In September 2015, 52 gastroenterologists from 24 states met on Capitol Hill. Our goal was two-fold — to brief members of the U.S. Congress and their staffers about the potentially regressive effects of the proposed Centers of Medicare and Medicaid Services (CMS) cuts to colonoscopy reimbursements, and also to advocate for increases to NIH research funding.
As a member of the AGA Government Affairs Committee and AGA Trainee and Young GI Committee, I was given the opportunity to participate in this annual event, better known as AGA Advocacy Day. The event welcomes AGA members from all over the country to Washington, D.C. to raise awareness among government officials about the policy issues most critical to clinicians and researchers in gastroenterology.
Between our respective AGA committee meetings, we shuttled ourselves to the Hill, each with an itinerary of three to six appointments with Representatives, Senators and staffers. We traversed the long hallways of the historic Longworth, Hart, Canon and Rayburn congressional buildings to deliver five-minute pitches about the issues that matter most to the GI community.
The culmination of this interaction was our specific “ask”— for our representative to sign a “Dear Colleague” letter to CMS expressing concern for the then-proposed colonoscopy reimbursement cuts, and requesting CMS to consider the impact of such policy on colorectal cancer (CRC) screening. Some of us were greeted with smiles and words of encouragement from congressional representatives while other encounters, despite our enthusiasm, left us a bit discouraged.
Upon arrival in Washington, D.C. in September, I knew very little about what Advocacy Day would entail. I suddenly found myself in a slight panic sitting at the Advocacy Day breakfast, listening to a briefing on what to expect on the Hill and how to handle new and potentially difficult interactions.
Looking around the room, I wondered if, at two months into my first GI faculty position, I would be the best candidate to represent AGA in front of the likes of Sens. Dianne Feinstein and Barbara Boxer, who represent my home state of California in Congress.
There was little time to coddle this anxiety though. Following brief instructions and talking points, our team of California AGA members headed to our first of six scheduled meetings on the Hill. Fortunate to have a few seasoned lobbyists on my team, I learned quickly, embracing the “see one, do one … ” mantra we often champion in medicine.
After silently participating in our first meeting at Rep. Raul Ruiz’s office, I took the lead in our appointment with Rep. Jackie Speier — a woman whose historic reverence and political longevity only added to my nervousness. I shared my personal journey as a young researcher studying barriers to CRC screening in the Veterans Affairs Healthcare Network. I emphasized that, while this cancer is largely preventable, only 62 percent of Americans undergo screening. And that among Black, Hispanic and Asian racial/ethnic minorities, screening rates are even lower. I added that limiting access to colonoscopy for Medicare beneficiaries is contrary to the National Colorectal Cancer Roundtable goal to screen 80 percent of Americans by 2018.
— Fola May, MD PhD (@drfolamay) September 18, 2015
Along with the other AGA members in my group, I also asked members of Congress to protect NIH against additional funding cuts that limit our ability to conduct essential scientific research. NIH dollars for science decreased by over 22 percent between 2003 and 2013, and the number of R01-equivalent investigator grants fell by 34 percent. More and more, young clinician-scientists are faced with the difficult decision to remain in academic research in the setting of seemingly impossible funding.
As the morning continued, my panic about being a suitable envoy for our gastroenterologist community rapidly receded. It became clear to me that the policy issues in question were critically relevant to my career. In order to sustain our field, we must defend the value of our life-saving procedures, like colonoscopies, and assure that there is continued funding to research the delivery, technology and treatments for the diseases we treat. These are issues that should concern GIs throughout the country.
On Oct. 2, 2015, less than a month after AGA Advocacy day, AGA, ACG and ASGE announced that 27 members of Senate and 94 members of the House of Representatives signed our letter challenging CMS’ proposal for a reduction in colonoscopy reimbursement. Though the reimbursement cuts still took place and the fight is far from over, it was empowering to learn that our work potentially helped and serves as a testament to the value of efforts like AGA Advocacy Day.
Dr. May has no conflicts to disclose.