Today's post comes to us from Margo Minissian, ACNP-BC, MSN, CSN. Margo is heavily involved in ACC committees, as Chair of the CCA Chapter Liaison Working Group, Co-Chair of the Cardiovascular Team Council and "ex-officio" cardiac care associate member of the Board of Governors. When she's not involved in ACC committee work, or speaking on behalf of the College with her lawmakers, Margo is a cardiology nurse practitioner at Cedars Sinai Womens Heart Center.

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As a nurse practitioner, I work with patients to help them understand and manage their heart condition. I’ve seen patients across the spectrum – from those who have the means and the commitment to changing their health to those for whom every day is a struggle. I hear them when they talk about their day-to-day experiences managing heart disease and I do what I can to help.

Because I see the health care system from both the perspective of a health provider and from the experiences of my patients, I have a unique perspective to provide lawmakers and others in talks of reform. All health care professionals have this unique perspective. WE are the experts on health care and our lawmakers need us to get up-to-date on the different issues. One congressman put it this way: “We know a lot about a little, and rely on the professionals to get us up to speed.”

Proposed Physician Fee Schedule
One issue right now where that statement couldn’t be more true is the proposed 2010 Physician Fee Schedule, which, if enacted as proposed, would cut payments for cardiovascular services by as much as 30 percent. This is going to have a devastating effect on patients’ well-being.

I think there are a lot of issues at play here that led up to the cuts being so large – pressure to be budget-neutral and to give increases to primary care, and to use data from a flawed study, among many others. But also, I personally feel that there’s a stereotype present in lawmakers’ mind about cardiologists’ income. Lawmakers think: “Here is this group of well-appointed individuals, predominately physicians, who are concerned that if cuts are made, they might have to keep the office open Wednesday afternoon instead of going golfing.”

We all know this couldn’t be farther from the truth. Cardiovascular professionals work tirelessly in service of their patients. This means calls in the middle of the night, a workload that far exceeds 40 hours per week, a constant attention to medical journals to stay on top of the newest scientific evidence. Our primary concern is the patient.

Breaking the Stereotype
Knowing that the stereotype exists, what can we do to break it? My ACC Chapter, the California Chapter, has done a great job of this. First of all, we show up as a team. Doctors, nurses, and technicians with a unified voice to show all the different, and complicated, aspects to providing care.

Secondly, we bring patient examples. One great story to tell lawmakers is of appropriate use criteria at its best. This shows the lawmaker why it’s so important to have the right test for the right patient at the right time, while demonstrating that there are alternatives to blunt cuts to payments, like the one that CMS is proposing. In sum, if you want to make a difference, contemplate bringing staff from your office (after all, you’re likely not the only person at the clinic caring for patients) and make sure to be ready with patient examples to bring your points home.

Taking Action
The August recess is a critical time to contact your lawmakers about the proposed 2010 Physician Fee Schedule, especially because the comment period ends August 31. Let them know how the proposed fee schedule will affect your practice and your ability to provide patient care. Make sure that the other providers in your office contact their lawmakers as well. It’s up to us to tell Congress what we think the health care needs and how best to provide it. No one is going to do it for us – so take action now!

* Margo Minissian’s post is part of a monthly series of guest posts by ACC leadership. Check back next month to see which ACC leader is sharing his or her thoughts on health care reform!

*** Image from Flickr (marie-II). *** 

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