Straight Talk from the Policy Forum
By Rebecca St. Andrie, O&P Almanac

A common complaint about politicians? They’ll never give you a straight answer.

That wasn’t the case at AOPA’s Policy Forum, held March 9-11 in Washington, D.C. Straight talk was the order of the day from people poised to know how the political process worked. Lobbyists, legislative aides and high-ranking government officials gave advice on the strengths of O&P’s message, suggesting ways to get its points through to Washington.

The straight talk meant that there were some hard truths to hear. Budgets, for one thing, aren’t going anywhere: with health care costs predicted to be 20 percent of the U.S. gross domestic product in about 10 years, everyone is feeling the pinch. But it also meant attendees heard some straightforward advice and honest encouragement.

Read on for the realities of the political situation, what O&P has going for it and what you can do to move the conversation forward.

Straight talk
Anyone who listened to Charlie Coulter’s experiences with promoting the Virginia parity bill could understand why those in O&P can get frustrated with the political process. Coulter, who works for Roanoke-based Virginia Prosthetics, fought disinterested colleagues and tough opposition to get a bill introduced, only to have it sent to review by subcommittee (effectively tabling the bill until the next session).  
 
“Working with Congress is like running a marathon,” says Sarah Bittleman, legislative and policy director for Rep. Darlene Hooley, D-Ore. “It’s not a sprint.”

And persistence pays off. Morgan Sheets, national advocacy director for the ACA, talked about the efforts the ACA has made to pass parity legislation. As of press time, nine states have passed parity laws, 31 other states are working to introduce parity legislation and a federal parity bill has been introduced.

AOPA itself has been persistent in talking to both Congress and CMS on many different issues affecting O&P. Kathy Dodson, senior director of government affairs at AOPA, has been especially vocal with CMS about several issues concerning O&P. One is CMS’ proposed rule for surety bonds, which would require all suppliers of DMEPOS to furnish the Medicare program with a $65,000 surety bond for each National Provider Identifier (NPI). AOPA, along with the O&P Alliance, has submitted comments addressing O&P’s concerns to CMS.

For more information on AOPA’s work on Capitol Hill, see the sidebar at the end of the article.

You have to participate
Former Sen. Robert Dole illuminated why getting involved in these conversations is so important. Entering to a standing ovation, Dole spoke not only about his own career but also about his work on the President’s Commission on Care for America’s Returning Wounded Warriors. Dole highlighted the committee’s six major recommendations:

1. Have one care coordinator for a veteran all the way through the rehabilitation process.
2. Have disability evaluations and payments made solely by the Department of Veterans’ Affairs.
3. Improve treatment of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).
4. Change the Family and Medical Leave Act to allow up to six months’ leave for families of wounded soldiers.
5. Create a comprehensive Web site where soldiers can see their benefits.
6.  Keep Walter Reed up-to-date until the day it closes.

These recommendations have not yet been acted on by Congress. In addition, some veterans’ organizations are opposing the recommendations because they only apply to veterans of the current wars in Iraq and Afghanistan. But that’s why getting involved is so important. Dole had some clear advice to give those in attendance: “If you don’t participate, then don’t complain about the result.”

Straight talk from CMS
The forum even offered participants a chance to get involved in one of those conversations themselves. Kerry Weems, head of CMS, talked about the state of CMS, and listened to O&P’s concerns as well.

Weems’ attendance itself was encouraging. As the head of an agency whose budget is larger than the Pentagon’s, Weems was making an investment to be here, pointed out Tom Scully, AOPA’s legislative counsel from Alston & Bird.

Weems started off his talk by emphasizing the benefits he saw coming from Medicare Part D (the recent prescription drug legislation). He said that beneficiary satisfaction rates were 87 percent. More tellingly, he stated that Part D had depoliticized the debate over drug pricing. “That is a real lesson,” he said. “The market is choosing the price, not Congress––and not my employees.” In fact, Weems stated that the fundamental problem of Medicare was that the government was in the business of setting prices.

With that outlook, it should come as no surprise that Weems is in favor of competitive bidding. Several times during his talk, Weems emphasized his satisfaction with the process. In replacing the DME fee schedule with competitive bidding, CMS has received 6,300 certified bids, “and small suppliers are participating,” he noted.

