Michelle Roeser, M.D.

PGY-4, Mayo Clinic

My name is Michelle M. Roeser, MD.  I am an ENT resident at Mayo Clinic in Rochester, MN.  I attended medical school at Georgetown University in Washington, DC, and despite my best efforts to avoid all things political, it is in the air in that city.  It did not help also that my husband worked on Capitol Hill.  It was during medical school that I became educated about the issues facing the medical community, and I realized how easy and critically important it is for physicians to get involved in the legislation which affects our livelihood and our patients.

As a resident, I continued my interest in political advocacy by becoming active in the Academy of Otolaryngology – Head and Neck Surgery.  They participate in a surgical advocacy conference in Washington, DC every Spring which educates surgeons about the current political issues facing the specialty as well as inspires them to get involved.  It culminates with a trip to Capitol Hill to “lobby” on these topics.  I have attended the last 3 year, and as a result of my participation, I received the Resident Legislative Advocacy Award from the AAO-HNS.

I continue to attempt to motivate my colleagues and friends to be aware and involved in the legislative process.  I’m happy that the folks at HeadMirror.com have included an advocacy page on their site.  I hope you find this information valuable.

NEW UPDATES:

Audiology Scope of Practice

H.R. 3024 Medicare Hearing Health Care Enhancement Act of 2009  was introduced in the House in June.  This bill proposes to provide audiologists direct access to Medicare patients without a physician referral.  This bill contains the same language as bills introduced in previous sessions of Congress, which were never acted upon but have been progressively gaining support.  The AAO-HNS has opposed this bill every year.  The AAO-HNS and AAA (American Academy of Audiology) Boards of Directors cooperated to compose acceptable language containing appropriate and necessary patient safeguards, yet this did not appear in this new bill.

FDA Tobacco Legislation

On June 22, 2009, the Family Smoking Prevention and Tobacco Control Act (H.R. 1256) was signed by Preseident Obama, giving the FDA the authority to regulate tobacco products.

ACTIVE ISSUES:

Medicare Payment Reform

To ensure that Medicare patients continue to have access to surgical care, Congress must do the following:

1. Stop the 21.5% cut from going into effect on January 1, 2010
   

2. Increase Medicare payments in 2010 to account for the growth in the cost of providing quality health care
   

3. Repeal the current SGR formula and establish a new baseline for the physician payment system
   

4. Replace the current SGR formula with a system of multiple conversion factors
   

What is the SGR?

1. Medicare law and regulations contain very detailed rules governing payments to physicians and other providers under the fee-for-service system.
   

2. Payments are made on the basis of a fee schedule, which was established by the Omnibus Budget Reconciliation Act of 1989 went into effect January 1, 1992.
   

3. The law specifies a formula for the annual update to the physician fee schedule, which is based on whether spending in a prior year has exceeded or fallen below a spending target
   

4. The target--known as the sustainable growth rate (SGR)--is essentially a cumulative target for Medicare spending growth over time
   

5. If spending is in excess of the target, the update for a future year is reduced; the goal is to bring spending back in line with the target.
   

6. Application of the update formula would have led to a negative update for each year beginning in 2002.
   

7. The update for 2002 was a negative 5.4%, as compared to a 4.5% increase in 2001
   

8. Since 2002, application of SGR would have meant a negative update each year.
   

9. However, Congress overrode the application of the formula every year since 2005, which temporarily prevented cuts to physicians payments
   

10. While in the short term, this prevented reductions in payments, the underlying problems with the formula have not been addressed.
    

11. Generally, the short-term fixes actually increase the cost of a permanent fix.
    

12. The 2007 Medicare Trustees report predicts total cuts of about 40 percent by 2016 under the current formula
    

13. SGR needs to be replaced, but a consensus has not developed on a long-term solution
    

Truth in Advertising

1. TIA is monitored at the state and federal levels.
   

2. The goal of TIA is to provide “transparency” and “informed decisions” for patients regarding their healthcare providers.
   

