What’s Up with Washington? AAMC Federal Legislative and Advocacy Update

Well welcome everyone it's a pleasure to see those of you who were not up early enough this morning to enjoy this particular discussion at seven in the morning it is just our pleasure to have the the dream team from the double AMC here while we were all worrying about you know the pandemic and mitigating its impact on all of our activities we were vulnerable we were vulnerable to legislative attack and unfortunately our wonderful representative the WMC have done a wonderful job through the last few years to make sure that not only our ongoing agendas have been well represented in DC but also the ones that pop up along the way so thank you so much for being here today I love the title of the of the session which is what's up with Washington right it could have been called what's up in Washington but I think you're asking a more fundamental question this could be a philosophy course required of all college freshmen actually but instead you're going to be uh helping us understand what how things really work there so I will embarrass you just a bit by reading um chapters one through five of each of your biographies briefly okay so uh first Erica Freud team director for advocacy and engagement join the double AMC in January 2019 as senior director of advocacy and engagement and in this new role for the double AMC she develops and leads efforts to strengthen the advocacy engagement build more academic medicine legislative and policy Champions she comes the position with more than two decades of extensive experience in professional advocacy at the federal level including direct lobbying policy development public affairs and Grassroots and Grassroots advocacy grass tops advocacy I want to learn what that is it sounds fun focusing on issues affecting Healthcare research and academic medicine she previously been a government relations director for the double AMC and director of government relations and public affairs for the Society of Neuroscience as well as the Grassroots representative of ACOG American College of OB GYN she received a master stream public administration with a health policy focused from George Washington University and her Bachelor's in political science from Carlton College join me in welcoming America that's okay uh well Lynn doesn't remember this but I forget how many moons ago I picked up the phone and called him him about a question I had at a previous institution he's been are you the most senior I mean been around the longest oh you're the new guy okay so he's the senior director of government relations and legislative advocacy at Double AMC uh he's the primary contact for Congressional staff and legislators and is the lead associate Advocate on such issue as gme Medicare Medicaid payments physician Workforce prior to come to double AMC in 2009 he gained more than 15 years of experience in government relations at the Cleveland Clinic and Metro Health System in Cleveland Ohio and office of U.S senator Mike dewine in Washington DC Mr Mark Crystal to be in communication from Xavier University Masters in journalism and public affairs home American University which lies in Potomac Falls Virginia and you're all from Virginia right you all live in Northern Virginia we do absolutely well welcome Lynn Marcus and my last but not least is tanaz and a senior director of public policy and strategic Outreach at the Double AMC tonight rasuli holds primary responsibility for the deadline Steve's legislative advocacy in support of medical research medical education and public health funding and preparedness in July 2016 she was named executive director of the ad hoc group for medical research which is a coalition of more than 200 patient and voluntary health groups medical societies Etc and as we know in Washington Size Matters and so not only the size of your organization but how many organizations band together to represent so this is a very important initiative um and it involves folks folks who have research supported by the NIH obviously so you received her bachelor's degree from Johns Hopkins University in Baltimore Maryland Masters in public health and health policies from GW and since 2013 has been an adjunct faculty member in the Georgetown University School of Nursing and health studies my goodness welcome to Nas thanks you you really appreciate the opportunity to be here we've had just a lovely couple days here in uh Roanoke it really is helps crystallize for us why we love what we do which is to get to actually visit our member institutions and see and learn about the work that you do um so we hope this uh will be fairly informal and that if you have questions that come up let us know we're going to run through kind of about doubling why don't I show you the agenda about double AMC um give us just a quick bit on sort of what is up with Washington and that's funny I think we might have been Punchy when we came up with the title but I'm glad that you appreciate it we have to have humor to get us through some of these times um and then um get into more in the Weeds on the AMC advocacy priorities you can sort of see where things you're working on and hopefully plug in with that agenda and then at the end talk some about um kind of how you all can engage why it's important to engage kind of why advocacy see and we had such a great conversation with the hssip cohort yesterday who really helped us you know understand a little bit better where you all sit and how and basically you know how much time and bandwidth you have it's limited um to engage so um we appreciate this opportunity um so you may or may not be aware of how many institutions make up WMC of course we are an organization of Institutions but we also feel that you all when we call constituents are vitally important and of course the institutions wouldn't operate without you all so um uh while these are are kind of the how our membership structure is made up the way we sort of engage faculty is through that third bar of academic and professional societies so even some of your professional societies are also members of double AMC and they have Representatives that participate in our meetings as well and then each of the institutional members so you also have a couple effects Representatives who also participate in double AMC but of course we have a Dean's gang and we have a teaching Hospital CEO gang so um and what we're going to talk a little bit more about later is the government relations Representatives Mark do you want to wave oh there he is um and uh that is each of our institutions has a has a essentially a lobbyist an advocate um who is employed by the institution to help um familiarize of course members of Congress and make sure that your concerns and priorities are being considered so um as you all uh may or