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Past Pact Activities
UPDATE ON AARC PACT TRIP 2013: OUR DAY ON THE HILL
Prior to our trip to DC, the AARC again pushed our Virtual Lobby Week whereby we sent numerous emails requesting that letters of support for our newly proposed legislation be sent via the AARC Capitol Connection site. A total of 21,903 emails had been sent which were the most that have ever been sent prior to our Hill visits! IL was # 11 with a total of 530 messages. That is the second highest total (2 yrs ago we sent over 700 messages) in the past 7 years. This was very good but Im sure we can do better. The ISRC Federal Advocacy Committee is going to regroup and strategize this year on how to reach more of our membership regarding advocacy issues.
This year the AARC PACT Team descended on Washington DC from March 11-13, 2013. Our primary day for congressional office visits was March 12th. We had a total of 322 congressional visits scheduled. We had 44 states and DC represented by over 167 individuals (RTs/RT students/patients).
In Illinois, we had congressional office visits scheduled with both Senator Durbin (Co-Chair of the COPD Caucus) and Senator Kirks offices. We also had scheduled meetings and/or dropped off information with the following House congressional representatives:
On Monday, March 11th, we had a briefing that set the table for what we were going to be discussing in our visits the following day. The following is a synopsis:
I am attaching the following information for the ISRC Board:
I will keep everyone posted on any updates. I have also sent updates to our ISRC webmaster so that it can be put on the ISRC website. I would like to thank everyone who worked hard to get emails sent out prior to our visits. It is very much appreciated! I would also like to thank Valerie Klans, Deb Linhart and Linda Penkava who attended the AARC PACT meeting in DC this year. We all truly worked as a team! We are working right now to get an article for an upcoming TRACT talking about our day on the Hill and the importance of advocacy for our patients and our profession.
Respectively submitted - Lisa Zaenger, RRT, RCP
AARC 2012 Hill Advocacy Day Recap Report
We had roll out of Virtual Lobby (VL) Week (Feb 27th-March 2nd)
Created specific webpage for VL Week
Linked to our Capitol Connection to send emails
Requested emails be sent to Hill prior to PACT Lobby Day
Over 12,000 messages sent
Helped pave the way for RTs and patients just before Hill Day
Template letters for RTs, Caregivers of Pulmonary Patients, Physicians, Pulmonary Patients and at the request of Alpha 1 template letter specifically for Alpha 1 patients to send
Encouraged continued emails/calls through March 6th (Hill Day)
IL dropped down this year to end up 24th in letter writing with 77 individuals and a total of 158 messages sent via Capitol Connection. This is a sharp contrast to last year when we had 248 individuals write 697 messages and were #2 in the country with letter writing. We need to and can do better! This is definitely an area that needs focused improvement and we will be working on that this year.
Also on VLWeek webpage during actually Hill Day had continuous tweets posted from RTs who were tapped to do so as well as rolling Flicker photos taken by RTs and patients during Hill Day.
March 5, 2012 - AARC Briefing for Hill Day visits
March 6, 2012 - Congressional Visits (Hill Day)
135 RTs 46 states and DC
32 Patient Advocates
4 Patient Organizations:
Alpha 1 Association
Alpha 1 Foundation,
Pulmonary Hypertension Association
349 scheduled Hill meetings, most ever in the 13 years PACT has done DC Hill Day
Advocated for support for HR 941
Please see attached for IL visits completed
Post Hill Day
Gained 11 new House Co-sponsors for HR 941!!!
One of the Co-Sponsors was from IL (Congresswoman Jan Schakowsky - IL 9) who actually Co-Sponsored our bill just prior to our trip! We took her a Certificate of Appreciation and were able to take a picture with her just after we presented it to her!
Initiatives that were forged with congressional offices to work on obtaining new CBO Score:
1) Congressman Ross, principle Sponsor of our bill, is organizing (at the request of the Arkansas Society) a letter to be signed from all the Arkansas House Members over to CBO.
2) ILLINOIS: We were requested to send over information to our congressional office healthcare legislative advisors regarding what the actual scores (costs) that were projected to the House and Senate for their respective versions of the Healthcare Reform bill. This was completed. We are currently following up with the offices to see if there are any other questions that need to be answered. We are also working with our other AARC PACT Team members and the AARC to try to get a letter circulated that can be signed by various House congressional representatives to be sent to CBO to ask them to detail the assumptions they made when scoring (costing out) HR 941.There was a BIG discrepancy between the House and Senate score so we need to know what assumptions they made to cost out our bill. The AARC is working very hard on this issue!