In addition, Weems stated that competitive bidding was one of CMS’ major weapons in fighting fraud. Since AOPA and others in O&P have been fighting to reduce fraud with “qualified provider” statutes, those in the audience asked why those statutes (particularly section 427 of the Benefits Improvements Protection Act) were not implemented. Weems acknowledged O&P’s efforts to enforce quality, and gave an honest answer: it was probably due to the layers of bureaucracy that existed, and he could look into it.

Weems also made it clear that O&P’s financial picture will stay the same. “With health care costs almost 20 percent of our economy by 2017, budgets will stay where they are,” Weems said. “The budget is a blunt instrument, but it is what we have.” As head of CMS, he is facing the reality that the Medicare trust fund will be bankrupt in 11 years if there is no change.

He also commented that there seemed to be regional disparities in cost. “In one area, there is a very high cost and very intensive services, with no difference in outcomes,” he said. To do a hip replacement on a person in that area would cost just as much as flying a patient out to a cheaper part of the country, performing the surgery, putting him in rehab—and then giving him a two-week ski vacation.

“In Medicare today, you buy by the yard,” Weems said. “In a dream world, you would pay for an outcome…What’s the evidence base?”

Sound familiar? The mention of the phrase “evidence-based” drew interested questions from the audience about whether CMS would be interested in seeing the work O&P has done in establishing its outcomes. Weems was interested, too, but offered some common-sense advice: the best way to work with a bureaucracy was to ask what they wanted, not show them what you have.

Would he be willing to help O&P figure out what CMS would like to see? someone in the audience asked.

Yes, he’d be willing to help with that, he answered.

Talking points
The key to participating successfully is understanding how best to communicate your points with those in Congress. A number of lobbyists, legislative aides and legislators gave attendees tips on how to do that.
Sarah Bittleman, legislative and policy director for Rep. Darlene Hooley, D-Ore., advised attendees to:

• Speak in plain English. Many of the terms in O&P––sometimes even the term “orthotics”––are unintelligible to those outside the field.
• Have a specific “ask.” Lawmakers expect to be asked for something. Being clear and quick about what you want increases your chances that you’ll get results. One example of a clear “ask” might be: Why can’t you get Transmittal 656 implemented? (Transmittal 656 requires Medicare to only pay claims from licensed O&P practitioners. See www.aopanet.org/op_events/policy_forum/Issue_Paper_for_Policy_Forum.pdf for other specific issues O&P should advocate for.)
• Emphasize that you want high quality standards. O&P’s insistence on enforcing accreditation, and its frequent requests that payment be restricted to licensure makes it stand out. Most fields come in requesting less oversight, Keenan says. O&P’s requests that laws already enacted be enforced, and its desire to reduce fraud and abuse, means that it has a distinctive message for lawmakers.
•  Link credentialing and the fee schedule together.

Executive Director Tom Fise, from his years of experience talking with lawmakers, pointed out that simply saying “Don’t cut us!” is ineffective. It’s a negative message, and one that is no different from what everyone else has to say. He clarified four things unique to O&P that would explain to lawmakers why they should fund O&P:

• O&P rate increases have been less than inflation.
• We have a qualified provider statute.
• We want to have standards for accrediting bodies.
• Congress didn’t enforce linking payment with quality.

Look past this year
Even though O&P has a strong message, getting it heard may take some repetition. Congressman Mike Ferguson, D-N.J.,  who is retiring from Congress after four terms, says that this will be a holding pattern year because of the presidential election. As a result, there will be trouble bringing legislation to the floor. He said that bigger legislative changes will happen at the beginning of the next presidential term.

But progress is visible. When asked at the meeting if he would be a cosponsor on the federal parity bill recently introduced, Ferguson said he would look at doing so.

The legislative process is slow and uncertain. An outright “no” is rarely heard, bills can be tabled, and last-minute negotiating can change a lot. But as you can see from this weekend, legislators are willing to talk and offer tips. O&P has a distinctive message. And there’s a lot out there. So don’t complain––participate. In the marathon of campaigning for political influence, O&P is moving forward.

Rebecca St. Andrie is managing editor of the O&P Almanac.