may not be aware that while we are Hospital members only make up five percent of all hospitals they have an out oversized share of really important work um and you all know this from your Hands-On work here carillion um and uh also our members are hubs of research and the very most critical Cutting Edge care um and so we spend a lot of time talking to um legislators and helping them to understand how our institutions are unique from a hospital down the road whatever kind of house would let me be safety net Rural and so we want to we really try and Flash up these stats a lot and encourage you to do the same I know you all probably have your own set of stats that make it clear how how unique you are and another of course important component that makes Our member institutions unique is the research piece um and uh we feel that of course the investment in research is well worth it because of the cost of in the burden of these diseases um and so we another piece of course that um we emphasize and that we're excited to hear about when we come to the institutions is that full complement and um we stress that so much of the research and research that leads to I don't know covet vaccines starts at institutions like these um and so you'll hear more about the advocacy that we do for these federal agencies that make this research possible and another piece of course it is all about the Mighty Dollar so we also do talk a lot about the economic impact of Our member institutions um and that really just can't be denied that um the uh role uh the leadership of our institutions in the communities and how many people are employed the economic impact and uh sort of that is um something that members of Congress like to hear right I mean they are excited about and they do and and you'll find different when we were actually talking with Mark about this yesterday different members of Congress have different priorities and health isn't always Health Care policy isn't always going to be top of mind but you can often grab their attention pretty much everyone's attention with these kinds of stats and especially the kinds that help them understand how many of their constituents are employed and then how many people are affected um by buyer um by your Institution so this is how we like to consider so I just ran through the fact that research patient care the key component of course of education and then a more a newer one uh that we felt necessary to be added to the four missions of and officially it is one it is these are the four missions of the double AMC membership is community engagement Community collaborations um which is what you all have already been doing and has folded into so much your work but we certainly felt that that was um uh such a key tenet that it needed to be flagged and drawn out in our regular Communications um and engagement with policy makers in the public so all these things I've talked about leads to the fact that um as the government relations folks uh staff at Double AMC um any almost any topic you can think of Under the Sun it when it relates to Health Care ends up touching one of our member institutions of course we make decisions based on hearing from you all and hearing from our board and our different councils which of these we should focus on and which really rise to level of needing sort of a full court press I mean your government relations representatives are essential to taking that pulse at the institution and letting us know we just want to give you a flavor of all the things that are going on and and these all were occurring even while covid was happening over the last two years so in addition to us having to keep an eye on and of course manage all of the um and inform a lot of it is about educating policy makers about um what these names these words mean um and what they mean to our institutions um we had to make sure that these very important issues weren't being tackled or a lot of it was protection which is what I know lens sometimes a lot of it's just sort of you know making sure bad things don't happen um and this was all happening under the water um while covid was um sort of overshadowing everything else um so we're going to get into some more of that um I want to give you just a quick snapshot so I'll very quickly just say uh give a very this is just quickly what's sort of the um tenor in Washington right now um and I think you all read enough so we don't have to we don't have to spell that out uh for you but of course this is just some a few images and this is just the tip of of the many that are out there um that we saw over the last couple years um and what's interesting what we found to be unique and especially um stressful I guess and I'm sure for you all too is that no other time that we can think of a recent memory was then health and your institutions your institution our institutions in particular are at the heart of so many of the these very controversial and very widespread hotly debated and affecting so many people so it was uh you know while we're trying to get sort of the nitty-gritty done we also have all these Optics that are occurring I know for you all just then the information that's coming in federal decisions that impact the decisions that you have to make on a minute to minute basis really like no other time and and then in Washington this these stresses really made um it challenging even more challenging than it was even before I don't know just throughout 2016. as a date even before that um uh that seminal election made it even more difficult for members of Congress to come together I would say with the exception of maybe right when coven started there was a big bunch of money that went out the door remember the cares bill that was when at that moment legislators realized we have to set aside our difference and really just Infuse our economy and our in our constituents and the people with a whole lot of funding to try and beat back this thing but since then pretty much been downhill um you know it's just been a lot of inviting and a lot of disagreement and now that um there's this coveted fatigue which will come up when we're talking um that's that's it's just become a little bit more difficult to really um make sure our stories are getting through but we're not giving up and so we'll talk about that too so where we sit now is of course we're looking at the rest of this Congressional year um and basically any sort of actual legislating is going to stop around June so June is when uh you know tension starts to wane then it goes into Fourth of July recess and from then on it's pretty much campaigning up until November um and so and then they'll have a lame duck session which is then remember after the election the even the losers and the members get to go on come back and try and finish up what they didn't finish