CMS Physicians Storm Washington

Using personal stories to highlight impact on patient care and practice

THE CHICAGO Medical Society hit Capitol Hill for two packed days with elected leaders on Feb. 12-14. These visits brought added visibility to CMS on many pressing issues while also reinforcing the Medical Society’s year-round legislative outreach in the Chicago area. While in Washington, the CMS team also took part in the National Advocacy Conference, in which hundreds of physicians gather for political and policy programs hosted by the American Medical Association. As advocacy becomes an extension of medical practice and patient care, CMS has redoubled its legislative outreach and assistance for physicians who want to expand on their traditional role.

The CMS team of eight physicians met with their Cook County Congressional Delegation representatives as well as U.S. Senators Durbin and Duckworth of Illinois. In recent years, CMS’ boundaries have grown to include a working relationship with the Congressional Doctors Caucus. CMS physicians also met with Alec Alexander, deputy administrator of the Centers for Medicare and Medicaid Services and director of the Center for Program Integrity. In a first, Chicago doctors also met with U.S. Department of Education officials.

Participants on the CMS team: Vemuri S. Murthy, MD, president of CMS; Kathy Tynus, MD, past president and president-elect of ISMS; A. Jay Chauhan, DO, secretary; Tariq Butt, MD, treasurer and trustee; Raj B. Lal, MD, trustee; Robert Bernat, MD, JD, Louis Kraus, MD, and Anjeet Singh, a medical student.
Along with focused talks with officials, CMS took time to thank all elected officials who support measures on behalf of medicine, and to simply renew relationships.

What Our Physicians Had to Say
CMS raised a host of pressing concerns. At the top of the list were physician burnout, the opioid crisis, and prescription drug price gouging. Other issues included school security and mental health, insurance preauthorization and narrowing of networks, mental health funding, Medicaid and Medicare.
Heading the team was Vemuri S. Murthy, MD, president of the Chicago Medical Society. Dr. Murthy emphasized that CMS brings a broad nonpartisan approach to these discussions, whether it’s mental health and gun violence or physician workforce expansion. “We were there to educate and advance our position on a range of issues that concern all physicians in general, and members of CMS in particular,” Dr. Murthy said. “In our talks with lawmakers on both sides of the political aisle, we always stress the need for bipartisan involvement on any healthcare policy," he noted. "And prior to these discussions we always poll our members for their views and ask them to provide us specific examples that we can communicate on their behalf,” Dr. Murthy added. “It’s critical to show the everyday impact of a law.”
Preparation is key. “Before we meet with legislators, we also collect the latest evidence-based information about the issues,” Dr. Murthy said. The sources of information include physician colleagues, patients, and experts in healthcare. “We study previous legislative efforts, bills sponsored and areas of interest (track record) of a particular lawmaker,” he explains.
Once a meeting is over, CMS is diligent in following up with more real-life impact stories or data. When legislators request additional information about the issues, they can expect to receive it from CMS.
Members may be aware that CMS has been exchanging information and expertise with select lawmakers for several years, notably, U.S. Senator Durbin, on prescription drug price gouging and the opioid crisis. This work with Senator Durbin led to his requesting CMS' support and input on a bill to require transparency from pharmaceutical companies and to his listening to CMS' concerns on opioid prescribing issues. CMS has also built strong relationships with U.S. Reps. Bill Foster; Jan Schakowsky; and Peter Roskam.

Explaining Burnout
Physicians spend hours checking off boxes, documenting and reporting. While certain mandates are designed to achieve healthcare’s “Triple Aim” and physicians are working hard to achieve these goals, many feel the tasks do not add value to their workday. “So much of the administrative burden and paperwork is related to our interactions with patients,” A. Jay Chauhan, DO, said. “If instead we were able to provide direct patient care, it would improve outcomes.” In fact, he adds, “increased faceto-face time with patients has been shown to improve compliance.” Dr. Chauhan is secretary at CMS.
Add up the burdens of electronic medical records and prior authorizations, navigating the insurance labyrinth and pharmaceutical hurdles, it’s no wonder that more than half of physicians report at least one symptom of burnout. For this reason, many are calling for a “Quadruple Aim” that makes physician satisfaction a priority. Not only does burnout lower the quality of care, but it is also linked to increased medical errors and higher physician and staff turnover.