HR 941 Background
HR 941 Medicare Respiratory Therapy Initiative
Permits RRTs with Bachelor degree to work in physician practices without the physician being on site (aka General Supervision)
Current Medicare law requires the physician to be on site (Direct Supervision)
Would not change how RTs provide services now in physician offices
Our current efforts are focused on obtaining an accurate CBO score!!
Bill would be attached to any "must pass" Hill legislation
"Doc Fix" by end of 2012 (again) will possibly generate Hill legislation
Possible Hill legislation depending on Supreme Court ruling on Affordable Care Act
Recap of IL Hill Visits
I feel that our visits this year overall went very well. We had a couple of new healthcare legislative advisors that we met with this year (Congressman Roskam's office/Senator Durbin's office). In Congressman Roskam's office, his healthcare advisor is someone who has had asthma all his life so he told us he already knew the value of a respiratory therapist! That's a very good ally for us to have as Congressman Roskam sits on the Healthcare Subcommittee of the House Ways and Means Committee.
The big nut to crack is the Congressional Budget Office's (CBO) score (costing) of our bill. Without a re-score, it will be tough to continue to move forward. There are tireless efforts going on to try to get a meeting with the CBO to determine what assumptions they used to score the bill. On the House bill side they scored our bill at 100million over 10 years but when it got to the Senate side they rescored it at between 1-2 billion over 10 years. That's when our bill got taken out of the healthcare legislation. The AARC has been trying to get some type of meeting with CBO to find out what assumptions they made to determine the cost. Without knowing that, it will be difficult to know if we need to tweak any of the language in our bill to make its intent more clear. The AARC has stated that they would be willing to make changes if needed. So, hopefully all of the AARC PACT Team efforts will move us towards getting this meeting.
Also, unfortunately, Congressman Mike Ross (AK) is retiring. He has been the House champion for our Medicare Respiratory Therapy Initiative for years. We will be working on getting a new champion or two to support us. The AARC is working on this also from the House and Senate side. Valerie and I did address that in Senator Durbin's office as he is now a Co-Chair of the COPD Caucus so perhaps he'd be our Senate champion.
I would like to thank Valerie Klans for her assistance this year as she was able to give the view of the RT working in the short term acute care hospital while I was able to give a picture of patients arriving in the post-acute care arena. I would also like to thank the AARC for setting us up with great "leave with" packets of information that were the foundation of our discussions in the congressional offices. I am attaching the list of Hill visits we made for completion of this report.
Lisa Zaenger, RRT, RCP ISRC - AARC PACT Committee
AARC Advocacy Trip for March 2012 - Lisa Zaenger, RRT, RCP AARC IL Co-Chair
On the AARC website Government Affairs, they state, theres no better cause than that of respiratory therapy and the right of respiratory patients to receive competent respiratory care. To that end, the AARC interacts with local, state, and federal governments on public policies that affect our patients and our profession. As an advocate for our members, AARC does more than simply watchdog issues. We aggressively advocate for the recognition of the value of respiratory therapy and therapists in all areas of public policy.
This year in April, the AARC turns 65! We are going to hope to turn some of the birthday year spirit into some action as we head for Capitol Hill this year. Once again, Illinois will be represented as we are right now making appointments with our congressional representatives. This year I will be accompanied by Valerie Klans, member of the ISRC AARC Federal Advocacy Committee, ISRC Chapter 2 Board Member and Past President of the ISRC. We are both very determined to represent the voices of Illinois respiratory care practitioners and the many individuals residing in Illinois who live with chronic lung diseases.
Our main issue will again be support of HR 941: Medicare Respiratory Therapy Initiative. Briefly, this bill will revise the Medicare program to permit certain qualified respiratory therapists to provide a variety of respiratory therapy services, such as smoking cessation, asthma management and MDI device selection and patient education to Medicare patients in a physicians office without the physician having to physically present. (aarc.org/advocacy/activities/index.cfm) The AARC Government Affairs Activities page has a description of the many efforts the AARC has and is taking to advocate for changes in the healthcare system that will benefit our profession and our patients.
We will once again, be asking you for a push to email your support for HR 941 via the AARC Capitol Connection. Its easy and important to do! Just go to www.aarc.org. That will take you to the AARC Home Page. Then on the right hand side, just click on Write Now. That will take you to Capitol Connection. Just follow the prompts for sending the emails. You will hear from us very soon to get that email machine going. Last year, we did hear from some of our offices that they had heard from YOU! That definitely sets the table so to speak when we sit to talk to them in that they already realize that the issue is important to their constituents.