this year so that is likely to happen but what we're looking at here is and we say this a lot but we think this year really is one of the most contentious elections ever because the margins are so very tight we've got literally a 50 50 with Kamala Harris being the tiebreaker in the Senate um and right now I think the Dems what do they they have an eight seat margin I think that maybe even has changed some um and so that you can see how tight those are so just any little Littlest thing is going to flip this we anticipate and everybody pretty much anticipates borrowing some miracle that the house will flip back Republican um and uh and then the Senate is sort of Leaning that way just even a new poll that went out this morning said that it's light it's leaning that looks like that the Republicans will take back um the Senate but there's so many things that can happen in this um the rest of this year of course covid and all of the different mandates I was just reading that um even the Biden Administration right now is weighing whether to appeal the court decision that removed the mandate on masks and airplanes because but of course it's mostly a political decision they're like so do we want to be the ones that are telling people that or should we stick with the CDC so those little decisions every single one of those decisions is fraught with um sort of recognizing understanding the impact it will have on this midterm election and so you can imagine the administration is also hearing from all these vulnerable Democrats that are like don't screw this up make sure you think of my race and all this stuff because if you want to keep control of the senate in particular I think is what I bet Joe Biden is paying the most attention to um because he knows he'd like to keep a hold of that one so there's also some very key court cases that all Supreme Court cases that will be coming up this year that'll drive a lot of voter turnout so while we know Health Care is important I think other than covet I'm not sure if there's anything that is going to really um sway this election necessarily um in our space it really comes down to the big p politics so it's it's interesting and for junkies like us it's sort of you know it's something the news is kind of fascinating um but it certainly makes it um kind of challenging to get the work done that we'd like to get done so we're gonna race and try and get a lot of these things that my colleagues are going to talk about now done before uh June wish us luck with that but um thank you both for the kind introduction the warm welcome and it was nice of the dean to say that we are the Dream Team but I think we've come to realize there's really a Dream Team here so thank you for that um so I'm gonna as Erica showed that slide with all the different issues that we might be tracking on any given day we really are working on all of those uh issues all the time with varying degrees of intensity we're not going to go into all of them we're going to share a small sampling of some of the issues that we're uh tracking at any given time and I'll start with some of the funding priorities that our members are tracking most closely so technically the federal fiscal year started uh October 1st of 2021. Congress did not actually finalize the spending bills to actually fund those agencies until just about a month ago so it was about six months late but they did finally get the job done and the numbers that you see and that purple box there are the final funding levels for some of the agencies that we track most closely and as you can see pretty decent increases across the board for some of the health programs within the Department of Health and Human Services not quite as ambitious as the house and the Senate originally had proposed and that ultimately came out to some of the political jockeying that forced them to really scale back those uh originally proposed funding levels but still doing pretty well um one in particular obviously that we spend a lot of time and attention on given that 50 percent uh more than 50 percent of the research that the National Institutes of Health uh supports are happening on campuses like this and other medical school and teaching Hospital campuses all across the country NIH is one that we follow very closely and we were very excited to see a uh an increase of close to five percent for the NIH uh that uh is an increase above inflation biomedical research inflation so providing some meaningful growth for the agency in addition to that 45 billion dollars that Congress provided for NIH itself it also established this new entity you may have heard of the advanced research projects Agency for health or arpa H this is an initiative that has been a top personal priority for President Biden himself it is modeled after uh DARPA intended to support high-risk High reward transformative research initiatives um and Congress ultimately there's been some debate about whether it should live within the NIH if it should be set up as an independent agency ultimately what Congress decided was to provide a billion dollars to the Secretary of Health and Human Services and let him figure it out so they gave him the flexibility to transfer that money to the NIH if he should so choose and a few weeks ago he announced yes he chooses to transfer that money to the NIH but only really intended to allow this new entity to leverage some of the administrative functions at the National Institutes of Health so rather than rebuilding the HR infrastructure and I.T infrastructure and so on and so forth they will leverage that infrastructure at NIH but the arpa H director will be appointed by the president uh and that person will report to the Secretary of HHS rather than the director of NIH and the actual physical location for this new entity will not be on the nih's campus now Congress is still figuring out the rest of the details so we're expecting additional legislation sometime over the course of the Year potentially to put some flesh on the bones in terms of how this new entity will actually operate the whole idea is to provide it with additional authorities that the NIH does not have so there's some more flexibility there and a different process for funding research but at minimum there is this down payment now that the Administration has to actually start to make some progress in this area now in terms of nih's Base itself uh the funding level that Congress provided for fiscal year 2022 represents the seventh consecutive multi-billion dollar increase for the agency since fiscal year 2015. what we have been encouraging Congress is for sustained predictable growth for the nih's base and we have been really encouraged to see strong bipartisan support for the agency that has resulted in an increase of 15 billion dollars or close to 50 percent over the last uh