April 1, 2013
Volume 77, Number 4
Residents' Review: From the Hospital to Capitol Hill
Michael Oleyar, D.O.
Picture a busy hospital floor with nurses bustling between rooms, residents and attendings verbalizing plans, technicians reading telemetry monitors and alarms sounding. To the uninitiated, this setting is completely bewildering. As physicians, we learn to navigate this seemingly chaotic environment to effectively care for patients, recognizing how to prioritize the critical information and filter out the noise. It is much the same in the political world, where issues arise and stories break – all while the core of business continues underneath the surface. For many resident physicians, most of whom have little exposure to the inner workings of state and national politics, it is easy to feel overwhelmed and perhaps intimidated by this relatively unfamiliar environment.
Although entering the political sphere can be daunting, involvement has never been more important. As we look forward in 2013, some political journalists have referred to it as “the year of health care.” A large part of the ongoing discussion focuses on raising the value of health care, which ideally means raising quality as well as cutting costs. Quality improvement is a complex challenge, but it is critical for physicians to help our political leaders understand the importance of addressing quality topics. For example, the importance of improving our nation’s drug supply chain should be clear after the outbreak of spinal meningitis linked to neuraxially administered drugs last year. However, physician input may help both clarify the systems issues that influenced this outbreak and help to keep political will focused on this issue.
Unfortunately, cutting costs seems easier for some on Capitol Hill to understand and implement. The larger programs of Medicare and Medicaid are big targets, but within those larger domains are specific areas particularly vulnerable to cuts. Many of these areas are of vital interest to both anesthesiologists and residents. Physician payment tied to the use of the sustainable growth rate (SGR), a formula designed to control Medicare costs but which threatens to drastically slash compensation, has proven to be continually problematic for all physicians and should be addressed on a permanent basis. The implementation of accountable care organizations may radically alter how doctors are paid and how care is delivered to the patient. Graduate medical education (GME) costs the government around $17 billion per year, and although the importance for workforce issues has been recognized, even GME could be a target for cuts. It is crucial that physicians be involved in these discussions.
When physicians contact political leaders, legislators and their staff have varying levels of familiarity with topics. If a topic is new to the office, they will often gladly hear your perspective and then likely conduct more research. There is a good chance the topic is not new, but it may need to be presented in the right light. This is where medical professionals can really help propel important issues. Although staff members know a great deal about health policy, they most likely have an entirely different perspective from an anesthesiologist, which means your input can help portray an issue in ways that matter to patients and physicians.
Some of these topics may be more familiar than others. Physicians may feel like they do not have a sufficient grasp of
the issues or that they do not have the connections to political leaders to make a difference. These feelings, while under-standable, should not prevent physicians from participating in the discussion. ASA provides advocacy resources for members at www.asahq.org/for-members/advocacy.aspx. This site provides information on key legislative issues as well as resources on how to become more involved in the political process. Participating in the annual ASA Legislative Conference is also a great way to learn about how to become involved.
Navigating the political landscape and its policies can certainly seem daunting, but in many ways Congress resembles our health care systems: large, complex and always changing. Physicians are eminently qualified to assist our legislators in shaping policy, and they must do so in order to protect the interests of our patients and the future of our profession. Anesthesiology residents should jump right in to advocacy – the future of our health care system and our country depends on it.
See select ways to get involved in the table on the next page.
Michael Oleyar, D.O. is a CA-2 resident, Johns Hopkins Hospital, and ASA
Lansdale Fellow, Washington, D.C.
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