Millimeters Apart, Not Kilometers
Asked for his impressions, Dr. Chauhan said it’s abundantly clear that legislators and their staff are well-versed in the data surrounding healthcare. “I found them receptive to CMS discussing the practical implications, and the human impact. They were open to our concerns and objectives,” he notes.
And while some might beg to differ, Dr. Chauhan said he believes that legislators and physicians are closer together than apart on certain issues. “I continue to hold on to the belief that we have much more in common in terms of our goals, and although we may have differences on how to reach our goals, these differences are generally separated by millimeters and not kilometers.”
Moreover, Dr. Chauhan notes, “even when legislators object to our goals or techniques to reach our goals, we frequently were able to find common ground through sharing of physicians’ on-the-ground experiences." He adds, “we were able to draw upon our experiences throughout our careers not only as practicing physicians but also as student and resident trainees,” Dr. Chauhan said.
CMS President Dr. Murthy advises members who have never worked with a legislator to have a preparatory discussion with leaders of organized medicine, so that messaging is consistent and objective. He, too, agrees that while lawmakers may not agree with everything physicians suggest, these visits give them an opportunity to listen to doctors, and vice-versa. “Our persistent efforts at communication can result in their reconsidering and modifying their decisions,” Dr. Murthy said.
When it comes to leaving an impression, “stories and experiences will be long remembered whereas the data provided will be quickly forgotten,” Dr. Chauhan believes. Dr. Chauhan even shared with his patients that he would be serving on a Chicago Medical Society delegation to Washington, in order to raise critical issues facing physicians and their patients. “My patient said he had experience with the Illinois State Teachers Association, and comically pointed out that you don’t want to know how two things are made: sausage and legislation.”
While Dr. Chauhan said he understands this perspective, he is "more inclined to agree with U.S. Rep. Peter Roskam, who says it is imperative for physicians to let policymakers know their proposals for improving medical practice and healthcare, because if we don’t, others will certainly be present to advise what those proposals should be.” Another thing Dr. Chauhan found is that legislators want feedback in other areas on which physicians have expertise and alternative views.

Finding Balance on Opioids
CMS regularly discusses the opioid epidemic with lawmakers. “We wholeheartedly support several bills working their way through Congress, and we gave commentary to illustrate potential benefits,” Dr. Chauhan said (see “Support These Bills!”). He calls for an “all hands-on-deck approach.” Matterof-fact discussions about physician prescribers should go hand-in-hand with opportunities for patient education, as well as addressing some of the causative factors.
Dr. Chauhan gave the example of the “fifth vital sign” and its consequences. “This resulted in the prescribing of larger quantities of opioids to manage postoperative pain, and it was done in order to avoid being designated as a ‘deficient’ physician by oversight committees,” he points out. Additionally, he said, “we provided to lawmakers recent data showing a 20% reduction in opioid prescriptions in just the last two years with the goal of a one-third reduction in the near term.”
Kathy Tynus, MD, a past CMS president and currently president-elect of ISMS, was on the CMS team to Washington. Her focus was the opioid crisis and legislators’ responses. As such, she noted recent positive developments as well as challenges that remain. “While funding has increased to tackle the problem," Dr. Tynus said, "there are still major gaps in access to treatment.” She cited medicine’s strong support for bills pending in Congress that would address these gaps (see sidebar), and physicians’ advocacy on their behalf.
At the same time, Dr. Tynus outlined some concerns. “I cautioned legislators on the perils of restricting physicians’ ability to prescribe according to their clinical judgment by placing hard and arbitrary limits on prescriptions.”
Action also is needed to modify the DEA policy on e-prescribing of controlled substances. “The requirement of a two-step verification process is a major barrier to physicians’ ability to prescribe appropriate amounts of opioid medication,” Dr. Tynus explained. “Often, patients cannot renew prescriptions easily, without unnecessary travel to pick up a new written prescription,” she added. Lawmakers should support efforts to reform DEA policy in that area. 
Dr. Tynus called for making prescription drug monitoring programs available to physicians on a nationwide network, with a requirement that electronic medical records be integrated with the nationwide database. “Both of these measures would give physicians important tools to prescribe opioids more safely.”

Telling Powerful Personal Stories
To engage lawmakers with real-life experiences, Dr. Tynus told a personal story. “I spoke about my elderly patient who developed an acute flare up of her sciatica and was unable to walk. She had limited resources and had to call an ambulance so she could get treatment for her pain in the emergency department. She was sent home with such a short supply that three days later she ran out of her prescription in the middle of a snowstorm,” Dr. Tynus said.
“My patient suffered unnecessarily because there is such fear of over-prescribing narcotics that she was not given enough medication to last until she could get more definitive treatment. This highlights the unintended consequences of the pendulum swinging too far to over-correct a problem.”