seven years now we realize it doesn't necessarily feel like there's been a huge influx of cash however uh and in part that's because for the 15 years that preceded that uh seven years of consecutive growth uh Congress essentially uh flat funded or effectively flat funded NIH is based which means an inflation-adjusted terms and I just purchasing power actually started to dip so we've just now not quite yet but almost started to recover that purchasing power and now our goal is to ensure that we're continuing to make investments that allow for Meaningful growth to expand nih's capacity to support medical research um so how are we going about doing that as was mentioned double AMC convenes this coalition of stakeholders across the NIH advocacy stakeholder Community from patient groups to clinicians and scientists academic institutions and others that come together to speak with one voice in terms of what we think is needed uh for Congress to invest to really maximize the potential of medical research and there's a whole different set of considerations that we take into account when we're putting forward that recommendation first and foremost is that we recognize that even with that seven years of consecutive growth uh we're still NIH is still only able to fund one in every five promising proposals we know at some institutes and centers like the National Cancer Institute that number is as low as one and every nine or ten and so we're still leaving a lot of good science on the table if we want to be aspirational in terms of ending cancer as we know it like the president has said or making progress in Alzheimer's or against diabetes or against any host of other conditions we need to be as aspirational in terms of the funding that we're putting forward um so uh the community has come together and double AMC is joining the community in recommending that Congress provide at least 49 billion dollars for nih's base in fiscal year 2023. um in addition to that as supportive as we are of the arpa H uh idea we think it's really critical that in order for arpa H to be successful it needs to be able to rely on a healthy NIH that is supporting that foundational science that will allow for the Transformations that arpa H can can Leverage and so we're recommending at least 49 billion dollars for nih's traditional structure and anything that Congress wants to provide for arpa H should be in addition to that base funding level Erica mentioned it's in an election year Congress generally isn't very good as you saw uh how delayed they were in getting funding done even when it isn't an election year they're even worse in an election year so we're not anticipating that we'll Bell finalize funding levels until at least December at the soonest uh but nonetheless we think it's really important for our community to be speaking out about why this investment is so critical and uh and and why this investment is needed another set of programs that we track very closely are administered by the health resources and services Administration or hersa there's a whole variety of programs really intended to help shape the healthcare Workforce National Health Service Corps provides scholarship and loan repayment programs the teaching Health Center graduate medical education program supports community-based Primary Care residencies the children's hospitals graduate medical education program provides support and there's a series of programs under the Title VII and title eight of the Public Health Service Act that are intended to help shape the diversity geographic distribution and the supply of the healthcare Workforce with a specific focus on interprofessional education primary care and geographic distribution so institutions like this are eligible for funding through these programs and then they're able to with you know specific Focus areas under each of the programs uh help put those resources to good use to help allow students to have exposure to community-based settings or to practice in be exposed to practice in a rural community or have more of an emphasis on Primary Care double AMC has been a strong supporter of these programs for many years and similar to the trajectory that we saw for NIH before the last seven years the funding was not necessarily as robust as we would have liked to have seen in the case of Title VII that's the overall programs uh there was even a dip back in 2006 that was pretty problem dramatic unfortunately we've not only been able to recover that funding but also been able to see some growth in the programs overall just about doubling in terms of funding over the last seven years now the caveat there is that most of those increases really have been concentrated toward brand new programs um uh so there's a new program the medical student education program really exclusively focused on Primary Care very important program we're very supportive but we'd also like to see investment in some of the other Primary Care programs under Title VII similarly the green line that you see depicted here are investments in the Title VII diversity pathway programs so trying to recruit students from underserved marginalized rural backgrounds into pathway programs at the k k-16 level or Recruitment and Retention programs at the Health Professions level through the health careers opportunity program or the centers of excellence as you see here even though you've seen growth in Title VII overall over the last seven years the funding for those specific core programs has only been flat funded essentially over the last seven years so as a community there's a coalition that our colleague convenes at Double AMC um of about 90 Health Professions organizations we have come together and are recommending that Congress essentially double funding for these programs in fiscal year 2023. last area that I'll touch on briefly is public health and preparedness obviously a lot of lessons learned over the course of the last two years in terms of how our country has responded to this pandemic and what sort of underlying fractures existed in our public health system and so there is at least one Committee in Congress the Senate health education labor and pensions committee that has put forward legislation intended to try and apply some of those Lessons Learned to help better prepare for future pandemics you may have seen some headlines about different components of this bill it is bipartisan and the most notable uh piece of it that folks have really been reporting on recently has been to subject the CDC director that that appointment to a senate confirmation um but beyond that there are some structural changes that the uh bill is proposing um but no funding associated with it um so it will it remains to be seen how uh far legislation like this can go without any funding associated with it to help uh support the