In closing, I would like to ask our respiratory care practitioner colleagues to please email me with any issues, concerns and/or ideas youd like me to take to our legislative meetings. Please let me know your current experiences as we take these to your legislative offices and let them know what is going on in their District. Please email me at firstname.lastname@example.org. Both Valerie and I will be looking forward to taking your concerns to Washington DC on March 5-7, 2012. Please remember that your voice counts! View the Update from the 2011 AARC Pact visit to Washington
THE SCOPE OF COPD IN ILLINOIS (Accessed April 2, 2011)
The American Lung Association in Illinois has assessed the scope of COPD in Illinois. See the executive summary that provides a sampling of the findings for our multi-method assessment, including hospitalization and emergency department data from 2000-2009 provided by Illinois Department of Public Health Hospital Discharge Data and 2010 Health Care Effectiveness Data and Information Set (HEDIS) commercial data set. A full report will be available through the American Lung Association in Illinois next month.
¢ COPD Not an "old man's disease"; COPD effects both middle-aged men and women.
¢ One out of three (31.7% in 2009) Illinois residents who were hospitalized for COPD were under the age of 65, making COPD an employment issue.
¢ COPD is expensive. In 2009, the average hospitalization for COPD was $24,975, excluding professional fees.
¢ In 2009, the total hospitalization charges for COPD in Illinois, excluding professional fees was over $1.1 billion. The majority of COPD hospitalizations are preventable.
¢ 80% of the $1.1 billion in charges were to Medicare or Medicaid - making COPD hospitalizations a tax payer issue.
¢ 2007 was the first year that more females were hospitalized due to COPD than males in Illinois, a rate of 14.45 females per 1,000 population versus 14.38 for males. This trend continued during 2008 and 2009.
¢ The rate of COPD hospitalizations in Illinois in 2008 was greatest in rural and urban counties, and lowest in Chicago and the Metro Collar Counties. The rate of hospitalizations in rural Illinois counties was nearly three times that of Metro Collar Counties.
¢ According to the 2010 HEDIS aggregated commercial data set (excluding Medicare and Medicaid) for Illinois showed that only 35% of Illinois residents with COPD received a spirometry test in their assessment and diagnosis of COPD. This is lower than the national average of 37.6%. There is room for improvement in utilizing this gold standard for the diagnosis and management of COPD. Spirometry is inexpensive. An office spirometer costs less than $800 and trainings are available. For two webinars on spirometry implementation and interpretation in the primary care practice, please click here.
¢ The average age for a COPD hospitalized patient is going down. Between 2000 and 2009, the average age for a hospitalized patient with COPD has declined 1.5 years; from 71.8 years to 70.3.
¢ In 2009, COPD was the PRIMARY reason for 3 percent of all hospitalizations in Illinois.
Chronic obstructive pulmonary disease (COPD) is no longer a disease of elderly men; increasingly, it is a disease of both middle-aged men and women. Each year, there are an average of 67,800 COPD hospitalizations in Illinois. 2007 was the first year that more females were hospitalized due to COPD than males, a rate of 14.45 females per 1000 population 45 years of age and older, versus 14.38 for males. This trend continued during 2008 and 2009.
The rate of COPD diagnosis in women has caught up with the rate for men for several reasons. One reason is that women's lungs are more susceptible to developing COPD compared to men with the same exposure. However, the main reason is an increase in tobacco use by women form the 1950s through the '90s.
The American Lung Association in Illinois undertook this COPD surveillance study as the state's leader in COPD patient and professional education. This data will provide guidance to the goals and objectives listed in the May 2008 Illinois COPD State Plan. In addition, this data will guide the future direction of the American Lung Association in Illinois and Greater Chicago. This data has never before been available to health care and public health professionals in Illinois.
As a result of this data, the American Lung Association in Illinois is forming the Illinois COPD Provider and Public Awareness Task Force. For more information or to join this task force, contact Lori Yonker at email@example.com or 217-787-5864.
For more information about the Scope of COPD in Illinois study, please contact Jill Heins Nesvold, director of respiratory health, at firstname.lastname@example.org or 651-223-9578.
View The American Lung Association Suumary from March 2011 AARC PACT MEETING
MARCH 8-10, 2010
Once again it is time for the AARC (American Association for Respiratory Care) PACT Meeting.
