Introduction to Advocacy

Advocacy is defined as the act or process of supporting a cause or proposal. Information and tools to help SCAI members and their allies conduct effective advocacy are found here to advance our shared mission.

SCAI’s advocacy program focuses primarily on three strategic interests:

  1. Legislation
  2. Regulation
  3. Coverage, coding, and reimbursement

Get Involved!

Use these tools and tactics to identify your legislators and develop relationships:

  • Go to elected officials' websites and sign up for their newsletters. Visit Congress.gov for a list of current Members of Congress that includes their contact information.
  • Attend in-person or virtual events with Members of Congress to get to know them and the issues they care about.
  • Introduce yourself as a member of SCAI and ask a question related to health care, the more specific to invasive and interventional cardiology, the better.
  • Introduce yourself to their legislative assistant for health, legislative director, or chief of staff.
  • Remind them that you are a constituent and that you keep up with health care issues important to you and SCAI.
  • Send an email to your Representative or Senator copying their staff reminding them that you met and what your conversation was about.
  • Follow them on social media platforms such as Twitter. 
  • You want this to be a positive and long-term relationship so remember to say “thank you” for their time and attention.
  • Tell us about your experience at advocacy@scai.org.

SCAI maintains a highly active Government Relations Committee that engages policy-makers regularly in connection with legislation critical to SCAI members and patients.

The SCAI Political Action Committee (SCAI PAC) engages political candidates for Congress and their campaigns for federal office. SCAI PAC solicits funds from its members, publicly discloses its activities and makes campaign contributions to elected officials and candidates that demonstrate support for our goals.

Challenging policy matters in the courts may also be warranted as a matter of recourse when required.

 

Overview

Payment policy for healthcare in the U.S. is often arcane and complicated. The Centers for Medicare and Medicaid Services (CMS) regulates a number of federally-sponsored payment systems that account for approximately 40 percent of healthcare expenditures in the U.S. Private insurers often follow the rules and regulations that govern government-sponsored health insurance programs including the issues surrounding physician payment and patient rights. Physician reimbursement is critical to enabling quality patient care.

In general, Medicare primarily covers Americans aged 65 and older. Medicaid covers low-income Americans that qualify and apply to this program governed by the states under federal rules. Within Medicare and Medicaid, there are a large number of different plans, often administered by private insurance companies, that provide varying degrees of coverage.

CMS allows its contractors to make most coverage decisions related to patient care. CMS only makes a few National Coverage Determinations (NCDs) each year that mandate policy regarding which patients and physicians CMS will cover. Many, but not all, private insurance coverage determinations are based upon the NCD. SCAI regularly comments on coverage policy matters, primarily in instances where clinical judgment is required.

MACRA and More

Following the passage of the “Medicare Access and CHIP Reauthorization Act of 2015 (MACRA),” CMS regulations moved the program from fee-for-service payments to a quality-based payment system. MACRA repealed annual fee increases for fee-for-service medicine in favor of two new systems: the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs). MIPS adjusted CMS payments to a physician group based upon four factors: quality (Physician Quality Reporting System, PQRS), cost (Value-Based Payment Modifier, VBPM), promoting interoperability using electronic health records (EHRs), and improvement activities. APMs are more than ten other CMS payment systems that include financial incentives to provide high-quality, cost-efficient care to patients. MACRA also encouraged the move to Medicare Advantage programs that allow beneficiaries to choose these alternatives over traditional fee-for-service medicine. Thirty-four percent of Medicare patients have chosen this option.

Regulatory Advocacy and Action

SCAI’s advocacy efforts are comprehensive and not limited to legislative matters alone. Once a bill becomes a law the regulatory process begins. SCAI actively monitors and engages in the regulatory process throughout the required notice and comment period and attends meetings with the Executive Branch departments including, but not limited to, the following:

U.S. Department of Health and Human Services (HHS)

Centers for Medicare and Medicaid Services (CMS)

Food and Drug Administration

National Heart, Lung and Blood Institute

Coverage, Coding, and Reimbursement

Medicare’s allowed charges for physicians, are partly based on the time and effort expended during an episode of care and are used in determining relative value units (RVUs). A 31-member multispecialty advisory committee of the American Medical Association (AMA) called the Relative Value Update Committee (RUC, pronounced “ruck”) assigns RVUs to each new Current Procedural Terminology (CPT) code and reviews codes for which changes have been proposed. The RUC often surveys physicians for input: this is an opportunity for advocates to have their voices heard especially regarding clinical concerns. SCAI often facilitates the collection of survey data in such instances, notifying its members and asking them to provide practice information and insights to the RUC.