infrastructure needed to really rebuild our Public Health uh system but then also uh be able to build on that and strengthen it so that we really can be more agile in responding to Future threats um I call this graph our our too little too late approach to Public Health funding I think one of the main uh lessons from the coveted pandemic has been that this whack-a-mole approach that we have to funding uh Public Health only when there's a crisis doesn't seem to work very well um and yet as you can see Illustrated here um massive infusion of cash in 2020 when maybe it was a little too late to to be throwing massive infusion of cash um and it remains to be seen what happens after you know when this chart is continued in the next few years do we see a dramatic drop off after that um unfortunately you would think that we would have learned from that and there would be more of an appetite to try and make the types of Investments that are needed to help sustain the infrastructure as Erica said there's been quite a bit of coven fatigue Congress is sort of ready to move on that's true true of both parties and you've seen that play out most notably you may have seen some of the headlines around the emergency funding that the Administration has requested just to help purchase new additional Therapeutics additional vaccines additional Diagnostics Administration has said they need 22.5 billion dollars for a variety of sources that bill has stalled in both the house and the Senate I think we will end up seeing something move at some point um relatively soon probably closest to the column you see labeled Senate agreement here which will include 9.25 billion dollars primarily to purchase new counter measures uh and then another 750 million dollars for research on uh vaccines to address future variants um but if it's been this difficult just to get Congress to come together to invest in a pandemic that still hasn't ended uh we're a little nervous in terms of what that means for Investments uh uh to build the infrastructure we need to prepare for threats that we haven't even yet identified uh double AMC has been very active we know that it's really you know the the folks on campuses like this that have really as Erica said laid the groundwork for the the research and the clinical care and the uh extraordinary efforts to get folks vaccinated and tested and treated um and so we've been trying to share a lot of those recommendations with um both the house and the Senate and the administration and we will continue uh to be telling that story moving forward with with that let me turn things over to Len to cover some of our clinical priorities thanks for the reminder that you reached out several years ago I I hope that was helpful um if not I apologize uh so uh I'm gonna quickly hit on some of the uh key clinical priorities uh that we've uh and goals and things we've accomplished over the last uh several years uh I think number one uh we we cannot come and do a have a conversation if we don't talk about Medicare support for graduate medical education and where that stands as I'm sure you all know Medicare is the largest public provider of support for gme um we do like to point out though that the largest providers of support for for gme are those actual institutions who are doing the training who take their own Revenue their own clinical revenue and own Investments and support those support those programs now back at the end of uh 2020 we had the first increase in the number of Medicare supported gme positions in nearly 25 years uh those numbers of positions had been capped and well the number that the uh Medicare program would support has been capped since 1997. uh and basically that's because in 96 uh there was a feeling that we were going to have too many positions and this was a way to actually also help constrain Medicare spending uh that did not turn out to be the case we now project 124 000 position shortage by 2034 and so we have been working uh for many years to try and get these caps uh lifted so as I mentioned at the end of 2020 uh for the first time in nearly 25 years we had an increase of 1 000 positions um uh in again a thousand doesn't sound like a lot uh but when you're someone like me who every day for the last Almost 13 years has been working on this issue a thousand uh you take a thousand when you can get a thousand and you call it a good start and a way to break through and to continue that that push forward well we're really excited about though is the uh the uh Congressional Democrats and president's um build back better legislation which is tied up past the house is tied up in the Senate unclear what's going to happen but it built on our success from the end of 2020. it had 4 000 more positions so we're very excited about that and it targets them at communities uh that they can use these positions and really at bipartisan um uh and targets them in bipartisan ways so that uh rural Republicans can see themselves real Democrats can see themselves in these positions but also uh our our partners uh on on you know in New York you know they obviously can see themselves as as part of this and so uh we're very excited about about this very hopeful that it'll move forward uh one of the other key components that we're very interested in or very excited about is this Pathway to um Pathway to practice scholarship program is really aimed at diversification of the workforce how do we ensure that there are more Physicians from rural communities who have those opportunities to go to medical school uh how do we ensure that there are more Physicians of color who are able to go to to medical school and these are really uh scholarships that will allow them uh to do that so again we believe these things are tied together should be tied together as part of this package and we're and we're hopeful that it will will move forward it's it's unclear as I said at this point but we're continuing to push um some of the other things that we have worked on is um uh as part of covid uh is Telehealth uh that is one of the you know one of the one of the key priorities we have heard from our members the waivers that were included as part of the cares act that really allowed uh our members to go from providing very little Telehealth relatively to providing a lot of Telehealth very quickly um now the challenge with Telehealth is uh Congress and the Congressional budget office who make decisions about how much things will cost uh the Medicare program I think this is very expensive they think that this is an additive service and we'll be on top of everything that's already happening I think we have data that actually shows that's not the case it's a substitute uh certainly was during covid and it really will be up to us we'll be um up to us and our members of course uh and to to help tell that story