Aaron Kithcart, MD, PhD, and Sandeep Krishnan, MD, talked with Thad Waites, MD, FACC, chair of ACC’s Health Affairs Committee (HAC) and a leading voice in the ACC, to get his thoughts on advocacy and learn about his journey to becoming an advocate for the ACC.

How did you first become involved in advocacy?

My first advocacy effort was through the American Legion Boys State in Mississippi just before my senior year in high school. I was elected to be Superintendent of Education for the state for a day. My parents were teachers and my father had run for superintendent of our county school district, so advocacy was a natural part of my life from a young age.

I then had a long hiatus from advocacy during my medical training, military tenure and very busy clinical practice. My election as governor of the ACC Mississippi Chapter signaled my return to advocacy. In that role, I learned more about advocacy at the state and national levels. Then, as chair of ACC’s Board of Governors (BOG), my involvement and study of the political process grew exponentially. As a past chair of the BOG, I was ex-officio on the Advocacy (now Health Affairs) Committee and found myself hooked on the exciting world of advocacy. Since then, I’ve been chair of the HAC and worked very closely with our ACC staff – the best advocacy staff I’ve worked with in any association.

Why should Fellows in Training (FITs) get involved in advocacy?

I’ll answer by asking if the following affect FITs and their budding careers: the Affordable Care Act, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), relative value units, electronic health records, maintenance of certification and the appropriate use criteria or Advanced Imaging Mandate, among others that could encroach upon the sacred interaction between patient and physician. Since “yes” is the answer, I encourage FITs to be fully involved. It is our First Amendment right and responsibility to speak out and we must.

How can FITs become engaged in the advocacy process?

Attend the annual ACC Legislative Conference held every September in Washington, DC! At the conference, FITs can network, learn about advocacy and visit Capitol Hill. Travel grants may be available through the state chapter and national office to fund your trip.

Get involved with your state chapter and reach out to the ACC staff who focus on state advocacy. Within the nominating process during the fall, apply for any of the numerous positions within the ACC that include advocacy needs. This would include all member sections, various work groups and task forces, and steering committees of the councils. Apply for the Emerging Advocates Program, which provides advocacy education to a small group of ACC members who do not have previous advocacy experience. Also, apply for the HAC itself; we currently have two FITs, as well as an Early Career member, amongst our ranks.

From an advocacy standpoint, what do you worry about?

We have a very complex legislative process. And, our very complex health care system was built over the years by the accretion of more and more regulation and complexity. I would like our country to have the best health care system possible: a system that achieves the ACC’s triple aim of lowering costs, improving outcomes and improving the health of the populace. This will be difficult but we will never achieve it without constant advocacy for our patients.

Is there anything that FITs should do to get ready for MACRA implementation?

MACRA and its Quality Payment Program is the law and repeal is not on the agenda. It was passed by a very strong bipartisan vote and its supporters are largely still in Congress. The basis of MACRA is a transition from volume to value that the ACC has advocated for over several years. Yet, whether we got more complexity than we bargained for is another consideration.

Implementing MACRA is a team effort. FITs should know, within their individual systems, whether they will be scored in the Merit-based Incentive Payment System or in an Alternative Payment Model and adjust their daily work accordingly. And, FITs should learn as much as possible about MACRA and what their hospitals and institutions are doing to get ready. A valuable resource is the MACRA Hub: ACC.org/MACRA.

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Keywords: ACC Publications, Cardiology Magazine, Patient Protection and Affordable Care Act, Military Personnel, Medicare Access and CHIP Reauthorization Act of 2015, Medicare, Physicians, Delivery of Health Care, Certification, Electronic Health Records

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