3. The AAO-HNS believes legislators should address the lack of clarity in healthcare provider advertisements and marketing – this includes such professionals such as physical therapists, podiatrists, optometrists, psychologists, chiropractors, speech pathologists, and audiologists.
   

FDA Tobacco Legislation

1. On June 22, 2009, the Family Smoking Prevention and Tobacco Control Act (H.R. 1256) was signed by Preseident Obama, giving the FDA the authority to regulate tobacco products.
   

2. Restricts tobacco marketing and sales to kids, and stops tobacco companies from misleading the public about the health consequences of using their products.
   

3. On April 2, 2009, HR 1256 passed the U.S. House of Representatives by a 298-112 vote.
   

4. On May 5th, Sen. Edward Kennedy (D-MA) introduced S. 982, the Family Smoking Prevention and Tobacco Control Act, the companion bill in the senate.
   

NIH Funding

1. The NIH includes agencies related to otolaryngology – head and neck surgery such as the National Cancer Institute and the National Institute on Deafness and Other Communication Disorders.
   

2. $10 billion was included for NIH in the stimulus package for research and building reconstruction.
   

3. Funding will be included in the FY 2010 Appropriations bills.
   

Newborn Hearing Screening

1. Continue to strongly support increased funding and appropriate expansion of the Early Hearing Detection and Intervention (EHDI) program.
   

2. The EDHI reauthorization bill, HR 1246, advanced to the U.S. Senate on March 30, 2009, after passing the U.S. House by a voice vote.
   

Health Information Technology

1. Standards and implementation for HIT to be adopted through Health and Human Services by December 31, 2009.
   

2.   HHS will make available to providers a HIT system for a “nominal fee.”
   

3.   Financial incentives through Medicare to encourage physicians to use certified electronic health records.  Incentives would start in 2011, with penalties if physicians do not comply by 2016.
   

Scope of Practice

1. Audiologists are licensed in each state and the District of Columbia
   

2. The scope of services furnished by audiologists is determined by each such jurisdiction involved
   

3. In past sessions, audiologists and speech-language pathologists have attempted to expand their scope of practice through federal legislation
   

4. Recent bills seeking direct access to medicare patients have not passed
   

5. Currently the AAO-HNS is working with the AAA to develop legislation that is amenable to both parties, thus no audiology scope of practice bill has been introduced in this Congress thus far.
   

HOW TO GET INVOLVED

1. Be Aware
   

2.   Read the AAO-HNS Bulletin 
   

3.   Visit the AAO-HNS Advocacy website
   

4.   Follow the local and national news
   

5.   AAO-HNS emails and alerts
   

6.   Sign up for legislators’ newsletters
   

7. 
   

8. Be active
   

9.   Call, write, or visit Members of Congress
   

10.     Attend the JSAC     SEE THE 2009 PRESENTATION ( JSAC NOTES.pdf )
    

11. Enlist in the AAO-HNS ENT-CAN (Congressional Advocacy Network)
    

12.   Support ENT-PAC &/or MED-PAC 
    

13.   Support individual campaigns or political parties
    

14. 
    

15. ENT-PAC
    

The main objectives of ENT PAC are:

1. ELECT politicians who champion AAO-HNS legislative goals
   

2. Gain better ACCESS and build stronger RELATIONSHIPS with bipartisan Members of Congress
   

3. BUILD better networks for fundraising and advocacy that will increase AAO-HNS’ IMPACT on the legislative process
   

4.   Financially supports Federal Congressional and Senatorial races of incumbents and candidates who support AAO-HNS legislative initiatives and publicly opposes those who speak against our priorities
   

5.   Non-partisan basis
   

6.   Strictly voluntary
   

7.   Resident participation is LOW
   

8.   Big health changes are on the horizon – we need to be sure this changes in our/our patients’ best interest
   

9. Be a good citizen
   

10.   Physicians are respected members of society
    

11.   Use position to advance agenda
    

12.   Develop relationships with legislators and other local professionals
    

13.   Educate your patients