to engage with Congress and continue telling that story but also work with that Congressional budget office I talked about and help tell them that that story now what they decided to do uh in the last in the Omnibus package that we talked about is they've extended those waivers for 151 days past the end of the public health emergency we don't know when the public health emergency is going to end uh the sort of expectation had been that they were good they renewed it about a week ago that it would run until about mid-july and then uh then they would were going to let it expire I think we're hearing more rumors that it's it's possible uh that that they could renew it again and it could go into the fall and we've actually even heard they may redo it after that and renew it till the end of um calendar year 22. it's unclear that's where the politics Parts comes into this like you know do we want to be in a public health emergency at election time um you know we'll we'll have to see but the reason this is so important is all those waivers um around Telehealth are completely tied to the end of the public health emergency so what have we been doing to help with this well obviously like I said we've worked with our members but we've also joined uh the Telehealth access for America Coalition which is a public affairs uh effort which is really aimed at educating and doing I don't want to call it PR but it's kind of PR targeted at members of Congress uh but also there's members in their communities uh to help them tell the story and to help get them engaged and excited about this and we've partnered uh this is sort of how we do what we do and we've partnered with the American Medical Association the American Hospital Association as you can see there's there's other partners there but also some of our own members are parts of this uh Coalition and we're hopeful that you know in working with them we can continue to to push this forward uh and and really the ultimate goal is to get a two-year extension of all these waivers so that gives uh Congress then actually some amount of time to figure out how do we go forward with with Telehealth um so that's the goal 151 days in so we've got you know 500 and some odd to get the rest of it but we're working on that uh Medicaid you know I just really wanted to hit on Medicaid it's also tied to the uh to the public health emergency uh and the unwinding of the Medicaid because you know many uh people became eligible for Medicaid is uh due to some uh programs that were put in place at the beginning of the pandemic there's a concern that once the pandemic ends uh you're going to have a lot of people who will um uh well they'll lose their Medicaid coverage they'll be uh the determination will be made as to whether or not uh they're eligible and they will very quickly drop from the rolls uh which means people aren't going to have access to care um and so we have been working closely with our members and with others uh and with certainly with the administration and uh CMS to try and figure out how do we um you know how do we ease that uh that process and what can uh what can Congress help put in place to ensure that people have access to care uh for for as long as possible one of the things that CMS has indicated uh to put out guidance on over the last uh several weeks is that there will be a 12-month period after the public health emergency to make those redeterminations so it's not going to be Public Health Emergency ends you know July 15 August 1 people are going to start losing their coverage they're going to have you know that year uh to uh to figure out and make those redeterminations and actually CMS put out an RFI and request some information on you know um what are other ways we can improve Medicaid access in a Medicaid coverage for beneficiaries and we had the opportunity to respond and did so uh spent a lot of time on that unwinding piece of it uh but also pieces you know interesting is um uh you know like when doing reject redeterminations they should be for a year right because sometimes these these uh these beneficiaries they're um their income will fluctuate you know throughout the year so they may look like they're not eligible in uh December however by February March all of a sudden their income's gone down and they would be uh eligible and but they were kicked off of the roles in December it it uh it hurts continuity of care for this for those patients another very important thing that we should talk about as part of the um as part of the certainly as part of the pandemic but certainly going back much further than that uh there has been a real bipartisan focus on mental health and how and and really this is is much and this is certainly a provider issue do we have the providers uh but then also certainly an access issue um well that makes it an access issue uh and Senator Ron Wyden the chairman of the Senate finance committee uh Senator Mike krapo the ranking member the ranking Republican on the finance committee last fall uh issued an RFI asking stakeholders how do we improve access to mental and Behavioral Health uh the AMC we submitted a response we talked about growing the workforce using Telehealth to extend the workforce uh but then also uh investing in collaborative care models and integrated Behavioral Health ensuring that Primary Care Providers and mental health providers uh are incentivized and given the tools to ensure that they can work together to to improve care and interestingly we've been able to have multiple meetings with the Senate finance committee and members uh senators and their staff on the committee uh aimed at these uh sort of five bucket areas these priority areas Workforce Telehealth uh integration parity and children we've had the opportunity to work with them to talk to them and we hope that we will see legislation uh later this year um whether or not they can actually get something across the finish line and um certainly I don't think this that will happen before they go away for elections but maybe in lame duck we might we might have an opportunity the last thing I just want to mention and not a ton a ton of detail on this uh but the house ways and means committee chair Richie Neal from Massachusetts uh reached out to 12 what they called um early adopters uh Health Systems hospitals and Health Systems asking what steps they have taken around um basically decarbonizing uh their their institutions but not just that piece like what are you doing but what also is the impact of um of the climate crisis uh and climate change on your on your institution so they identified 12 hospitals across the country they talked to but then they also reached out to AMC and said we'd like you to provide us the same information but also identify members uh your other members uh who you think might have a story to