcome, opening remarks, keynote speaker • 9:00 am: program overview and briefing packet review

27. Act III: Grand Finale • D.O. Day Agenda cont’d • 9:20 to 10:20 am: policy briefing (a.k.a. review #3 of the issues to be lobbied) • 10:30 am: leave for Capitol Hill • 12:00 to 6:00 pm: meetings with legislators and staffers • Anytime: lunch (vouchers can be used in any House cafeteria) • 6:00 to 7:00 pm: D.O. Day reception at Renaissance Washington Hotel

28. Act III: Grand Finale • What to bring to D.O. Day • White coat!! (this usually indicates that there will be a press conference) • Comfortable shoes!! • Professional outfit (i.e. pantsuit) • Pen and paper to take notes during meetings • Camera • Smile

29. Act III: Grand Finale • To prepare mentally for the lobbying experience, please review part II of the SOMA PATC, which is available online at www.studentdo.com • Remember to write your thank-you notes to your legislators at the end of the day

30. The End!!! THANK YOU FOR YOUR ATTENTION!!! QUESTIONS?