Although the legal option was dismissed, there are two important directions that we must pursue until the adverse effects of the Physician Fee Schedule rule can be reversed.

Option One: Legislative
The legislative route is still a viable option. We need to understand that nothing much will happen in this regard until Congress resolves the health system reform issues, one way or another.  However, the Gonzalez bill now has over 70 cosponsors! Note that we probably need 100 more cosponsors before the Speaker and leadership will demand a solution, and find a way to achieve one.

Other constituencies have prevailed in similar uphill battles in Congress to reverse bad Medicare policy with a legislative fix like we have proposed. Rehabilitation services were cut a few years back by 40 percent or more, and most medical professional societies looked the other way or tacitly supported the cuts in order to get more money for an SGR fix. But the rehab doctors and their patients persisted in showing the harm that was occurring with the cuts until they got to a threshold of about 170 members of Congress committed to a solution for them. At that point, Congress reversed most of their cuts in one of those quick, almost invisible stealth actions tied to a fast-moving bill. We need to get a similar thing to happen -- one Congressperson at a time until we exceed the critical mass. WE need to move fast to prevent other specialties from visiting members first to undermine our dilemma.

But here’s what’s really going to be powerfully effective is: directly communicating with the 465 members of the House and Senate (out of 535 total) who haven’t yet signed on to the Gonzalez bill as House members or to propose a bill in the Senate. This is going to be a struggle which will succeed one member of Congress at a time by virtue of their awareness of damages being done to patients and practices in their domain. Sen. Mary Landrieu (D-La.) is on our side — she wrote to Senate Majority Leader Harry Reid eloquently expressing her concerns about the effects of the cuts on cardiology practices. Senator Bill Nelson says he supports us as well. We’re incredibly grateful for the support of members like Sens. Landrieu and Nelson, and more of our lawmakers need to hear the messages she has heard directly from those who have been harmed. There is no other way by which we will more likely succeed in getting the attention we need. 

Option Two: Public Opinion
But there is a second strategy beyond the legislative one, and this is to continue to press in the court of public opinion. This will be most effective locally than it will be in the big national papers. Op-eds, letters to the editor, editorial board meetings and locally produced ads in small town and local newspapers and other media venues will have more direct impact on members of Congress than anything else we do in the PR area. The ACC will still be posting critically timed ads in the news venues that go directly to Congress, but we need to make this a local grassroots media blitz to have the most impact. 

That’s the challenge. The ACC will be ready to help all of you at the local level with talking points, media suggestions and whatever else you need (contact us at advocate@acc.org). Once again, documenting real damages to practices and frustrations for patients is what we need to succeed; but one-on-one messages will make it happen.

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