tell and so we are now working with them uh on on that issue to try and um uh get responses it's a long survey but we're working we're working to get that but I think I think the goal of this isn't uh the goal from the Congressional side is to start a national Dialogue on these challenges uh but I think our goal is to demonstrate that this shouldn't be all sticks right like we our members are trying to address this there are many who are addressing this uh and it's the carrots it's incentivizing them and how do you how do you make it easier uh for for these um these institutions that you don't want to have to turn off the lights right like you don't want them to be turning off emergency room equipment you know to uh to reduce uh you know electricity use uh those are all the sorts of very very complex things that we're trying to figure out and hopefully we'll be able to do that so I just went through that very quickly don't ask what happened this morning get a little bit into the how and then we hope that this will like indicate some discussion you know we've gone through a bit of detail on the what right all of the different issues and the backdrop to it and the environment and then sort of want you to think about sort of where you see yourself and this um I mean advocacy is a very broad term and it can mean a lot of different things to a lot of different people we think all those forms of advocacy are very important um and so you know this is just a way of of demonstrating that there are all different types of attitudes and of course what you all do just by being providers and working in an institution like this you are engaged in individual advocacy just by virtue of what you do of course process is when you're actually looking to make improvements and find new creative ways to do things at your institution which you all do um and then it gets into the more technical side which of course is where you work with your government relations folks your policy folks folks like us at Double AMC to really think about Regulatory and legislative changes that you know affect policies that affect a larger even larger group of people but they're also similar skill sets I mean what you're doing now prepares you so when you see some type of policy whether it be local state federal that you think could use the insights that you have you've already been doing that and we can just help you and and others can just help you plug into the right places where it's appropriate and so we always we like to um sort of um show how that we think activism is an important sort of instigator but this in order sometimes to really find those Solutions and and inform the policies um you want to work with some folks like us and some other and there's lots of groups every professional society that you might belong to has government relations folks that can help you think about this um but these are how you turn that kind of passion into some maybe more tangible changes um and so we and of course we and why we include this and because um is because of students students are really aware so much of this energy and excitement comes from um and so we love working with our student we have student organizations within doublemc the organization of student Representatives is the actual name of it um osr and we love to help think about ways to channel that energy um and so we mentioned grrs this is an official name uh government relations Representatives is a group within the double AMC that meets by phone weekly meets in person three times a year and with various other meetings and of course regular very regular interactions with everyone in our government relations office and they can really serve as a touch point and helping you understand because as we learned from Mark yesterday the Virginia political landscape is fascinating and intricate and um challenging in its own way um and uh in addition to what's going on at the most highest um Federal level so we don't have that expertise Mark has that expertise on how to navigate the Virginia folks so when you think then about um sort of your federal and this will um you know this will be particular to sort of I mean you could apply this kind of ladder to a lot but we kind of think of from a federal lens of course starting at the bottom of the wrong vote right that's the first way to engage um and then Grassroots is is the whole is the collective it's it's how you can um link click on something and and send shoot a letter off to as many legislators as you want but those numbers are actually counted and logged by folks in the Congressional offices op-eds is the next level letters where you actually put your name to something I mean now it's tweets right even faster than that is putting out a tweet or er um that is shown that is um shown to the masses unlike a Grassroots letter which just goes to one place of course then there's the in-person stuff which is one-on-one meetings Town Halls Congressional hearings is where um you work with your government relations person um and that is after a lot of sort of building up to this and demonstrating that that you have a particular interest and a particular perspective that might be interesting to policy makers to testify before a state or federal legislative body and then double AMC and other organizations put on these briefings that are educational informative to staff and we love to have members like you participate in those service presenters and then the biggest the grass tops to answer your question about what is a grass tops is when you are actually seen by the legislator or staff as a resource where they call you and they say I need to hear from you on this I've heard about this policy and I remember because of a conversation that we had that you would be a good resource in that and that is sort of the where we love to get to right and we want your at our Our member institutions to have those kinds of connections because you kind of do already even if you don't take advantage of them a lot because of a virtue of who you are your role your stature for lack of a better term in the community members of Congress want to know what you think think and so we're looking for ways to help strengthen those relationships fortify them and get and and open up more Avenues of communications between our our members and the members of Congress and of course this is all undergraded like we said important to connect with your grrs which is your government relations folks here are a few resources you can click on these links we do have our own Grassroots Community AMC action.org is where you can go and just you'll start to get emails from us and we be judicious about it we really want to figure out when Grassroots lobbying makes sense some of our issues are so complex that sometimes it's like yeah we're not going to get really