Health policy 'valentines' from ACP

ACP actively worked to improve the lives of members and their patients in 2023 by addressing several key issues, such as reducing administrative burdens and calling for Medicare to be able to negotiate prescription drug prices.

Yes, it is that time of year. We are all slogging through the winter, and yet there is love in the air! And in love, like with most things, actions speak louder than words—even louder than a badly written health policy valentine poem. Along these lines, ACP actively worked to improve the lives of members and their patients in 2023 by addressing several key issues and calling for policy reforms on the federal and state level.

These reforms included our work to reduce administrative burdens, particularly prior authorizations. We advocated directly with private payers such as UnitedHealthcare to pull back on proposed prior authorization policies regarding gastrointestinal endoscopies. The College has also advocated with CMS and Congress to overhaul the prior authorization processes used by Medicare Advantage plans. Further, ACP has been pushing Congress to improve step therapy processes via the Safe Step Act, which would require group health plans to provide an exception process for administration of prescription drugs in their step therapy protocols.

ACP's efforts also led to some significant wins for internal medicine physicians in day-to-day practice. CMS finally implemented the G2211 code on Jan. 1 to better recognize the work involved in physicians establishing meaningful relationships with patients and providing continuity of care. Additionally, the Center for Medicare and Medicaid Innovation (CMMI) launched "Making Care Primary," a multistate initiative to enhance access to high-quality primary care, which is extremely responsive to ACP feedback on other past and current CMMI models and includes key elements of ACP's Medical Neighborhood Model.

ACP has also been extremely active in advocating for broader public health-focused issues. We were one of the first medical societies to ever call for Medicare to be able to negotiate prescription drug prices. This has finally led to CMS officially announcing the first 10 drugs for which it will negotiate prices with pharmaceutical manufacturers in the coming year. And the College's efforts to reduce the cost of prescription drugs do not stop there, as we have engaged in efforts to urge a federal judge to throw out several lawsuits by drug companies challenging Medicare's ability to negotiate prices.

Additionally, ACP has initiated a national campaign demanding policy change to reduce firearms-related injuries and deaths; engaged in critical efforts to ensure patient access to reproductive health care and gender-affirming care; and achieved success when the FDA lifted its time restrictions that prohibited blood donations by men who have sex with men.

Given that ACP is data driven, I would be remiss if I did not mention that these efforts are backed up by the numbers. In 2023, ACP helped facilitate 5,089 grassroots messages to lawmakers, advocating for state and federal legislation, as well as federal rulemaking, reflecting engagement on more than a dozen different issues. We also held 428 Congressional meetings during ACP's 2023 Leadership Day, leading to a 127% increase in House of Representatives cosponsorship for the Safe Step Act; a 50% increase in Senate cosponsorship for the Resident Education Deferred Interest (REDI) Act; a 64% increase in House of Representatives cosponsorship for the Resident Physician Shortage Reduction Act; a 92% increase in House of Representatives cosponsorship for the Strengthening Medicare for Patients and Providers Act; and a 142% increase in House of Representatives cosponsorship for the Kids' Access to Primary Care Act.

Even more, six new ACP policy papers were developed to help guide and build upon our advocacy efforts. These papers are focused on preparing for future pandemics; modernizing the public health infrastructure; ensuring access to comprehensive reproductive health care services; outlining effective care transitions between settings; removing barriers to participation in the electoral process; and underscoring the importance of physician-led, team-based care.

2023 also saw ACP champion one new critically important payment code for primary and continuous care (G2211); one new primary care alternative payment model (Making Care Primary); and 25 amicus (friend-of-the-court) briefs that ACP initiated or signed onto, covering five major issue areas including climate change, reproductive health, gender-affirming care, the Affordable Care Act, and prescription drugs.

So, what is next? Last year's efforts were made possible by identifying 10 key priority issues, which helped keep us focused and proactive. Therefore, for 2024, to keep us even more focused, we have outlined a list of eight advocacy priority issues:

  • promoting patient access to care;
  • protecting the patient-physician relationship;
  • addressing prescription drug access and affordability;
  • reducing administrative burden in health care (also known as "Patients Before Paperwork");
  • compensating physicians, particularly internal medicine physicians, for the value of the care they provide;
  • supporting programs that strengthen the physician workforce;
  • supporting policies that help leverage health information technology to improve patient access to high-quality care; and
  • preventing firearms-related injuries and deaths.

These public policy priorities were identified via a thorough assessment of potential options, considering three major contributing factors. First, the needs of the internal medicine profession and ACP members were considered, based on feedback received over the past year and ongoing discussions of the key ACP policy committees. Second, ACP's overall strategic priorities of valued professional identity; membership growth and engagement; diversity, equity, and inclusion; and innovation were taken into account.

Finally, the external environment and opportunities for action for each potential priority area were evaluated, including the primary ways we might be able to influence change (i.e., legislation, regulations, ACP policy development, communications, state/chapter engagement, judicial advocacy, and practice support).

It is important to recognize that myriad public policy issues fall outside of the eight priority topics outlined above, and we will continue to advocate on them in alignment with ACP policy. However, the identification of these top priorities for 2024 will allow us to be more proactive and focused in our efforts and to better engage our members on the ground to help move them forward.

Coming soon will be an updated public policy advocacy priorities website for 2024, with one-page issue briefs on each issue area. These one-pagers can be used by our members in their own advocacy efforts at the state and federal level and, like last year, will be updated regularly to reflect what is happening in that environment (e.g., new bills that are introduced and new proposed or final regulations). These priority areas will also be used to help guide the development of ACP Action Alerts, where we facilitate the ability of our members who are part of the Advocates for Internal Medicine Network to call on Congress, the administration, or their state legislators to support, revise, or oppose certain key measures.

ACP members can look out for updated state health policy toolkits based on these priority areas, along the lines of the ones we currently offer on issues such as prior authorization and reducing firearms-related injury and death.

All of us will need to take action this month and beyond to ensure that these new policy priorities lead to even greater success next year. It will be difficult, given that making meaningful policy changes during an election year is particularly tough, but I have faith that we can do it!

So, in closing …

Roses are red,

And policies are choices.

To make a real difference,

We need physician voices!

Be sure to check out the hashtag #healthpolicyvalentines for more on X!