Be an Advocate for Your Patients and Your Practice

Stephanie F. Williams, MD
IMOS President

ad-vo-cate (ad’v∂ kit, noun): (1) a person who pleads another’s cause; (2) a person who speaks or writes in support of something.

It’s such a simple word. It’s such a simple process. We fulfill this role everyday in our practice as we manage our patients’ cases. But when it comes to advocating to elected officials, our first reaction may be to shy away and leave it to someone else, perhaps because we think we don’t know how.

Let me tell you about my experiences in the advocacy arena, and how easy it was!

Advocacy on the Local Level. Last year, we invited to our office, and had the pleasure of hosting, two representatives from Illinois to the US House of Representatives. This gave the staff and me the opportunity to discuss issues of great importance to physicians, other oncology care providers, and our patients.

Representative Danny K. Davis (IL-7th), who sits on the Sub-committee on Health in the US House of Representatives, came by to personally tour the office and discuss his legislative agenda. Rep. Davis is very knowledgeable about healthcare and is especially concerned about access for all and the growing uninsured population in our country. He was sympathetic to the issue of erythropoietin stimulating agents (ESAs) and what the new policy will mean to both providers and patients. The policy handed down by the Centers for Medicare and Medicaid Services (CMS), effective January 11, 2008, requires that all claims for reimbursement for ESAs include three new modifiers as well as the most recent hematocrit or hemoglobin levels.

On another occasion, Matthew Abbott, legislative assistant for health issues for US Rep. Mark Kirk (IL-10th) came to the office. Mr. Abbott went on a tour of the office and discussed several oncology issues, including access to care; patients’ ability to pay for oral medication and chemotherapy agents; physician reimbursement; and the new ESA policy. Like Rep. Davis, Mr. Abbot was interested in discussing issues occurring at the practice level, and both guests were open to continuing the discussion about ways to improve oncology care.

I encourage you to invite these or other US Representatives to your practices, offer them a tour, and engage them in discussions about today’s system of providing cancer care and needed changes in the future. There is a great deal yet to be done to make oncology better understood by elected and appointed public officials. Taking the time to enlighten our legislative representatives to the concerns of patient access as well as physician resources, costs, and reimbursement cannot be undervalued. Unless they’ve had personal experience with cancer or been involved in the care of a loved one with cancer, most public officials know little about our specialty and the needs of our patients. They rely on us, as specialists in cancer care, to describe and discuss our issues with them.

Similarly, our elected state legislators hear even less from their constituents than do legislators in the US Congress. Don’t forget about them, too.

If you haven’t already established relationships with your state and federal representatives and senators, or those running for these positions, the time to do so is NOW. It is hard to share concerns and make requests of elected officials who don’t know who you are and what you represent.

Advocacy on a National Level. Speaking of being an advocate, both the Association of American Cancer Centers (ACCC) and the American Society of Clinical Oncology (ASCO) are promoting legislation that would prevent certain CMS cancer policies from going into effect.

IMOS recently signed on to a letter initiated by the ACCC and supported by the American Society of Hospital Pharmacists (ASHP) and the Hematology and Oncology Pharmacy Association (HOPA). The letter encourages the introduction of new legislation that calls for drug reimbursement in hospital outpatient departments to be returned to at least ASP +6 percent for 2009, from the current level of ASP +5 percent. CMS has also proposed to continue lowering the rate to ASP +3 percent in 2009, and ACCC is concerned that reimbursement at these levels will potentially harm patient access to therapies.

ASCO is working to prevent the cuts to Medicare physician payment rates proposed by CMS from going into effect. These rates are scheduled to be cut 10.6 percent on July 1, 2008, and an additional 5 percent on January 1, 2009. ASCO would like Congress to stop the pay cuts for 18 months, “extend the positive 2008 update through the rest of the year, provide a positive 2009 update that covers the increase in the cost of care, and begin to pave the way for a permanent replacement of the physician update formula.” Only Congress can effect changes in proposed CMS policies.

I urge your participation in the advocacy efforts of our national organizations as well as those you can sponsor in your local community. Please contact me at Stephanie.williams2@usoncology.com to discuss these advocacy opportunities in greater detail.

On a final note, please save the date of November 12 when IMOS will have its Annual Membership Meeting at the Hyatt Regency O’Hare in Rosemont. Stay tuned for further details here on the IMOS website. Click on the MEETINGS AND EVENTS button at left.