The hospital is often the intersection between patients’ medical illness and their social and financial issues.
As physicians, it is important to recognize that patient care encompasses the prescribing of medications, the performing of procedures as well as systems-based practice, and ensuring that social and financial barriers do not impede access to, and delivery of, care. Some of these barriers cannot be eliminated by any one individual health care professional (HCP); they can only be improved by working with government representatives and policymakers to make systemic changes. For gastroenterologists, advocacy involves educating patients, HCPs and our government representatives about issues related to gastrointestinal (GI) illnesses and the importance of ensuring access to GI specialty care and treatment for all the patients who require it.
AGA, via the Government Affairs Committee, facilitates advocacy in several ways. These include policy briefs, position statements, and facilitating meetings with our congressmen and senators in home districts and in Washington, D.C. AGA hosted Advocacy Day in Washington, D.C, on Sept. 14, 2018. Seventeen AGA members from 11 states visited 26 congressional offices. I am an assistant professor at the Baylor College of Medicine in Houston, Texas. During Advocacy Day, I visited the office of my congressman, Representative Pete Olsen (R-Texas, District 22), as well as health policy advisors for Sens. Ted Cruz (R-Texas) and John Cornyn (R-Texas). For the visits to the senators’ offices, I was joined by my colleagues from Baylor, Drs. Avinash Ketwaroo and Richard Robbins, as well as Dr. Thomas Kerr of University of Texas – Southwestern. During these visits, we discussed NIH funding and barriers to effective care in digestive diseases such as copays for colonoscopy.
Academic institutions share the aim of conducting high-quality research to further advances in medicine. These research projects are often funded through NIH grant programs. Unfortunately, these programs are also often the target of budget cuts, which can affect primary research as well as downstream economic growth. For every dollar spent in NIH grants, an analysis by United for Medical Research found that $2 of economic output is generated.1 In 2016, these programs created 379,000 jobs and $64 billion in economic activity nationally. AGA calls for increased NIH funding to maintain pace with inflation.2
We also discussed how projects funded by NIH have led to important advances in gastroenterology in Texas. For example, NIH- funded research by Drs. Hashem El-Serag and Fasiha Kanwal has produced studies to evaluate biomarkers and improve screening techniques in hepatocellular carcinoma.3,4 Dr. Kerr discussed his experiences as a physician- scientist and the importance of basic science research as a foundation for clinical advances.
Following the passage of the Affordable Care Act, deductibles and coinsurance fees were waived for colorectal cancer screening tests that received an “A” or “B” grade from the U.S. Preventive Services Task Force. However, once a polyp is found and removed during a screening colonoscopy, the procedure is reclassified as a therapeutic procedure, meaning the patient will have to pay the coinsurance.5
Coinsurance costs can be 20 to 25 percent of the Medicare- approved amount. In essence, a patient may go into a procedure with the expectation that it will be 100 percent covered by insurance only to find out that he or she will receive a larger bill because polyps were removed. It puts the gastroenterologist in a difficult position, who knows that polyp removal will increase the cost to the patient; however, waiting for a repeat procedure would be redundant and lead to possible loss of follow-up care. The Removing Barriers to Colorectal Cancer Screening Act would correct this by waiving the coinsurance for a screening colonoscopy even if polyps were removed.6 We discussed the importance of this legislation to removing barriers to screening.
AGA Advocacy Day is an important event to discuss our perspective as physicians and our experiences dealing with the health care system on a daily basis.
Use of biologics has advanced the treatment of many diseases, including inflammatory bowel disease (IBD). However, mandates by insurance companies can make it difficult to use these medications without first “stepping” through other less costly medications. We spoke with staffers regarding the Restoring the Patient’s Voice Act, which would remove unneeded barriers to prescribing appropriate therapy. It would also streamline the prior authorization/ appeals process by requiring insurance companies to respond in a timely manner. We discussed the impact IBD has on the quality of life of our patients and shared our experiences in obtaining timely therapy.
As physicians, we are uniquely positioned to represent the needs of our patients. We appreciate AGA facilitating that voice by providing updates on legislation and coordinating meetings between senators, others members of Congress, and practicing gastroenterologists and GI fellows. AGA Advocacy Day is an important event to discuss our perspective as physicians and our experiences dealing with the health care system on a daily basis. Congressional staffers were very interested to hear our points of view as HCPs. They even shared their personal stories regarding friends and relatives with colon cancer and other digestive diseases. I strongly encourage other AGA members to take advantage of this important program. Other advocacy programs by AGA are discussed as follows.
Congressional Advocates Program
This is a grassroots program aimed to establish a stronger foundation for our current and future advocacy initiatives by creating state teams to work on advocacy on the local, state and national levels. Participation can include a wide variety of activities, ranging from creating educational posts on social media to meeting with government representatives. Members are mentored by AGA leadership and staff for advocacy training. Participating members receive an AGA Congressional Advocate Program Certificate, a Digestive Disease Week® (DDW) badge ribbon, policy badge on the AGA Community and recognition on AGA’s website. Applications for the next cycle will be released in 2019.
The AGA PAC is a voluntary, nonpartisan political organization affiliated with and supported by AGA and is the only political action committee supported by a national gastroenterology society. Its mission is to give gastroenterologists a greater presence on Capitol Hill and a more effective voice in policy discussions. AGA PAC supports candidates that support our policy priorities such as fair reimbursement, cutting regulatory red tape, supporting patient protections and access to specialty care, and support for federal funding of digestive disease research. If you are interested in learning more, contact AGA’s Government and Political Affairs Manager, Navneet Buttar, at firstname.lastname@example.org or 240-482-3221.
AGA’s online advocacy platform allows members to contact their member of Congress with just a few clicks. AGA develops messages on key pieces of legislation, key efforts in Congress or on issues being advanced by federal agencies that have a great impact on gastroenterology. The platform also allows AGA to track legislation, key votes, a legislator’s priority issues and other key legislative activity. AGA can also track member activity with a legislator and their staff, a key component in building and maintaining relationships with key legislators.
Dr. Natarajan has received clinical trial support from Gilead and Allergan. Dr. Natarajan is a member of the AGA Government Affairs Committee.
1. Ehrlich, E; United for Medical Research. NIH’S role in sustaining the U.S. economy. Published 2017. http:// www.unitedformedicalresearch.com/wp-content/ uploads/2017/03/NIH-Role-in-the-EconomyFY2016.pdf. Accessed Oct. 9, 2018.
2. AGA. AGA position statement on research funding. http://www.gastro.org/take-action/top-issues/research- funding. Accessed Oct. 9, 2018.
3. El-Serag, H.B., Kanwal, F., Davila, J.A., Kramer, J., Richardson, P. A new laboratory-based algorithm to predict development of hepatocellular carcinoma in patients with hepatitis C and cirrhosis. Gastroenterology. 2014;146:1249-1255.
4. White, D.L., Richardson, P., Tayoub, N., Davila, J.A., Kanwal, F., El-Serag, H.B. The updated model: an adjusted serum alpha-fetoprotein-based algorithm for hepatocellular carcinoma detection with hepatitis C virus-related cirrhosis. Gastroenterology. 2015;149:1986-1987.
5. AGA. AGA position statement on patient cost sharing for screening colonoscopy. http://www. gastro.org/take-action/top-issues/patient-cost-sharing-for- screening-colonoscopy. Accessed Oct. 9, 2018.
6. Removing Barriers to Colorectal Cancer Screening Act of 2017. § 479 U.S.C. (2018).