into the ipps rule you know we're just going to really make it where a mass number of folks can help Elevate an issue for Congressional staff and then here are a whole host of other ones if you haven't signed up the Washington highlights Weekly Newsletter comes in your inbox every Friday and it just shows you it is the best way to see what we at Double AMC are working on focused on and provides a whole ton of links and it lives forever so you can go back and even search and find other information so I'll just fly I'll end on this note we think that in while covet is not over so we should never say in the wake of covid but we're sort of saying in the wake of Congress is waning interest in covid um and with a new Congress coming in with so many I think we're in some sort of record number of retirements of some really long-standing member of Congress we have this opportunity to educate policy makers at all levels about really what is academic medicine right and what is the value of that and how are our institutions unique how are we bringing this very specialized kind of care and research that you won't get anywhere else and not to mention like I mentioned earlier the economic impact and then how you're all part of this Collective um this this whole um ecosystem that is academic medicine and then secondarily how double AMC is an excellent resource if if they need it as well and that we love to serve and we are an umbrella Organization for all of these entities so that's going to be a campaign kind of a public affairs slash PR campaign that we're going to be launching this year and we'll be sharing more information with our member institutions on that with that questions be cute sorry again Punchy when we're making buds [Music] thank you for all of you for coming uh participating online or in person um are there any questions in the room or online feel free to unmute yourselves or I will open this little chat so I can see if there are any questions that pop up um either way questions comments concerns foreign medical students and it's just directing them I go from zero to six feet my daughter's a law student they're the same way um how do we really feel locally but also how do we connect you know to a larger group to really Harbor that energy and just a great ideas that they have that are just tremendous that just need to be heard we have I mean so I mentioned the organization of student representatives osr and they actually have alleged on part of their governance there is someone who has appointed the legislative resource I think or legislative um director for the osr and then each of those Dimensions so osr then has how many regions do we have six or something like that AMC you know they're around the country and then they each have a legislative rep I think that's what they call the legislative rep so that's one Avenue the other course is AMC action.org which is a way to become part of a collective voice um but then I guess practically speaking right how do you um sort of channel that energy um I mean not to stick them on Mark but you know that's why Virginia Tech is also a government related person there but sometimes maybe a way is to invite folks like that to just you know where we want to tell you about all the work that we as an institution are doing in this space and then emphasize like why it is you know when you put on also one more resource that I'll direct you and we can send you is our Groupon student affairs has a committee on like student a subcommittee on student activism which actually put together a handbook that emphasizes um arguments or it reminds folks that when you put on a white coat there's a certain responsibility when you put on Michael it says you know when it says BTC on there that's a whole other you know then you are part of that institution and you are speaking of course as an individual you can do what you want but there is some responsibility comes with that and we also have our own agenda which we have to be representative of the whole so we can't tackle your particular issues so there's a a few ways and I can share that reasons for you um with you and then I think maybe yeah like a webinar or something like that and we're exploring ways to do that we actually for the NC Action Program are looking at um coming up with an ambassador program which is a way that those particularly active students can plug in and help even create a little community on campus that's like here are ways you can engage sort of but in a targeted using tools that we questions others questions concerns comments foreign doctor olendorf is our um is our Dio so he is a big fan I'm sure of your work to try yes [Music] this is not that much yeah exactly and you know like I said you know with a thousand thousand total is not uh it's the first step right it's the first step and our goal is to just keep pushing keep asking uh keep making the case uh and honestly I think you know Eric and I I told this story many times but Eric and I went to Arkansas several years ago a summer before coveted we need to make this a bipartisan issue we have to make sure that it's Republicans and Democrats that everybody can see themselves uh in this because there is a perception on Capitol Hill that um and perhaps we feel it here too right like I don't know but there's a perception that all these gme dollars are going to New York uh in the west coast uh and large urban communities nobody else gets anything uh and again that's why we worked so hard to ensure that uh rural hospitals hospitals over the cap hospitals and State Community medical schools and high schools should serve underserved populations we're all eligible at designations I appreciate your support and uh thank you and it's good for your client I mean more it's so terrible level of applications and it just shows the the everything we learned a lot I mean it's a very interesting application for us to learn kind of what's what's prioritizing and I think we all have the same way I think that when the residents don't have to follow the money the money actually follows the residents where we think they should go that that's you know that's hard to you know legislators trust me but I think it's so Dynamic that you know a lot of people Center resident here for something and you know that shouldn't affect the funding for them for two months to a rural site we'll turn it up I can't hold my cost report and unfortunately we're way overcast and it works for us and you know those are the type of Innovations thank you for keeper so we realized that we're at time uh if there are those of you who can stay longer um our presenters are happy to answer more questions um and take more comments just just if you want to stay on feel free to do so but also feel free to leave if you need to do so also thank you so much for participating.