Value-Based Medicine

Why Your Legislators Should Know You

BY MELISSA M. BROWN, MD, MN, MBA

Politics reigns supreme this month! We have heard a lot about health care, Medicare and how much our political candidates care, what each candidate would “do” to Medicare and Medicaid, and how they believe private insurers will be affected.

Whether the Affordable Care remains the law of the land or an alternative health-care plan is put forth, how do we physicians allay our anxieties, and maintain and improve the already high standards of our profession? We participate in directing and maintaining our abilities to practice medicine and enhance the health of our patients.

This month seems an appropriate time to review what actions we as a profession and individuals can take to influence our political process. The things we do can make a major difference for our patients and our country. Here are my ten steps to making a difference.

Marching Orders

1 First, learn the facts and be ready to communicate them to your legislative representatives. Be prepared to tell legislators that ophthalmic interventions typically have a great financial return-on-investment (ROI) to patients, Medicare, Medicaid, private insurance companies and the wealth of the nation. Ophthalmic interventions confer extraordinary patient health value (improvement in quality-of-life), particularly compared to commonly used treatments for systemic arterial hypertension, osteoporosis, hyperlipidemia, prostate therapy and many others.¹

Value-Based Medicine analyses show that the general public, and thus legislators, equate bilateral blindness to be less serious than migraine headaches! In reality, severely blind patients equate their condition the same as a Rankin 4-5 stroke in which a paralyzed patient requires round-the-clock care.² Vision is valuable and essential to allowing our patients a good quality of life and allows them to continue to contribute to our country’s economy in real dollars.

Value-Based Medicine analyses demonstrate what you do every day. Ophthalmic interventions can return to patients 1) their quality-of-life; 2) their independence (driving, thus staying in their own homes); 3) their privacy (writing their own checks and reading their mail); and 4) their dignity and confidence by allowing them to recognize people and not having to always depend upon others.

Spending $5,000 on bilateral cataract surgery provides over a $100,000 financial ROI to patients, Medicare, Medicaid, private payers and to the economy. Caregiver costs drop, more people can still work, there is less cost due to depression, in-home injuries decrease, nursing home admissions decrease, etc.³ Cataract surgery is a big cost-saver for Medicare, but policymakers typically look at expenses to the program, not to the costs that treatments help avoid.

You can find a lot about national health-care macroeconomics at: www.cms.gov/-Research-Statistics-Data. If you are visiting a state politician, know his or her interests, background and issues, your own issues and your opponents’. Information is power. And if I can be of any help to you, please contact me at the e-mail address provided below.

2 Once armed and comfortable with the information, put yourself in a position to communicate the great value ophthalmic care provides to our patients and ultimately, society. If we don’t tell our legislators, no one will! Be warned that it will take continued time, talent and treasure, but it will be well worth it.

3 Support our lobbying organizations. The American Academy of Ophthalmology (AAO), the American Society of Cataract and Refractive Surgery (ASCRS), the American Society of Retinal Specialists, the state academies of ophthalmology, and other organizations lobby effectively for you. If you haven’t written the check yet for this cycle, do it now — or contribute your support online. The AAO is one of the most effective medical political organizations in Washington, year in and year out.

4 Tell the AAO, ASCRS and ASRS to enhance their efforts to work together. Coordinated efforts do more!

5 Attend fundraisers for your representatives. Show up and deliver your contribution personally. Federal legislators cannot accept checks in their Congressional or Senate offices, so go to their fundraisers and deliver your donation in person. Hopefully you are offering $1,000 or more for federal candidates (maximum donation is $2,500 per election cycle). Support candidates whom you believe will best represent your views and profession. Always better to support their election efforts before you ask them for support. That is just the way of the political world.

6 Better yet, organize a fundraiser in your home or office for a legislator. Be sure you can: a) get enough people, preferable at least 30, and b) that you will be able to raise $2,000-$5,000; more is better. Representatives do not forget these efforts. Their staff will assist in the details. You need a place, refreshments, and donors to attend or send a donation.

7 Once elected, visit the legislator — not his or her staff. Having met the representative at prior functions will be the first step in getting to know him or her. You want to become their best resource on health care and patient care. Personal relationships are critical. Offer personally to assist them in any way. Share how you can be a resource.

8 Don’t waste time on legislators if you are not in their districts. Representatives pay attention to their constituents! Communicate with visits, calls, letters, in that order. E-mails seem relatively ineffective at this point.

9 Tell your legislators, or your insurers, about how you change the lives of your patients. A human interest story about a child or adult goes a long way. Introduce them to your patients who can relate their own stories on the importance of vision. Take your patients to meet the representative and share their story.

10 I know it sounds trite, but voting is power. Trust me, each and every vote counts. Races can be won and lost by a handful of votes. Take the time to vote, take your family to the polls and make time for office staff to vote. The next important election starts the day after Election Day. We need to be in it for the long haul. OM

References

1. Brown GC, Brown MM, Kertes P. Value-based medicine, cost-utility analysis The value of commonly-used pharmaceuticals. Evidence-Based Ophthalmol. 2009;10:107-122.

2. Brown GC, Brown MM, Sharma S. Difference between ophthalmologist and patient perceptions of quality-of-life associated with age-related macular degeneration. Can J Ophthalmol. 2000;35:27-32.

3. Javitt JC, Zhou Z, Willke RJ. Association between visual loss and higher medical care costs in Medicare beneficiaries. Ophthalmology. 2007; 114:238-245.

Melissa M. Brown, MD, MN, MBA, is president and CEO of the Center for Value-Based Medicine in Philadelphia. She can be reached via e-mail at mbrown@valuebasedmedicine.com.