Last year we had over 100 RT's, several patients and completed over 300 Hill visits. Hopefully this year we will do the same. The congressional offices will certainly get a lot of education regarding lung health issues as there are visits from members of AACVPR (American Association of Cardiovascular and Pulmonary Rehab) and ACCP (American College of Chest Physicians) around this same time period of our visits.This year I will be going to DC with our current President of the ISRC, Audrea Hardwick-Williams.I have meetings in the following offices scheduled:
1. Congressman Mark Kirk
2. Congressman Peter Roskam
3. Congresswoman Jan Schakowsky
4. Congressman John Shimkus
5. Congressman Aaron Schock
6. Congresswoman Judy Biggert
7. Senator Richard Durbin
I hope to have meetings scheduled with the offices of Congressman Bobby Rush and Congressman Danny Davis also.
Main Issue for Support:
1. Medicare Respiratory Therapy Initiative: (HR1077/S343) Again, this will
allow certain qualified respiratory therapists under Medicare B to be
recognized as "physician extenders" which would give individuals living with
chronic lung diseases increased access to respiratory care practitioners
outside of the hospital setting. Please go to aarc.org if you wish to read
more about this important Initiative for our patients and our profession.
Other Issues on the Table:
1. Home Oxygen Therapy: There are currently
2 House Bills that address the provision of Home O2. HR3220 (Medicare Home Oxygen Therapy Act of 2009) would reform the current Medicare coverage and reimbursement and HR2373 (Home Oxygen Patient Protection Act of 2009) would restore the Medicare payments for Home O2 throughout the beneficiary's period of medical need.
HR2372 has more co-sponsors (82) then HR3220 (2) but neither Bill has a Senate companion Bill as of yet.
I have personally been to a few Support Groups in IL and am taking their concerns with me to DC. I did meet directly with Congressman Schock, along with Chapter 1 Chair and AARC IL District Rep, Donny Byrd, in the Congressman's Peoria office last summer to speak about this as several of his constituents voiced their concerns over the reimbursement changes.
2. National Coverage Determination for Pulm Rehab: I have spoken to
several hospital-based Pulmonary Rehab Coordinators regarding how the
changes that began January 1st are affecting program implementation. I will
take their concerns with me to DC as well.We always encourage our congressional leaders to become members of the COPD Caucus. Currently, Senator Durbin is the only member from Illinois.
If anyone would like me to take their concerns to DC during this visit,
please email me at email@example.com
I would also like to ask everyone to send in their support for the Medicare
Respiratory Therapy Initiative and the Home Oxygen Therapy issues by
emailing their congressional representatives. We need a lot of letters
going into DC prior to our arrival!
AARC PACT Update-August 2009
Before I update you on the current Bills/Issues, I would like to take this opportunity to thank one of my District Reps and current ISRC Chapter 1 Chair, Donny Byrd, on setting up a meeting with his congressional representative in his District office. Due to his efforts, we were able to have a great meeting with Congressman Aaron Schock, IL-18, in Peoria this summer. I had the occasion to meet with the Congressmans healthcare legislative aide in his DC office, but not directly with him. We understood that their District office had received phone calls from constituents regarding the changes in the provision of home oxygen therapy, so this definitely was one of the topics of discussion during our meeting. I hope that by telling you about this that everyone will realize that you can be heard! You can also meet directly with your elected officials and tell your story your experience and give your insight on how to make things better. Thanks Donny for your continued efforts!
It has certainly been an interesting year so far for healthcare. We are all definitely working in an industry that is undergoing a lot of talk about reform, even as we have undergone changes already. Here is a highlight of some of the legislation/issues that were presented last month in the AARC Federal Government Affairs Activity Report.
Medicare Respiratory Therapy Initiative - (HR1077/S343)
Briefly, this legislation will allow qualified respiratory therapists to provide certain services under the medical and other health services benefit category under Medicare Part B. If you are not familiar with this Initiative, please go to aarc.org/Government Affairs section to gain more information..
We continue to gain co-sponsors for this legislation from across the country. As of the writing of this article, we have 23 House Co-Sponsors and 8 Senate Co-Sponsors. We do have several consumer/patient organizations that have offered their support. I personally have spoken to some local groups in IL and have been offered pledges of support by their members.
We need to get some of our Illinois congressional representatives on board with this important legislation. I want to thank all of my colleagues who did write a letter at the ISRC Convention in May but I am asking again that you please keep the letters coming! There are a lot of issues that are being talked about with the upcoming the Healthcare Reform Packages that are being introduced on both the House and Senate side, so we want to keep our Initiative in the forefront of their minds.
Outpatient Pulmonary Rehabilitation (PR) National Coverage
To update, the Bill was passed whereby CMS will make a National Coverage Determination (NCD) for the coverage of PR as a Medicare benefit. The go live date for this NCD is January 1, 2010. Several stakeholder groups have been involved in many meetings over the past months in an attempt to ensure that the NCD becomes a good coverage benefit for those individuals who require this benefit. The AARC has been one of those stakeholder groups.
CMS has issued proposed regulations (regs) for the NCD. According to the individuals from the AARC who presented the Activity Report,
The AARC continues to work in partnership with other PR stakeholders, including the AACVPR, ATS, ACCP and NAMDRC to present a united front and unified recommendations to CMS. This joint approach has had a very positive impact on policymakers in the past and we expect speaking in one voice on the proposed regs will carry weight.
All of the PR stakeholders are currently reviewing the proposed regs and are due to send their recommendations/response by August 31st.
Home Oxygen Reform Initiative
There has been a move by several stakeholder organizations to work together and to send a proposed initiative to reform the current legislation for coverage of home oxygen therapy by Medicare. If you are not familiar with the current law you can gain insight into this by going to aarc.org/government affairs.
In a nutshell, the stakeholders proposal includes asking for the elimination of oxygen from Competitive Bidding and repealing the 36 month cap. It also will include looking at other payment reform strategies and categorizing portability options. It is uncertain as of the writing of this article if there will be further changes in DME legislation. It is certainly an area of hot debate and scrutiny. If you have not written your congressional representatives about this issue, NOW would be a good time to do so as there is slated to be healthcare reform sooner rather then later.
Oxygen on Airlines
The final rule from the Department of Transportation (DOT) regarding permitting passengers with electronic respiratory assist devices to board the plane went into effect May 13, 2009. The devices permitted include portable oxygen concentrators (POC), respirators, ventilators and CPAP devices. The two primary conditions for use are that the devices must be tested and labeled by the manufacturer as safe for air travel and they must be able to be stored safely according to FAA rules. I would recommend that anyone using one of these devices arrange their travel plans in advance and call their airline ahead of time to obtain and follow their procedures.
Medicare, Medicaid, and Maternal Child Health (MCH) Tobacco Cessation Promotion Act of 2009 (HR 1850/S 770)
This bill would create a Medicare and Medicaid benefit that would cover smoking cessation programs provided by qualified smoking cessation counselors. Senator Durbin from IL was one of the Sponsors of this legislation. If the Bill becomes enacted, the AARC would work towards the recognition of respiratory therapists as qualified professionals to provide tobacco cessation counseling.
The Centers for Disease Control and Prevention (CDC) Chronic Disease COPD Program Appropriations Request
According to the Activity Report, the AARC continues to partner with the US COPD Coalition to support a public health program that would address COPD in the Chronic Disease and Health Prevention Division of the Centers for Disease Control and Prevention (CDC). We are asking that Congress fund $1 million to be directed to the CDC for a COPD Action Plan. The AARC set for a letter writing campaign earlier this year so that we could write to our Senators to ask for their support in this effort. Due to the sustained efforts of many, CDC has named a COPD Czar who will look into ensuring we have better surveillance of COPD! The Czar will begin by looking at all the States Behavior Risk Factor Surveillance Surveys (BRFSS). In Illinois, for example, our BRFSS asks questions about tobacco use and asthma. There is no question specific to COPD.
I hope that all of the above will give you some information on what is currently going on. As the IL AARC PACT Chair, I would like to thank Cheryl West (AARC Director of Government Affairs), Miriam ODay (AARC Director of Legislative Affairs) and Anne Marie Hummel (AARC Director of Regulatory Affairs) and all of the staff at the AARC for their tireless efforts. I would also like to thank all of my colleagues in Illinois who continue to write letters and set up meetings with their congressional representatives to voice their opinions regarding the issues at hand.
These are pivotal times in healthcare! We must remember that our opinions and voice matter! Please make sure you take the time to make yourself heard. Also, make sure you spread the word to others and encourage them to write. The more we all unite together as one, the louder the voice will be from Illinois on the issues. For any questions/comments, please email me at firstname.lastname@example.org
Lisa M. Zaenger, RRT, RCP